Anesthesiology Commons^™

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

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

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

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

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

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

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

Department of Anaesthesia

Reports of pulmonary physiopathological insults following severe trauma resulting in respiratory failure are not new in medical literature^1,2. 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

Department of Anaesthesia

No abstract provided.

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

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

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 …

Combined Antagonist Compositions, Scott R. Hamann

Anesthesiology Faculty Patents

Novel compositions of a combination of nicotinic, opioid, serotonergic and/or adrenergic antagonists in combination with nicotinic and opioid agonists, anti-depressants, stimulants, non-steroidal anti-inflammatory drugs, and local anesthetics, such combinations being useful in the treatment of excitable system disorders, pain and psychiatric disorders, and methods of use thereof.

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

Department of Anaesthesia

No abstract provided.

The Accuracy Of Nitrous Oxide Passive Dosimeters As Compared With An Infra-Red Spectrographic Reference Method, Susan Allen

Community & Environmental Health Theses & Dissertations

Nitrous oxide is a gas often used in dental, surgical and veterinary operations as an anesthetic agent. Employees stationed in proximity of fugitive gas emissions may potentially suffer adverse health effects from chronic exposure to this agent. Passive dosimeters can be worn in the breathing zone of potentially affected personnel during exposure periods, then later analyzed to quantify nitrous oxide exposure. This study sought to establish the accuracy of several commercially available passive monitoring devices for nitrous oxide by comparison against an infra-red spectrophotometric reference method.

Induction Of Integral Membrane Pam Expression In Att-20 Cells Alters The Storage And Trafficking Of Pomc And Pc1, Giuseppe D. Ciccotosto, Martin R. Schiller, Betty A. Eipper, Richard E. Mains

Life Sciences Faculty Research

Peptidylglycine alpha-amidating monooxygenase (PAM) is an essential enzyme that catalyzes the COOH-terminal amidation of many neuroendocrine peptides. The bifunctional PAM protein contains an NH2-terminal monooxygenase (PHM) domain followed by a lyase (PAL) domain and a transmembrane domain. The cytosolic tail of PAM interacts with proteins that can affect cytoskeletal organization. A reverse tetracycline-regulated inducible expression system was used to construct an AtT-20 corticotrope cell line capable of inducible PAM-1 expression. Upon induction, cells displayed a time- and dose-dependent increase in enzyme activity, PAM mRNA, and protein. Induction of increased PAM-1 expression produced graded changes in PAM-1 metabolism. Increased expression of …

Investigation Of The Contractile And Regulatory Proteins In Malignant Hyperthermia And Normal Skeletal Muscle, Louise C. Norbury

Theses : Honours

Malignant hyperthermia/hyperpyrexia (MH) is a serious human skeletal muscle disorder that manifests itself during general anaesthesia. Currently, the most reliable method of diagnosing this disease is the in-vitro contracture test (IVCT). This procedure is both highly invasive for the patient and expensive to perform. The skinned muscle fibre technique is less invasive, and could possibly be used as an alternative diagnostic test for MH. In this study, skeletal muscle samples were obtained from B adults (age 23-54 years) undergoing elective surgery at Royal Perth Hospital. Six patients were diagnosed as normal (controls) and two equivocal for MH (MHE). Using the …

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

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

Department of Anaesthesia

No abstract provided.

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

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

Department of Anaesthesia

No abstract provided.

Adverse Cerebral Outcomes After Coronary Bypass Surgery, Gary W. Roach , M.D., Marc Kanchuger , M.D., Christina Mora Mangano , M.D., Mark Newman , M.D., Nancy Nussmeier , M.D., Richard Wolman , M.D., Anil Aggarwal , M.D., Katherine Marschall , M.D., Steven H. Graham , M.D., Ph.D., Catherine Ley , Ph.D., Gerard Ozanne , M.D., Dennis T. Mangano , Ph.D., M.D., Ahvie Herskowitz , M.D., Vera Katseva , Ph.D, Rita Sears , R.N., M.S.

