Background and Aims: In a day care setting, communication of preprocedure instructions prior to general anesthesia (GA) is critical. Verbal information may be inadequate at times leading to ...unnecessary rescheduling. The aim of the study is to evaluate the use of patient information leaflet (PIL) and its impact on rescheduling and patients' satisfaction levels.
Material and Methods: Adult ASA I-III patients scheduled for elective day care Head Neck procedures such as direct laryngoscopy, examination under anesthesia, and biopsy under GA were recruited. In the outpatient department (OPD), the attending surgeons verbally instructed the patients as well as handed them the PIL. The process was streamlined over a month and thereafter patients' satisfaction levels and rescheduling rates were captured over 2 months. This was compared to the data from the pre-PIL phase.
Result: Prior to PIL, 12% cases were rescheduled due to avoidable causes. After introducing of the PIL, only 8% case were rescheduled (P = 0.02). There was a significant improvement seen in patient satisfaction with 89% patients reporting that the PIL was good or better while 77% were willing to recommend it to the others.
Conclusion: PIL is an effective way of imparting perioperative instructions to patients which will improve not only satisfaction but also reduce patient rescheduling. The institution is in the process of implementing PIL to provide instructions to patient posted for day care procedures.
Background and Aims: Passage of double-lumen tubes (DLT) can be challenging in patients with limited glottis view. This study aims to determine the usefulness of McGrath® MAC videolaryngoscope (VL) ...in cases with limited glottis view on direct laryngoscopy with Macintosh blade.
Material and Methods: After study approval and registration of trial, consent was sought from all adult patients planned for elective DLT insertion for lung isolation during the course of general anesthesia. Patients not consenting, less than 18 years, with anticipated difficult mask ventilation or need for rapid sequence induction were excluded. Following routine anesthetic induction, laryngoscopy was attempted by an experienced anesthesiologist using Macintosh scope. If the view obtained was Cormack and Lehane (CL) view IIB and above or the attempt at intubation using DLT failed despite a CL I/IIA view, the patient was included in the trial. The laryngoscope was removed and after ensuring adequate oxygenation and depth of anesthesia, intubation was attempted using McGrath® MAC VL. The percentage of glottis opening (POGO) score was noted for both the scopes.
Results: DLT insertion was attempted in 76 patients in the study period. Eight patients were included in the trial on account of limited glottis view/failure with Macintosh scope. Insertion of DLT with McGrath MAC was tried only in six patients, in two patients, the VL was not available for use. The mean (standard deviation) POGO score with Macintosh scope was 9 (±20), which significantly improved with the use of VL to 71 (±24), P = 0.01.
Conclusion: McGrath MAC is helpful in inserting DLT in patients with limited glottis view with Macintosh scope.
The quest for an effective regional anaesthesia technique in breast surgery has always been eluded by its apparent complexity. Various techniques had been described as anaesthetic techniques for ...breast cancer surgeries. Fascial plane blocks had been used as analgesic techniques for this procedure. We describe a case series of 12 patients who were given a combination of erector spinae plane block (ESP), Pectoralis I (Pecs I) and serratus anterior plane (SAP) block as sole anaesthetic technique with high risk surgical morbidity. Two patients had discomfort during retraction of axillary apex towards the end of surgery, and one patient had discomfort during medial parasternal incision, which needed a single bolus of low dose ketamine injection. Combined fascial plane blocks could be effectively utilized as a sole regional anesthesia modality for breast cancer surgeries with mild sedation.
