Frequency of difficult and failed intubation in apparently normal patients undergoing elective surgery

To find the frequency of difficult and failed intubation in apparently normal patients undergoing elective surgery. We also aimed to look at sensitivity and specificity of Mallampatti classification in our population. Cross sectional study. Combined Military Hospital, Rawalpindi and Multan from 1[st] May 2013 to 1[st] June 2013. There were 467 patients, who underwent elective surgery with general anesthesia and endotracheal intubation. During their pre-anesthetic visit, we assessed the airway according to Mallampatti score. After endotracheal intubations, frequency of difficult intubations was evaluated [i.e. Grade III and Grade IV] with special emphasis on intubation done by consultant anaesthetist and post graduate trainees followed by frequency of failure of intubation and other complications during intubation were also noted. Furthermore, comparison of Mallampatti with Cormack and Lehane's classification of difficult intubation was done. Difficult intubation in these centers was 4.28% [20/467]. Sensitivity of mallampatti was 98.2%. Incidence of failure of intubation was 0.42% in our study. The frequency of difficult intubation is 4.28% whereas failure of intubation is very low [0.42%] and was observed in special cases only. In our study, the sensitivity of Mallampatti to Cormack and Lehane's classification of intubation was 98.2% which suggests that it is a sensitive predictor of difficult intubation but complete accuracy cannot be determined by using the Mallampatti score

Zolmitriptan is effective in relieving post-dura! puncture headache in young parturients

This comparative study was designed to assess the efficacy of zolmitriptan, a triptan widely employed as first-line therapy for migraine, in relieving post-dural puncture headache in parturients who were operated for cesarian section under spinal anesthesia. The study was carried out at department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of twelve months from August 2012 to July 2013. We enrolled 60 adult parturients who complained of post-dural puncture headache in post-partum period. They were divided into two equal groups of 30 each; Group-1 [Z-group] received zolmitriptan along with other supportive treatment for spinal headache and Group-2, control group [C-group] was given only supportive treatment. Efficacy of zolmitriptan in relieving post-dural puncture headache [PDPH] was studied and frequency of complications of the drug were noted. After 6 hours, 60% patients of Z-group got relief from headache. While in control group only 36.66% patients were pain free [p 0.016]. After 12 hours, relief from headache was noted in 70% patients of zolmitriptan-group while in C-group only 46.66% were relieved [p 0.015]. After a period of 24 hours results were 86.66% vs. 63.33% [p 0.006]. After 48 hours, in Z-group 96.66% patients were pain free, while in C-group 63.33% were free from headache [p 0.001]. There was no change in results for Z-group after 72 hours. In contrast, in C-group 80% were pain free and 20% patients were still symptomatic. Borderline statistical significance was present [p 0.046]. The study revealed that anti-migraine drug zolmitriptan in combination with supportive treatment is effective in relieving PDPH in parturients

Psychiatric co-morbidity in chronic pain disorder

To determine the psychiatric co-morbidity in patients with chronic pain disorder in hospital setting. Cross sectional descriptive study. This study was conducted at Combined Military Hospital [CMH] Okara from June 2011 to May 2012. A purposive sample of 400 patients [males=117; females=283] gathered from pain clinic and other outpatient departments of the hospital and were interviewed in detail and Present State Examination was carried out. Demographic variables were scored using descriptive statistics and results were analyzed using correlation methods. It was revealed that psychiatric illness in overall sample prevailed among 266 participants [67%]. Among which 164 participants [62%] were diagnosed with depression, 67 patients [25.2%] of chronic pain were diagnosed with anxiety disorders, 28 patients [11%] with adjustment disorder and 1.5% and 1.1% diagnosed with drug dependence and somatization disorder, respectively. Psychiatric co-morbidity especially the incidence of depression, anxiety and adjustment disorders were high amongst patients suffering from chronic pain disorder

Postdural puncture headache; comparison between lumbar puncture needle no 25 G and 27 G

To evaluate the role of needle diameter in causing postdural puncture headache [PDPH] in patients undergoing elective caesarian section. Comparative cross-sectional study. This study was conducted in Department of Anaesthesia and Intensive care PNS Shifa Karachi over duration of six months. It was a cross sectional study of 100 patients, which were divided into two separate groups. Group I and Group II were given spinal anaesthesia with 25 gauge and 27 gauge Quincke needles respectively. In both the groups the patients were randomly selected and were blind to size of the spinal needle used. The data was analyzed using Chi-square test. A P value of <0.05 was considered statistically significant. Two patients in 25-G group and one in 27-G group required additional general anaesthesia because of inadequate spinal anaesthesia. Thus, a total of three patients were excluded from the study. Five out of forty-eight patients in group 1 and one out of forty-nine patients in Group II suffered from post spinal headache. The proportion of patients with post spinal headache with 25 G needle is significantly more than those with 27 G

Gynaecological surgery; postoperative prophylaxis of nausea vomiting: dexamethasone and metoclopramide in combination or alone

Objective: This study evaluated the antiemetic efficacy, costeffectiveness and clinical utility of prophylactic metoclopramide or dexamethasone, alone or in combination, compared with placebo in the prevention of postoperative nausea and vomiting [PONV]. DESIGN: A prospective randomized clinical trial

Setting and Period: From July 2003 to March 2004 at CMH Nowshera and Risalpur

Patients and Methods: 182 gynaecological patients [25-48 yr, ASA I-II]. After induction with intravenous [IV] Thiopental, anaesthesia was maintained with halothane and nitrous oxide in oxygen including relaxation with Pavulon. The patients received IV dexamethasone 8 mg, metoclopramide 10 mg or dexamethasone 5 mg IV plus 10mg metoclopramide and placebo. Postoperative analgesia and antiemetic rescue medication were standardized

Results: Episodes of PONV were recorded for the first 24 h after the operation. The incidences of PONV were analyzed with Fisher`s Exact test and the severity of PONV rated by a standardized scoring algorithm. The incidence and severity of PONV in the first 24 h were significantly less in the dexamethasone and metoclopramide combination groups than in individual drugs or placebo group [P<0.05]. The reduction of the severity of PONV induced by metoclopramide or dexamethasone alone was not statistically significant [metoclopramide vs placebo: P = 0.27; dexamethasone vs placebo: P = 0.12]. PONV was comparable in both the metoclopramide and the dexamethasone group

Conclusion: Good prophylaxis of PONV can be achieved by combination of commonly available drugs dexamethasone with metoclopramide in most gynaecological surgeries, and it is 22 times economical than ondansetron