scholarly journals Post-operative Recovery of Morbidly Obese Patients under General Anaesthesia Using Desflurane versus Sevoflurane

2020 ◽  
Vol 14 (2) ◽  
pp. 116-119
Author(s):  
Md Mahbub Ul Alam ◽  
Abhay Patwary ◽  
Most Sarmin Sultana ◽  
Md Nurunnabi ◽  
Md Abdul Wahab
Keyword(s):  
General Anaesthesia ◽  
Armed Forces ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Verbal Command ◽  
Extubation Time ◽  
Group A ◽  
Eye Opening ◽  
Group B ◽  
Operative Recovery

Introduction: Laparoscopic sleeve gastrectomy (LSG) is commonly performed under general anaesthesia. LSG operation has become one of the most effective treatments of morbidly obese patients. There are several modalities of inducing and maintenance of general anaesthesia (GA). Objectives: To compare the post-operativerecovery of morbidly obese patient using desflurane versus sevoflurane with remifentanyl infusion as maintenance of anaesthesia. Materials and Methods: This prospective randomized singlecentre analytic study was carried out in Jaber Al Ahmed Armed Forces Hospital, Kuwait from July 2015 to July 2017. Total 60 morbidly obese patients(BMI>40kg/m2) undergoing LSG under GA were randomly selected into two equal groups(Group-A and Group-B).Group-A received desflurane, Group-B received sevoflurane and both groups receivedremifentanyl infusion as maintenance of GA. To maintain hemodynamic stability and bispectral index score in the range of 40-60, using volatile anaesthetic either desflurane 2-6% or sevoflurane 1-2% with airand oxygen 50: 50 during maintenance. Early recovery criteria were response to painful stimuli,obeying verbal command, spontaneous eye-opening, extubation time, handgrip, and orientation assessed by answering name and location. Intermediate recovery was assessed by modified Aldrete’sscore at PACU. Results: No significant differences in perioperative heart rate, systolic blood pressure, and diastolic blood pressurewas found between two groups. Group-A patients had significantly faster eye-opening (9.7±4.3 vs 18.5±6.6),voluntary head rising on command (3.46±2.1 vs 7.38±4.52) shorter extubation time(12.2±8.1 vs 24.2±12), and orientation in time(16.2±8.2 vs 31.2±12.9)as compared to Group-B. Conclusion: Volatile anaestheticdesflurane provided better post-operative recovery than sevoflurane in morbidly obese patients undergoing LSG with GA. Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 116-119

scholarly journals Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Gian Luigi Canu ◽  
Fabio Medas ◽  
Federico Cappellacci ◽  
Michele Guido Podda ◽  
Giorgio Romano ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
High Body Mass Index ◽  
Health Concern ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients. Methods Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI < 30 kg/m2 were included in Group A, while those with BMI ≥ 30 kg/m2 in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analyses were performed to evaluate whether the BMI value (considered in this case as a continuous variable) had a significant role in the development of each individual postoperative complication. Results A total of 813 patients were included in this study: 31 (3.81%) were underweight, 361 (44.40%) normal-weight, 286 (35.18%) overweight, 94 (11.57%) obese and 41 (5.04%) morbidly obese. Six hundred and seventy-eight patients were included in Group A and 135 in Group B. At univariate analysis, the comparison between the two groups, in terms of operative time and thyroid weight resulted in statistically significant results (P = 0.001, P = 0.008; respectively). These features were significantly higher in Group B than in Group A. About postoperative stay and complications, no statistically significant difference was found between the two groups. At multivariate analyses, only the development of cervical haematoma was statistically significantly correlated to the BMI value. Patients with high BMI had a lower risk of cervical haematoma (P = 0.045, OR 0.797, 95% CI 0.638–0.995). Conclusions This study showed that obesity, in the field of thyroid surgery, is not associated with any increase of postoperative complications. Thus, it is possible to conclude that thyroidectomy can be performed safely in obese patients. Our result about operative times had no clinical significance.

scholarly journals Microecological preparation combined with an modified low-carbon diet improves glucolipid metabolism and cardiovascular complication in obese patients

