Use of Pregabalin as a Pre-Medication for Post-Operative pain in patients undergoing Laparoscopic Cholecystectomy

Background: Postoperative pain creates complications by increasing circulating level of catecholamines and systemic vascular resistance, thus putting the patients on increased risks of having stroke and myocardial infarction. In addition, it increases hospital stay, causing burden over economic as well as healthcare infrastructure. The aim of this study was to determine the frequency of pain in the postoperative period while using Pregabalin as pre-medication among patients undergoing laparoscopic cholecystectomy.Material and Methods: The randomized control trail was conducted at Department of Anesthesiology, Holy Family hospital, Rawalpindi from 1st Sept 2015 to 28th Feb 2016 over a period of 6 months. A total of 200 patients undergoing laparoscopic cholecystectomy were randomly divided in group A and B by consecutive non-probability lottery method. Group A received 100 mg oral Pregabalin 1 hour before surgery and Group B were not given Pregabalin and were taken as controls. Post-operative pain was measured by visual analog scale (VAS) in terms of pain scores at 4 hours postoperatively after the arrival of patient in the post-anesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data.Results: A total of 200 patients were included in the study. There were 100 patients in each group. Based on the visual analog pain scores, 9 patients were pain free in group A compared with none in group B. Similarly, there were 55 patients in group A, who reported a pain score of 1 whereas no patient in group B had a VAS score of 1. There were 29 patients in group A and only 3 patients in group B with VAS score of 2 (90.6% vs. 9.4%). For VAS score of 3, there were 6 patients in group A and 34 patients from group B (15% vs. 85%). For a VAS score of 4, there were 1 patient in group A and 61 patients in group B (1.6% vs. 98.4%). Two patients in group B experienced a VAS score of 5. All this data was significant with chi square p value of 0.0001.Conclusion: Oral Pregabalin administered prior to laparoscopic cholecystectomy was effective in reducing postoperative pain in the patients. Further studies are needed for post-operative evaluation of side effects, different dosing schedules at different time intervals for both rest and dynamic pain

Inguinal Hernia Repair on Day Care Basis During Global COVID-19 Pandemic

  Abstract Background: COVID-19 has effected General Surgical Elective list and most of the surgical procedures are postpone. Inguinal hernia surgery can be performed under local anesthesia on day care basis in selected group of patients taking all necessary precautions for COVID-19. Patients & Methods: This prospective study was conducted at department of General Surgery Federal Hospital, Islamabad for a period of three months from 15th March 2020 to 15th June 2020. All patients were included in the study through purposive sampling and preference was given to patients elder than 50 years of age. This study included 59 adult patients with inguinal hernia who under mesh repair under local anaesthesia on day care basis. Results: A total of 59 patients were included in the study. All patients were male. The age range was from 37 to 82 years (SD=± 10.23).  30 (50.84%) patient had inguinal hernia on left side while 26 (44.06%) had hernia on right side. Mean Operative time was 35 min. Pain was chief complaint postoperatively 30 (50.8%) patients had moderate pain while 6 (10.1%) patients had severe pain in first 24 hours after surgery. Fever was present in 15 (25.42%) patients in first 24 hours. All patients were negative for COVID -19 preoperatively and after 2 weeks none of the patients develop any symptoms of COVID-19. 3 (5.08%) patients needed readmission within 24 hours for pain and some haemorrhage. There was no mortality in our study Conclusions: Inguinal Hernia Surgery under local anaesthesia on day care basis in a very good practice at this time of global pandemic of COVID-19. This is a safe and reliable strategy. Key words: Inguinal Hernia, COVID-19, Local Anaesthesia &nbsp

GABA-Ergic Premedication and Hemodynamic Stability during Induction Laryngoscopy Phase of General Anesthesia

introduction: Gabapentin is a second generation anticonvulsant that is effective in the treatment of chronic neuropathic pain. Recent data suggests its perioperative administration for attenuation of the hemodynamic response to laryngoscopy and intubation. The aim of this study was to compare Oral Gabapentin premedication with no premedication in patients undergoing rigid laryngoscopy and endotracheal intubation for General Anaesthesia in terms of mean heart rate and mean arterial pressure.Methods: This was a randomized controlled trial conducted at Anesthesia Department Holy Family Hospital Rawalpindi. Total 100 patients were included in the study and randomly divided into 2 groups. In Group-A patients were given 800 mg Gabapentin orally and in Group-B patients were not given Gabapentin orally. Baseline parameters (including heart rate, Mean Arterial Pressure MAP) were recorded 1 hr. before surgery. Drug selected for given patient was given orally with a sip of water. After 1 hr. Data was collected on a standardized Performa and analyzed on SPSS 16 version.Results: Mean hear rate in Group-A patients at 1st, 3rd, 5th and at 10th minute was 96.22±11.96, 91.84±11.28, 84.66±10.98 and 82.10±11.47 respectively. While in Group-B mean heart rate in Group-B patients at 1st, 3rd, 5th and at 10th minute was 105.70±11.95, 100.42±11.58, 92.18±10.56 and 88.40±9.61 respectively. It was observed that at 1st , 3rd , 5th and at 10th minute mean heart rate was statistically different in both treatment groups. Mean arterial pressure in Group-A patients at 1st, 3rd, 5th and at 10th minute was 103.68±6.55, 100.42±5.63, 96.54±5.72 and 95.04±5.86 respectively. While in Group-B mean arterial pressure in Group-B patients at 1st, 3rd, 5th and at 10th minute was 112.40±6.93, 106.60±5.98, 100.90±5.95 and 99.16±5.69 respectively. It was observed that at 1st, 3rd, 5th and at 10th minute mean arterial pressure was statistically different in both treatment groups. Conclusion: 800 mg oral gabapentin given 1 hour before undergoing rigid laryngoscopy and endotracheal intubation for general anesthesia significantly affects mean heart rate and mean arterial pressure at 1st, 3rd, 5th and at 10th minute

