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Aga Khan University

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Articles 301 - 330 of 333

Full-Text Articles in Anesthesiology

Unanticipated Hospital Admission After Ambulatory Surgery, Mueenullah Khan, Aliya Ahmed, Laila Abdullah, Azmeena Nizar, Aslam Fareed, Fauzia Anis Khan Jun 2005

Unanticipated Hospital Admission After Ambulatory Surgery, Mueenullah Khan, Aliya Ahmed, Laila Abdullah, Azmeena Nizar, Aslam Fareed, Fauzia Anis Khan

Department of Anaesthesia

The unplanned admission rate is considered to be an important measure of the quality of ambulatory surgical units. The objective of our study was to evaluate the unanticipated hospital admission rate from the Surgical Day Care (SDC) unit of our university affiliated teaching hospital and to analyze the reasons for admission. A review of all unanticipated admissions over a one-year period was done. The admission rate was calculated and the reasons for admission were analysed. The overall admission rate was 4.93%. Most of the admissions were ordered by the surgeons (97%). The main reasons for admission were patient observation indicated …


Perioperative Anaesthetic Management Of A Patient With Relapsed Aplastic Anaemia, Aliya Ahmed, Abdul Monem Jun 2005

Perioperative Anaesthetic Management Of A Patient With Relapsed Aplastic Anaemia, Aliya Ahmed, Abdul Monem

Department of Anaesthesia

Aplastic anaemia occurs due to failure of blood cell production by bone marrow. All blood cell counts are low. Untreated patients may die within one year mainly due to uncontrolled infection due to neutropenia. Anaemia and thrombocytopenia cause troublesome symptoms and necessitate frequent red cell and platelets transfusions. Surgery poses a very high risk for these patients because of the several complications that can occur in the perioperative period. In this paper we report on a patient with relapsed aplastic anaemia who was optimized preoperatively and underwent a total abdominal hysterectomy under general anaesthesia.


Knowledge, Attitude And Practice Of Parturients Regarding Epidural Analgesia For Labour In A University Hospital In Karachi, Mohammed Raheel Minhas, Rehana Kamal, Gauhar Afshan, Hafsa Raheel Feb 2005

Knowledge, Attitude And Practice Of Parturients Regarding Epidural Analgesia For Labour In A University Hospital In Karachi, Mohammed Raheel Minhas, Rehana Kamal, Gauhar Afshan, Hafsa Raheel

Department of Anaesthesia

Objective: To assess the knowledge, sources of knowledge, attitude (fears and misconceptions) regarding Epidural Analgesia (EA) and practices of parturients delivery at Aga Khan University hospital (AKUH).Methods: A hospital based cross sectional study was conducted at the obstetric unit of AKUH, from November to December 2003. A questionnaire was filled through verbal interviews conducted on 448 parturients fulfilling the inclusion criteria.Results: Seventy six percent of the females were aware of epidural analgesia as a labor pain relieving method. However, only 19% availed EA. About 40% had heard about EA from their obstetricians and 64% from friends or relatives. Twenty even …


Drug Related Critical Incidents, F A. Khan, M Q. Hoda Jan 2005

Drug Related Critical Incidents, F A. Khan, M Q. Hoda

Department of Anaesthesia

Drug related incidents are a common form of reported medical errors. This paper reviews the critical incidents related to drug errors reported from the main operating theatre suite in a teaching hospital in a developing country from January 1997 to December 2002. Each report was evaluated individually by two reviewers using a structured process. During this period, 44 874 anaesthetics were administered; 768 critical incidents were reported, 165 (21%) of which were related to drug errors. Underdosage, side-effect/drug reaction and syringe swap were the most common. A total of 76% were classified as preventable; 56% due to human error and …


Outcome Of Home Mechanical Ventilation, N Salahuddin, K Haider, Sj Husain, S Siddiqui, Fazal Hameed Khan, R. Manasia Jan 2005

Outcome Of Home Mechanical Ventilation, N Salahuddin, K Haider, Sj Husain, S Siddiqui, Fazal Hameed Khan, R. Manasia

Department of Anaesthesia

OBJECTIVE: To determine the outcome of patients discharged home on portable ventilator.
DESIGN: Descriptive study.
PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi from January 2000 to December 2004.
PATIENTS AND METHODS: All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data.
RESULTS: Eleven patients were discharged home on invasive ventilation. Mean age was 49 years (range 10-98 years). Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% …


Case Of Inhaled Prostaglandin E1 Used To Improve Hypoxia In Ards, Shahla Siddiqui, Salwa Zubair, F Hameed Khan Dec 2004

Case Of Inhaled Prostaglandin E1 Used To Improve Hypoxia In Ards, Shahla Siddiqui, Salwa Zubair, F Hameed Khan

Department of Anaesthesia

No abstract provided.