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Jianguo Liu ◽  
Liehui Xiao ◽  
Hezhongrong Nie ◽  
Yong Pan ◽  
Yan Liu ◽  
...  
Keyword(s):  
Intestinal Barrier ◽  
Intestinal Barrier Function ◽  
Control Group ◽  
Obese Patients ◽  
Carotid Atherosclerotic Plaque ◽  
Low Carbon ◽  
Balanced Diet ◽  
Group A ◽  
Group B ◽  
Control Group Group

Abstract Objective To investigate the impact of microecological preparation combined with modified low-carbon diet on the glucolipid metabolism and cardiovascular complication in obese patients. Methods From August 2017 to July 2020, 66 obese patients were recruited, and administrated with an modified low-carbon diet with (group A) or without (Group B) microecology preparation and a balanced diet in control group (group C) for 6 months. Meanwhile, 20 volunteers administrated with a balanced diet were recruited as the healthy control group (group D). Results After 6-month intervention, obese subjects in group A and B showed significant improvement of body and liver fat mass, reduction of serum lipid levels, intestinal barrier function markers, insulin resistance index (IRI), high blood pressure (HBP) and carotid intima thickness, as compared with subjects in group C. More importantly, subjects in group A had better improvement of vascular endothelial elasticity and intimal thickness than subjects in group B. However, these intervention had no effect on carotid atherosclerotic plaque. Conclusion Administration of microecological preparation combined with modified low-carbon diet had better improvement of intestinal barrier function, glucose and lipid metabolism, and cardiovascular complications than low-carbon diet in obese patients, but the effect of a simple low-carb diet on carotid atherosclerotic plaque need to be further addressed.

scholarly journals Efficacy of Narrow-Band Ultra Violet B versus Narrow-Band Ultra Violet B with Topical Tacrolimus Ointment (0.1%) in the Treatment of Vitiligo

2017 ◽  
Vol 13 (1) ◽  
pp. 86-89
Author(s):  
Jweena Bintey Jamal ◽  
Muhammed Ashraful Alam Bhuiyan ◽  
Md Abdul Latif Khan
Keyword(s):  
Narrow Band ◽  
Excellent Result ◽  
Ultra Violet ◽  
Armed Forces ◽  
Military Hospital ◽  
Tacrolimus Ointment ◽  
Topical Tacrolimus ◽  
Group A ◽  
Group B ◽  
Response Score

Introduction: Several treatment options e.g. topical corticosteroids, phototherapy like narrow-band ultra violet B (NB-UVB) and psoralen+ultra violet A (PUVA) etc are available for vitiligo. But none is so effective in single but combined one is more effective and superior. Objective: To compare the efficacy of NB-UVB vs NB-UVB with topical Tacrolimus ointment (0.1%) in the treatment of Vitiligo. Materials and Methods: This descriptive cross-sectional study was conducted in Combined Military Hospital, Dhaka from October 2015 to April 2016. Total 100 patients with vitiligo were divided into 2 groups of 50 patients. NB-UVB was given for 04 weeks to Group-A. In Group-B patients, topical Tacrolimus ointment (0.1%) twice daily was advised with simultaneous NB-UVB. The patients were followed-up at the baseline of the 4th, 8th and 16th week. Results: Majority (46%) of the patients were from 25-34 years of age with a mean age of 27.4±12.6 years. Among all risk factors, Family history of Vitiligo was the most common risk factor and common skin type (Fitzpatrick) was Type IV (40%). At the end of 4th week, maximum cases of Group-B showed good response (score 3) with a mean score of 1.74. Whereas, maximum cases of Group-A showed poor response (score 1) with a mean score of 0.86. End of the 16th week, maximum cases of Group-B improved successfully. In the end, 20% patients of Group-A showed an excellent result; but it was 42% from Group-B. Conclusion: It is revealed from this study that patients treated with a combination of NB-UVB with topical Tacrolimus ointment (0.1%) showed better treatment outcome, more effective and becomes a new mode of treatment. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 86-89

scholarly journals O’CONOR (TRANSABDOMINAL) REPAIR: IS IT ALWAYS NECESSARY TO INTERPOSE A FLAP IN SIMPLE VESICO-VAGINAL FISTULA? A COMPARATIVE STUDY

