Premedication with Dexamethasone and Propofol to Control Fentanyl-Induced Cough

Background: Fentanyl-induced cough is a common difficulty encountered at induction of anesthesia. Various interventions both pharmacological and non-pharmacological have been used to prevent this side effect including dexamethasone and propofol. Aim: To compare the effectiveness of dexamethasone and propofol to prevent fentanyl-induced cough at the induction of general anesthesia. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesiology, Surgical ICU & Pain Management, Dow University of Health Sciences and Civil Hospital Karachi from 16th September 2011 to 15th March, 2012. Methodology: One hundred patients who underwent elective surgical procedure were selected. Patients were randomized in two groups of 50 patients each; Group D was given intravenous dexamethasone; whereas patients of group P received intravenous propofol as the premedication before induction. The main outcome measure was effectiveness of both drugs to prevent fentanyl-induced cough. Results: Majority of patients (40%) were between 20-30 years of age group with mean age was 35.80±10.14 years. Males were more than females. Intravenous dexamethasone was significantly effective (90%) than intravenous propofol (70%) [p=0.012]. Conclusion: Intravenous dexamethasone is effective in reducing fentanyl-induced cough in comparison to propofol. Keywords: Dexamethasone, Propofol, Fentanyl-induced cough (FIC)

Patient’s perspective regarding the elective surgical procedure during Covid 19 pandemic.

Context: The ongoing Covid-19 pandemic and the subsequent nationwide lockdown, has impacted all aspects of society including the medical profession. In hospitals, the focus has mainly shifted to prevention and treatment of Covid-19 infection. Owing to this, all elective surgeries are being postponed and only emergent surgeries are being performed. This has affected the patients differently depending on the progression of disease and development of complications.Methods and Material: A well-structured telephonic scripted questionnaire was administered to all patients who were given an appointment for any elective surgery. Data was collected regarding the status of disease including complications and the patient’s perspective on the method of treatment. Patients who developed complications or underwent emergency surgery or surgery elsewhere were excluded.Statistical analysis used: Collected data was entered in MS Office Excel spreadsheet and analysis was done using SPSS software.Results: The man to women ratio was 2.3:1. The mean age of patients was 41.16 years. A total of 86 patients were included in the study. Almost all (98.8%) were aware that the lockdown and withholding of elective surgeries were directed to prevent the spread of coronavirus infection. Among 34 patients with progressive disease, 88.2% were willing to undergo the surgical procedure and 73.5% were willing to visit hospital within a week or two. Among 46 patients, who were Willing to continue the treatment on wait and watch policy, 45.7% patients wanted to wait for more than 2 months for their treatment, and 93.5% patients were avoiding hospital visit because of infection.Conclusions: Patient’s attitude towards the choice of treatment (wait and watch Vs surgery) mainly depended on the progression of disease. It is critical, during these tough times of Covid-19 pandemic, that risks are weighed against benefits to decide the line of management for patients waiting for elective surgeries.

The efficacy and safety of bronchoscopy for treating transluminal broncholiths

We aim to reveal the clinical features of transluminal broncholiths and to evaluate the efficacy and safety of bronchoscopy for treating transluminal broncholiths. Patients with transluminal broncholiths were enrolled in this retrospective study in Lanzhou University Second Hospital between January 2010 and December 2018. Then age, gender, symptoms, and signs, imaging characteristics, treatment methods, outcomes as well as complications were retrospectively analyzed. Twenty-eight patients with 36 pieces of transluminal broncholiths were diagnosed using chest CT and bronchoscopy, of which two patients underwent broncholiths removal via an elective surgical procedure and six patients were treated with one-time removal of broncholiths by bronchoscopy. Among the six patients who received one-time removal of stones by bronchoscopy, two underwent massive hemorrhage and one suffered from bronchial wall laceration in the process of broncholiths removal, all of the three patients received surgical treatment eventually. No serious complications occurred in the other 20 patients who underwent broncholiths removal via repeated bronchoscopy. Removal of transluminal broncholiths by bronchoscopy are effective and safe with less complications. When it is difficult to remove the transluminal broncholith completely at one time, repeated bronchoscopy could be chosen: First, to remove the portion which causes airway obstruction; and then to remove the remaining part by repeated bronchoscopy during the follow-up period. In case that severe distal lung tissue injury, massive hemoptysis or bronchial wall laceration occurs or the diagnosis of broncholiths is unclear, surgical treatment is required.

Care of the surgical patient: part 1

This article provides clinical guidance on the care of a patient undergoing an elective surgical procedure. It discusses preoperative care and the preparation of the patient. It aims to provide an awareness of the complications associated with perioperative care. Through the use of a patient case study, the authors demonstrate the care required across the full perioperative journey from diagnosis to discharge.

Patient’s perspective regarding the elective surgical procedure during Covid 19 pandemic.

