ABSTRACT
Background: Smoking cessation is the most powerful intervention to modify progression of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. Thus, nicotine dependence status and factors associated with moderate to high nicotine Dependence in patients with COPD needs to be evaluated. Method: A hospital based cross-sectional observational study performed on 50 patients with COPD attending the outpatient department at smoking cessation clinic, Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan during 2019-2020. Result: Multiple logistic regression analysis revealed that low education status, age 60 yrs., and mild to moderate airflow obstruction were related to moderate to high nicotine dependence. Conclusion: Nicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.
ABSTRACT
Introduction: Caudal epidural block is one of the most popular, reliable, and safe techniques in pediatric patients that can provide analgesia for a variety of supra- and infra-umblical surgical procedures. This study aimed to compare the efficacy of dexmedetomidine-bupivacaine, fentanyl-bupivacaine mixture and bupivacaine alone on duration of postoperative analgesia, sedation, emergence agitation, duration of sensory and motor block, hemodynamic stability and side effects
Methodology: After approval from ethical committee 90 pediatric patients of age 2-7 y were enrolled. The children were randomly allocated to three equal groups of 30 each using a computer generated randomization list. Caudal block was given after induction of general anesthesia for urogenital surgery. General anesthesia was maintained with sevoflurane at a concentration adjusted to maintain BIS between 40-60. Hemodynamic parameters, Pediatric Anaesthesia Emergence Delirium [PAED] score, Richmond agitation sedation scale [RASS], and Children's Hospital of Eastern Ontario Pain Scale [CHEOPS] were recorded immediate postoperatively and then regularly every hour for the next 12 hours
Results: PAED score was less in group BD than group B and BF from baseline. RASS Score was less in Group BD than Group BF from base line to 12 h except at 240 min and Group BF is less than Group B from base line to 12 h. Group BD was less than B from base line to 12 h. CHEOP score was less in Group BD than Group BF and Group B from base line to 12 h
Conclusion: Dexmedetomidine [1 micro g/kg] added to bupivacaine in caudal block increases the duration of postoperative analgesia, provides arousable sedation, and decreases emergence delirium with stable hemodynamics and minimal side effects in pediatric patients
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Fentanyl , Bupivacaine , Anesthesia, Caudal , Pediatrics , Urogenital System/surgery , Analgesia , Emergence Delirium , Hemodynamics , Prospective Studies , Double-Blind MethodABSTRACT
Introduction: Laparoscopic cholecystectomy is now the gold standard for treatment of symptomatic gallstones. After this surgery patients suffer visceral and shoulder pain secondary to peritoneal insufflation. Use of intraperitoneal and port site instillation of local anaesthetics has been used to reduce postoperative pain and decreases the need for intravenous opioids. Studies regarding comparison of intraperitoneal use of ropivacaine and bupivacaine to reduce postoperative pain are few. This study compared the efficacy of ropivacaine and bupivacaine in reducing postoperative pain after laparoscopic cholecystectomy
Methodology: After ethical committee's clearance and informed consent 100 patients with symptomatic cholelithiasis, aged 20-70 years, of either gender, ASA status I to III and within +/- 20% of ideal body weight, scheduled for laparoscopic cholecystectomy were included. Patients were randomized into two groups with 50 patients in each group. Group-B: Patients received 0.5% bupivacaine in a dose of 2 mg/kg diluted in normal saline to make a solution of 50 ml. Group-R: Patients received 0.75% ropivacaine in a dose of 2 mg/kg diluted in normal saline to make a solution of 50 ml. Drug was instilled intra-peritoneal through in situ placed infra-umbilical trocar before extubation. NIBP, HR, SpO[2], VAS, verbal rating scale [VRS] and rescue analgesia were recorded immediately postoperatively and then regularly every hour for the next 12 hours
Results: HR, SBP and DBP were comparatively lower in Group-R than in Group-B. The VAS score was significantly lower in Group-R from postoperative 5[th] hr to 12[th] hr. Rescue analgesia was given when VAS was > 40. VRS score was significantly lower in Group-R from postoperative 7[th] hr, showing longer duration of analgesia in this group. The rescue analgesia requirement was also less in Group-R
Conclusion: We conclude that the instillation of bupivacaine and ropivacaine intraperitonelly is an effective method of postoperative pain relief in laparoscopic cholecystectomy. It provides good analgesia in immediate postoperative period with ropivacaine providing longer duration of analgesia
ABSTRACT
Background: A variety of minimally invasive techniques [chemonucleolysis, laser, automated percutaneous discectomy, percutaneous manual nucleotomy] have been invented over the years, as treatment of low back pain related to disc disease. Automated percutaneous lumbar dissectomy [APLD], being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as 'automated' since it involves a mechanical probe, working by a 'suction and cutting action for removal of the nucleus pulposus
Methodology: After meeting the inclusion criteria, minimal invasive procedure - APLD, performed in between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by MRI and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance
Result: Based on patient satisfaction, 72 [60%] patients had excellent pain relief [75 - 100%], 34 [28.3%] had good pain relief [51-74%] whereas 14 [11.7%] patients had poor pain relief. Two [1.6%] patient developed discitis, which was the only complication and it resolved within fifteen days without sequelae
Conclusion: Percutaneous decompression [APLD] techniques for intervertebral disc herniation are safe and cost-effective techniques with significant and long lasting results concerning pain reduction and mobility improvement. They can be proposed as initial treatment or attractive alternatives prior to major surgery
ABSTRACT
Bispectral [BIS] monitoring provides an objective, non-invasive measure of the level of consciousness in sedated patients. Sedation has been shown to increase patient satisfaction during regional anesthesia. Propofol is extensively being used as a sedative, providing sedation while patients remain cooperative and can be easily aroused. In this study, we sought to determine whether BIS is a useful adjunctive manoeuvre to reduce the sedative dose of propofol by using BIS. Forty patients of ASA grade I and II, weighing between 30 to 60 kg, undergoing elective gynecological surgery of about 60 minutes duration were included in the study, and randomly divided into two groups. All patients received combined spinal epidural anesthesia [CSEA]. The patients in Group-P [n=20] received propofol without BIS monitoring and those in Group-PB [n=20], received propofol under BIS monitoring. Total doses of propofol consumed in all patients were calculated and compared using paired t-test. A p-value <0.05 was considered to be significant. The mean total dose of propofol consumed was 130.25 mg +/- 46.95 without BIS monitoring [Group-P] compared to 68.49 mg +/- 12.59 in patients [Group-PB] in which BIS was used to monitor the desired sedation level [P< 0.001]. Mean dose to reach required level of sedation was also reduced [68.35 +/- 21.10 vs 29.01 +/- 9.45, P< 0.001]. Use of BIS during propofol infusion reduces requirement of propofol for sedation during regional anesthesia