Anesthesiology Commons^™

Unintentional, Paediatric Domestic Injury In A Semi Rural Area Of Karachi., Emaduddin Siddiqui, Kiran Ejaz, Uzma Siddiqui

Department of Emergency Medicine

OBJECTIVE:

To identify the characteristics of unintentional domestic injury in children living in a semi-rural area of Karachi.

METHODS:

This retrospective descriptive study was carried out at a private hospital located at the northern outskirts of Karachi, Pakistan, from January 2005 to January 2007. We enrolled 271 out-patient children of either gender with a positive injury history. A questionnaire inquiring socio-demographic characteristics, timing of injury, monthly variation, injury pattern and factors was filled out. Descriptive analysis and Chi-square test were applied to find out the statistically significant differences.

RESULTS:

Among the 271 patients, the male-to-female ratio was 1.2:1. Fall from …

Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy, Muhammad Shahzad Shamim, S. Ather Enam, Muhammad Zubair Tahir, Mueenullah Khan

Section of Neurosurgery

Objective: To evaluate midazolam as an epidural analgesic in patients undergoing single-level microdiscectomy.
Methods: This prospective case control study was carried out at the Aga Khan University Hospital, Karachi, from January 20 to September 20, 2007, on patients undergoing microdiscectomy. Cases (group A) received midazolam with saline, while controls (group B) received saline only, placed intra-operatively over involved nerve root. Post-operatively, patients were monitored for various variables. Data was analysed using SPSS 13.0 and groups were compared using student's t-test for continuous variables and chi square for categorical variables. P-value <0.05 was considered significant.
Results: Patients in group A ambulated earlier (p = 0.005) …

A Randomised Controlled Trial Comparing Haemodynamic Stability In Elderly Patients Undergoing Spinal Anaesthesia At L5,S1 Versus Spinal Anaesthesia At L3,4 At The Aga Khan University Hospital, Nairobi, Karen Nkatha Mbaya

Master of Medicine in Anaesthesiology

Background: Spinal anaesthesia is a routinely used anaesthetic technique for elderly patients undergoing operations involving the lower limbs, lower abdomen, pelvis and the perineum. Spinal anaesthesia has several advantages over general anaesthesia and these include stable haemodynamic variables, less blood loss, less post operative pain, faster recovery time and less post operative confusion. However, despite these advantages, the sympathetic blockade induced by spinal anaesthesia can result in hypotension, bradycardia, dysrhythmias and cardiac arrests. Conventionally, spinal anaesthesia is performed at the level of L3,4 interspace; with a reported incidence of hypotension in the elderly ranging between 65% and 69%. A possible …

Effectiveness Of Premedication At The Time Of Separation From Parent And Mask Induction In Paediatric Patients Coming For Congenital Heart Disease Surgery, Mohammad Hamid, Mansoor Ahmed Khan, Aftab Khatri, Irfan Akhtar

Department of Anaesthesia

OBJECTIVE: To compare the effectiveness of oral midazolam and chloral hydrate on anxiety and sedation at various stages of pre-operative period in congenital heart surgery patients.

STUDY DESIGN: Cross-sectional comparative study.

PLACE AND DURATION OF STUDY: Operating rooms of The Aga Khan University Hospital, Karachi, from October 2009 to December 2010.

METHODOLOGY: Sixty-six patients between the ages of 6 months and 6 years received either chloral hydrate (Group C) or midazolam (Group M) pre-operatively. All congenital heart disease patients coming for cardiac surgeries were included while cases of emergency surgery and those patients in whom premedication was not given were …

Rotational Vs. Standard Smooth Laryngeal Mask Airway Insertion In Adults, Dileep Kumar, Mueenullah Khan, Muhammad Ishaq

Department of Anaesthesia

OBJECTIVE: To compare the ease of insertion between rotational laryngeal mask airway (LMA) insertion and Brain's LMA insertion technique in terms of number of LMA insertion attempts, time duration of LMA insertion and complications: trauma, laryngospasm, and hypoxaemia.

STUDY DESIGN: Randomized control study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from September 2006 to May 2007.

