Intravenous lignocain 2% [plain] efficacy in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital morbidity and mortality

Objective: To evaluate the efficacy of plain lignocain in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital mortality or morbidity

Study Design: A randomized control trial

Place and Duration of Study: Our study was carried out from December 2013-14, at tertiary-care hospital

Material and Methods: Patients [n=100 total] were randomized, using non-probability convenient sampling, dividing the population in two groups. Group A [n=50] as control, and in group B [n=50] Injection lignocain plain 2% 1.5 mg/kg was used 3 minutes prior to intubation. Both the groups were observed for changes in hemodynamic parameters i.e. heart rate [HR] systolic and diastolic blood pressure, Mean Arterial Pressure for every minute after baseline [0] and for 5 consecutive minutes [1, 2, 3, 4, and 5]. Deviation of >20% from baseline was considered significant. The mortality [death within hospital, irrespective of cause] and morbidity [defined as emergence of 4 condition as hypertensive encephalopathy, Acute Coronary Syndrome, Lab proven Myocardial Infarction and negative pulmonary edema] within 10 days of hospitalization were noted

Results: Statistically significant [p-value extremely significant at confidence interval of 98 degrees] results were obtained in the effect of study drug; however, 10 days of hospitalization remained inconclusive for emerging morbidity categories strictly due to the intubation reflexes. We consider few technicalities in peri-operative management resulted in such events

Conclusion: Lignocain is effective in blunting the pressor response towards laryngoscopy and intubation. However the impact on mortality/ morbidity for four conditions remained inconclusive

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Quasi-experimental study. Combined Military Hospital Peshawar from June 2008 to Dec 2009. Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% [intravenous immunoglobulin] was infused over a period of 6 hours and repeated for three consecutive day. Sequential Organ Failure Assessment [SOFA] score was used to assess the progress in all the patients. At the time of enrolment mean SOFA score was 5.41 +/- 1.127 and on the 15th day it was 1.62 +/- 2.24, mean age was 39.21 +/- 10.26 years. Thirty four patients [73.91%] developed gram negative sepsis and eighteen patients [39.13%] developed septic shock. Mean duration of stay in ICU and on of these patients was 30.43%. The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis

Association between periurethral colonization with uropathogens and subsequent bacteriuria in catheterized patients

To determine the number of catheterized patients who develop bacteriuria due to the presence of organisms in their periurethral flora, which may subsequently cause Urinary Tract Infection [UTI] in these patients. Non-interventional, cohort study. This study was conducted on patients of Medical Intensive Care, Surgical and Urology Units of Combined Military Hospital, Lahore, from February to April 2006. A total of 60 hospitalized patients, who were catheterized for various underlying diseases, were included in the study. Urine samples and periurethral swabs were obtained from all patients and cultured on appropriate culture media. Various tests used for the identification of microorganisms were: Gram-staining, catalase test, coagulase test and esculin hydrolysis for the identification of Gram-positive bacteria, API 20e for Gram-negative bacilli, whereas lactophenol blue preparation and germ tube test were used for the identification of yeasts. Out of 60 patients, 41[68.3%] were males and 19 [31.7%] were females. The mean duration of catheterization was 4.5 days. In males, culture of periurethral swabs revealed coagulase negative staphylococci in 11 [40.7%], Staphylococcus aureus in 10 [37%] and Enterococcus fecalis in 3 [11.1%] patients. In females, the organisms isolated were coagulase negative staphylococci in 4 [25%], Staphylococcus aureus in 4 [25%], Enterococcus fecalis in 4 [25%], Pseudomonas aeruginosa in 2 [12.5%], Escherichia coli in 3 [18.6%] and Candida albicans in 3 [18.6%] patients. Twenty nine patients developed bacteriuria [p < 0.05]. Escherichia coli was the commonest organism causing bacteriuria in either gender followed by other Gram-negative organisms. Coagulase negative Staphylococcus was isolated in the urine of one male patient only. In males, 2 [10%] out of 20 patients with Gram-negative bacteriuria were colonized by the same organism, whereas in females, 4 [44.4%] out of 9 bacteriuric patients were colonized by the same organism. Predominantly Gram-positive organisms colonized the periurethral area in males as well as in the majority of females, whereas Gram-negative bacteria were mainly responsible for the bacteriuria in both genders. There was a significant association between periurethral colonization and subsequent bacteriuria, however, prior colonization with a particular organism is not a decisive event in the initiation of bacteriuria

Post SMR intranasal packing - do we really need it?

Sub mucous resection [SMR] for the deflected nasal septum [DNS] is the commonest nasal surgery all over the world. The unpleasant part of the whole event is postoperative nasal packing for 24 to 48 hours. Handsome numbers of patients delay the operation just to avoid the horrible experience of nasal packs by close friends or relatives. Many a times there is no bleeding at all on termination of operation but we still do nasal packing for the sake of doing it perhaps a fear of reactionary or primary bleed on the back of our mind. A variety of packing materials are being used most of which are not evidence based. This study was conducted at combined military hospital, Lahore over a period of one and half year from June 2006 to December 2007. A total of 72 patients were included in the study having moderate to marked deflection of nasal septum. All patients underwent classical SMR operation under local anesthesia. Only 04 patients were given nasal packs on termination of opearation. All patients were closely monitored for in 02 to 03 hours post operatively. All patients were seen on 2[nd], 5[th] and 15[th] day. 65 [90.27%] patients had no problem. 02 [2.7%] patients reported back with 24 in hours with septal haematoma. The operation was terminated in 01 [1.3%] patient just at the time of incision

comparative study of caudal epidural block single dose Bupivacaine versus tramadol for postoperative analgesia in children

The management of postoperative pain in paediatric surgery focuses on complete pain relief with no or minimum possible untoward side effects. The effects of single dose caudal tramadol with single dose caudal bupivacaine in controlling the postoperative pain were compared in this randomized double blind study, conducted in children, presented for genital surgery/vesicolithotomy. 50 children ASA I and II between 2-6 years of age were randomly divided into 2 groups and evaluated for pain relief by Hannallah pain score scale while sedation was assessed with a 5 point test. For 24 hours postoperatively, the Hannallah pain score scale value showed no statistically significant difference among groups. Postoperative analgesia was maintained from 12-24 hours in both the groups. In conclusion, Tramadol used caudally as single dose was found to be as effective and safe agent as bupivacaine in reliving postoperative pain in children