The overall primary haemorrhage rate in the first audit cycle was 1.8% (8/441). In the second cycle with no coblation procedures, 1.4% of patients (6/416) suffered from primary haemorrhage (c.f. 8/441 (1.8%) in the first cycle, p=0.666). Secondary haemorrhage, was seen among 15.4% of patients (68/441) in the first audit cycle. In the second cycle, after coblation was discontinued, the secondary haemorrhage rate fell significantly (p<0.001) to 5.8% (24/416). A breakdown of the results of cold steel/diathermy and coblation techniques in both adults and children is also presented.
Background: EF is an important measurement in determining how well the heart is pumping out blood and in diagnosing as well as tracking the heart failure (HF). Normal EF varies at 55% to 70%, while EF 40% to 55% may indicate damage perhaps from previous heart attack, but may not indicate HF. However, measurement under 40% may show evidence of HF or cardiomyopathy and patient with EF< 35% may be at the risk of life threatening irregular heartbeats. Such patients are considered to be at high risk for anaesthesia as life threatening irregular heartbeats lead to sudden cardiac arrest and sudden death.Objectives: The aim of this study was to find out the characteristics of patients, identifying of the risk factors, better understanding of pathophysiology, pre-operative optimization of the patients, uses of stable drugs & anesthetic techniques, reduces intraoperative or early postoperative complications & perioperative morbidity, mortality.Methods: In this retrospective study we described our experiences of 236 cases of very low ejection fraction (20% - 35%) from 1st July 2014 - 30th June 2017. We reviewed their medical history and noted age, sex, type of operation & anesthesia, pattern of operation either elective or emergency, preoperative investigation and preparation, as well as details of anaesthetic management, were also recorded.Results: General anaesthesia was performed in 176 (74.58%) cases and rest of 60(25.42%) cases were regional where spinal 42(17.80%) cases & epidural 18(7.62%) cases. The age of the patients were in the range of 20 to 70 years, with majority of the patients were in 60 to 69 years age group. The majority of the patients about 46.19% were in LVEF 26 - 30% group, 36.01% patients were in 31 - 35% group and rest of 17.80% patients were in 20 - 25% group. Average duration of operation incase of general anesthesia 66.5(±2.28SD) min and incase of regional 44.2(±3.25SD) min. The mortality rate only 1.27%.Conclusions: Preoperative patient optimization, intraoperative haemodynamic stability and postoperative care have contributed to the success of very low ejection fraction patients in our hospital.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 114-120
Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations Bangladesh Heart Journal 2018; 33(2) : 134-137
Anaesthetic management of patients with large adrenal gland tumor pheochromocytoma is a challenge to the anesthesiologist, due to perioperative uncontrolled blood pressure, risk of arrhythmias and sudden cardiac arrest. Therefore, preoperative assessment and appropriate anaesthetic management are important in patients with pheochromocytoma. Laparoscopic adrenalectomy for Pheochromocytoma offers some technical advantages owing to its improved ability to visualize the contiguous anatomy and its relationship to the adrenal tumor. The decreased manipulation of the tumor during dissection of the adrenal gland has been espoused as another benefit of the laparoscopic approach. The decreased release of catecholamines and the resultant attenuation in haemodynamic liability has been a purported advantage of the laparoscopic approach.1,2,3,4 This is a case report of successful anaesthetic management of a patient with pheochromocytoma undergoing laparoscopic adrenalectomy using combined general and epidural anaesthesia the patient who developed intraoperative cardiac arrest and complete recovery after given lateral position CPR. Birdem Med J 2019; 9(2): 165-169
Background: Effective analgesia is important after laparoscopic cholecystectomy. Paracetamol have been used extensively as alternatives, and it seems that they are more effective for mild to moderate pain control postoperatively. As laparoscopic Cholecystectomy poses moderate pain, in this study we compare the quality of analgesia and side effects of paracetamol versus pethidine for post-operative analgesia after laparoscopic cholecystectomy. Objectives: This study was designed to observe the effect of I.V. paracetamol and I.M. pethidine for analgesic efficacy in post-operative analgesia with their side effects in laparoscopic cholecystectomy. Material and method: Sixty (60) patients were selected in the pre anaesthetic check up room whose were going to be operated for laparoscopic cholecystectomy. Each patient in group A received intravenous paracetamol (1g/100ml)15mg/kg over 15minutes and group B received intramuscular pethidine (100mg)- 2mg/kg postoperatively. Results: In group A that was paracetamol group and group B that was pethidine group the visual analogue scale (VAS) almost similar but total analgesic consumption in pethidine group were slightly higher than paracetamol group and the respiratory rate were significantly lower in pethidine group. Conclusion: Our results indicate that IV paracetamol 15mg / kg has better analgesic potency and less side effects than 2 mg / kg IM pethidine for postoperative analgesia after laparoscopic cholecystectomy. Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 46-53
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