Prevalence of Surgical Site Infections in IPD Department of Surgery: A Hospital Based Study

Background: The most common causes of nosocomial infections are surgical site infections (SSIs). It is also reported that SSIs rate ranges from 2.5% to 41.9% worldwide and resulting in high morbidity and mortality. Methods: This study conducted in Department of Surgery, Ananta Institute of Medical Sciences and Research Centre, Rajsamand. Results: In this study, 410 cases were included, out of which 5.6% were infected post-surgery and 94.3% were non- infected. From the 5.6% cases 60.9% had mild infection and 30.4% had moderate infection and 8.7% had severe infection. Conclusions: In the present study, the infection rate was higher. This high infection rate was due to the contaminated and dirty procedures where some of the patients were first seen about 2 to 3 days after development of peritonitis. It has been noted that the infection rate was higher in the emergency operative procedures in comparison to the elective procedures.

Role of Prophylactic Antibiotics and Prevalence of Post-operative Wound Infection in Surgery Department

Background: the Surgical Wound Infection Task Force changed the term ‘surgical wound infection’ with ‘surgical site infection’. Surgical site infection is defined as superficial site infection and organ or space infection. Methods: Total 100 cases were involved in this study , 50 for Group A and 50 as Group B. The case control study was carried out in the Departments of Surgery and Microbiology of Ananta Institute of Medical Sciences and Research Centre, Rajsamand. Results: Some associated factors were found such as Anemia Diabetes Mellitus Obesity & Prolonged duration of surgery in group A as well as group B. After post-operative surgery, we found that Staphylococcus aureus most popular organisms which causes infection followed by P. aeruginosa ,K. pneumonia, Escherichia coli. Conclusion: For surgical-site infections, surgeon should remember local and microbial factors should take appropriate measures to avoid them. One should use the most efficient and the best surgical techniques should try to avoid undue delays in the procedure to prevent postoperative wound infection.

Anesthetic management for emergency cesarean section and aortic valve replacement in a parturient with severe bicuspid aortic valve stenosis and congestive heart failure.

Asymptomatic women with mild aortic stenosis (AS) and normal left ventricular functions can successfully carry pregnancy to term and have vaginal deliveries. However, severe AS (valve area <1.0cm 2 ) can result in rapid clinical deterioration and maternal and fetal mortality. So, these patients require treatment of AS before conception or during pregnancy preferably in the second trimester. In suitable patients percutaneous balloon aortic valvutomy appears to carry lower risk. It can also be used as a palliative procedure allowing deferral of aortic valve replacement until after delivery. The present patient had severe critical AS with congestive heart failure that was refractory to medical therapy and the fetus was viable (>28wks). So, combined lower segment cesarean section and aortic valve replacement were performed under opioid based general anesthesia technique to reduce the cardiac morbidity and mortality.

Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery.

The objective of this study was to evaluate the effectiveness of acute normovolemic hemodilution (ANH) as a sole method of reducing allogenic blood requirement in patients undergoing primary elective valve surgery. One hundred eighty eight patients undergoing primary elective valve surgery were prospectively randomized into two groups: Group I (n=100) acted as control and in Group II (n=88) autologous blood was removed (10% of estimated blood volume in patients with hemoglobin (Hb) >12g% and 7% when the Hb was <12g%) in the pre-cardiopulmonary bypass (CPB) period for subsequent re-transfusion after protamine administration. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution. Banked blood was transfused in both the groups when Hb was ≤6g % on CPB and ≤8g% after CPB. Platelets were transfused when the count fell to <100´10 9 /L and fresh frozen plasma (FFP) was transfused whenever there was diffuse bleeding with laboratory evidence of coagulopathy. The two groups were comparable as regards demographic data, type of surgical procedures performed, duration of CPB and ischemia, duration of elective ventilation and re-exploration for excessive bleeding. The autologous blood withdrawn in patients with Hb≥12g% was 288.3±69.4 mL and 244.4±41.3 mL with Hb<12g% (P=NS). The Hb concentration (g %) was comparable pre-operatively (Group I= 12.1±1.6, Group II= 12.4±1.4), on postoperative day 1 (Group I =10.3±1.1, Group II= 10.6±1.2) and day 7 (Group I = 10.9±1.5, Group II=10.4±1.5). However, the lowest Hb recorded on CPB was significantly lower in Group II (Group I =7.7±1.2, Group II=6.7±0.9, p0 <0.05). There was no difference in the chest tube drainage (Group I =747.2±276.5 mL, Group II=527.6±399.5 mL), blood transfusion (Group I=1.1±1.0 units vs. Group II=1.3±1.0 units intra-operatively and Group I=1.7±1.2 units vs. Group II=1.7±1.4 units post-operatively) and FFP transfusion (Group I =581.4±263.4 mL, Group II=546.5±267.8 mL) in the two groups. We conclude that low volume autologous blood pre-donation does not seem to provide any added advantage as a sole method of reducing allogenic blood requirement in primary elective valve surgery.