RESUMO
BACKGROUND & OBJECTIVES: The COVID-19 pandemic emerged as a major public health emergency affecting the healthcare services all over the world. It is essential to analyze the epidemiological and clinical characteristics of patients with COVID-19 in different parts of our country. This study highlights clinical experience in managing patients with COVID-19 at a tertiary care centre in northern India. METHODS: Clinical characteristics and outcomes of consecutive adults patients admitted to a tertiary care hospital at Chandigarh, India, from April 1 to May 25, 2020 were studied. The diagnosis of SARS-CoV-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. All patients were managed according to the institute's consensus protocol and in accordance with Indian Council of Medical Research guidelines. RESULTS: During the study period, 114 patients with SARS-CoV-2 infection were admitted. The history of contact with COVID-19-affected individuals was available in 75 (65.8%) patients. The median age of the patients was 33.5 yr (13-79 yr), and there were 66 (58%) males. Of the total enrolled patients, 48 (42%) were symptomatic. The common presenting complaints were fever (37, 77%), cough (26, 54%) and shortness of breath (10, 20.8%). Nineteen (17%) patients had hypoxia (SpO2<94%) at presentation and 36 (31%) had tachypnoea (RR >24). Thirty four (29.8%) patients had an accompanying comorbid illness. Age more than 60 yr and presence of diabetes and hypertension were significantly associated with severe COVID-19 disease. Admission to the intensive care unit (ICU) was needed in 18 patients (52%), with three (2.6%) patients requiring assisted ventilation. Mortality of 2.6 per cent (3 patients) was observed. INTERPRETATION & CONCLUSIONS: Majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Fever was noted only in three-fourth of the patients and respiratory symptoms in half of them. Patients with comorbidities were more vulnerable to complications. Triaged classification of patients and protocol-based treatment resulted in good outcomes and low case fatality.
Assuntos
COVID-19/epidemiologia , Pandemias , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Demografia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. METHODS: Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. RESULTS: Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign post-intubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. CONCLUSIONS: Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia , Stents , Adulto , Obstrução das Vias Respiratórias/etiologia , Brônquios/cirurgia , Broncoscopia/efeitos adversos , Humanos , Índia , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Traqueia/cirurgia , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/cirurgia , Estenose Traqueal/complicações , Estenose Traqueal/cirurgia , Adulto JovemRESUMO
UNLABELLED: This article evaluates all the EEG parameters suggested in the literature that undergo changes due to anaesthetic dose, and suggests a set of EEG parameters that act as best signatures of anaesthetic state of a patient. This set of EEG parameters is validated by an artificial neural network. PRIMARY OBJECTIVE: The purpose of this study is to arrive at a set of EEG parameters that 'best' distinguish between awake and anaesthetized states of human patients for halothane anaesthesia. METHODS AND PROCEDURES: A total of 21 EEG parameters were evaluated for 40 patients. Stepwise discriminant analysis (SDA) pruned them to a set of five parameters. They were fed to a 5-3-1 artificial neural network (ANN) for classification into awake and anaesthetized state. To confirm the results, variance analysis was applied to the set of 21 parameters. Five parameters were finalized after validation by the ANN. MAIN OUTCOMES AND RESULTS: The classification accuracy of the ANN with SDA parameters was found to be 96%. With variance analysis parameters, it returned an accuracy of 100%. CONCLUSION: The set of five EEG parameters - approximate entropy, average frequency, Lempel Ziv (LZ) complexity, delta power and beta power forms the best set to distinguish between awake and anaesthetized state of human patients. Variance analysis is a better tool to converge at the optimal set than SDA.
