ABSTRACT
Background and Aims: Clonidine is widely used as an adjuvant to spinal anaesthesia to improve quality of anaesthesia but with haemodynamic side effects with increasing dose. We have conducted a study to observe the effects of Clonidine as an adjuvant to intrathecal isobaric levobupivacaine at different doses in terms of time to onset, duration and quality of block along with hemodyanamic changes to determine the optimal dose. Seventy-?ve Methods: patients were divided randomly in three groups of 25 patients each who got admitted for lower abdominal surgeries. Group LC15: 0.5% 15mg 3 ml levobupivacaine with Clonidine 15?g (0.1ml) and 0.4cc of normal saline. Group LC30: 0.5% 15mg 3 ml levobupivacaine with Clonidine 30?g (0.2ml) and 0.3ml of normal saline. 0.5% 15mg 3 ml levobupivacaine with Group LC45 : Clonidine 45?g (0.3ml) and 0.2ml of normal saline. volume of drug was equal in all three groups. The time to onset of Results: sensory as well as motor block was decreased in dose dependant manner, was least in group LC45 and most in group LC15 (Pvalue=0.0001). The two segment regression, duration of analgesia was most in group LC45 (Pvalue=0.0001). There was signi?cant fall (>80%) in blood pressure in group LC45 seen in 9 cases out of 25 (36%) than in group LC30 seen in 3 cases out of 25 (12%) and LC 15 seen in 0 cases. the optimum dose of Clonidine as an adjuvant to spinal anaesthesia given Conclusion: with intrathecal isobaric levobupivacaine 0.5% was 30?g with dose dependant decrease in duration to onset of sensory and motor blockade and prolonged postoperative analgesia with haemodynamic stability most with 30?g dose.
ABSTRACT
Lumbar spinal steroid injections (LSSI) are universally used as preferred diagnostic or therapeutic treatment options before major spinal surgeries. Some recent studies have reported higher risks of surgical-site infection (SSI) for spinal surgeries performed after injections, while others have overlooked such associations. The purpose of this study is to systematically review the literature and perform a meta-analysis to evaluate the associations between preoperative LSSI and postoperative infection following subsequent lumbar decompression and fusion procedures. Three databases, namely PubMed, Scopus, and Cochrane Library, were searched for relevant studies that reported the association of spinal surgery SSI with spinal injections. After the comprehensive sequential screening of the titles, abstracts, and full articles, nine studies were included in a systematic review, and eight studies were included in the meta-analysis. Studies were critically appraised for bias using the validated MINOR (methodological index for non-randomized studies) score. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Subgroup analysis was performed according to the time between LSSI and surgery and the type of lumbar spine surgery. Meta-analysis showed that preoperative LSSI within 30 days of lumbar spine surgery was associated with significantly higher postoperative infection compared with the control group (OR,1.79; 95% CI, 1.08–2.96). Based on subgroup analysis, lumbar spine fusion surgery within 30 days of preoperative LSSI was associated with significantly high-infection rates (OR, 2.67; 95% CI, 2.12–3.35), while no association was found between preoperative LSSI and postoperative infection for lumbar spine decompression surgeries. In summary, given the absence of high-level studies in the literature, careful clinical interpretation of the results should be performed. The overall risk of SSI was slightly higher if the spinal surgery was performed within 30 days after LSSIs. The risk was higher for lumbar fusion cases but not for decompression-only procedures.
ABSTRACT
Background: Ischemic heart disease is defined as inadequate blood flow resulting in decreased oxygenation to the myocardium due to severe narrowing and/or complete blockage of coronary arteries. Although a number of risk factors have been identified over the past several decades, the precise aetiology and mechanisms leading to the development of CAD are not fully understood. These includes abnormal levels of circulating cholesterols with elevated level of LDL-cholesterol and reduced level of HDL-cholesterol, hypertension, cigarette smoking, diabetes mellitus, male gender, post-menopausal state, advanced age, sedentary life style, obesity and a positive family history of premature cardiovascular disease female population. Methods: Our study was aimed to interrogate and to assess the patients presenting with acute coronary syndrome, for the presence of conventional risk factors with special eye on diabetes and to stratify patients with acute coronary syndrome according to their diabetic status (Diabetic vs. non diabetic) and also to study pattern of involvement of coronary arteries in diabetic and non-diabetic patients and to stratify patient according to treatment they received PTCA vs. CABG. Results: It was observed that out of 100 patients with diabetes mellitus, 71% patients were having diabetes mellitus. Among the diabetics in this study, STEMI (73.13%) was the commonest presentation of ACS. On the other hand amongst diabetics, 58.33% had STEMI. Conclusion: Patients with diabetes mellitus had more dyslipidemia, hypertension and smokers. This group of patients required maximum intervention in the form PTCA and CABG.