Surgery In Tertiary Care Hospital Research Articles

Haemodynamic responses to intubation, extubation and post‐operative analgesia after intravenous lignocaine in laparoscopic cholecystectomy surgeries: a randomized control study

ABSTRACT:
 Objectives: To evaluate the effect of intravenous lignocaine on haemodynamic responses to intubation, extubation and post‐operative analgesia in laparoscopic cholecystectomy surgeries.
 Methods: This prospective, randomized, double blinded study was conducted in patients for elective laparoscopic cholecystectomy surgery in tertiary care hospital of Tamil Nadu. Group A (n=60) received 0.9% normal saline for perioperative intravenous infusion and Group B (n=60) received preservative free lignocaine 2% (20mg/ml) as intravenous infusion Hemodynamic responses were recorded to intubation, extubation and post‐operative analgesia in both groups. VAS scores and pain free period were also compared.
 Results: Pulse rate (PR) and mean arterial pressure (MAP) were significantly increased in both the groups during laryngoscopy and intubation, though the rise of both in lignocaine group was significantly less than normal saline group. (p<0.0001) Similarly, both PR and MAP were significantly increased during extubation in both the groups. (p<0.0001) However, the rise of both the parameters in lignocaine group was significantly less as compared to normal saline group. (p<0.0001) VAS scores in immediate post operative period were better in lignocaine group than normal saline group. The mean pain free period was less than an hour in normal saline group, while it was approximately 4 hours in lignocaine group. (p<0.0001)
 Conclusions: This study concluded that i.v infusion of lignocaine had significantly increased the pain free period post operatively. So those who are not affordable for epidural block, lignocaine i.v infusion is better alternative for post operative analgesia.

Clinical Characteristics of Cataract Patients and Outcome of Cataract Surgery in Tertiary Care Hospital in Central Nepal

Background Cataract remains the leading cause of avoidable blindness in low-income countries such as Nepal. Despite the availability of surgical interventions for cataract in leading institutions, still a large number of patients from remote areas delay or have difficulty in getting treatment, present late or with complications.
 Objective To determine the clinical characteristics and visual outcome of patients undergoing cataract surgery in Tertiary Care Hospital in Central Nepal.
 Method We retrospectively reviewed the medical records of 138 patients who underwent cataract surgery at a tertiary care hospital from January 2018 to September 2022. R version 4.0.3 was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation).
 Result During follow-up visits between one to three weeks, 91.9% out of 135 patients had normal/near normal presenting visual acuity and with best correction it was 96.9% out of 131 patients. About 1.6% out of 124 operated eyes still had moderate visual impairment after best correction when they visited for follow-up at 12 weeks.
 Conclusion The study findings underline the ongoing gap in increasing access to cataract treatment, given the large proportion of individuals who still presented extremely late.

Duration of postoperative analgesia with Nalbuphine vs Butorphanol as an adjunct to spinal anesthesia for lower limb orthopedic surgeries: A randomized double-blind active control trial.

