Surgery Commons^™

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 …

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 …

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 …

Bapcap2-1 Does Preoperative Aspirin Improve Outcomes In Cardiac Surgery Patients?, Jian-Zhong Sun, L. Cao, H. Liu, W. Sun, S Silvestry, J. Diehl

Department of Anesthesiology Faculty Papers

Best Abstracts - Runner-up Session 2 presented at Euroanaesthesia 2011 in the Netherlands.

Background and Goal of Study: The effects of preoperative aspirin on major cardiocerebral and renal outcomes and mortality remain uncertain.

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 …

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.

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 …

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. …

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.

Ultrasound Visualization Vs. Electrical Nerve Stimulation For Interscalene And Axillary Nerve Block In Upper Extremity Surgery: A Prospective Randomized Trial (Poster), Joseph W. Galassi Md, Jodie Buxbaum Md, J John Collins Md, Dorothy Hartman Md, Michael He Md, Farheen Hussain Ms, Leslie Baga Bsn, Sherrine Eid Mph, Mary Jane Cerrone Msn, Nanette M. Schwann Md

Department of Anesthesiology

No abstract provided.

Hypertonic Saline For Peri-Operative Fluid Management, Vivian Mcalister, Karen E. A. Burns, Tammy Znajda, Brian Church

Surgery Publications

BACKGROUND: Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium.

OBJECTIVES: To determine the benefits and harms of HS versus IS solutions administered to patients undergoing surgery.

SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library) Issue 1, 2009; MEDLINE (1966 to 2009); EMBASE (1980 to 2009); LILACS (to August 2009) and CINAHL (1982 to 2009) without language restrictions.

SELECTION CRITERIA: We included randomized clinical trials where HS was compared to …

Anaesthesia At Remote Location: Use Of Modified Bain Circuit (Mapleson D) At Kunri Christian Hospital (Kch), Ehtesham Izhar Khan, Hameed Ullah, Rehana Kamal

Department of Anaesthesia

OBJECTIVE: To develop a safe general anaesthesia technique for remote areas with lack of facilities.

METHODS: Four types of anaesthesia techniques using TIVA and modified Bain circuit were planned. Monitoring facility was limited to manual sphygmomanometer, palpation of radial pulse and monitoring of colour of skin and blood. Depth of anaesthesia was assessed using EVANs, RPST scoring system. Patients were asked in recovery room for awareness.

RESULTS: Surgeries done were cesarean sections, laparotomies, gynaecological, urological, hernia and burn contractures. Six patients had RPST score of 5 or more and three patients in recovery room complained of awareness. Cost per Anaesthesia …

Success And Failure Of Fast Track Extubation In Cardiac Surgery Patients Of Tertiary Care Hospital: One Year Audit, Mohammad Irfan Akhtar, Mohammad Hamid

Section of Cardiothoracic Surgery

OBJECTIVE: To identify the causes of delayed extubation in patients planned for fast tract extubation during cardiac surgery.

METHODS: A prospective observational study was conducted at cardiothoracic unit of Aga Khan University Hospital for the period of one year. All elective coronary artery bypass graft (CABG) surgery patients, between the ages of 35-75 years with LVEF > or = 40 percent were included. Patients with Intra aortic balloon pump, chronic renal failure, respiratory compromise and requiring high ionotropic support were excluded from this audit. A performa was designed and later filled by the primary investigator. Patient demographics and various reasons for …

Use Of Anticonvulsants Drugs For Neuropathic Painful Conditions, Aziza Mohammad Hussain, Gauhar Afshan

Department of Anaesthesia

Neuropathic pain, a form of chronic pain initiated and sustained by an insult to the peripheral or central nervous system, is a challenge to clinicians as it does not respond well to traditional pain therapies. However exact pathophysiology is not known but considering similarities between epilepsy models and in neuropathic pain models justify the rationale for use of anticonvulsant drugs in the symptomatic management of neuropathic pain disorders. The role of anticonvulsant drugs in the treatment of neuropathic pain is evolving and various clinical trials have used these anticonvulsants and shown positive results in the treatment of trigeminal neuralgia, painful …

Anaesthetic Management Of A Pregnant Patient For Aortic Valve Replacement, Khalid M Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Cardiac disease can be encountered during pregnancy with the frequency being 1% to 2% of all pregnant women. Because of the high foetal and relative maternal mortality during surgery, medical management is the first line of treatment. Nevertheless, when medical treatment fails, cardiac surgery becomes necessary. We present the anaesthetic management of a case of Aortic valve disease in a pregnant woman undergoing surgery.

Effect Of Diclofenac Suppository On Tramadol Consumption In Posthysterectomy Pain, Aziza Mohammad Hussain, Fauzia A Khan, Lumaan Sheikh

Department of Anaesthesia

OBJECTIVE: To determine reduction in dose of tramadol and side effects in posthysterectomy patients on addition of diclofenac on rectal suppository.

