Objective: To ascertain the frequency and risk factors for post-operative surgical site infection (SSI) in cesarean section. Study Design: Cross-sectional study. Setting: Departments of Gynecology & Obstetrics and Anesthesiology, Secondary Care Hospital. Period: January to December 2017. Material & Methods: After the approval of hospital ethical committee, 337 parturient who underwent cesarean section were included in our study. Outcomes were: frequency and risk factors for post-cesarean wound infection. Data was analyzed by SPSS version 20. Qualitative data presented as frequency and percentage. Chi-square (Fishers test) used to analyze significance. P-value ≤ 0.05 taken as significant. Results: A total of 337 patients were included in our final analysis. The frequency of wound infection was 15 (4.4%). The mean age was 27.5 years ± 5.8 in our study population. There was no difference in age (p=0.781), parity (p=0.898), antenatal visits (p=0.319), referral from doctor (p=0.205), anemia (p=0.731), nature of surgery (elective or emergency LSCS) p=0.548, severity of anemia (p=0.962), blood grouping Rh-factor (p=0.531), chorioamnionitis (p=0.707), labor (p=0.955), premature rupture of membrane (p=0.427) and antepartum hemorrhage (p=0.769). 11 (3.3%) of the patients with SSI were treated conservatively while 4 (1.2%) required debridement and secondary suturing. None of our patients required referral to tertiary care hospital for treatment of SSI. Conclusion: The incidence of SSI after cesarean section was less in our study and we didn’t find maternal age, gestational age, previous cesareans delivery, antenatal visits, PROM, labor before LSCS, anemia to be associated with risk of SSI.
We present a case of large multinodular goiter with retrosternal extension scheduled for thyroidectomy under general anesthesia (GA). We anticipated difficult airway due to tracheal compression as well as perioperative hemodynamic instability. She had had hyperthyroidism previously, which had been treated successfully. We planned and prepared to encounter airway problems in the light of Difficult Airway Society guidelines. After counselling and consent, her upper airways were sprayed with local anesthetic solution. Awake, flexible fiberoptic nasal intubation was performed and GA was induced. She had two episodes of bradycardia and hypotension peri-operatively, which were treated with inj atropine. Tracheostomy was performed in anticipation of tracheomalacia, which was de-cannulated on 3rd postoperative day. She was discharged on 4th post-operative day.Citation: Ikram M, Mahboob S. Anesthetic challenges in a large multinodular thyroidectomy at a peripheral hospital. Anaesth pain & intensive care 2019;23(3):311- 313
Objective: To assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. Study Design: Double blind study. Duration of Study: This study was of six months duration and was carried out from March 2004 to September 2004. Setting: Combined Military Hospital Kharian. Patients and Methods: One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawalmovements of the arm were studied. Results: Out of total of 120 patients, only 17 patients (14%) developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 patients out of 60 patients had withdrawal movements while in Group B, who received normal saline as pre-treatment fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Conclusions: Pretreatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium.
Objective: To evaluate the frequency of Hepatitis B and Hepatitis C on our surgical patients and its impact on operation theater delay, change of anesthesia plan and requirement of perioperative blood and blood products transfusion. Study Design: Cross sectional, analytical study. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital, Okara, from Apr to Sep 2019. Methodology: After the approval of the hospital ethical review committee, 154 patients with either Hepatitis B or Hepatitis C undergoing various surgeries were included in our study. Data was analyzed using SPSS-20. Results: The overall frequency of chronic liver disease was 154 (4.71%). A total of 23 (0.70%) were found to be seropositive as viral Hepatitis B and 127 (3.88%) as Hepatitis C; whereas 4 (0.12%) patients were diagnosed to have both virus serology positive. There was mean delay of 26.2 ± 8.29 minutes in 78 (52%) patients. The anesthetist had to change the plan of anesthesia for only 1 (0.7%) patient. There was also no difference in frequency of change of anesthesia plan (p=0.35); delay in surgery (p=0.16) and blood transfusion between the patients with Hepatitis B or Hepatitis C infection (p=0.72). Conclusion: The frequency of Hepatitis B and Hepatitis C was lower (4.71%) in our surgical patients with no effect of Hepatitis B and Hepatitis C on blood loss, peri-operative transfusion, delay in surgery or change in anesthesia plan.
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