Background: Emergency laparotomies present a challenge in pain management given sick patients, odd timings and poor outcomes. Current recommendations favour multimodal opioid-sparing analgesia ...following elective laparotomies. No recommendation exists for emergency surgeries. Methodology: After approval and registration of the trial, adult patients posted for emergency laparotomy in the hospital (tertiary centre for cancer care) starting August 2015, for 6 months, were included in this prospective study. Patients' details including indication for emergency surgery, preoperative haemodynamic parameters, baseline coagulation status were captured. Patients were followed for pain scores, satisfaction with pain management and outcome. The number of anaesthesiologists present and their experience concerning regional techniques were noted. Results: Intestinal obstruction was the commonest cause of emergency laparotomy. Most patients belonged to the ASA IE/IIE class (91%). Intraoperatively, opioids were the mainstay of pain management with an epidural catheter inserted in only 9% of cases even though most cases were conducted by anaesthesiologists confident/expert in thoracic epidural insertion. There was no correlation of choice of pain management technique with the time of surgery (P = 0.22), ASA grading (P = 0.28), predicted mortality by p-Possum scores (P = 0.24). Pain at movement was moderate-severe in more than 50% of patients within the first 24 h. The regional group had better satisfaction when compared to opioid and non-opioid based management. (P < 0.001). Conclusion: Regional techniques for pain management in emergency laparotomies are less preferred, therefore, opioids are the mainstay. Lack of experience is essentially not the primary reason for regional techniques not gaining popularity. Pain management in this group needs a thorough re-evaluation.
Background and Aims: It is essential that patients posted for day-care surgeries are adequately prepared preoperatively. Verbal information alone may not be always effective. This study aimed to ...prepare, validate, and evaluate the efficacy of a patient information leaflet (PIL) for patients undergoing day-care surgeries under general anesthesia (GA).
Material and Methods: After approval from the hospital ethics committee a PIL was prepared in English. Readability and design of the leaflet were checked using standard tests: Flesch readability ease test (FRE), Flesch Kincaid grade level (FKGL), and Baker Able leaflet design (BALD). It was translated into three regional languages. The PIL was tested among patients using a questionnaire. Seventy-nine adult patients posted for elective day-care procedures were included while emergency surgeries were excluded. Patient knowledge pre and post-PIL was compared using paired 't' test. The influence of age, gender, and education level on the usefulness of PIL were analyzed using the Chi-square test and knowledge was compared using ANOVA.
Results: The English leaflet had an FRE Score of 63.9 and FKGL of 6.4, which is "standard". The BALD score for all leaflets was 25 ("above standard"). The overall knowledge scores significantly improved from 52.6% (preintervention) to 70.7% (postintervention), P < 0.001. Knowledge improvement was seen with the use of PIL in all four languages. Sixty eight percent of patients strongly recommended the PIL while 31% were willing to recommend it to others.
Conclusion: The PILs developed in this study have standard readability, good design and validated for efficacy.
Post-dural puncture headache in the parturient Panigrahi, Amit R.; Armstrong, Cathy
Anaesthesia and intensive care medicine,
September 2019, 2019-09-00, Letnik:
20, Številka:
9
Journal Article
Recenzirano
Post-dural puncture headache (PDPH) is a common and debilitating complication of central neuraxial blockade in the parturient. The obstetric population is at particular risk with up to 80% of women ...developing symptoms after accidental dural puncture (ADP) during labour epidural insertion. PDPH typically develops 24–48 hours post puncture and is classically described as an occipito-frontal headache with postural features. Diagnosis and assessment should include consideration of other potential causes of post-partum headache. Initial treatment of PDPH includes adequate hydration and analgesics. Epidural blood patch (EBP) remains the gold standard treatment. It is more successful if performed over 24–48 hours after the development of symptoms. Complete and permanent relief of symptoms following a single EBP occurs in up to one third of cases where headache follows ADP with an epidural needle. Complete or partial relief may be seen in 50–80% overall. Higher success rates are achieved following a second EBP. There is now UK national guidance on the treatment of post dural puncture headache published by the Obstetric Anaesthetists Association (OAA).
The objective of the present study was to prepare a matrix tablet for colon targeting. Natural gaums (guar gum and xanthan gum) were used for the preparation of colon targeted drug delivery system. ...Different concentrations of guar gum and xanthan gum and their combinations were tried for the purpose. The prepared tablets were evaluated for in-process parameters as well as colon targeting characteristics. The colon targeting properties were evaluated by analysing the formulations for drug release in physiological pH medium of colon. All the formulations were found to be suitable in in-process quality control parameters. The guar gum and xanthan gum were used from 10% to 30% concentration in the formula. The third series of formulations contained guar gum and xanthan gum combinations in ratios of 10% and 20%, 20% and 10% and 15% and 15% respectively. The drug release was found to be 82% to 100% for guar gum formulations, 85% to 99% for xanthan gum formulations and 87% to 100% for the combination of xanthan gum and guar gum. The dissolution study shows that both the natural gums are suitable for use to develop colon targeted drug delivery system.
