RESUMO
Severe acute postoperative pain following breast surgery increases the risk of persistent pain and affects the recovery of patients. Recently, pectoral nerve (PECs) block has gained significance as a regional fascial block that can provide adequate postoperative analgesia. This study aimed to evaluate the safety and efficacy of PECs II block, which was given intraoperative under direct vision after performing modified radical mastectomy for breast cancer patients. This prospective randomised study was comprised of a PECs II group (n = 30) and a control group (n = 30). Group A patients received 25 ml of 0.25% bupivacaine for PECs II block intraoperatively after the surgical resection was done. Both groups were compared with respect to the demographic and clinical parameters, total intraoperative fentanyl dose, total duration of surgery, postoperative pain score (Numerical Rating Scale) and the analgesic requirement, postoperative complications, postoperative duration of hospital stay, and the outcome. Intraoperative PECs II block was not associated with any increase in the duration of surgery. The postoperative pain scores were significantly higher in the control group till 24 h after the surgery, and so was the postoperative analgesic requirement. Patients in the PECs group were found to have rapid recovery and decreased postoperative complications. Intraoperative PECs II block is not only safe, time-saving procedure but also significantly reduces the postoperative pain and analgesic requirement in breast cancer surgeries. It is also associated with a faster recovery, decreased postoperative complications, and better patient satisfaction.
RESUMO
Background and Aims: In emergency airway management, unstable haemodynamics of the patients calls for the early need to detect correct endotracheal tube (ETT) placement. Ultrasonography has an advantage of being readily available along with being non-invasive and providing real time images. We aimed to study the usefulness of tracheal ultrasonography and use it as a tool to assess correct tracheal intubation in patients in the intensive care unit. Methods: This was a hospital-based observational study. The study included 92 patients who needed and were taken up for endotracheal intubation. Tube placement was confirmed simultaneously by three different observers with their respective method, i.e., ultrasonography, clinical method and capnography. Results: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography against capnography were 100% each with P value of 1. However, for clinical method against capnography, the sensitivity was 96.5%, specificity 28.6%, PPV 94.3% and NPV 40% with P value of 0.727. Mean time taken to detect correct placement of the ETT by ultrasonography, capnography and clinical method was 4.93 s, 15.39s and 17.80s, respectively. Out of 92 intubations, 85 were tracheal and 7 were oesophageal. All intubations were detected accurately with ultrasonography and capnography, ultrasonography being faster. Clinical method correctly detected 82 out of 85 tracheal intubations and 2 out of 7 oesophageal intubations, and was therefore less accurate than the other two methods. Conclusion: The study shows that ultrasonography is as reliable a method for confirmation of endotracheal intubation as capnography and is more reliable than clinical method. Besides, ultrasonography is faster than the other two methods.
RESUMO
Extant legislation, professional and societal ethics provide fundamental guidance to professionals in practising their profession. Legal rules are enforced by courts of law whereas rules of ethics are enforced by professional bodies like the Medical Council of India (now National Medical Commission). In this article, we explore some of the principal guidelines that regulate medical ethics. The role of informed written consent is vital in safeguarding the patient as well the doctor's interests; the approach for getting consent will differ depending on patient and procedure. Medical records document every aspect of the patient's history and details of the procedure and are the only means to settle disputes as they provide legitimate, real-time and accurate details of events that have occurred in the past. Although not explicitly listed as a 'service' in the Consumer Protection Act (CPA), healthcare-related complaints can be filed under the Consumer court and the precedent has been established that it is a service. CPA of 2019 provides detailed regulations for performing scrutiny of cases, fines that can be levied, the directives for seeking compensation, etc., Every anaesthesiologist must have some knowledge of law and ethics in order to protect himself/herself from avoidable litigation or disciplinary action.
