Objective: To study the effect of propofol dilution on pain at injection site with formulations of 1% and 0.33%. Methodology: A randomized controlled trial was conducted for 24 months at the Department of Anaesthesia and Critical Care, Pakistan Institute of Medical Sciences Islamabad. A total of 100 patients were included in the study. Patients were divided into two equal groups: group C received 1% propofol while patients of group D received 0.33% formulation diluted with distilled water. Patients received propofol at the start of anesthesia before any premedication. A 5ml volume was injected over a period of 5s in an 18G cannula over dorsum of hands. Behaviourial pain scale was used and descriptive data analysis was done. Results: Then mean age of patients was 37.36±14.77 with 46 males and 56 females. Pain at the injection site was experienced in 20 (40%) patients of group C whereas 16 (32%) patients experienced pain in group D. There was no association of pain with a strength of propofol solution (p value 0.405). Conclusion: Strength of propofol solution has no association of pain at the injection site and dilution has no better effect in terms of pain score
Background: Percutaneous dilatational tracheostomy (PDT) is a simple bedside procedure, particularly useful in intensive care units. Over the last few decades, the technique of PDT has gained popularity due to its comparable safety to the more surgical tracheostomy (ST). Objective: To describe the outcome of PDT using modified Ciaglia’s technique in patients of Surgical ICU. Methodology: This was a prospective cohort study that analyzed the outcomes of PDTs carried out on critically ill patients admitted in the surgical ICU, Pakistan Institute of Medical Sciences, Islamabad from August 2015 to January 2017. All PDTs were performed by the presiding consultant and his team using modified Ciaglia’s (Blue Rhino) technique. The main outcome was the frequency of perioperative and early complications within the first six days. Demographic variables and complications were recorded. Data was analyzed using SPSS version 18. Results: Seventy-four patients underwent PDTs in the surgical ICU with the mean age of the patients was 49.17 ± 12.82 years. The commonest indication of tracheostomy was prolonged mechanical ventilation followed by failure to wean. Complications rate was 12.16% of which perioperative bleeding occurred in 6.7% of patients. Early complications within the first six days were wound infection, tube displacement and blocked tube. Conclusion: PDT is a valuable, efficacious and safe method that can be performed at the bedside with minimal complication rate and needs to be considered more frequently in the intensive care units in developing countries. Keywords: Percutaneous Dilatational Tracheostomy, Complications, Intensive Care Unit.
BACKGROUND: Laryngeal Mask Airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees OBJECTIVE: To assess the effectiveness of Laryngeal Mask Airway (LMA) placement after induction with propofol or thiopentone in one hundred day case urological patients. METHODS: An analytical, non interventional, cross sectional comparative study. Patients were divided into Group A (Propofol Group n=50) received propofol (2.5mg/kg) and Group B (Thiopentone group n=50) received thiopentone sodium (4-6 mg/kg) IV. Management of anaesthesia was identical in both groups. Standard monitoring was including NIBP, pulse oxymetery and ECG was done. Co-induction with done with midazolam 0.1 mg/kg body weight. LMA was inserted after adequate level of anaesthesia and then assessed. The presence of gaging, coughing, laryngospasm and movement were noted , recorded by a colleague anaesthetist who entered the induction room during the two minutes assisted ventilation phase and was not aware of the type of induction agent. Statistical analysis was done by using SPSS version 10. The mean and standard deviation was calculated for age. Frequency of subjects was calculated for gender Lund and stovner assessment scheme. The p value of less than 0.05 was considered significant. RESULTS: Thiopentone was associated with an adverse response in 76% of patients, compared with propofol in 26% (p<0.01). Head movement, Laryngospasm, inadequate jaw relaxation were more common using thiopentone (p<0.05). The quality of anaesthesia according to patients was significantly higher in the propofol group (Group A, 80%) than in thiopentone group (Group B, 30%). CONCLUSION: Adverse responses in Group A were less than Group B. Propofol, therefore is superior to thiopentone as an induction agent for laryngeal mask airway.
Objective: To evaluate the effects of different volumes (2ml-3ml) of hyperbaric bupivacaine as spinal anaesthesia in patients undergoing lower limb orthopaedic procedures. Methodology: Randomized control trial was done at the Department of Anesthesiology and intensive care, PIMS, Islamabad. Two intravenous lines with 18G cannulas were maintained, and patients were preloaded with 1L of ringer-lactate solution. Patients were randomly divided into low volume and high-volume groups. The spinal injection was given in a sitting position with complete aseptic technique, using a 26G spinal needle and the L3-4 interspinous space. In the low volume group, 2 ml of hyperbaric bupivacaine 0.75% was administered, and in the high-volume group, 3 ml of 0.5% hyperbaric bupivacaine was injected in 20 seconds. After the spinal injection, the patient was put in a supine posture with a 5-degree head down. The level of block was assessed with a pin prick at 2 minutes, 10 minutes, and 15 minutes. Data was collected via a study proforma. Results: The mean age of patients was 44.5±8.2 years in group I and 47.7 ± 9.6 years in group II. Males were predominant in both groups. The higher block level was compared among the study groups after 15 minutes. In group I (2 ml 0.75% hyperbaric bupivacaine), 1 (2.9%) had a higher block (above T4), while in group II (3 ml 0.50% hyperbaric bupivacaine), 7 (20.0%) patients were found to have a higher block (above T4) out of the total 35 cases in each group. This difference between the two study groups was statistically significant, as the higher block level was associated with a high volume of hyperbaric bupivacaine (p-0.02). Conclusion: Larger volume of hyperbaric bupivacaine is associated with a higher level of blockade in subarachnoid block for orthopaedic surgical procedures. Keywords: Spinal anesthesia, volume of drug, hyperbaric bupivacaine
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