Recombinant factor VII [rFVII] can be useful for massive hemorrhage during radical nephrectomy

Radical nephrectomy for renal tumors can be associated with serious complications, e.g. massive bleeding or even table deaths. Various regimens like normovolemic hemodilution, autologous transfusion, hypotensive anesthesia, etc have been used in anticipation of hemorrhage in these operations. In our case there was not only massive hemorrhage but also a failure to clot and disseminated intravascular coagulation. All the routine regimens failed to stop bleeding and the generalized ooze. Recombinant Factor VII [rFVIIa] was used and it saved the day

Combined thoracic epidural and light general anaesthesia for upper abdominal surgery in high risk patients

The goal of the study was to assess the safety and effectiveness of the thoracic epidural anesthesia [TEA] in high risk patients undergoing upper abdominal surgery. Quasi Experimental. Department of anaesthesia, Liaquat National Hospital, Karachi from August 2002 - July 2003. 20 adult patients aged between 50 - 70 years were selected with ASA status III and IV. TEA was performed in sitting position at the level of T7 -T8 using hanging drop method. Titrated doses of 0.25%. Bupivacaine and 1% Xylocaine was injected 1 ml / dermatome through the catheter, anesthetic levels achieved were found to be T4 - T10. Light general anesthesia was instituted by using I/V propofol 50 - 60 mg, I/V Nalbuphine 5 - 7.5 mg and Midazolam 1.5 - 2 mg I/V. Total dose of local anesthetic varied from 12 -18 ml [mean 16 ml]. Two patients had bradycardia with heart rate less than 60 beats/min treated with atropine. Two patients had hypotension treated with titrated doses of ephedrine and I/V Ringer's solution. Our results were very promising and we can state confidently that thoracic epidural is a viable option and safe alternative, reducing morbidity in high risk patients

To compare changes in serum electrolytes during turp, while using 5% dextrose water and glycine as irrigation fluids in two groups

To compare changes in serum electrolytes during TURP, while using 5% dextrose water and gly-cine as irrigation fluids in two groups. Experimental study design. Department of Anaesthesiology, Liaquat National Hospital, Karachi, from January 2004 to Jun 2004. 60 ASA I and II patients who presented for TURP under spinal anaesthesia were divided in two groups. 30 patients were included in each group. Patients in group A received 5% dextrose water as irrigation fluid while patients in group B received 1.5% glycine as irrigation fluid. Serum electrolytes were checked preoperatively, intraoperatively at every 15 minutes interval and postoperatively every hour for 2 hours. Serum Na+ level was decreased in both groups, but it was more marked in group A, maximum change being recorded at 45 minutes interval. These changes returned towards baseline with in 2 hours. Serum K[+], Cl and HCO[3] were also decreased in both the groups with more marked changes in group A. However, these changes were statistically insignificant. After comparing 1.5% glycine with 5% dextrose water as irrigation fluids during TURP, we concluded that glycine was found to be better irrigation fluid as dextrose water causes more evident hyperv-olemia, hyponatremia and hemodilution than glycine