Frequency and antibiogram of isolates from surgical units of a tertiary care hospital in Quetta

Objective: To determine the frequency and antibiogram of the isolates from infected patients in surgical units of a tertiary care hospital

Study Design: Cross-sectional, descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Quetta, from March to October 2015

Methodology: Clinical samples from the surgical units received in Department of Microbiology for culture and sensitivity were analyzed by Gram stain, culture and biochemical tests for identification of the isolates; and the antibiotic susceptibility was determined by modified Kirby Bauer disc diffusion method. Data was analyzed by Statistical Package for Social Sciences [SPSS] version 19

Results: The commonest isolate was Acinetobacter baumannii [22%] followed by Escherichia coli [20%], Pseudomonas spp. [15%] and Methicillin-resistant Staphylococcus aureus [MRSA] [11%]. Acinetobacter baumannii showed highest susceptibility to doxycycline [41%], Enterobacteriaceae to meropenem [96%], Pseudomonas spp. to polymyxin-B [100%] and Gram positive bacteria to linezolid [100%]. Seventy-two percent of the isolates were found to be multi-drug resistant

Conclusion: There was a high infection rate in surgical patients with Acinetobacter baumannii, Eschericia coli, Pseudomonas spp. and MRSA being the commonest isolates. Acinetobacter baumannii showed highest susceptibility to doxycycline, Enetrobacteriaceae to meropenem, Pseudomonas spp. to polymyxin-B and Gram positive bacteria to linezolid

Role of preloading with and without intramuscular ephedrine to prevent post spinal hypotension in elderly patients

To evaluate the efficacy of intramuscular ephedrine along with preloading in prevention of post Spinal hypotension in elderly patients. Randomized controlled trial. Department of Anaesthesia and Intensive Care Combined Military Hospital Peshawar, from 20[th] March 2007 to 20[th] March 2008. A total of 100 patients of ASA I and II were selected. The patients were randomly divided by random numbers table into two groups of 50 each. Group A was preloaded with ringer solution 15 ml/kg and intramuscular injection of 1 ml normal saline as placebo was given. Group B preloaded with 7.5 ml/kg and intramuscular injection of ephedrine 0.5 mg/kg was given. Heart rate and mean arterial pressure were monitored after the spinal blockade. Hypotension was treated with intravenous bolus of 5mg ephedrine and additional rapid infusion of lactated ringers. In group A, hypotension occurred in 30 [60%] patients as compared to group B, where hypotension occurred in 11 [22%] patients. In group A, ephedrine 10mg [2 boluses] were given in 14 [28%] patients, while in group B, ephedrine 5mg [1 bolus] was given in 11 [22%] patients. It is concluded from the results of this study that less preloading is required in intramuscular preloading along with intramuscular ephedrine is more effective in preventing patients after spinal anaesthesia as compared to preloading alone

Frequency of persistant backache in patients of spinal anaesthesia in the absence of prior history of backache

To determine the frequency of persistant backache in patients of spinal anaesthesia in the absence of prior history of bachache. Quasi experimental study. CMH Kharian from May 2008 to Sep 2009. Total 150 patients who were admitted at CMH Kharian during the study period were included in the study. The selection criteria included male and female patients above twenty years of age due for elective gynaecological, orthopaedics, urology and general surgical procedures. Only 112 patients reported for complete follow up for one year. Out of 112 patients, 61.6% were males while 38.4% were females. All patients with prior history of back pain were excluded from the study. At the end of one year the frequency of persistent back pain after one year of spinal anaesthesia is [1/112] 0.89% in the absence of previous history of back pain. The results of this study indicate that frequency of persistant back pain after spinal anaesthesia in the absence of previous history of back pain is very low

Hemodynamic response of low dose bupivacaine with fentanyl spinal anesthesia in elderly patients

To determine whether a reduced dose of bupivacaine in combination with fentanyl could give reliable block with greater hemodynamic stability in elderly patients. Quasi experimental study. Department of Anaesthesiology, Intensive Care and Pain Management Combined Military Hospital Rawalpindi. One year duration, from May 2006 to April 2007. ASA I-III elderly patients [n=60] undergoing surgery for fracture neck of femur, meeting the inclusion and exclusion criteria. Sixty elderly patients were randomized in two groups. The study group [group-A] received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and fentanyl 15 µgm while the control group [group-B] received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared. All patients had adequate duration of block. There was no significant difference in the change of heart rate between the two groups. Fall in blood pressure was more pronounced in the control group [group-B] patients requiring more ephedrine as compared with the study group [group-A] patients which remained more hemodynamically stable. A reduced dose of hyperbaric bupivacaine in combination with fentanyl provides reliable spinal anesthesia in elderly patients with few events of hypotension and little need for vasopressor support of blood pressure.

