Comparative study of intubating conditions after Rocuronium and Suxamethonium [study of 50 cases]

To compare the Intubating Conditions and Changes in heart rate [HR] achieved after suxamethonium chloride and rocuronium bromide, during intubation, in patients between ages 11-50 years out of which 4 were in paediatric age group [11-12 years] and 46 in adult group [19-50 years]. This study was conducted at the Armed Forces Hospital Sharourah kingdom of Saudi Arabia during six months period starting from 01/02/09. Fifty patients aged between 11-50 years, 4 including in paediatric age group [11-12 years] and 46 in adult age group [19-50 years], requiring general anesthesia for various surgical procedures, were randomly divided into two groups, i.e. Group A in which Rocuronium bromide, 0.9 mg kg-1 was given for intubation [[n=25] [23 adults, 2 children]] Group B in which Suxamethonium chloride 1.5 mg kg -1 was used for intubation [[n=25] [23 adults, 2 children]] Intubating conditions were observed at 60 seconds after intravenous bolus administration of suxamethonium or Rocuronium. HR was also observed immediately before induction [Pre-Op], at 60 seconds after bolus of Suxamethonium or Rocuronium [Immediately after relaxation], Immediately after intubation and then five minutes after intubation. Intubating conditions were rated as excellent in 96% [n=24 Twenty two adults two children] and good in 4% [n=1 Adult] of the patients who received Rocuronium and excellent in 100% of the patients who received Suxamethonium. There were no statistically significant changes observed in HR at all observation times between the two groups. It is concluded from this study that intubation can be performed under good to excellent conditions at 60 seconds after a bolus dose of Rocuronium of 0.9 mg kg-1. As far as affect on HR are concerned, our study indicate no significant difference between the two drugs. The result of this study indicates that to facilitate intubation using rapid sequence induction technique Rocuronium is a reasonably good alternative to Suxamethonium

Nosocomial pneumonia in mechanically ventilated patients

Ventilator associated pneumonia [VAP] is a disease caused by different microorganisms and is associated with high mortality. The objective of this study was to ascertain the causative organisms of VAP and the mortality associated with this disorder. It was a prospective comparative study of 100 patients who underwent ventilatory support at a tertiary care teaching hospital [Combined Military Hospital Rawalpindi] from 1st July, 2000 to 30th June 2001. Patients who developed clinical signs of pneumonia are investigated by bronchoalveolar lavage[BAL] and blood culture. In patients who were diagnosed as a case of VAP, microorganisms were identified by BAL [79%] and blood culture [21%]. Patients who developed VAP were followed as well as the controls that do not developed VAP. Mortality among both groups was recorded. Outcome of the study showed organisms including Pseudomonas aeruginosa [26%], Staphylococcus aureus [20%], Acinetobacter spp. [9%], Proteus spp. [6%], Haemophilus spp. [6%], Escherichia coli [6%], Klebsiella spp. [3%], Streptococcus pneumoniae [3%], Corynebacteria spp. [3%], and Polymicrobial flora [9%]. The mortality among the patients of VAP was 50% compared to 30% among the patients without VAP. But this difference is non-significant. In conclusion VAP is developed by diverse groups of microorganisms with Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter spp amongst the commonest pathogens. VAP is associated with higher percentage of mortality