Anesthesiology Publications

ABSTRACT

Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury.

Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures).

Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of …

Evaluation Of Oral Midazolam As Pre-Medication In Day Care Surgery In Adult Pakistani Patients, N Ahmed, F A. Khan

Department of Anaesthesia

A placebo controlled randomized double blind study was designed to assess the suitability of oral Midazolam as a premedication in day care surgery in adult Pakistani patients. Fifty ASA I and II patients aged between 20-60 years received either Midazolam 7.5 mg or a placebo approximately one hour prior to surgery. Midazolam 7.5 mg produced significant anxiolysis and sedation (p < 0.001) in comparison to placebo after one hour of premedication. There was a significant difference (p < 0.001) in the mean heart rate and blood pressure in both groups after 1 hour of premedication with a lesser rise in blood pressure and heart rate in the Midazolam group. Psychomotor performance assessed by 'n' deletion test was impaired by Midazolam (p < 0.001) and recall of pictures revealed differences (p < 0.05) in the groups at one hour after premedication. However, at four hours after surgery there were no differences in both groups. These findings indicate that rapidly acting oral Midazolam in doses of 7.5 mg provided safe and effective premedication in terms of anxiolysis, sedation, amnesia and psychomotor performance and is suitable for day surgery.

A Comparison Of Four Muscle Relaxant Techniques And Their Incidence Of Postoperative Myalgia In Ambulatory Patients, William James Garske Jr.

Community & Environmental Health Theses & Dissertations

Postoperative myalgia was measured 24 and 72 hours following the administration of four different anesthetic regimens to 36 patients undergoing outpatient or 23-hour admission procedures. Each patient, ASA class I or II, was to undergo procedures of limited duration, 30 to 90 minutes, and surgical stimulation, including procedures such as knee arthroscopy, hernia repair, and breast biopsy. Anesthesia was induced with propofol 1.5 mg/kg, fentanyl 50 mcg, and maintained with O₂ , N₂O, and isoflurane. Group I (n=20), the control, received no muscle relaxant and was maintained with mask ventilation. Group II (n=5) received succinylcholine 1.5 mg/kg …

The Degree Of Exposure To Anesthetic Nitrous Oxide Waste Gas In The Operating Room During Various Surgical Procedures, Kathryn Ann Longworth

Community & Environmental Health Theses & Dissertations

Halsey (1991) summarized the underlying reasons for continuing concern about the problem of waste anesthetic gases. Careful and systematic monitoring studies indicate that individual trends in anesthetic pollution levels are not as low as was confidently predicted 10 years ago, when scavenging devices became commonplace. Second, there are now clear legal requirements for assessment of the situation. It is estimated that each year more than 200,000 health professionals are occupationally at risk of illness as a consequence of chronic exposure to low doses of waste anesthetic gases (Rogers, 1986).

These contaminants are suspected pf being ~eratogenic, carcinogenic, mutagenic, and embryo-lethal. …

Management Of Diabetic Patient’S Undergoing Major Surgery Using Glucose Insulin Potassium Infusion, Fazal Hameed Khan, Rs Kamal

Department of Anaesthesia

No abstract provided.

The Effect Of Body Position Changes On Arterial Oxygen Saturation In Obesity As Measured Noninvasively By Pulse Oximetry, Anna Marie Angela Klosterman

Theses and Dissertations

This study utilized a quasi-experimental pretest-posttest design that compared the effect of body position changes on arterial oxygen saturation in obesity as measured noninvasively by pulse oximetry. The null hypothesis, that there would be no difference between oxygen saturation values measured by pulse oximetry with position change from sitting to supine in obese subjects as compared to nonobese subjects, was tested. Fourteen obese, American Society of Anesthesiologist (ASA) physical class status II subjects and 14 nonobese ASA physical class status I subjects were included in the sample population. Thirteen of the obese subjects were further classified as morbidly obese. After …