Purpose: to study the analgesic ef¿ cacy of intraperitoneal and periportal injection of bupivacaine following laparoscopic cholecystectomy. Materials and methods: 40 patients undergoing laparoscopic cholecystectomy were randomized into two groups of 20 each. Group A (study group) received 40 ml of intraperitoneal injection of 0.25% bupivacaine and 20 ml of same concentration in 4 ports, 5 ml each at the end of surgery. Group B (control) received no treatment. Post operative patient monitoring and pain assessment was done by another doctor blinded to the procedure using VAS score at 1,2,3,6,9 and 24 hours after surgery. Pethidine 50 mg intramuscular was given as rescue analgesic when demanded by patient within ¿ rst 24 hours. Results: when VAS score was analyzed in the two groups, the study group had less scores compared to control group though it was statistically not signi¿ cant (p>0.05). The rescue analgesic requirement was signi¿ cantly less in study group (p<0.00). Conclusion: Intraperitoneal and periportal injection of bupivacaine is effective in decreasing pain after laparoscopic cholecystectomy.
This study was conducted from a behaviour change perspective to assess the association between the constructs of Health Belief Model and enrolment in health insurance (HI).A cross-sectional study was conducted among 810 households in Kailali and Baglung districts. The study used personal interviews to collect data. Perceived susceptibility, severity of diseases, benefits of enrolment, causes of non-enrolment, interaction with peers/neighbours, and family member's approval to enrol were independent variables and enrolment in HI served as dependent variable. More than half (52%) of the respondents evaluated themselves as not susceptible to health problems. The severity of the health problem was perceived as an economic burden. General treatment
Introduction: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery. Methods: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2 and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups. Results: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups. Conclusions: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation. Keywords: I gel; Laparoscopic cholecystectomy; positive pressure ventilation; tracheal intubation.
Background: Despite use of adequate medications and techniques, tracheal intubation induces haemodynamic stress response, which can be minimized by using supraglottic airway devices instead of tracheal tube in elective surgical cases with adequate oxygenation and ventilation. Objectives: To compare haemodynamic variables and ventilation parameters of I-gel and laryngeal mask airway with tracheal intubation during laparoscopic surgery. Methods: This is a prospective randomized comparative study among 90 cases of American Society of Anesthesiologists physical status class I and II, undergoing laparoscopic cholecystectomy, who were equally divided into three groups of 30 patients each: I-gel group, Laryngeal mask airway group and Tracheal tube group. Randomization was done with pick up of cards from sealed envelope. Basal readings of heart rate, systolic, diastolic and mean arterial pressure were recorded and these parameters were measured again before airway device placement, one, three and fi ve minutes after airway manipulation, during carboperitoneum creation and before and after extubation. Oxygen saturation, end tidal CO 2 , airway pressure and inhaled and exhaled tidal volume and minute volume were monitored before, during and after carboperitoneum creation. Leak volume was calculated by deducing exhaled tidal volume from inhaled tidal volume. Statistical analysis (Analysis of variance test) was done to see the differences among the groups. Results: Haemodynamic perturbations were maximum with tracheal intubation and moderate with laryngeal mask airway while stable haemodynamics was observed with I-gel. Intra and inter-group comparison revealed signifi cant differences after use of airway devices and after removal as well. Regarding ventilatory response, oxygenation and ventilation was well maintained with maximum airway pressure of mean ± SD: 20.11 ±3.46, 20.24 ±4.42, 19.05±4.82 cmH 2 O during carboperitoneum creation in I-gel, laryngeal mask airway and tracheal tube group respectively and oxygen saturation of 98 to 100% and end tidal CO 2 level of 31-35 mmHg. In all groups, minute volume was well maintained and leak volume of 18.88±12.40, 17.13±13.32 and 20.89±12.20 ml were recorded in I-gel, laryngeal mask airway and tracheal tube group respectively during carboperitoneum creation. There was no statistically signifi cant difference among the groups at any time regarding the monitored parameters. Conclusion: Among the three airway management devices used during general anaesthesia with positive pressure ventilation, I-gel produced least haemodynamic stress response, both supraglottic devices can be used with proper size and placement with acceptable haemodynamics and ventilation during laparoscopic surgery.
Exposure to mass media plays a crucial role in behavior change or decision‐making. The study used a cross‐sectional survey design. A total of 810 households were randomly selected for data collection by using a validated interview schedule. The study examined exposure to radio, television (TV), hoarding boards (billboards), newspapers, and brochures, pamphlets, and posters as media platform “independent variables” and enrollment in health insurance (HI) as the “dependent variable.” Data showed that 60% of the respondents had exposure to HI information with electronic (radio and TV) media and 33% had exposure via printed or displayed media. All these media were significantly associated with enrollment in HI. But exposure to HI‐related information from radio (adjusted odds ratio [aOR] = 1.91, 95% confidence interval [CI] = 1.39–2.61, p < 0.001), TV (aOR = 1.72, 95% CI = 1.25–2.38, p < 0.01), and hoarding board (billboard) (aOR = 1.87, 95% CI = 1.25–2.81, p < 0.01) were the significant predictor for enrollment in HI. The study findings suggest that it would be best to consider the use of these predictor communication channels when making strategic communication plans to promote HI enrollment in Nepal.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.