General Anaesthesia

Profound bradycardia during eye surgery is potentially serious event. In clinical practice this Oculocardiac Reflex (OCR) is most often encountered during squint surgery. The objective of this study was to assess the occurrence of OCR and prove the effect of anticholinergic premedication (atropine) to prevent OCR. This study comprises of sixty patients (age 2-30 years) operated for squint surgery under general anaesthesia. Cases were divided into two groups of thirty each. Group 1 was premedicated with intravenous injection of atropine and Group 2 did not receive any premedication. Patients were monitored during operation for any bradycardia or dysrhythmias. The observed data showed occurrence of 70% OCR in Group 2 as compared to only 10% in Group 1. Severe bradycardia in 40% cases of Group 2 needed intervention by IV injection of atropine. Our study showed that atropine premedication in the patients of squint surgery under general anaesthesia definitely obtunds OCR and prevents any...

An undifferentiated abdominal sarcoma was removed surgically from a koi carp. The diagnostic procedures, including radiography and computed tomography, and the procedures for general anaesthesia and the surgical approach for a celiotomy in a fish are described. The gross and microscopic appearance of the tumour is described and lustrated.

Background  Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic

Patients with myasthenia gravis receive pyridostigmine, an anticholinesterase agent, as a part of therapy. These patients demonstrate a heightened sensitivity towards non-depolarising muscle relaxants. Continuing pyridostigmine till the day of the surgery or omitting it on the night before surgery could provide variable results with regards to the effect of vecuronium. Myographic evaluation of a dose of vecuronium in patients with myasthenia gravis on pyridostigmine therapy. A randomised, double-blind, clinical study conducted in a teaching hospital. Medically (oral pyridostigmine) well-controlled adult patients with myasthenia gravis who were posted for thymectomy, were randomly divided into two groups. Patients in Group 1 received their last dose of pyridostigmine on the night before surgery while those in Group 2 received even the morning dose of the drug on the day of surgery. Neostigmine (1-2 mg) intravenously was used as rescue medication. Vecuronium (0.01 mg/kg) was used for ...

Insertion Ventilation Tube In Patients With Otitii Media And Care Otitis media is a disease which is seen frequently in childs and adults. As ventilation tube ventilates the middle ear, it could prevent recurrent otitis media, provide a regression in otitis media and improve the hearing function average as 12 dB. Ventilation tube insertion is usually performed under a general anaesthesia in child, local anaesthesia in adults and it is programmed as day surgery. Patients are usually ready to go home within two to four hours after the surgery. Surgical nurses have important responsibilities on patients' discharge education and their daily activities to return and adapt to their new lives. It is clear the importance of education of the patients who have been inserted ventilation tube or parents during the preoperative and postoperative periods and then prepare them for home-care. In this article, the preoperative and postoperative care applications for the patients - having adenoi...

Exogenous morphine downregulates the activity of immunocompetent cells such as lymphocytes, granulocytes and macrophages. Furthermore, morphine increases the secretion of CRH, ACTH and glucocorticoids, i.e. substances with inhibitory effects on the immune system. In the present study we tested the hypothesis that endogenous morphine production is increased as part of the antiinflammatory response to cardiac surgery. Sixteen patients submitted to elective coronary artery bypass grafting (CABG) surgery were randomized to either thoracic epidural analgesia combined with general anaesthesia (group I) or high-dose fentanyl anaesthesia (group II). Patients in group I did not receive morphine while patients in group II received systemic morphine for postoperative pain relief. From each patient 18 blood samples were taken perioperatively and tested for morphine. Furthermore, monocyte function with respect to motility and shape was determined by computer-assisted image analysis. A steep increase in plasma morphine concentrations was demonstrated on the first postoperative day in patients in group I (not given morphine). Plasma morphine levels remained significantly elevated during the following five postoperative days. Patients in group II given morphine as pain treatment showed a larger and earlier morphine peak related to the morphine administration. Computer-assisted image analysis of leukocyte behaviour revealed a biphasic increase in cell motility. In conclusion, we demonstrate for the first time that endogenous morphine levels increase after the trauma of surgery. We surmise that morphine is part of the antiinflammatory response to cardiac surgery.