Anaesthesia For Surgical Correction Of Scoliosis With Spinal Cord Monitoring--A Case Series, M Q. Hoda, S U. Zafar Nov 2004

Anaesthesia For Surgical Correction Of Scoliosis With Spinal Cord Monitoring--A Case Series, M Q. Hoda, S U. Zafar

Department of Anaesthesia

Objective: To share our experience of anaesthetic management of scoliosis with intra-operative somatosensory evoked potential monitoring and wake up test.Methods: All the cases of scoliosis surgery scheduled during a period of two years in which SSEP and intra-operative wake-up test was planned were included in the study. The patient in which intra-operative wake-up test was not planned were excluded from this case series.Results: We managed a series of sixteen cases of scoliosis in our hospital. Eleven patients were female and five were male with the age ranging from six to twenty two years. SSEPs were monitored throughout the procedure and …


Negative Pressure Pulmonary Edema: Case Report, S M. Abbas, M Q. Hoda Jul 2004

Negative Pressure Pulmonary Edema: Case Report, S M. Abbas, M Q. Hoda

Department of Anaesthesia

No abstract provided.


Effect Of Ketorolac On Postoperative Pain Relief In Dental Extraction Cases--A Comparative Study With Pethidine, S M. Abbas, R S. Kamal, G Afshan Jun 2004

Effect Of Ketorolac On Postoperative Pain Relief In Dental Extraction Cases--A Comparative Study With Pethidine, S M. Abbas, R S. Kamal, G Afshan

Department of Anaesthesia

Objective: To compare the analgesic efficacy and side effects of ketorolac with pethidine in a day care procedure.STUDY Design: Single dose, double blind, case matched study.Methods: Sixty patients were divided into group A and group B, who received either ketorolac 30 mg or Pethidine 0.8 mg/kg ( both IN ) respectively at the time of induction of general anaesthesia. Patients were assessed in recovery room for pain according to visual analogue scale and any side effects. Amount of rescue analgesia required by both groups were also recorded. Odds Ratio and and Chi Square test were used for statistical analysis.Results: Statistical …


Chemical And Biological Warfare Preparing To Meet The Threat, S Sophie, S U. Haq, M R. Khan Apr 2004

Chemical And Biological Warfare Preparing To Meet The Threat, S Sophie, S U. Haq, M R. Khan

Department of Anaesthesia

No abstract provided.


Peri-Operative Management Of A Patient With Uncontrolled Polycythemia Vera For Above Knee Amputation, A Ahmed, K A. Shah Jan 2004

Peri-Operative Management Of A Patient With Uncontrolled Polycythemia Vera For Above Knee Amputation, A Ahmed, K A. Shah

Department of Anaesthesia

No abstract provided.


Midazolam And Thiopentone Co-Induction: Looking For Improvement In Quality Of Anaesthesia, M A. Khan, F A. Khan Nov 2003

Midazolam And Thiopentone Co-Induction: Looking For Improvement In Quality Of Anaesthesia, M A. Khan, F A. Khan

Department of Anaesthesia

Objective: To evaluate improvement in quality of anaesthesia induction using thiopentone and midazolam for co-induction of anaesthesia. An additional end point was taken as loss of response to a tetanic stimulation (50 Hz) delivered for 5 seconds after the loss of verbal contact and eyelash reflex.Methods: Ninety ASA I and II patients, within the age range of 20-60 years were studied. Patients were randomly divided into three equal groups; A, B and group C.Results: Onset of induction and loss of response to a tetanic stimulation was achieved earlier in group B as compared to the other study groups (p < 0.05).CONCLUSION: Co-induction with midazolam 0.02 mg x kg(-1) followed by thiopentone 3 mg x kg(-1) was superior to other two groups. Induction of anaesthesia in this group was found to be smoother and faster, provided better hemodynamic stability, better airway maintenance and with lesser incidence of untoward effects.


