ABSTRACT
The supply of oxygen is a complex issue in disaster situations and snowbound mountainous areas. Innovative solutions are required for safe anesthesia practice; one such innovation is a small portable oxygen concentrator for oxygen therapy in remote austere environment. We conducted this study to ascertain the economy achieved by employing this equipment to improve functionality of a surgical unit in an austere environment. Retrospective review of patient records and cylinder consumption from 1st October 2008 to 30th March 2009 was carried out and this data was classified as group A. While group B consisted of all the patients, who required oxygen therapy from 1st October 2009 to 30th March 2010, and were divided into sub-groups, on the basis of type of anesthesia or oxygen therapy. They were further categorized with respect to use of oxygen concentrator or oxygen cylinder for oxygen provision. The percentages of patients in these subgroups were summed to ascertain the economy achieved in the use of oxygen cylinders by comparing cylinder/patient ratio between group A and B respectively. Percentage economy achieved was then calculated. In group A cylinder/patient ratio [21/53] was '0.4' as compared to [3/81] '0.03' of group B. Percentage economy achieved was hence found to be [0.4/0.03%]] 1333%. Use of oxygen concentrator is an innovation which is economical, easily applicable and highly recommended in remote austere environments
Subject(s)
Humans , Male , Female , Oxygen Inhalation Therapy/economics , Anesthesia, Inhalation , Equipment Safety , Minimally Invasive Surgical Procedures , Retrospective Studies , Delivery of Health Care , Military Personnel , Review Literature as TopicSubject(s)
Humans , Female , Analgesics, Opioid , Arterial Occlusive Diseases/drug therapy , Pain , Acute Disease , Drug ToleranceABSTRACT
To compare haemodynamic changes on Laryngeal Mask Airway [LMA] insertion using tidal volume induction technique with sevoflurane at high concentration versus an intravenous induction with propofol. Randomized Controlled Trial [RCT]. Place and Duration of study: The study was carried out at Department of Anaesthesiology, Intensive Care and Pain Management, Military Hospital Rawalpindi from May 2006 to April 2007. One hundred patients were enrolled after written informed consent. Patients were divided in two groups. Group A received propofol and group B received sevoflurane for induction of general anaesthesia. Heart rate and mean arterial pressure [MAP] were recorded one minute before induction of anaesthesia and three minutes after induction and LMA placement. Independent sample "t-test" was applied to compare means for MAP and mean heart rate in both the groups and p value was inferred to judge the significance. In group A 20 males and 30 females were enrolled for the study while in group B there were 16 males and 34 females. The mean age of the patients in group A was 30.5 +/- 4.8 years while in group B was 28.4 +/- 5.2 years. Mean weight was 60.5 +/- 5.8 and 62.2 +/- 4.7 kilograms respectively in both groups. Twenty two patients were ASA I and 28 were classified as ASA II in group A while 27 were ASA I and 23 were ASA II in group B. In the group A, MAP was recorded to be 90 +/- 5.3 mmHg before induction and 79.9 +/- 7.5 mmHg after LMA placement following propofol induction. Whereas MAP in Group B before induction of anaesthesia and after LMA placement were 90 +/- 4.8 and 84.2 +/- 7.03 mmHg respectively. The fall in MAP was found to be significant in Group A when compared to Group B after induction and insertion of LMA [p value < .005]. In group A, mean HR was recorded to be 79.1 +/- 4.3 before induction and 82.2 +/- 8 per minute after LMA placement following propofol induction. While mean HR in Group B was 78.1 +/- 7.8 before induction and 83.3 +/- 8.0 per minute after LMA placement following sevoflurane induction. Hence, we found no significant difference in terms of change in mean HR between the two groups [p value > 0.4] before and after LMA insertion. Considering more fall in the MAP following propofol induction in group A and as there was no significant change in MAP and heart rate before and after sevoflurane induction, we conclude that sevoflurane provided better haemodynamic stability than propofol for LMA insertion
ABSTRACT
Postoperative nausea and vomiting [PONV] are most common and distressing complications after anaesthesia and surgery, leading to various problems. Metoclopramide, a benzamide, used as an anti-emetic, has got various side-effects. Propofol, a short acting induction agent, possesses anti-emetic properties in sub hypnotic doses, without having unwanted side- effects in this low dose. To compare the frequency of PONV in patients treated with propofol and metoclopramide. Experimental study. Setting: Department of anaesthesia and intensive care, Combined Military Hospital Rawalpindi. Duration: 06 months [01[st] July to 31[st] December 2004]. 1 82 female patients scheduled for open cholecystectomy were selected for this study. All of them received general anaesthesia without any prophylactic antiemetic. Out of them, 60 patients who complained of PONV in post anaesthesia care unit [PACU] were selected by non probability convenience sampling and were equally divided into two groups. Group [A] received propofol [0.5 mg/kg] while group 'B' received metoclopramide [0.2 mg/kg]. Recurrence of PONV was recorded 60 min after administration of the study drug. Patients still complaining of PONV 30 min after administration of the study drug received a rescue medication i.e. I/V ondansetron [4mg]. Results: In group [A], 18 patients responded to intervention [60%] whereas 26 [86.66%] patients gave a positive response in group [B] [p; 0.020]. More patients who received propofol needed the rescue medication [40%] than those who received metoclopramide [13.33%] [p 0.020]. Metoclopramide is a better option for managing PONV than propofol