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 compare the intraoperative blood loss and adhesions, peri-operative blood and intravenous iron supplementation between hepatitis seropositive and seronegative pregnant women undergoing elective cesarean delivery. Study Design: Cross-sectional, analytical study. Place and Duration of Study: Departments of Anesthesiology and Gynecology & Obstetrics, Combine Military Hospital, Okara Cantt Pakistan, from Oct 2018 to Mar 2019. Methodology: After approval of the hospital ethical committee, 134 (n=67 in each Group) pregnant women were included in our study by convenient sampling. Patients were divided into two groups. Group-A included seronegative pregnant women, whereas Group-B were seropositive pregnant women. Results: There was no difference in the age (p=0.357), gravidity (p=0.159), parity (p=0.226) and the number of cesarean sections (p=0.475) between the two groups. There was no difference in the two groups regarding peri-operative haemoglobin change,with an insignificant reduction of 0.60±1.21 g/dL in Group-A versus a reduction of 0.50±1.08 g/dL in Group-B. A mild level of adhesion was observed intraoperatively in 26(35.6%) in Group-A versus 27(37.5%) in Group-B; p=0.170. Mild difficulty securing hemostasis was reported in 25(34.2%) vs 29(40.2%) patients; p=0.329. 61(83.5%) did not require a peri-operative blood transfusion in Group-A versus 59(81.9%) in Group-B; p=0.528. Conclusion: Our study has shown that the peri-operative haemoglobin level, blood product and intravenous iron supplementation, intra-operative adhesions encountered, and difficulty in hemostasis were comparable between sero-positive and sero-negative viral hepatitis pregnant women.
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.
Objective: Investigating the perinatal outcome in pregnant patients with oligohydramnios at term. Study Design: Prospective observational study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pakistan Naval Ship (PNS) Shifa Hospital Karachi, from Mar to Oct 2020. Methodology: The investigation comprised of 60 parturient ladies with gestational amenorrhoea of 37-42 weeks and no associated medical illnesses. Collection A consisted of 30 patients with maximum vertical pocket (MVP) <2cm or amniotic fluid index (AFI) ≤5cm. Collection B involved 30 pregnant women having normal amniotic fluid index >5cm. The 2 collections were tallied with respect to demographic characteristics and perinatal outcome particularly low birth weight, delivery mode, poor APGAR score, umbilical artery acidosis and meconium staining. Neonatal future stands upon evaluation of levels of lactate found in umbilical cord arterial blood. Results: According to our findings, commonest mode of childbirth 37 (61.7%) was Caesarean section. No statistical difference was found between the two aggregations of low weight at birth i.e. 4 (13.3%). Based on our study, meconium staining at birth was prevalent in 8 (13.3%) of neonates however no meconium aspiration was seen, umbilical artery acidosis was apparent in 27 (45%) and only 5 (8.3%) accounted for poor APGAR scores. Conclusion: Detrimental pregnancy aftermath and elevated perinatal morbidity correlates with oligohydramnios.
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