Comparison of spinal anesthesia dosage based on height and weight versus height alone in patients undergoing elective cesarean section / 대한마취과학회지

BACKGROUND: Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens. METHODS: This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted according to height and weight, and in the other, the dose was adjusted according to height only. RESULTS: Sixty women with a singleton pregnancy were included. Of the factors that could affect dose and blood pressure, including age, weight, height, and dose, only height differed between the groups. Mean heart rate was similar between the groups. Hypotension was significantly more frequent with dosage based on height alone than with two-factor dose calculation (56.7% vs. 26.7%; P = 0.018). CONCLUSIONS: Adjusting the dose of isobaric bupivacaine to a patient's height and weight provides adequate anesthesia for elective cesarean section and is associated with a decreased incidence and severity of maternal hypotension and less use of ephedrine.

Emergency dilatation and curettage in a patient with bombay blood group

Bombay blood group is a rare autosomal recessive phenotype within the ABO blood group. It represents genetically suppressed A, B and H genes. When considering such patients for transfusion, only blood of identical Bombay type can be safely transfused. We are reporting a patient having Bombay phenotypic blood, underwent emergency dilatation and curettage with active per vaginal bleeding due to retained products of placenta. There are numerous anaesthetic considerations, including emergency surgery with hemodynamic instability due to ongoing blood loss, dilutional coagulopathy as well as presence of Bombay phenotype that severely limit the possibility of red blood cell transfusion. Only four donors were registered with the blood bank of the institution and none was traceable. It becomes a real challenge for the anesthesiologist to manage such type of patients without having units of red packed cell which management is described hereby

Total thyroidectomy for multi - nodular goitre

To assess the efficacy and safety of total thyroidectomy for benign multi-nodular goitre. Descriptive study. The study was conducted in the Department of General Surgery, Combined Military Hospital Kharian from January 2004 to December 2008. A total of 66 patients with bilateral benign multi nodular goitre [61 females and 5 males] underwent total thyroidectomy. Sixty two cases were euthyroid while 4 had hyperthyroidism Surgical dissection techniques involved identifying both recurrent laryngeal nerves through out their course, securing of parathyroid glands with their intact blood supply and ligation of inferior thyroid artery branches close to the thyroid capsule. All the patients were evaluated post operatively for signs of recurrent laryngeal nerve injury and hypoparathyroidism and other complications. All patients were put on thyroxin replacement therapy post-operatively and were followed for 9 to 12 months. There was no injury to the recurrent laryngeal nerves. One case of injury to external laryngeal nerve was found. Transient hypocalcaemia occurred in 4 patients without permanent hypoparathyroidism. All cases of transient hypocalcaemia recovered fully within 3 months. Four patients had occult malignancy diagnosed post-operatively on histo-pathology. In experienced hands total thyroidectomy is an effective and relatively safe operation for benign multi-nodular goitre and its complication rate is same as that of a sub-total thyroidectomy

Management of thoracic injuries: our experience at military hospitals

Thoracic trauma is a major health care problem accounting for a significant percentage of the morbidity and mortality associated with the management of trauma patients. We performed a prospective study with the purpose to review our experience of the management of thoracic injuries at military hospitals having no proper thoracic surgical set up. The study was conducted at Combined Military Hospital Quetta and Combined Military Hospital Peshawar from January 2001 to September 2005 and a total of 84 cases of thoracic trauma with blunt and penetrating injury were managed. Mean age of patients was 36.5 years and female to male ratio was 1:13. Penetrating trauma was more common cause, 51 [61.7%] cases of chest injuries as compared to the blunt trauma 33 [39.3%] cases. The clinical conditions resulting ribs fractures in 73 cases [86.9%], flail chest in 3 patients [3.57%], haemothorax in 24 [28.57%] cases, pneumothorax in 8 [9.52%] cases, haemo-pneumothorax in 43 [51.19%] cases, pulmonary contusions in 5 [5.95%] cases, bronchial injury in 1 patient [1.19%], ruptured left diaphragm in 5 [5.95%] with herniation of abdominal contents in the left chest in 2 patients. Bilateral thoracic involvement was seen in 3 cases [3.57%]. Right chest was involved in 48 patients [57.14%] while the left in 36 patients [42.86%]. Extra-thoracic associated injuries were seen in 33 [39.3%] cases. Cardiac, great vessels, thoracic duct and esophageal injuries were not encountered during the course of this study. Seventy seven patients [91.66%] were treated initially with tube thoracostomy and it alone was effective in 69 patients [89.61%]. Overall thoracotomy rate was 9.52% [8 cases]. Emergency thoracotomy was performed in 3 [3.57%] cases and delayed thoracotomy in 5 [5.95%] cases. Empyema thoracic was seen in 3 patients [3.9%] with tube thoracostomy. Overall percentage of empyema was 3.57%. Seven patients [8.33%] were managed without the need of either tube thoracostomy or thoracotomy. Minor complications of tube thoracostomy were seen in 10 cases [12.99%]. Overall mortality rate was 3.57% [3 deaths]. Tube thoracostomy remains the most effective treatment modality in the management of most of the cases of chest trauma