...Elective Caesarean Delivery: A Randomized Controlled Double Blind Study Karthik Ganesh Ramamoorthy FCARCSIa*, Mohammed Ibrahim MRCSb, Nasir Z. Ahmad FRCS, MMScc, Kevin Bailey FFARCSIb, Paul O’ Connor. FFARCSIb a. Department of Anaesthesia, Fortis Malar Hospital, Chennai, India b. Department of Anaesthesia, Letterkenny General Hospital, Letterkenny, Ireland c. Department of Surgery,Letterkenny General Hospital, Letterkenny, Ireland Received: August 3, 2015 Accepted: August 19, 2015 Abstract Objective: The objective of this prospective randomised double blinded placebo controlled trial was to assess the efficacy of acupuncture for prophylaxis of intrathecal morphine induced pruritis in patients undergoing Elective Caesarean delivery. Methods: After ethical approval and informed consent parturients scheduled for elective Caesarean section under spinal anaesthesia with intrathecal morphine, were randomised to receive acupuncture (Group 1) or sham acupuncture (Group 2). In Group 1 acupuncture was applied unilaterally at the Quchi acupoint for 30 minutes before initiation of spinal anaesthesia. In Group 2 sham acupuncture was applied at a non – acupoint 2 cm lateral to Quchi for 30 minute before initiation of spinal anaesthesia. The primary outcome was the incidence of pruritis and the secondary outcomes were severity of pruritis, patient’s satisfaction with anti-pruritic prophylaxis and the need for rescue anti-pruritic medications. Results: The...
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...Short name |Operating theatre performance | | |Detailed name |Efficiency of use of the operating theatre for elective and emergency surgery (inpatient| | |and outpatient). | |Short definition |Percent of usefully spend time (directly with patient) in operating theatre. | |Rationale |Justification | |(including justification, |The operating theatre (OPT) or operating room is a high cost department within | |strengths and limits) |hospitals. Considerable resources are wasted if operating room is not used effectively. | | |Effective management of operating room is paramount when operating room is a | | |“bottleneck”. By increasing use of operating room, patient flow improves and waiting | | |list can be reduced. | | | | | |Direct measure of optimal use of the capacity. Increasing surgical theatre use maybe | | |achieved by better work organization, such as better preparation by the team of | | ...
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...Preoperative fasting: Is it based on evidence? The rule ‘Nil by Mouth’ from midnight is used traditionally to ensure that the stomach is empty prior to induction of anaesthesia. It is clearly stated that during induction of anaesthesia, the protective laryngeal reflex is diminished, which maximises the risk of pulmonary aspiration. Even in the early days of the anaesthetic era, most people understood that prior to surgery, no intake of solid food was to be consumed. (Ljunggvist&Soreide, 2003) Ljungvvist&Soreide (2003) explains that surgical authorities recommended that patients have fluids containing carbohydrates, for example, beef tea, during the preoperative period. In spite of this, later studies revealed anaesthetic related aspiration. This resulted in progressively firmer rules for preoperative fasting, in which case patients were informed not to consume solids and liquids prior to sugery- ‘Nil by Mouth’ from midnight. (Ljunggvist&Soreide, 2003) Over the past two decades, authors have questioned the need for such intense fasting regimes. Following this, studies have been completed, which showed that guidelines which are less intense can be used to benefit the patient. (Ljunggvist&Soreide, 2003)Ljunggvist&soreide (2003) explain that following the studies, healthy adults who are undergoing surgery, can consume clear fluids up to two hours prior to surgery. However, this does not apply to people who have got gastrointestinal deficiencies or diabetes. This...
