Background: Laryngoscopy and tracheal intubation lead to stress response which is characterized by transient rise in blood pressure and heart rate. This response is tolerated well in normal individuals but can lead to significant morbidity and mortality in patients with cardiovascular and cerebrovascular diseases. Search for the better drugs to suppress these responses is going on through decades. Aim of Study: To compare the effects of IV nitroglycerin alone and in combination with IV lignocaine, on attenuation of stress response to end tracheal intubation. Material and Methods: This is a randomized, double blind study conducted in 60patients admitted for operation at NGMCTH, between June 2018 to November 2018. Patients were of 16- 60 years age groups and belonging to ASA group I and II. Patients were divided into two groups: Group I IV Nitroglycerin 500 mcg+ NS 3 ml. (n=30) and Group IIIV Nitroglycerin 500 mcg+ IV Lignocaine 63 mg (n=30). Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart rate (HR) were measured and Rate Pressure Product (RPP) calculated. Results: Baseline values were comparable in both groups. Post Intubation, there was significant decrease in SBP at 0,1,3 and 5 minutes while DBP and MAP significantly decreased at 1, 3 and 5 minutes, in both groups. Significant tachycardia was noted in both groups at 0,1and 3 minutes, and RPP remained unchanged in both groups. Conclusion: Nitroglycerin significantly decreases blood pressure, prevents rise in RPP but does not attenuate heart rate after end tracheal intubation. There is no benefit of adding IV lignocaine to IV nitroglycerin for attenuation of stress response to end tracheal intubation.
Introduction: Post operative pain following caesarean section delivery can negatively affect early wound healing, proper breast feeding to the new born baby and therefore impair mother to child bonding. Combination of non steroidal anti inflammatory drugs (NSAIDS) and opioids has most commonly been used in pain management. The combination of regional anesthetic techniques like Transversus Abdominis Plane (TAP) block reduces pain and the dose of total analgesics consumed and therefore helps to prevent opioid related side effects. Objective: To evaluate the analgesic efficacy of Transversus Abdominis Plane block for management of postoperative pain in the first 24 hours after caesarean section. Methodology: It is a prospective randomized controlled single blinded study involving 60 patients of ASA II done in Nepalgunj Medical College Teaching Hospital over a period of 2 months. They are divided into two groups of 30 patients each. Group 1 received 20 ml of 0.25% isobaric bupivacaine in the triangle of Petit bilaterally. Group 2 received IV analgesics (NSAIDS and Tramadol 50 mg with Phenargan 25 mg). VAS score was taken every 6 hourly for 24 hours post operatively. Results: The mean VAS score of the patients in group 2 at 0-6 hours, 6-12 hours, 12-18 hours and 18-24 hours was 6.73(SD±0.69), 6.63(SD±0.610), 6.40(SD±0.56) and 6.43(SD±0.57) respectively. The mean VAS score of the patients who received block is significantly less as compared to those who did not receive the block with a p value of <0.001. The mean time to first analgesic request in group 1 was 10.83(SD±2.95) and in group 2 was 4.87(SD±0.68) with a p value of <0.001. In group 1, 70% patients received single dose of analgesics, 23.3% received two doses and 6.7% received three doses of analgesics. In group 2 all the patients received four doses of analgesics. Conclusion: Transversus Abdominis Plane Block can be used as a part of multimodal analgesic therapy for the management of post operative pain after caesarean section as it is technically less demanding, safe and economical. It reduces the side effects related with opioid analgesics and encourage early mobility, wound healing and proper mother to child bonding.
Background Coronavirus disease 2019 (COVID-19) presents clinically a variety of pathological and clinical organ dysfunctions, ranging in severity from asymptomatic to fatal. The care and monitoring of COVID-19 patients may benefit from the use of biochemical and hematological markers. Objective To observe the alteration of serum biochemical and hematological parameters in COVID-19 positive patients, attending a Tertiary Care Hospital. Method A descriptive cross-sectional study was conducted on all COVID-19 positive patients attending Nobel Medical College Teaching Hospital, Biratnagar, Nepal from 15th December 2021 to 15th February 2022. The test results of different serum biochemical and hematological parameters done for these patients were recorded in clinical laboratory services and obtained retrospectively for the analysis. The data were entered in MS excel and analyzed by SPSS version 20. Result Out of 1537 COVID-11699 declared positive patients, 712 (46.32%) were male and 825 (53.68%) female. Mean age of COVID positive patients was 40.03±20.08 years. The level of serum SGOT, SGPT, ALP and GGT was significantly elevated in 39.9%, 42.8%, 32.3% and 47.2% of COVID positive patients respectively. Blood Urea, creatinine, uric acid and sugar level were significantly elevated in 63%, 56.1%, 33.1% and 47.6% patients respectively. The serum level of LDH, D-dimer, CRP and procalcitonin (PCT) were significantly increased in 52.1%, 75.9%, 71.6% and 61.2% of patients respectively. The serum value of total cholesterol, triglyceride, HDL and LDL were significantly lowered in 52.2%, 43.8%, 70.1% and 60.3% of patients respectively. RBC concentration and level of hemoglobin was reduced in 56.6% and 53.6% of COVID positive patients respectively whereas total leukocyte count was elevated in 80.7% with increase in neutrophil in 87.9% and decrease in lymphocyte in 79.4%. Conclusion A portion of COVID-19 positive patients showed drastically altered test results for various serum biochemical and hematological markers, although many of them had normal findings.
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