Background Lumbar discectomy is most commonly performed under general anaesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anaesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under spinal anesthesia. Objective We have compared patient satisfaction between spinal versus general anaesthesia in patients for single level lumbar surgery. Methods Eighty consecutive patients of ASA grade I-II were recruited and randomized into two equal groups, with half of this patients receiving spinal anaesthesia (n-40) and the remainder general anaesthesia (n-40). A comprehensive postoperative evaluation was carried out documenting any anaesthetic complications, pace of physiological and functional recovery and patient satisfaction. Variables were recorded as pain level using a visual analogue scale (VAS) at 1, 6, 12 and 24 hours; patient level of satisfaction during the stay on the ward using verbal rating scale (VRS) as it was detected by A p-value < 0.05 were considered as significant. Results Spinal anaesthesia patients achieved the milestones of physiological and functional recovery more rapidly and reported less postoperative pain. Perioperative hypotension in 25 % of patients and none was hypertensive in spinal group and in G/A Group 05% of patients was hypotensive and 20% were hypertensive. Postoperative pain intensity more in G/A group than spinal group. Patient satisfaction in spinal group was more comparative to G/A group. Conclusion Spinal anaesthesia ensures better operating conditions, better postoperative pain control and a quicker postoperative recovery when compared to general anaesthesia for single level lumbar spine surgery DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18173 Journal of BSA, 2009; 23(2): 47-50
Complication during anaesthesia is inevitable but judicious start, vigilant monitoring, application of pharmacology can prevent or lessen it. Shivering is one of the complications of Subarachnoid block (SAB). To prevent shivering during SAB many techniques had so long been applied. Among them during shivering giving low dose intravenous Pethidine is so far popular in our country. As the drug is not available all the times due to legal restriction & our socioeconomic circumstances, so we studied with another opioid, Nalbuphine and has got an acceptable result which is equipotent and some where better than that of Pethidine. This randomized prospective study conducted in 60 ASA I, II patients, was designed to explore the efficacy and potency of Nalbuphine in comparison to Pethidine for shivering under subaracnoid block. Patient received Nalbuphine 5mg LV or Pethidine25mg after appearance of shivering. Disappearance and recurrence of shivering, as well as haemodynamics were observed at scheduled intervals. Onset of disappearance of shivering was found at 1 minute in Nalbuphine group (N) (p<0.05) and at 3 minutes in Pethidine group (P) (p <0.05). The complete disappearance of shivering took 5 minutes in N group and 20 minutes in P group. Thus Nalbuphine and Pethidine were equally efficacious, but Nalbuphine was more potent with respect to control of shivering and its recurrence. It was concluded that I.V Nalbuphine is qualitatively superior to Pethidine for control shivering. Key words: Shivering in SAB, Nalbuphine, Pethedine Journal of BSA, Vol. 20, No. 2, July 2007 p.66-69
Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. MethodsIn this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middleincome countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42•4% vs 44•2%; absolute difference -1•69 [-9•58 to 6•11] p=0•67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H 2 O; p=0•0011). ICU mortality was higher in MICs than in HICs (30•5% vs 19•9%; p=0•0004; adjusted effect 16•41% [95% CI 9•52-23•52]; p<0•0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0•80 [95% CI 0•75-0•86]; p<0•0001).Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status.
At present central neuroaxial blockade, e.g. subarachnoid blockade (SAB) or epidural blockade (EB), especially the former one, is widely used by the clinical anaesthesiologists due to its procedural simplicity, low cost & better physiological benefits and thus reduced complications than that of general anaesthesia (GA). Subarachnoid or epidural spaces can be traversed from the posterior aspect of the body either through a midline approach (MA) or a paramedian approach (PMA). There is another approach described as ‘lumbosacral puncture' or Taylor's approach, which actually is a variant of conventional paramedian approach. Theoretically, subarachnoid & epidural spaces can also be approached through the paravertebral foramen or even via an anterior intraoperative approach through the intervertebral discs1. The most common & popular technique is the MA. But the PMA (both conventional & Taylor's) is also a very easy & effective technique that can be practiced routinely as well as for some clearly indicated cases. The requirement for this procedure is the same as for the MA except having some ideas about the offmidline anatomy. Keywords: Blockade, subarachnoid; approach, paramedian. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.51-53
Introduction: Manual small incision cataract surgery (MSICS) is a cost-effective alternative to phacoemulsification cataract surgery for developing countries. This prospective study was carried out in Combined Military Hospital (CMH), Chittagong from October 2009 to March 2011 on 75 cataract patients who were operated by MSICS technique. Objectives: Aim of this study was to assess the visual outcome and complications of MSICS in a peripheral CMH. Methods: Seventy five cataract patients were operated by MSICS technique. All surgical procedures were performed by the principal author. Major per-operative and postoperative complications were documented. Visual outcome was assessed by Snellens visual acuity test 06 weeks after operation. Results: Uncorrected visual acuity (UCVA) was 6/6 6/18 in 57 (76.0%) patients, < 6/18 6/60 in 15 (20%) and < 6/60 in 03 (4.0%) patients. Best corrected visual acuity (BCVA) was 6/6-6/18 in 65 (86.7%) patients, < 6/18-6/60 in 07 (9.3%) and < 6/60 in 03(4.0%) patients. Visual outcome was good in 86.7% of patients according to World Health Orgnization (WHO) criteria and was not far away from the WHO expected outcome. Posterior capsule rupture was the most significant per-operative complication which was found in 7(9.3%) cases and surgically induced astigmatism was main postoperative complication that affected visual outcome. Mean postoperative astigmatism (against-the rule) was - 1.25DC. 14 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 Conclusion: MSICS is a safe and cost-effective technique of extra-capsular cataract extraction where surgical skill and experience of the surgeon plays a significant role in the result. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22895 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014
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