ABSTRACT
Objective: To evaluate the role of sub anesthetic dose of ketamine when given 5 minutes prior to Propofol injection in alleviating pain of injection during cesarean section surgery
Study Design: Randomized controlled trial
Place and Duration of Study: Department of anesthesia and critical care, Nishtar Hospital Multan, from Aug 2016 to Feb 2017
Material and MethodsA total number of 130 [100 percent] patients were included in the study. Data was analyzed using SPSS [v 23.2], mean and SD calculated for continuous data [age, BMI] and in continuous data was presented as frequency and percentages [ASA status, pain of propofol injection]. Effect modification seen by applying chi square test and p-value
Results: A total number of 100 percent [n=130] patients were included in this study, all were females. The main outcome variable of this study was pain of propofol injection. It was observed that, in control group, 87.7 percent [n=57] patients complaints about pain after propofol injection and 12.13 percent [n=8] remain normal. But, in ketamine group only 16.9 percent [n=11] patients complaint about pain of propofol injection and 83.1 percent [n=54] were remained pain free
Conclusion: Administration of ketamine 0.25Ug/kg five minutes before propofol injection is a safe and effective method in preventing propofol injection pain
ABSTRACT
Objective: To compare the effectiveness of Morphine alone and Morphine with MgSo4 in pain management after CABG surgery
Methods: This randomized control trial was conducted in the department of anesthesia and critical care Choudhary Pervaiz Ellahi Institute of Cardiology, Multan from November 2016 to June 2017. All collected data was entered and analyzed by using computer software SPSS version 23.1. Quantitative data like age, VAS score was analyzed and presented as mean and standard deviation. Similarly qualitative data like gender and ASA status was calculated and presented as frequency and percentages. Independent sample T-test was applied for significance of VAS score. P value ?0.05 was considered as significant
Results: A total number of 150 patients of both genders were included in this study. The main outcome variables of our study were VAS score. It was observed that, in group [M], the mean VAS score after 4, 12 and 24 hours of operation was 5.24+/-1.61, 5.8+/-2.27 and 5.44+/-2.27 respectively. And in group [MM], the mean VAS score after 4, 12 and 24 hours of operation was 4.36+/-2.58, 3.48+/-2.10 and 4.12+/-1.05 respectively. It was noted that both groups had statically significant difference of VAS score, as group [M] had higher VAS score than group [MM]
Conclusion: Morphine with Mgso4 has better efficacy as compared to morphine alone when used as analgesic agent after CABG surgery
ABSTRACT
Background and objective: Postoperative pain requires a well-planned analgesia regimen to ensure adequate patient comfort, satisfaction, early mobilization and also to decrease the hospital stay after anesthesia. We conducted this study to compare the transversus abdominis plane block with direct infiltration of bupivacaine into surgical incision in cesarean section to prolong the mean duration of postoperative analgesia
Methodology: This Randomized control trial was conducted in department of anesthesia, Nishtar Hospital, Multan from July 2016 to December 2016. A total of sixty patients were included in the study and randomly divided into two equal groups of 30 each; Group-T and Group-I. Group-T received TAP block with 0.3 ml/kg of 0.25% bupivacaine on each side under double pop technique, and Group-I received 0.6 ml/kg of 0.25% bupivacaine infiltration in surgical incision. Postoperatively all the patients were monitored in PACU. VAS was noted at 1/2, 1, 2, 4 and 6 h intervals. Inj tramadol 1.5 ml/kg was given as rescue analgesia when VAS score >/=4. Time to requirement of first rescue analgesia was noted. Sample size was calculated with 80% power of test, 95 % confidence interval taking mean and standard deviation of rescue analgesia in Group-T 148 +/- 46.7 and in Group-I 85.38 +/- 38.07. Data were analyzed with computer software SPSS version 23. Mean +/- SD was calculated for quantitative variables and frequency [percentage] was calculated for qualitative variables. Student t-test and chi square test were applied. P value 0.05 was considered as significant
Results: Mean VAS score at half hour in Group-T was 3.8 +/- 2.9 and in Group-I was 5.0 +/- 3.0; and mean VAS score at one hour was 4.4 +/- 3.01 in T Group and in Group-I was 5.3 +/- 3.09 respectively; at two hours 4.7 +/- 2.9 and 6.3 +/- 4.2, and at four hours was 5.2 +/- 2.9 and 5.7 +/- 2.8 in Group-T and Group-I respectively. Mean VAS score during six hours was 5.5 +/- 2.8 and 6.1 +/- 2.5 in Group-T and Group-I respectively. Mean time for 1st analgesia in Group-T was 296.3 +/- 37.1 min and in Group-I was 202.0 +/- 34.9 min, by applying t-test P= 0.000 a significant value
