Résumé
Introduction: Organophosphorus compound (OPC) poisoning has assumed alarming proportions and it is primarily a problem of the developing countries. Serum cholinesterase levels are easier to estimate and usually depressed after OP poisoning. Peradeniya OP poisoning scale has not been studied much in Indian scenario. So, we decided to have first hand information and hence conducted this study. Aim and objectives: To find out severity of patients with OP poisoning by calculating Peradeniya OP Poisoning score, level of plasma and RBC cholinesterase level of patients of OP poisoning on admission before any treatment, and correlate the level with severity and outcome of patients and requirement of ventilator support with OP poisoning. Material and methods: All patients who presented to emergency department with history of poisoning with known compound were taken as study subjects. A detailed history, clinical examination and relevant biochemical investigations were performed. Peradeniya OP poisoning scale Patel P, Patel VP, Patel H, Rathod GB. Study of prognostic value of serum and RBC acetyle cholinesterase level in organophosphorus poisoning and its correlation with the outcome. IAIM, 2016; 3(3): 147-157. Page 148 was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. In all study subjects, 3 ml of plain blood was collected on admission before administration of atropine and plasma cholinesterase and RBC cholinesterase was estimated. Results: Most of the patients consumed poison with a suicidal intent. Majority had consumed poison orally. Most patients had consumed 50 – 100 ml of poison. Quantity of poison consumed did not correlate with severity of poisoning. In this study, requirement of ventilatory support was seen in 16% of patients. Mortality in our study was 9%. Pseudo cholinesterase levels were significantly depressed in patients who required ventilatory support and correlated with mortality. Miosis, Bradycardia, increased respiratory rate, impaired level of consciousness, all correlated well with need for ventilatory support and increased mortality. Peradeniya OP poisoning score of more than 8 correlated in predicting the need for ventilatory support and mortality. RBC and Plasma cholinesterase levels estimation in conjunction with Peradeniya OP poisoning score is a useful parameter for grading severity of OP poisoning and in predicting the need for ventilatory support and mortality. Conclusion: The POP scale and RBC Che and plasma cholinesterase levels both showed a significant association in predicting the need for ventilatory support and outcome. Lower grade of poisoning had a better outcome whereas higher severity of poisoning had a poorer outcome.
Résumé
Background: The international association for the study of pain has defined pain as unpleasant and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Spinal anesthesia was first produced by Corning in 1885 and first used deliberately by Bier in 1898. Glucose containing solution for spinal anesthesia was introduced by Barker in 1907. Since then hyperbaric solutions are in use for spinal anesthesia. All these advantages of spinal anesthesia are offset by complain of postoperative pain when effect of local anesthesia wears off due to relatively shorter duration of action of local anesthetic drug. Aim: The present study was designed to evaluate the effect of intrathecal bupivacaine 0.5% heavy 3.0 ml (15 mg) with neostigmine 5 mcg and bupivacaine 0.5% heavy 3.0 ml (15 mg) with neostigmine 5 mcg and nitroglycerin patch (5 mg/24 hour) in various surgeries divided 2 groups, 25 patients in each group. The objectives of study were to observe onset and duration of sensory and motor blockade, to observe duration of post operative analgesia, to observe perioperative hemodynamic stability, to observe perioperative complications. Patel VP, Patel P, Mehta SS, Rathod GB. Effect of transdermal nitroglycerin patch on intrathecal neostigmine with bupivacaine for post operative analgesia. IAIM, 2016; 3(2): 31-40. Page 32 Materials and methods: The study was conducted by taking 50 randomly selected patients for various surgeries. Patients belonged to ASA Grade I/II aged 18 to 60 years were included. Patients were divided into 2 groups. Group - A: 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg. Group - B: 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg + transdermal nitroglycerin patch (5 mg/24 hours), applied on a non anaesthetised area after 20 minutes. All the patients were evaluated preoperatively and those having history of allergy to any drug, having any contraindications to spinal anesthesia, any neurological disorder and psychiatric illness were excluded from the study. Detailed preoperative history of past and present illness was taken. Systemic and general examination was done and back of patients were examined to rule out any spinal deformity and infection at local site. Patients were investigated for laboratory investigations like complete blood count, blood Sugar, renal function test, serum electrolytes, serum bilirubin and chest X-Ray, ECG were reviewed. Results: In our study of 50 patients we observed that intrathecal neostigmine 5 mcg with bupivacaine 15 mg with transdermal nitroglycerin patch (5 mg/day) markedly prolong duration of post operative analgesia than intrathecal neostigmine with bupivacaine alone. Intra-operative complication like bradycardia do occur but it was not significant, and other complication like hypotension occur with both groups but more in group B which requires monitoring . Conclusion: Transdermal nitroglycerin patch increases post-operative analgesia of low dose intrathecal neostigmine with bupivacaine in spinal anesthesia with less side effects.