A Comparison Of Morphine And Nalbuphine For Intraoperative And Postoperative Analgesia, F N. Minai, F A. Khan Sep 2003

A Comparison Of Morphine And Nalbuphine For Intraoperative And Postoperative Analgesia, F N. Minai, F A. Khan

Department of Anaesthesia

Introduction: Short acting narcotics are not available in Pakistan and the supply of drugs like morphine and pethidine is short and erratic; therefore there is a need for investigating acceptable alternatives for analgesia, to be used for balanced anaesthesia.Objective: We studied the agonist-antagonist narcotic nalbuphine compared to morphine, for intra and postoperative pain relief in total abdominal hysterectomies.Methods: In a randomised double blind trial, fifty ASA I and II patients in two groups of twenty five each were given equianalgesic doses of morphine and nalbuphine. Hemodynamic stability, intraoperative analgesia, recovery profiles, incidence of side effects and need for postoperative supplements …


Effect Of Acupressure On Postoperative Nausea And Vomiting In Laparoscopic Cholecystectomy, K Samad, G Afshan, R Kamal Feb 2003

Effect Of Acupressure On Postoperative Nausea And Vomiting In Laparoscopic Cholecystectomy, K Samad, G Afshan, R Kamal

Department of Anaesthesia

Objective: To evaluate the effectiveness of acupressure applied at meridian P6 point for prevention of nausea and vomiting in patients undergoing laparoscopic cholecystectomy.METHODOLOGY: A randomized double blind study was performed in 50 ASA I and II patients scheduled for laparoscopic cholecystectomy. Patients were divided into two groups; control and placebo. In the control group acupressure was applied at P6 point half an hour before surgery while in the placebo group the acupressure band was tied on meridian P6 point but the plastic bead was placed on the dosum of right forearm away from meridian P6 point. Patients were assessed for …


Comparison Of Keorolac With Morphine For Intraoperative Analgesia In Patients Undergoing Total Abdominal Hysterectomy, S. S. Hasan, Fazal Hameed Khan, M. Ahmed Jan 2003

Comparison Of Keorolac With Morphine For Intraoperative Analgesia In Patients Undergoing Total Abdominal Hysterectomy, S. S. Hasan, Fazal Hameed Khan, M. Ahmed

Department of Anaesthesia

Direct laryngoscopy and endotracheal intubation during anaesthesia and cutting, stretching and tissue manipulation during surgery is the most painful time for a patient undergoing surgery. The elicited pain during a surgical procedure is associated with significant hemodynamic changes including rise in blood pressure, heart rate, sweating, pupillary dilatation etc. These hemodynamic changes are not desirable and may produce deleterious effects in patients with hypertension, ischemic heart disease and cerebro-vascular disease and impose a great challenge for anaesthesiologist to maintain physiologic homeostasis during these periods of stress. Opioids are considered to be the corner stone in the management of intraoperative and …


Comparison Of Fentanyl And Nalbuphine In Total Intravenous Anaesthesia (Tiva), F A. Khan, Hameedullah Oct 2002

Comparison Of Fentanyl And Nalbuphine In Total Intravenous Anaesthesia (Tiva), F A. Khan, Hameedullah

Department of Anaesthesia

Objective: To compare Nalbuphine and fentanyl as total intravenous anaesthesia with propofol infusion in laproscopic cholecystectomy cases.STUDY Design: Double blind randomised.Methods: Changes in haemodynamic variables greater than twenty percent above or below the baseline and recovery profile were observed.Results: Blood pressure remained within 20% of baseline in either group. Nine patients in fentanyl and fifteen in nalbuphine group required an additional bolus of propofol intraoperatively. Heart rate response after tracheal intubation was significantly higher in the nalbuphine group (25%). No difference was observed in the incidence of nausea and vomiting in the recovery room. Twenty-seven percent patients in the nalbuphine …


Respiratory Arrest In A Child After Flushing Of Pancuronium From The Dead Space Of Intravenous Cannula, Robyna Irshad Khan, Fazal Hameed Khan, Hamid Iqil Naqvi Oct 2002

Respiratory Arrest In A Child After Flushing Of Pancuronium From The Dead Space Of Intravenous Cannula, Robyna Irshad Khan, Fazal Hameed Khan, Hamid Iqil Naqvi

Department of Anaesthesia

It is common practice for patients admitted to Intensive Care Units to have indwelling intravenous cannulae. Sometimes these cannulae are used only for the administration of drugs and are closed otherwise. Residual drugs in the deadspace of these intravenous cannulae as well as connected stoppers or 3-way stopcocks can later be flushed unknowingly. We would like to report a case in which inadvertent flushing of residual pancuronium caused complete muscle paralysis and respiratory arrest in a young child.