Assuntos
Anestesia , Eletroencefalografia , Redes Neurais de Computação , Adulto , Anestésicos Inalatórios , Halotano , Humanos , Pessoa de Meia-Idade , Sono/fisiologia , Vigília/fisiologiaRESUMO
BACKGROUND: Multidrug-resistant Candida auris infection has been reported from five continents in recent years. The prevalence of C. auris invasive infection has been estimated at 5.3% for intensive-care-acquired candidaemia in India. The transmission of the organism between the patients and from environment to patients is rapid. AIM: To understand the intra-hospital dynamics of C. auris transmission and to determine the possible interventions to prevent its spread. METHODS: Surveillance of intensive care units was carried out to assess patient colonization, environmental contamination and hand carriage of the yeast among healthcare workers. Interventions including chlorhexidine washing of patients and decontamination of environmental surfaces with stabilized hydrogen peroxide disinfectant (Ecoshield) were undertaken. We further evaluated the effectiveness of frequently used disinfectants in the hospital against C. auris on various inanimate surfaces, and its persistence on hospital fabrics. FINDINGS: Three cases of C. auris bloodstream infection were detected over a period of three months. Many patients admitted at the same time, in the same area, were colonized by C. auris. Surveillance detected C. auris contamination of environmental surfaces and hands of healthcare workers. Interventions such as chlorhexidine washing and appropriate use of disinfectants could eradicate C. auris from patients and hospital environment. CONCLUSION: The frequently used disinfectants in our hospital and current hand hygiene practices were efficient against C. auris if proper contact time and procedures were followed. Evaluation of possible persistence of C. auris on dry fabrics showed that they can persist for up to seven days.
Assuntos
Candida/isolamento & purificação , Candidíase Invasiva/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/métodos , Idoso , Candidíase Invasiva/microbiologia , Candidíase Invasiva/transmissão , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Desinfetantes/administração & dosagem , Microbiologia Ambiental , Feminino , Seguimentos , Mãos/microbiologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
In a prospective double-blind study, 40 children scheduled for hypospadias repair were allocated randomly to receive either caudal tramadol (1 mg/kg) or 0.25% plain bupivacaine (0.5 ml/kg). Postoperative pain score, side-effects and oxygen saturation (SaO2) were recorded during 24-hour observation period. The results point toward a significantly lower pain scores with caudal bupivacaine in the immediate postoperative period, whereas caudal tramadol caused a significantly lower pain score in the late postoperative period. Total consumption of rescue analgesics was significantly higher in bupivacaine group as compared to tramadol group during the study period (p < 0.001). The incidence of side-effects such as vomiting was more frequent with caudal tramadol, but there was no detectable difference in SaO2. We conclude that caudal tramadol can safely be used for postoperative analgesia with a longer duration as compared to caudal bupivacaine.
Assuntos
Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Tramadol/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Criança , Pré-Escolar , Método Duplo-Cego , Humanos , Hipospadia/cirurgia , Injeções Epidurais , Masculino , Tramadol/administração & dosagem , Tramadol/efeitos adversosRESUMO
Thirty-two adult female ASA I patients (American Society of Anesthesiologists' grading) undergoing voluntary termination of pregnancy (VTP) under general anaesthesia were randomly divided into three groups. Patients received 0.6 mg/kg pentazocine intravenously five minutes prior to induction of anaesthesia along with either isotonic saline, or promethazine 0.5 mg/kg or metoclopramide 0.2 mg/kg. Anaesthesia was induced with intravenous thiopentone and maintained with nitrous oxide in oxygen and boluses of thiopentone. Vomiting and sedation were scored at the end of anaesthesia, one hour later and at the time of discharge. The mean vomiting score was comparable in the three groups. Though the mean dose of thiopentone used was significantly less in the promethazine group, the sedation scores and the duration of stay in the clinic were comparable in all the groups. It is concluded that promethazine and metoclopramide in the doses used are ineffective as antiemetic agents in outpatient gynaecological patients.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Dilatação e Curetagem/métodos , Metoclopramida/administração & dosagem , Prometazina/administração & dosagem , Vômito/prevenção & controle , Aborto Induzido/métodos , Adulto , Análise de Variância , Anestesia Geral/efeitos adversos , Distribuição de Qui-Quadrado , Feminino , Humanos , Metoclopramida/uso terapêutico , Gravidez , Prometazina/uso terapêutico , Estatísticas não Paramétricas , Vômito/etiologiaRESUMO
Tramadol acts through multiple mechanisms and has a low risk of post operative respiratory depression. We compared the efficacy of epidural tramadol with that of morphine for postoperative analgesia in these patients. The demographic data and the summed pain intensity difference scores (SPID) were similar in both the groups. The time to first supplementary dose was significantly shorter in the tramadol group compared to the morphine group (p<0.05). No patient in either group suffered respiratory depression.
Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Laminectomia , Morfina/administração & dosagem , Morfina/efeitos adversos , Tramadol/administração & dosagem , Tramadol/efeitos adversos , Adulto , Analgesia Epidural , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológicoRESUMO
BACKGROUND: The purpose of this study was to evaluate the effect of two different volume of crystalloid given intraoperatively on postoperative nausea and vomiting (PONV). MATERIALS AND METHODS: Eighty adult patients of either sex belonging to ASA I and II class undergoing elective surgeries under general anesthesia for 1-2 h were studied in this prospective, randomized double blinded study. First group (group L) (n=40) received normal saline 4 mL/kg and second group (group H) (n=40) received 10 mL/kg of normal saline. This was in excess of the fasting requirement of the patients. No propofol or antiemetic drugs were given. PONV was evaluated by verbal descriptive score (VDS) [0 = none, 1 = mild, 2 = moderate, 3 = severe, and 4 = unbearable]. Ondansetron (4 mg i.v.) was given if VDS score was 3 or more. RESULTS: The median immediate PONV score was 2 and 1 in group L and H, respectively. The median 2 h PONV score in group L was 3 and in group H was 1. The median 6 h PONV score in group L was 3 and in group H was 1. The 24 h median postoperative PONV score was 1 and 0 in group L and H, respectively. In all these period of time the differences were statistically significant. The incidence of vomiting was more in group L [72.5% (29/40)] than in group H [30% (12/40)]. This was statistically significant (P=0.0003). CONCLUSION: From the current study it was concluded that patients who received larger volume of crystalloid intraoperatively have lesser incidence of PONV.
Assuntos
Adjuvantes Anestésicos/uso terapêutico , Midazolam/uso terapêutico , Estremecimento/efeitos dos fármacos , Adjuvantes Anestésicos/administração & dosagem , Adulto , Anestesia/efeitos adversos , Período de Recuperação da Anestesia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas , Midazolam/administração & dosagem , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Most of the research efforts to monitor the depth of anaesthesia using the mid-latency auditory evoked potential (MLAEP) signal in humans are based on the detection of the amplitudes and latencies of the signal peaks. Attempts have also been made to combine different time-domain and frequency-domain parameters. A comparison of different parameters is required to identify those which best discriminate the awake state from the anaesthetized state. METHODS: Although the sensitivity of MLAEP signal peaks is appreciable in awake and light anaesthesia states, it is reduced considerably at the moderate anaesthesia level, rendering this method unsuitable for predicting the surgical stage of anaesthesia. To overcome this problem, a numerically derived quantity--the morphology index--was used which does not require location of the peaks of the signal, but, at the same time, reflects the changes in both the latency and amplitude of the peaks. AEPs were recorded in the hospital for 18 patients during various states, i.e. awake, induction, unconscious and after regaining consciousness from halothane anaesthesia. The peak latencies, amplitudes, morphology index and peak power frequency (PPF) were calculated. RESULTS: The sensitivity and specificity of PPF (89% and 95%, respectively) were found to be better than those for Pa and Nb peak amplitudes, their latencies and the morphology index. In addition, PPF showed minimum inter-patient variation. The mean value (standard deviation) of this parameter was 26.9 (0.67) during the awake state, decreased to 17.1 (1.2) during the anaesthetized state, and increased again to 26.1 (0.93) when the patients regained full consciousness. CONCLUSION: PPF is the best of the four studied MLAEP parameters for the clinical characterization of the anaesthetized state during surgery.
