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Background: Comparison of ropivacaine alone or with dexamethasone as an adjuvant for reducing pain during positioning for neuraxial blockade with ultrasound-guided fascia iliaca compartment block.Methods: In this double-blinded study, a total of 60 patients between 18 to 80 years of age, undergoing surgery for hip fracture were enrolled. Patients in Group A received 40 ml of 0.25% ropivacaine +2 ml saline and patients in Group B received 40 ml of 0.25% ropivacaine +8 mg dexamethasone. USG guided FICB and postoperative monitoring was done by the chief investigator who was unaware of group allotted and drug administered.Results: There is no significant difference in the heart rate between the two groups after 30 min of the block. The variation of systolic blood pressure of both the group for the first 30 min after giving FICB block was not significant (p>0.05). The absolute value of diastolic blood pressure (DBP) was significantly lower in Group B compared to group A just before the block, a variation of DBP with time was not significant. There was a gradual improvement of pain score from mean 6.7 in Group A and 6.6 in Group B at 0 min to score of 2 at the end of 30 min in both the group. This improvement was achieved earlier in Group B compared to Group A, although the difference was not significant (p>0.05). Vital parameters like HR, SBP, DBP, SpO2 values were similar in both the groups. No patients in either group required any interventions both pre-operatively and pos-operatively. Time of rescue analgesia was noted with the VAS score was significantly more in Group B (p≤0.004). The incidence of hematoma, accidental intravascular injection, convulsion, and paresthesia were nil in both groups.Conclusions: Although both the groups had comfortable and pain-free positioning for administering spinal anaesthesia before surgery. USG guided FICB is easy to perform block and give excellent analgesia for positioning and mobilization of hip fracture patients pre and post-operatively both, and dexamethasone as an adjuvant to 0.25%ropivavaine prolong its local anesthetic effect significantly.
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Background: Acute Normovolemic Hemodilution (ANH) and autologous transfusion can mitigate the harmful effects of banked blood intraoperatively. This study was planned to evaluate its effects on perioperative transfusion requirement, hemodynamic stability and safety profile.Methods: Hundred patients were randomized to Group 1, where assigned patients received ANH and autologous transfusion after hemostasis; and Group II where assigned patients received homologous transfusion. In group I, 350 to 700 ml of patient's blood was collected before induction of anaesthesia and was kept in the operation theatre at room temperature. This was followed by rapid infusion of calculated Hetastarch. Intraoperative blood loss, amount of transfused blood, serial haemoglobin (Hb) assessment, and change in hemodynamics were carefully monitored. The blood was reinfused once hemostasis was secured at the end of surgery.Results: It was observed that hemodynamic stability was maintained in both the groups during and after haemodilution. There was no significant change in bleeding and clotting time due to haemodilution. The mean intra-operative blood loss in both groups was comparable. 350 mL and 700 mL blood withdrawn in 27 and 23 patients and 500mL and 1000 mL HES infused respectively. There was an average fall in the mean Hb level by 1.74 gm % and in the mean haematocrit (Hct) level by 6.4 % after haemodilution. The mean 12th and 24th hour Hb and Hct levels were comparable. The requirement of homologous blood transfusion in group I was significantly low (p<0.0001). Need for homologous transfusion was 0.72 per patient treated in the Group I.Conclusions: Acute normovolemic hemodilution is a simple, safe and effective modality to reduce perioperative transfusion of banked blood and should be considered in patients undergoing surgical procedures where major blood loss is expected.
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Background: Post-operative nausea and vomiting (PONV) is generally self-limiting, associated with high level of patient dissatisfaction and may delay hospital discharge. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors and variety of antiemetic drug available in market. With this issue we aim to compare the effectiveness of dexamethasone with granisetron or ondansetron in patients undergoing laparoscopic gynaecological surgery.Methods: 120 patients were registered in this prospective, randomized double blind study. Group I (n=60) received ondansetron 4 mg intravenously (IV)+dexamethasone 8mg I/V or II (n=60) received granisetron 1 mg IV+dexamethasone 8 mg I/V prior to anaesthesia. Post-operative data of PONV was recorded at pre-defined intervals.Results: The majority of the patients were of the age group 20-25 years (55.83%). The mean score of Group I subjects was 0.30±0.72 and that of Group II was 0.20±0.57 (p=0.43). There are 3.33% of patients in group-I having vomiting episodes, and 1.67% of patients in group-II having vomiting episodes, none of the patients developed 2nd episodes of vomiting in either group. Thus it appears that dexamethasone in combination with ondansetron and granisetron is effective in decreasing the number of episodes of PONV. The occurrence of sickness episodes within 24 hours of surgery revealed no significant different in both groups. Haemodynamic variables showed no significant difference recorded in postoperative care unit between the study groups. The most common complaint was headache 16.67% in both groups. Conclusions: Dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg showed no significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.
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Background: Baska Mask® (BM) a newer Supraglottic Airway Device (SAD) considered to cause low incidence of Postoperative Pharyngolaryngeal Complications (POPC). This study was designed to assess efficacy, safety and early and late POPC between BM and commonly use ProSeal LMA (PMLA).Methods: Patients between 18 to 60 years of age undergoing elective short gynecological procedures were randomized into two groups, to receive ventilation with either BM (group 1, n=50) or an PMLA (group 2, n=50).Results: There was no significant difference in the ease of insertion for both the devices (p<0.24). There was no significant difference in the number of attempts for both the devices (p<0.69). When compared to PLMA, the time (in seconds) required for insertion of BM was significantly less in duration (20.9 vs. 16) (p<0.0001). Between the two groups significant hemodynamic changes noticed after removal of SGA. The blood staining of device was similar in both groups. Failure to place device, postoperative complication like laryngospasm and bronchospasm did not occur in both BM and PLMA groups.Conclusions: In conclusion, findings of this study support that BM takes significantly shorter placement time and provides a better seal as compared to PLMA but without any reduction in laryngopharyngeal complications.
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OBJECTIVES:The aim of this study was to study patient, disease, and treatment related characteristics in geriatric patients 65 years and older treated by Radiotherapy (RT).MATERIAL AND METHODS:A retrospective observational and descriptive study was conducted in a tertiary care gov- ernment institute with academic and research potential. The electronic medical records, medical documents, and Radiotherapy treatment charts were retrieved and studied.RESULTS:247 patients aged 65 years and older were included over 2-year study period. Mean age was 70.3 years and the oldest patient treated was of 94 years. 66% patients were males. 82 patients (33%) had metastatic disease. The common sites of origin were head and neck (28%), lung (23%), genitourinary (20%), and gastrointestinal malig- nancies (15%). 125 patients (51%) were having one or more co-morbidities. 135 patients (55%) were treated with radical intent. 66 patients (27%) received chemotherapy in concurrent setting. 89 patients (36%) were hospitalized for some duration of their RT course. In 58 patients (23%), RT was interrupted briefly. 46 patients (19%) could not complete the prescribed RT. 8 patients (3%) developed Grade 3 and 4 hematological toxicities. 57% patients developed Grade 2,3 mucocutaneous toxicities. 53% patients developed Grade 2,3 GI toxicities. Mortality rate while on treatment was 4%.CONCLUSION:Geriatric patients, though more prone to develop systemic and site-specific toxicities warranting supportive care in indoor or outdoor setting, can be offered Radiotherapy either alone or concurrently with che- motherapy. Such patients present with heterogeneous spectrum of entities often posing a therapeutic challenge to clinicians; but proper selection of cases and diligent supervision may allow these patients to be treated with Radiotherapy with radical or palliative intent as indicated.