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Implications of Social Cohesion in Entrepreneurial Collaboration: a Conceptual Model and Research Propositions

This paper explores how the moderation of social cohesion could sustain optimal synergy in entrepreneurial collaboration. Modern firms increasingly engage entrepreneurs in the pursuit of innovation as a means to gain competitive advantage. Managers that oversee such initiatives are hesitant to interfere with the social linkages between entrepreneurs fearing that they will somehow upset the creative process. The consensus that entrepreneurs are inherently collaborative and adept at mitigating conflict also fuels this hands-off approach. Using a systematic literature review, the authors demonstrate that without moderation of social cohesion, the expectation of sustainable innovation arising from the entrepreneurial collaboration is unwise. Organisations may overspend time, money, and technological assets without successful innovation occurring. The dangers range from poor and even risky decision-making to group disintegration. This paper proposes a conceptual model and research propositions to steer future research in managerial interventions designed to moderate social cohesion towards sustaining optimal synergy amongst collaborating entrepreneurs. This paper concludes with a commentary on the implications to business, society, public policy, and teaching

A study on the effect of bioactive glass and hydroxyapatite-loaded Xanthan dialdehyde-based composite coatings for potential orthopedic applications

Abstract The most important challenge faced in designing orthopedic devices is to control the leaching of ions from the substrate material, and to prevent biofilm formation. Accordingly, the surgical grade stainless steel (316L SS) was electrophoretically deposited with functional composition of biopolymers and bioceramics. The composite coating consisted of: Bioglass (BG), hydroxyapatite (HA), and lawsone, that were loaded into a polymeric matrix of Xanthan Dialdehyde/Chondroitin Sulfate (XDA/CS). The parameters and final composition for electrophoretic deposition were optimized through trial-and-error approach. The composite coating exhibited significant adhesion strength of “4B” (ASTM D3359) with the substrate, suitable wettability of contact angle 48°, and an optimum average surface roughness of 0.32 µm. Thus, promoting proliferation and attachment of bone-forming cells, transcription factors, and proteins. Fourier transformed infrared spectroscopic analysis revealed a strong polymeric network formation between XDA and CS. scanning electron microscopy and energy dispersive X-ray spectroscopy analysis displayed a homogenous surface with invariable dispersion of HA and BG particles. The adhesion, hydrant behavior, and topography of said coatings was optimal to design orthopedic implant devices. The said coatings exhibited a clear inhibition zone of 21.65 mm and 21.04 mm with no bacterial growth against Staphylococcus aureus (S. Aureus) and Escherichia coli (E. Coli) respectively, confirming the antibacterial potential. Furthermore, the crystals related to calcium (Ca) and HA were seen after 28 days of submersion in simulated body fluid. The corrosion current density, of the above-mentioned coating was minimal as compared to the bare 316L SS substrate. The results infer that XDA/CS/BG/HA/lawsone based composite coating can be a candidate to design coatings for orthopedic implant devices

Improvement of CO2/N2 separation performance by polymer matrix cellulose acetate butyrate

© Published under licence by IOP Publishing Ltd. With the rapid development of modern civilization, carbon dioxide (CO 2 ) is produced in large quantities and mainly generated from industrial sectors. The gas emission is the major contributor to global warming. To address this issue, the membrane technology is implemented for the CO 2 removal, due to the energy efficiency and economic advantages presented. Cellulose acetate butyrate (CAB) is selected as the polymeric material, due to the excellent film-forming properties and capable of developing a defect-free layer of neat membrane. This study described the fabrication development of CAB using a wet phase inversion method with different casting conditions. Where the composition of the casting solutions (3-5 wt %) and solvent evaporation time (4-6 min) were determined. The outcomes of these dominant parameters were then used to determine the best CAB membrane for CO 2 /Nitrogen (N 2 ) separation and supported by the characterization i.e. scanning electron micrograph. Gas permeation measurements showed satisfactory performance for CAB membrane fabricated with 5 min evaporation time and 4 wt% polymer composition (M2). Where, its permeance and selectivity are 120.19 GPU and 3.17, respectively. In summary, this study showed a brief outlined of the future direction and perspective of CAB membrane for CO 2 /N 2 separation