Archive for January, 2017

EFFECT OF PRE-OPERATIVE ADMINISTRATION OF ORAL ASPIRIN ON SUXAMETHONIUM INDUCED MYALGIA : COMPARATIVE STUDY

ABSTRACT
Objectives: A comparative study to evaluate effect of pre-operative administration of oral aspirin and precurarization (with pancuronium) in prevention of suxamethonium induced myalgia.
Methodology Design and setting: Tertiary care teaching hospital. Subjects: The present study was carried out on 75 patients in age group of 16-65 years belonging to ASA grade I or II. The cases undergoing surgery under general anaesthesia where endotracheal intubation was considered desirable and in whom aspirin was not contraindicated.
Results: In entire case series of 75 patients, 52 (69.3%) had fasciculation. Out of them Group I patients has least i.e. 24% while group II and Group III had equal i.e 92%of patients having fasciculation.
Conclusion: Preoperative aspirin 600mg orally 1 hr before operation effectively reduces Suxamethonium induced pain and avoid complications associated with pretreatment with non-depolarising agents.
Key words: Oral aspirin, Suxamethonium, Fasciculation.

ORAL ATROPINE PREMEDICATION IN INFANTS ATTENUATES CARDIOVASCULAR DEPRESSION DURING HALOTHANE ANAESTHESIA

ABSTRACT
Objectives:
To evaluate the effect of oral atropine premedication in infants attenuates cardiovascular depression during halothane anaesthesia.
Methodology Design and setting:Tertiary care teaching hospital.Subjects:A double blind study was conducted on 60 patients of paediatric age group of ASA Grade I were divided into Group A(4-9 months) & Group B(10-15 months). Patients of both the groups were randomly placed into premedication subgroups: subgroup I (Placebo), subgroup II (Lo Dose, 0.02mg/kg), subgroup III (Hi Dose, 0.04mg/kg) with 10 patients in each group.
Results:Oral atropine given one hour before the induction of anaesthesia in the doses of 0.02mg/kg and 0.04mg/kg is effective in attenuating cardiovascular depression caused by halothane which is the most commonly used inhalational anaesthetic agent in paediatric patients.
Conclusion:Oral atropine given one hour before the induction of anaesthesia was effective in attenuating cardiovascular depression caused by halothane which was the most commonly used inhalational anaesthetic agent in paediatric patients.
Key words: Oral atropine, Premedication, Halothane Anaesthesia, Cardiovascular depression.

A RARE PRESENTATION OF UNUSUAL BENIGN MULTICYSTIC THYROID SWELLING IN THE LATERAL PART OF NECK

ABSTRACT
Thyroid swellings rarely present as cystic masses in neck laterally. Mostly cystic neck masses appearing in neck are usually benign. However, they may occasionally have a sinister origin and should be investigated rigrously. Thyroid cysts most often result from cystic degeneration in an adenomatous nodule. ² Brachial Cysts, dermoid cysts and epidermoid cysts are the most common benign neck cysts. Presentation of thyroid tissue as a cystic mass in the lateral side of the neck is rare . We present a rare case of multicystic swelling in left supra-clavicular region of neck with no other thyrotoxic or pressure features . The swelling appeared to be malignant during surgery on gross examination, but turned to be a benign thyroid cyst by histopathological examination.
Keywords: multicystic, thyroid cyst, cystic degeneration

PREVALENCE OF SUBCLINICAL HYPOTHYROIDISM IN COMMON BILE DUCT STONE PATIENTS

ABSTRACT
Subclinical thyroid dysfunction is a common laboratory diagnosis characterized by an abnormal high serum thyrotropin (TSH) concentration with normal free triiodothyronine (T3) and thyroxine (T4) levels. Refinements in serum thyrotropin measurements during the past few decades have resulted in a sharp increase in the diagnosis of thyroid dysfunction, mirroring the tendency towards early diagnosis of many other conditions such as hyper lipidemia for which early treatment appears beneficial. Various studies have been done regarding subclinical thyroid dysfunction and its clinical relevance in common bile duct (CBD) stone patients. This study of subclinical hypothyroidism was done on 30 common bile duct stone patients, admitted in Department of General Surgery. The aim of the study was to find out the prevalence of subclinical hypothyroidism in common bile duct stone patients.
Key words: subclinical hypothyroidism, common bile duct stone, thyroid dysfunction

MEASUREMENT OF INTRA-ABDOMINAL PRESSURE AS AN INDICATOR OF MORBIDITY AND MORTALITY IN CRITICALLY ILL SURGICAL PATIENTS

ABSTRACT
Intra abdominal pressure (IAP) is defined as the pressure in the peritoneal cavity and an acute rise in this pressure can result in adverse physiological consequences termed Abdominal Compartment Syndrome (ACS). This increase in abdominal pressure can affect multiple organ systems and once a certain stage has been passed, the effects are no longer reversible by decompression. So challenge is to be aware of the condition and act sufficiently early to reverse the effects.
Aims: 1) To assess whether intra abdominal pressure is an independent predictor of morbidity and mortality for patients undergoing emergency exploratory laparotomy. 2) To identify the hidden causes of abdominal compartment syndrome.
Settings and Design : this was a randomised controlled trial involving 50 patients, who were admitted and
underwent emergency laparotomy.
Methods and Material:50 patients who underwent emergency laparotomy due to various indications ,were included in the study. Intra abdominal pressure was measured through urinary bladder with Foley’s catheter, which was connected to saline manometer. Readings were taken preoperatively and then post operatively at 0, 6, 24 and 72 hours. Grading of intra abdominal hypertension (IAH) was done as per the pressure. ACS was labelled if IAH was associated with at least one newly developed organ system dysfunction.

Results: Pre operative IAH was seen in 62% of the patients. Raised IAP at 6 hours and 24 hours is significant predictor of morbidity (p =0.031 and p = 0.004 respectively) whereas, raised IAP at 48 hours is a significant predictor of mortality. Similarly, raised IAP at 6 hours is also a significant predictor for longer hospital stay (p=0.031).
Conclusions : IAP is a significant indicator of morbidity and mortality in the patients undergoing emergency laparotomy. Thus a thorough monitoring and early decompression can decrease the morbidity and mortality rate.