We report the clinical outcomes of a randomized trial comparing prophylactic whole-pelvic nodal radiotherapy to prostate-only radiotherapy (PORT) in high-risk prostate cancer.
This phase III, single ...center, randomized controlled trial enrolled eligible patients undergoing radical radiotherapy for node-negative prostate adenocarcinoma, with estimated nodal risk ≥ 20%. Randomization was 1:1 to PORT (68 Gy/25# to prostate) or whole-pelvic radiotherapy (WPRT, 68 Gy/25# to prostate, 50 Gy/25# to pelvic nodes, including common iliac) using computerized stratified block randomization, stratified by Gleason score, type of androgen deprivation, prostate-specific antigen at diagnosis, and prior transurethral resection of the prostate. All patients received image-guided, intensity-modulated radiotherapy and minimum 2 years of androgen deprivation therapy. The primary end point was 5-year biochemical failure-free survival (BFFS), and secondary end points were disease-free survival (DFS) and overall survival (OS).
From November 2011 to August 2017, a total of 224 patients were randomly assigned (PORT = 114, WPRT = 110). At a median follow-up of 68 months, 36 biochemical failures (PORT = 25, WPRT = 7) and 24 deaths (PORT = 13, WPRT = 11) were recorded. Five-year BFFS was 95.0% (95% CI, 88.4 to 97.9) with WPRT versus 81.2% (95% CI, 71.6 to 87.8) with PORT, with an unadjusted hazard ratio (HR) of 0.23 (95% CI, 0.10 to 0.52;
< .0001). WPRT also showed higher 5-year DFS (89.5%
77.2%; HR, 0.40; 95% CI, 0.22 to 0.73;
= .002), but 5-year OS did not appear to differ (92.5%
90.8%; HR, 0.92; 95% CI, 0.41 to 2.05;
= .83). Distant metastasis-free survival was also higher with WPRT (95.9%
89.2%; HR, 0.35; 95% CI, 0.15 to 0.82;
= .01). Benefit in BFFS and DFS was maintained across prognostic subgroups.
Prophylactic pelvic irradiation for high-risk, locally advanced prostate cancer improved BFFS and DFS as compared with PORT, but OS did not appear to differ.
The present work combines Concentration-Area (C-A) fractal model with the Fuzzy Analytical Hierarchy Process (FAHP) on a GIS platform for mapping gold potential in the Sonakhan Greenstone Belt, ...India. A set of stream sediment geochemical data obtained over a part of the study area was used to delineate potential regions of gold mineralisation. In order to develop a suitable predictive model, the gold exploration target was taken as target (dependent variable) and concentration of pathfinder elements of gold such as Au, As, Ag, Hg, Sb and Se in the stream sediments were used as predictors (independent variables). The C-A fractal model was applied to the geochemical data of each element to decompose anomaly and background components of the spatial dispersion of element concentration in the study area. AHP combined with fuzzy set theory (FAHP) was used to determine the priority or, the weight of each evidential geochemical anomaly map. The Gold exploration targets are delineated by multiplying the weights with the respective fuzzy normalised geochemical anomaly map of the gold pathfinder elements and integrating the weighted geochemical evidential layers using fuzzy Gamma operator. The reliability of the outcome was assured by the coincidence of known gold mineralisation with the potential regions delineated in the final gold potential map. The areas with high potential are good targets for detailed exploration of gold in the region. The results highlight that (a) application C-A fractal model can effectively separate geochemical anomalies as it considers the spatial variation of the data unlike the conventional statistical methods which account only the frequency of the data, (b) the FAHP allows more flexibility in judgements of multiple decision makers in a group and reduces the inconsistency of the result which is essentially required in the knowledge-driven predictive mapping of mineral prospectivity.
•Maiden attempt in knowledge-driven computerized mineral potential mapping in India.•Effective use of existing database for mineral exploration in India.•Novel combination of the multifractal and fuzzy based AHP methodology for mineral exploration.
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