ABSTRACT
Background: It was observed that post?COVID patients reported persistent exertional dyspnea, cough, fatigue, or chest pain. About 10%–20% of patients may progress to pulmonary fibrosis. Pulmonary rehabilitation has been proven to be useful in improving effort tolerance and quality of life in chronic respiratory diseases. Objectives: The objective of this study was to assess the effectiveness of pulmonary rehabilitation in improving 6?min walk distance (6 MWD), peak flow, fatigue, anxiety, and depression in early postacute COVID disease. Materials and Methods: This quasi?experimental study was conducted during January 2021 to March 2021. The patients who recovered from COVID?19 and having persistent exertional dyspnea and fatigue after 3 weeks of recovery were included in the study. Baseline and postintervention assessment of 6 MWD, Visual Analog Scale for Fatigue (VAS?F), peak flow, and Hamilton rating scales (HAM) scales after 4 weeks were done. Compliance was ensured with weakly telemonitoring. Results: Significant improvement in peak flow, 6 MWD, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and VAS-F (P < 0.01) after 4 weeks of pulmonary rehabilitation. Conclusion: Early pulmonary rehabilitation in post?COVID syndrome can contribute to statistically significant improvement in functional and psychological parameters as well as post-COVID fatigue.
Subject(s)
Anesthesia , Craniocerebral Trauma/complications , Craniocerebral Trauma/physiopathology , Craniocerebral Trauma/surgery , Electrocardiography , Heart Diseases/complications , Heart Diseases/diagnosis , Hemodynamics/physiology , Humans , Neurosurgical Procedures/methods , Preoperative Care , Treatment OutcomeABSTRACT
Resuscitation of head injured patients at the accident site is paramount in minimizing morbidity and mortality. This can be achieved through prehospital care which is nonexistent in our country. This review is a step forward, so that we can formulate guidelines in this regard.
Subject(s)
Brain Chemistry/physiology , Craniocerebral Trauma/diagnosis , Developing Countries , Emergency Medical Services , Hazardous Substances , Humans , India , Transportation of PatientsABSTRACT
Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this surgery. It is associated with intense hemodynamic response, may influence the intracranial pressure, and thus may worsen the existing intracranial pathology. The purpose of this report is to evaluate the commonly used opioid fentanyl, along with butorphanol, an agonist-antagonist compound. Twenty adult patients undergoing ventriculoperitoneal shunt surgery were induced with fentanyl 2-mcg.kg[-1] and thiopentone 4-5 mg.kg[-1]. Intubation followed the administration of rocuronium 1 mg.kg[-1]. All patients were put on mechanical ventilation to maintain end-tidal carbon dioxide levels of 32 +/- 2 mmHg. Anesthesia was maintained with isoflurane in N[2]O and O[2] [MAC 1.0 +/- 0.2]. Routine monitoring, arterial blood pressure and intracranial pressures were measured. Three minutes prior to the tunneling phase, patients received either fentanyl 1 mcg.kg[-1] or butorphanol 1 mg in a randomized manner. Thereafter hemodynamic and intracranial pressure changes were noted during tunneling and each minute in the post-tunneling period for 5 minutes. The duration of the tunneling phase was also noted. Data were presented as number [proportion] or mean +/- SD/median [range] as appropriate. Statistical analysis was done using Wilkoxon ranksum test and the repeated measures of ANOVA. The value of p < 0.05 was considered significant. A significant rise in the intracranial pressure and cerebral perfusion pressure along with the hemodynamic parameters was noted during the tunneling phase in both groups. The changes were of longer clinical duration in the butorphanol group. Butorphanol must be used with caution in neurosurgical patients. The ventricular end of the shunt catheter should preferably be put before the tunneling phase to avoid rise in intracranial pressure
Subject(s)
Humans , Male , Female , Hemodynamics/drug effects , Fentanyl , Butorphanol , Ventriculoperitoneal ShuntABSTRACT
In neurosurgical practice, extradural or subgaleal drains are commonly placed and connected to a vacuum system. Several reports have described severe bradycardia or arterial hypotension, or both, after connection of negative suction pressure to the extradural or epicranial drains following craniotomy. We encountered an unusual complication with the use of the vacuum drain after an elective aneurysmal clipping surgery. Our case is an iatrogenic intracranial hypotension leading to a clinically significant and potentially fatal complication