Frequency of difficult and failed intubation in apparently normal patients undergoing elective surgery

To find the frequency of difficult and failed intubation in apparently normal patients undergoing elective surgery. We also aimed to look at sensitivity and specificity of Mallampatti classification in our population. Cross sectional study. Combined Military Hospital, Rawalpindi and Multan from 1[st] May 2013 to 1[st] June 2013. There were 467 patients, who underwent elective surgery with general anesthesia and endotracheal intubation. During their pre-anesthetic visit, we assessed the airway according to Mallampatti score. After endotracheal intubations, frequency of difficult intubations was evaluated [i.e. Grade III and Grade IV] with special emphasis on intubation done by consultant anaesthetist and post graduate trainees followed by frequency of failure of intubation and other complications during intubation were also noted. Furthermore, comparison of Mallampatti with Cormack and Lehane's classification of difficult intubation was done. Difficult intubation in these centers was 4.28% [20/467]. Sensitivity of mallampatti was 98.2%. Incidence of failure of intubation was 0.42% in our study. The frequency of difficult intubation is 4.28% whereas failure of intubation is very low [0.42%] and was observed in special cases only. In our study, the sensitivity of Mallampatti to Cormack and Lehane's classification of intubation was 98.2% which suggests that it is a sensitive predictor of difficult intubation but complete accuracy cannot be determined by using the Mallampatti score

Oxytocin IV bolus vs infusion; haemodynamic effects in women undergoing caesarean section

Obstetric texts advocate the use of oxytocin, either intramuscularly or as a dilute infusion, but warn against the use of intravenous bolus oxytocin, fearing significant maternal hemodynamic consequences. To compare the hemodynamic effects of oxytocin given intravenous bolus versus infusion form. Randomized clinical trial. Study was conducted in main operation theatre and OPD of Combined Military Hospital, Rawalpindi. Study was carried out over a period of six months from 24-03-2009 to 23-09-2009. Total 138 patients were included in this study. Patients were divided into two groups [Group-A received oxytocin as bolus of 5 iu given as quickly as possible [approximately over 1 s] and in group-B 5 iu diluted to 20ml normal saline given over 5 minute using an infusion pump]. Each group comprised of 69 patients. Mean age of the patients in group-A was 27.3 +/- 1.8 and in group-B, 26.9 +/- 1.7. Heart rate [beast/min] effect of oxytocin given intravenous bolus vs infusion showed statistically significant difference from 1 minute to 15 minute [P<0.001]. Similarly mean arterial pressure [MAP] rate [beast/min] effect of oxytocin given intravenous bolus vs infusion also showed statistically significant difference from 1 minute to 15 minute [P<0.001]. In conclusion, we found that at elective Caesarean section, 5 iu of i.v. oxytocin results in less haemodynamic change than 5 iu diluted to 20ml normal saline given over 5 min using as an infusion pump results in less haemodynamic change than 5 iu of oxytocin given as i.v. bolus

Comparison of effectiveness of thoracic epidural and paravertebral block for post thoracotomy pain relief

To compare the effects of thoracic epidural and thoracic paravertebral block in post thoracotomy pain relief and early ambulation. Randomized control trial [RCT]. Combined Military Hospital Rawalpindi a tertiary care health facility, from Jan 2007 to Dec 2007. Thoracic epidural block was given in group-A while thoracic paravertebral block was given in group-B patients post operatively. Pain scores were assessed at 30 min intervals after the dose of 0.25% Bupivacaine using visual analogue scale [VAS]. There was no significant difference for pain scores in first 24 hours after surgery between paravertebral block [PVB] and thoracic epidural group measured at 30 min interval. But complication like hypotension occurred less with PVB. Paravertebral block is a safe and effective technique and can to be used more widely for unilateral post thoracotomy pain relief