RESUMO
BACKGROUND: To compare the anaesthetic techniques for laparoscopic tubal ligation using either general anaesthesia with LMA or a combination of local anaesthetic and intravenous sedation, this study was conducted on 60 ASA-1/2 patients in the age group of 20-40 years. PATIENTS #ENTITYSTARTX00026; METHODS: 60 ASA grade I & II female patients undergoing laparoscopic tubal ligation on a day care basis were randomly divided in two groups- group I (GA using LMA, n=30), group II (Local anaesthesia, n=30). Both groups received similar premedication. General anaesthesia in group I was induced with propofol 2-3 mg kg(-1) and following LMA insertion, the anaesthesia was maintained with 0.5-1.5% halothane. In group II the incision site was infiltrated with 10 ml of 1.5% lidocaine with adrenaline and patients were sedated with intravenous midazolam 0.07mg kg(-1) and ketamine 0.5 mg kg(-1). A rescue dose of 0.15 mg kg(-1) of ketamine was given in group II if the patient complained of pain or discomfort during the procedure. Diclofenac sodium 1 mg kg(-1) was used for postoperative analgesia in both the groups. All patients were observed in the PACU until they met the discharge criteria. RESULTS: The demographic profile was similar in both the groups. The induction to skin incision time was significantly more in group I (5.13 ±0.93 min vs 3.01 ±1.86 min in group II). The decrease in pulse rate and blood pressure (systolic and diastolic) was also significant in group I. The incidence of intraoperative bradycardia was 16.7% and 10% in group I & group II respectively. The changes in SpO(2) during the procedure, recovery time and time to meet discharge criteria were comparable in both the groups. The incidence of PONV was 20% & 3.3% in group I and 10% & 6.6% in group II respectively. All patients in both the groups required postoperative analgesics. CONCLUSIONS: Both the techniques were found to be comparable for laparoscopic sterilization, however a longer induction to skin incision time and higher incidence of PONV and shivering in GA group makes LA with sedation a better choice.
RESUMO
BACKGROUND: Cytological grading (CG) on aspirates of breast carcinoma is a useful tool for surgical maneuver and prognosis. AIMS: An endeavor was made to use CG on aspirates of breast carcinoma using Robinson's grade and to correlate it with Bloom Richardsons' histopathological grading. MATERIALS AND METHODS: A total of 59 patients of breast carcinoma, aged 28-57 years, were aspirated and the smears were graded using Robinson's criteria. All the cases were correlated with Bloom Richardson's grade on histopathology in mastectomy specimens. Lymphadenopathy in 38 cases was aspirated and stained with Papanicolaou and Romanowsky stain. RESULTS: Robinson's CG correlated well with Bloom Richardson's histopathological grading. For grade I and II tumors, there was substantial strength of agreement between cytology and histopathology, while in grade III, the concordance was nearly perfect. Lymph node metastasis was found in 27 of 32 axillary nodes, three of five cervical nodes and the only palpable supraclavicular node. Lymph node metastasis was observed in three with cytological grade II, 28 of grade III and none of grade I. All grade I had stage A, two of grade II had stage B, while all grade III had either stage B or stage C disease. CONCLUSIONS: Thus, CG of breast carcinoma correlates well with histopathological grading and may well be useful as a prognostic marker.