Assuntos
Anestesia Geral , Potenciais Evocados Auditivos/fisiologia , Estimulação Acústica , Anestésicos Inalatórios , Estado de Consciência/fisiologia , Interpretação Estatística de Dados , Eletroencefalografia , Halotano , Humanos , Vigília/fisiologiaRESUMO
The incidence and degree of hypoxaemia during induction of balanced anaesthesia and endotracheal intubation were studied prospectively in 80 healthy adults undergoing elective surgery randomly divided into four equal groups of 20. Group 1 was preoxygenated for three minutes. The other three groups were not preoxygenated. Groups 1 and 2 were ventilated with 100% oxygen, while Groups 3 and 4 were ventilated with 50% and 33% oxygen respectively. Anaesthesia was induced with thiopentone 3-5 mg/kg and endotracheal intubation was done after ventilating for one minute with the chosen gas. Arterial desaturation was measured by pulse oximetry. In Groups 1-3 there was a significant increase and in Group 4 a significant decrease in saturation from the preinduction value. The arterial oxygen saturation was similar in Groups 1 and 2. Two patients in Group 3 and four in Group 4 had hypoxaemia. This incidence was not statistically significant. We conclude that ventilation with 100% oxygen for one minute prior to intubation and preoxygenation for three minutes are equally effective in preventing hypoxaemia during induction.
Assuntos
Anestesia Geral , Hipóxia/etiologia , Oxigênio/administração & dosagem , Oxigênio/sangue , Adolescente , Adulto , Idoso , Anestesia por Inalação , Anestesia Intravenosa , Estudos de Avaliação como Assunto , Feminino , Humanos , Hipóxia/sangue , Incidência , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Óxido Nitroso/administração & dosagem , Oximetria , Oxigenoterapia , Estudos Prospectivos , Tiopental/administração & dosagemRESUMO
Positioning for placement of an epidural catheter can be quite painful for patients with lower limb injuries. We randomly allocated 50 patients scheduled for surgery after lower limb injuries for placement of a lumbar epidural catheter in the sitting position with the back in the neutral unflexed position by either the midline or paramedian approach. If the approach failed after two attempts, patients were placed in a flexed-spine position, and the procedure was attempted again. Technical difficulties and complications were recorded. In 17 patients in the midline group, and 1 patient in the paramedian group, it was not possible to insert the needle initially, and a flexed-spine position was required (P < 0.05). The incidences of resistance to catheter insertion (eight versus one), paresthesia (seven versus zero), and appearance of blood in the catheter (six versus zero) were significantly more frequent in the midline compared with the paramedian approach. The midline group also experienced more discomfort than the paramedian group. We conclude that, with the patient sitting with an unflexed spine, it is usually possible to insert an epidural catheter with the paramedian approach.
Assuntos
Anestesia Epidural , Postura/fisiologia , Coluna Vertebral/fisiologia , Adulto , Anestésicos Locais , Dor nas Costas/etiologia , Cateterismo , Espaço Epidural/anatomia & histologia , Feminino , Humanos , Lidocaína , Extremidade Inferior/lesões , Masculino , Dor Pós-Operatória/epidemiologia , Estudos ProspectivosRESUMO
The influence of the relative position on the operating list on pre-operative anxiety was studied in 60 adult female ASA 1 patients undergoing major surgery. Thirty patients were placed first on the operating list (group 1) and 30 were given a time 4-5 h later (group 2). Each patient was visited on the evening prior to surgery and again on the morning of surgery. Anxiety was measured at each visit by objective criteria and part 1 of the State-Trait Anxiety Inventory questionnaire. The pulse rate, systolic blood pressure and the State-Trait Anxiety Inventory questionnaire scores were higher on the second visit than on the first (p < 0.001) in all patients. This increase was greater in group 2 than in group 1 (p < 0.05). The evening anxiety scores were not correlated with those on the morning visit and could not predict them.