Comparison of the efficacy of single bolus intravenous lignocaine with magnesium sulphate to attenuate the haemodynamic response of laryngoscopy and intubation

Background: Endotracheal intubation is routinely practiced in general anaesthesia, with potential hemodynamic effects on patients

Objective: The objective of this study was to compare the efficacy of single bolus intravenous lignocaine with magnesium sulphate to attenuate the haemodynamic response of laryngoscopy and intubation

Material and Methods: Atotal of 178 patients were included, randomly dividing them in two groups, 89 in each group. Group A, received intravenous 1% lignocaine Img/kg and group-B intravenous magnesium sulphate lOmg/kg. The data on heart rate, mean arterial pressure was compared among both groups and with baseline values, for the purpose of comparing efficacy. The data was entered and analyzed in SPSS version 14. Students t test was applied to compare means. A P value of less than 5% was taken as significant. Study design: Double Blind Randomized Clinical Trial. Place and duration of study: Departments of Anesthesiology of CMH Multan, from 1[st] September, 2010 to 1[st] March 2011

Results: There was statistically significant difference between the two groups in terms of efficacy i.e reduction of pressor response to laryngoscopy and intubation. 20% reductions in Mean Arterial Pressure [MAP] from baseline values were observed in 54% of the patients in Group A and 36.69% in group B. Similarly, 25% reduction in heart rate [HR] from baseline values were observed in 11 % of the patients in Group A and 6.23% in Group B. Incidence of > 20% increase in MAP was 4.2 % in Group A versus 20.6 % in group B and > 25% increase in HR 12.35% in group A versus 25.6 % in Group B. Incidence of >20% increase in MAP was 4.2% in group A versus 20.6% in Group B and > 25 % increase in HR 12.35% in group A versus 25.6% in Group B

Conclusion: There is statistically significant difference between two groups that is, lignocaine was more effective and efficacious than magnesium sulphate by preventing the increase in MAP and HR after laryngoscopy and intubation

Comparison of the efficacy of single bolus intravenous lignocaine with magnesium sulphate to attenuate the haemodynamic response of laryngoscopy and intubation

Background: Endotracheal intubation is routinely practiced in general anaesthesia, with potential hemodynamic effects on patients

Objective: The objective of this study was to compare the efficacy of single bolus intravenous lignocaine with magnesium sulphate to attenuate the haemodynamic response of laryngoscopy and intubation

Material and Methods: A total of 178 patients were included, randomly dividing them in two groups, 89 in each group. Group A, received intravenous 1% lignocaine 1mg/kg and group-B intravenous magnesium sulphate 10mg/kg. The data on heart rate, mean arterial pressure was compared among both groups and with baseline values, for the purpose of comparing efficacy. The data was entered and analyzed in SPSS version 14. Students t test was applied to compare means. AP-value of less than 5% was taken as significant. Study design: Double Blind Randomized Clinical Trial. Place and duration of study: Departments of Anesthesiology of CMH Multan, from 1[st] September, 2010 to 1[st] March 2011

Results: There was statistically significant difference between the two groups in terms of efficacy i.e. reduction of press or response to laryngoscopy and intubation. 20% reductions in Mean Arterial Pressure [MAP] from baseline values were observed in 54% of the patients in Group A and 36.69% in group B. Similarly, 25% reduction in heart rate [HR] from baseline values were observed in 11% of the patients in Group A and 6.23% in Group B. Incidence of > 20% increase in MAP was 4.2% in Group A versus 20.6% in group B and > 25% increase in HR 12.35% in group A versus 25.6% in Group B. Incidence of >20% increase in MAP was 4.2% in group A versus 20.6% in Group B and > 25% increase in HR 12.35% in group A versus 25.6% in Group B

Conclusion: There is statistically significant difference between two groups that is, lignocaine was more effective and efficacious than magnesium sulphate by preventing the increase in MAP and HR after laryngoscopy and intubation

Comparison of haemodynamic changes following tracheal intubation by using laryngoscope with intubating laryngeal mask airway