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...Knee Surg Sports Traumatol Arthrosc (2013) 21:1510–1515 DOI 10.1007/s00167-012-2149-5 KNEE Patient recall of surgical information after day case knee arthroscopy R. E. da Assuncao • J. Neely • J. Lochab • ¸˜ N. Mizumi-Richards • A. Barnett • H. Pandit Received: 29 November 2011 / Accepted: 19 July 2012 / Published online: 2 August 2012 Ó Springer-Verlag 2012 Abstract Purpose Day case knee arthroscopy is frequently performed on dedicated lists designed to optimise the throughput of patients. This could affect patient recall of clinical information with clinical, ethical and medicolegal consequences. The purpose of this study was to assess patient recall after knee arthroscopy and identify potential contributory factors. Methods Seventy-two patients undergoing day case knee arthroscopy were provided with information about their surgery post-operatively and tested for recall of the information prior to discharge. All patients underwent cognitive assessment when information was delivered and again when tested. Patient recall was correlated with demographic and anaesthetic factors and a multivariate regression model was used to identify risk factors for reduced recall. Results Recall overall was poor. Significant independent risk factors for reduced recall were reduced cognitive state at the time of information delivery and a shorter time between surgery and information delivery. Duration of R. E. da Assuncao (&) Á J. Lochab Á N. Mizumi-Richards ...
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...originate in trachea, larynx , bronchi or lungs & effect a response by sudden increase in vagal tone. These reflexes were termed vasovagal as both afferent and efferent paths were assumed to be the vagus nerve. Investigations by Burstein et al(22) in 1950 showed 43 out of 109 patients developed sinus tachycardia, 1 had atrial fibrillation & 2 developed ventricular tachycardia at the time of intubation. This was attributed to reflex stimulation of sympatho adrenal system. Wycoff et al(23) in 1960 postulated endotracheal intubation to cause reflex autonomic response resulting in tachycardia because of systemic arteriolar constriction, arterial pressure increases by 30-50mmHg.They compared this response to same procedure performed under light anaesthesia with regional block & found that the latter technique produced a smaller increase in BP & heart rate. Forbes & Dally(24) in 1970 observed that laryngoscopy & intubation was associated with an average increase in MAP of 25mmHg in all 22 patients. Highest rise was 1 min after intubation. Return to prelaryngoscopy levels occurs within next 5-10min. Barak et al(25) reported the stress response to tracheal intubation is comparable when using direct laryngoscopy or fibreoptic bronchoscope. Bucx et al(26) found that duration of laryngoscopy has more influence on cardiovascular response as compared to force applied during laryngoscopy. MECHANISM OF CARDIOVASCULAR RESPONSE TO LARYNGOSCOPY AND TRACHEAL INTUBATION : Tracheal intubation leads...
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...Propofol is an approved synthetically derived hypnotic agent used in the induction and maintenance of anaesthesia or sedation. After its approval, it replaced thiopental as the anaesthetic of choice by hospitals. It was estimated in the year 2010 that propofol accounted for at least 75% of anesthetics given in the U.S. Pharmacology Propofol is a small strongly lipophilic molecule which is usually housed in an oil-in-water emulsion. It is administrated through intravenous infusion at a strength of 10mg/100ml, and due to its lack of analgesic potency and may be injected with an analgesic drug.Propofol in the blood plasma is highly protein bound (97-99%) by serum albumin and hemoglobin. The onset of action is usually rapid and unconsciousness can be induced within 15-40sec of administration on average. This is mostly due to the molecules large volumes of distribution and fast distribution from plasma to CNS. Propofol induces hypnosis by significantly increasing the activity of GABAA (β3, β2) receptors and consequently decreasing neuronal activity. Induction of GABAA β3 receptors is theorized to lead to immobility,...
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...Quantitative Critical Appraisal To commence this quantitative analysis the start point was to formulate a robust quantitative question in order to provide direction for the literature search. Newell & Burnard (2006) suggest that a strong question informs the research design, research method, the population, the intervention and the outcomes of interest. There are three factors for focusing questions 1. Facilitating the search for relevant evidence, 2. deciding whether the evidence is applicable to the group in question, and 3. sorting best evidence from weaker, less valid evidence (LoBiondo-Wood et al, 2002). The question was framed around the elements of PICO; standing for “patients,” “intervention,” “comparison,” and “outcome” (Boston University Medline Plus, 2000a; Craig & Smyth, 2002). The PICO approach was developed around Evidence-Based Medicine (Richardson & Wilson, 1997), and was therefore designed for clinical studies, it can though be adapted to any research context. | | |People, patients or population - who are you asking the question about? | |Intervention - what intervention are you interested in? | |Control or comparison - what are you comparing the intervention to? ...
