Abdul Quadir

Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature

We report two cases of gastrointestinal perforation by ventriculoperitoneal (VP) shunts and review the literature on the topic. The time interval between shunt surgery and detection of bowel perforation is minimum in infants and increases with age. Sigmoid and transverse colon followed by stomach are the most frequent sites of gastrointestinal perforations by VP shunts.

Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation

Objective: The present study compared the efficacy of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation. Design: Prospective, randomized, placebo controlled, double-blinded study. Setting: Operation room. Patients and Methods: 75 ASA physical status I and II adult patients, aged 18-45 years undergoing elective surgical procedures, requiring general anesthesia and orotracheal intubation. Interventions: Patients were allocated to any of the three groups (25 each)-Group C (control)10 ml 0.9% saline i.v. Group E (esmolol) 0.5 mg/kg diluted with 0.9% saline to 10 ml i.v. Group L (labetalol) 0.25 mg/kg diluted with 0.9% saline to 10 ml i.v. In the control group 10 ml of 0.9% saline was given both at 2 and 5 min prior to intubation. In the esmolol group 0.5 mg/kg of esmolol (diluted with 0.9% saline to 10 ml) was given 2 min prior and 10 ml of 0.9% saline 5 min prior to intubation. In the labetalol group 10 ml of 0.9% saline was administered 2 min prior and 0.25 mg/kg of labetalol (diluted with 0.9% saline to 10 ml) 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique. Measurements: Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP) and rate pressure product (RPP) were calculated. Abnormal ECG changes were also recorded. Results: Compared to placebo and esmolol (0.5 mg/kg), labetalol (0.25 mg/kg) significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant among the values for DBP and MAP. Conclusion: In lower doses, labetalol (0.25 mg/kg) is a better agent than esmolol (0.5 mg/kg) in attenuating the sympathomimetic response to laryngoscopy and intubation.

A comparison between EMLA cream application versus lidocaine infiltration for postoperative analgesia after inguinal herniotomy in children.

Background: EMLA cream (eutectic mixture of local anesthetics) has been shown to penetrate intact skin and provide analgesia of superficial layers. There are no studies on the effects of topical application of EMLA cream for postoperative pain relief after inguinal hernia repair. Objective: This randomized, double-blind, placebo-controlled study compared the efficacy of topical application of 5% EMLA cream before surgery, with wound infiltration with 1% lidocaine for postoperative analgesia in children. Methods: Ninety children, aged 4 to 12 years, undergoing elective inguinal hernia repair under general anesthesia were enrolled in the study. Patients were randomly assigned to receive either placebo cream (group1), 5% EMLA cream (group 2), or placebo cream followed by 0.5 mL/kg 1% lidocaine (group 3) in the wound after induction of anesthesia. The anesthetic technique and monitoring were standardized, and postoperative pain was assessed using a 10-point objective pain scale. Fentanyl was used as rescue analgesic in immediate postoperative period, and acetaminophen was administered for postoperative pain in surgical ward. Results: The number of patients requiring fentanyl in the immediate postoperative period was significantly less in the study groups compared with the placebo group. Sixty-seven percent of patients in the placebo group required more than 1 dose of acetaminophen in the first 6 hrs compared with 23% (EMLA group) and 20% (lidocaine group). Four patients (two in the lidocaine group, one in the EMLA group, and one in the control group) developed subcutaneous infection at the site of incision 10 to 15 days postoperatively. Conclusion: Topical application of EMLA (5%) provides postoperative analgesia comparable to infiltration with 1% lidocaine after inguinal hernia repair in children.

Ondansetron and dexamethasone in middle ear procedures

A randomised, double-blind study was conducted on 90 ASA I & II patients undergoing middle ear surgery to compare the efficacy of ondansetron, dexamethasone and a combination of Ondansett on+dexamethasone for the prevention of postoperative nausea and vomiting. Group I patients received ondansetron (0. 1 mg/kg), group IIpatients received dexamethasone(0.1z mg./Kg) while group III received ondansetron (0.1 mg./kg) + dexamethasone (0.15 mg/kg), 10 minute before induction of general anaesthesia. A standardised general anaesthetic technique was employed through out. A complete response, defined as no postoperative nausea and vomiting and no need for another rescue antiemetic during the first 4 hours after anaesthesia was achieved in 58%, 55% and 83% of patients who had received ondansetron, dexamethasone and ondansetron + dexamethasone respectively. The corresponding incidence during the next 20 hours after anaesthesia was 54%, 47% and 85%. No clinically important adverse effects were observed in any of the groups. We conclude that prophylactic therapy with ondansetron +dexamethasone,one is superior in the prevention of postoperative nausea and vomiting after middle ear surgery.

Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study

Background and Aims: Bupivacaine has been the most frequently used local anaesthetic in brachial plexus block, but ropivacaine has also been successfully tried in the recent past. It is less cardiotoxic, less arrhythmogenic, less toxic to the central nervous system than bupivacaine, and it has intrinsic vasoconstrictor property. The effects of clonidine have been studied in peripheral nerve blockade. The purpose of this study was to evaluate the effects of clonidine on nerve blockade during brachial plexus block with ropivacaine using peripheral nerve stimulator. Methods: Sixty patients were randomly divided into two groups, Group A and B. Group A received 30 ml of 0.5% of ropivacaine with 0.5 ml normal saline while Group B received same amount of ropivacaine with 0.5 ml (equivalent to 75 μg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia and intra and post-operative complications. Results: There was a significant increase in duration of motor and sensory block and analgesia in Group B as compared to Group A patients (P < 0.0001). There was no significant difference in onset time in either group (P = 0.304). No significant side effects were noted. Conclusion: The addition of 75 μg of clonidine to ropivacaine for brachial plexus block prolongs motor and sensory block and analgesia without significant side effects.

Recovery profile of intrathecal ropivacaine with or without fentanyl: A randomized double-blind controlled trial in equivalent doses

Background: Since its inception, the subarachnoid block has remained the technique of choice for lower limb surgeries. However, nowadays, day surgery units are becoming popular which require anesthesia to be rapid, selective, and reversible with minimal hemodynamic alterations. Ropivacaine with its profile ideal for these types of surgeries is hereby compared with and without fentanyl as an adjuvant in patients undergoing spinal anesthesia for lower limb orthopedic surgery. Materials and Methods: A total of 60 American Society of Anesthesiologists Grade I/II patients posted for elective lower limb orthopedic surgeries were randomly given either 3 ml of 0.75% plain ropivacaine (22.5 mg) + 0.5 ml normal saline or 3 ml of 0.75% plain ropivacaine (22.5 mg) + 0.5 ml fentanyl (25 μg). The sensory and motor block characteristics, hemodynamic changes as well as any adverse effects were recorded. Results: Demographic data were similar between both groups. Onset to T 10 was faster (5.76 ± 1.4) in Group RF compared to R (7.47 ± 2.14; P < 0.001). The median (range) maximum height in Group RF was T 2 (C 7 -T 4 ) while in Group R was T 4 (T 1 -T 6 ). Time to reach maximum height was shorter in Group RF. The onset of motor block was faster (8.43 ± 1.80 min) in Group RF compared to Group R (12.27 ± 1.78; P < 0.001). Time to regression of sensory block to L 1 was longer in the Group RF than Group R (245.66 ± 22.35 min vs. 187.16 ± 17.053 min; P < 0.001). Group RF (289.33 ± 23.11) produced significantly longer duration of motor block compared to Group R (232.33 ± 18.65; P < 0.001). Duration of analgesia was significantly longer in Group RF than Group R (P < 0.001). Conclusion: Both groups achieved adequate anesthesia and analgesia, however, ropivacaine with fentanyl produced a more rapid and prolonged sensory and motor blockade with minimal hemodynamic changes.

Hydatid Disease of the Breast: A Case Report

DOI: http://dx.doi.org/10.5915/40-1-5284 Hydatid disease of the breast is rare and may be confused with other cystic lesions. Radiological findings of hydatid disease of the breast are nonspecific. We report a case of a 30-year-old female with a palpable lump in her left breast. An ultrasound examination of the breast revealed a cystic lesion. Excisional biopsy was done, and histopathology confirmed it to be a hydatid cyst.

Effect of preamputation lumbar sympathectomy on stump pain of lower limbs in patients of thromboangitis obliterans (Buerger's disease)

Background: Thromboangiitis obliterans (Buerger′s disease) is a nonatherosclerotic inflammatory disorder primarily involving small and medium sized vessels, mainly arteries of the extremities. As the disease progresses, it could cause gangrene and amputation of limbs, eventually leading to persistent pain and disability. Settings and Design: A prospective, randomized, single-blinded comparative study. Materials and Methods: Fifty patients of Buerger′s disease planned for amputation below the knee were divided randomly into two equal groups of 25 each. Patients of both groups were advised to stop smoking. Lumbar (chemical) sympathectomy was carried out in patients of study group 1 week before amputation. The severity of postamputation stump pain was assessed using visual analog scale (VAS) and requirement of analgesics on weekly basis for 12 weeks. The incidence of phantom limb pain and overall quality of life was also evaluated using Short Form-36 (SF-36) scale. Results: VASs and requirement of analgesics were significantly less in patients who underwent lumbar sympathectomy as compared to patients of control group. The quality of life as reflected by SF-36 score was also significantly better in the study group. However, there was no significant difference in the incidence of phantom limb pain in the two groups. No major complications were reported following lumbar sympathectomy. Conclusions: Lumbar sympathectomy significantly decreases the severity of postamputation stump pain of lower limbs and thus improves the overall quality of life in patients of Buerger′s disease.