Background:Perforation peritonitis continues to be one of the most common surgical emergencies that need a surgical intervention most of the times. Anesthesiologists are invariably involved in managing such cases efficiently in perioperative period.Aims:The assessment and evaluation of Acute Physiology and Chronic Health Evaluation II (APACHE II) score at presentation and 24 h after goal-directed optimization, administration of empirical broad-spectrum antibiotics, and definitive source control postoperatively. Outcome assessment in terms of duration of hospital stay and mortality in with or without optimization was also measured.Settings/Design:It is a prospective, randomized, double-blind controlled study in hospital setting.Materials and Methods:One hundred and one patients aged ≥18 years, of the American Society of Anesthesiologists physical Status I and II (E) with clinical diagnosis of perforation peritonitis posted for surgery were enrolled. Enrolled patients were randomly divided into two groups. Group A is optimized by goal-directed optimization protocol in the preoperative holding room by anesthesiology residents whereas in Group S, managed by surgery residents in the surgical wards without any fixed algorithm. The assessment of APACHE II score was done as a first step on admission and 24 h postoperatively. Duration of hospital stay and mortality in both the groups were also measured and compared.Statistical Analysis:Categorical data are presented as frequency counts (percent) and compared using the Chi-square or Fisher's exact test. The statistical significance for categorical variables was determined by Chi-square analysis. For continuous variables, a two-sample t-test was applied.Results:The mean APACHE II score on admission in case and control groups was comparable. Significant lowering of serial scores in case group was observed as compared to control group (P = 0.02). There was a significant lowering of mean duration of hospital stay seen in case group (9.8 ± 1.7 days) as compared to control group (P = 0.007). Furthermore, a significant decline in death rate was noted in case group as compared to control group (P = 0.03).Conclusion:Goal-directed optimized patients with perforation peritonitis were discharged early as compared to control group with significantly lesser mortality as compared with randomly optimized patients in the perioperative period.
Background: Postoperative nausea and vomiting (PONV) is common complication after general anesthesia and surgery. This randomized double-blind study was designed to compare the effects of acupressure wrist bands and palonosetron for the prevention of post-operative nausea and vomiting (PONV) in laparoscopic cholecystectomy under general anaesthesia.Methods: Sixty ASA I and II patients undergoing elective laparoscopic surgeries under general anaesthesia were divided into two groups. In Group A patients, acupressure wrist bands were applied on p6 point on both hands half an hour before induction. Group P patients received inj. palonosetron 0.075 m.g. i.v. just before induction. Anaesthesia technique was standardized. Post-operatively patients were monitored for nausea, retching or vomiting upto 24 hours. If patients vomited more than once, they were given inj. Metoclopramide 10mg as rescue antiemetic. Efficacy of drugs was compared using Chi square test. ‘p’ value of <0.05 is considered significant.Results: The incidence of PONV and requirement of rescue antiemetic were lower in palonosetron group than acupressure wrist band group.Conclusions: Palonosetron is more effective than acupressure wrist band for prophylaxis of post- operative nausea and vomiting in the patients undergoing laparoscopic cholecystectomy under general anaesthesia, but acupressure wrist band can also be used as an alternative non-pharmacological method.
Survival after nylon rope suicidal hanging is a rare occurance. We describe here a patient who attempted suicide by nylon rope hanging and developed post obstructive pulmonary edema was managed successfully. Patient recovered completely with ventilatory support in next 60 hours without any neurological deficit.This case highlights an unusual complication of hanging and its recovery. KEYWORDS: Post obstructive pulmonary edema,cerebral edema, Nylon rope attempted suicidal hanging. KEYMESSAGES: Patient was lucky enough to be rescued and brought to the hospital early, even after nylon rope attempted suicidal hanging. Such cases need to be managed aggressively as there are chances of their complete recovery INTRODUCTION:Depression is increasing at an alarming rate globally. (1,2,3) Hanging is one of the oldest and common mode of suicide in the young adults. Death takes about 8-10 minutes in such cases. (4) The mortality and morbidity change dramatically if such patients are rescued early and managed aggressively, even in small ICUs. Here we report a case who presented in severe pulmonary and cerebral edema after attempted suicidal nylon rope hanging.
Background: Failure/delayed effect of spinal anesthesia were noted in several patients with past history of scorpion sting during routine practice. Scorpion venom is known to delay the activation of sodium neuronal channels. Local anesthetic agents also act through the sodium channels. Therefore this study was conducted to test the association of scorpion sting with failure/resistance to effect of spinal anesthesia. Methods: 40 patients in the age range of 18-80 years were divided into two equal groups. Group 1 with past history of one or multiple scorpion stings and group 2 with no such history. The anaesthetic management was identical i.e. subarachnoid block with 3.5 ml. 0.5% Bupivacaine heavy. The onset of sensory and motor block was noted. Peaks of sensory and motor blocks were also observed. Sensory block was assessed by pin prick method and motor block by Bromage scale. After waiting for 20 min, general anesthesia was administered if the block was inadequate. Results: The time of onset of sensory and motor block as well as the time for the peak of sensory and motor blocks was significantly prolonged in scorpion sting group. 5 patients had failed sensory and motor block. All the patients in control group had adequate subarachnoid block. Conclusion: There is a direct association between previous scorpion sting and development of resistance to the effect of spinal anesthesia.
Spinal anaesthesia is the most commonly used technique for lower limb orthopaedic surgery. Various drugs are being used as additive along with local anaesthetics agents in spinal anaesthesia for prolongation of intraoperative and post-operative analgesia. Dexmedetomidine is a highly selective alfa-2 adrenergic receptors agonist act on the dorsal horn of the spinal cord to prolonged the analgesic effects. AIM: Evaluate the effects of addition of 10μg of dexmedetomidine, to 2.5ml of 0.5% hyperbaric bupivacaine for spinal anaesthesia in lower limb orthopaedic surgeries. SETTING AND DESIGN: prospective, randomized, double blind study. METHODS AND MATERIAL: A study was carried out in 60 adult patients age between 20 and 60 years of age ASA grade I and II, scheduled for lower limb surgery under spinal anaesthesia. Patients were divided into 2 groups. Group DM received 2.5ml 0.5% hyperbaric bupivacaine along with 10μg dexmedetomidine in 0.5ml of normal saline and Group NS received 0.5% hyperbaric bupivacaine along with 0.5ml of normal saline intrathecally. The parameters assessed were the onset time, time to reach peak sensory level and regression time of sensory block, rescue analgesia, hemodynamic changes and side effects were recorded. Statistical analysis was done using appropriate tests. RESULT: Patients in dexmedetomidine group (Group DM) had a significantly longer sensory block than patients in bupivacaine group (Group NS). The mean time of sensory regression to S2 was (323±31 min) in group DM and (191±15min) in group NS. The time to rescue analgesia was significantly longer in group DM (383±38 min) as compared to group NS (228.6±15 min). CONCLUSIONS: The addition of dexmedetomidine to bupivacaine intrathecally produces a prolongation of sensory block duration and analgesic period.
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