A prospective comparative study of effect of intravenous etomidate and propofol during induction of anesthesia for electroconvulsive therapy

Introduction: The use of electroconvulsive therapy (ECT) for the treatment of psychiatric disorders dates back to 1937. Since then, its indication has become more diversified and includes the vast majority of major depressive disorders, bipolar mood disorders, and even post-partum psychosis. Electroconvulsive therapy is considered to be one of the important treatment modalities available. It has the advantage of producing a more rapid response compared to conventional treatment, an important consideration in the management of patients with suicidal tendencies. Materials and methods: This prospective, comparative study was carried out at a private psychiatric set up in Bidar from January 2020 to December 2020. Written informed consent from 120 patients of the American Society of Anesthesiologists (ASA) class I and II, aged 18-60 years, scheduled for ECT therapy, included in this study. Patients with a severe systemic disorder like IDDM, uncontrolled hypertension, kidney or liver disease, severe respiratory disorder, seizure disorder, coronary artery disease or recent history of MI, patients with known hypersensitivity or allergy to drugs to be used, anticipated difficult airway, bodyweight >100 kg or obese and pregnant or breastfeeding females and in patients in whom seizures failed to occur during ECT were excluded from the study. Results: All the patients in both groups were comparable for a demographic profile which includes age, bodyweight which statistically showed no significant difference. Results of our study showed that the induction was rapid with propofol as compared to etomidate, which was statistically significant (p < 0.001). Induction time with propofol was 40.3 ± 3.65 seconds and that for etomidate was 48.63 ± 3.29 seconds (table-1). Conclusion: In our study, when used for acute courses of ECT, propofol and etomidate are equally well tolerated as induction agents. Patients who received propofol had longer acute courses of ECT and, consequently, longer and costlier inpatient stays. Etomidate could be a better alternative induction agent in ECT

A prospective analytical study on epidemiology and management of incisional hernia

Introduction: A hernia is the protrusion of viscous or a part of viscous through a normal or abnormal opening in the wall of its containing cavity. A ventral hernia is any hernia protruding through the abdominal wall, while Incisional hernia (IH) is a hernia protruding through an operational scar. According to the various studies abdominal surgeries have 11% to 19% chance of developing IH. Materials and Methods: The study is a prospective study and study group was patients admitted and operated in Bidar Institute of Medical Science, Bidar Karnataka from April 2019 to December 2020. Total 75 cases of various types of hernias operated. Out of 30 cases of incisional hernias were included in this group for study. In this series patients admitted in surgical wards under all surgical units were examined to assess the abdominal wall defects, etiological and predisposing factors. A detailed case history and thorough clinical examination was done to determine the type and cause of hernia and necessary investigations were done according to proforma. After detailed physical examination of patients, clinical diagnosis was established including the associated etiological and predisposing factors. Results: During the period of our study, a total of 75 patients have been operated for various types of hernia, out of these 30 cases were incisional hernia. Inguinal hernia was most common type accounting for 42.66%, next common hernia was incisional hernia (40%) remaining rare type of hernias constituting 17.34% of total cases studied. Maximum number of cases in middle age group (30-60 yrs.) constituting 80%. Incisional hernia was found to be more common in females with male female ratio of 1:2.3. Conclusion: Mesh repair results in less recurrence than anatomical repair for incisional hernia. The incidence of incisional hernia is more common in women than men due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries. Sterile aseptic technique and appropriate use of pre-operative antibiotics is necessary to reduce the occurrence of incisional hernia

Evaluation of intravenous magnesium sulphate on postoperative pain after spinal anesthesia

The major goal in postoperative pain management is to minimize the dose of medications and lessen side effects, while still providing adequate analgesia. Effective post-operative analgesia may facilitate recovery and decrease morbidity in surgical patients. Magnesium sulphate (MgSO4), a NMDA receptors antagonist, has been tried to control peri-operative pain by modifying the pain mechanism. The present study was conducted to determine efficiency and safety of preventive intravenous MgSO4 to postoperative pain relief and analgesic requirement after spinal anesthesia. This was a open label randomized study conducted in a tertiary care hospital in South India, from March 2013 to September 2013. The study was approved by institutional ethics committee and informed consent was taken from the subjects. The patients were randomized to receive either magnesium sulphate 50 mg/kg in 250 ml of isotonic sodium chloride solution IV (Group MG) or same volume of isotonic sodium chloride solution (Group NS). Pain at rest was evaluated using a 0-10 cm visual analogue scale at emergence from anesthesia and 2, 4, 8, 16 and 24 hrs after surgery. Rescue analgesia was provided in the form of diclofenac 75mg intramuscularly. The dosage and timing of analgesia was recorded immediately after consciousness, 2, 4, 8, 16 and 24 after operation. Results on continuous measurements are presented on Mean ± SD and results on categorical measurements are presented in Number (%). Repeated measures ANOVA were used to compare measurements over time. P˂0.05 was considered statistically significant. The results of the present study showed that infusion of MgSO4 during operation under spinal anesthesia reduced postoperative pain and analgesic consumption. Hemodynamic parameters of both groups were also comparable and no patient developed hypotension or bradycardia in both groups