RESUMO
Authors present a case of 26 years old female who was having Esophagectomy done due to esophageal perforation secondary to severe corrosive intake strictures. Pre-operative course was uneventful, but during 5 hours of extensive surgery, she developed fulminant disseminated intravascular coagulation [DIG] which was initially managed, but proved to be fatal after 4 hours of ICU stay. Surgeons should be alert that hypercoaguable state can develop in unprepared patients having extensive surgery
Assuntos
Humanos , Feminino , Evolução Fatal , Complicações Intraoperatórias , EsofagectomiaRESUMO
To compare the operative time, the postoperative pain scores, duration of hospital stay and wound infection rates between Lichtenstein and totally extra peritoneal [TEP] laparoscopic hernia repair for direct inguinal hernias. Comparative study. This study was conducted at surgical unit 1, Benazir Bhutto hospital and surgical unit 1, Holy Family hospital, Rawalpindi from 1[st] July 2007 to 31[st] December, 2010. A total of hundred patients were divided into open and laparoscopy groups and their age, sex, operative times, pain scores, duration of hospital stay and wound infections were compared and analyzed. Mean age was 60.7 [ +/- 9.2] years for open group and 59.7 [ +/- 9.3] for the laparoscopic group. Time for surgery was 48.9 minutes in open and 49.0 minutes in the laparoscopic group. Pain scores at 2 hours and 24 hours after surgery were significantly less in laparoscopic group as compared to open group. Hospital stay was 39.6 hours in open versus 31.4 hours in the laparoscopic group, which was also significant. There was no case of wound infection in either groups, requiring operative intervention or mesh removal. The laparoscopic approaches to hernia repair have clear advantages, including lesser post operative pain and shorter hospital stays
Assuntos
Humanos , Masculino , Laparoscopia , Duração da Cirurgia , Dor Pós-Operatória , Tempo de Internação , Infecção da Ferida CirúrgicaRESUMO
OBJECTIVE: The aim of our study was to evaluate the efficacy of fentanyl and alfentanil in relation to hemodynamic stability of pediatric patients during routine general anesthesia
PLACE AND DURATION OF STUDY: A prospective double staged clinical trial was conducted at Anesthesia department of the Hospital over a period of 1 year from June 2010 till May 2011
METHODS: Total of 102 children, aged 7.3+/-2.1years, scoring ASA ?-??, undergoing general anesthesia were recruited and randomly divided in two groups. Group A received fentanyl bolus injection while group B received alfentanil. High flow oxygen was followed by inflow of fentanyl and alfentanil administered in the respective groups. The dose was adjusted to 1.5?g/kg for both fentanyl and alfentanyl. Induction was done by 2mg/kg propofol and rocuronium was administered via automatic infusion pump system. Lungs were mechanically ventilated with a mixture of 60 % [NO] nitrous oxide and [O2] oxygen along with 1% isoflurane. Hemodynamic parameters in terms of blood pressure and pulse were recorded before and after intubations
RESULTS: Time for the systolic Blood Pressure to reach its peak value and then to normal i.e.: [51 +/- 16secvs.71 +/-34 sec, 95% CI 1.243-2.458, P 0.01] and [119 +/- 33 sec vs. 74 +/- 31, 95% CI 2.589-4.821, P 0.01] was statistically significant among the two groups. In addition to this, the time for the pulse to reach maximal value and then back to normal i.e., [54 +/- 27sec vs.103 +/- 39, 95% CI 3.035-4.786, P 0.01] and [123 +/-28sec vs. 59 +/-18, 95% CI 3.212-4.789, P 0.01] was also clinically and statistically significant among the two study groups. It shows that fentanyl group patients achieved maximal values of blood pressures and pulse quickly, but retained their peak and returned to baseline levels after a prolonged interval in comparison to the group of patients who received alfentanil
CONCLUSIONS: Alfentanil 1.5-2?g/kg bolus injection dose in children provides a safe circulatory and hemodynamic balance with minimal cardiovascular response and a stable anesthetic state
RESUMO
To determine if intraoperative instillation of bupivacaine into gall bladder fossa would decrease early postoperative pain after laparoscopic cholecystectomy, Double-blind, randomized, controlled trial. Surgical Unit-l, Holy Family Hospital, Rawalpindi and Surgical Unit-1, Benazir Bhutto Hospital, Two year study. Fifty patients underwent laparoscopic cholecystectomy group-A. They were compared with a control group of fifty patients who had laparoscopic cholecystectomy but did not receive bupivacaine Group-B. Instillation of 10 ml of 0.5% bupivacaine into gall bladder fossa intra operatively after removal of gall bladder. Visual analogue scale [VAS] pain scores assessed 3 times post operatively, at 1, 6 and 24 hours, using similar peroperative and postoperative analgesics in both groups. Mean VAS pain scores [range 0 [no pain] to 10 [severe pain]] at 1 hour and at 6 hours after surgery were 6.5 and 4.2 respectively, in the bupivacaine group [Group-A] compared with 6.2 and 4.5 respectively, in the control group [Group-B] [p =.085 and 0.078,sd=.919 and.495]. VAS scores at 24 hours postoperatively did not differ between the two groups [2.4 VS 2.5][p=.282,sd=.636]. Instillation of bupivacaine into gall bladder fossa has no effect on post operative pain control in elective laparoscopic cholecystectomy