Post-operative nausea and vomiting (PONV) are common complications in patients undergoing major abdominal surgery, with reported frequencies of up to 54% for vomiting and 71% for nausea. PONV, typically within the first 24 hours after surgery, can result in significant morbidity, unexpected hospital admissions, reduced patient comfort, prolonged hospital stays, and increased healthcare costs. The aim of this institutional-based randomized controlled study, conducted at Aziz Bhatti Teaching Hospital in Gujarat from March 2022 to March 2023, was to assess the efficacy of dexamethasone alone and in combination with metoclopramide in preventing post-operative nausea and vomiting in patients undergoing abdominal surgery. One hundred fifty patients aged 18 to 65 who were scheduled for abdominal surgeries were recruited for this study. The patients were randomly assigned to three treatment groups: Group P (placebo), Group D (dexamethasone), and Group DM (dexamethasone and metoclopramide). Data analysis was performed using SPSS version 21, with the one-way ANOVA test used for continuous variables and the Chi-Square test employed for categorical data. A p-value of less than 0.05 was considered statistically significant. The results revealed that the overall incidence of PONV was 62% in the placebo group, 26% in the dexamethasone group, and 14% in the dexamethasone plus metoclopramide group. Significantly fewer patients in the dexamethasone + metoclopramide group (p < 0.05 compared to Group P) and only one patient in the dexamethasone group (p < 0.05 compared to Group P) required rescue antiemetic medication, whereas 8 patients in the placebo group required such treatment. Pain scores, time to first analgesic request, and adverse effects were comparable across all treatment groups. In conclusion, the combination of dexamethasone and metoclopramide demonstrated superior efficacy in preventing PONV compared to dexamethasone alone.
This study aimed to assess the prophylactic efficacy of Tramadol and Dexamethasone in preventing shivering following spinal anesthesia. A total of 162 patients aged 18 to 60, with ASA physical status I or II, undergoing various surgical procedures, were randomly assigned to receive intravenous normal saline (Group C), intravenous tramadol at a dose of 1 mg/kg (Group T), or intravenous dexamethasone at a dose of 0.1 mg/kg (Group D). The occurrence of shivering, its impact, and the onset of dizziness, nausea, and perspiration were documented. Baseline demographics, body temperature, type of operation, sensory blockade level, duration of surgery, and anesthesia were comparable among patients. Shivering was observed in 42 out of 162 patients (25.92%). Shivering occurred in 24 patients in the placebo group, 11 in Group D, and 7 in Group T. A statistically significant difference was found between Group T and Group C (p = 0.004). However, there was no significant difference between Group T and Group D (p = 0.771). Hallucination was reported in 1 patient (1.85%) in Group T. In conclusion, tramadol at a dose of 1 mg/kg effectively reduces shivering induced by spinal anesthesia compared to a placebo. Nevertheless, our study did not find a statistically significant difference between intravenous tramadol at 1 mg/kg and intravenous Dexamethasone at 0.1 mg/kg.
Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them. Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded. Results: Nasal and periorbital region defects were present in twenty-one and two patients respectively.13 had full thickness nasal defects, 14 had BCC while SCC in 2 patients. Reconstruction was performed in multiple stages except in three patients. Expanded forehead flap was used in four, subcutaneously islanded pedicle forehead and flap prefabricated forehead flaps in three each, split forehead and delayed reconstruction in two patients each. No total loss of flap was observed except in one folded forehead flap where partial distal one cmnecrosed; one patient with expanded forehead flap required revision due to flap contraction. Conclusions: Modifications of Paramedian forehead flap appear reliable, versatile and excellent tool for nasal and periorbital reconstruction. Judicious modifications of flap de-sign as per indication can give satisfactory results with minimal complications by following the techniques mentioned in literature.
Post-Dural puncture headache (PDPH) is a distressing complication that can occur following a dural puncture during spinal anesthesia. It is believed to arise from cerebrospinal fluid leakage and subsequent reflex cerebral vasodilation. Notably, PDPH occurs more frequently in young parturient women undergoing Caesarean sections. This study aims to evaluate the frequency of PDPH in patients undergoing elective Caesarean delivery, comparing the use of 25G and 27G Quincke spinal needles during spinal anesthesia. A randomized controlled trial was conducted at Aziz Bhatti Shaheed Teaching Hospital's anesthesiology department in Gujrat from March 2022 to March 2023. A total of 140 parturient women with an American Society of Anesthesiologists (ASA) physical status classification of I to II, who underwent Caesarean sections, were included in the study. Exclusion criteria encompassed patients with infection at the injection site, severe hypervolemia, coagulopathy, increased intracranial pressure, severe aortic and mitral stenosis, severe preeclampsia, placenta previa grade–IV, placenta accreta, and twin pregnancy. The participants were divided into groups (Group I and Group II), each comprising 70 individuals. Spinal anesthesia was administered in the sitting posture using 25G Quincke spinal needles for Group I and 27G Quincke spinal needles for Group II. The puncture sites were the L3-4 or L4-5 intervertebral spaces. The incidence of PDPH was evaluated at 6, 12, 24, and 48 hours following the surgical procedure. Quantitative data, such as age, were presented as mean ± SD, while qualitative data were reported as frequency and percentages. Statistical significance was defined as a P-value < 0.05. The age range of the patients included in the study was 18 to 40 years. The mean age of patients in Group I was 26.12 ± 5.82 years, while in Group II, it was 26.34 ± 5.30 years. Eleven patients (15.71%) in Group I experienced PDPH, unlike three (4.28%) in Group II. The difference in PDPH incidence between the two groups was statistically significant (p = 0.031). Our findings indicate that using a 27G Quincke spinal needle for spinal anesthesia during Caesarean sections confers a distinct advantage in reducing PDPH occurrence compared to the 25G Quincke spinal needle. The results strongly support the superiority of the 27G Quincke spinal needle in minimizing the occurrence of PDPH.
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