Propofol in an emulsion of long chain triglyceride and medium-long chain triglyceride: the effect on pain during injection

Pain on injection is major disadvantage of standard propofol formulated with long chain triglycerides [LCT] during induction of anesthesia and sedation in critically ill patients. It is found that concentration of free propofol in aqueous phase of emulsion is responsible for pain on injection and that reducing amount of free propofol would also reduced frequency and intensity of pain on injection. The study was design to investigate whether pain on injection can be reduced by new formulation of propofol which consist of medium chain and long chain triglycerides [MCT/LCT] which is now available in market, and claimed reduced concentration of free propofol in aqueous phase. We devised a prospective, analytical; double blind randomized study to compare the pain on injection of two formulation of propofol for induction of general anesthesia. The present study included 200, non premeditated ASA I, II - adult patients scheduled for elective surgery under general anesthesia at Abbasi shaheed hospital. Patients were allocated randomly in two groups to receive either propofol - MCT/LCT [group I] or propofol - LCT [group II]. The study solution injected at speed of 1ml/sec in a dose of 2.5 mg /kg for induction of general anesthesia and patients graded any associated pain on injection using four point scale: 0= no pain, 1= mild pain, 2= moderate pain, 3= severe pain. There was a significantly less incidence and intensity of injection pain in group-I compared with group-II. The author concluded that propofol MCT/LCT significantly reduced the incidence and severity of pain on injection

Routine preoperative chest radiograph in healthy asymptomatic adult schedulled for non-cardiopulmonary surgery

The objective of study was to detect the abnormalities and establish the evidence against the routinely ordered preoperative chest radiographs in asymptomatic young adults between 15-40 years of age, scheduled for elective non-cardiopulmonary surgery. Descriptive study. Study was conducted at anesthesia clinic of Abbasi Shaheed Hospital from August 2004 to August 2005. A descriptive study of 725 asymptomatic patients, without risk factors and age ranging between 15 to 40 years scheduled for elective non-cardiopulmonary surgery was conducted at Abbasi Shaheed Hospital over a period of one year. Routine chest radiograph define as these ordered for asymptomatic healthy individuals in the absence of any clinical indication and not a candidate for major vascular, abdominal, thoracic surgery. In the study we analyzed the routinely ordered chest X-rays to detect any abnormality. The abnormalities detected on chest X-rays films were classified as significant and insignificant. Data showedinsignificant abnormalities do not influence the management of anesthesia. The routine preoperative chest radiograph ordered in 725, asymptomatic patients without risk factors scheduled for elective non-cardiopulmonary surgery. The age of individuals were ranging between 15-40 years. The abnormalities detected on chest X-rays film were assessed. No significant abnormalities were found in these subjects. In this study we found few insignificant abnormalities includes, borderline cardiome-galy, aortic unfolding, prominent broncho-vascular marking, cervical rib, pleural thickening. These insignificant abnormalities do not influence the peri-operative management of anesthesia. This study support the evidence that routine preoperative chest X-ray in asymptomatic young adults undergoing for elective non cardiopulmonary surgery should be limited to the patients with clinical symptoms and high risk patients. Such routine preoperative chest radiograph should be avoided in young asymptomatic patients. The routine preoperative chest radiograph is still widely overused in our country. The study suggested that history and physical examination are best way to screen the disease. The data showed that routine chest X-rays in asymptomatic patients scheduled for elective non-cardiopulmonary surgery do not influence the peri-operative management of anesthesia. Our study shows that chest radiograph abnormalities are rare and insignificant in asymptomatic patients, age ranging between 15-40years. Study recommended that investigation should be performed as indicated by clinical finding. The study suggests that routine chest radiograph is unnecessary in asymptomatic patient age ranging 15-40 years scheduled for elective non-cardiopulmonary surgery