The effect of coarctation degrees on wall shear stress indices

Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Flow quantification can be immensely valuable for an early and accurate diagnosis. However, there is a lack of appropriate diagnostic approaches for a variety of cardiovascular diseases, such as CoA. An accurate understanding of the disease depends on measurements of the global haemodynamics (criteria for heart function) and also the local haemodynamics (detailed data on the dynamics of blood flow). Playing a significant role in clinical processes, wall shear stress (WSS) cannot be measured clinically; thus, computation tools are needed to give an insight into this crucial haemodynamic parameter. In the present study, in order to enable the progress of non-invasive approaches that quantify global and local haemodynamics for different CoA severities, innovative computational blueprint simulations that include fluid–solid interaction models are developed. Since there is no clear approach for managing the CoA regarding its severity, this study proposes the use of WSS indices and pressure gradient to better establish a framework for treatment procedures in CoA patients with different severities. This provides a platform for improving CoA therapy on a patient-specific level, in which physicians can perform treatment methods based on WSS indices on top of using a mere experience. Results show how severe CoA affects the aorta in comparison to the milder cases, which can give the medical community valuable information before and after any intervention.

The Effect of Coarctation Degrees on Wall Shear Stress Indices: An FSI Study

Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Flow quantification can be immensely valuable for an early and accurate diagnosis. However, there is a lack of appropriate diagnostic approaches for a variety of cardiovascular diseases, such as CoA. An accurate understanding of the disease depends on measurements of the global haemodynamics (criteria for heart function) and also the local haemodynamics (detailed data on the dynamics of blood flow). Playing a significant role in clinical processes, wall shear stress (WSS) cannot be measured clinically; thus, computation tools are needed to give an insight into this crucial haemodynamic parameter. In the present study, in order to enable the progress of non-invasive approaches that quantify global and local haemodynamics for different CoA severities, innovative computational blueprint simulations that include fluid-solid interaction (FSI) models are developed. Since there is no specific routine for managing the CoA regarding its severity, this study investigates haemodynamics in regions where clinicians do not have any information that would help physicians introduce a framework when and where initiating the intervention.

TO DETERMINE THE DIFFERENCE IN HAEMODYNAMIC PARAMETER OF ORAL 75MG, 150MG PREGABALIN PREMEDICATION AND CONTROL GROUP AMONG PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY.

Background: In preemptive analgesia, the analgesic treatment is started before and is operational during the surgical procedure so that the physiological consequences of nociceptive transmission are reduced. Methods: This Hospital based, prospective, randomized, double blind, comparative study was conducted in Department of Anaesthesiology. Results: The mean baseline variable i.e. pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure were comparable in both the groups. (P value>0.05). Thus we can say that the randomization was done adequately. Hemodynamic variables (pulse rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) were also comparable during intraoperative period. Conclusion: Although preemptive use of both pregabalin 75mg and pregabalin 150 mg are effective for prolongation of postoperative analgesia but pregabalin 75mg is superior to pregabalin 150mg as it provides similar postoperative analgesia as compared to 150mg without causing significant change in haemodynamic variables and any adverse effect. Keywords: Preemptive analgesia, Gabapentin, Rescue analgesic.

Analgesic Efficacy and Tolerability of Tramadol Versus Low Dose Tramadol-Paracetamol in Patients with Gastro Intestinal Surgery

INTRODUCTION: Analgesic regimens with an improved efficacy and tolerability balance have potential to improve acute pain management, and thus reduce the progression into chronic pain. Hence, an opportunity was gained to compare analgesic efficacy and tolerability of Tramadol (T) 1.5 mg/kg versus low dose Tramadol 1mg/kg-Paracetamol 1000mg (T-P) in patient with Gastro Intestinal (GI) surgery. MATERIAL AND METHODS: The study was a hospital based prospective, observational study conducted in sixty post-operative GI surgery patient at Universal College of Medical Sciences-Teaching Hospital, Ranigaon, Bhairahawa, Nepal. One group received Tramadol 1.5mg/kg (n=30) while the other group received Tramadol 1mg/kg with Paracetamol 1000 mg (n=30). The primary efficacy outcome measures were pain intensity difference (PID) and sum of pain intensity difference (SPID) whereas secondary efficacy measures included number of patient who require rescue medication, haemodynamic parameter, their quality of sleep in the night and satisfaction with their medication. For tolerability, adverse effect was noted that occurred during study time intervals. RESULTS: Mean pain intensity differences assessed on Numerical Rating Scores (NRS) were significantly better for Group T-P compared to Group T at all the points except 0.5, 1 and 6 hrs. The sum of pain intensity difference over 8, 16, 24, 48 hrs for Group T-P was significantly superior to Group T. Two patients in Tramadol group required rescue medication. Satisfaction to the pain medication was comparatively higher for Tramadol-Paracetamol group. CONCLUSION :- Tramadol-Paracetamol had more pronounced analgesic effect with lower incidence of side effect than Tramadol alone. Thus, low dose Tramadol-Paracetamol is better option for management of post-operative pain in patient with GI surgery.