STUDY DESIGN: Randomized double blinded placebo controlled study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, Pakistan, from August 2004 to January 2006. Methodology: Seventy ASA I and II females, aged 20 and above, who underwent elective abdominal hysterectomy, were included in this study. Patients received identical looking suppository of either 100 mg diclofenac sodium or placebo after induction of anaesthesia and then 12 hourly for 24 hours. General anaesthesia was standardized and tramadol was given …

Role Of Psoas Compartment And Caudal Epidural Steroid Injection In Spinal Stenosis Patients Associated With Low Back Pain And Lower Limb Radiculopathy, Mueen Ullah Khan, S. Zaki Hussain

Department of Anaesthesia

OBJECTIVE: To study the efficacy, safety and patient satisfaction of psoas compartment and caudal epidural steroid injection in patients with spinal stenosis and lumbosaccral radiculopathy.

METHODS: Patients with a diagnosis of spinal stenosis and lumbosaccral radiculopathy having visual analogue score (VAS) less than five were included in the study. Bilateral psoas compartment and caudal epidural injection was given to all patients. In group-A patients haemodynamics and complications were examined immediately after injection. In group-B the same patients were examined through a questionnaire after eight weeks, for pain relief, duration of pain relief, reduction in painkillers and overall improvement in activities …

Migraine And Patent Foramen Ovale: Exploring The Association And A Possible Treatment Option, Muhammed Yaser Hasan

Department of Biological & Biomedical Sciences

Migraine is a very common type of headache. With a prevalence of 10-12%, migraine ranks 19th among diseases causing worldwide morbidity. Number of studies have shown a high prevalence of patent foramen ovale (PFO) in patients with migraine, especially migraine with aura. The right to left shunting of blood in a PFO could serve as a conduit for chemicals that would exert a trigger effect on hyper excitable neurons leading to the development of migraine. Furthermore patients with PFO and migraine also show a marked improvement in their symptoms after percutaneous closure of the PFO. This review is a close …

Anaesthetic Management Of Patient With Ellis Van Creveld Syndrome, Faisal Shamim, Fauzia N. Minai

Department of Anaesthesia

A known case of Ellis-Van Creveld Syndrome was scheduled for emergency repair of obstructed paraumblical hernia. We describe the anaesthetic management of the case with special reference to the classic physical and physiological manifestations of this syndrome present in our patient.

Sedation-Analgesia In Non Operative Locations: Practice Trends Of Anaesthetists, Fauzia Khan, Khalid Maudood Siddiqui, Rehan Qureshi

Department of Anaesthesia

Sedation/analgesia is a mode of anaesthesia which facilitates an uncomfortable or painful procedure, such as gastrointestinal endoscopy, in a rousable and cooperative patient. The objective of the study was to assess the practice trends for administering sedation analgesia in non operative locations in Aga Khan Hospital, Karachi by anaesthetists. It was a descriptive study which retrospective reviewed anaesthesia records. A total of 41 ASA I-IV cases were reviewed. Non invasive cardiorespiratory monitoring and clinical sedation monitoring were applied. Intravenous Propofol infusion and midazolam boluses were used, singly or in combination with fentanyl boluses. All our patients recovered uneventfully within 5 …

Postoperative Sore Throat After Elective Surgical Procedures, Aliya Ahmed, Shemaila Abbasi, Hasham Bin Ghafoor, Muhammad Ishaq

Department of Anaesthesia

Postoperative sore throat is a common complication of anaesthesia and can lead to dissatisfaction after surgery. Many factors can contribute to postoperative sore throat and the incidence varies with the method of airway management Methods: In this prospective observational study elective gynaecological and general surgical patients were interviewed 24 hours postoperatively to determine the presence of sore throat. Information collected included demographic data, surgical procedure, duration of surgery, airway device used and position of patient during surgery. This study was done over a period of 3 months. Results: 312 patients were interviewed. 81(26%) patients suffered with sore throat postoperatively. 28% …

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 …

Intravenous Procaine During Thoracic Surgery, Forrest E. Leffingwell

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Surgery on the heart and paracardial structures or traction on the hilus of the lung may initiate serious arrhythmias which can result in death if not promptly controlled. Procedures involving the pericardium are particularly apt to be followed by severe derangements of rhythm. Thus anesthesiology is faced with another challenge.

It is now evident that the intravenous administration of procaine has become a valuable addition to the armamentarium of the anesthesiologist in his endeavor to preserve the integrity of the thread of life while the surgeon carries out his heroic assignment without restrictions.

A Study In Local Anesthesia Diethanolaminoethylester Of Para-Aminobenzoic Acid., Wilbur P. Crouch 1907-1964

Electronic Theses and Dissertations

No abstract provided.