Autism is a neurodevelopmental disorder that manifests in the first three years of life. Children may attend hospital for diagnostic and therapeutic procedures at different points of their lives. Due to increased anxiety of patient and family members, uncooperative or combative behaviour, these patients are considered to be difficult cases for anaesthesia. Overweight and obesity in children has become endemic and perioperative complications are more frequent in these patients. A versatile approach should be adopted for management of these patients.
A prospective study of 70 elderly conventionally continuously randomized patients was done to compare thehaemodynamic changes produced during continuous infusion versus intermittent bolus epidural anaesthesia.The hemodynamic parameters (Blood pressure, Heart rate) were slightly changed in continuous infusiongroup but there was no significant difference compared with baseline value (p>0.05). Whereas, In bolusgroup, the hemodynamic parameters differed significantly compared with baseline values and the patientsin group I. So conclusion of better hemodynamic stability in continuous infusion epidural anaesthesia thanthat in intermittent bolus epidural method in elderly is reached.Key Words: Epidural anaesthesia, haemodynamic, intermittent bolus, continuous infusion.
Rocuronium bromide is an amino-steroidal neuromuscular blocking drug frequently used in anesthetic practice. It causes intense discomfort and pain at the site of injection and was reported by 50-80% of patients. Use of local anesthetic agents have been widely supported for prevention of pain. We studied the effect of lignocaine in prevention of pain during rocuronium injection in 160 patients. Preservative free lignocaine at a dose of 1mg/kg was given intravenously after applying tourniquet. Venous occlusion was released after one minute and 0.6mg/kg of rocuronium was injected. Pain score was recorded according to a 5-point likert scale of pain and withdrawal was graded with 4-point scale. Total number of female patients was 96 (60%) and male patients was 64 (40%). Among them, 131 (81.9%) fell in ASA I and remaining 29 (18.9%) in ASA II. One hundred and thirty-eight (86.3%) patients did not complain of pain when asked. Mild and moderate pain was seen in 17 (10.6%) and 4 (2.5%) patients respectively whereas 1 (0.6%) patient had severe pain. Wrist movement was noted in 10 (6.25%) patients and remaining 150 (93.75%) had no withdrawal movement during the injection of rocuronium. Pre-treatment with intravenous lignocaine helps in prevention of pain and withdrawal movements caused by intravenous rocuronium injection in patients.
Introduction: Laparoscopic cholecystectomy is one of the most frequently performed elective surgical procedures. Post-operative pain has been reported to be seen in 35-63% of patients undergoing laparoscopic surgeries. Use of intraperitoneal Ropivacaine has been widely advocated in various minimal access abdomino-pelvic surgeries with satisfactory results. Laparoscopic cholecystectomy is a common surgical procedure in our hospital and pain is complained by the patients time and again in the postoperative period especially in the first 24 hours. Method: A cross sectional descriptive study was conducted in Nepal Medical College and Teaching Hospital among 129 patients. Patients(male/female) aged 18-65 years who were given ropivacaine intraperitoneally during laparoscopic cholecystectomy were included for the study. The post-operative analgesic effect of ropivacaine, a long-acting local anaesthetic agent was assessed. Result: Total number of female cases was 87 (67.4%) and male cases was 42 (32.6%). One hundred and fifteen (89.1%) patients fell in ASA I and remaining 14 (10.9%) in ASA II. Normal BMI was seen in 89 (69%) patients whereas 1 (0.8) patient was underweight and 39 (30.2) patients were overweight. VAS more than 4 was seen mostly at 8 hours. Adverse effect in postoperative period was seen in 11 patients. Among which 4 (36.3%) patients had tachycardia and PONV was seen in 7 (63.6%) patients Conclusion: Ropivacaine as intraperitoneal instillation during laparoscopic surgery prolongs the time of post-operative duration of analgesia as assessed by VAS score and need of rescue analgesia.
Pheochromocytomas are catecholamine secreting tumours arising from the chromaffin cells of sympathoadrenal system. The patients usually present with hypertension, palpitation and sweating but may have varied presentation as well. Surgery is the definitive treatment of pheochromocytoma both to control the symptoms and more importantly to prevent further complications of hypertensive crisis, particularly the cerebrovascular and cardiovascular events. The laparoscopic adrenalectomy via transperitoneal or retroperitoneal approach is preferred due to advantages of laparoscopy over the open approach. The anesthetic management of such surgeries becomes challenging due to the potential for perioperative hemodynamic instability.
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