Background and Aims:Nalbuphine as well as butorphanol as adjuvant to intrathecal bupivacaine have been studied in comparison to bupivacaine alone. Both are kappa receptor agonist and have never been compared for its efficacy in terms of postoperative analgesia. The aim of this study was to evaluate duration of postoperative analgesia as well as intraoperative block characteristics using intrathecal nalbuphine hydrochloride (800 μg) or butorphanol (25 μg) as adjuvant to hyperbaric bupivacaine (12.5 mg) in lower limb fracture femur surgeries as compared to active control, that is, saline and bupivacaine.Material and Methods:This prospective, randomized, double-blind, active control study was conducted on 90 adult patients of either sex belonging to ASA grade I/II, aged 18–70 years, being operated for fracture femur surgeries in tertiary care hospital of North India. Patients were randomly divided into 3 groups (n = 30) Group A: received 0.5% hyperbaric bupivacaine 12.5 mg with 800 μg nalbuphine. Group B: Received 0.5% hyperbaric bupivacaine 12.5 mg with 25 μg butorphanol. Group C: Received 0.5% hyperbaric bupivacaine 12.5 mg with normal saline. Total volume injected was 3.0 ml. Duration of analgesia, mean VAS scores, requirement of rescue analgesia in 24 h along with intraoperative sensory or motor characteristics of block and hemodynamic parameters were studied. Statistical analysis was done using ANOVA with post-hoc Tukey test, Student’s t-test and Chi-Square test.Results:Demographic profile was comparable among all the three groups. Mean duration of postoperative analgesia was 348.33 ± 66.96, 156.17 ± 43.9 and 110.36 ± 29.18 min in group A, B, and C, respectively (P = 0.006). Total doses of rescue analgesia were least in group A (32), followed by group B (42) and group C (64), respectively (P = 0.001). Group A had significantly earlier onset of sensory action (P = 0.03) as compared to group B and C. There was significant difference in sensory (P = 0.08) and motor duration (P = 0.04) among all the three groups. However, onset of motor block, haemodynamic profile and side effects were comparable among groups A, B, and C (P > 0.05).Conclusion:Addition of 800 μg nalbuphine and 25 μg butorphanol as adjuvant to intrathecal bupivacaine has better outcome as compared to active placebo group. But intrathecal nalbuphine was more effective compared to intrathecal butorphanol in terms of prolonging postoperative analgesia, reducing rescue analgesic doses and onset of sensory block. However, hemodynamic profile and side effects were comparable among all groups.

Post-operative hypocalcemia in patients undergoing thyroid surgeries in tertiary care hospital: an observational study

<p><strong>Background: </strong>Post-operative hypocalcaemia is one of the most common complications of thyroid and parathyroid surgery. Temporary hypocalcaemia has been reported to occur in 1.6-50% of the patients undergoing bilateral thyroid resection. Permanent hypoparathyroidism results in 0-13% of patients after bilateral thyroid surgery.</p><p><strong>Method: </strong>We have analyzed the data of 34 patients undergoing total thyroid surgery (with or without neck dissection) and completion thyroidectomy at the department of ENT and HNS, SMHS hospital over a period of 1.5 years between May 2019 to November 2020.</p><p><strong>Results:</strong> Hypocalcemia was found in a total of 15 patients out of 34 patients in the post-op period. Among the total patients who developed hypocalcemia 5 (14.7%) were males and 10 (29.4%) were females. Among the patients who developed post-op hypocalcemia 14 patients developed transient hypocalcemia (p>0.01) which is not statistically significant and 1 patient developed permanent hypocalcemia (p>0.01) which also has no statistical significance.</p><p><strong>Conclusions: </strong>The study suggests that female gender is a strong risk factor for developing post-operative hypocalcemia, other factors that play a role include difference in serum calcium levels in the perioperative period and type of surgery.</p>

SARS-CoV-2 (COVID-19) and Spine Surgeries in Tertiary-care Hospital of India

The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on spine surgery worldwide. India, with its large population and limited health resources, will be overwrought due to the number of cases of critically ill patients with COVID-19. It is important to understand the challenges for spine surgeons in India when dealing with patients during the COVID-19 pandemic. In India, elective spine surgeries stand cancelled whilst trauma and emergency surgeries have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines. This article highlights the challenges in the triaging of patients, care in dealing with a patient with COVID-19 in spine surgery, and the effects on academics and research activities; it also suggests immediate measures and recommendations that also apply to other specialties. Keywords: COVID-19, coronavirus disease, Spine surgery, India.

