ABSTRACT
Background: Supraglottic airway device results in less hemodynamic responses during laparoscopic surgery but supraglottic airway device to be used should have higher oropharyngeal seal pressure than peak pressure for effective ventilation as laparoscopic surgery also leads to higher airway pressure. In this study the efficiency of the I-gel with SLMA is compared in patients undergoing laparoscopic cholecystectomy surgeries.Methods: Sixty patients were randomized in to two groups, group A where I-gel was considered for airway management and group B where LMA Supreme was the device chosen for airway management.Results: Oropharyngeal seal pressure was significantly lower in group A than group B, 5 minutes after insertion of airway device it was 24.90±3.03 cm H2O and 27.30±3.41 cm H2O in group A and group B, respectively and 5 minutes after creation of pneumoperitoneum it was 25.53±3.17 cm H2O and 27.57±3.36 cm H2O in group A and group B, respectively. There was significant difference in the difference between inspiratory and expiratory tidal volume between the groups at all the time periods being higher in group A than group B. Hemodynamics were comparable between the two groups. Time taken to insert the airway device and Ryle’s tube insertion was significantly lesser in group B in comparison to group A. The percentage of complications was higher in group A than group B with no significant (p>0.05) association.Conclusions: Both the I-gel and SLMA devices can be used safely in laparoscopic cholecystectomy in non-obese patients. But in SLMA group oropharyngeal seal pressure was higher with lesser leak volume in comparison to I-gel group.
ABSTRACT
Introduction: Multimodal anaesthesia techniques includeregional anaesthesia in the form of paravertebral block andvarious anaesthetic drugs which acts on different sites of painpathway with different mechanism of action, results in goodquality of analgesia with minimal side effects. They improverecovery along with early mobilization and rehabilitationand early resumption. This technique lowers the level ofinflammatory cytokines. Due to this we aim to evaluate theeffects multimodal anaesthesia technique on level of IL-6inflammatory cytokines in breast carcinoma surgery.Material and Methods: Patients were randomized intofollowing three groups (n=30 in each group) using a computergenerated random number tables. Group I: paracetamol 10 mg/kg, Group II: paracetamol at 10 mg/kg and dexmedetomidine0.5μg/kg, Group III: paracetamol 10 mg/kg, dexmedetomidine0.5 μg/kg and paravertebral block with levobupivacaine.Fentany (2 μg/kg) with general anaesthesia were common inall three groups. Statistical Analysis: All the categorical datawas compared by using student “t” test, chi-square test andparametric data by analysis of variance (ANOVA).Results: Patients of group III was haemodynamically morestable as compared to group II and I. IL-6 level was 358.15, ingroup I, 354 in group II and 346.65 in group III preoperativelywhile 324.85 in group I, 320.95 in group II, 278.35 in group IIIafter 2 hour surgery. IL-6 level was significantly different ingroup III as compared to group II and group I postoperatively.Conclusion: Multimodal approach is a better anesthetictechnique in terms of hemodynamic stability with decreasedlevels of IL-6 inflammatory cytokines.
ABSTRACT
Background: Idiopathic Congenital Talipes Equino-Varus (CTEV) is a complex deformity of foot that is difficult to treat. The goal of treatment is to gain a functional, pain free, plantigrade foot, with good mobility and without callosities. Currently, the most accepted and popular method is the Ponseti method which allows correction of all components of CTEV by manipulation and serial casting without any major surgical intervention. This prospective study was done in a tertiary care centre to statistically assess the efficacy of Ponseti method. Methods: We treated 150 children (210 feet) with idiopathic clubfoot deformity, using Ponseti technique. The severity of foot deformities were assessed by Pirani scoring system and were also recorded clinically, radiologically and podographically. The changes in the mean Catterall-Pirani scores at different follow ups were evaluated statistically. Results: The mean number of casts that were applied to obtain correction was 7.86 (range 5 to 11 casts). Percutaneous tendoachilles tenotomy was done in 70% of feet. All children were given foot abduction orthosis after the correction. The results were graded according to Ponseti and Smoley criteria. Good results were obtained in 83% of feet, acceptable results in 7% of feet and poor results in 10% of cases. Statistically significant correction was achieved in manipulation and casting stage which was maintained during bracing phase. The recurrences of the deformity were primarily due to poor compliance in the use of orthosis in post correction phase. Conclusion: The Ponseti method of correction is a safe and effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics is the main factor causing relapse of the deformity.
ABSTRACT
Fibro-osseous pseudotumor of the digit is a very rare benign lesion however it may be a cause of concern as it forms differential diagnosis to aggressive bone forming tumors like extraskeletal osteosarcoma. Till date only a few cases have been reported in the literature. We came across a case of 7yr old female presented with complains of post traumatic progressively growing hard swelling present on the palmar surface of the hand at the hypothenar region for last 6 months. Investigations i.e. X-rays, MRI and CT scan were done along with other blood investigations to rule out other common diseases such as exostosis or myositis ossificance or extraskeletal osteosarcoma. Excisional biopsy of the lesion confirmed the diagnosis of fibro-osseous pseudotumor of the digit.