Introduction: Children undergoing oncologic procedures as part of their treatment may suffer from... more Introduction: Children undergoing oncologic procedures as part of their treatment may suffer from anxiety. It could be related to parental separation, pain/ bodily harm or a previous bad experience of procedure. Pre-procedure anxiety may result in adverse clinical outcomes such as emergence delirium, pulmonary complications and behavioral issues. Preoperative anxiety must be assessed to deal with using appropriate preinduction distraction techniques. Aims & Objectives: The objective of audit is to determine efficacy of preinduction distraction techniques used in our clinical set up (to meet RCoA standards) in reducing anxiety and need of restrain for children at time of induction. Place and duration of study: Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore Pakistan. 14th of January 2020 to 15th of March 2020 (8 Weeks). Material & Methods: It is a prospective outcome-based audit study of 101 children (2-8 years) undergoing intrathecal chemotherapy and bone marrow bi...
The authors have highlighted the ever-spreading menace of fake research and predatory journalism ... more The authors have highlighted the ever-spreading menace of fake research and predatory journalism in the medicine. The lack of incentives and facilities for genuine research, coupled with compulsion to publish a minimum number of papers for promotions, have forced the authors to adopt the short-cut and choose the journals, which are willing to publish for money, without rigorous peer-review. This tendency can only be curtailed by strict adherence to the rules already set by international agencies. Key words: Access to Information; Authorship; Editorial Policies; Fraud; Open Access Publishing / standards; Peer Review; Scientific Misconduct Citation: Saleem H, Iqbal A. The scam of the research world: the predatory practices. Anaesth. pain intensive care 2022;26(4):430-432; DOI: 10.35975/apic.v26i4.1943 Received: June 14, 2022; Reviewed: June 22, 2022; Accepted: July 06, 2022
Journal of Ayub Medical College, Abbottabad : JAMC, 2020
BACKGROUND Regional anaesthesia is choice of anaesthesia for orthopaedic surgery due to lower sid... more BACKGROUND Regional anaesthesia is choice of anaesthesia for orthopaedic surgery due to lower side effects such as nausea, vomiting, postoperative pain and early mobilization. Despite of this, some orthopaedic patients refuse this modality. This study was conducted to interrogate the surgeons about their choice of anaesthesia in order to gain some insights into the concerns of surgeons and to change their minds and choose a safer mode of anaesthesia. The aim of the study was to assess the surgeons' fears and their perception about regional anaesthesia. METHODS After institutional approval, thirty surgeons from three different tertiary care hospitals were interviewed. They were asked questions as per the questionnaire to choose choice of anaesthesia for their patients. RESULTS After regional anaesthesia, 27.6% of respondents were concerned about paralysis and neurological disorders, 34.5% about seeing and hearing whatever is happening in theatre, 17.2% about perioperative pain, 2...
Pakistan Journal of Medical and Health Sciences, 2021
Background: The outbreak of COVID-19 in Pakistan started from February 2020 and over the next few... more Background: The outbreak of COVID-19 in Pakistan started from February 2020 and over the next few months it affected around a million people, leaving thousands dead in an already burdened healthcare infrastructure. Rising to the challenge of COVID 19 airway management, we adopted components of ‘Consensus guidelines for managing airways in patients with COVID 19 to improve success of first pass intubation alongwith minimising risk of infection to self and others. Aim: To analyse the techniques of airway management and complications of suspected or confirmed COVID status at time of their airway management. Methodology: After ethical approval by the institutional review board, data is collected from the Hospital Information System (HIS) for cases fulfilling inclusion criteria, from April to September 2020 in a tertiary care cancer hospital, Pakistan. Results: In our centre, forty-five intubations were performed, 71% of these intubations were out of hours and 43% performed by consultant...
BACKGROUND Lumbar spine surgery can be performed using different anaesthetic techniques such as g... more BACKGROUND Lumbar spine surgery can be performed using different anaesthetic techniques such as general endotracheal anaesthesia (GA) or spinal-based regional anaesthesia (RA). Few of the studies have been done to compare the outcomes of spinal anaesthesia versus general anaesthesia for lumbar laminectomies as both having some advantages as well as disadvantages but still it is controversial. The objective of current study is to make a comprehensive review of literature for comparing the outcomes of lumbar laminectomy performed under general anaesthesia versus spinal anaesthesia. METHODS Literature search was performed by using PubMed, Google scholar and bibliography of related articles. To compare groups of general anaesthesia versus spinal anaesthesia, the variables focused were mean heart rate (HR), mean arterial pressure (MAP), blood loss during surgery, duration of surgery, post-operative anaesthesia care unit (PACU) time, postoperative narcotic use/pain scale, post-operative u...
Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal c... more Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. It occurs more frequently with minimally invasive techniques and very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 36 years old male underwent minimally invasive esophagectomy and presented with chest pain and dyspnoea in the emergency department 8 months after the procedure. He was started on acute coronary syndrome treatment protocol but was later diagnosed on CT scan to have diaphragmatic hernia through a defect in the oesophageal hiatus. As he was already loaded with dual anti platelet therapy it led to qualitative defect of the platelet which resulted in bleeding post procedure and the patient needed resuscitation with blood products. Dual anti-platelet therapy is an integral component of early management strategy in acute coronary syndrome. Chest X-ray was not helpful, but abdominal or che...
Co-amoxiclav is used as a routine prophylactic antibiotic in surgical procedures. We present a ca... more Co-amoxiclav is used as a routine prophylactic antibiotic in surgical procedures. We present a case of 61 years old lady came to outpatient clinic with a diagnosis of right sided lower alveolar tumour. A plan was made to proceed with a Right Marginal Mandibulectomy. She received Co amoxiclav as prophylactic antibiotic and was clinically uneventful. On further questioning there were many different occasions on which the patient had oral co amoxiclav with no complications or side effects. No known drug allergies or otherwise were documented. As a part of surgical antibiotic prophylaxis, Co amoxiclav 1.2 gm was given to patient at the time of induction. After the antibiotic administration patient started having bronchospasm with increased airway pressures and severe hypotension indicating anaphylactic reaction. The patient was resuscitated, recovered from the anaphylactic shock successfully and provided extended recovery in post anaesthesia care unit followed by High Dependency Unit fo...
Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND Endotracheal intubation is one of the basic prerequisites of general anaesthesia. Reco... more BACKGROUND Endotracheal intubation is one of the basic prerequisites of general anaesthesia. Recovery of patients is delayed due to the development of post-operative nausea, vomiting, sore throat and shivering. This study was conducted to determine role of dexamethasone for improved recovery of patients. METHODS This randomized controlled trial was performed in the Department of Anaesthesia, Ayub Teaching Hospital, Abbottabad from June to November 2018. One hundred and twenty-two consenting patients of both genders, aged between 18-60 years, American Society of Anaesthesiologists (ASA) I and II, scheduled for general surgeries of 60-180 minutes duration under general anaesthesia were included. Patients with long duration surgeries, anticipated difficult airways, nasogastric tube in situ, upper respiratory tract infections, on steroid therapy and critically ill and emergency surgeries were excluded. They were randomly allocated into two groups by lottery method as dexamethasone (grou...
Background & Objectives: Radiation therapy is one of the modalities used in cancer treatment to d... more Background & Objectives: Radiation therapy is one of the modalities used in cancer treatment to destroy rapidly growing tumor mass. The fractionated radiation session targets up to four fields of 90 sec each, over 10-15 min. Young children require deep sedation or general anesthesia to make them immobile, for the safe delivery of radiation fractions. Common drugs used for sedation are propofol, ketamine and midazolam. Repeated exposure to anesthetic drugs over a short period of time may lead to development of tolerance and increased dose requirements. We aimed to determine if drug tolerance phenomenon develops in children receiving frequent doses of anesthetic drugs over a short time period. Methodology: This is a retrospective observational study of the pediatric population who underwent frequent radiotherapy sessions with deep sedation from January to May 2019. The data of the first and last day of drugs administered was analyzed to determine if the dose requirement for any of th...
International Journal of Medical and Biomedical Studies
Background: Different crystalloids commonly used in preloading are Ringer lactate, normal saline ... more Background: Different crystalloids commonly used in preloading are Ringer lactate, normal saline and colloids that are used in preloading are gelatin, dextran, hetastarch, pentastarch, tetrastarch. This study was aimed to compare the efficacy of both as preloading infusion to prevent hypotension, requirement of vasopressors and requirement of total fluid given during surgery to maintain stable hemodynamics Methods: This randomized control trials was conducted in the Department of Anaesthesia , R.V.R.S. Medical College, Bhilwara. 60 patients between 18- 40 years of age, belonging to American society of anaesthesia grade I or II going for elective caesarian section under spinal anesthesia were screened for the study eligibility criteria Results: In group (I), in 20 females, efficacy was achieved while in 10 females efficacy could not be achieved because of drop in BP. In group (II), in 22 females, efficacy was achieved while in 8 females, efficacy could not be achieved. The differenc...
