Adequacy of postoperative pain relief after discharge

Day care surgery has shown a remarkable development over the last two decades, comprising approximately 60-70% of all surgical procedures. Therefore major proportions of surgical patients are recovering at home and have little or no assessment of the adequacy of their pain relief. The aim of our audit was to compare suggested postoperative pain indicators with targets for best practice. This audit was done at the Aga Khan University Hospital day care unit for a period of three months. On the day of surgery patients having the contact numbers were informed about the telephone call 24 hrs after the surgery inquiring about their pain relief. Patients were shown and explained the visual analogue score from 0 to 10. The data was collected by one of the investigators on the day of surgery. We could assess 63.3% of day care patients. All patients were discharged with analgesia. Only three percent reported severe pain after 24 hrs which is according to the proposed standard for best practice that is \u3c 5 %. Sixty percent of patients had mild or no pain which is less than the proposed standard (\u3e85%) and 84.2% were satisfied which is almost borderline (\u3e85%) according to the standard of best practice

Vasopressin for the management of catecholamine-resistant anaphylactic shock

Severe anaesthetic anaphylaxis is relatively uncommon. Oxygen, fluids and epinephrine are considered to be the mainstay for treatment of cardiovascular collapse and current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of a cardiovascular collapse. Recently, evidence has emerged in the support of the use of vasopressin in cardiopulmonary resuscitation, it is also recommended for the treatment of ventricular fibrillation, septic shock and post-cardiopulmonary bypass distribution shock. Currently, there is no algorithm or guideline for the management of anaphylaxis that include the use of vasopressin. We report a 24-year-old woman who developed severe anaphylactic shock at induction of anaesthesia while undergoing laparoscopic cholecystectomy. Circulation shock was refractory to epinephrine and high doses of pure alpha-agonist phenylephrine and norepinephrine. Single intravenous dose of two units of vasopressin re-established normal circulation and blood pressure

Threshold effects in excited charmed baryon decays

Motivated by recent results on charmed baryons from CLEO and FOCUS, we reexamine the couplings of the orbitally excited charmed baryons. Due to its proximity to the [Sigma_c pi] threshold, the strong decays of the Lambda_c(2593) are sensitive to finite width effects. This distorts the shape of the invariant mass spectrum in Lambda_{c1}-> Lambda_c pi^+pi^- from a simple Breit-Wigner resonance, which has implications for the experimental extraction of the Lambda_c(2593) mass and couplings. We perform a fit to unpublished CLEO data which gives M(Lambda_c(2593)) - M(Lambda_c) = 305.6 +- 0.3 MeV and h2^2 = 0.24^{+0.23}_{-0.11}, with h2 the Lambda_{c1}-> Sigma_c pi strong coupling in the chiral Lagrangian. We also comment on the new orbitally excited states recently observed by CLEO.Comment: 9 pages, 3 figure

Knowledge about Pain Clinics and Pain Physician among General Practitioners: A Cross-sectional Survey

Introduction: There is an on-going debate about what qualifies one to be called a pain physician and who can run the pain clinic . Currently, the discipline of anesthesiology is producing the majority of pain physicians. A literature search was unable to find data for any Pakistani or other South Asian countries with regards to general practitioner (GP) knowledge about pain clinics and pain physicians. The main objective of this study was to assess the awareness of GPs regarding the existence of the pain clinic and pain physician.Methods: A total of 411 GPs were included in this cross-sectional survey. A questionnaire consisting of ten questions was designed to identify their knowledge about the existence of pain clinics and pain physicians. Questionnaires were completed in the field and edited for the inconsistencies and in-completeness.Results: The results showed that only 52.6% of GPs were aware of the existence of pain clinics. The survey showed that 37.5% believe neurologists are the pain physicians and only 10.9% know that pain clinics are run by anesthesiologist. The vast majority (85.0%) are unaware of the modern pain relieving methods used in pain clinics.CONCLUSION: The survey indicates that nearly half of the GPs are unaware of the existence of pain clinics and pain physicians, and the majority of GPs are unaware of new pain relieving methods

