Post Operative Period
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2021 ◽  
Vol 7 (3) ◽  
pp. 134-139
Author(s):  
Pinaki Ranjan Debnath ◽  
Arnab Kumar Saha ◽  
Rashmi D ◽  
Vasu Gautam ◽  
Chetna Khanna ◽  
...  

To compare single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for the pediatric inguinal herniotomy.The present study was conducted on 100 patients of elective inguinal herniotomy from January 2019 to April 2020 and compared on the basis of single dose preoperative antibiotic versus five days antibiotic course. All the patients were evaluated on the 3rd, 7th and 28th post-operative period and instructions were given to the guardians about wound care and to attend for early follow up if any signs & symptoms of wound infection appear.50% of the patients were treated with prophylactic single dose antibiotic, i.e. inj. Ceftriaxone (30 mg/kg/dose) at the time of induction only and rest 50% were treated with inj. Ceftriaxone(30mg/kg/dose) at the time of induction as well as postoperatively at night followed by four days of oral antibiotic with Syr/Tablet. Cephalexin (25mg/kg/day) three times daily for another 4 days.Surgical Site Infection (SSI) in Group-B (4.0%) was higher than that of Group-A (2.0%) on day 3 but it was not significant (p=0.40). There was no significant difference in health status of the patients of the two groups when compared on post-operative day 7 and day 28 (p=0.99, p=0.99 respectively).Implementation of single dose antibiotic prophylaxis regimes tailored to the prevalent organisms in the institution can result in enormous savings, as the study shows significant reduction in hospital stay with no significant increase in incidence of SSI.


2021 ◽  
Vol 7 (3) ◽  
pp. 140-144
Author(s):  
Keerthidarshini ◽  
Sandeep R ◽  
Gopalkrishna Shanbag

Although trachea-esophageal fistula (TEF) and esophageal atresia (EA) is rare, it is one of the most common congenital anomaly. There is paucity of data due to rarity of condition. More and more data on clinical profile, complications, and outcome are needed to guide the future research. To study clinical profile of newborns with TEF and EA and factors associated with outcome.Hospital based prospective study was carried out among 21 newborns with TEF and EA. Diagnosis was confirmed by investigations like X-ray chest after passing nasogastric catheter. Depending upon final diagnosis type of surgery required was determined and procedure was carried out as per the standard guidelines and operating techniques. All cases were followed till the complete post-operative period and the complications and outcome was assessed. Outcome was classified as death or discharge.Males outnumbered females giving a male to female ratio of 2.5:1. 57.1% did not require ventilator pre-operatively. 61.9% of the cases had no associated abnormality. The most common type of surgery required and performed was tracheoesophageal repair in 52.4% of the cases. Two cases (9.5%) died during the post-operative period. 14 cases (66.7%) recovered and were discharged. Most common complication was anastomotic leak (57.1%). Term status and associated abnormalities were not found to be associated with outcome like death (p>0.05). Trachea-esophageal fistula and esophageal atresia was more common in males. Tracheoesophageal repair was commonly required surgery. Recovery rate was good. Anastomotic leak was most common complication. Outcome like death was not associated with term status and associated abnormalities.


Author(s):  
Neeraj ◽  
Banshilal Beniwal ◽  
Padmanidhi Agarwal ◽  
Vikas Berwal ◽  
Richa Malik

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique. Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed. The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap). The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.


Author(s):  
Neeraj ◽  
Banshilal Beniwal ◽  
Padmanidhi Agarwal ◽  
Vikas Berwal ◽  
Richa Malik

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique. Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed. The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap). The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.


2021 ◽  
Author(s):  
Vladimir Ostrovskij ◽  
Vladimir Tolkachev ◽  
Sergey Bazhanov ◽  
Galina Korshunova ◽  
Andrei Chekhonatsky

Background. The incidence of sciatic nerve (SN) damage after a total hip replacement (THR) is 10 percent. The underdiagnosis of paucisymptomatic sciatic neuropathy may lead to the unsatisfactory outcome of the treatment in these patients featured by frequent chronic pain syndrome. This research was aimed at the evaluation of the dynamics of clinical and electrophysiological patterns in SN after THR. Material and methods. The research involved 16 individuals 45 to 68 years old with primary idiopathic coxarthrosis who underwent THR in the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, Federal State Budgetary Educational Institution of Higher Education V.I. Razumovsky Saratov State Medical University, the Russian Federation Ministry of Healthcare. We compared the findings of clinical and neurologic examinations (VAS, muscle strength, and sensitivity evaluation) as well as ENMG before surgeries and 14 days after them. Results. In the evaluation of the clinical score in 9 patients, we observed some negative changes featured by paresthesia around the area of the SN innervation. The analysis of changes in ENMG findings revealed the decrease in M-response amplitudes of both peroneal and tibial nerves by more than 10 percent of the age-appropriate normal value; this was more prominent in patients who had undergone the lengthening of extremities in more than 3 cm. Conclusion. THR is associated with a higher risk of traction and entrapment changes in SN that lead to the progress of their neuropathies in the post-operative period.


