Mohamad Ommid

PERIOPERATIVE MANAGEMENT OF A PATIENT WITH DILATED CARDIOMYOPATHY UNDERGOING HEMICOLECTOMY

The anesthetic management of a patient with Dilated Cardiomyopathy (DCM) undergoing non-cardiac surgery is always a challenge to the anesthesiologist as DCM is most commonly complicated by progressive congestive heart failure and malignant arrhythmias. Idiopathic dilated cardiomyopathy is a primary myocardial disease of unknown etiology characterized by left ventricular or biventricular dilation and impaired contractility. Depending upon diagnostic criteria used, the reported annual incidence varies between 5 and 8 cases per 100,000 population. It is more common in men. Dilated cardiomyopathy is defined by the presence of: a) fractional myocardial shortening less than 25%(>2SD) and/or ejection fraction less than 45%(>2SD), and b) Left ventricular end diastolic diameter (LVEDD) greater than 117% excluding any known cause of myocardial disease. Such cases always prove a challenge to the anesthetist because of the complications associated with the condition. Here we report the successful perioperative management of a patient with severe dilated cardiomyopathy undergoing surgery for carcinoma colon.

Comparative evaluation of ondansetron and granisetron in prevention of postoperative nausea and vomiting following laparoscopic cholecystectomy in females

Post operative nausea and vomiting (PONV) continue to be frequent occurrences, even when conventional antiemetics are prophylactically used. In a randomized double blind study, 100 female patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were divided into 2 groups of 50 patients each and received 0.1mg/Kg of Ondansetron (Group X) or 0.04mg/Kg of Granisetron (Group Y) pre- operatively. Patients were observed for 24 hours post operatively and interpretation of symptoms of nausea and vomiting was done according to Gan and Alexander scale (0-2). 80% of patients in Group Y and 48 % patients in Group X did not experience PONV; the difference was statistically significant (p<0.001). 2 patients (4%) in Group Y and 15patients (30%) in Group X required rescue antiemetic medication during the 24 hour study period. The difference was found to be highly significant (p<0.001) The difference in the incidence of PONV between the two groups after 6 hours to 24 hours was highly significant (p<0.001). It was concluded that prophylactic administration of Granisetron is more effective than Ondansetron, in reducing in incidence of PONV with prolonged effects.

Attenuation of the Pressor Response to Laryngoscopy and Tracheal Intubation with Intravenous Diltiazem and Esmolol Intravenous in Controlled Hypertensive Surgical patients

SUMMARY Introduction Tachycardia and hypertension are well documented sequels of laryngoscopy and endotracheal intubation which is transient, highly variable and is generally well tolerated in healthy patients. In hypertensive patients, cardiovascular response to laryngoscopy and intubation is exaggerated. The aim of this study intended to find a better alternative by comparision amongst diltiazem and esmolol to attenuate the pressor response to laryngoscopy and intubation in Kasmiri Population. Materials & Methods Randomized placebo controlled double blind study. One hundred fifty hypertensive patients of both sexes (ASA II), controlled on antihypertensive drugs, between age range of 40-60 years scheduled for routine surgical procedures were divided into 3 groups Group A (10 ml of 5 % Dextrose), Group B (Diltiazem 0.2 mg/Kg) and Group C (Esmolol 1.5 mg/Kg). Baseline parameters, i.e. heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product were noted at baseline level, at 1 min., 3min. and 5min after tracheal intubation. Results Both Esmolol and Diltiazem showed statistically significant attenuation of rise in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product when compared to control. However Diltiazem failed to attenuate rise in heart rate. Conclusions We conclude that Esmolol is a very effective agent in attenuating the pressor response to laryngoscopy and intubation in controlled hypertensive patients.