Monopolar cautery versus cold steel dissection for tonsillectomy in children. a randomized clinical trial

Objective: To compare monopolar cautery with cold steel dissection for tonsillectomy in pediatric age group

Study Design: A randomized clinical trial

Place and Duration of Study: Ear, nose and throat [ENT] department Combined Military Hospital Gujranwala, from Jan 2013 to Jan 2015

Material and Methods: A total of 220 consecutive pediatric patients undergoing tonsillectomy for recurrent or chronic tonsillitis between Jan 2013 to Jan 2015. Both groups were compared with regards to surgery time, intraoperative bleeding, post operative pain and complications

Results: A total of 20 patients were excluded from the study for various reasons while the data of the rest of the patients has been presented. Mean age of the study group was 8.82 years. A total of 58% of the patients were male. Average time of surgery for monopolar cautery was 29.33 [SD 2.77] min as compared to 18.53 min [SD 2.94] for dissection method which was significant [p<0.005]. Average blood loss for monopolar surgery was 11.66 ml and 29.04ml for dissection method [p<0.005]. Average pain scores were less for dissection method at 2nd post op day 3.59 vs. 5.51. Rates of primary and secondary hemorrhage were less for monopolar method although they were not statistically significant

Conclusion: Monopolar cautery though causes decreased intraoperative blood loss however requires longer anesthesia and causes significant post operative pain to the patient

Role of dexamethasone in brachial plexus block

To evaluate the effect of dexamethasone added to [lignocaine] on the onset and duration of axillary brachial plexus block. Randomized controlled trial. Combined Military Hospital Rawalpindi, from September 2009 to March 2010. Patients and Methods: A total of 100 patients, who were scheduled for elective hand and forearm surgery under axillary brachial plexus block, were randomly allocated to group A in which patients received 40 ml 1.5% lidocaine with 2 ml of isotonic saline [0.9%] and group B in which patients received 40 ml 1.5% lidocaine with 2 ml of dexamethasone [8 mg]. Nerve stimulator with insulated needle for multiple stimulations technique was used to locate the brachial plexus nerves. After the injection onset of action and duration of sensory blockade of brachial plexus were recorded at 5 minutes and 15 minutes interval. Group A showed the onset of action of 21.64 +/- 2.30 min and in group B it was 15.42 +/- 1.44 min [p < 0.001]. Duration of nerve block was 115.08 +/- 10.92 min in group A and 265.42 +/- 16.56 min in group B [p < 0.001]. The addition of dexamethasone to 1.5% lignocaine solution in axillary brachial plexus block prolongs the duration of sensory blockade significantly

Arterial blood pH low ph as predictor of prognosis

Arterial blood gas analysis is the most commonly performed investigation in intensive care unit[ICU] as the changes in acid-base balance are common in critically ill patients. Changes in pH are directly related to severity of disease. Keeping in view our clinical experience and literature search, we assume that patients whose pH is less than 7 at any time in the course of disease carries poor prognosis. Quasi experimental study. ICUs of Combined Military Hospital Rawalpindi and Combined Military Hospital Multan. From 1st Jan 2006 to 6th Aug 2007 and 7th Aug 2007 to 31st May 2010 respectively. All the patients having pH less than 7 at any time in the course of disease were considered and patient having otherwise fair state of health before recent insult were included. Moribund terminally ill patient were excluded. All the thirty patients needed intubation and ventilation except one who remained conscious despite having pH. 6.95. Twenty two patients [73.4%] died and eight patients [26.6%] survived. All patients who survived were diabetic except one having tracheal stenosis. All patients who died were non diabetic. Only one non diabetic patient was among the survivor. Survival among diabetic patient as group was 100%[7/7]. Patients having pH below 7 at any time in the course of disease carry poor prognosis especially if they are non diabetic. Diabetic has best prognosis. However it is a small study of thirty cases only, further multi centre studies are needed to demonstrate the co-relation of pH with prognosis prediction

Tracheal stenosis surgery; airway management

To highlight the problems and solutions in airways management in patients with tracheal stenosis undergoing surgical interventions and to highlight the alternative methods of airway control where high frequency ventilatory facility is not available. Case series study. Combined Military Hospital Rawalpindi from 1[st] Jan 2004 to 30[th] June 2007. Twenty nine patients of both sex and all age groups presenting with difficulty in breathing due to tracheal stenosis undergoing surgical intervention on trachea have been included. All the patients were managed under general anaesthesia. Nasogastric tube 10 Fr, suction catheter, laryngeal mask airway or mask ventilation was used for initial ventilation where conventional endotracheal tube of even smallest size did not work. Small size endotracheal tube were used in twenty four patients. Difficulty was faced in five patients. In these patients endotracheal tube of smallest size available could not be passed and we had to provide ventilation by innovative measures like nasogastric tube 10Fr in one, suction catheter 10Fr in two, laryngeal mask airway in one and mask ventilation in one. There was no mortality. Adequate ventilation during tracheal stenosis surgery can be very difficult in some cases. Therefore a thorough understanding, a tier of flexible plans and a variety of ventilating means should be arranged before administering anaesthesia.Nasogastric tube 10Fr or suction catheter of similar size are suitable alternative if facility for high frequency ventilation is not available