Author(s):  
Deepu Thottath ◽  
Dayananda Babu ◽  
Saravanan Thangavel ◽  
Radhika Kannan

Background: Hypocalcemia is one of the most common complications of thyroid surgery. It is usually temporary, but it may rarely take several months to resolve. The aim of this study was to determine the incidence of hypocalcaemia after total thyroidectomy and assess the biochemical factors that may be predictive of hypocalcemia.Methods: An observational study was conducted in 98 patients at the general surgery department of a tertiary care medical college hospital for a period of one year. Convenient method of sampling was done. All the patients undergoing total thyroidectomy were included in this study. The serum calcium level was evaluated at different times in the post-operative period as a part of the routine post-operative care at the hospital. During the postoperative period patients were carefully watched for clinical symptoms and signs of hypocalcemia.Results: In the study group, 19 (19.4%) had hypocalcemia. In the study group, 14 (14.3%) had symptomatic hypocalcemia and 5 patients (5.1%) had asymptomatic hypocalcemia. 18 patients (18.4%) had temporary hypocalcemia and 1 patient (1%) had permanent hypocalcemia. Among the patients with hypocalcemia, 18 (95%) were females and 1 (5%) patient was male. 13 (68%) patients were euthyroid, 5 (26%) patients were hyperthyroid and 1 (5%) patient was hypothyroid. Significant association was seen between diagnosis of thyroid disorders and hypocalcemia, thyroid function and hypocalcemia and between operating time and hypocalcemia.Conclusions: Incidence of hypocalcemia in patients who had undergone total thyroidectomy was found to be less. Majority of them had temporary hypocalcemia and permanent hypocalcemia was seen only in one patient.


Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Huichen Zhu ◽  
Lu Cong ◽  
Yi Chen ◽  
Shaoyi Chen ◽  
Lingke Chen ◽  
...  

Abstract Background Post-operative cognitive dysfunction (POCD) is an overarching term used to describe cognitive impairment identified in the preoperative or post-operative period. After surgical operations, older patients are particularly vulnerable to memory disturbances and other types of cognitive impairment. However, the pathogenesis of POCD remains unclear with no confirmed preventable or treatable strategy available. Our previous study demonstrated that the concentration of choline acetyl transferase in the cerebral spinal fluid was a predictive factor of POCD and that donepezil, which is an acetylcholinesterase inhibitor used in clinical settings for the treatment of Alzheimer’s disease, can prevent learning and memory impairment after anaesthesia/surgery in aged mice. This study aimed to determine the critical role of donepezil in preventing cognitive impairment in elderly patients undergoing orthopaedic surgery. Methods A multicentre, double-blind, placebo-controlled, crossover clinical trial will be performed to assess the efficacy of donepezil in elderly patients undergoing orthopaedic surgery. Participants (n = 360) will receive donepezil (5 mg once daily) or placebo from 1 day prior to surgery until 5 days after surgery. Neuropsychological tests will be measured at 1 day before the operation and 1 week, 1 month, 6 months and 1 year after the operation. Discussion This research project mainly aimed to study the effects of donepezil in elderly patients undergoing orthopaedic surgery due to underlying POCD and to investigate the underlying physiological and neurobiological mechanisms of these effects. The results may provide important implications for the development of effective interfering strategies, specifically regarding cognitive dysfunction therapy using drugs. Trial registration ClinicalTrials.govNCT04423276. Registered on 14 June 2020


Author(s):  
Arti Mitra ◽  
Unmed Chandak ◽  
Shiv Kumar Sahu ◽  
Yuvraj Pawaskar ◽  
Akanksha Waldia