METHODOLOGY: One hundred ASA I and II adults undergoing short elective surgical procedures requiring general anaesthesia with spontaneous breathing were enrolled. Following pre-oxygenation, anaesthesia was induced with propofol 2 mg/kg and fentanyl 2 mug/kg. Patients were randomly assigned into one …

Technique Of Anaesthesia For Different Grades Of Caesarean Section: A Cross-Sectional Study, Samina Ismail, Faraz Shafiq, Aliya Malik

Department of Anaesthesia

OBJECTIVE: The percentage use of regional anaesthesia (RA) and failure rate of RA for different grades of caesarean section (CS) has become a marker of quality for obstetric anaesthesia service. The objective of our prospective observational study is to find out the technique of anaesthesia used in different grades of CS, reasons for choosing general anaesthesia (GA) and failure rate of RA in our hospital setting.

METHODS: This prospective cross sectional study was carried in the obstetric unit of Aga Khan University Hospital from 1st January 2010 to 31st May 2011. The anaesthetist performing the procedure filled out the data …

Spontaneous Intracranial Hypotension In A Patient With Marfan's Syndrome Treated With Epidural Blood Patch--A Case Report, Samad Khalid, Punshi Gurmukh Das, Hamid Mohammad, Ullah Hameed

Department of Anaesthesia

Spontaneous intracranial hypotension (SIH) is a well-defined clinical entity that is frequently misdiagnosed. We are reporting a case of 38 years old male who presented with severe headache and an episode of generalized tonic-clonic seizure. He was managed successfully with an epidural blood patch. Understanding of the characteristics, symptomatology, evaluation, treatment options, and prognosis is discussed.

Are We Anesthesiologists, Aware About The Incidence Of Muscle Stiffness Associated With Remifentanil?, Gauhar Afshan

Department of Anaesthesia

No abstract provided.

Anaesthetic Management Of Abdominal Hysterectomy In Patient With Congenital Sinus Node Dysfunction, Dileep Kumar, Faisal Shamim

Department of Anaesthesia

A 45 years old woman having dysfunctional uterine bleeding was scheduled for total abdominal hysterectomy with bilateral salpingo-oophorectomy under general anaesthesia. On pre-operative anaesthesia assessment, she was found to have junctional rhythm at rate of 44 beats/minute with bigeminies and pre-mature ventricular contractions on ECG. On further evaluation, she was diagnosed as having congenital sinus node dysfunction on the basis of 24 hours Holter monitoring. She was asymptomatic, no prior comorbidity and belonged to functional class one. General anaesthesia was successfully managed by vigilance, invasive monitoring, standby transcutaneous and transvenous pacemakers; use of cardiostable and vagolytic anaesthetic agents like Etomidate, …

Magnesium, A Drug Of Diverse Use, Mohammad Irfan Akhtar, Hameed Ullah, Mohammad Hamid

Department of Anaesthesia

Magnesium has evolved as a drug with diverse clinical applications. Mg++ is an important caution and its homeostasis is very important for normal body functioning. The physiological role of Mg is due to its calcium channel blocking properties at smooth muscle, skeletal muscle and conduction system levels. The analgesic properties are due to NMDA receptor blocking action. Mg++ is beneficial in acute Myocardial Infarction, protection during open heart surgery and treatment and prevention of heart rhythm disturbances. Mg has an established role in the management of preeclampsia and eclampsia. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing …

Anaesthesia As A Career Choice In A Developing Country; Effect Of Clinical Clerkship, Fauzia Khan, Fauzia Nasim Minai, Shahla Siddiqui

Department of Anaesthesia

OBJECTIVE: To explore the fourth year medical student's knowledge regarding anaesthesia as a specialty, their attitude towards anaesthesia as a career choice and the effect of clinical clerkship on these.

