Anaphylactic reaction from atracurium

For induction of anaesthesia many agents are administered intravenously, anaphylactic reaction can occur to any of these agents

Neuromuscular blocking agents are most commonly implicated as the cause of anaphylactic reaction in anaesthesia practice

Amino-steroids, benzylisoquinoliniums and suxamethonium are being commonly used for intubation and perioperative muscle relaxation. We are presenting a case of anaphylactic reaction to benzylisoquinolinium i.e. atracurium in a young patient. The patient was revived with a prompt diagnosis and treatment

Open cholecystectomy; management of ponv: comparison of sub hypnotic dose of propofol vs metoclopramide

Postoperative nausea and vomiting [PONV] are most common and distressing complications after anaesthesia and surgery, leading to various problems. Metoclopramide, a benzamide, used as an anti-emetic, has got various side-effects. Propofol, a short acting induction agent, possesses anti-emetic properties in sub hypnotic doses, without having unwanted side- effects in this low dose. To compare the frequency of PONV in patients treated with propofol and metoclopramide. Experimental study. Setting: Department of anaesthesia and intensive care, Combined Military Hospital Rawalpindi. Duration: 06 months [01[st] July to 31[st] December 2004]. 1 82 female patients scheduled for open cholecystectomy were selected for this study. All of them received general anaesthesia without any prophylactic antiemetic. Out of them, 60 patients who complained of PONV in post anaesthesia care unit [PACU] were selected by non probability convenience sampling and were equally divided into two groups. Group [A] received propofol [0.5 mg/kg] while group 'B' received metoclopramide [0.2 mg/kg]. Recurrence of PONV was recorded 60 min after administration of the study drug. Patients still complaining of PONV 30 min after administration of the study drug received a rescue medication i.e. I/V ondansetron [4mg]. Results: In group [A], 18 patients responded to intervention [60%] whereas 26 [86.66%] patients gave a positive response in group [B] [p; 0.020]. More patients who received propofol needed the rescue medication [40%] than those who received metoclopramide [13.33%] [p 0.020]. Metoclopramide is a better option for managing PONV than propofol

Neonatal resuscitation; the use of laryngeal mask airway

The key to success in newborn resuscitation is the knowledge about the neonatal physiology and adequate preparation of the staff involved in the resuscitation process. The pulmonary part of the resuscitation can be accomplished with either Endotracheal Tube [ETT] or Face Mask [FM], both of these techniques require expertise and are associated with high rates of failure. Hence a third potential option has been suggested to overcome these problems. To evaluate the efficacy of Laryngeal Mask Airway [LMA] in neonatal resuscitation and artificial ventilation and to compare it with that of ETT and FM. To evaluate LMA's efficiency in situation where endotracheal intubation and facemask ventilation is difficult or not possible. A Non interventional, analytical/ comparative study. Combined Military Hospital Rawalpindi. 20 weeks [1st] January 2002 to 31 May 2002]. A group of 75 neonates born with C-Section were selected on the basis of non-probability convenience sampling. They were subdivided into three sub gps with 25 neonates in each sub gp. 75 neonates born after C-Section, were divided into sub gps i.e. A, B, and C containing a no of 25 neonates in each gp. They were ventilated with ETT, FM and LMA respectively. These newborn babies had an Apgar score < 4. They were resuscitated using a fix protocol. The efficacy of ventilation with either technique was evaluated in terms of placement and ventilation. The LMA emerged, as a valuable and better option in newborn resuscitation. Moreover, it was a successful tool in situations where endotracheal intubation and facemask ventilation was difficult or impossible. The LMA is a potential valuable adjunct for the management of neonatal airway