Objective:To evaluate pre-operative implications, anesthetic management and post-operative anesthetic concerns in patientswith co-morbid diseases undergoing ambulatory laparoscopic cholecystectomy under general anesthesia. Study Design and setting:Retrospective study was conducted at Rawal Institute of Health Sciences, Islamabad from 8thOct 2017 to 5th Nov 2018. Methodology:Total one hundred and twelve patients were placed in American society of Anaesthesiologist (ASA) classII, III & IV (medically optimized) on pre-operative evaluation for ambulatory laparoscopic cholecystectomy. Generalanesthesia was administered with co-induction (nalbuphine 0.1mg/kg plus midazolam 0.01mg/kg) tracheal intubationfacilitated by 0.15mg/kg cis-atracurium. Post-operatively on clinical status evaluation and Post Anesthesia Discharge score,patients were shifted to respective ward /intensive care. Statistical analysis was done by SPSS v.21. Results:Pre-operatively medical and cardiologist evaluation was taken in 34(30.35%) and 42(37.5%) cases respectivelywhereas consultant anesthesiologist reviewed all cases. In study single case was converted to open method due to mirrizisyndrome and adhesions creating difficult laparoscopic dissection in 9(8.03%) of cases. Post-operatively in single caseatrial fibrillation with fast ventricular response noted followed by sudden bradycardia, managed and sinus rhythm restored,whereas in other case of ischemic heart disease with viral respiratory infection, needed ventilatory support after 2 hoursdue to respiratory distress and weaned off after 24hrs. In the study 76(67.9%) cases were shifted post-operatively to surgical ward and 36 cases (32.1%) needed intensive care treatment. Conclusion:Laparoscopic cholecystectomy in patients with co-morbid states requires balanced anesthetic technique considering consequences of pneumoperitoneum to decrease morbidity.
Spinal anesthesia is frequently used in pregnant female undergoing caesarean section due to its safety than general anaesthesia. Post dural puncture headache (PDPH) is commonly occurring problem associated with spinal anaesthesia and causes a considerable morbidity. PDPH depends on several factor and various methods have been used to reduce and treat the pain of PDPH. We evaluated effects of hydrocortisone on the treatment of PDPH in obstetrical patient. To compare mean decrease in Visual Analogue Scalepain score in patients who developed PDPH after elective caesarean section under spinal anaesthesia who were given conventional treatment versus conventional treatment plus hydrocortisone. Double blind randomized control trial. Study conducted in department of anaesthesia and obstetrics of Allama Iqbal Medical College, Jinnah hospital (tertiary care) conducted from13th June 2014 to 13th December 2014. Sample size was calculated 60 (30 each) cases using 95% confidence interval, 80% power of test. Patients who developed PDPH after spinal anaesthesia for elective caesarean section were divided into 2 group; Group A (Conventional Treatment) and Group B, (Conventional Treatment plus Hydrocortisone 100mg 8 hourly for 48 hours). Details were recorded regarding age; mean pretreatment and post treatment VAS after 6 hours. Mean decrease in pain VAS score was 3.30 + 1.2 in group A while 7.17+ 1.3 in group B. (P value 0.001). Intravenous hydrocortisone is more effective in reducing post dural puncture headache pain severity after spinal anaesthesia for elective caesarean section when given along with conventional treatment as compared to conventional treatment alone.
The usage of Propofol is the most common method for the sake of insertion of I-Gel. But when propofol is used it may cause serious problems like swelling or inflammation at the injection site, low blood pressure, and apnea. There is a need to find another better method for providing anesthetics during the insertion of I-Gel. Objective: To find out the effects of two anaesthetics propofol and sevoflurane during the insertion of I-Gel. Methods: For the sake of the study a group of 66 patients were selected. All of these patients have to go under some surgeries using commonly available an aesthetics. The patients were divided into two groups 33 patients in each group. One group received Propofol before surgery and the other group receive sevoflurane. Then after the insertion of I –Gel, patients were analyzed in detail for all the changes that took place. Results: After the insertion of I-Gel, all the physical changes of the patients were analyzed in detail. Both of the study groups were given different drugs, but after surgery, no difference was observed between two groups having different an aesthetic. Both of the group have same heart rate, blood pressure and other insertion details except that Sevoflurane need much time to perform it’s an aesthetic function as compared to Propofol. Conclusion: After all these experiments, it is inferred that, when the effects of both drugs were compared, Sevoflurance has stability in the case of hemodynamics, it can replace propofol in a number of procedures due to its stability. Propofol does not have so much hemodynamic stability. But when I-Gel insertion has to be performed, Propofol has a better rate of induction as compared to sevoflurane.
Objective: The objective of this analysis was to govern the analgesic effect of tramadol with caudal bupivacaine in children enduring inguinal-scrotal surgery postoperatively. Study design: A Quasi experimental study. Methods: In this comparative and double-blind study, 120 children undergoing inguinal scrotal surgery were involved in the analysis. They were 2-12 years old. The inclusion standards were children from ASA I and II. The two identical groups were formed. After initiation of general anesthesia, group A patients (n = 60) 0.25% bupivacaine 0.75 ml / kg was administered and tramadol 1 mg / kg with 0.25% bupivacaine 0.75 ml / kg were administered in B group (n = 60). Postoperative pain was evaluated with a visual analogue pain score in 6-7 years of age children and with behavioural reflexion in pre-speech children. Using a 4-point sedation scale; Sedation was assessed; heart rate, mean arterial pressure, arterial oxygen saturation and respiration rate. The sedation and pain were documented at consistent duration up to 24 hours after surgery immediately after recovery from anesthesia. If the pain score was higher than 4, paracetamol (20 mg / kg) was administered rectally. Results: Addition of intravenous bupivacaine and tramadol suggestively have longer postoperative analgesia (10.1 ± 2.1 hours) in group B, while the mean duration of analgesia (2.90 ± 0.79 hours) in group A, where bupivacaine alone was, provided. No significant changes were observed in blood pressure, O2 saturation and heart rate between groups. Apart from vomiting and nausea, no side effects like retention of urine, depression and pruritus were observed. Conclusion: In children undergoing inguinal scrotal surgery, caudal bupivacaine and tramadol have more lasting and better postoperative analgesia than bupivacaine alone. Keywords: Postoperative analgesia, tramadol, Caudal and bupivacaine.
Objective: To assess the effect of pregabalin in reducing the postoperative requirement of analgesics of patient undergoing knee arthroscopic anterior cruciate ligament repair surgery. Study Design: Prospective randomized control trial. Place and Duration of Study: Department of Anesthesia, Ghurki Trust Teaching Hospital Lahore from 1st June 2021 to 31st December 2021. Methodology: Eighty patients were randomly divided into two groups; group A and group B, each group comprised 40. Group A receive placebo and group B receive pregabalin 150mg once a day for two days after surgery. Pain assessment done with the help of Numeric Rating Scale and rescue analgesia was recorded. Results: The mean age was 31±10.2 years of group A and 33±10.3 year of Group B. There were more males within both groups in comparison to females with a percentage of 77.5% and 85% respectively. The reduction was seen within Group B in comparison of Group A in terms of ASA class, VNRS, and maximum sensory block. Cumulative volume of PCA in ml was also less in group B than group A with a significant difference within 0-6 hours. Conclusions: The use of pregabalin 150mg after surgery for two days significantly reduces the analgesic consumption Keywords: Pregabalin, Postoperative analgesic, Numeric rating scale
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