Post-dural puncture headache after spinal anaesthesia for caesarean section

Objective: To find out the frequency and severity of post-dural puncture headache [PDPH] after spinal anaesthesia for caesarean section using 25G Quincke spinal needle

Study design: Descriptive case series

Place and duration of study: Department of Anaesthesiology, Surgical Intensive Care and Pain Management, Civil Hospital Karachi, Dow University of Health Sciences Karachi, from July 2010 to June 2011

Methodology: Pregnant women, aged 18 to 40 year, ASA I and II, presenting for elective or emergency caesarean deliveries under spinal anaesthesia were included. Spinal anaesthesia was performed with standardized technique using 25G Quincke spinal needle. Patients were followed for three consecutive days postoperatively for the frequency and severity of postdural puncture headache

Results: Out of four hundred and fifty parturient, 337 underwent emergency operations while 113 operated electively. In more than 93% cases spinal anaesthesia was instituted in first attempt. Thirty nine out of 450 patients [8.7%] developed post-dural puncture headache after spinal anaesthesia for caesarean section with 25G Quincke spinal needle. Thirty one had mild headache while eight parturient developed moderate headache

Conclusion: The frequency of post-dural puncture headache was in conformity to what has been reported in literature using 25G Quincke spinal needle

Efficacy of pre-incisional peritonsillar infiltration of ketamine for post-tonsillectomy analgesia in children

To assess the efficacy of pre-incisional peritonsillar infiltration of two doses of ketamine on postoperative analgesia compared with peritonsillar normal saline in children undergoing tonsillectomy. Double blind, randomized controlled trial. Department of Anaesthesiology, Surgical Intensive Care and Pain Management, Civil Hospital, Karachi, Dow University of Health Sciences, from August 2008 to January 2009. Seventy-five ASA physical status one patients, aged 5-12 years scheduled for tonsillectomy were enrolled in this study. Patients were divided into three groups of 25 each. Group-A received normal saline, Group-B, ketamine 0.5 mg/kg while group-C ketamine 1 mg/kg respectively. All medications were 2 ml and were applied 1 ml per tonsil; 3 minutes before tonsillectomy incision. Anaesthesia was induced and maintained with standard technique. All patients were monitored throughout surgery. The Children's Hospital of Eastern Ontario Pain Scale [CHEOPS] and Wilson sedation scale were used to evaluate pain levels and sedation respectively after operation. Mean duration of analgesia was significantly higher in group-C [17.28 +/- 5.33 hours] as compared to group-B [11.36 +/- 4.15 hours] and A [3.2 +/- 0.71 hours] as well as group-B was also significantly higher than group-A [p < 0.05]. Group-A had significantly higher pain scores than group-B and group-C. Both B and C groups had comparable pain scores, which were statistically significant at 6 and 8 hours. Single 0.5 or 1 mg/kg injection of ketamine given before surgical incision by peritonsillar infiltration provides efficient pain relief during postoperative period without significant side-effects in children undergoing tonsillectomy

New single use supraglottic airway device with non-inflatable cuff and gastric tube channel

To assess ventilatory characteristics and airway complications associated with the use of I-gel in patients undergoing gynaecological surgeries. Experimental study. Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of Health Sciences, Karachi, from July 2008 to June 2009. One hundred adult female patients aged 15 - 75 years, ASA-I and II scheduled for elective gynaecologic surgical procedures under general anaesthesia with controlled ventilation were included in this study. After insertion of device, ease of insertion, time of insertion, peak airway pressure, leak pressure were noted. After proper placement of device, gastric tube was also passed in every patient. Pharyngolaryngeal morbidities [sore throat, dysphagia, dysphonia, neck pain and coughing at 1 hour and 24 hours postoperatively] were also noted. I-gel was inserted in the first attempt in 92% patients while second attempt was required in 8% of patients. Average time of insertion was 9.68 +/- 2.69 seconds. Average leak pressure of 22.48 +/- 2.07 cm H[2]O. After removal of I-gel no blood staining was found on any device. Coughing was noted in 6% patients after removal of device and mild sore throat was noted in only one patient after 24 hours of surgery. I-gel is a simple and easy to use supraglottic airway device. Its insertion do not require laryngoscopy and airway can be maintained in very short time in adult female patients

Comparison of performance and safety of i-gel with laryngeal mask airway [classic] for general anaesthesia with controlled ventilation

To compare ease of insertion, effectiveness of the positive pressure ventilation and airway complications of i-gel with laryngeal mask airway-classic [LMA] for general anaesthesia with controlled ventilation. This study was conducted in the Department of Anaesthesiology, Surgical intensive care unit and Pain Management, Civil Hospital Karachi, Dow Medical College, Dow University of Health Sciences, from July 2008 to December 2008. One hundred adult patients aged 15 to 75 years, ASA I and II, Mallampati I and II, scheduled for various elective general or orthopaedic surgical procedures under general anaesthesia with controlled ventilation were included in the study. The patients were divided into two groups e.g. i-gel group or LMA group by systematic random sampling technique. Anaesthesia was induced and maintained with a standard gasrelaxant-IPPV technique. Ease of insertion was noted on a 3-grade scale. After insertion of the device vital signs and oxygen saturation were monitored non-invasively. Effectiveness of the positive pressure ventilation was compared. Pharyngolaryngeal morbidity, e.g. sore throat, dysphagia, dysphonia, blood on device, neck pain and cough were noted immediately on removal of the device, and by patient interviews at 1 hour and 24 hours postoperatively. In this study both LMA-classic and i-gel were easy to insert and did not require laryngoscope for insertion. Patients of i-gel group had comparatively less pharyngolaryngeal morbidity [blood on device] than patients of LMA group [18% in LMA group while none in i-gel group]. Both supraglottic devices, LMA [classic] and i-gel can be used safely and effectively in selected patients for general anaesthesia with controlled ventilation with almost no morbidity