2021 ◽  
Vol 71 (1) ◽  
pp. 347-50
Author(s):  
Qamar Zia ◽  
Asma Rizwan ◽  
Adil Khurshid ◽  
Mudassar Sajjad ◽  
Muhammad Nawaz ◽  
...  
Keyword(s):  
Comparative Study ◽  
Vesicovaginal Fistula ◽  
Armed Forces ◽  
Vaginal Fistula ◽  
Fistulous Opening ◽  
Vesicovaginal Fistulae ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B ◽  
Vesico Vaginal Fistula

Objective: To assess morbidity and success of transabdominal (O’Conor) repair of vesicovaginal fistula with orwithout interposition of flap between vagina and urinary bladder. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2016 to Jan 2019. Methodology: Fifty five patients were randomized into group A & B by lottery method. An inclusion criterionwas single fistulous opening of ≤3cm. Complex and recurrent fistulae were excluded. Patients in group A underwent O’Conor repair without interpositional flap while in group B vesicovaginal fistulae were repaired with flap interposition. Results: Twenty two patients were randomized in group A while 27 in group B. Mean age of patients was 41.65± 11.93 years. Gynecological and obstetrical surgery was the main cause of fistula. Mean duration of surgerywas 162.7 ± 18.49 minutes. Per-operative ureteric catheterization was done in 9 (16.8%) patients. Seventeen(30.6%) patients had paralytic ileus. There was transient fever in 4 (7.6%) of cases and wound infection was seenin 3 (5.8%) of patients. Mean hospital stay was 3.4 ± 2.3 days. Cystogram was done in 35 (64.5%) of patients before the removal of per-urethral catheter. The overall success rate was 92.9%. Ten (18.2%) of patients developed denovo urgency which was managed conservatively. There was no statistical difference in both groups in terms of morbidity and success. Conclusion: In simple Vesico-vaginal fistulae repair, interposition of flap can be omitted and it does not affect the outcomes in terms of success and morbidity.

scholarly journals Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

2015 ◽  
Vol 1 (2) ◽  
pp. 80
Author(s):  
Mastan Saheb Shaik ◽  
Venkata Rama Rao M ◽  
Sailaja K
Keyword(s):  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Cardiac Complications ◽  
Anesthetic Techniques ◽  
Ecg Changes ◽  
Arterial Blood ◽  
Group A ◽  
Urological Procedures ◽  
The Mean ◽  
Group B

Context: There are limited studies indicating the incideance of post operative morbidity and mortality in high risk patients. Urological procedures constitute a major portion of geriatric surgeries where a cardiac obligation is almost inevitable and selected for this study purpose.Aims: To compare the incidence of post operative cardiovascular complications during regional and general anesthetic techniques in patients with known cardiac risk undergoing urological surgeriesSettings and Design: Prospective randomized double blind study.Methods and Material: 40 patients aged above 50 years posted for elective urological surgeries were enrolled in the study after obtaining approval from hospital ethics committee and written informed consent from the patients. Patients were divided into two groups A& B. Group A (n=20) received general and group B (n=20) received regional anaesthesia (spinal/ Epidural). All the patients received standard premedication and their basal vitals( BP, HR, ECG pattern) were recorded. The same parameters were monitored in the post operative period at regular intervals.Statistical analysis used: Student T test is used to test the significance of stastical difference in the variables between the two groups.Results: The mean heart rate and the mean arterial blood pressure were increased (P<0.01) in the general anaesthesia group. Group A showed 10% incidence of ECG changes and group B showed 35% incidence of ECG changes. But the changes in the hemodynamics were not significant.Conclusions: There is no difference between regional anaesthesia and general anaesthesia regarding the post operative outcome after urological procedures with respective hemodynamic changes.

scholarly journals Penile nerve block at the base of penis in combination with intravenous ketamin plus midazolam versus general anaesthesia(GA) in children undergoing circumcision for post operative pain management in the Eastern Nepal

