A Study of Anatomical Variations in Transverse Foramen of Cervical Vertebrae for Morphological and Clinical Importance

Introduction: Cervical vertebrae constitute the skeletal framework of vertebral column in the region. The most important feature to identify the cervical vertebra is the presence of foramen transversarium. Vertebral artery, vertebral vein and sympathetic chain run through this foramen as a single unit. Compartmentalization or absence of the foramen may alter the course of these structures. Material and methods: The study was performed on 240 dry human cervical vertebrae of both sexes, which were collected from Anatomy department of MSYMCH, Meerut and HIMS, Varanasi. The variations in number and shape were observed, recorded and analyzed. The intact cervical vertebrae without any degenerative or traumatic disorders were included in this study. Result: Out of 240 cervical vertebrae, 63 vertebrae were found to have variations in the transverse foramina. Complete double transverse foramina were observed in 48 vertebrae (20%), out of which unilateral double foramina were found in 29 vertebrae (12%) and bilateral double foramina were found in 19 vertebrae (8%). Similarly, incomplete double transverse foramina were observed in 15 vertebrae (6%), of which the foramina were unilateral in 8 vertebrae (4%) and bilateral in 5 vertebrae (2%). Conclusion: In our study, we observed the double foramen transversarium in 26.25% of the cases. These variations may alter the course of vertebral artery. Presence of compartmentalization suggests the chances of compression of neurovascular bundle. Spicules of incomplete septation between the two foramina may pierce the vascular or neural structures resulting into vascular insufficiency or persisting pain. These findings may suggest a cue to the spinal surgeons in planning preoperative procedures for surgeries related to this region

Comparative Efficacy of Ondansetron Versus Granisetron to Prevent Perioperative Nausea and Vomiting in Patients undergoing Gynaecological Surgery under Spinal Anaesthesia

Posotoprative nausea and vomiting remains a persistent and distressing problem inspite of many advances on perioperative care and anti-emetic drugs. A newer antiemetic drug Granisetron has not been studied in patients undergoing gynaecological surgery under spinal anaesthesia

Comparative Analysis of Unilateral Subarachnoid block with Ankle block for elective foot surgery.

Background: There are many accepted anesthesia techniques for elective foot surgery ranging from general anesthesia to regional anesthesia, regional anesthesia being the preferred method. Regional anesthesia techniques employed for foot surgery includes subarachnoid block, epidural anesthesia and ankle block. Objective: The present study is aimed at providing comparative analysis of ankle block with unilateral subarachnoid block for elective foot surgeries in terms of hemodynamic safety profile and post operative analgesia. Material and Methods: Study includes prospective analysis of 80 ASA II and III patients who underwent elective foot surgery. Patients were randomly divided into two groups of 40 each, Ankle block group (AB) and Unilateral subarachnoid group (US). The parameters recorded for study includes systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale for pain severity, time of first analgesic need and the complications. Results: There were minimal blood pressure changes and heart rate variability in AB group as compared to US group when compared with basal values (p<0.05). The time for first analgesic requirement is prolonged in AB group as compared to US group. The visual analogue scale score was assessed at 2nd ,4th and 6th hours for group AB were lowered as compared to group US (p <0.05).

Ebola virus disease: Emerging outbreak.

Ebola Virus Disease or Ebola Haemorrhagic Fever is one of the highly fatal viral disease caused by ebola virus in humans. Mortality rate as high as 90% is reported. Virus is transmitted to humans through bats and other animals infected from bats. Although Ebola Virus Disease is reported since 1976 but currently West Africa is facing the largest outbreak of disease with danger of spread to other parts of the world. More than 5000 cases with mortality of more than 2600 cases has been reported till the end of 3rd quarter of year 2014. There is no specific treatment and vaccination available till date. Mainstay for managing patient is supportive care with early fluid resuscitation and symptomatic treatment. Our main target is to prevent human transmission by educating and supporting the community.

Ventilator-associated pneumonia: Revisited.

Ventilator-associated pneumonia (VAP) is a type of hospital acquired pneumonia commonly encountered in patients who receive mechanical ventilation and is associated with significant mortality and morbidity. VAP is associated with prolonged ventilation, increased antibiotic use, emergence of multidrug resistant organisms, prolonged critical care unit stay resulting in increased cost of care. It has been reported to occur in 9 to27 percent of all intubated patients. As per International Nosocomial Infection Control Consortium (INICC) report data summary, the overall rate of VAP was 13.6 per 1,000 ventilator days. Preventive measures, early diagnosis and treatment of VAP result in better outcome. The aim of this review was to search the literature for incidence, various risk factors, etiology, pathogenesis, treatment, and prevention of VAP. A literature search for VAP was done through the PUBMED/MEDLINE database. VAP is a commonly encountered nosocomial infection occurring in ventilated patients and is associated with increased mortality and morbidity. Outcome of patient with VAP depends on hospital setting, patient group, infection control policy, early diagnosis and judicious antibiotic use.

The efficacy of intravenous Paracetamol versus Tramadol for postoperative analgesia after elective surgery.

Background: Pain is an unpleasant sensory or emotional experience usually occurs due to potential tissue damage associated with surgical trauma. Opioids and Non steroidal antiinflammatory drugs are commonly used to alleviate pain but both have their own limitations in clinical use. Objectives: This prospective randomized clinical trial was undertaken to evaluate the efficacy and quality of recovery with intravenous paracetamol versus tramadol for post operative analgesia after elective surgery. Material and Methods: 40 ASA I&II patients of age group 15-40 years scheduled for elective surgery under general anaesthesia were enrolled in the study. After premedication, patients were randomized into two groups. Following induction of general anaesthesia patients of group 1 [n=20] received 15mg/kg of IV paracetamol and group 2 [n=20] received 1.0 mg/kg of IV tramadol over 15 minutes. During measurements, modified hanallah pain observation scores, Aldret scores [readiness for discharge], Sedation scores and Time to first rescue analgesia were recorded every 5 minutes during the first 30 minutes, then every 10 minutes for the remaining 30 minutes of the PACUs stay and upto first 2 hours in the ward. Statistical Analysis was done using SPSS Software Ver. 17. Results: Results reveals there is statistically significant difference in mean postoperative observational pain score, aldret score and time to first rescue analgesia though the mean post operative nausea & vomiting incidence and sedation score between two groups are statistically non significant . Conclusion:Clinically intravenous paracetamol offers better analgesic benefits to the patients than that of tramadol and due to early recovery characterstics in paracetamol group, patients are discharged early in case of paracetamol group and thus are economically effective in day care surgeries.