Pterygium Excision with Suture-Free, Glue-Free Conjunctival Autograft (SFGF CAG): Experience of a Tertiary Care Hospital of Eastern India

Background: Pterygium poses various visual problems and needs surgical excision. But due to various complications related to excision ,needs alternative approach to minimise potential hazards. Recently suture free glue free conjunctival autograft has been selected as a novel postoperative interventional approach but research on its efficacy and outcomes are scanty. Aim and Objective: The present work was aimed to evaluate the outcomes of suture-free, glue-free conjunctival autograft (SFGF-CAG) after pterygium excision. Methods: This was a prospective, interventional, hospital-based study on one hundred twenty patients with primary pterygium. One eye of each patient was selected for surgical excision of pterygium with conjunctival autograft with autologous serum from bare sclera, to prevent recurrence. The eye was patched for 24 hours, and treated with topical eye drops (moxifloxacin 0.5 % two weeks, prednisolone acetate 1 %in tapered dose for 4 weeks and carboxymethyl cellulose 0.5 %for4 weeks).The outcomes were assessed in terms of intra operative surgical time, intra and post operative complications and recurrence. Follow-up was done on 1st , 7th , 15th , 30th , 90th , 180th and 360th day. Results: Out of 120 patients, females(n= 82; 68.33 %) outnumbered males (n=38; 31.66 %).11 patients had pterygium in both eyes and 109had unilateral occurrence. Among them pterygium was of Grade I in 35 eyes(29.16 %), Grade II(44 eyes; 36.66 %), Grade III (34 eyes; 28.3 %), and Grade IV (7 eyes; 5.83 %).The mean age of occurrence was 38.92 ± 11.2 years. Foreign body sensation and watering were the chief indication of surgery in 68 patients (56.66 %), Cosmetic blemish in 45 patients (37.50 %) and defective vision in 7 patients (5.83 %).Average surgical time was 7.53 ± 1.35 min. only 3 cases(2.5 %) were found with Graft displacement on 1st post operative day. Conjunctival granuloma was found in 1 case (0.83 %) in 1 week follow up. No recurrence of pterygium was observed in any patient in the operating eye within 1-year follow-up.Conclusion: It is a safe and cost effective technique with no recurrence, low complication rate, and minimal operative time of SFGF CAG. This technique could avoid surgical adjunct and its potential hazards. However, it needs further research on large samples

A comparative study of train-of-four (TOF) count at corrugator supercilii and at adductor pollicis reflecting abdominal muscles relaxation

Introduction: Diaphragm and lateral abdominal muscles frequently show sparing effects to muscle relaxants. This study compared visual estimation of neuromuscular transmission of corrugator supercilii and adductor pollicis (AP) with electromyographic measurements of lateral abdominal wall muscles during recovery from vecuronium-induced intense neuromuscular block. Methods: 60 patients undergoing elective surgeries under general anesthesia  were included. Following loss of consciousness, supramaximal stimulations were applied using electrical nerve stimlators to left 10th intercostal, ulnar and facial nerves. Electromyographic activity (EMG) of abdominal wall muscles were measured. After Inj. Vecuronium 0.1 mg/kg, Electromyographic activity measurements counted the visually detectable train-of-four (TOF) responses at corrugator supercilii and adductor pollicis. The onset time, the duration of action and quantitative measurements of neuromuscular block were done. Observations: Clinical duration of action of vecuronium almost coincided with train-of-four response at corrugators supercilii where as train-of-four recovery at adductor policis occurred late during recovery stage. Corrugators supercilii had a stronger positive correlation with abdominal muscles relaxation as compared to the adductor policies. Corrugators supercilii had a stronger correlation coefficient (0.910 vs 0.417) than adductor policis with respect to abdominal muscle. It indicated that corrugator supercilii is a better predictor than AP to measure abdominal muscle relaxation

A comparative study of postoperative acidemia after intraoperative administration of balanced crystalloid (Plasma-lyte A@) versus 0.9% sodium chloride in gastrointestinal surgery

Background: The administration of intravenous fluids is one of the most common and universal interventions in medicine. Fluid therapy is the most challenging and debated aspect of perioperative care. Plasma-lyte A® Injection (multiple electrolytes injection, type 1, USP) is indicated as a source of water and electrolytes or as an alkalinizing agent. 0.9% sodium chloride is an isotonic crystalloid solution having a sodium concentration higher is useful in replacing fluid and electrolyte loss. Aims and Objectives: The study was designed to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% NaCl on acid-base balance in the post-operative period in patients undergoing gastrointestinal surgery. Materials and Methods: Eighty consenting patients of ASA-l and ASA-II who underwent Gastrointestinal surgery were at first randomly allocated to 2 groups. One group received Plasma-Lyte A® as the sole crystalloid and the other group received 0.9% sodium chloride. Results: Serum Na+ conc. of the groups were comparable and no difference was shown at the time of induction, but postoperatively at 12 h, there was a significant increase in group 2. There was no significant difference in serum K+ concentration in both the groups except at 6 h postoperatively when there was an increase in K+ concentration in group 1. Serum Cl− concentration was having no significant difference at the time of induction and 1 h intraoperative, but postoperatively at 1, 6, and 12 h the Cl− concentration significantly increased in group 2. HCO3− concentration of the two groups had no difference between them throughout the study period. The pH of patients in both the groups showed no statistically significant difference during the entire procedure (P>0.05). A significant decrease in pH observed in 0.9% sodium chloride group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 min. Conclusion: Both plasma-lyte A and 0.9% sodium chloride can be used safely as intravenous infusion fluid without altering pH status and blood electrolyte concentration in patients undergoing gastrointestinal surgery