Acute Lung Injury/Acute Respiratory Distress Syndrome, Fazal Hameed Khan Jan 2002

Acute Lung Injury/Acute Respiratory Distress Syndrome, Fazal Hameed Khan

Department of Anaesthesia

Reports of pulmonary physiopathological insults following severe trauma resulting in respiratory failure are not new in medical literature1,2. In 1967 Ashbaugh and colleagues described a syndrome of acute respiratory distress following a variety of precipitating conditions3. Severe hypoxemia, diffuse pulmonary infiltrates, poor lung compliance and absence of left heart failure characterize this condition. Ashbaugh et al4 subsequently named it as adult respiratory distress syndrome to differentiate it from infant respiratory distress syndrome. It was proposed at that time that both conditions manifest similar physiopathological changes. It was also referred to as “traumatic wet lung”, “congestive …


Anaesthetic Management For A Patient With Severe Multiple Sclerosis, E I. Khan, N Amjad, A A. Khan Jun 2001

Anaesthetic Management For A Patient With Severe Multiple Sclerosis, E I. Khan, N Amjad, A A. Khan

Department of Anaesthesia

No abstract provided.


Comparison Of Spontaneous With Controlled Mode Of Ventilation In Tonsillectomy, F A. Khan, G A. Memon Mar 2001

Comparison Of Spontaneous With Controlled Mode Of Ventilation In Tonsillectomy, F A. Khan, G A. Memon

Department of Anaesthesia

Methods: This randomized study compares spontaneous versus controlled ventilation in 60 ASA I and II patients undergoing tonsillectomy as regards haemodynamic stability, recovery characteristics, intra- and immediate postoperative complications and surgical impressions.Results: The patients in the balanced anaesthesia (B) group showed less haemodynamic variability compared to baseline after tracheal intubation, mouth gag application and removal and incision. Two patients had dysrhythmias in the B group compared to six in the spontaneous breathing (S) group. Six patients in the S group had a rise in endtidal carbon dioxide concentration above 7.8 kPa (60 mmHg). Recovery scores were higher in the B …


Pneumoperitoneum Following Mechanical Ventilation In A Child, Fazal Hameed Khan, Nadeem Ahmad Jan 2001

Pneumoperitoneum Following Mechanical Ventilation In A Child, Fazal Hameed Khan, Nadeem Ahmad

Department of Anaesthesia

No abstract provided.


Anatomical Variations Of Internal Jugular Vein As Seen By "Site Rite Ii" Ultrasound Machine--An Initial Experience In Pakistani Population, Hameedullah, M. A. Rauf, Fazal Hameed Khan Jan 2001

Anatomical Variations Of Internal Jugular Vein As Seen By "Site Rite Ii" Ultrasound Machine--An Initial Experience In Pakistani Population, Hameedullah, M. A. Rauf, Fazal Hameed Khan

Department of Anaesthesia

Objective: To determine the anatomical variations of the internal jugular vein (IJV) in Pakistani adult population with the help of Site Rite II ultrasound machine.
Material and Method: The right IJV relation to the carotid artery was visualized at four different landmarks (angle of the mandible, thyroid cartilage, cricoid cartilage, and the supraclavicular area). Size of IJV in comparison to carotid artery was also seen.
Results:
In 49 cases the IJV was found in aberrant relation to carotid artery at the angle of the mandible (p value
Conclusion:Care should be taken while cannulating IJV at the angle of the …


A Comparative Study Of Positive Pressure Ventilation Via Laryngeal Mask Airway And Endotracheal Tube, A Idrees, F A. Khan Oct 2000

A Comparative Study Of Positive Pressure Ventilation Via Laryngeal Mask Airway And Endotracheal Tube, A Idrees, F A. Khan

