Comparison of Ondansetron Used Alone and in Combination with Dexamethasone as a Prophylaxis for Postoperative Nausea and Vomiting Following Laparoscopic Cholecystectomy.

Postoperative nausea and vomiting (PONV) is common after anaesthesia and surgery. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence can be as high as 76% which would cause unexpected delay in hospital discharge. This study was designed to compare the efficacy of the ondansetron alone with combination of ondansetron and dexamethasone the given as prophylaxis for PONV in patients undergoing laparoscopic cholecystectomy. One hundred patients undergoing elective laparoscopic cholecystectomy were selected and randomly divided into 2 groups of 50 each. Group I received 4mg of ondansetron intravenously (iv), whereas Group II received ondansetron 4mg and dexamethasone 4mg just before induction of anaesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting and need for rescue antiemetic. Complete response defined as no nausea and vomiting during first 24 hours, was noted in 76% of patients in Group I and in 92% of patients in Group II. Rescue anti emetic requirement was less in Group II (4%) than Group I (20%). So it can be concluded that the combination of ondansetron and dexamethasone is more effective in preventing PONV in patients undergoing laparoscopic cholecystectomy than ondansetron alone.

Rate of Conversion and Postoperative Complications of Laparoscopic Cholecystectomy in District Level Hospital of Bangladesh..

Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy and postoperative complications are still inevitable in certain cases. Knowledge of the rate and underlying reasons for conversion and postoperative complications could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion and postoperative complications of our LC series. This study included 760 consecutive laparoscopic cholecystectomies from July 2006 to June 2011 at Faridpur Central Hospital and Faridpur Medical College Hospital. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 19 (2.5%) patients. The most common reasons for conversion were severe adhesions at calot's triangle (6, 0.83%) and acutely inflamed gallbladder (5, 0.66%). The incidence of postoperative complications was 1.58%. The most common complication was wound infection, which was seen in 5 (0.66%) patients followed by biliary leakage in 3 (0.40%) patients. Delayed complications seen in our series is port site incisional hernia (2, 0.26%). LC is the preferred method even in difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery and it should not be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.

Initial Experience Of Laparoscopic Incisional Hernia Repair.

The laparoscopic incisional hernia repair is a safe alternative to open mesh repair. The procedure has the advantages of minimal access surgery and lower recurrence rate. A prospective study of laparoscopic incisional hernia repair of our first 11 patients was performed from July 2008 to December 2009. No serious intraoperative or postoperative morbidity was encountered, only two patients developed seroma. The mean operating time was 90 minutes (60 to 180 minutes). The mean day of discharge after surgery was 3 days (2-7 days). No patient developed a recurrence during mean follow up period of 10 months. Laparoscopic repair of incisional hernia has been shown to be feasible, safe and effective. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.

Drugs In Pregnancy.

In 1991 WHO International Survey of Drug Utilization in Pregnancy is 86% of women took medication during pregnancy, Average of 2.9 prescriptions and despite this high rate of medication intake, most drugs are not labeled for use during pregnancy. Most women use a number of different medications during pregnancy, many of which are self-administered. It is essential to consider the following factors before prescription of drugs during pregnancy. A) Dose and duration of drug exposure is important. The larger the dose is more likely the effects. The longer the duration of drug exposure is greater chance of susceptible periods of organogenesis and developmental problem. B) Timing of exposure is very crucial. Certain organ systems may have only limited period of susceptibility for damage. C) Pathogenetic mechanism, teratogens produce their adverse effect by specific mechanism. D) Host susceptibility, variability in the genetic factors related to mechanism of certain drugs. All drugs can affects the health of the mother and fetus, therefore any drugs should be administer with care during pregnancy.

Laparoscopic Cholecystectomy In Acute Calculus Cholecystitis-Experience At District Level Hospital.

Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallbladder disease. Its role in surgical treatment of acute cholecystitis has also been well defined. Here a prospective study was conducted over a 3 year period of 28 patients with acute cholecystitis at district level hospitals of Bangladesh, where many modern surgical facilities were lacking. Out of 28 patients of acute cholecystitis, 24 were operated by laparoscopic methods and rests 4 were converted to open cholecystectomy. Mean operation time was 87.95 minutes and only 2 patients had postoperative complications. This study showed the appropriate time of laparoscopic cholecystectomy for acute cholecystitis, conversion rate and complications. It may be concluded that laparoscopic cholecystectomy is feasible and beneficial to the patient with acute cholecystitis in its early phase, if necessary support and expertise is available.