RESUMO
BACKGROUND: Lung hydatid disease is an endemic problem in Mediterranean countries, and the ideal surgical management for it is still debated. In this prospective study, we aimed to evaluate the feasibility and safety of thoracoscopy in patients with lung hydatid disease. We studied the advantages of thoracoscopic procedure over posterolateral thoracotomy. METHODS: A total of 32 patients with an uncomplicated, unilateral lung hydatid cyst were subjected to surgical treatment over a period of 5 years. Of the 32 patients, 18 were treated with thoracotomy and 14 with thoracoscopy. Observations were made with regard to duration and ease of operation, complications, hospital stay, return to activity, and recurrence. RESULTS: The mean operative duration in the thoracoscopy group was 95.21 min compared to 137.77 min in thoracotomy group (P < 0.0001). Postoperative analgesia requirement was less in the thoracoscopic group (mean 4.92 days) compared to that in the thoracotomy group (mean 13.94 days; P < 0.0001). The intercostal drain was removed earlier in the thoracoscopic group (mean 5 days) than in the thoracotomy group (mean 8.83 days; P < 0.0001). The postoperative hospital stay was 8.35 days (mean) in thoracoscopic group and 18.77 days in the thoracotomy group (P < 0.0001). The most serious morbidity was wound infection, with three cases (16.66%) in the thoracotomy group and one (7.11%) in the thoracoscopy group. There was no operative mortality and no recurrence during the follow-up period. CONCLUSIONS: We strongly recommend the use of thoracoscopy as a primary tool for the management of uncomplicated, unilateral lung hydatid disease. Thoracoscopy offers a great advantage over open thoracotomy in terms of very low morbidity.
Assuntos
Equinococose Pulmonar/cirurgia , Toracoscopia , Toracotomia , Adulto , Distribuição de Qui-Quadrado , Equinococose Pulmonar/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Recidiva , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: A double blind randomized prospective study was undertaken to determine the effect of adjuncts like epinephrine 200µg or clonidine 90µg in combination of bupivacaine and lignocaine into the brachial plexus sheath to study the sensory and motor onset, duration of analgesia, hemodynamic changes and adverse effects. PATIENTS #ENTITYSTARTX00026; METHODS: 60 patients aged 18-65 years, with ASA grade I and II were randomly divided into group I and group II to receive 10 ml of lignocaine2% and 20 ml of bupivacaine0.5% with 1ml of 200µg epinephrine or 90µg clonidine respectively. Onset of sensory blockade was determined by pinprick method by a three point score and motor blockade by three point scale. Duration of postoperative analgesia, the hemodynamic changes, sedation scores and any adverse effects were observed. Statistical analysis was done by student's "t" test and p<0.05 was considered significant. RESULTS: It was found that there was faster onset of sensory and motor blockade, the postoperative analgesia was prolonged and the amount of sedation was profound in group II as compared to group I. All the above findings were statistically significant. CONCLUSION: We thereby conclude that clonidine 90µg is a better option as an additive than epinephrine 200µg for hastening the onset of sensory and motor block with prolonged postoperative analgesia and sedation as the only adverse effect.
RESUMO
BACKGROUND: Laryngoscopy and intubation are associated with increase in heart rate and mean blood pressure which are deleterious for patients especially with hypertension, ischaemic heart disease, raised intraocular and intracranial pressure. This study was undertaken with an objective to determine the efficacy of nalbuphine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and orotracheal intubation. PATIENTS #ENTITYSTARTX00026; METHODS: A randomized controlled, prospective, double blinded study was undertaken on 60 patients ASA grade I and II posted for elective laparoscopy surgery to receive either saline (group I, control group, n=30) or Nalbuphine 0.2mg kg(-1)(group II, study group, n=30 ) as a bolus dose, 5 minutes before laryngoscopy. Heart rate and mean arterial pressure were taken 3 minute after study drug (T-1), just after intubation (T-2), then after every minute till 5 min (T3-7) and after 10 min of intubation (T-8). Twenty percent rise in heart rate and mean arterial pressure was considered as significant. Students 't' test was used for the analysis of data by using statistical software Medcal version 11.1.1.0. and P < 0.05 was considered significant. RESULTS: There was significant rise in heart rate(20.4%) in group I after intubation at T-2 compared with baseline at T-1 as compared to group II (16.66%). Mean arterial pressure showed rise of 12.35% in group I and 4.39% in group II at T-2 but was not significant. Heart rate and mean arterial pressure then gradually decreased from T3-8 but remained slightly higher than group II at 8th minute. CONCLUSION: We thus conclude that Nalbuphine 0.2 mg kg (-1)prevented a marked rise in heart rate and mean arterial pressure associated with laryngoscopy and orotracheal intubation.