Injection sclerotherapy versus rubber band ligation for second degree hemorrhoids

Objective: To compare the efficacy of injections Sclerotherapy [IST] and rubber band ligation [RBL] for the treatment of 2nd degree haemorrhoids in terms of improvement in symptoms severity score [SS score] in OPD patients

Study Design: Randomized controlled trial

Place and Duration of Study: It was conducted in surgical OPD of CMH Kohat, from 15th October 2010 to 10th April 2011

Material and Methods: A total of 116 patients with symptomatic 2nd degree haemorrhoids were randomly divided into two groups, RBL and IST [58 patients each] respectively and a baseline symptoms severity score was noted for each patient. Patients in RBL group were treated with RBL while in IST group were treated with IST. The outcome measures were relief of symptoms and improvement in SS score

Results: In RBL group, baseline SS score was 4.67 +/- 2.01 which reduced to final mean SS score of 1.34 +/- 0.96 whereas in IST group the baseline SS score was of 4.31 +/- 2.13 which reduced to a final mean SS score of 1.6 +/- 0.97. 44 [75.95%] patients had complete recovery and control of bleeding in RBL group; whereas in IST group 32 [55.1%] of the patients had this response by the end of two weeks

Conclusion: Rubber band ligation was found to have better patient outcomes as compared to injections sclerotherapy in treatment of 2nd degree hemorrhoids

Use of a portable oxygen concentrator and its effect on the overall functionality of a remote field medical unit at 3650 meters elevation

The supply of oxygen is a complex issue in disaster situations and snowbound mountainous areas. Innovative solutions are required for safe anesthesia practice; one such innovation is a small portable oxygen concentrator for oxygen therapy in remote austere environment. We conducted this study to ascertain the economy achieved by employing this equipment to improve functionality of a surgical unit in an austere environment. Retrospective review of patient records and cylinder consumption from 1st October 2008 to 30th March 2009 was carried out and this data was classified as group A. While group B consisted of all the patients, who required oxygen therapy from 1st October 2009 to 30th March 2010, and were divided into sub-groups, on the basis of type of anesthesia or oxygen therapy. They were further categorized with respect to use of oxygen concentrator or oxygen cylinder for oxygen provision. The percentages of patients in these subgroups were summed to ascertain the economy achieved in the use of oxygen cylinders by comparing cylinder/patient ratio between group A and B respectively. Percentage economy achieved was then calculated. In group A cylinder/patient ratio [21/53] was '0.4' as compared to [3/81] '0.03' of group B. Percentage economy achieved was hence found to be [0.4/0.03%]] 1333%. Use of oxygen concentrator is an innovation which is economical, easily applicable and highly recommended in remote austere environments

Patient satisfaction following cataract surgery under loco-regional anaesthesia; a comparison of conscious sedation using proofol infusion versus loco-regional anaesthesia alone

To compare loco-regional anaesthesia alone and its combination with conscious sedation using intravenous propofol infusion, in terms of patient satisfaction following cataract surgery. Randomized controlled trial Conducted in operation theatre complex of Combined Military Hospital Multan during April 2006 to April 2007. One hundred outpatients [n=100], who met inclusion criteria and were scheduled for cataract surgery under loco-regional anaesthesia [Retrobulbar block along with topical anaesthesia], were randomly allocated to group "A" and "B" of 50 patients each. In group A [n=50], patients were also provided conscious sedation using intravenous propofol infusion titrated to the desired effect. While group B [n=50] patients were not provided any sedation in addition to loco-regional anaesthesia. Patient satisfaction of both the groups was assessed by filling a questionnaire, using scoring system modified from Iowa Satisfaction with Anaesthesia Scale [ISAS] at the time of discharge from the hospital. Mean ISAS score of patients in Group A [n=50] was found significantly higher [23.26 +/- 9.52] than mean ISAS score of patients of group B [18.56 +/- 11.20]. Comparison depicted statistically significant difference as the p value was 0.026 [< 0.05]. Conscious sedation with Propofol infusion provided higher patient satisfaction after cataract surgery under loco-regional anaesthesia when compared to surgery under loco-regional anaesthesia alone, as measured by ISAS score. Propofol infusion is recommended to be a novel technique for conscious sedation in outpatient cataract surgery because of propofol's excellent pharmacokinetic profile

