Frequency of Prescribing and Administering Premedication in Paediatric Surgical Patients at a Tertiary Care Hospital: An Observational Study.

INTRODUCTION:  Preoperative period is a stressful event, especially for paediatric patients undergoing surgery. Stress may lead to the development of perioperative maladaptive behaviour, activation of stress responses, and susceptibility to postoperative infections. To alleviate preoperative stress, the use of a multimodal approach including preoperative pharmacological premedication in the ward is recommended. We conducted an observational study to determine the frequency of prescribing and administering premedication in paediatric surgical patients. METHODS: This three-month retrospective observational study was conducted in the main operating room of the Aga Khan University Hospital, Karachi, from October to December 2014. It included all paediatric patients (aged 1-16 years) coming for elective surgery. Patients' preoperative forms and medical records were reviewed, and data recorded for written orders of premedication and the timing of administration of the premedication drug in the inpatient ward/surgical day care ward. A p-value <0.05 was considered statistically significant. RESULTS: This study included 125 paediatric patients. Premedication was not prescribed to 40% (50/125) patients. In these patients, drug and dose were properly mentioned in 98.7% (74/75) of cases while the route and time of administration were not mentioned in 26.6% and 12% prescription orders, respectively. The premedication drug was administered in 67 out of 75 patients (89.3%) by ward nurses as per prescription. The administration of premedication was documented in 95.5% patients, but the time was missing in 46.3% of cases. CONCLUSION: A significant number of patients were not prescribed preoperative premedication by the anaesthetist. Moreover, the route and timing of administration of drug were not mentioned especially in cases when premedication was prescribed in the wards.

Frequency of Immediate Neonatal Complications (Hypoglycemia and Neonatal Jaundice) in Late Preterm and Term Neonates.

Background Evidence suggests that neonates born at 34-36 weeks should not be considered full-term neonates, given the magnitude of morbidities they experience compared with term infants. Neonates born at 34 to 36 weeks are at increased risk for early illness such as hypoglycemia and hyperbilirubinemia compared to term infants. Objective This study's objective was to determine the frequency of immediate neonatal complications (hypoglycemia and neonatal jaundice) in late preterm and term neonates. Subjects and methods A serial descriptive case study was conducted at the private tertiary care hospital. Random samplings were taken, and the sample size was calculated on Epi Info software (Centers for Disease Control and Prevention, Atlanta, GA). All the eligible samples were taken into confidence following approval by the College of Physicians and Surgeons Pakistan's institutional review board. A structured questionnaire was used in which demographic information of the patient was collected, and all neonates were closely observed for early targeted morbidities (hypoglycemia, hyperbilirubinemia) Results A total of 215 neonates were born during the study period, of whom 108 (50.2%) were term babies and 107 (49.8%) late preterm babies. There were 122 (56.7%) male infants and 93 (43.3%) female infants. Jaundice was observed in 6.5% (n=7) of term neonates and 22.4% (n=24) of late preterm neonates (p<0.0). Similarly, hypoglycemia was observed in only 4.6% (n=5) of term neonates and 15.9% (n=17) of late preterm neonates (p<0.01). Conclusion There is a significant association between gestational age and immediate neonatal complications of jaundice and hypoglycemia. Compared with term neonates, late preterm neonates are at a higher risk of neonatal jaundice and hypoglycemia. Gender and mode of delivery did not correlate to complications rate.

First-Pass Success of Tracheal Intubation With Videolaryngoscopy in Head and Neck Cancer Patients: A Registry-Based Retrospective Cohort Study.

Background The incidence of difficult airway is higher in head and neck oncological surgery than in other surgeries. Limited evidence is available on the use of videolaryngoscopes in this cohort. A registry database on perioperative management of these patients was set up in our department in 2017. Methods Data from 2018 to 2019 were retrieved from this database. In 128 patients, videolaryngoscopy was used as the initial airway management of choice. Ease of intubation by first-pass success, its association with accessory manoeuvres, and complications were noted. Results Of the patients, 87% (n = 111) were successfully intubated with a videolaryngoscope in the first attempts. There was a strong association between the use of external laryngeal manipulation and successful first-pass intubation with videolaryngoscope. In patients with reduced inter-incisor distance, videolaryngoscope has shown greater benefit. There were very few complications including bleeding from the tumour site and a transient decrease in oxygen saturation to 88% in two patients. Conclusion Videolaryngoscopy was associated with high first-attempt intubation success and we recommend its use as the initial choice for airway management in head and neck cancer patients.