Perioperative invasive monitoring in obstetric emergencies

The choice of monitoring in obstetric emergencies depends upon many factors, including the liking and the expertise of the anesthesiologist and the availability of the required disposables and equipment. But the main deciding factor remains the clinical condition of a particular obstetric patient and the judgment of the treating physician. This editorial throws some light on the varied aspects of invasive monitoring

Prevalence of geriatric diseases among parents of medical doctors in Lahore

The burden of geriatric diseases has a significant impact upon the socio-cultural, socioeconomic and administration of health services. The study was carried out to identify a burden of geriatric conditions, magnitude of disease problems and involvements of body systems in the parents of medical doctors from Lahore. After taking the consent, interview based active disease surveillance/information was collected from a total of 137 medical doctors and their parents. They were interviewed about the health status of their parents and recorded in a pre-tested questionnaire. The prevalence of each system involved in each of the category of parents was compared by ANOVA at a significant alpha level of 0.05. Prevalence of cardiovascular diseases was the highest, [18.61%], followed by musculoskeletal [10.21%] and digestive system [9.12%]. The ranking of other systems in descending order was 4.74%, 3.64% and 1.82% for the respiratory system, urogenital system, and ENT respectively due to single system involvement. A cumulative prevalence due to all diseases in terms of disease load/burden of diseases in both mothers and fathers was 53.28% due to single system involvement and 67.51% because of multiple system involvement. Fifty three percent of the older population, who were above the age of 60, were sick due to the involvement of one body system and sixty eight percent had multiple body systems involvement.

Emergency mangement of cardiac temponade resulting from blunt trauma

A nine year old girl was brought to emergency reception in shock. Her attendant gave history of blunt trauma chest by falling on a pair of scissors while playing with her brother. She was pale, sweating and had cold peripheries. Her pulse was 170 beats per minute with very low volume. Her blood pressure was 40/30 mmHg and JVP was raised. On auscultation her heart sounds were muffled. On local examination, there was a bruise, 1/2 x 2 cm in the fourth intercostal space just lateral to left sternal edge. Her X-Ray chest was non-conclusive and cardiac temponade was diagnosed on echocardiography. Case was shown to cardiac surgeon who with mutual consultation with pediatric cardiologist decided to go for an emergency thoracotomy as they were suspecting big tear or trauma to the big vessel, so it was decided for definitive repair. Intravenous lines maintained and blood arranged. Patient was resuscitated with intravenous fluids, inotropic support and oxygen with face mask in intensive care unit. After about half an hour patient improved slightly and was shifted to operation theatre. Invasive blood pressure monitoring by 22 G intra-arterial cannula in right radial artery was started. After induction with Ketamine and tracheal intubation, central venous lines were established with one double lumen catheter and one 16 G cannula passed in the right internal jugular vein. Mid sternal thoracotomy was performed. It revealed pericardial cavity full of clots and fresh blood. There was an injury mark about 1/4 x 1/2 cm just lateral to left anterior descending artery on right ventricle and blood was spurting from the wound which was stitched. Hemostasis secured and chest closed. She was transfused with two units of blood during the operation. She remained hemodynamically stable afterwards

Outcome of ventricular septal defect closure

To identify the factors affecting the outcome, measured in terms of morbidity and mortality, after primary ventricular septal defect [VSD] closure. Design: Descriptive study. Place and Duration of Study: Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, from January 2002 to October 2003. Subjects and Children upto the age of 5 years who had primary VSD closure were studied. Patients were divided into two groups. Group-I included survivors and group-II included non-survivors. There was no difference in the conduct of operation among the two groups. A total of 53 patients were operated of whom 47 survived. Pulmonary hypertensive crisis [p < 0.001], pulmonary infections [p < 0.001] and pleural effusions [p < 0.003] were higher in non-survivor group. Patients in non survivor group were younger [0.75 + 0.34 years vs 2.24 + 1.16 years, p = 0.01] having less body weight [4.91 + 1.56 kg vs 7.94 + 3.35, p = 0.03] and high pulmonary artery to systemic pressure ratio at the time of coming off bypass [0.63 + 0.13 vs 0.43 + 0.09, p < 0.001]. Non survivors had higher association [66.6% vs 19.1%] of additional left to right shunts [p < 0.001]. Body weight less than 5 kg along with young age, high pulmonary artery to systemic pressure ratio at the time of coming off bypass and presence of additional left to right shunt are risk factors for adverse outcome

Effect of pre-medication on arterial oxygen saturation in patients undergoing coronary artery bypass sugery

We studied 50 patients scheduled for coronary artery bypass surgery at Armed Forces Institute of Cardiology/ National Institute of Heart Diseases, Rawalpindi, following premedication with lorazepam, morphine and promethazine using pulse oximetry readings. Arterial oxygen saturation [SPO2] values were obtained a night before operation and compared with those values obtained after premedication administration. Twenty two of the 50 patients developed significant hypoxemia which was readily corrected by administration of supplementry oxygen in the operating theatre. It is concluded that significant oxygen de-saturation occurs after opioid plus sedative premedication in coronary artery bypass surgery patients. As a result of our findings we urge caution in the use of opioid plus sedative premedication and recommend that oximetry monitoring and oxygen supplement be considered after premedication of these patients