Objective: To determine the role of betamethasone gel and lidocaine jelly on reducing the post-operative airway complications related to tracheal tube. Study Design: Comparative prospective study. Place and Duration of Study: Department of Anesthesia, Liaquat National Hospital, from Jul 2019 to Jan 2020. Methodology: A total of 150 patients were randomly assigned into three different groups; group-B (0.05% betamethasone gel), group-L (tube lubricated with 2% lidocaine jelly) and group-C (intubated with un-lubricated tubes). Patients were assigned by using lottery method, which was carried out by a research assistant who was not involved in the study. There were 50 patients in each group. Results: Post-operative sore throat and post-extubation cough at 24-hours were statistically insignificant (p>0.05) between groups while hoarseness of voice at 24-hours postoperatively was significant (p<0.05) in all the groups. The overall difference for severity of postoperative sore throat, hoarseness of voice and post-extubation cough at24 hours in the groups B, L, and C were statistically significant (<0.05). Conclusion: The application of betamethasone gel on endotracheal tube before intubation reduces the post-extubation cough, severity of post-operative sore throat, hoarseness of voice and post-extubation cough in comparison with the application of lidocaine jelly and un-lubricated ETT.
Background: Intra-thecal anaesthesia is the commonly preferred, block for surgeries of lower abdomen, perineal and lower limb. It is easy to administer and very economical but needs skills. Intrathecal use of local anaesthetics possesses a short duration of action and needs early use of rescue analgesia postoperatively. Objective was to assess the efficacy of Dexmedetomidine in adjuvant with bupivacaine for neuraxial anesthesia and postoperative analgesic characteristics. It was a prospective comparative study, conducted at Anesthesia Department, Liaquat National Hospital, Karachi from January to July 2020. Methods: Overall 100 patients conveniently recruited who underwent lower abdominal procedures were allocated into two groups’ by randomization, i.e., 50 in each group and were labeled as Group N and Group D10. Group N consist of 0.5% bupivacaine 10 mg (2 ml) + diluted with 0.5ml normal saline dilution and group D10 consist of 10μg Dexmedetomidine + 0.5% bupivacaine 10 mg (2ml) with 0.5 ml normal saline dilution, total 2.5 ml dose in each group. The duration of block and regression was evaluated. Results: The study showed significant differences in sensory and motor block to reach T10 and Bromage 3 respectively. Patients who were assigned in Group D reported short onset of sensory to reach T10 (5.4±1.17) and motor to reach Bromage 3 (10.4±1.03) as compared to Group N (9.9±2.12 and 17±22) respectively. Participants of Group D required rescue analgesia in less amount throughout intervals as compare to group N. Conclusion: The usage of 10ug Dexmedetomidine adjuvant with 0.5% bupivacaine significantly reduced the onset on sensory T10 and motor Bromage 3 and also prolong duration of sensory and motor regression, moreover minimal adverse effects and less use of rescue analgesic drugs were observed.
Introduction: Chondrosarcoma is a well defined tumor of soft tissue with calcification. Extraskeletal myxoid chondrosarcoma is an unusual sarcoma of soft tissue adding only 3% to all soft tissue tumors. Majority of mediastinal foci originates from variety of tissues, the reason being their diverse embryological and anatomical approximations. Chondrosarcomas are more common in males with 2: 1 male to female ratio. The exact pathology of these tumors is unclear; however recent data ensures that these tumors have multidirectional delineation. Classical histopathological features of chondrosarcoma include S-100 positivity, EMA positivity. These features of Immunohistochemical favor extra skeletal myxoid chondrosarcoma. Case Report: Recent data signifies that the tumor is known for its rare occurrence, here we have reported a unique case of 40 years old male visited Abbasi Shaheed Hospital for pre employment checkup without any symptoms. All the tests were negative except Chest Xray PA view which revealed dense mass on lower lobe of lung. For further evaluation, CT scan of chest with contrast was ordered and eventually the mass was resected surgically. On the basis of macro and microscopic findings, histopathological tests and immunohistochemical stains, the mass was found to be chondrosarcoma with myxoid origin. This tumor has to be distinguishing among the list of different diseases like hamartoma, hydatid cyst, and neuroendocrine tumors for the differential diagnosis of the case. Conclusion: Our paper reports an extraskeletal mesenchymal chondrosarcoma originating in the posterior mediastinum with a rare presentation.
Myasthenia gravis (MG) is a chronic autoimmune disease in which autoantibodies destroy acetylcholine receptors at motor end plat of neuromuscular junction which prevent skeletal muscle depolarization and contraction, causes muscle weakness and tiredness upon exertion with a tendency to be subsided after taking some rest or after taking anticholinesterase medication. Symptoms of progression of MG include the involvement of upper and lower extremities and muscle weakness that leads to inability in doing basic motor functions. The diagnosis of myasthenia gravis includes sign and symptoms, clinical examination and laboratory investigation of serum autoantibody (AChR autoantibodies) implicated in the disease pathology. Surgical procedures under general anesthesia in a patient with MG could be very challenging for an anesthetist because of pathophysiological manifestations of the disease. We report a case of a patient undergoing 4 level spinal fixation with coexistent myasthenia gravis (according to Osserman II B), requiring general anesthesia for spinal surgery in prone position. Myasthenia gravis affects the neuromuscular junction that is why it has a great significance of interest for the anesthetist.
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