BACKGROUND:Tracheal extubation and emergence is associated with significant haemodynamic alterations and is poorly tolerated by patients with co-morbid conditions. We compared the efficacy of fentanyl and dexmedetomidine in mitigating haemodynamic stress response and assessed extubation quality in study groups. MATERIALS AND METHODS: One fifty patients of either sex, ASA grade I & II normotensive patients, aged 18-55 years undergoing elective surgeries under general anaesthesia were randomized into 3 equal groups. Anaesthetic technique was standardized. 10 minutes prior to extubation, patients in Group N, F and D received intravenous bolus infusion of 0.9% normal Saline, Fentanyl 1μg /kg and Dexmedetomidine 1μg /kg respectively over 10 minutes period. Heart Rate (HR), Systolic BP (SBP), Diastolic BP (DBP) and Mean Arterial Pressure (MAP) were noted at extubation, 2, 4, 6, 8, 10 min and at regular interval thereafter for a period of two hours. Extubation quality was evaluated on 5-point extubation quality scale [ scale 1 = no coughing, 2 = smooth extubation, minimal coughing (1 or 2 times), 3 = moderate coughing (3 or 4 times), 4 = severe coughing (5-10 times) and straining, 5 = poor extubation, very uncomfortable (laryngospasm and coughing >10 times)]. Ramsay sedation score and Aldrete's recovery score were recorded. Any adverse events, use of rescue drugs and postoperative analgesics were noted.
BACKGROUND Peritonitis due to hollow viscus perforation is one of the common causes for emergency ward admission under surgery department. Its causes vary from the ones requiring immediate surgical intervention to those requiring conservative management. Its accurate diagnosis and management are a challenge to every surgeon. Scoring systems that provide objective descriptions of the patient's conditions at specific points in the disease process aid our understanding of these problems. Hence this study is undertaken to study the effectiveness of Mannheim's Peritonitis Index (MPI) in predicting the outcome in peritonitis patients who presented to Basaveshwara Teaching and General Hospital, Kalaburagi. MATERIALS AND METHODS This study is a clinical, prospective, observational and open study conducted at the department of General Surgery, Basaveshwar Teaching and General Hospital, Kalaburagi from July 2014 to March 2016. The sample size estimation was also done at convenience. RESULTS The mean age of the patients was 45.72 (SD 14.26) years. There was male preponderance (66%) with male to female ratio of 1.9:1. In our study, the most common aetiology of peritonitis was duodenal perforation seen in 70% of patients, followed by gastric perforation (13%), ileal (12%), jejunal (3%) and appendicular perforation (2%). CONCLUSION Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. MPI scoring system is the easiest score to apply. It helps in the determination of the risk during operation and also helps the surgeon know about the possible outcome and the appropriate management. MPI is more effective in predicting the mortality in peritonitis due to hollow viscus perforation.
Neonates born with critical duct dependent congenital heart diseases acutely deteriorate in first few days after birth when physiological conduits which allow for mixing blood close. Balloon Atrial septostomy is performed on emergency basis in such neonates to create a right to left intracardiac shunt, until a definitive surgery is performed, but requires a cardiac intervention setup. In settings where advanced cardiac interventions are not available, we propose an alternative approach for atrial septostomy using nasogastric feeding tube through umbilical venous route, under echocardiographic guidance. Feeding tube gradually inserted into the umbilical vein, reaches the right atrium, following which it is thrust into the atrial septum at the location of foramen ovale, perforating it to create an emergency conduit between the atria. We performed the above procedure in a neonate with dTGA at our NICU setup, with partially successful outcome. We propose this method as an alternative, safe, simple and cost effective procedure, though not definitive, in resource limited settings for emergency stabilisation of neonates with critical duct dependent heart defects.
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