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...Immediate Post Operative Care 2 The following essay will use a systematic approach to critically evaluate the care and treatment delivered to a non-elective paediatric orthopaedic patient within the Post Anaesthetic Care Unit (PACU) by a student Operating Department Practitioner at a local trust hospital. The assessment and management of the patients care will be examined and rationale provided for strategies employed during delivery of individualised patient care. In accordance with Health and Care Professional Council’s standards of conduct, performance and ethics (HCPC, 2012) the confidentiality of the service user will be up held at all times. The service user shall be referred to as “Daisy” to protect her confidentiality. Daisy was received to the PACU after surgical stabilisation of her left fibula and tibia with flexible intramedullary nails following a fall. A specified paediatric bay was utilised enabling the patient to be cared for separately from the adults in the PACU (RCOA, 2013). Anaesthetic and surgical handover was received (RCOA, 2013) which detailed that she was 14 years old with no known allergies. She had no significant medical history. She had a general anaesthetic with 140mfg of Propofol used on induction followed by Sevoflurane as a maintenance agent. 30mg of Atricurium, 4mg Dexamethasone, 4mg Ondansatron, 10mg Morphine and 1g Paracetemol had been administered intraoperatively. 1 litre of Hartmanns solution had been administered during surgery and...
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...Consultant & Interventional Cardiologist). There was a brainstorming on the treatment approach with a sole objective to save both the lives i.e. the mother and the child. The traditional Open Heart surgery on Cardiopulmonary Pump was ruled out because of high risk of blood loss, which might lead to abortion. Closure of ASD in Catheterization laboratory was also considered to be risky; since, it could bring about radiation induced anomalies in the unborn child. After much deliberation, the experts decided upon a unique approach; Hybrid Device Closure of the ASD through a small (2 inch) incision in the right chest (4th ICS) and deployment of a 28 mm ASD Device, which is a Double disc mesh made of NITINOL. The patient was put under anaesthesia...
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...NARCO-ANALYSIS AS A TOOL FOR CRIMINAL INVESTIGATION Project Submitted in Partial Fulfilment of the Requirements For The Degree of Master of Laws of the Mahatma Gandhi University. By NIJIL.D PREFACE . In India scientific methods have emerged as a tool for interrogation and extraction of information from uncooperative suspects and witnesses. But the legality of these methods is in peril, mostly because of the procedure involved and the nature of information obtained through these method. Most of these modern techniques are non invasive methods, which can detect deception without causing physical or mental injury to the subject. Narco-analysis is one of the important techniques among them. It makes use of scientific methods by which the medicine “truth serum” is injected to the convicts so as to prove the crime. But they often raise doubts regarding basic human rights and also about their legal validity. Also when some up holds it’s validity in the light of medical and legal principals and others rejects it on the ground of health hazards and a blatant violation of constitutional provisions. Thus the main issue regarding narco-analysis is its ultimate admissibility in court as forensic evidence and its useful in investigation scientific technique. Recently the supreme court of India in the case of Smt. Selvi and others v. state of Karnataka, has held that involuntary subjecting an accused, a suspect or a witness to narco-analysis...
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...2014 2,495 words Contents Summary ............................................................................................. 2 Introduction ........................................................................................ 2 Opioids ................................................................................................ 2 Local Anaesthetics .............................................................................. 3 Side Effects.......................................................................................... 3 Pharmacodynamics ............................................................................. 4 Pharmacokinetics ................................................................................ 5 Legal Aspects ...................................................................................... 6 Conclusion .......................................................................................... 6 References .......................................................................................... 7 Table 1. Effects of CNS depression associated with increasing plasma concentrations of lidocaine................................................................. 4 1 Summary This report discusses the intended uses and advantages of two types of analgesic drugs, opioids and local anaesthetics. The severity of the side effects for each category of analgesia are assessed. Methadone is an opioid that is regularly used in veterinary...