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

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Quasi-experimental study. Combined Military Hospital Peshawar from June 2008 to Dec 2009. Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% [intravenous immunoglobulin] was infused over a period of 6 hours and repeated for three consecutive day. Sequential Organ Failure Assessment [SOFA] score was used to assess the progress in all the patients. At the time of enrolment mean SOFA score was 5.41 +/- 1.127 and on the 15th day it was 1.62 +/- 2.24, mean age was 39.21 +/- 10.26 years. Thirty four patients [73.91%] developed gram negative sepsis and eighteen patients [39.13%] developed septic shock. Mean duration of stay in ICU and on of these patients was 30.43%. The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis

comparison of sevoflurane with midazolam to provide sedation to patients for surgery under locoregional anaesthesia

To compare the quality, speed of recovery, and side effects of sevoflurane sedation compared with intravenous midazolam. Quasi experimental, double-blind, comparative study. Operation theatre complex, Combined Military Hospital Rawalpindi from 1st June 2006 to 31st Dec 2006. Total of sixty patients, American Society of Anaesthesiology I-III aged 18-70 years undergoing surgery under locoregional anaesthesia were divided into two equal groups by convenient sampling. Group A: [n=30] received Sevoflurane sedation. Group B: [n=30] received Midazolam sedation. The patients were sedated gradually during the procedure and maintained at Observer`s assessment of alertness and sedation [OAAS] score of 3. At recovery the OAAS score was measured at 5, 10 and 30 minutes after stopping the drug administration. Subjective assessment of quality of recovery was measured by visual analog scale [VAS] determined at baseline and 5, 10, and 30 min of recovery. On observer`s assessment of alertness and sedation score no significant difference was observed between the two groups in the first 10 min after drug discontinuation but after 30 min allpatientsin group A and 26 out of 30 patients in group B had returned to an OAAS of 5 [p= 0.039]. Subjective recovery as assessed by VAS scores showed that patients were more awake, had higher energy level, were less confused and better coordinated in group A sedation at 10 and 30 min post-procedure as compared to midazolam group B. Sevoflurane for sedation produced faster recovery as compared to intravenous midazolam measured by OAAS score and subjective assessment on VAS scale. However, sevoflurane is complicated by a high incidence of intra-operative excitement

Anaesthestic management in disasters an anaesthetist's experience in "LAMNO" banda ache, Indonesia

The purpose of this study is to highlight the problems faced by the anaesthesiologist in the field and to mention some of the anaesthetic techniques which have proved useful in such adverse circumstances. Responding to the call for help to the victims of Tsunami on December 26 2004, the Pakistan Field hospital [Level II] arrived in Sumatra [Indonesia] and was deployed in a remote island, Lamno, Banda Ache. A total of 11,299 patients were treated including 1164 surgeries, from 12[th] January 2005 to 26[th] February 2005. The main problems were non availability of pressurized oxygen source, hostile and adverse circumstances, language barrier and massive number of tsunami victims requiring immediate medical attention. The Boyle's apparatus could not be used as it requires high pressure gases at 40 to 50 psi. The Oxygen concentrator was the only source of Oxygen. Descriptive. The surgical patients mostly had wounds of extremities which were infected. Majority of the surgical procedures included debridements of the wounds, skin grafting and amputation of the extremities. Most of the surgeries were performed under local and regional anaesthetic techniques. A modified general anaesthetic technique using an oxygen concentrator was devised for those few patients where regional anaesthetics alone were inappropriate. Local anaesthesia was administered to 1055 [90.64%] patients with minor injuries; peripheral regional blocks were administered to 35 [3.0%] patients, spinal anaesthesia to 31 [2.66%] patients and extradural anaesthesia to 17 [1.46%] patients. Eighteen [1.546%] patients were operated under dissociative anaesthesia with Ketamine and 08 [0.687%] patients were administered total intravenous anaesthesia, muscle relaxants, endotracheal intubation, bag valve mask [Ambu's] ventilation, oxygen supplementation from the oxygen concentrator and local anaesthetic infilteration. The incidence of complications was very low and none of the surgical patients had anaesthesia related morbidity or mortality. Most of the Tsunami affected patients could be managed safely under local anaesthesia, regional blocks or dissociative anaesthesia with Ketamine. The oxygen concentrator proved to be highly useful source of oxygen for a modified general anaesthetic technique without using a proper anaesthesia machine