ABSTRACT
Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Here, we report the case of an 18-year-old male with cerebral palsy who was admitted to the hospital with symptoms of lower respiratory tract infection and with high-grade fever. His initial blood workup revealed an elevated creatinine and CPK of 32,000 which was suggestive of rhabdomyolysis. His worsening renal function with acidosis and hyperkalemia required initiation of hemodialysis. A respiratory viral PCR profile revealed Influenza B. He was re-started on Oseltamivir with gradual clinical improvement. Respiratory viral PCR testing should be considered in patients with features of lower respiratory tract infection and rhabdomyolysis as this can detect influenza B and other viruses which cannot be detected by doing H1N1 PCR.
ABSTRACT
Background: Accurate management of post operative pain is quite impossible with single drug therapy approach. For this, our aim was to combine use of tapentadol tablet orally along with thoracic epidural in comparison with intravenous combined use of tramadol, paracetamol and diclofenac for postoperative analgesia in case CABG patients. Methods: 60 patients of CABG (Coronary Artery Bypass Surgery) randomly and equally divided into two groups. Group TTE (Tab. Tapentadol -Thoracic Epidural, n=30) were given oral Tablet Tapentadol through NG (Nasogastric) tube at the time of shifting the patient from Operation Theatre to postoperative ward along with Tramadol through Thoracic epidural catheter. In Group TPD (Tramadol -Paracetamol -Diclofenac, n=30) were given Inj. Tramadol, Inj. Paracetamol IV at time of shifting of patient. If pain score is too high (>4) then additional analgesia were given with Diclofenac only if preoperative renal and hepatic profile were normal. Patients were monitored for duration of rescue analgesia, total no. of doses of analgesics in first 72 hours, total consumption of analgesics and response to physiotherapy. Results: Duration of need of rescue analgesia was significantly longer in TTE group (p<0.05) while total no. of rescue doses were significantly more in group TPD (p<0.001). We also observed that patients of TTE group were recovered earlier, response to chest physiotherapy was significantly better and thus reduces their total length of ICU stay (p<0.05). Conclusions: Our study concludes that Tapentadol with Thoracic epidural is very much effective as a multimodal analgesia approach in controlling acute postoperative pain after CABG. Tapentadol is quite a newer drug so its usefulness for other patients and different surgeries is still to be debated.
ABSTRACT
Aim: The hemodynamic effects of propofol-fentanyl and isoflurane-fentanyl anesthesia during surgery were compared in 100 patients undergoing coronary artery bypass grafting (CABG) and valvular surgeries. Material and Methods: Patients were divided into two groups randomly. Group PF (n=50) were induced with Fentanyl, Midazolam, Vecuronium and Propofol infusion. While Group IF (n=50) were induced with Fentanyl, Midazolam, Vecuronium and Isoflurane (0-2%) as per the standard doses. Hemodynamic measurements were made before induction of anesthesia and at various times throughout the surgery. Observation and Results: Significant decreases in mean arterial pressure MAP, left ventricular stroke work index (LVSWI), and stroke volume index (SVI) occurred after 15 minutes of propofol anesthesia. With isoflurane MAP was well maintained with reductions in LVSWI and SVI. Isoflurane was, however, associated with a slight increase in heart rate (HR), whereas no significant change in HR in patients receiving propofol. With both techniques there was no significant change in systemic vascular resistance index. Isoflurane prevents myocardial damage and thus it is cardio protective by developing ischemic preconditioning phenomenon. Conclusion: The study suggests that propofol-fentanyl anesthesia is an acceptable technique but Isoflurane- fentanyl is still preferred due to less hemodynamic instability and greater myocardial protection in cardiac surgeries.