Efficacy of Anaesthesia Techniques in Periapical Diseased Tooth

Almost all minor oral surgical procedures can be performed effectively if patient is relaxed and comfortable. One of the contributing factor for patient comfort is effective pain control. This can be achieved pre and per-operatively by various local anaesthetic techniques. Infiltration techniques are commonly employed in all maxillary and mandibular teeth whereas mandibular posterior teeth requires a nerve block. In certain cases, these techniques fails or provide inadequate anaesthesia, for example, teeth associated with periapical pathology. Therefore, we conducted a study to determine effectiveness of infiltration and block techniques as well as when supplemented by intra-ligament injection for anaesthesia in periapical infected teeth. Keywords: anaesthesia, infiltration technique, block technique, intraligamental technique, periapical pathology.

A CLINICAL STUDY OF INTRATHECAL KETAMINE WITH ADRENALIN FOR LOWER ABDOMINAL SURGERIES

Background: This study was designed to evaluate the efficacy, onset and duration of sensory and motor blockade, occurrence of delirium reaction and other complications of Ketamine with Adrenaline given intrathecally. Methods: After informed and written consent, ASA Physical status I and II aged 18-60 years, of either sex randomly selected 100 Patients for elective lower abdominal surgeries were been enrolled after inclusion and exclusion criteria. Patients with severe systemic disease metabolic disorders, neurological, congenital or cardiovascular diseases were excluded from this study. Results: In the present study the maximum level achieved ranged from T6-T10. The time taken to achieve maximum sensory blockade ranged from 2-8 minutes. There were no significant changes in mean systolic and diastolic arterial blood pressure or pulse rate. Intra-operatively, nystagmus was seen in all patients. Sedation and delirium was seen in 72 patients and 2 patients respectively. Conclusion: We conclude that intra thecal ketamine with adrenaline produces a reliable anaesthesia, better operative conditions and patients comfort with minimal side effects in elective lower abdominal surgeries. Keywords: Anaesthesia, Ketamine, Adrenaline, Intrathecal.

Hiccups in the Neuro-Critical Care Unit: A Symptom Less Studied?

Background: Hiccups (also referred to as “hiccoughs”) are usually a transient condition that affects almost everyone in their lifetime. However, persistent and intractable hiccups are the types which are often linked with unfavorable outcomes and can also result in respiratory alkalosis in the intubated patients. There is no accurate estimate of the prevalance of hiccups in the patients admitted in the neuro-ICU.The most commonly witnessed hiccups in the neuro-ICU are intractable and neurogenic in nature. In this communication, we discuss the strategy of respiratory care and pharmacological management of hiccups in an adult male post decompressive craniotomy in view of unilateral basal ganglion bleed. He suffered from persistent hiccups and was managed conservatively with intravenous Metachlorpromide 10 mg on as and when needed (SOS) basis. In conclusion, it seems that persistent and intractable hiccups as a risk factor for ventilator-associated pneumonia in patients who are intubated and mechanically ventilated should be given due attention. We encourage clinical trials in this area of critical care medicine and should also encourage more studies to analyse the effectiveness of non-pharmacological methods. Keywords: Anaesthesia, Critical care, Hiccups, Mechanical ventilation, Basal ganglia.

Ekonominis ir klinikinis anestezijos pasirinkimas trumpoms operacijoms: sevoflurano farmakoekonominis tyrimas