Introduction: Children undergoing oncologic procedures as part of their treatment may suffer from... more Introduction: Children undergoing oncologic procedures as part of their treatment may suffer from anxiety. It could be related to parental separation, pain/ bodily harm or a previous bad experience of procedure. Pre-procedure anxiety may result in adverse clinical outcomes such as emergence delirium, pulmonary complications and behavioral issues. Preoperative anxiety must be assessed to deal with using appropriate preinduction distraction techniques. Aims & Objectives: The objective of audit is to determine efficacy of preinduction distraction techniques used in our clinical set up (to meet RCoA standards) in reducing anxiety and need of restrain for children at time of induction. Place and duration of study: Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore Pakistan. 14th of January 2020 to 15th of March 2020 (8 Weeks). Material & Methods: It is a prospective outcome-based audit study of 101 children (2-8 years) undergoing intrathecal chemotherapy and bone marrow bi...
The authors have highlighted the ever-spreading menace of fake research and predatory journalism ... more The authors have highlighted the ever-spreading menace of fake research and predatory journalism in the medicine. The lack of incentives and facilities for genuine research, coupled with compulsion to publish a minimum number of papers for promotions, have forced the authors to adopt the short-cut and choose the journals, which are willing to publish for money, without rigorous peer-review. This tendency can only be curtailed by strict adherence to the rules already set by international agencies. Key words: Access to Information; Authorship; Editorial Policies; Fraud; Open Access Publishing / standards; Peer Review; Scientific Misconduct Citation: Saleem H, Iqbal A. The scam of the research world: the predatory practices. Anaesth. pain intensive care 2022;26(4):430-432; DOI: 10.35975/apic.v26i4.1943 Received: June 14, 2022; Reviewed: June 22, 2022; Accepted: July 06, 2022
Journal of Ayub Medical College, Abbottabad : JAMC, 2020
BACKGROUND Regional anaesthesia is choice of anaesthesia for orthopaedic surgery due to lower sid... more BACKGROUND Regional anaesthesia is choice of anaesthesia for orthopaedic surgery due to lower side effects such as nausea, vomiting, postoperative pain and early mobilization. Despite of this, some orthopaedic patients refuse this modality. This study was conducted to interrogate the surgeons about their choice of anaesthesia in order to gain some insights into the concerns of surgeons and to change their minds and choose a safer mode of anaesthesia. The aim of the study was to assess the surgeons' fears and their perception about regional anaesthesia. METHODS After institutional approval, thirty surgeons from three different tertiary care hospitals were interviewed. They were asked questions as per the questionnaire to choose choice of anaesthesia for their patients. RESULTS After regional anaesthesia, 27.6% of respondents were concerned about paralysis and neurological disorders, 34.5% about seeing and hearing whatever is happening in theatre, 17.2% about perioperative pain, 2...
Pakistan Journal of Medical and Health Sciences, 2021
Background: The outbreak of COVID-19 in Pakistan started from February 2020 and over the next few... more Background: The outbreak of COVID-19 in Pakistan started from February 2020 and over the next few months it affected around a million people, leaving thousands dead in an already burdened healthcare infrastructure. Rising to the challenge of COVID 19 airway management, we adopted components of ‘Consensus guidelines for managing airways in patients with COVID 19 to improve success of first pass intubation alongwith minimising risk of infection to self and others. Aim: To analyse the techniques of airway management and complications of suspected or confirmed COVID status at time of their airway management. Methodology: After ethical approval by the institutional review board, data is collected from the Hospital Information System (HIS) for cases fulfilling inclusion criteria, from April to September 2020 in a tertiary care cancer hospital, Pakistan. Results: In our centre, forty-five intubations were performed, 71% of these intubations were out of hours and 43% performed by consultant...
BACKGROUND Lumbar spine surgery can be performed using different anaesthetic techniques such as g... more BACKGROUND Lumbar spine surgery can be performed using different anaesthetic techniques such as general endotracheal anaesthesia (GA) or spinal-based regional anaesthesia (RA). Few of the studies have been done to compare the outcomes of spinal anaesthesia versus general anaesthesia for lumbar laminectomies as both having some advantages as well as disadvantages but still it is controversial. The objective of current study is to make a comprehensive review of literature for comparing the outcomes of lumbar laminectomy performed under general anaesthesia versus spinal anaesthesia. METHODS Literature search was performed by using PubMed, Google scholar and bibliography of related articles. To compare groups of general anaesthesia versus spinal anaesthesia, the variables focused were mean heart rate (HR), mean arterial pressure (MAP), blood loss during surgery, duration of surgery, post-operative anaesthesia care unit (PACU) time, postoperative narcotic use/pain scale, post-operative u...
Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal c... more Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. It occurs more frequently with minimally invasive techniques and very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 36 years old male underwent minimally invasive esophagectomy and presented with chest pain and dyspnoea in the emergency department 8 months after the procedure. He was started on acute coronary syndrome treatment protocol but was later diagnosed on CT scan to have diaphragmatic hernia through a defect in the oesophageal hiatus. As he was already loaded with dual anti platelet therapy it led to qualitative defect of the platelet which resulted in bleeding post procedure and the patient needed resuscitation with blood products. Dual anti-platelet therapy is an integral component of early management strategy in acute coronary syndrome. Chest X-ray was not helpful, but abdominal or che...
Co-amoxiclav is used as a routine prophylactic antibiotic in surgical procedures. We present a ca... more Co-amoxiclav is used as a routine prophylactic antibiotic in surgical procedures. We present a case of 61 years old lady came to outpatient clinic with a diagnosis of right sided lower alveolar tumour. A plan was made to proceed with a Right Marginal Mandibulectomy. She received Co amoxiclav as prophylactic antibiotic and was clinically uneventful. On further questioning there were many different occasions on which the patient had oral co amoxiclav with no complications or side effects. No known drug allergies or otherwise were documented. As a part of surgical antibiotic prophylaxis, Co amoxiclav 1.2 gm was given to patient at the time of induction. After the antibiotic administration patient started having bronchospasm with increased airway pressures and severe hypotension indicating anaphylactic reaction. The patient was resuscitated, recovered from the anaphylactic shock successfully and provided extended recovery in post anaesthesia care unit followed by High Dependency Unit fo...
Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND Endotracheal intubation is one of the basic prerequisites of general anaesthesia. Reco... more BACKGROUND Endotracheal intubation is one of the basic prerequisites of general anaesthesia. Recovery of patients is delayed due to the development of post-operative nausea, vomiting, sore throat and shivering. This study was conducted to determine role of dexamethasone for improved recovery of patients. METHODS This randomized controlled trial was performed in the Department of Anaesthesia, Ayub Teaching Hospital, Abbottabad from June to November 2018. One hundred and twenty-two consenting patients of both genders, aged between 18-60 years, American Society of Anaesthesiologists (ASA) I and II, scheduled for general surgeries of 60-180 minutes duration under general anaesthesia were included. Patients with long duration surgeries, anticipated difficult airways, nasogastric tube in situ, upper respiratory tract infections, on steroid therapy and critically ill and emergency surgeries were excluded. They were randomly allocated into two groups by lottery method as dexamethasone (grou...
Background & Objectives: Radiation therapy is one of the modalities used in cancer treatment to d... more Background & Objectives: Radiation therapy is one of the modalities used in cancer treatment to destroy rapidly growing tumor mass. The fractionated radiation session targets up to four fields of 90 sec each, over 10-15 min. Young children require deep sedation or general anesthesia to make them immobile, for the safe delivery of radiation fractions. Common drugs used for sedation are propofol, ketamine and midazolam. Repeated exposure to anesthetic drugs over a short period of time may lead to development of tolerance and increased dose requirements. We aimed to determine if drug tolerance phenomenon develops in children receiving frequent doses of anesthetic drugs over a short time period. Methodology: This is a retrospective observational study of the pediatric population who underwent frequent radiotherapy sessions with deep sedation from January to May 2019. The data of the first and last day of drugs administered was analyzed to determine if the dose requirement for any of th...
International Journal of Medical and Biomedical Studies
Background: Different crystalloids commonly used in preloading are Ringer lactate, normal saline ... more Background: Different crystalloids commonly used in preloading are Ringer lactate, normal saline and colloids that are used in preloading are gelatin, dextran, hetastarch, pentastarch, tetrastarch. This study was aimed to compare the efficacy of both as preloading infusion to prevent hypotension, requirement of vasopressors and requirement of total fluid given during surgery to maintain stable hemodynamics Methods: This randomized control trials was conducted in the Department of Anaesthesia , R.V.R.S. Medical College, Bhilwara. 60 patients between 18- 40 years of age, belonging to American society of anaesthesia grade I or II going for elective caesarian section under spinal anesthesia were screened for the study eligibility criteria Results: In group (I), in 20 females, efficacy was achieved while in 10 females efficacy could not be achieved because of drop in BP. In group (II), in 22 females, efficacy was achieved while in 8 females, efficacy could not be achieved. The differenc...
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