Background and Aim: During anesthesia, hypertension is the most common additional risk factor that contributes to higher mortality rate. Antihypertension medicine’s withdrawal might leads to symptoms such as anxiety, rebound hypertension, myocardial infarction, tachyarrhythmia, angina exaggeration, and sudden death. The present study aimed to assess the perioperative management of blood pressure and effects of anesthesia in hypertensive patients undergoing general and orthopedic surgery. Patients and Methods: This cross-sectional study was carried out on 162 hypertensive patients in the General Surgery and Orthopedics Units of Khyber Teaching Hospital, Peshawar for the duration from April 2022 to September 2022. Study protocol was approved by institute ethical committee. Patients aged 16 to 70 years of either gender underwent general surgery and orthopaedic surgery were enrolled. The data was acquired during the anesthetist’s initial visit to the operated hypertensive patients' 24 hour postoperative period. Antihypertensive medications, hemodynamics, anesthesia drugs, fluid use, and blood loss were main variables noted. Heart rate, systolic blood pressure, and diastolic blood pressure were Intraoperative hemodynamics. SPSS version 27 was used for data analysis. Results: Of the total 162 hypertensive patients, there were 68 (42%) male and 94 (58%) females. The overall mean age was 58.62±8.4 years. Before surgery, about 119 (73.5%) patients took antihypertensive medication whereas 124 (76.5%) had antihypertensive medication within 24 hours. The most prevalent antihypertensive medication used and most common class during postoperative management was Calcium channel Blockers and Amlodipine. The most prevalent used anesthetic drug use was Bupivacaine. The incidence of Systolic Blood Pressure (SBP) fall and rise was found in 28 and 6 patients respectively. The incidence of Diastolic Blood Pressure (DBP) fall and rise during intraoperative management was 11 and 8 patient respectively. Conclusion: The present study found that a decreased heart rate in patients who were taking beta blockers consistently. Those who took diuretics had greater DBP and HR at the completion of the procedure. There was no significant change in hemodynamic parameters with any other antihypertensive treatment. Keywords: Hypertension, General Surgery, Orthopaedic, Hemodynamics
Background and Aim: Most primary renal neoplasms are caused by renal cell carcinomas (RCCs). There is a high risk of morbidity and mortality following radical nephrectomy due to acute kidney injury (AKI). It is crucial to detect and prevent this complication as early as possible. The present study aimed to anesthesia comparison after radical nephrectomy for kids: a study with different anesthesia techniques. Patients and Methods: This retrospective study was carried out on 84 children of the age up to 12 years undergoing radical nephrectomy in the department of Anaesthesiology, Chaudhary Muhammad Akram Hospital (CMA) Lahore during three years, from August 2019 to July 2022. Prior to study conduction, ethical approval was taken from research and ethical committee. Patients were allocated to three different groups: Group-D (Dexmedetomidine group), Group-C (Caudal group), and Group-P (Placebo group). Children were evaluated by taking history, physical examination, and laboratory examinations such as liver function, CBC, kidney functions, and coagulation profile. SPSS version 28 was used for data analysis. Results: A total of 84 children investigated with different anesthesia techniques. Each group was assigned 28 children undergoing radical nephrectomy. A significant difference did not appear between the three groups in terms of serum creatinine at any of the times of measurement. Group D showed significant lower values for cystatin C and NGAL compared with group C and group P regardless of the measurement period. In all three studied groups, there were no significant differences in age, gender, or weight of the patients (p> 0.05). Comparatively to the other two groups, the Dex Group had significantly higher urine output, more sedation, and lower objective pain scores. Conclusion: Clinical prediction schemes using cystatin C and NGAL biomarkers showed that dexmedetomidine prevents AKI in children undergoing renal replacement therapy. The Dex Group had significantly higher urine output, more sedation, and lower objective pain scores as compare to the other two groups. Furthermore, dexmedetomidine provides renal protection and sedation as well as analgesia. Keywords: Radical nephrectomy; Dexmedetomidine; Cystatin C; Children
Background: Post-operative pain is one of the common concerns in all the surgical interventions including gynecological surgeries. There is always a need for the agent with better efficacy and minimal side effect profiles. Aim: To compare the mean postoperative pain score between intravenous Paracetamol vs intravenous ketorolac among patients undergoing gynecological abdominal surgery Study design: Randomized Controlled Trial Setting & duration: Department of Anesthesia, Hameed Latif Hospital, Lahore from 12-06-2018 to 12-12-2018 Methodology: In this study, females with age 20 - 50 years with ASA I and II undergoing gynecological abdominal surgery were included. Group A was administered with intravenous paracetamol and group B with ketorolac. Pain was measured in terms of mean of numerical rating scale recorded at 12 hours postoperatively. Results: In the present study there were total 80 cases included, 40 in each group. The mean age in group B was 37.66±12.67 years and in group A was 41.29±11.36 years Mean post operative pain score was 3.05±0.61vs 3.56±0.89 in group B and A with p= 0.04 Mean post operative pain was 3.04±0.61 vs 3.51±0.77 with p= 0.03 in cases with BMI > 25. There was no significant difference in terms of type of procedure and mean pain score in both groups. Conclusion: Ketorolac is significantly better than Paracetamol in gynecological abdominal surgeries and this difference is also significantly better in cases with BMI > 25. Keywords: Pain, ketorolac, paracetamol, BMI
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