To compare haemodynamic changes following tracheal intubation using direct laryngoscopic technique with intubating laryngeal mask airway technique. Randomized control trail [RCT]. Military Hospital Rawalpindi from Jan 2008 to Dec 2008. After approval by the hospital ethics committee, 100 patients admitted for elective surgery from OPDs were randomly distributed equally in groups I and II for either direct laryngoscopy or laryngeal mask airway intubation respectively, as a part of general anaesthesia. A uniform protocol of general anaesthesia was followed. Heart rate and mean blood pressure were recorded before and at 1, 3 and 5 minutes after intubation. It was observed that increase in mean arterial blood pressure and heart rate at 1 and 3 minute was significant in patients intubated with laryngoscope as compared to patients intubated with Intubating laryngeal mask airway [ILMA]. Intubation with ILMA produces less haemodynamic response as compared to direct laryngoscopy

Positive end expiratory pressure [PEEP]; comparison different values during one lung ventilation, for its effects on blood arterial oxygenation and carbon dioxide levels

Thoracic surgeries and aesthesia for lung resection has presented anaesthesiologists with certain unique physiological problems. These include placing [lateral decubitus position] in order to obtain optimal access for most operations on lungs, pleura, esophagus, and great vessels, opening the chest wall [open pneumothorax] and one lung ventilation anaesthesia. One lung ventilation anaesthesia and lateral decubitus position produces decrease in functional residual capacity and an obligatory right to left shunt that ranges from 15% to 40% leading to increase in ventilation perfusion [V/Q] mismatch thus causing hypoxia and or hypoxemia. An optimal level of positive end expiratory pressure of 5cmH O when added to dependent lung is known to improve arterial oxygenation and improve ventilator 2 efficiency. To compare different values of positive end expiratory pressure [PEEP] during one lung ventilation, for its effects on blood arterial oxygenation and carbon dioxide levels. Study Randomized controlled trial [RCT]. Conducted in surgical Unit-III and Department of anaesthesia and Intensive Care, Combined Military Hospital, Rawalpindi. Duration of study with dates: Ten months from 25-12-2008 to 01-10-2009, Additional quantum of Data was collected from 01-01-2011 to 25-01-2011. The patients were divided into two equal groups of 100 patients each, by random allocation of patients to either in-group A [subjected to zero PEEP] or group-B [subjected to PEEP 5cm of water]. At induction and start of two lung ventilation 14 [14.0%] of the patients from group-A and 16 [16.0%] from group-B had normal PaCO. At initiation of one lung ventilation 25 [25.0%] of the patients from group-A and 80 [80.0%] from group-2 B had normal PaO. At initiation of one lung ventilation 26 [26.0%] of the patients from group-A and 80 [80.0%] from group-B had normal PaCO 2 2 with p<0.001. At end of procedure one lung ventilation 30 [30.0%] of the patients from group-A and 90 [90.0%] from group-B had normal PaO. 2 At end of procedure one lung ventilation 32 [32.0%] of the patients from group-A and 91 [91.0%] from group-B had normal PaCO. 2 The execution of one-lung ventilation still constitutes a challenge in clinical and surgical practice

Tracheal intubation; direct laryngoscopic oral intubation vs fiberoptic bronchoscopic nasal intubation haemodynamic response

Haemodynamic response to direct laryngoscopy and tracheal intubation has always been concern especially in cardiac patients. The use of fiberoptic bronchoscope for endotracheal tube placement may reduce the haemodynamic changes associated with intubation. To compare haemodynamic changes [pulse and mean arterial pressure] following tracheal intubation, using direct laryngoscopic technique with fiberoptic bronchoscopic technique. Randomized Controlled Trial [RCT]. Department of Anaesthesiology, Intensive Care and Pain management Military hospital Rawalpindi. The study was of six months duration starting from April 2008 to October 2008. ASA-I and II patients [n=160] undergoing surgery meeting the inclusion and exclusion criteria.Informed consent was taken from all the patients undergoing the study. Patients were divided in two groups. Patients assigned to Group A got endotracheal intubation through direct laryngoscopic technique and Group B through fiberoptic bronchoscopic technique after induction of general anaesthesia. Pulse and Mean arterial pressure were recorded before induction of anaesthesia and three minutes after the intubation. One hundred and sixty patients were studied. Eighty patients intubated through direct laryngoscopy [Group A] and eighty patients intubated through fiberoptic bronchoscope and it was observed that fiberoptic bronchoscopic intubation is haemodynamically safer as compared to conventional laryngoscopic intubation. The study concluded that bronchoscopic intubation provides better haemodynamic stability than direct laryngoscopic intubation

Post operative analgesia following open cholecystectomy; is intermittent epidural bupivacain bolus administration more effective than continuous administration?

Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Quasi Experimental study. Jan2010 to June 2010. Military Hospital Rawalpindi. This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Purposive [non probability] sampling. Patient who received intermittent boluses [group B] required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125% bupivacain

Thoracic epidural anaesthesia for open cholecystectomy

To compare the postoperative pain relief and vomiting and the length of hospital stay in patients undergoing open cholecystectomy under general anaesthesia versus those receiving thoracic epidural anaesthesia. Quasi experimental study. The Combined Military Hospital, Skardu, from February 2009 to July 2010. American Society of Anaesthesiology [ASA] physical status [PS] I and II patients of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group 1 [n=51] received general anaesthesia [GA] and group 2 [n=49] received thoracic epidural anaesthesia [EA]. Patients of both the groups were assessed for postoperative pain, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain the p-value. P-value of less than 0.05 was considered significant. Thirty six patients of GA group did not require additional analgesics for postoperative pain relief; however, injection Ketorolac had to be administered to 15 patients [29.4%] for pain relief in the postoperative period. Two patients [4.1%] in the EA group required additional analgesic during that period. Eleven patients [21.5%] in the GA group had postoperative vomiting. In the EA group only 1 patient [2%] had postoperative vomiting. Patients in EA group had better postoperative pain relief [p = 0.001] and remained free from vomiting than the GA group [p = 0.003]. Thirty six patients [70.5%] of the GA group and 34 patients [69.4%] in the EA group were discharged within 36 hours postoperatively [p = 0.896]. The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the postoperative pain and vomiting in patients undergoing open cholecystectomy

Management of cleft lip and palate: an appraisal of 50 cases managed in oral and maxillofacial surgery department, armed forces institute of dentistry, Rawalpindi, Pakistan

From Jan 2006 to Dec 2007 a total of 50 patients of congenital cleft lip and palate were managed in oral and maxillofacial surgical department of Armed Forces Institute of dentistry [AFID], Rawalpindi. Cleft of the lip was repaired with functional repair technique, and cleft in the palate was repaired using intra velor veloplasty. Cleft lip and palate is a congenital anomaly which requires a coordinated care of the patient involving multiple disciplines of medicine and dentistry. Unfortunately the incidence of clefts is on a rise in developing countries due to lack of awareness and improper handling of pregnancy by the mother. Lack of resources on the part of both, i.e., patients and the medical professionals is not helping the cause. Although a comprehensive care of the cleft patients is far from a reality in the subcontinent, we are reporting the cleft lip and palate cases which have been treated in coordination with different specialties accessible at the Armed Forces Institute of Dentistry [AFID], Rawalpindi. In this study, we highlight the demographics, clinical features and surgical management of cleft lip and palate

study of diabetic foot syndrome

This study was carried out to determine the number and predisposing factor of foot infection in the adult onset diabetes mellitus. An observational study. The study was carried out at PAF Hospital Islamabad, from June 2003 to June 2005. A total of 130 patients with adult onset diabetes mellitus were included in this study. The population was mixed. Clinical profile and investigations were recorded. Patients were managed as indoor cases. Plain insulin was used to control the diabetes. Broad-spectrum antibiotics and serial debridments, where required, were carried out. A total of 18.5% of the hospitalized diabetic population was due to foot infection. Males were affected 1.5 times more than the females. The disease was bilateral in 4% cases. Poor control of diabetes, bad foot hygiene, peripheral neuropathy, trauma, ingrowing toenails, callosities and corns were implicated as predisposing factors in majority of cases. Foot infection in diabetics is a common occurrence and both sexes are involved though males more commonly than females. Majority of the patients were elderly and have poor knowledge and insight of their disease