TO DETERMINE THE DIFFERENCE IN HAEMODYNAMIC PARAMETER OF ORAL 75MG, 150MG PREGABALIN PREMEDICATION AND CONTROL GROUP AMONG PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY.

Background: In preemptive analgesia, the analgesic treatment is started before and is operational during the surgical procedure so that the physiological consequences of nociceptive transmission are reduced. Because of this protective effect on nociceptive pathways, preemptive analgesia decreases the incidence of hyperalgesia and allodynia after surgery. Methods: This Hospital based, prospective, randomized, double blind, comparative study was conducted in Department of Anaesthesiology, Sawai Man Singh Medical College after obtaining approval from Institutional Ethics Committee and Research Review Board and written informed consent from all the patients. Results: The mean baseline variable i.e. pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure were comparable in both the groups. (P value>0.05). Thus we can say that the randomization was done adequately. Hemodynamic variables (pulse rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) were also comparable during intraoperative period. Conclusion: Although preemptive use of both pregabalin 75mg and pregabalin 150 mg are effective for prolongation of postoperative analgesia but pregabalin 75mg is superior to pregabalin 150mg as it provides similar postoperative analgesia as compared to 150mg without causing significant change in haemodynamic variables and any adverse effect. Keywords: Preemptive analgesia, Gabapentin, Rescue analgesic.

A Comparative Study of 0.25% Levobupivacaine, 0.25% Ropivacaine, and 0.25% Bupivacaine in Paediatric Single Shot Caudal Block

Aim. There are limited data comparing levobupivacaine, ropivacaine, and bupivacaine in paediatric patients. So, this study was performed to evaluate the caudal effectiveness of all the three drugs in paediatric patients undergoing infraumbilical surgeries and associated complications with these drugs. Material and Methods. 90 patients of ASA grade I and II posted for elective infraumbilical surgeries were randomly divided into three groups of 30 each. A standardized anaesthetic protocol was used. Patients received 0.25% levobupivacaine in group 1, 0.25% ropivacaine in group 2, and 0.25% bupivacaine in group 3. The effectiveness of block was assessed using caudal effectiveness score. Postoperative pain relief was assessed with modified Hannallah pain score. Haemodynamic parameter monitoring was done. The duration of analgesia and associated complications were studied. Statistical analysis was done using the chi-square test for nonparametric data. Parametric data were analysed using ANOVA for intergroup comparison and Tukey’s HSD for intragroup comparison. Results. Demographic data were comparable. Haemodynamic parameters remained within normal range. Mean caudal effectiveness score in all the three groups was statistically insignificant (p>0.05). The duration of analgesia provided by bupivacaine (145.31 ± 26.17 min) was longer than levobupivacaine (126.15 ± 15.15 min) and ropivacaine (114.68 ± 11.32 min) (p<0.01). Mean postoperative pain scores were lower in group 3 as compared to group 1 and group 2. Conclusion. We conclude that levobupivacaine and ropivacaine provide similar intraoperative quality with minimal haemodynamic variability and shorter duration of postoperative analgesia without any significant complications when compared with racemic bupivacaine. This trial is registered with CTRI/2018/03/012402.

Comparative Study of “Haemodynamic Changes between Endotracheal Intubations and LMA Insertion”

To compare the haemodynamic changes between LMA insertion & endotracheal intubation, 60 patients were assigned randomly to one of the two groups of thirty each. They were grouped randomly by card sampling. Every patient included in the study was allowed a card preoperatively. According to the card number patients were grouped. Group A. Airway was maintained by LMA. Group B: Airway was maintained by ETT. Haemodynamic parameter i.e. pulse rate, systolic blood pressure, diastolic blood pressure and presence of any dysrhythmia were monitored after 1,3,5 & 10 minutes after LMA insertion or ETT intubations. There was statistically significant changes (P<0.05) in pulse rate, systolic blood pressure, diastolic blood pressure and (appearance of dysrhythmia in some patients) in group ti patients whereas there was less changes in pulse rate, systolic blood pressure, diastolic blood pressure whose airway was maintained by LMA insertion (Group-A). We conclude that LMA insertion causes less Haemodynamic changes than that of endotracheal intubation. So LMA insertion is safer than ETT intubations in some selected patients. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.28-32