General Anaesthesia for Emergency Caesarian Section in a Patient with Eisenmenger\u27s Syndrome and Pre-eclampsia

Pregnancy is poorly tolerated in patients with Eisenmenger syndrome (ES) with maternal mortality of 30-50%. Physiological changes of pregnancy decreases systemic vascular resistance that further aggravates the bi-directional or right to left shunt associated with ES. When it occurs with eclampsia, the morbidity and mortality are even higher. We report a case of 30 weeks pregnant woman with ES, who underwent emergency caesarian section because of pre-eclampsia. The intra-operative course was uneventful but she died on the second post-operative day. Post-operatively she was managed by the cardiologist in the coronary care unit. The probable cause being that she was over transfused, as the fluid status was not assessed by any invasive monitoring (like CVP). It was concluded that patients should be monitored closely in the post-operative period in the intensive care unit with complete invasive monitoring for up to a week to prevent factors resulting in worsening of the shunt (such as fluid balance) and thromboembolic phenomenon

Effect of gender on pain perception and analgesic consumption in laparoscopic cholecystectomy: An observational study

Background: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy.MATERIALS AND Methods: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts.Results: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002), but not in the later period.CONCLUSION: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia

Design and implementation of a low-cost circuit for medium-speed flash analog to digital conversions

Despite the considerable advancements in analog-to-digital conversion (ADC) circuits, many papers neglect several crucial considerations: Firstly, it does not ensure that ADCs work well in the software or hardware. Secondly, it is not certain that ADCs have a wide range of amplitude responses for the input voltages to be convenient in many applications, especially in electronics, communications, computer vision, CubeSat circuits, and subsystems. Finally, many of these ADCs need to look at the suitability of the proposed circuit to the most extensive range of frequencies. In this paper, a design of a low-cost circuit is proposed for medium-speed flash ADCs. The proposed circuit is simulated based on a set of electronic components with specific values to achieve high stability operation for a wide range of frequencies and voltages, whether in software or hardware. This circuit is practically implemented and experimentally tested. The proposed design aims to achieve high efficiency in the sampling process over a range of amplitudes from 10 mV to 10 V. The proposed circuit operates at a bandwidth of frequencies from 0 Hz to greater than 10 kHz in the simulation and hardware implementation

Evaluation of the knowledge, attitudes, and resulting behavior changes in response to COVID-19 among students at the College of Applied Medical Sciences (CAMS), Jazan University, Saudi Arabia

Background: The emergence of COVID-19 posed a threat to millions of lives worldwide. The pandemic impacts extended to affect people’s psychological well-being, resulting in significant behavioural change. This study was designed to assess the knowledge regarding COVID-19 precautions among the College of Applied Medical Science students at Jazan University and to evaluate the eneral, psychosocial, and behavioral changes due to COVID-19. Methods: This is an observational study targeting 630 undergraduate students randomly selected during January 2020, using stratified random sampling. Data were collected using an online questionnaire. Linear regression models were used to evaluate the predictors of three outcome measures: knowledge, attitudes, and practice scores. Results: Knowledge of COVID-19 revealed that the students with correct answers ranged from 48.9 to 95%. Furthermore, significant gender differences are found regarding shortness of breath, fatigue, persistent chest discomfort, headache, and malaise (p 0.05). The linear regression model showed that females had significantly higher knowledge, attitudes, and practice scores (p Conclusion: The results demonstrated moderate knowledge about COVID-19 among study participants, with significant differences between the responses of males and females and among the urban and rural populations. Outcomes suggest the need for interventions to bridge students’ knowledge about COVID-19 and practice gaps. Students were concerned about basic life amenities and the inability to provide for their dear ones regarding behavioral changes.</p