Efficacy of Intravenous Paracetamol in Combination with Lidocaine Pretreatment for Reducing Pain During Injection of Propofol.

Introduction The association of pain and discomfort of moderate to high severity and a high incidence with the intravenous (IV) administration of propofol is well known. Various physical and pharmacological methods are used to minimize propofol-induced pain, but the best intervention is still unknown. Therefore, our aim was to determine the analgesic efficacy of IV paracetamol when used in combination with lidocaine pretreatment in reducing propofol injection pain. Materials and methods This double-blind, randomized controlled trial was conducted after receiving the approval of our institutional research ethics board. A total of 74 patients were included after providing informed consent, and participants were placed into two equal groups: group A received IV paracetamol (1 g) in combination with lidocaine pretreatment prior to the injection of propofol, and group B received lidocaine pretreatment alone prior to propofol injection. After propofol injection, all participants were asked to evaluate pain on the visual analog scale. Results Patients who received the lidocaine-paracetamol combination reported significantly more pain-free responses (51.35%) than those from patients who received lidocaine pretreatment alone (8.11%; P<0.05). The analgesic efficacy of group A was positive in 36 patients (97.3%), and for group B, the analgesic efficacy was positive in 24 patients (64.9%). Conclusion The administration of IV paracetamol with lidocaine pretreatment was more effective than lidocaine pretreatment alone in reducing the pain caused by the injection of propofol. Physicians should consider using IV paracetamol in combination with lidocaine pretreatment when patients require IV propofol to ease patient suffering and reduce pain, which may help provide optimal patient care.

Hypertension as a reason for cancellation of elective surgical cases on day of surgery: A five year audit report from The Aga Khan University Hospital Karachi.

OBJECTIVE: To assess the controllable factors in preventing undue cancellation of elective surgical cases and to suggest measures to address the issue. METHODS: The retrospective audit was conducted at the Aga Khan University Hospital, Karachi, and comprised all cancellations of elective surgery from 2011 to 2015. The cases reviewed had been cancelled primarily due to hypertension. A three-member committee regularly reviewed files regarding case cancellations and data was gathered. RESULTS: Of the 42,242 surgical cases scheduled during the period, 2903 (6.8%) were cancelled. In 11(0.37%) of these cases, hypertension was the primary reason. Of them, 10(91%) were men and 1(9%) woman. Overall age range was 30-77 years. Among the cancelled cases, 3(27.3%) each belonged to neurosurgery and general surgery, 2(18%) each to orthopaedic and urology, and 1(9%) to ear, nose and throat surgery. CONCLUSIONS: Hypertension as the primary reason for cancellation was low. Further reductions in these cancellations can be done by emphasis on following guidelines and their dissemination through continuing medical education.

Factors associated with choice of delivery with or without epidural analgesia among laboring women: a cross-sectional survey at a tertiary care hospital of a developing country.

AIMS: The aim of this study was to evaluate the factors responsible for epidural analgesia (EA) refusal among parturient patients. METHODS: In this prospective cross-sectional study of six months, we included all consenting postpartum patients having a non-operative delivery in the obstetric unit of our hospital. Data were collected on a predesigned questionnaire and included information such as parity, education, reasons for delivering with or without EA, source of information and patient satisfaction. Knowledge regarding EA was assessed from patients delivering without EA. RESULTS: From 933 patients enrolled, 730 (78.2%) delivered without EA, and 203 (21.7%) with EA. Only 11 (1.5%) patients refused EA for the reason of having natural birth process. Otherwise common reasons were misconceptions (65.9%) and lack of awareness about EA (20.5%); 70.5% had no knowledge of common side effects of EA. Among patients delivering with EA, 92.6% were offered EA by health care providers and had obstetricians and anesthesiologists as their sources of information. CONCLUSIONS: Patients in developing countries are laboring without EA, even in centers where there is a provision for it. The main reasons for not availing themselves of EA are lack of awareness and knowledge and misconceptions, rather than the desire to have un-medicated natural birth.

Epidural anaesthesia during labour for a patient with congenital complete heart block: a case report.

We report labour pain management in a full-term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only problem encountered was a transient bradycardia of 40 per minute with a systolic blood pressure of 70 mmHg, which settled with ephedrine. Pace maker insertion is recommended early in case the patient is symptomatic or has a prolonged Q-T interval or left atrial enlargement on ECG. Regional anaesthesia is recommended to prevent valsalva induced bradycardia or cardiac arrest during expulsive efforts by the patient.

Laryngeal mask airway insertion anaesthesia and insertion techniques.

Laryngeal Mask Airway has gained wide acceptance for routine airway management, difficult airway and in emergency situations. The classical method of insertion was recommended by Dr Brain. Over the years various induction and insertion techniques have been described with variable results. Combination of induction agents with narcotics, with or without small dose muscle relaxants has been found to be very effective. There is less also lesser incidence of mucosal trauma with partially inflated cuff. Insertion with cuff facing laterally or backwards and rotating it forwards into position has also been described. A review of various options and their advantages and limitations is presented.

Paraneoplastic syndrome of renal cell carcinoma.

We report a case of renal cell carcinoma who presented with the classic triad of flank pain, hematuria and fever as well as progressively developed multisystem disease, including a massive anteroseptal myocardial infarction. This was diagnosed as paraneoplastic syndrome of renal cell carcinoma and the decision to proceed with nephrectomy was taken after 3 weeks of acute myocardial infarction, despite predicted high cardiac risk under general anaesthesia; following removal of tumour, all symptoms and signs regressed. He has remained well till the time of last follow-up 4 months later.

Perioperative anaesthetic management of a patient with relapsed aplastic Anaemia.

Aplastic anaemia occurs due to failure of blood cell production by bone marrow. All blood cell counts are low. Untreated patients may die within one year mainly due to uncontrolled infection due to neutropenia. Anaemia and thrombocytopenia cause troublesome symptoms and necessitate frequent red cell and platelets transfusions. Surgery poses a very high risk for these patients because of the several complications that can occur in the perioperative period. In this paper we report on a patient with relapsed aplastic anaemia who was optimized preoperatively and underwent a total abdominal hysterectomy under general anaesthesia.