Department of Anaesthesia

Objective: To investigate the use of Laryngeal Mask Airway (LMA) and its comparison with the endotracheal tube for positive pressure ventilation.SETTING: A tertiary care teaching hospital.Methods: Fifty adult ASA I and II patients undergoing peripheral limb surgery were randomly allocated to 2 groups for LMA or endotracheal tube insertion. A standardized anaesthetic technique was used. The groups were then compared regarding haemodynamic changes on insertion as well as removal of LMA and ETT and any complications that occurred were noted.Results: The haemodynamic response to insertion was significantly attenuated (p < 0.05) in LMA group as compared to ETT group. The cardiovascular response to extubation was not significantly different between the groups. A higher incidence of coughing and mild hypoxaemia at extubation was noted in ETT group as compared to LMA group (p < 0.05) and blood was detected in 4 cases after LMA removal.CONCLUSION: It is concluded that the use of LMA during positive pressure ventilation is safe in selected cases. There is an attenuated haemodynamic response to insertion of LMA as compared to endotracheal tube which will be beneficial in certain patients e.g., those with ischaemic heart disease, vascular disease and hypertensives.


Incidence And Pattern Of Thrombocy To Penia In Cardiac Surgery Patients, S Bashir, S M. Shah, I Babar Jun 2000

Incidence And Pattern Of Thrombocy To Penia In Cardiac Surgery Patients, S Bashir, S M. Shah, I Babar

Department of Anaesthesia

No abstract provided.


Anaesthetic Management Of Patients With Phaeochromocytoma And Uncontrolled Blood Pressure, Ursula Chohan, Fazal Hameed Khan Jan 1999

Anaesthetic Management Of Patients With Phaeochromocytoma And Uncontrolled Blood Pressure, Ursula Chohan, Fazal Hameed Khan

Department of Anaesthesia

No abstract provided.


Ectopic Placement Of Central Venous Catheter, Importance Of X-Ray Chest, Nadeem A. Zaidi, Fazal Hameed Khan Jan 1998

Ectopic Placement Of Central Venous Catheter, Importance Of X-Ray Chest, Nadeem A. Zaidi, Fazal Hameed Khan

Department of Anaesthesia

A case of malpositioning of central venous catheter which was judged to be correctly placed on clinical criteria isbeing presented. Abberant positioning was picked up on X-ray


Bronchospasm/Desaturation Under Anaesthesia: Are They Signs Of Pneumothorax?, N A. Zubair, A Zaidi, R S. Kamal Jun 1997

Bronchospasm/Desaturation Under Anaesthesia: Are They Signs Of Pneumothorax?, N A. Zubair, A Zaidi, R S. Kamal

Department of Anaesthesia

No abstract provided.


Experience With Larangeal Mask Airway In Pakistani Patients, F A. Khan, M A. Afzal, R S. Kamal Dec 1996

Experience With Larangeal Mask Airway In Pakistani Patients, F A. Khan, M A. Afzal, R S. Kamal

Department of Anaesthesia

One hundred and thirty seven adult patients undergoing peripheral surgery were studied regarding ease of larangeal mask airway (LMA) insertion, airway maintenance during surgery and complication encountered during insertion, maintenance and in the postoperative period. In a majority (84%) of patients, the airway was positioned correctly at the first attempt, 3% patients had mild laryngospasm at insertion and in 85% a good airway was obtained. No airway related problems were encountered intraoperatively. Two percent patients had laryngospasm on removal of LMA. Postoperatively, the complaint of sore throat and uvular trauma was seen in 4% cases.


Complications Of Endotracheal Intubation In Mechanically Ventilated Patients In A General Intensive Care Unit, Fazal Hameed Khan, Fauzia A. Khan, Robyna Irshad Khan, Rehana S Kamal Sep 1996

Complications Of Endotracheal Intubation In Mechanically Ventilated Patients In A General Intensive Care Unit, Fazal Hameed Khan, Fauzia A. Khan, Robyna Irshad Khan, Rehana S Kamal

Department of Anaesthesia

During a period of one year, 126 patients were prospectively audited to analyse complications of endotra­cheal intubation in a general intensive care unit setting. A total of 62 complications were observed in 48 patients. The most frequent complications during intubation were hypotension and bradycardia. The blockage of endotracheal tubes significantly increased with the duration of intubation. Sore throat was the commonest (22%) complication following extubation. Other complications like stridor and ulceration of mouth and lips which followed extubation were not related to the duration of intubation.


Pregnancy Induced Hypertension--Anaesthetic Considerations, N A. Zubair Sep 1996

Pregnancy Induced Hypertension--Anaesthetic Considerations, N A. Zubair

Department of Anaesthesia

No abstract provided.