Conclusion: TAP block is a promising technique in alleviating postoperative pain in patients' cesarean section. The procedural simplicity of this block, along with reliable level of analgesia [T10-L1], and longer duration makes the TAP block a good option
ABSTRACT
Objective: To compare the mean duration of atracurium induced neuromuscular blockade in minutes when dosed according to real body weight [RBW] or ideal body weight [IBW] to obese patients undergoing abdominal surgeries under general anesthesia
Study Design: Randomized controlled trial
Place and Duration of Study: Department of Anesthesiology, National hospital defense Lahore, From March 2015 to March 2016
Material and Methods: One hundred and fifty [150] patients were selected for this study and divided in to two equal groups [75 patients in each group], group-I [experimental group] and group-II [control group]. Sample size was calculated with 80% power of test, 95% confidence interval taking mean and standard deviation of duration of atracurium induced neuromuscular blockade in minutes in both groups i.e. 74.6 +/- 37.56 in real body weight group versus 40.02 +/- 22.5 in ideal body weight group. Non probability consecutive sampling technique was used. SPSS version 16 was used for data analysis. Frequency and percentages were used to present categorical data and mean +/- standard deviation for numerical data. Independent sample t-test was applied to compare the significance of outcome variables. A p-value of <0.05 was considered statistically significant
Results: There was a prolong duration of action in experimental group [real body weight group] 69.64 +/- 3.11 minute versus 46.33 +/- 2.77 minute in control group [ideal body weight group] which suggests that dose of atracurium should be calculated and given on basis of ideal body weight in obese
Conclusion: It was observed in our clinical trial that body weight calculation and dosage of atracurium accordingly has altered duration for recovery from blockade, the results of the study showed that atracurium when used according to ideal body weight as compared to total body weight has reduced duration of action. So atracurium dose should be calculated according to ideal body weight rather than total body weight in obese patients
ABSTRACT
Objectives: Comparison of effects of propofol and isosorbide dinitrate during rewarming on cardiopulmonary bypass in patients undergoing coronary artery bypasses grafting
Methods: it was randomized prospective clinical trial. One hundred and twenty patient [120] undergoing CABG surgery were included in this study. Group-1 [Study group, n=60]: in which only propofol infusion used during rewarming and Group-ll [control Group, n=60] in which isosorbide dinitrate and propofol infusion combination was used during rewarming. The data was entered and analyzed through SPSS Version 19
Independent sample T-test and chi-square test were used for data analysis. P value of < 0.05 was taken as significant
Results: Mean arterial pressures during rewarming were 63.41 +/- 3.61 mmHg in propofol group versus 60.80 +/- 4.86 mmHg in control group [p-value 0.001]. Core temperature on weaning from cardiopulmonary bypass was 37.11 +/- 0.49 °C in propofol group and 37.00 +/- 0.18 °C in control group. After drop in core temperature was little more in propofol group [1.02 +/- 0.36 °C] versus 0.96 +/- 0.37 °C in control group but this difference was not statistically significant [p-value 0.41]. Mean Ventilation time after surgery in propofol group was 4.65 +/- 0.65 hours versus 5.03 +/- 0.81 hours in control group [p-value 0.006]
Conclusion: Propofol alone is capable of fulfilling the requirements of adequate rewarming during Cardiopulmonary bypass and can produce more hemodynamic stability and early post-operative recovery
ABSTRACT
Objectives: Hoarseness of voice, cough and sore throat are well known complications of endotracheal intubation. Many pharmacological strategies are used to reduce the incidence of these complications post surgery. We conducted this study to see the effectiveness of local application of diclofenac sodium gel, lidocaine gel or the effect of these two drugs when applied in combination on tracheal tube during intubation, regarding hemodynamic response and the incidence of postoperative sore throat, hoarseness of voice and cough
Methodology: In this prospective, randomized single blind trial, 150 patients undergoing coronary artery bypass graft [CABG] surgery at Chaudhry Pervaiz Elahi Institute of Cardiology from January 2016 to March 2016, were selected. The patients were divided into three groups; Group X [control Group] in which endotracheal tube [ETT] was lubricated with 2% lignocaine gel. Group D: ETT was lubricated with diclofenac sodium gel [2%]. And Group XD: where a mixture of lignocaine and diclofenac sodium gels was used to lubricate ETT before insertion. Data were analyzed in SPSS V16. One way ANOVA and chi-square test was used for analysis of quantitative and qualitative variables respectively taking p-value < 0.05 to be significant