MRI is a common medical imaging investigation. Patients, including young children, can be required to keep still for up to 60 min for the study to be completed successfully. Children often find the confined space, noise, need to lie still and possibility of intravenous administration of contrast agent anxiety-provoking and sometimes so distressing that they are unable to cope and require general anaesthesia. A practice MRI intervention was introduced at the Royal Children's Hospital in Melbourne, Australia. The program is conducted by educational play therapists in conjunction with the Department of Medical Imaging. This study explored the effectiveness of this intervention. The intervention was conducted in a practice MRI unit devoid of magnets. Data were collected as a clinical audit with respect to age, gender, times of scans, position in bore, diagnostic scans and movement artefact. Epidata and Stata were used to analyze the data. A total of 291 children were included; their...

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. 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 collection proforma .Suggested Indicators were percentages of Grade 1-4 CS done under RA and GA, percent of failed regional, percent of failed regional in different grades of CS. A total of 407 patients having undergone Caesarian Section (CS) were reviewed. General Anaesthesia (GA) was used in 201(49%) patients and Regional Anaesthesia (RA) in 206 (51%) patients. There was no sign...

Use of prompt and efficient anesthetic management of an actively convulsing gravid to term female in the OPD. In this case report, we present a successful anesthetic induction and management in a case of gravid to term female with active convulsions and complaints of vomiting and headache, later diagnosed as Posterior Reversible Encephalopathy Syndrome under General anesthesia.

GENERAL ANAESTHESIA continues to be widely used for Caesarean section. Despite the reduction of neonatal depression and the decreased risk of maternal aspiration with regional anaesthetic techniques, 1,2 there are many indications for general anaesthesia for Caesarean ...

While peripheral polyneuropathy is a well-known complication in diabetes mellitus, and the subject of a great deal of study, the clinical importance of autonomic diabetic neuropathy is increasingly recognised. Using an animal model, where the pupil diameter of the eye serves as a parameter of autonomic function, we produced an age and weight curve of pupil diameter and studied the development of autonomic neuropathy in rats with streptozotocin-induced diabetes. We show that diabetic rats develop significantly (P < 0.009) smaller pupils compared with controls, most probably due to a defective sympathetic input, caused by sympathetic neuropathy. Treatment with the neurotrophic peptide Org 2766, a synthetic ACTH4-9 analogue, prevents the occurrence of this sympathetic neuropathy, as the pupil diameters in the ACTH4-9 analogue-treated group are significantly (P < 0.05) larger than the pupils of placebo-treated rats, and are comparable to the pupil diameters of the rats in the cont...

To identify specific fears being entertained about general anaesthesia. People who do work in any medical facility were targeted in this prospective questionnaire-based study. All respondents were literate. The questionnaire was divided into two sections; (a) The baseline information, which included age, sex, marital status, occupation, previous exposure to anaesthesia and patient preference for anaesthesia technique. (b) Fear about risks associated with general anaesthesia; respondents were expected to pick one of four options (very concerned, somewhat concerned, not concerned and not sure), to indicate how they feel about each of the eight risks listed in the questionnaire. The data obtained was analyzed using SSPS version 10 for Windows. In a bivariate analysis, marital status, occupation and previous exposure to anaesthesia are not associated with the expressed fear by the respondents. Respondents had the highest concern for the fear of death (82%), followed by fear of postopera...

To test the accuracy of a new combined oxygen saturation and cutaneous carbon dioxide tension (SPO2-PCO2) sensor in a routine adult clinical environment. This probe provides a non-invasive and continuous monitoring of the arterial oxyhaemoglobin saturation, arterial carbon dioxide tension and pulse rate at the ear lobe. The sensor is intended to measure both relevant respiration/ventilation parameters in one single probe. Ten adult patients were consecutively studied during general anaesthesia. During the first 5 min after sensor placement at the ear lobe, arterial blood samples were drawn each minute. Carbon dioxide tension and oxygen saturation measurements were obtained simultaneously at 1-min intervals. After this period, patients were hyper-, normo- and hypoventilated. After 15 min at each setting, the simultaneously obtained cutaneous and arterial carbon dioxide tension values were compared. A total of 80 comparisons between ear lobe SpO2-PCO2 measurement, finger clip pulse ox...