Comparative study of postdural puncture headache in midline and paramedian approach of spinal anaesthesia at a tertiary hospital

Background: Postdural puncture headache (PDPH) is a known complication of spinal anaesthesia. It is an iatrogenic cause,results after either intentional or accidental dural puncture.It begins typically within 2 days but regresses spontaneously in a few days. Present comparative study was conducted in patients who underwent elective lower abdominal surgery under spinal anaesthesia by midline or paramedian approach to evaluate incidence of postdural puncture headache at our tertiary hospital. Material and Methods: This prospective and comparative study was conducted 120 patients undergoing elective lower abdominal surgery under spinal anaesthesia were considered for present study. Patients were randomly divided in double‑blind fashion (patient and observer were blind to procedure) into two groups of 60 each. Numeric visual analog pain score was used to assess the postdural puncture headache in both the groups. Any case of persistent postdural puncture backache after discharge was followed up to 7 days through telephonic communication with the patient. The data collected was analysed statistically. Quantitative variables were expressed as Mean ± SD (standard deviation) while qualitative variables were expressed as relative frequency and percentage. The PDPH was analysed using Chi square test. P-value <0.05 was considered as statistically significant. Results:120 patients undergoing elective lower abdominal surgery under spinal anaesthesia were randomly divided in double‑blind fashion (patient and observer were blind to procedure) into two groups as Group M (median approach) and Group P (paramedian approach) of 60 patients each. General characteristics such as age, weight, gender and ASA status were comparable in both groups. Intra-operative hypotension was noted in 10% patients of group M and 8% patients of group P, difference was not statistically significant. 3 % patients of group M and group P required medications (tramadol / paracetamol) to treat PDPH.In present study postdural puncture headache was mild in 8 % and moderate in 3% patients in group M. While 7% patients had mild and 3% patients had moderate postdural puncture headache in group P. Incidence of postdural puncture headache was 10% in group M and 8% in group P, difference was not statistically significant. Conclusion: There was no difference regarding the incidence of PDPH in median and paramedian approach for spinal anaesthesia.

Creatine supplementation does not augment muscle carnosine content in type 2 diabetic patients

We examined whether creatine supplementation affects muscle carnosine content in type 2 diabetic patients. Subjects were randomly assigned to receive either creatine (5 g·day–1) or placebo in a double-blind fashion. At baseline and after 12 weeks, carnosine content was evaluated in gastrocnemius and soleus muscles by using a 1H-MRS technique. No changes were found in gastrocnemius (p = 0.81) and soleus (p = 0.85). We concluded that creatine supplementation does not augment muscle carnosine content in type 2 diabetic patients.

Hearing Loss after Spinal Anesthesia: The Effect of Different Infusion Solutions

OBJECTIVE: We speculate that the preoperative volume replacement with a convenient solution may protect the inner ear function after spinal anesthesia. METHODS: The patients were randomized in a single-blind fashion into two groups: group LR (n = 40) received lactated Ringer's and group GF (n = 40) received gelatin polysuccinate 4% (Gelofusine). Spinal anesthesia was performed with a 25 G Quincke needle and was given bupivacaine 0.5% 10 mg and fentanyl 25 jxg. Audio-grams were performed preoperatively and 2 days postoperatively. RESULTS: The overall incidence of hearing loss was 7.5%. The hearing loss was unilateral in two and bilateral in four patients. Hearing loss occurred within the low-frequency range and the hearing thresholds returned to normal by the fifth postoperative day. CONCLUSIONS: Although the incidence of hearing loss for the lactated Ringer's group was higher than the Gelofusine group, there was no statistically significant difference between the groups. For medicolegal and ethical reasons, patients should be informed about the possibility of hearing loss after spinal anesthesia.

Rapid oral endotracheal intubation with a fibre-optic scope in rabbits: a simple and reliable technique

The orotracheal intubation of rabbits is complicated by their oropharyngeal anatomy. Numerous techniques to intubate rabbits have been described; however, these methods require specialized devices, tracheostomy, or are performed in a blind fashion. We describe a technique for the intubation of the rabbit under direct visualization with a standard, small-bore, fibre-optic laparoscope, which is both rapid and simple to perform.

Use of dexamethasone and granisetron in the control of delayed emesis for patients who receive highly emetogenic chemotherapy. National Cancer Institute of Canada Clinical Trials Group.

PURPOSE To evaluate the roles of granisetron and dexamethasone for emesis control on days 2 through 7 after the administration of cisplatin in doses of 50 mg/m2 or greater to patients who had not previously received chemotherapy. PATIENTS AND METHODS Four hundred thirty-five eligible and assessable patients were randomized to one of two arms in a double-blind fashion: arm A; granisetron 3 mg intravenous (i.v.) plus dexamethasone 10 mg i.v. prechemotherapy followed by granisetron 1 mg orally at 6 and 12 hours, then granisetron 1 mg orally and dexamethasone 8 mg orally twice daily on days 2 through 7 (219 patients); arm B; as in arm A but with placebo substituted for granisetron on days 2 through 7 (216 patients). All patients completed diaries in which episodes of emesis and severity of nausea were recorded. RESULTS The addition of granisetron on days 2 through 7 had no discernable impact on nausea and vomiting during this period. CONCLUSION The administration of a 5-hydroxytryptamine3, receptor (5-HT3) antagonist, in this case granisetron, after 24 hours conferred no benefit. This negative result needs to be assessed in light of conflicting literature, but at present it does not appear that the routine use of these drugs in this setting is justified.

Accidental Injuries of Hospitalized Patients: A Prospective Cohort Study

Eight hundred and six medical and surgical patients who were hospitalized via the emergency ward were followed over their entire inpatient stays and rated in anterograde, double-blind fashion for inpatient incidents (falls, medication errors, other). Injuries were minor but affected 2.2% of admissions, a figure which is strikingly similar to studies in other hospitals. There was a statistical trend toward a higher-than-normal risk of hazardous in-hospital incidents for males age 20 to 40 admitted because of injury and for medically ill females over 60 years old.

Response to 35% CO2 in Patients with Chest Pain and Angiographically Normal Coronary Arteries

Objectives: Several interview studies have suggested that panic disorder (PD) exists in patients with angiographically normal coronary arteries (NCA). Interview studies require corroboration by other studies in order to validate them. The purpose of this study is to test whether response to the inhalation of 35% CO2 reliably discriminates between PD and non-panic disorder patients in this population. Method: Three groups were studied: six with NCA and PD, five with NCA and no PD, and ten in the control group. All subjects breathed room air, then 35% CO2 in a single-blind fashion. Each completed the Acute Panic Inventory (API) before and during the procedure. Results: The NCA-panic group scored significantly higher than the other two groups on the Acute Panic Inventory from baseline to post- inhalation. Conclusion: Despite several methodological limitations including a relatively small number people in each cells, 35% CO2 was shown to trigger more intense responses in panic patients, thus helping to validate the interview findings.

Inter-Observer Agreement in Assessing Comatose Children

ABSTRACT:Inter-observer agreement was evaluated for twelve items used in the neurological assessment of comatose children. Data were obtained prospectively on fifteen patients examined independently by two observers in a double-blind fashion. Observer variability was measured by using the Disagreement Rate and Kappa statistic. The Disagreement Rate ranged from 0.01 to 0.12 for all items. Values for Kappa statistic were generally in accordance with those for Disagreement Rate. The data suggest fair to almost perfect inter-observer agreement for the items used to assess comatose children in this study.