METHODS: This survey was conducted in the Department of Anaesthesia of a university medical centre in a developing country. One hundred and fifty year four medical students rotating in anaesthesia were enrolled. They were asked to fill a structured questionnaire before (pre) and after (post) their anaesthesia rotation. The questionnaire sought information on their perception of anaesthesia as a specialty, role of anaesthetists clerkship duration, and reasons for considering or …

Audit On Preoperative Midazolam And Level Of Sedation, Sanam Muhammad, Shahla Siddiqui

Department of Anaesthesia

We wished to observe by carrying out a prospective clinical audit, the level of sedation and time interval of all adult elective surgery patients. We enrolled adult ASA I-III patients who came for elective surgery to the Aga Khan University Hospital preoperative surgery suite for 3 months. Hundred patients were enrolled. The majority of patients got 7.5 mg of PO Midazolam. Our median Ramsay sedation score was 2 and the Median drug to door time was 52.35 minutes. 11 patients were reportedly 'drowsy' in the recovery room one hour after surgery was completed. These were mostly the same patients who …

Surgical Correction Of Aorto-Pulmonary Window: A Rare And Lethal Cause Of Pulmonary Hypertension, Adeel Ahmed Shamim, Mubashir Zareen Khan, Mehnaz Ahmed Atiq, Mansoor Ahmed Khan, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

Aorto-pulmonary window is a relatively rare congenital cardiac malformation with an overall incidence of 0.1%. Pulmonary hypertension develops quickly if the lesion is left untreated hence early surgical intervention is warranted after diagnosis. The surgery for correction of APW has evolved over years, currently an open repair on cardiopulmonary bypass (CPB) with a single patch technique yields good results. Mortality is affected by association of pulmonary hypertension and other cardiac malformations. We present a case of an infant with a large type II APW with a relatively low pulmonary vascular resistance. Hospital stay was complicated because of pulmonary arterial disease …

The Impact Of A Multimodal Approach To Pre-Emptive Analgesia On Postoperative Pain And Analgesic Requirements For Patients Undergoing Orthopaedic Lower Limb Surgery At The Aga Khan University Hospital, Nairobi: A Single Blind Randomised Controlled Trial, John M. Bugo

Master of Medicine in Anaesthesiology

Study Objective: The aim of this study was to evaluate the postoperative morphine-sparing and pain reducing effects of a preemptive, multimodal, perioperative analgesic regimen incorporating the use of preincisional intrathecal blockade plus parenteral anti-inflammatory agents, in patients undergoing lower limb orthopaedic surgery. Study design: Prospective Single blinded Randomized Controlled Trial. Study setting: The Aga Khan Hospital, Nairobi, Kenya. Methods: 44 ASA physical status 1 and 2 patients undergoing lower limb orthopaedic surgery were randomly allocated into two groups of 22 patients each. Patients in the Intervention group were given a preincisional subarachnoid injection of 15mg hyperbaric Bupivacaine and 25mcg Fentanyl, …

A Randomised Controlled Trial Investigating The Effect Of Adding Fentanyl To Low Dose Bupivacaine In Combined Spinal-Epidural Anaesthesia, Using Epidural Volume Extension Technique In Caesarean Section, Mudola V. Manyano

Master of Medicine in Anaesthesiology

Background: Epidural volume extension (EVE), is a technique whereby a small-dose intrathecal block is enhanced by an epidural injection of physiological saline. This epidural injection exerts a compression effect on the dura, which then leads to a cranial increase in sensory spread of the intrathecal local anaesthetic. The lower dose of local anaesthetic required in the EVE technique has made it possible to avoid the side effects of the conventional dose of local anaesthetic while still having the benefit of adequate anaesthesia. Several studies have been conducted in this area; these studies have either used or omitted fentanyl. The successful …

Pain Control For Uterine Fibroid Embolisation : An Initial Experience In East Africa., Gilbert Mwaka, Vitalis Mung’Ayi, Nigel Hacking, William. Stones

Anaesthesiology, East Africa

Uterine fibroid embolisation (UFE) generates moderate to severe post-procedural pain. We present a case series of 24 patients who underwent UFE during our first experience in managing the sometimes excruciating pain that accompanies embolisation of the uterine arteries. We also show the evolution of our protocol for post-procedural pain management from a first to second round of procedures.

Dual Chamber Pacemaker Implants--A New Opportunity In Pakistan For Children With Congenital And Acquired Complete Heart Block, Awais Ashfaq, Mansoor Ahmed Khan, Mehnaz Atiq, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

Implantation of cardiac pacemakers has been practiced for at least five decades with continuous developments of the hardware. The invention of dual chamber pacemakers has initiated a debate concerning its superiority over single chamber ventricular pacemakers. Throughout the world, surgeons have been using dual chambered permanent pacemakers with successful follow ups. However, Pakistan has not yet taken the advantage of such pacemaker devices till now. We report three cases that underwent a dual chamber permanent pacemaker implantation for the first time in children less than 8 kg with successful follow ups.

