ABSTRACT
Maintenance of sinus rhythm is superior to incidence of atrial fibrillation (AF) in patients with rheumatic heartdisease undergoing Closed Mitral Valvotomy (CMV). The present study was done to evaluate the effect ofprophylactic use of Magnesium Sulphate (MgSo4), intravenously (i.v) soon after opening the stenosed MitralValve using Tubbs dilators by Surgeon, in patients undergoing CMV. One hundred and twenty patients withMitral Stenosis (MS) (mitral valve area < 1cm2), normal mitral valvular apparatus, no mitral regurgitation,mitral score not more than 7/16 planned for CMV. These patients were divided in two groups of 60 each.Group (I) (n=60) received. MgSo4, 30 mg/kg diluted to 20 ml with normal saline soon after mitral valvotomyand Group - II (n=60) received 20 ml of normal saline. The standardized protocol for CMV was maintainedfor all the patients. Before surgery AF was observed in 56.67% of patients in group I and 48.33% of patientsin group II (p=0.46). Postoperatively in ICU, 30% of patients in group I and 70% of patients in group II hadAF(p<0.0001). A single prophylactic intra operative dose of i.v MgSO4 decreased post valvotomy arrhythmiain comparision to placebo group . Thus, a single dose of intraoperative MgSO4 can be used to decreasepostoperative arrhythmias in patients of M.S undergoing CMV
ABSTRACT
Early postoperative pain in patients undergoing thoracotomy may be intense, and can delay the rehabilitationand mobilization unless appropriately treated. General, Epidural and combination of these have separaterisks and benefits which vary according to patient's comorbidity and medications. Intravenous drugs foranalgesia like morphine sulphate need close monitoring as they cause respiratory depression.. Tramadolhydrochloride has been used both intravenously and epidurally and results have been found to be comparablewith morphine. Sixty three ASA I and II patients scheduled for elective thoracotomy were divided intothree equal groups in a randomized, double blinded fashion. Group I, II, III received 1, 2 and 3 mg/kg bodyweight Thoracic epidural Tramadol respectively. Onset time, duration and side effects of analgesia werestudied in all the groups.Duration of pain relief in group I, II, III was 6, 10, 20 hrs respectively which wasstatistically significant. Incidence of post operative nausea and vomiting was significant in group III comparedto other groups. It is concluded that 2 mg/kg body weight thoracic epidural Tramadol is optimum dose forpostoperative analgesia without significant side effects and in dose 3 mg/kg body weight, can be used withappropriate anti-emetics to reduce the incidence of nausea and vomiting.