Thoracic epidural anaesthesia for open cholecystectomy

To compare the postoperative pain relief and vomiting and the length of hospital stay in patients undergoing open cholecystectomy under general anaesthesia versus those receiving thoracic epidural anaesthesia. Quasi experimental study. The Combined Military Hospital, Skardu, from February 2009 to July 2010. American Society of Anaesthesiology [ASA] physical status [PS] I and II patients of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group 1 [n=51] received general anaesthesia [GA] and group 2 [n=49] received thoracic epidural anaesthesia [EA]. Patients of both the groups were assessed for postoperative pain, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain the p-value. P-value of less than 0.05 was considered significant. Thirty six patients of GA group did not require additional analgesics for postoperative pain relief; however, injection Ketorolac had to be administered to 15 patients [29.4%] for pain relief in the postoperative period. Two patients [4.1%] in the EA group required additional analgesic during that period. Eleven patients [21.5%] in the GA group had postoperative vomiting. In the EA group only 1 patient [2%] had postoperative vomiting. Patients in EA group had better postoperative pain relief [p = 0.001] and remained free from vomiting than the GA group [p = 0.003]. Thirty six patients [70.5%] of the GA group and 34 patients [69.4%] in the EA group were discharged within 36 hours postoperatively [p = 0.896]. The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the postoperative pain and vomiting in patients undergoing open cholecystectomy

Anaesthestic management in disasters an anaesthetist's experience in "LAMNO" banda ache, Indonesia

The purpose of this study is to highlight the problems faced by the anaesthesiologist in the field and to mention some of the anaesthetic techniques which have proved useful in such adverse circumstances. Responding to the call for help to the victims of Tsunami on December 26 2004, the Pakistan Field hospital [Level II] arrived in Sumatra [Indonesia] and was deployed in a remote island, Lamno, Banda Ache. A total of 11,299 patients were treated including 1164 surgeries, from 12[th] January 2005 to 26[th] February 2005. The main problems were non availability of pressurized oxygen source, hostile and adverse circumstances, language barrier and massive number of tsunami victims requiring immediate medical attention. The Boyle's apparatus could not be used as it requires high pressure gases at 40 to 50 psi. The Oxygen concentrator was the only source of Oxygen. Descriptive. The surgical patients mostly had wounds of extremities which were infected. Majority of the surgical procedures included debridements of the wounds, skin grafting and amputation of the extremities. Most of the surgeries were performed under local and regional anaesthetic techniques. A modified general anaesthetic technique using an oxygen concentrator was devised for those few patients where regional anaesthetics alone were inappropriate. Local anaesthesia was administered to 1055 [90.64%] patients with minor injuries; peripheral regional blocks were administered to 35 [3.0%] patients, spinal anaesthesia to 31 [2.66%] patients and extradural anaesthesia to 17 [1.46%] patients. Eighteen [1.546%] patients were operated under dissociative anaesthesia with Ketamine and 08 [0.687%] patients were administered total intravenous anaesthesia, muscle relaxants, endotracheal intubation, bag valve mask [Ambu's] ventilation, oxygen supplementation from the oxygen concentrator and local anaesthetic infilteration. The incidence of complications was very low and none of the surgical patients had anaesthesia related morbidity or mortality. Most of the Tsunami affected patients could be managed safely under local anaesthesia, regional blocks or dissociative anaesthesia with Ketamine. The oxygen concentrator proved to be highly useful source of oxygen for a modified general anaesthetic technique without using a proper anaesthesia machine