Knowledge And Attitudes Of Pakistani Women Towards Anaesthesia Techniques For Caesarean Section, Imtiaz Ahmad, Gauhar Afshan

Department of Anaesthesia

OBJECTIVE: To assess knowledge and attitudes of Pakistani women towards different options of anaesthesia techniques for caesarean section and also to identify their sources of information about them.

METHODS: A total of 410 women scheduled for elective caesarean section were enrolled after informed written consent in this hospital based cross sectional survey. The women were interviewed preferably in Urdu (national) language according to structured pre coded questionnaire by one of the investigators and the sequence of questions was strictly followed. This survey included pertinent questions to assess knowledge and attitudes of our women towards choices of anaesthesia techniques. The questionnaire …

Audit Of Postoperative Nausea And Vomiting In Paediatric Day Case Surgery, Fauzia N. Minai, Faraz Shafiq, Azhar Rehman

Department of Anaesthesia

OBJECTIVE: To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgical cases done at the Surgical Day Care Unit at Aga Khan University between January and July 2009.

METHODS: All paediatric ASA 1-2 cases, from 6 months to 18 years of age undergoing day case surgeries at the Surgical day care unit were included in this retrospective audit. Data was collected on a designed form filled with information from preoperative, intraoperative and postoperative recovery forms. Any relevant data was also noted from nurses notes in recovery room and step down unit. Episodes of vomiting, delay …

Course And Outcome Of Obstetric Patients Admitted To A University Hospital Intensive Care Unit, F. Githae, Vitalis Mung’Ayi, William Stones

Anaesthesiology, East Africa

Background: Obstetric Critical Care is an important service in the reduction of maternal morbidity and mortality, but few developing country data are available.

Objectives: To review all maternity patients admitted to the ICU over a seven year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal morbidity and mortality.

Design: Retrospective patient file and ICU chart review.

Subjects: ICU Charts and medical files of obstetric patients admitted to the ICU at The Aga Khan University Hospital between (November 2003 – November 2010) were reviewed.

Setting: The ICU at The Aga Khan University …

Anaesthetic Challenges In Emergency Surgical Repair Of Acute Aortic Dissection Rupturing Into The Pericardium In A Pregnant Patient, Mohammad Irfan Akhtar, Khalid Samad

Department of Anaesthesia

Acute aortic dissection in pregnancy is a serious situation, because rapid and appropriate surgical decision making is required to save the life of both mother and baby. Aortic dissection is rare in young women but is likely during pregnancy (third trimester) secondary to the hyperdynamic and hypervolaemic circulatory state associated with pregnancy. A 35 years old 27 weeks pregnant patient weighing 90 kg presented in the emergency with severe chest pain. In the immediate post cardiopulmonary bypass period, the patient started bleeding profusely from the anastamotic sites irrespective of utilization of all the conventional methods of haemostasis including multiple units …

Apache-Ii Score Correlation With Mortality And Length Of Stay In An Intensive Care Unit, Saad Ahmed Naved,, Shahla Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Objective: To correlate the APACHE-II score system with mortality and length of stay in ICU. Study Design: Cohort study. Place and Duration of Study: The Intensive Care Unit (ICU) of the Aga Khan University Hospital, Karachi, from May 2005 to May 2006. Methodology: All adult patients who were admitted in the ICU were included. APACHE-II score was calculated at the second and seventh days of admission in the ICU. Patients who were discharged alive from the ICU or died after first APACHE-II Score (at 2nd day) were noted as the primary outcome measurement. Second APACHE-II score (at 7th day) was …

Post-Dural Puncture Posterior Reversible Encephalopathy Syndrome, Fauzia N. Minai, Syeda Fauzia Hasan, Mughis Sheerani

Department of Anaesthesia

We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there …

Grown Up Congenital Heart Disease Patient Presenting For Non Cardiac Surgery: Anaesthetic Implications, Mohammad Hamid, Mansoor Ahmed Khan, Mohammad Irfan Akhtar, Hameedullah, Saleemullah, Khalid Samad, Fazal Hameed Khan

Department of Anaesthesia

Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies.