Saulė Švedienė1, Jurgita Zidanavičiūtė2, Juozas Ivaškevičius11 Vilniaus universiteto Anesteziologijos ir reanimatologijos klinika;Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-04130 Vilnius2 Vilniaus Gedimino technikos universiteto Fundamentinių mokslų fakultetoMatematinės statistikos katedraEl paštas: [email protected] Tikslas Nustatyti 2005 ir 2006 metais Vilniaus universitetinėje greitosios pagalbos ligoninėje trumpoms operacijoms vartotų anestetikų kainų skirtumus. Metodai Tyrimui naudotas farmakoekonominis modelis, vadinamas mobilia anestezijos kainos konsultacine programa (Mobile Anesthesia Cost Consultant Program). Kiekvieno paciento duomenys buvo fiksuojami programoje: operacijos pobūdis, paciento svoris, amžius, koks anestetikas vartotas indukcijai, koks – anestezijai palaikyti. Taip pat įtraukti kiti preparatai: raumenų relaksantai, reversiniai agentai, analgetikai ir t. t. Anestezijos kaina pateikta automatiškai, apskaičiuota pagal tam tikras formules. Laikydamiesi programos gairių mes sudarėme protokolą, kuriame registravome mūsų operacinėse stebėtus duomenis. Kaip tyrimo obektą pasirinkome angiochirurgines, abdominalines (laparoskopines cholecistektomijas) ir ginekologines operacijas. Tai trumpos chirurginės intervencijos, kurioms mūsų ligoninėje vartojami skirtingi anestetikai. Pacientų charakteristikos ir gauti duomenys buvo apdorojami statistiškai. Rezultatai Trumpoms angiochirurginėms operacijoms anestezijos vidutinė bei 1 valandos kaina (vartojant tiek izofluraną, tiek sevofluraną) statistiškai reikšmingai nesiskyrė (p = 0,305, p = 0,181). Trumpų abdominalinių operacijų anestezijos vidutinė bei 1 valandos kaina (vartojant ir izofluraną, ir sevofluraną) statistiškai reikšmingai nesiskyrė (p = 0,305, p = 0,526). Ginekologinių operacijų grupė nors ir išsiskyrė iš kitų grupių tam tikrais požymiais (amžiumi, svoriu, ASA), galėtume teigti, kad trumpos anestezijos 1 valandos bei vidutinė kaina statistiškai vienoda, palaikymui vartojant propofolį ar sevofluraną. Lyginant vidutinę anestezijos kainą, reikšmingo skirtumo tarp visų tirtų grupių nebuvo (p = 0,305). Išvada Nesant reikšmingo kainų skirtumo, trumpoms chirurginėms intervencijoms galėtų būti vartojami kliniškai naudingiausi, saugiausi ir mažiausiai toksiški anestetikai, pavyzdžiui, sevofluranas. Išmintingai naudojant informacines technologijas gali būti geriau paskirstomas operacinio bloko laikas, stengiantis sumažinti įvairias reikšmingesnes išlaidas, prieš imantis riboti anestezijos tipo ir vaistų pasirinkimą. Pagrindiniai žodžiai: anestezijos kaina, inhaliaciniai anestetikai, sevofluranas, farmakoekonominis modelis Economical and clinical selection of anaesthesia during short operations: pharmaco-economical analysis of sevofluran Saulė Švedienė1, Jurgita Zidanavičiūtė2, Juozas Ivaškevičius11 Clinic of Anaesthesiology and Intensive Care, Vilnius University2 Vilnius Gediminas Technical University, Faculty of Fundamental Sciences,Department of Mathematical StatisticsE-mail: [email protected] Objective To determine the difference in the costs of various anaesthesia options by applying various medicaments during short operations performed at the Vilnius University Emergency Medical Service Hospital in 2005 and 2006. Methods A pharmaco-economical model called Mobile Anaesthesia Cost Consultant Program was used for the analysis. The program fixed each patient’s data: the character of an operation, the patient’s weight, age, the anaesthetic used for induction, and the anaesthetic used for anaesthesia support. Other preparations were also included: muscle relaxants, reversible agents, analgesics, etc. The anaesthesia cost is presented automatically by calculation using certain formulas. Acting in accordance with the guidelines of the program, we have created a protocol wherein we registered the data observed at our operation theatres. We selected angiosurgical, abdominal (laparoscopic cholecystectomies) and gynaecological operations as the object of analysis. These were short surgical interventions performed at our hospital, for which various anaesthetics are used. The patient records and the data obtained were processed on a statistical basis. Results The anaesthesia average cost and cost per one hour during short angiosurgical operations (in cases where both isofluran and sevofluran are used) did not credibly differ with respect to statistics (p = 0.305, p = 0.181). The anaesthesia average cost and cost per one hour during short abdominal operations (in cases where both isofluran and sevofluran were used) did not reliably differ with respect to statistics (p = 0.305, p = 0.526). Though patients of the gynaecological operation group differed from other groups by certain criteria (age, weight, ASA), we are in the position to maintain that short anaesthesia cost per one hour and the average cost are statistically equal when using propofol or sevofluran for support. Comparison of the anaesthesia average cost revealed no reliable differences among all the groups studied (p = 0.305). Conclusion In the absence of reliable cost difference, in short surgical interventions the clinically most useful, safest and least toxic anaesthetics such as sevofluran could be used for anaesthesia. The rational use of information technologies enables to improve the operation block time consumption in order to reduce various relevant costs before the initial axing of the anaesthesia type and medicament selection. Keywords: anaesthesia cost, inhalation anaesthetic, sevofluran, pharmaco-economical model