review of hemodynamic response to the use of different types of laryngoscopes

Endotracheal intubation is the gold standard in airway management either as a means to administer general anesthesia or for mechanical ventilation in critically ill patients for protecting the airway when the airway reflexes are dysfunctional. Macintosh laryngoscope is the standard laryngoscope used for intubation though advances in science have resulted in development of laryngoscopes of different designs. The process of laryngoscopy and intubation [L and I] can result in significant hemodynamic response and this is a topic of debate and research in anesthesia. A comprehensive review of hemodynamic responses to various laryngoscope designs has been undertaken here. Tracheal intubation contributes to more hemodynamic response compared to laryngoscopy alone. The hemodynamic responses to L and I are exaggerated in the elderly and those with uncontrolled hypertension. Orotracheal intubation causes less hemodynamic response as compared to nasotracheal intubation. Laryngoscope design, duration of L and I and the forces applied on the laryngoscope all contribute to hemodynamic fluctuations. McCoy blade and videolaryngoscopes where L and I can be performed without the aid of stylets provide better attenuation of hemodynamic response compared to intubation using the Macintosh laryngoscope. Fibreoptic orotracheal intubation with the aid of combined lingual traction and jaw thrust maneuver provides superior attenuation of hemodynamic response compared to use of laryngoscope

Zika virus: no cases in the Eastern Mediterranean Region but concerns remain

Following the WHO declaration on 1 February 2016 of a Public Health Emergency of International Concern [PHEIC] with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus, the WHO Regional Office for the Eastern Mediterranean conducted three rounds of emergency meetings to address enhancing preparedness actions in the Region. The meetings provided up-to-date information on the current situation and agreed on a set of actions for the countries to undertake to enhance their preparedness and response capacities to Zika virus infection and its complications. The most urgent action is to enhance both epidemiological and entomological surveillance between now and the coming rainy seasons in countries with known presence of Aedes mosquitoes. Zika virus like other vector-borne diseases poses a particular challenge to the countries because of their complex nature which requires multidisciplinary competencies and strong rapid interaction among committed sectors. WHO is working closely with partners and countries to ensure the optimum support is provided to the countries to reduce the risk of this newly emerged health threat

Comparison of intrathecal fentanyl and midazolam for prevention of nausea-vomiting during cesarean section under spinal anesthesia

Nausea and vomiting remain as [the big little problem] in cesarean section underspinal anesthesia. Incidence of nausea-vomiting during and immediately after surgery in spinal anesthesia is high. It is physically as well as mentally distressing to the patient and disturbing to the surgeon and the anesthesiologist. Purpose of this study was to compare the clinical efficacy of intrathecal fentanyl and midazolam for prevention of nausea-vomiting in parturients undergoing cesarean section under spinal anesthesia. This prospective randomized double blind study was conducted in 90 women aged between 18-31 years [ASA physical status I] scheduled to undergo elective cesarean section under spinal anesthesia. Subjects were randomly divided into three equal groups. Group A received 0.5 ml normal saline, Group B received 2 mg midazolam and Group C received 12.5 micro/g fentanyl with 2 ml of hyperbaric bupivacaine 0.5% intrathecally. Nausea-vomiting was assessed according to Belville's score. The statistical analysis of data was done by using statistical package for social science [SPSS] evaluation version 20. Results were expressed as mean, standard deviation, and range values. Frequencies expressed as number and percentage. ANOVA was used for multiple group comparisons, and categorical data were analyzed by Chi-square test. 24 subjects out of 30 in the placebo group developed intraoperative and early postoperative nausea-vomiting compared to 11 in midazolam group and 8 in fentanyl group. Incidence of intraoperative and early postoperative nausea-vomiting was 79.5% with placebo, 36.6% with midazolam and 26.6% with fentanyl. Intrathecal fentanyl 12.5 microg or midazolam 2 mg, both reduce the incidence and severity of nausea-vomiting when administered with bupivacaine for cesarean section

Dexmedetomidine as an adjuvant to hyperbaric spinal bupivacaineforinfra-umbilical procedures: a dose related study

Various adjuncts have been used with local anesthetics in spinal anesthesia to provide good quality of intra-operative and better post-operative analgesia. Dexmedetomidine is a new

Perioperative anesthetic management for cesarean section in patients with cardiac disease

The perioperative anaesthetic management of a pregnant patient with pre-existing cardiac disease undergoing caesarean section poses a challenge for an anaesthesiologist. The anaesthesiologist must have the knowledge of its pathophysiology, clinical features, diagnostic evaluations and anaesthetic modalities and various drug interactions during anaesthesia. This review summarises the current management of a parturient with cardiac disease requiring surgical delivery

Awake rigid bronchoscopy for post intubation tracheal stenosis

Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present with respiratory insufficiency and stridor of insidious onset and progressive nature. Immediate management includes securing the airway which requires anesthesia. We present successful management of a case of post intubation tracheal stenosis using rigid bronchoscopy under a combination of regional and general anesthesia

Census survey for a primary health care programme

Objectives: To describe the process of gathering information from a census survey as a preliminary step for supporting the working of a primary health care center. It also presents briefly the results of the survey and its broader implications on the health needs of the local population

Methods: A questionnaire was used to obtain basic information regarding the ethnicity / area of origin, number of household members and their breakdown according to gender, age and marital status. The medical students of different batches were involved in the data collection process, as part of their Survey Methodology course of Community Health Sciences [CHS] in first year

Results: Data was obtained from 2,033 houses, having a total population of 16,118 persons. Fifty three per cent of the population was under fifteen years, 42% were between 15-49 and 5% were over 50 years of age. The overall percentage of males was 52% and females 48%. Approximately 79 percent people were Pushto speaking

Conclusion: Sikanderabad is a typical slum settlement, with an emigrant population being mostly of Pathan and Afghan refugees. The fertility rate in Sikanderabad is much higher than that of Karachi. This highlights the need for education and availability of family planning facilities. At the same time, due to the fact that there is a major portion of the population aged under five years, so facility for treating children must be appropriately provided. The Primary Health Care center established in Sikanderabad is based on the above information. The emphasis is on maternal and childcare, including antenatal and postnatal care; family planning and nutritional counseling

National Polio Day Campaign in a squatter settement through medical students

To provide maximum polio vaccination coverage to under-five [<5] year children of a squatter settlement through Ziauddin Medical University [ZMU] medical students. ZMU has established a Primary Health Care Program in a squatter settlement, which is predominantly inhabited by migrants from North Western Province of Pakistan and Afghanistan. The total population is approximately 20,000 and the proportion of <5 year children is nearly 19%. ZMU started Oral Polio Vaccination [OPV] campaigns from 1996; up to 1999. The OPV campaigns were confined to the National Immunization Days [NIDs]. A different strategy of "door-to-door" OPV services by medical students was undertaken in 1997. In December 1999 the polio vaccination coverage of <5-year children was evaluated through cluster sampling. This paper describes the steps for improving OPV coverage in Sikanderabad. The estimated number of <5 year children in the area is 4,600. In a cluster sample survey after the 1999 NID campaign out of 620 under 5 year children living in 429 households, 529 [85%] received OPV, with a 95% CI for OPV coverage of 82 to 88%. The coverage before the campaigns initiated by ZMU was 52%. The results indicate that the polio coverage of <5-year children has risen with the change in strategy. Door-to-door coverage strategy with the help of medical students proved effective in providing vaccination. No case of suspected poliomyelitis has been reported from the area since October 1999