Chemical Dependency: An Occupational Hazard In The Field Of Anaesthesia, Samina Ismail

Department of Anaesthesia

The medical personnel are vulnerable to substance abuse and dependence due to ready access to substance of abuse. Addiction is considered as an occupational hazard for those involved in the practice of anaesthesia for the same reason. Substance abuse is defined as a psychosocial biogenetic disease, which results from dynamic interplay between a susceptible host and favourable environment. According to the 5th and the last National Survey on Drug Abuse (NSDA) in 1993 by Pakistan Narcotic Control, there are nearly three million drug dependants in Pakistan, but no data is available to determine the prevalence among medical or anaesthesia personnel. …

Emergency Airway Management Of A Patient With Tracheal Stenosis, Anwar-Ul-Huda, Muhammad Qamar-Ul-Hoda, Mohammad Sohail Awan

Department of Anaesthesia

We are presenting a case of a 26 year old healthy male, who came with gradual worsening of dyspnoea following prolonged intubation and ventilation, after a road traffic accident five months back. On arrival in ER, he was hypoxaemic with severe respiratory distress. He was transferred to the operation room (OR) for emergency tracheostomy. During the transfer, he was placed in an upright position with oxygen at 15 L/M. In the OR, anaesthesia was induced with sevoflurane gradually. Direct laryngoscopy was done which revealed normal vocal cords. A size 4.00 mm ID endotracheal tube was impossible to pass more than …

Single Lung Ventilation In A Young Child For Repair Of Coarctation Of Aorta, Mohammad Hamid, Mansoor Ahmed Khan, Muneer Amanullah

Department of Anaesthesia

Single lung ventilation in small children is extremely challenging. In this case, a paediatric bronchial blocker was successfully inserted in a 19-month-old child to provide single lung ventilation using a modified insertion technique. It provided excellent working conditions during thoracotomy and our method of insertion may help in reducing the cost.

Anaesthetic Management Of Two Patients With Beta-Thalassaemia Intermedia, Shahnawaz Ali, Fauzia Khan

Department of Anaesthesia

There is paucity of literature regarding the anaesthetic management of patients with thalassaemia intermedia. In this case study, the anaesthetic management and concerns in two children with thalassaemia intermedia aged eleven and nine years undergoing herniotomy and splenectomy respectively is reported. Both children had unanticipated difficulty in airway management and high intraoperative blood pressure trends. These cases are representative of the range of problems seen in children with thalassaemia intermedia.

Anaesthetic Management Of An Infant With Epidermolysis Bullosa Undergoing Inguinal Hernia Repair, Khalid Maudood Siddiqui, Sobia Khan

Department of Anaesthesia

Epidermolysis bullosa is a group of inherited disorders characterized by blistering of the skin as a result of minor trauma. We managed an infant with epidermolysis bullosa undergoing inguinal hernia repair. Anaesthesia was induced with oxygen/nitrous oxide mixture and sevoflurane. Oral tracheal intubation was done with a lubricated laryngoscope blade with KY jelly using atracurium 0.5 mg/kg and fentanyl 0.1 microgm/kg. To avoid frictions on the skin, endotracheal tube was tied with ribbon gauze and fixed around the neck. Pulse-oximetry probe and electrocardiogram electrodes were placed, and then attached to the patient's skin covered with KY jelly. Peripheral venous access …

A National Survey Into Desirable Personality Traits In Anaesthesia Trainees In A Developing Country, Fauzia Anis Khan, Fauzia N. Minai

Department of Anaesthesia

OBJECTIVE: To explore personality traits considered to be important in selection of trainees by consultant anaesthetists in a developing country.

METHODS: A questionnaire listing 28 traits was sent to 125 consultant anaesthetists. The raters were asked to mark each trait on a scale of 1 to 10, with one being least desirable and 10 as most desirable. Listing of five most desirable and one least desirable trait was also required.

RESULTS: The response rate was 79%. The most desirable trait was identified as reliability by 40%, followed by honesty 17%, functionality under stress 9%, punctuality 7%, and discipline 4%. The …