Background: Laparoscopic repair of umbilical and paraumbilical hernia has largely replaced conventional (Open) repair. The purpose of the study was to compare the effectiveness of laparoscopic vs. open repair of umbilical & para umbilical hernia in a tertiary care government hospital. Methods: A total 50 patients of age >18 years diagnosed with umbilical and paraumbilical hernia who underwent laparoscopic and open hernia repair from May2018 to Nov 2020 were enrolled and divided into two groups of 25 patients in each. The patients were followed up in the post-operative period in the wards during daily rounds till the time of discharge; 1 and 6 months after discharge and yearly. Results: The mean age for open group was 44.24±7.68years while the mean age for laparoscopic group was 50.0±11.82years. Operative time was more in laparoscopic repair (81.68±18.37min) as compared to open (55.44±16.54min). Post-operative pain (VAS score) was greatest in the open group in comparison to lap group at 6 hr, 24 hr, day 8 and at 1month. Postoperative overall complication rate (Infection, seroma and recurrence) was 12% in the laparoscopic group and 28% in the open group. Recovery was faster with laparoscopic repair with a mean postoperative hospital stay of 3.28days as compared to 5.88days for open mesh repair. Patients treated with laparoscopic repair were early return to routine activity and work. Conclusion: The laparoscopic approach appears to be safe, effective and acceptable. It is a complex but very efficient method in experienced hands and it offered a significant advantage over open repair.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Nagdy Rashad ◽  
Diaa Abdel khalek Akl ◽  
Mona Ahmed Ammar ◽  
Wael Sayed ElGharabawy

Abstract Background The use of opioid-free analgesic technique have the propensity to decrease and even avoid many of these side effects and lead to early oral intake, early ambulation, earlier hospital discharge, and lesser readmission rates to the hospital in the post-operative period. Aim of the Work to compare the effect of opioid-free using Dexmedetomidine and opioid-based using Fentanyl on hemodynamics (inducing deliberate hypotension and providing a better surgical field exposure), post-operative pain intensity and the incidence of side effects in patients scheduled for rhinoplasty surgeries. Patients and Methods This study included Fifty adult patients undergoing rhinoplasty surgery. Patients were randomly divided into two equal groups. Group D received Dexmedetomidine and Group F received Fentanyl. Patients are ASA physical status I, age group ranged from 18 to 45 years. Results The study revealed a statistically significant decrease mean of group D compared to group F according to intraoperative mean arterial blood pressure. statistically significant decrease mean of group D compared to group F according to intraoperative heart rate (beat/min). Conclusion We found that dexmedetomidine is better than fentanyl for patients who undergo rhinoplasty surgeries to achieve controlled hypotension, decrease dosages of postoperative analgesics, prolong the duration of postoperative analgesia and decrease postoperative nausea and vomiting.


2021 ◽  
Vol 12 (10) ◽  
pp. 64-68
Author(s):  
Manpreet Singh Banga ◽  
Sandeep BV ◽  
Anantha Kishan ◽  
Rajesh Babu Devabhakthuni ◽  
Arun MA ◽  
...  

Background: To assess respiratory function in cervical chronic compressive myelopathy (CCM) patients in pre-operative period, post-operative period and to compare pre-operative status with post-operative status. Aims and Objectives: 1. To assess respiratory function in cervical CCM patients in pre-operative period. 2. To assess respiratory function in cervical CCM patients in post-operative period, following relief of compression. 3. To compare, pre-operative status with post-operative status. Materials and Methods: A prospective study was done in 50 patients with cervical CCM due to either cervical disc disease or ossified posterior longitudinal ligament (OPLL) who were operated. None of the patients included in the study had any clinical signs & symptoms of respiratory dysfunction. Spirometry was performed in pre-operative and postoperative period after 3 months and results were analyzed. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), ratio of mean FEV1 to FVC (FEVI: FVC%) and peak expiratory flow rate (PEFR) were calculated. Results: Majority of the patients were in their fourth decade of life with male predominance. Thirty-six patients (72%) presented with prolapsed intervertebral disc and 14 patients (28%) had ossified posterior longitudinal ligament (OPLL). Patients were operated depending upon the pathology. The present study showed that there was significant reduction in preoperative FVC, FEV1, PEFR values as compared with predicted values and they showed significant improvement in post-operative period after surgical relief of compression. Conclusion: Significant yet occult respiratory dysfunction in form of impairment of various lung capacities exists in patients with cervical CCM. An objective evaluation of this occult respiratory dysfunction is essential to prognosticate, prevent respiratory complications and to improve post-operative respiratory rehabilitation. Institution of incentive spirometry as a routine in all cervical CCM cases will be of benefit in preventing respiratory complications.


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