Comparison of ropivacaine and bupivacaine as single-shot epidural anaesthesia for orthopaedic surgery

To compare the efficacy and side-effects of 0.5% ropivacaine with that of 0.5% bupivacaine when used for single-shot epidural anaesthesia for orthopaedic surgery. Randomized controlled trial. Department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of eight months from June 2013 to January 2014. The study was carried out in 60 ASA physical status I, II or III patients undergoing elective lower extremity orthopedic surgery. Two groups of 30 patients each received single-shot epidural anaesthesia either with ropivacaine 0.5% [ropivacaine group] or bupivacaine 0.5% [bupivacaine group]. Onset, time for maximum height and median height of sensory block was assessed as well as time to two segment recession. Modified Bromage scale was used for motor blockade. Total duration of motor block and common side effects were also recorded. The patients in both groups were similar in age, height, weight, gender and ASA status. There was no significant difference in onset of sensory block and time for maximum height of sensory block. The median heighest level of sensory block was T6 [T5-T8] for ropivacaine group and T5 [T4-T7] for bupivacaine group. Time for two segment regression and duration of sensory block were also comparable for both groups. The total duration of motor block was significantly more in bupivacaine group [159 min vs 134.2 min, p< 0.001]. Modified Bromage scale was also significantly higher in bupivacaine group [2.86 vs 1.96 min, p<0.001]. Side effects like hypotension, bradycardia, nausea, vomiting and shivering were similar in both groups. Epidural administration of 0.5% ropivacaine provided effective and good quality anaesthesia. Motor blockade was of less duration as compared to equivalent dose of 0.5% bupivacaine, which may offer potential benefit of early patient mobilization after orthopaedic surgery

Ultrasound guided internal jugular venous cannulation: comparison with land-mark technique

To compare real-time ultrasonography-guided technique versus the traditional land-mark technique for internal Jugular venous cannulation. Randomized controlled trial. Department of Anaesthesia, Combined Military Hospital, Rawalpindi, from September 2013 to July 2014. A total of 200 patients who required internal jugular vein cannulation were randomly assigned using either real-time ultrasound-guided technique or land-mark technique. Access time, number of attempts until successful cannulation, complications and the demographics of each patient were recorded. Access time was significantly less in real-time ultrasound group [34.95 +/- 11.47 vs. 146.59 +/- 40.20 seconds, p < 0.001]. Cannulation was performed in first attempt in 99% of patients in ultrasound group as compared to 89% of landmark group. Complication rate was significantly higher in the land-mark group than in the ultrasound-guided group. Carotid artery puncture rate [9% vs. 1%] and haematoma formation [7% vs. 0%] were more frequent in the land-mark group than in the ultrasound-guided group. Brachial plexus irritation was also more in land-mark group [6% vs. 0%]. Access time, failure rate and procedure related complications are reduced when real-time ultrasonography is used to cannulate internal Jugular vein

Frequency of difficult and failed intubation in apparently normal patients undergoing elective surgery

To find the frequency of difficult and failed intubation in apparently normal patients undergoing elective surgery. We also aimed to look at sensitivity and specificity of Mallampatti classification in our population. Cross sectional study. Combined Military Hospital, Rawalpindi and Multan from 1[st] May 2013 to 1[st] June 2013. There were 467 patients, who underwent elective surgery with general anesthesia and endotracheal intubation. During their pre-anesthetic visit, we assessed the airway according to Mallampatti score. After endotracheal intubations, frequency of difficult intubations was evaluated [i.e. Grade III and Grade IV] with special emphasis on intubation done by consultant anaesthetist and post graduate trainees followed by frequency of failure of intubation and other complications during intubation were also noted. Furthermore, comparison of Mallampatti with Cormack and Lehane's classification of difficult intubation was done. Difficult intubation in these centers was 4.28% [20/467]. Sensitivity of mallampatti was 98.2%. Incidence of failure of intubation was 0.42% in our study. The frequency of difficult intubation is 4.28% whereas failure of intubation is very low [0.42%] and was observed in special cases only. In our study, the sensitivity of Mallampatti to Cormack and Lehane's classification of intubation was 98.2% which suggests that it is a sensitive predictor of difficult intubation but complete accuracy cannot be determined by using the Mallampatti score

Post-epidural unilateral paralysis of intercostal muscles in child

Morbidity after paediatric epidural anaesthesia is unusual. We report a case of transient motor nerve root block in an eleven years old girl receiving epidural analgesia postoperatively following anterior instrumented spinal fusion for scoliosis. The epidural catheter was placed within the T8-T9 inter-space under general anaesthesia. Postoperatively the child developed unilateral paradoxical chest wall movement which was felt to be due to transient motor nerve roots blockade from the epidural analgesia, resulting from migration of catheter though uncommon, the complication needs to be considered in the differential of respiratory compromise postoperatively

Tension gastrothorax: a rare complication

Tension gastrothorax is herniation of abdominal viscera, stomach in particular, into the thorax that can simulate acute tension pneumothorax. This case reports an acute condition in which percutaneous needle decompression of the distended stomach, through the chest wall, allowed rapid decompression of the tension gastrothorax. After thoracotomy and repair of the ruptured diaphragm, the patient developed re-expansion pulmonary edema that was managed by differential lung ventilation