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...Give a brief account of the ethical issues associated with the use of animals in research (maximum 200 words or 2/3 if images of the correct injection sites are included pages) “Open the cages and we will know if they wish to participate”-Sapontzis. Public concern over animal rights has led to many ethical controversies when it comes to research using animals. Science today has definitely benefited from experimentation on animals, especially the likes of biomedical sciences. Research on animals has led to many innovations and a finer understanding of mechanisms behind human medicines which may have been synthesized or discovered accidently. But of course, there’s has been a huge controversy over ethical issues of using living beings for research purposes. "Speciesism”: morally and ethically wrong to treat other species harshly/callously or even just differently on the bases that they are not (in this case) Homo sapiens. Speciesism is the main factor of such ethical issue being raised. Concerned people think rights of animals should be considered and also their consent must be counted i.e. don’t experiment on them. Many critics worry about losing humanity due to this universal issue, they have a theory that working with animals that suffer continuously can deaden emotions of many researcher and so say that this could be a step away from being comfortable with human suffering, they believe an individual could be ‘mentally’ affected when working consistently with lab animals...
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...| | Prepared by: SHRUTI GULATI | | | | | | DEXELEX To assess the existing clinical practice of INTENSIVISTS & ANAESTHESIOLOGISTS for the management of sedation and analgesia while taken into consideration “dexmedetomidine” ACKNOWLEDGEMENT I would like to express my sincere gratitude towards RANBAXY Laboratories Limited, Mumbai for selecting me as a summer trainee and giving me an opportunity to work on this project and also for providing a good working ambience for successful completion of this project. I also thank the MARKETING RESEARCH TEAM for giving me an opportunity to conduct market research for DEXELEX belonging to INTENSIVA division of RANBAXY. I would like to express my special gratitude towards my guide Mr. Shoreb Khanduri, who throughout my project has been teacher and supporter for me showing me the right direction during my project. I am highly grateful to all summer interns and friends for their support and cooperation, owing to which I have successfully completed and compiled this report Last but not least, I would like to express my sincere thanks to my institute NIPER for providing me all kind of support in my summer project placement at RANBAXY Laboratories Limited. Shruti Gulati Certificate This is to certify that the dissertation submitted in partial fulfillment for the degree of M.B.A. in Pharmaceutical Management of National Institute of Pharmaceutical Education and Research (NIPER) is a result of the bonafide research work...
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...This paper seeks to find out and elaborate the term Early Warning Scores (EWS) while also showing its vital role in early identification and quick treatment of a patient who is experiencing a fast deterioration of health. There are other diverse scores that are similar to the Early Warning Score (EWS). For example, there is the ‘Modified Early Warning Score’ and the ‘National Early Warning Score’. The above scores have different terms because they use different set of parameters and variables in measurement when compared to the EWS. This paper will focus on the use of EWS consistently and will only refer to measurements that fall under EWS. Literature mainly drawn from national policies and guidelines issued by bodies such as the National Institute of Clinical Excellence (NICE), National Confidential Inquiry into Patient Outcome and Death (NCEPOD), and National Patient Safety Agency (NPSA) reinforce our support of the use and efficacy of EWS. Through the use of literature derived from medical books nursing journal, medical journals, and other medical sources from the internet we will provide evidence on the efficacy and use of EWS. The objective will be to come up with a recommendation on the EWS that is derived from research. The first consideration when discussing critical care is to consider what it comprises of. Critical care is the direct delivery of medical-care to the patients that are acutely ill. While giving critical care it should be understood...
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...are always risks associated with anesthesia. Etorphine\M99, the drug used for immobilizing rhino is procedure is a strictly controlled, high schedule potent opioid. Newer drug combinations and experience have reduced the risks. The current calculated mortality risk for free ranging rhino to < 1%. This procedure should only be carried out by a ‘rhino experienced’ wildlife vet and team using the correct protocols and taking the relevant precautions, should perform the dehorning. Due to the continual growth of the horn, dehorning may need to be repeated every 18 – 24 months. Repeated exposure to anaesthesia may contribute to short and long-term health problem; and increases the mortality risk to between 1-2 %. Contradictory opinions were expressed at the workshop. A specialist veterinary aneasthetist confirmed that risks increase with frequency of and repeated exposure to anaesthesia. Drugging and handling of mega-herbivores carries inherent risks that may include injuries, bruising, overheating, cardiac distress, respiratory depression, increased blood pressure, localized pressure myopathies, miscarriages in pregnant females etc. The horn should be cut off safely above the germinal growth layer. When the horn is removed too close to...
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