Field anesthesia - experience in United Nation missions

To communicate the experiences of anaesthesiologists while working in United Nations [UN] peace keeping missions in different parts of the world. Questionnaire based observational study. A questionnaire was sent to anaesthesiologists who had served in UN missions. The response was evaluated by simple percentage. Problems identified in a UN missions are: setup of operating room, high prevalences of HIV, Hepatitis B virus and Hepatitis C virus among the population of host country, different sources of medical stores, short supply of medical gases and problems related to malaria and its prophylaxis. The problems can be overcome by prior planning, use of non conventional practices of anesthesia and vigilance in monitoring in operating rooms and post operative recovery units. Optimal utilization of the equipment can be achieved with the help of non governmental organizations

Intensive care management after inadvertent intravascular injection of liquid paraffin

Medication errors in the hospitals are not uncommon even in the developed countries. A 30 years old lady was admitted with 32 weeks pregnancy with gastroenteritis followed by intrauterine death. In the high dependency unit of obstetric department, accidentally 50 milliliters of liquid paraffin was administered intravenously. With 12 days of vigorous treatment comprising mechanical ventilation with positive end-expiratory pressure, an emergency hysterotomy to avoid the complications of intrauterine death; 3 cycles of plasmapherisis; and ultimately broncho-alveolar lavage, her condition improved and she was discharged from hospital

Efficacy of esophageal detector device in verification of endotracheal tube placement

To assess accuracy of esophageal detector device [EED] for detection of endotracheal tube placement and to compare its performance with that of capnography. A prospective study in which 400 patients were divided into two groups. In group-I the patients were intubated as per routine, then the EDD and capnograph were again used to check both the tubes. The result showed 100% sensitivity, 100% specificity and 100% predictive value for EDD. The EDD was found to be very effective device in differentiating esophageal from tracheal intubation

Nosocomial pneumonia in mechanically ventilated patients

Ventilator associated pneumonia [VAP] is a disease caused by different microorganisms and is associated with high mortality. The objective of this study was to ascertain the causative organisms of VAP and the mortality associated with this disorder. It was a prospective comparative study of 100 patients who underwent ventilatory support at a tertiary care teaching hospital [Combined Military Hospital Rawalpindi] from 1st July, 2000 to 30th June 2001. Patients who developed clinical signs of pneumonia are investigated by bronchoalveolar lavage[BAL] and blood culture. In patients who were diagnosed as a case of VAP, microorganisms were identified by BAL [79%] and blood culture [21%]. Patients who developed VAP were followed as well as the controls that do not developed VAP. Mortality among both groups was recorded. Outcome of the study showed organisms including Pseudomonas aeruginosa [26%], Staphylococcus aureus [20%], Acinetobacter spp. [9%], Proteus spp. [6%], Haemophilus spp. [6%], Escherichia coli [6%], Klebsiella spp. [3%], Streptococcus pneumoniae [3%], Corynebacteria spp. [3%], and Polymicrobial flora [9%]. The mortality among the patients of VAP was 50% compared to 30% among the patients without VAP. But this difference is non-significant. In conclusion VAP is developed by diverse groups of microorganisms with Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter spp amongst the commonest pathogens. VAP is associated with higher percentage of mortality