Fauzia A Khan

Perioperative cardiac arrests in children at a university teaching hospital of a developing country over 15 years

Objective/Aim:  To study the incidence, causes, and outcome of perioperative cardiac arrests in children at a university teaching hospital with an aim of improving quality of care.

Comparison of analgesic effect of tramadol alone and a combination of tramadol and paracetamol in day-care laparoscopic surgery.

Background and objective To compare the analgesic efficacy of tramadol alone (1.5 mg kg−1) with a tramadol (1 mg kg−1) and paracetamol combination in day-care laparoscopic patients. Methods The analgesic efficacy of intravenous tramadol alone (1.5 mg kg−1) (group T) was compared with a combination of intravenous tramadol (1 mg kg−1) and oral paracetamol 1 g (group TP) in 60 day-care laparoscopic patients in a prospective randomized double-blind clinical trial in a tertiary care hospital. Intraoperative haemodynamic responses and postoperative visual analogue scores were used to assess the analgesic efficacy. Results Only one patient (in group T) received a single dose of rescue analgesia intraoperatively. The highest pain scores were recorded at 30 min postoperatively in both groups, and rescue analgesia was needed in eight patients in group T and in 13 patients in group TP (P = 0.08). The incidence of moderate-to-severe nausea was high in group T (P = 0.001). Conclusion We conclude that reducing the dose of tramadol to 1 mg kg−1 and combining it with paracetamol 1 g orally decreased the incidence of side effects of tramadol without reducing analgesic efficacy.

Effect of the menstrual cycle phase on post‐operative pain perception and analgesic requirements

Research has shown that menstrual cycle phase may affect pain sensitivity. There is a lack of studies evaluating this effect on post‐operative pain and analgesic needs.

Effect of gender on pain perception and analgesic consumption in laparoscopic cholecystectomy: An observational study

Background: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. Materials and Methods: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts. Results: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002), but not in the later period. Conclusion: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia.

Effect of one minimum alveolar concentration sevoflurane with and without fentanyl on hemodynamic response to laryngoscopy and tracheal intubation

Background: Drug combinations can be used for optimum obtundation of the hemodynamic response to tracheal intubation. The objective of this trial was to compare the hemodynamic response to laryngoscopy and tracheal intubation after administration of 2 μg/kg fentanyl bolus or a placebo with 2% end tidal sevoflurane at induction of anesthesia. Materials and Methods: A total of 70 surgical patients of either gender, age 18-45 years were selected for this double blind, randomized, placebo controlled trial, with 35 in each group. All patients received a standardized induction with thiopentone, atracurium, and an end tidal concentration of 1 minimum alveolar concentration (MAC) sevoflurane. Heart rate and noninvasive blood pressure were compared to the baseline post induction and for seven minutes post intubation. Some adverse events were noted. Results: The maximum heart rate response was significantly less in the sevoflurane fentanyl group (15% vs. 22%). Significant difference between groups was observed in the systolic blood pressure at six minutes post intubation. Hemodynamic adverse events recorded were similar. Conclusion: Addition of 2 μg fentanyl bolus to 1 MAC sevoflurane anesthesia at induction attenuated the hemodynamic response to a maximum of 15% above baseline values.

Comparison of hemodynamic response to tracheal intubation with Macintosh and McCoy laryngoscopes

Background: Use of McCoy blade laryngoscope avoids the lifting force in the vallecula and theoretically should lead to a lower hemodynamic response related to laryngoscopy and tracheal intubation. The available literature on the topic is conflicting. Materials and Methods: We studied the hemodynamic response to laryngoscopy and tracheal intubation in 60 ASA 1 AND 2 adult patients using either Macintosh or McCoy laryngoscopes. The change in systolic, diastolic, mean arterial pressure, and heart rate (HR) was observed for 10 min post intubation. Arrhythmias and ST changes were also observed. Results: The maximum change in HR was 18.7% in the Macintosh and 7.7% in the McCoy group, and in systolic arterial pressure was 22.9% in the Macintosh and 10.3% in the McCoy group. This difference between groups was significant (P < 0.0001). The change lasted for a lesser duration in the McCoy group. No arrhythmias or ST changes were observed in either group. Conclusion: Hemodynamic changes with use of McCoy laryngoscope were lesser in magnitude and of shorter duration.

Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery

Background: Several measurement tools have been used for assessment of postoperative pain in pediatric patients. Self-report methods have limitations in younger children and parent, nurse or physician assessment can be used as a surrogate measure. These tools should be tested in different cultures as pain can be influenced by sociocultural factors. The objective was to assess the inter-rater agreement on four different behavioral pain assessment scales in our local population. Materials and Methods: This prospective, descriptive, observational study was conducted in Pakistan. American Society of Anesthesiologists I and II children, 3-7 years of age, undergoing elective surgery were enrolled. Four pain assessment scales were used, Children′s Hospital of Eastern Ontario Pain Scale (CHEOPS), Toddler Preschool Postoperative Pain Scale (TPPPS), objective pain scale (OPS), and Face, Legs, Activity, Cry, Consolability (FLACC). After 15 and 60 min of arrival in the postanesthesia care unit (PACU), each child evaluated his/her postoperative pain by self-reporting and was also independently assessed by the PACU nurse, PACU anesthetist and the parent. The sensitivity and specificity of the responses of the four pain assessment scales were compared to the response of the child. Results: At 15 min, sensitivity and specificity were >60% for doctors and nurses on FLACC, OPS, and CHEOPS scales and for FLACC and CHEOPS scale for the parents. Parents showed poor agreement on OPS and TPPS. At 60 min, sensitivity was poor on the OPS scale by all three observers. Nurses showed a lower specificity on FLACC tool. Parents had poor specificity on CHEOPS and rate of false negatives was high with TPPS. Conclusions: We recommend the use of FLACC scale for assessment by parents, nurses, and doctors in Pakistani children aged between 3 and 7.

Anesthesia for Pituitary Surgery

Anesthesia for pituitary surgery is challenging because of the diverse endocrinological abnormalities associated with the disease process. Close collaboration is required between anesthesiologists, neurosurgeons, and endocrinologists during the perioperative period. There is a strong association of pituitary tumors with disorders like acromegaly/gigantism and Cushing’s disease. Preoperative optimization and identification of systemic involvement in terms of hypertension, diabetes, and obstructive sleep apnea is required. Airway abnormalities are common. Intraoperative anesthetic management should be based upon tumor size and associated physiological disturbances. Trans-nasal excision of tumor has benefits in terms of mortality and recovery profiles. Newer anesthetic agents like dexmeditomidine and remifentanil are excellent for maintaining hemodynamic stability during the intraoperative period. Postoperative period requires strict monitoring and a high suspicion for complications such as cerebrospinal fluid leak and diabetes insipidus.