Introduction: The ongoing Covid-19 pandemic and the subsequent nationwide lockdown, has impacted all aspects of society including medical profession. In hospitals, the focus has mainly shifted to prevention and treatment of Covid-19 infection. Owing to this, all elective surgeries were postponed and only emergent surgeries were performed. This has affected the patients differently depending on the progression of disease and development of complications.Materials and Methods: A well-structured telephonic scripted questionnaire was administered to all patients who were given appointment for any elective surgery. Data was collected regarding the status of disease including complications and the patient’s perspective on method of treatment. Patients who developed complications or underwent emergency surgery or surgery elsewhere were excluded.Results: The male to female ratio was 2.3:1. Mean age of patients was 41.16 years. A total of 86 patients were included in the study. Almost all (98.8%) were aware that the lockdown and withholding of elective surgeries was to prevent spread of coronavirus infection. Among 34 patients with complications, 88.2% were willing to undergo surgical procedure and 73.5% were willing to visit hospital within a week or two. Among patients without complications, 71.2% were willing to continue treatment on wait and watch policy, for a period of 2 months or more (45.7%). 93.5% of patients avoided visit to hospital due to risk of infection.Discussion: Patient’s attitude towards the choice of treatment (wait and watch Vs surgery) mainly depended on the progression of disease. It is critical, during these tough times of Covid-19 pandemic, that risks are weighed against benefits to decide the line of management for patients waiting for elective surgeries.

Effect of Low Dose Ketamine on Propofol Injection Pain: A Double-Blind Clinical Trial

Background: Propofol, most frequently used intravenous anesthetic for induction of routine elective surgical procedure. Pain on propofol injection (POPI) still remains a considerable concern for the anesthesiologist. A number of techniques has been tried to minimize propofol-induced pain with variable results. Objective: This study was performed to determine the effect of ketamine on reducing pain on propofol injection (POPI) at the onset of anesthesia. Materials and Methods: A total of 80 adult healthy patients were selected in this study of either sex, scheduled for routine elective ENT surgery under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I (ketamine group) received 10 mg intravenous ketamine in 10 ml normal saline. Group II (placebo group) received 10 ml of 0.9% intravenous normal saline. Then the patients were induced with propofol and asked to report their pain during injection of propofol and recorded according to the Mc Cririck and Hunter scale. Results: The incidence of pain experienced in ketamine group was 10% patients and in saline group was 60% patients, which is statistically significant p<0.05. The severity of POPI was also lower in ketamine group than the saline group (p<0.05). The incidence of mild and moderate pain in ketamine group versus saline group was 7.5% versus 45% and 2.5% versus 15% respectively p<0.05. There was no severe pain recorded in any groups. Conclusion:Intravenous ketamine in low dose before induction of general anesthesia can be effective medication in reducing pain on propofol injection. KYAMC Journal Vol. 11, No.-2, July 2020, Page 96-99

Metoclopramide Pretreatment for Prevention of Pain on Propofol Injection: A Randomized Placebo-Controlled Study

Background: Propofol, the most frequently used intravenous anaesthetic, is used for induction, maintenance of anaesthesia and for sedation in patients scheduled for routine elective surgical procedure. Pain on propofol injection still remains a considerable concern for the anaesthesiologist. Objective: Aim of this study was to observe the efficacy of metoclopramide as pretreatment for the prevention of pain caused by the propofol injection in patients undergoing elective surgery under general anaesthesia. Materials and method: A total of 80 patients were taken up in the study in the age group of 20 to 50 years of either sex, ASA grade I/II, scheduled for routine elective surgical procedure under general anesthesia with endotracheal intubation and using propofol as induction agent. The patients enrolled were divided randomly into two groups of 40 patients each. Group A received 10 mg metoclopramide IV diluted in 5 ml saline. Group B received 5 ml of normal saline as placebo before propofol injection. The patients were asked to report their pain according to the scale provided to them in the form of none, mild, moderate and severe after injection of propofol. Results: The overall incidence and severity of pain were significantly less in Group A (metoclopramide group) than in group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 15% vs 45% and 5% vs 25% respectively (p<0.05). The incidence of score ‘0’ (no pain) was higher in Group A (80%) thanGroup B (25%) (p< 0.05). Conclusion: Intravenous metoclopramide is effective for relief of pain on propofol injection without any significant side effects. Delta Med Col J. Jul 2019 7(2): 71-75

Effect of Intravenous Dexamethasone on Propofol Injection Pain: A Randomized Placebo Controlled Study

Background and aim of study: Pain on propofol injection (POPI) is a common problem. None of the commonly used methods completely attenuate the pain. Inflammatory response to propofol contributes to the pain. This study was conducted to compare the efficacy of dexamethasone in attenuation of pain following intravenous injection of propofol. Materials and methods: A total of 80 adult patients were scheduled in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I received 0.15 mg/kg of intravenous dexamethasone in 5 ml normal saline and Group II (placebo group) received 5 ml of 0.9% intravenous normal saline, following exsanguination and occlusion of the vein of the arm. This was followed by 0.5 mg/kg of propofol intravenously.The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexamethasone group was 45% patients and in saline group was 70% patients (p<0.05). The severity of POPI was also lower in dexamethasone group than the saline group (p<0.05). The incidence of mild and moderate pain in dexamethasone groups versus saline group was 30% versus 45% and 15% versus 25% respectively p<0.05. There was no severe pain recorded in any groups. Conclusion: Pretreatment with intravenous dexamethasone (0.15 mg/kg) before injection of propofol is effective and safe in reducing the incidence and severity of pain on propofol injection (POPI). Bangladesh J Otorhinolaryngol; April 2019; 25(1): 28-33