Strategies to cope claustrophobia during magnetic resonance imaging examination

Background: Claustrophobia associated with MRI scan is a well-recognized problem all over the world. The unpleasant psychological experience during MRI can lead to premature cancellation of the study resulting in non-interpretable data. In addition, performing future studies on the claustrophobic patient may not be possible leading to non-utilization of an important diagnostic modality. This study was conducted with the aim to determine a cheap and short intervention which can be applicable to small radiology set up as well.Methods: A prospective study was conducted at a tertiary care hospital from October 2016 to December 2016. Accompanying someone was the first strategy used to coped MR imaging claustrophobia followed by placebo (multivitamin), listening Quran and closed eye (blindfold). All those patients who failed to respond in these strategies were finally labeled as an unsuccessful candidate. Listening of Quran was selected as one of the tools as all the patients were Muslims in present study.Results: Among 84 claustrophobic patients, a closed eye was the most successful strategy found effective in (13) 81.2%, followed by placebo 66.7% patients, listening Quran (7) 30.4%, accompanying someone (15) 17.85% while 4% patients remained claustrophobic after application of all strategies. Significant association of accompanying someone and placebo was observed with education (p-value 0.037) and age of the patients (0.016) respectively.Conclusions: In general, placebo, being accompanied by someone and blindfold were found to be the most effective strategies to cope with MRI related claustrophobia. However, the success of these strategies is also dependent on certain factors like age, education status and socioeconomic status of the patients.

Efficacy of pre-incisional peritonsillar infiltration of ketamine for post-tonsillectomy analgesia in children

To assess the efficacy of pre-incisional peritonsillar infiltration of two doses of ketamine on postoperative analgesia compared with peritonsillar normal saline in children undergoing tonsillectomy. Double blind, randomized controlled trial. Department of Anaesthesiology, Surgical Intensive Care and Pain Management, Civil Hospital, Karachi, Dow University of Health Sciences, from August 2008 to January 2009. Seventy-five ASA physical status one patients, aged 5-12 years scheduled for tonsillectomy were enrolled in this study. Patients were divided into three groups of 25 each. Group-A received normal saline, Group-B, ketamine 0.5 mg/kg while group-C ketamine 1 mg/kg respectively. All medications were 2 ml and were applied 1 ml per tonsil; 3 minutes before tonsillectomy incision. Anaesthesia was induced and maintained with standard technique. All patients were monitored throughout surgery. The Children's Hospital of Eastern Ontario Pain Scale [CHEOPS] and Wilson sedation scale were used to evaluate pain levels and sedation respectively after operation. Mean duration of analgesia was significantly higher in group-C [17.28 +/- 5.33 hours] as compared to group-B [11.36 +/- 4.15 hours] and A [3.2 +/- 0.71 hours] as well as group-B was also significantly higher than group-A [p < 0.05]. Group-A had significantly higher pain scores than group-B and group-C. Both B and C groups had comparable pain scores, which were statistically significant at 6 and 8 hours. Single 0.5 or 1 mg/kg injection of ketamine given before surgical incision by peritonsillar infiltration provides efficient pain relief during postoperative period without significant side-effects in children undergoing tonsillectomy

New single use supraglottic airway device with non-inflatable cuff and gastric tube channel

To assess ventilatory characteristics and airway complications associated with the use of I-gel in patients undergoing gynaecological surgeries. Experimental study. Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of Health Sciences, Karachi, from July 2008 to June 2009. One hundred adult female patients aged 15 - 75 years, ASA-I and II scheduled for elective gynaecologic surgical procedures under general anaesthesia with controlled ventilation were included in this study. After insertion of device, ease of insertion, time of insertion, peak airway pressure, leak pressure were noted. After proper placement of device, gastric tube was also passed in every patient. Pharyngolaryngeal morbidities [sore throat, dysphagia, dysphonia, neck pain and coughing at 1 hour and 24 hours postoperatively] were also noted. I-gel was inserted in the first attempt in 92% patients while second attempt was required in 8% of patients. Average time of insertion was 9.68 +/- 2.69 seconds. Average leak pressure of 22.48 +/- 2.07 cm H[2]O. After removal of I-gel no blood staining was found on any device. Coughing was noted in 6% patients after removal of device and mild sore throat was noted in only one patient after 24 hours of surgery. I-gel is a simple and easy to use supraglottic airway device. Its insertion do not require laryngoscopy and airway can be maintained in very short time in adult female patients

Comparison of performance and safety of i-gel with laryngeal mask airway [classic] for general anaesthesia with controlled ventilation

To compare ease of insertion, effectiveness of the positive pressure ventilation and airway complications of i-gel with laryngeal mask airway-classic [LMA] for general anaesthesia with controlled ventilation. This study was conducted in the Department of Anaesthesiology, Surgical intensive care unit and Pain Management, Civil Hospital Karachi, Dow Medical College, Dow University of Health Sciences, from July 2008 to December 2008. One hundred adult patients aged 15 to 75 years, ASA I and II, Mallampati I and II, scheduled for various elective general or orthopaedic surgical procedures under general anaesthesia with controlled ventilation were included in the study. The patients were divided into two groups e.g. i-gel group or LMA group by systematic random sampling technique. Anaesthesia was induced and maintained with a standard gasrelaxant-IPPV technique. Ease of insertion was noted on a 3-grade scale. After insertion of the device vital signs and oxygen saturation were monitored non-invasively. Effectiveness of the positive pressure ventilation was compared. Pharyngolaryngeal morbidity, e.g. sore throat, dysphagia, dysphonia, blood on device, neck pain and cough were noted immediately on removal of the device, and by patient interviews at 1 hour and 24 hours postoperatively. In this study both LMA-classic and i-gel were easy to insert and did not require laryngoscope for insertion. Patients of i-gel group had comparatively less pharyngolaryngeal morbidity [blood on device] than patients of LMA group [18% in LMA group while none in i-gel group]. Both supraglottic devices, LMA [classic] and i-gel can be used safely and effectively in selected patients for general anaesthesia with controlled ventilation with almost no morbidity