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Background@#The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. @*Methods@#Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. @*Results@#We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. @*Conclusion@#The incidence of severe and post-extubation bleeding was significantly less with xylometazoline.Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.
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Background: The knowledge of fetal human Kidney morphology and developmental anatomy is very important for prenatal diagnosis of disorders such as Wilm’s tumor, hydronephroses and congenital malformation etc.Methods: The study was carried out on 40 kidneys procured from 20 spontaneously aborted fetuses (11males and 9 females) ranging from 14wks-36wks of gestation, after confirming their age through CRL they were grouped and then processed to form slides and stained with haemtoxylin and eosin and seen under light microscope.Results: All kidneys were lobulated at early gestational age and became fused by 36 wks. Corticomedullary junction and preformed collecting tubules were seen clearly by 18wks. Well differentiated PCT and DCT were formed by 19-23 wks. Well-formed pyramids by 28 wks and medullary rays by 29 weeks were clearly distinguished. Loop of Henle developed and distinguished by 28 wks. Increased vascularity was seen by 32-36 wks. Nephrogenic zone and undifferentiated mesenchyme decreased and matured glomeruli increased by 36 wks.Conclusions: The present study gave emphasis to the development of each component in medulla and cortex of kidney.
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VACTERL association is a notable syndrome for various congenital malformations, occurring in neonates. These neonates usually present for corrective surgery of one or more malformations. We report here a rare case of VACTERL spectrum with cleft lip and palate along with hypoplastic mandible, undergoing surgery for imperforate anus under general anesthesia
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Poor intensive care practices are to be blamed for development of any complication of prolonged tracheal intubation. Especially, the complications of subglottic stenosis or more rarely, a fistula between the tracheal wall and the innominate artery cannot be justified on any account. Yet, these complications may occasionally be seen in underdeveloped countries with poor nursing training and meager resources. We present a case report of this fatal complication in a 17 years old patient of tetanus who underwent surgical tracheostomy for mechanical ventilation and subsequently developed a fatal massive bleeding
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Indian origin aortoarteritis is a rare variant of Takayasu's arteritis [TA], a chronic progressive panendarteritis involving the aorta and its main branches. Anesthesia for such patients is complicated by their severe uncontrolled hypertension, end-organ dysfunction and stenosis of major blood vessels affecting regional circulation. A case report and it anaesthetic management is presented