Huge epidermal cyst- a unique presentation

Epidermoid/sebaceous/inclusion epidermal cyst is a common skin lelsion which may sometimes mimic a cancerous lesion and appear at abnormal site. Main objective of presenting this case report is to develop the insight that benign looking cutaneous/subcutaneous swelling should never be taken as benign until proved by histo-pathological examination

Intubating conditions 60 seconds after giving muscle relaxant for rapid sequence induction comparison between succinylcholine and rocuronium

To compare efficacy of succinylcholine with rocuronium for rapid sequence induction. Randomized control trial. The study was done in Anaesthesia department, Combined Military Hospital Kharian from 17th march 2007 to 16th march 2008 a total of 100 cases of elective surgery for haemorrhoids were taken and patients were randomly assigned in two equal groups using random number table. American Society of Anesthesiologist [ASA] status was assessed. Informed consent and approval of ethical committee was obtained. Patients were divided into group A and B. In both groups there were 25 males and 25 females of 20-40 years. In group A, patients were preoxygenated for 3 min then propofol was given followed by succinylcholine. After 60 seconds of giving muscle relaxant intubating conditions were assessed by vocal cords movements on laryngoscopy, apnea and abdominal jerky movements on intubation. In group B, rocuronium was given instead of succinylcholine. In group A one [2%] patient was having movement of vocal cords at the time of laryngoscopy while in group B nine [18%] patients had vocal cord movement [p=0.016]. As far as apnea is concerned, in group A one [2%] patient was not having apnea after 60 seconds but in group B eight [16%] patients were not having apnea [p=0.031]. At the time of intubation in group A three [6%] patients showed jerky movements of abdomen while in group B that movement was present in eleven [22%] patients [p=0.041]. Intubating conditions with rocuronium were not superior to those with succinylcholine

Epidural anaesthesia; single-shot for day-case knee arthroscopy using a 50-50 mixture of lignocaine and bupivacaine

To compare the benefits and adverse effects of three different drug combinations when used for single-shot epidural anaesthesia for day-case arthroscopy. Prospective, random, double-blind study. A 250 bedded secondary care hospital. From October 2005 to Feb 2007. We studied 75 adult male patients, aged between 23 to 63 years, weight <100 kg, ASA physical status I or II undergoing elective knee arthroscopy as day-case procedure/Patients were randomly divided into three groups [25 patients in each group] and single-shot epidural anaesthesia was performed using a total of 20 ml epidural lignocaine 2% [Group 1] bupivacaine 0.5% [Group 2] or a mixture containing lignocaine 2% and bupivacaine 0.5%, 10 ml each [Group 3]. Time to achieve maximum height [in minutes] was similar in group-1 and group-3 [10 +/- 4 and 11 +/- 2], but it was significantly longer in group-2 [20 +/- 3]. Block time was comparable in group-2 and 3 [130 +/- 25 and 118 +/- 37] but it was significantly shorter in group-1 [60 +/- 20]. Post-operative discharge time was longest in the group-2, and comparable in group-1 and S.The incidence of complications like bradycardia, hypotension, nausea and vomiting were more in group-2 and less in group-1 and group-3. Inadequate anaesthesia was more in group-1 and least in other two groups. Four patients of group-1 needed rescue analgesia and two from same group needed general anaesthesia as compared to none in group-2 and group-3. In 4-point patient satisfaction scale, maximum patients from Group-3 rated it perfect while most patients from group-1 were not satisfied with the quality of anaesthesia. The results of our study show that a 50-50 mixture of lignocaine and bupivacaine with fentanyl 50 pg when used for single-shot epidural anaesthesia for day case knee arthroscopy, provides better quality of analgesia, with fewerincidences of side effects and more patient satisfaction as compared to lignocaine or bupivacaine alone

Epidural analgesia; effect on the duration of labour

The influence of epidural analgesia on the length of labour remains a source of controversy in literature. To see the effect of epidural analgesia on the duration of active first stage and second stage of labour. Obstetric Department of CMH Kharian. From 1[st] January 2005 to 31[st] March 2006. One hundred pregnant full term, women were included in the study. Fifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fifty multiparous reporting at full term, twenty five women were given epidural the other twenty five were control. The mean duration of active first stage of labour in primiparous women after 3-4 centimeter cervical dilatation was 5.10 hrs in the epidural group while it was 6.65 hrs in the control group [p less than 0.001]. In the multiparous women the mean duration of active first stage of labour after 3-4 centimeter cervical dilatation was 2.40 hrs in the epidural group while it was 3.43 hrs in the control group [p less than 0.001]. In the primiparous women the mean second stage was 23.76 minutes in the epidural group, and 37.33 minutes in the control group [p less than 0.001]. In the multiparous group, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group [p less than 0.001]. Epidural analgesia decreases the duration of active first stage and second stage of labour

Comparison of intra-articular pethidine and neostigmine for postoperative analgesia in patients undergoing knee arthroscopy

Traditionally local anesthetics such as bupivacaine along with systemic analgesics have been used for postoperative analgesia after knee arthroscopy but it has a short duration of action. Recently, neostigmine a cholinestrase inhibitor has shown analgesic actions when used intrathecally but this central delivery of neostigmine is associated with side effects. Same is the case with central actions of pethidine. Both drugs also have a peripheral analgesic effect. The purpose of this study was to compare the peripheral analgesic effects of intra-articular neostigmine and pethidine used separately in patients undergoing knee arthroscopy. Fifty American Society of Anesthesiologist [ASA] class I and II patients, scheduled for diagnostic knee arthroscopy were allocated randomly in two groups. A standard anaesthetic technique was used. No systemic analgesic was administered. At the end of arthroscopy group I received intra-articular neostigmine 500 mg diluted in 30 ml of normal saline and group II received 50 mg pethidine diluted in 30 ml of normal saline. Postoperative analgesia was assessed by Pakistan Coin Pain Scale at 1, 4, 8, 24 and 48 hours. If required, rescue analgesia was given as intravenous Inj. pethidine. Pakistan Coin Pain Scale Scores were lower throughout in the neostigmine group as compared with pethidine group [p < 0.05]. The requirement of rescue analgesia was also lower in neostigmine group as compared to pethidine group [p < 0.05]. Intra-articular administration of 500 mg of neostigmine in patients under going knee arthroscopy has superior analgesic effect as compared to 50 mg of intra-articular pethidine

Nalbuphine compared to pethidine for postoperative pain relief after orthopaedic surgery

Nalbuphine hydrochloride, a synthetic agonist-antagtonist analgesic, in a dose of 20 mg was compared with pethidine 100 mg in 60 patients after elective surgery in a random double-blind study. Both drugs were given intramuscularly on the first day after surgery. The pain intensity and visual analogue scales would seem to indicate that nalbuphine has a longer duration of action than pethidine [P < 0.05]. The respiration rates in the pethidine group were significantly more depressed 30 minutes after the injection than in the nalbuphine group [P < 0.05]. Nalbuphine caused less depression of both systolic and diastolic blood pressure at both 30 and 60 minutes [P < 0.001]. The results of the study show that nalbuphine, in the dose used here, may prove to be a useful substitute for pethidine