2014 ◽  
Vol 4 (1) ◽  
pp. 33-36
Author(s):  
NR Sharma ◽  
P Timalsena ◽  
U Rai
Keyword(s):  
Pain Management ◽  
General Anaesthesia ◽  
Nerve Block ◽  
Randomized Study ◽  
Pain Scale ◽  
Single Shot ◽  
Post Operative Pain ◽  
Analgesia Requirement ◽  
Group A ◽  
Group B

Adequate post operative analgesia in children provides satisfactory psychological objective of this study was to compare the post operative analgesia requirement and child satisfaction between two groups, general anaesthesia(GA) alone and GA in combination with penile nerve block. This prospective randomized study was conducted in 50 children aged 6 to 14 years, who underwent circumcision. The boys were randomly allocated into two groups. Group A (n = 25) received GA with Single shot ketamin 2mg/kg IV plus midazolam 0.1 mg/kg and dorsal penile nerve block at the base of penis prior to circumcision with and Group B (n = 25) received GA with ketamine 2mg/kg IV plus midazolam 0.1 mg/kg plus halothane by laryngeal mask. Severity of pain was assessed quantitatively by children’s hospital eastern Ontario pain scale (CHEOPS). The pain intensity was assessed at one hour A1 in group A and B1 for group B and at two hour A2 for group A and B2 for group B during postoperatively period for two hours. Statistical analysis was done by SPSS method. The post operative analgesia was satisfactory with CHEOPS score 6 or <6 in group A 1. In group A 2 twenty two out of twenty five cases had CHEOPS score <6.Where as in group B1 and B2 it was > 6 .Which was statistically 100% significant. In conclu­sion, combined penile nerve block in combination with intravenous ketamine plus midazolam is the satisfactory method of Post operative pain management in children undergoing circumcision. DOI: http://dx.doi.org/10.3126/jcmc.v4i1.10846 Journal of Chitwan Medical College 2014; 4(1): 33-36

scholarly journals Xenon Anesthesia Improves Respiratory Gas Exchanges in Morbidly Obese Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Antonio Abramo ◽  
Claudio Di Salvo ◽  
Francesca Foltran ◽  
Francesco Forfori ◽  
Marco Anselmino ◽  
...  
Keyword(s):  
Heart Rate ◽  
Diastolic Pressure ◽  
Plateau Pressure ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Gas Exchanges ◽  
Pressure Oxygen ◽  
Extubation Time ◽  
Recovery Times ◽  
Induction Of Anaesthesia

Background. Xenon-in-oxygen is a high density gas mixture and may improve PaO2/FiO2 ratio in morbidly obese patients uniforming distribution of ventilation during anesthesia.Methods. We compared xenon versus sevoflurane anesthesia in twenty adult morbidly obese patients (BMI>35) candidate for roux-en-Y laparoscopic gastric bypass and assessed PaO2/FiO2 ratio at baseline, at 15 min from induction of anaesthesia and every 60 min during surgery. Differences in intraoperative and postoperative data including heart rate, systolic and diastolic pressure, oxygen saturation, plateau pressure, eyes opening and extubation time, Aldrete score on arrival to the PACU were compared by the Mann-Whitney test and were considered as secondary aims. Moreover the occurrence of side effects and postoperative analgesic demand were assessed.Results. In xenon group PaO2-FiO2 ratio was significantly higher after 60 min and 120 min from induction of anesthesia; heart rate and overall remifentanil consumption were lower; the eyes opening time and the extubation time were shorter; morphine consumption at 72 hours was lower; postoperative nausea was more common.Conclusions. Xenon anesthesia improved PaO2/FiO2 ratio and maintained its distinctive rapid recovery times and cardiovascular stability. A reduction of opioid consumption during and after surgery and an increased incidence of PONV were also observed in xenon group.

scholarly journals Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Andrea Balla ◽  
Silvia Quaresima ◽  
Pietro Ursi ◽  
Ardit Seitaj ◽  
Livia Palmieri ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Esophageal Hiatus ◽  
Consecutive Series ◽  
Obese Patients ◽  
Mesh Placement ◽  
Significant Difference ◽  
Group A ◽  
Group B

Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p=0.006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p=0.837) postoperatively became 9.5 and 2.4 (p=0.071). In group A, there was no difference between pre- and postoperative scores (p=0.279), whereas in group B, a highly significant difference was observed (p=0.002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p=0.0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.

scholarly journals Comparison of Dexmedetomidine versus Midazolam in weaning from mechanical ventilation and length of stay in ICU.