Assessment between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy: a record based study

Background: Hypoparathyroidism is a major complication of thyroidectomy. The association between the number of parathyroid glands preserved and hypoparathyroidism is not well understood. The objectives of the study were to evaluate the clinical characteristics and the frequency of hypoparathyroidism during thyroidectomy, and to determine the minimum number of parathyroid glands that need to be preserved to prevent hypoparathyroidism.Methods: A retrospective study was conducted in Department of Surgery in Tertiary care hospital from January 2016 to December 2017. Around 250 patients who underwent total thyroidectomy for papillary thyroid carcinoma were analysed. We evaluated the frequency of hypoparathyroidism according to the number of parathyroid glands preserved.Results: Incidental parathyroidectomy occurred in 20% of the patients; one parathyroid gland in 16%, two in 1.5%, and three in 0.9%. Transient hypoparathyroidism was increased when incidental parathyroidectomy occurred (odds ratio 1.63, 95% confidence interval 1.07 to 3.13, p=0.03). There was no significant relationship between the number of parathyroid glands preserved and permanent hypoparathyroidism (p=0.16).Conclusions: Conservation of all parathyroid glands decreases transient hypoparathyroidism equated with when three or fewer glands are preserved but does not affect permanent hypoparathyroidism.

Evaluation of Operational and Financial Feasibility of Robotic Surgery in Tertiary Care Hospital

Evaluation of Operational and Financial Feasibility of Robotic Surgery in Tertiary Care Hospital

Occurrence of Postoperative ptosis after cataract surgery in tertiary care hospital of south Gujarat area

Occurrence of Postoperative ptosis after cataract surgery in tertiary care hospital of south Gujarat area

Dexmeditomedine vs Esmolol for Hypotensive Anaesthesia in Oro-Maxillo Facial Surgeries in Tertiary Care Hospital, Kanchipuram District

Dexmeditomedine vs Esmolol for Hypotensive Anaesthesia in Oro-Maxillo Facial Surgeries in Tertiary Care Hospital, Kanchipuram District

Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital.

Background:Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.Methodology:A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome.Results:Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days.Conclusion:Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation.

A prospective study of lornoxicam as pre-emptive analgesic in abdominal surgeries in tertiary care hospital in Salem, India

Background: Preemptive analgesia, involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain.Methods: To determine the efficacy and safety of Lornoxicam when administered preemptively by using Wong-Baker FACES Pain Rating scale. The patients undergoing abdominal surgery were randomly categorized into group A and B of 25 each. Group A- Received Lornoxicam 8mg (1ml) one hour before surgery. Group B- Not received any analgesic before surgery. Primary measurement of the efficacy was done by using Wong-Baker Faces Pain Rating Scale at 2, 4, 8, 12 and 24 hour. All parameters were analyzed by using student t test.Results: Surgeries which were included in the study are hernia repair, open appendectomy, laparoscopic (appendectomy, cholecystectomy). Reduction in pain scores at 12th hourly and 24th hourly pain scores (<0.05) was significant. Tramadol usage decreased significantly with laparoscopic surgeries.Conclusions: In this study we could demonstrate that lornoxicam when used preemptively reduces the pain score slightly and reduces the requirement of post-operative analgesics significantly.

An Epidemiological Study on Perception of the Cataract Patients regarding Cataract Surgery in Tertiary Care Hospital, Bareilly District, Uttar Pradesh

ABSTRACT Blindness is one of the significant social problems in India with 7 million of the total 45 million blind people in the world residing in our country. Major barriers to cataract surgery are poverty, no transportation, need not felt, and sex related. The low literacy rate among females and poor accessibility of the surgical sites were identified as important barriers in rural areas. There was also association found between socioeconomic status and cataract among cataract patients. In this study, a total of 208 participants who attended the ophthalmology outpatient department were studied for the observation on perception of cataract patient regarding cataract surgery. Data were analyzed and results were compared with other global studies. How to cite this article Kumar P, Joshi HS, Katyal R, Ranjan P. An Epidemiological Study on Perception of the Cataract Patients regarding Cataract Surgery in Tertiary Care Hospital, Bareilly District, Uttar Pradesh. Int J Adv Integ Med Sci 2016;1(4):148-150.