Results: There was no difference in the age and gender of patients between groups. Post intubation HR increased more in Group D [108.94 +/- 7.40 beats/min.], and least in Group XD 96.62 +/- 3.84 beats/min and 100.72 +/- 6.98 beats/min in group X [p < 0.0001]. HR returned back to baseline value in group X and Group XD within five minutes after intubation but remained higher in diclofenac group [p < 0.0001]. The rise in blood pressure after intubation was highest in Group D [162.46 +/- 5.05 mmHg], then 157.34 +/- 5.43 mmHg in Group X, and least in Group XD [154.12 +/- 6.07 mmHg] [p < 0.0001]. Similarly blood pressure after five minutes of intubation was still high in Group D and was least in Group XD [p < 0.0001]. The time of return of HR and systolic blood pressure to baseline value was 9.00 +/- 1.33 min in Group D, 4.59 +/- 1.03 min in Group X and 3.43 +/- 0.81 min in group XD [p < 0.0001]. Incidence of sore throat, hoarseness of voice and cough was highest in Group X and less in Group D and was least in Group XD [p-values 0.039, 0.025 and 0.002 respectively]
Conclusion: Local application of a combination of lignocaine and diclofenac sodium gels over the endotracheal tube before intubation is associated with better hemodynamic control and significantly lower incidence of postoperative sore throat, hoarseness of voice and cough
ABSTRACT
Objective: Pulmonary dysfunction is considered to be the most important complication after open heart surgery. Different maneuvers like intermittent or continuous positive pressure ventilation, low tidal volume ventilation and different vital capacity maneuvers have been used for reducing the incidence of pulmonary dysfunction after cardiac surgery. In this study we evaluated the effects of low tidal volume ventilation versus no-ventilation during cardiopulmonary bypass [CPB] in patients undergoing conventional CABG surgery
Methodology: This randomized clinical trial was conducted in a tertiary care cardiac hospital. One hundred patients who were planned to undergo conventional CABG surgery were divided into two groups by using draw randomization procedure. In Group A patients [ventilation group] ventilation was continued at low tidal volume of 3 ml/kg, respiration rate of 12 breaths/min and PEEP of 5 cmH[2]O. In Group B patients [non-ventilation group] ventilation was arrested during CPB. For data analysis Statistical Package for Social Sciences [SPSS] V17 was used. Parametric variables were compared using unpaired t-test and non-parametric variables were compared using o[2]-test
Results: The mean patient's age in this study was 57.70 +/- 8.57 years in ventilated group and 54.5 +/- 8.33 years in non-ventilated group. PaO[2]/FiO[2] ratio and alveolar-arterial oxygen tension gradient immediately after intubation was same in groups. But PaO[2]/FiO[2] was significantly high in ventilated group after one hours of CPB and even after four hours of CPB [p < 0.001 and 0.002 respectively]. Alveolar arterial oxygen tension [A-a O[2]] gradient after 1 hour and four hours of CPB was significantly low in Ventilated group [p < 0.001 and 0.001 respectively]. Total Mechanical ventilation time was also significantly shorter in ventilated group 5.19 +/- 1.96 hours versus 6.42 +/- 2.60 hours in non-ventilated group [p 0.009]. On 4th post-operative day, incidence of atelectasis was significantly low 20% in ventilated group versus 38% in non-ventilated group [p = 0.04]
Conclusion: Continuous low tidal volume ventilation is associated with better oxygenation after surgery and reduced risk of post-op pulmonary complications during cardiopulmonary bypass in patients undergoing conventional coronary artery bypass graft surgery
ABSTRACT
Intravenous [IV] Paracetamol is an excellent post operative analgesic and antipyretic in children. Efficacy and tolerability of IV Propacetamol have been established in pediatric practice. It is believed that paracetamol works by inhibiting cyclooxygenase-2 [COX-2] enzymes. Studies bring to light that therapeutic doses of IV acetaminophen are effective and tolerable in children with least chances of hepatotoxicity. However, overdose toxicity has been reported in children and drug induced hypotension in febrile critically ill patients. Therapeutic doses according to body weight of neonates and children can be administered in hospital settings. Special education of health care staff regarding precise dose and solution is necessary to assess the role of IV paracetamol preparation in pediatric practice