2020 ◽  
Vol 27 (11) ◽  
pp. 2309-2313
Author(s):  
Afia Arshed Dodhy
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Significant Relationship ◽  
Controlled Trial ◽  
Cost Study ◽  
Extubation Time ◽  
Group A ◽  
Surgical Icu ◽  
Group B

Objectives: To compare the role of dexmedetomidine versus midazolam as sedative in facilitating early mechanical ventilation weaning thereby decreasing ICU cost. Study Design: Randomized Controlled trial. Setting: Surgical ICU of Lahore General Hospital, Lahore. Period: December 2018 to July 2019. Material & Methods: Total of 60 adult postoperative patients (30 in each group) who required mechanical ventilation in the surgical ICU for minimum 24 hours postoperatively after major pelvi-abdominal operations were included. Patients of group “A” and “B” received midazolam infusion 20-100 mcg/kg/hr & dexmedetomidine infusion 0.2-0.7 μg/kg/hr respectively while being mechanically ventilated. The degree of sedation was measured by using the Richmond agitation sedation score (RASS) every 6 hourly. Extubation time (i.e. time from termination of drug to extubation) was recorded. The time of ICU length of stay was also recorded Results: Mean age of patients was 41.97 ±10.21 and 42.57±10.93 years in group-A and B, respectively. In group-A 18 patients (60%) and in group-B 16 patients (53.0%) were male while 12 patients (40%) in group-A and 14 patients (47.0%) were females. A significant decrease in extubation time was observed in Group-B when compared with the Group-A (p=0.046) along with odds ratio 0.938 while no significant relationship could be proved between length of stay at ICU between two groups. Stratification with regard to age, gender height, weight and type of surgery was carried out. Conclusion: Dexmedetomidine is more favourable than midazolam for sedation in intensive care patients by facilitating early exubation and decreasing the duration of invasive ventilation while no significant relationship could be proved in two groups between length of stay in intensive care unit.

scholarly journals STUDY THE EFFECT OF SURGICAL STRESS ON SERUM POTASSIUM AND SERUM CALCIUM LEVEL

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Farukh Kha N ◽  
Sudarshan Gothwal ◽  
Prabha Om
Keyword(s):  
General Anaesthesia ◽  
Serum Potassium ◽  
Surgical Stress ◽  
Chemical Effect ◽  
Blood Calcium ◽  
Medical College ◽  
Blood Potassium ◽  
Group A ◽  
Group B ◽  
Duration Of Operation

Background: This study was randomized clinical trial carried out in 100 patients to study the effect of surgical stress on serum potassium and calcium and to relate these changes to age of the patient and duration of surgical stress. Materials and Methods: The study was done in the Department of General Surgery SMS Medical College, Jaipur from June 2015 to June 2017. Patients equally distributed in two groups A and B on the basis of timing of collection of sample. Blood was taken from the patients who were operated under spinal anaesthesia only, so that the chemical effect of anesthetic was as minimal as possible. For comparison few cases were investigated who were operated under general anaesthesia. In all the patients operated under spinal or general anaesthesia same drug and techniques were used to overcome bias. Observations and Results: In the study we observed that variation in serum electrolyte seen in period of stress. Range of hypokalemia and hypocalcemia were 2.8 to 3.7 meq/lt and 7.6 to 8.4 mg% respectively in group A and hypokalemia and hypocalcemia were 3.0 to 3.4 meq/lt and 7.6 to 8.4 mg% respectively in group B. Maximum incidence of hypokalemia and hypocalcemia seen during 30-60 minutes duration of operation. Conclusion: Surgical stress is main cause of fluctuation in blood calcium, and blood potassium levels in surgical ward. The variation consists of increase or decrease of both electrolytes because of activation of the pituitary adrenocortical systems and maximally seen in immediate post operative period. Keywords: Calcium (Ca+2), Potassium (k+), Serum electrolytes, Surgical stress

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