RESUMEN
A meningomyelocele is herniation of meninges along with neural elements through a congenital defect in the cranium or vertebral column. Reported incidence of occipital meningomyelocele is 1 in 5000 live births. Children with meningomyelocele may have varying degrees of sensory and motor deficits and other important associated congenital defects with clinical features of brain stem compression. The major anaesthetic challenges associated with myelomeningocoele repair includes difficulty in securing airway, intra-operative prone positioning, accurate assessment of blood loss and prevention of hypothermia.
Asunto(s)
Anestesia/métodos , Meningomielocele/patología , Meningomielocele/cirugía , Vértebras Cervicales , Niño , Humanos , LactanteRESUMEN
OBJECTIVES: To compare the effectiveness of oral nonsteroidal antiinflammatory drugs (NSAIDs) and locally injectable steroid (methylprednisolone) in the treatment of plantar fasciitis. MATERIALS AND METHODS: One hundred and twenty subjects with unilateral plantar fasciitis were recruited and randomly allocated to two study groups. Group I (NSAIDs group) (n=60) received oral tablet diclofenac (50 mg) and paracetamol (500 mg) twice a day (BD) along with tab. ranitidine 150 mg BD. Group II (injectable steroid group) (n=60) received injection of 1 ml of methylprednisolone (Depomedrol) (40 mg) and 2 ml of 0.5% bupivacaine into the inflammed plantar fascia. Pain intensity was measured using 10 cm visual analog scale (VAS). Subjects were evaluated clinically before, and 1 week, 2 weeks, 4 weeks, and 8 weeks (2 months) after the initiation of treatment in both the groups. The outcome was assessed in terms of VAS score and recurrence of the heel pain. STATISTICAL ANALYSIS USED: "Z" test and Chi-square test were used wherever applicable. RESULTS: Pain relief was significant after steroid injection (P<0.001) and the improvement was sustained. The recurrence of heel pain was significantly higher in the oral NSAIDS group (P<0.001). CONCLUSION: Local injection of steroid is more effective in the treatment of plantar fasciitis than oral NSAIDs.
RESUMEN
BACKGROUND: Postdural puncture headache (PDPH) is a distressing complication of the subarachnoid block. The previous studies conducted, including the recent ones, do not conclusively prove that pencil-point spinal needles decrease the incidence of PDPH. In this study, we have tried to find out whether a pencil-point Whitacre needle is a better alternative than the classic cutting beveled, commonly used, Quincke spinal needle, in patients at risk of PDPH. MATERIALS AND METHODS: Three hundred and twenty obstetric patients, 20-36 years of age, ASA I and II, posted for Cesarean section under subarachnoid block, were randomly assigned into two groups W and Q, where 25G Whitacre and 25G Quincke spinal needles were used, respectively. The primary objective of the study was to find out the difference in incidence of PDPH, if any, between the two groups, by using the t test and Chi square test. RESULTS: The incidence of PDPH was 5% in group W and 28.12% in group Q, and the difference in incidence was statistically significant (P<0.001). CONCLUSION: The pencil-point 25G Whitacre spinal needle causes less incidence of PDPH compared to the classic 25G Quincke needle, and is recommended for use in patients at risk of PDPH.
RESUMEN
BACKGROUND: Laparoscopic cholecystectomy (LC) is associated with a high risk of postoperative nausea and vomiting (PONV). Palonosetron is a newer 5HT3 receptor antagonist, which is routinely used in our institution to prevent PONV in patients scheduled for LC, under general anesthesia (GA). We formulated this study to find out whether the palonosetron and dexamethasone combination will be a better choice than palonosetron alone in the prevention of PONV. MATERIALS AND METHODS: Sixty American Society of Anesthesiologists (ASA) physical status I and II patients, scheduled for LC under GA, were randomized to receive either palonosetron or a combination of palonosetron and dexamethasone. The number of complete responders (no emesis, no requirement of rescue anti-emetic medication) and the four-point nausea score was recorded at 2, 6, 24, 48 h postoperatively and the data was analyzed statistically. RESULTS: The number of complete responders, as well as the nausea score, did not vary significantly (P=0.718) between the two groups over the 48-h postoperative period. CONCLUSIONS: The palonosetron and dexamethasone combination was not more effective than palonosetron alone in the prevention of PONV, in patients undergoing LC under GA.
RESUMEN
BACKGROUND: Postoperative nausea and vomiting (PONV) is commonly seen after laparoscopic surgery. In this randomized double blind prospective clinical study, we investigated and compared the efficacy of palonosetron and granisetron to prevent postoperative nausea and vomiting after laparoscopic cholecystectomy. PATIENTS #ENTITYSTARTX00026; METHODS: Sixty female patients (18-65 yrs of age) undergoing elective laparoscopic cholecystectomy were randomly allocated one of the two groups containing 30 patients each. Group P received palonosetron 75 µg intravenously as a bolus before induction of anaesthesia. Group G received granisetron 2.5 mg intravenously as a bolus before induction. RESULTS: The incidence of a complete response (no PONV, no rescue medication) during 0-3 hour in the postoperative period was 86.6% with granisetron and 90% with palonosetron, the incidence during 3-24 hour postoperatively was 83.3% with granisetron and 90% with palonosetron. During 24-48 hour, the incidence was 66.6% and 90% respectively (p<0.05). The incidence of adverse effects were statistically insignificant between the groups. CONCLUSION: Prophylactic therapy with palonosetron is more effective than granisetron for long term prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy.