A Prospective Observational study to determine the incidence of perioperative complications during Percutaneous Nephrolithotomy (PCNL) Surgery and the various risk factors predisposing to them

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is a relatively non-invasive surgical alternative available for removal of kidney stones. The traditional approach to renal stones was through open surgical procedures that required general anesthesia and long convalescence. Although, PCNL is a minimal invasive technique, it carries a potential risk of complications. These include bleeding, anaemia, hypotension, hyponatremia, hypothermia, injury to vital organs like pleural tear bowel perforation, infection, and septic shock. PCNL is a very common surgery that is being carried out in our institution. However, till date the there has been no study on the profile of complications that have been observed perioperatively. In literature, though the listed complications do not actually quantify their incidence. Considering the frequency of cases and complications seen, we feel that it would be a very useful exercise, since knowing the relative incidence of complications will help institute the appropriate monitoring techniques and so, in the better perioperative management. AIM OF THE STUDY: To assess the peri-operative anaesthetic complications of Percutaneous Nephrolithotomy (PCNL). OBJECTIVES: 1. To detect the incidence of cardiovascular changes namely hypotension and arrhythmias during the surgery. 2. To detect the incidence of hypothermia during the surgery. 3. To detect the incidence of bleeding requiring intra-operative blood transfusion. 4. To detect the incidence of acidosis resulting from the procedure. 5. To detect the incidence of any other complication that may result due to the surgery. 6. To determine risk factors associated with each of the above complication. METHODS: Data was collected on 60 patients who underwent elective PCNL surgery. This included monitoring of blood pressure, heart rate, nasopharyngeal temperature, saturation, end-tidal carbon-di-oxide, arterial blood gas (ABG), the volume and temperature of irrigation fluid, the temperature in the operating. The collected data was analyzed to find out the complications that occur during the procedure and to determine their incidence and risk factors associated with them. Data was analyzed using SPSS version 16. Chi-square test was the test of significance in the study. Odds Ratio was calculated and a p-value less than 0.05 was considered statistically significant. RESULTS: A total of 60 patients were studied of whom 42 were females and 18 males. 40 patients were ASA grade 1 and 20 were ASA grade 2.The incidence of hypothermia and acidosis was 60% and 26.7%, respectively. The incidence of hypothermia and temperature of the irrigating fluid had statistically significant association with a p-value of 0.026.The incidence of acidosis was significantly associated with the volume of irrigating fluid with a p-value 0.025.The risk of acidosis was increased with hypothermia (p-value 0.02 and OR 7.00). CONCLUSION: The most common complication observed intraoperatively was hypothermia, followed by acidosis and sepsis. Other complications that occurred were excessive bleeding and hydrothorax. Electrolytes imbalance and cardiovascular changes were not observed as major complications. The most significant risk factor associated with hypothermia was found to be the usage of cold irrigating fluid

The Feeding Tube- a Simple Yet Handy Aid to Intubate an Unanticipated Difficult Pediatric Airway

Pediatric intubation requires certain unique set of additional skills compared to intubating adults. The challenges of successfully intubation of a child increases as the age and size of the child decrease and are compounded when airway difficulties arise for various reasons. Often in the rural setting, such procedures may have to be carried out by health care personnel who get trained on-the-job, and in the absence of adequate technological back-up. This leads to an increased incidence of failed intubations which can have devastating complications, especially in the pediatric age group. We describe a simple technique which helped us while intubate a 40-day old infant, without any major catastrophes. Keywords: airway management; infant; newborn; intubation; endotracheal

Time spent by patients in a pre-anaesthetic clinic and the factors affecting it: An audit from a tertiary care teaching hospital

Background and Aims: Patient satisfaction from a pre-anaesthetic clinic (PAC) visit is greatly influenced by time spent there. We aimed to determine time spent in a PAC without an appointment system and the factors affecting the same. Methods: Four hundred and eight patients coming to PAC were tracked using a time-motion study model. Time spent in waiting and consultation was recorded. Independent variables potentially affecting time spent were documented. Patients were grouped based on independent variables, and the groups were compared for significant differences using appropriate statistical tests. Workload pending on physicians was calculated on an hourly basis by counting number of patients waiting and number of physicians in PAC. Results: Non-parametric statistical tests were used for analysis because the data were not normally distributed. The median and inter-quartile range for waiting time, consultation time and total time were 60 (30–90) minutes, 17 (12–26) minutes and 79 (53–111) minutes, respectively. There was considerable variation in all three. Waiting time was significantly lower in patients posted for same-day surgery or those arriving on a stretcher or wheelchair. Consultation time was correlated with American Society of Anesthesiologists physical status and grade of surgery. Most patients arrived in the morning rather than at equal intervals. Waiting time and workload were therefore maximum in the midmorning and dropped rapidly in the afternoon. Conclusion: Large variability in waiting time is linked to lack of an appointment system, and to patients being seen out of turn

Comparing the efficacy of aprepitant and ondansetron for the prevention of postoperative nausea and vomiting (PONV): A double blinded, randomised control trial in patients undergoing breast and thyroid surgeries

Background and Aims: Aprepitant, a Neurokinin-1 receptor antagonist, has been evaluated in abdominal and neurosurgeries, but its effect is less clear in breast and thyroid surgeries, which are also known to be high risk for post-operative nausea and vomiting (PONV). This study was done to compare the antiemetic efficacy of ondansetron and aprepitant in women undergoing mastectomy and thyroidectomy. Methods: One hundred and twenty-five ASA I and II, female patients, aged between 18 and 65 years were randomly assigned into Group I (ondansetron group, n = 62) or Group II (aprepitant group, n = 63), by computer-generated random sequencing. Per protocol analysis was done to assess the incidence and severity of PONV, use of rescue antiemetics, and patient satisfaction with PONV control between the two groups, till 24 h post-surgery. Results: In the immediate postoperative period, 79.7% of patients in Group I and 85.2% in Group II were free of emesis (P value: 0.49). In Group I, the first episode of vomiting occurred within a median duration 90 min (IQR 2575: 45-147) postoperatively, whereas the median duration in Group II was 160 min (IQR 25-75: 26-490), with request for rescue antiemetic at 60 min in Group I (IQR 25-75: 27-360) and 147 min in Group II (IQR 25-75: 11-457). Conclusion: A single dose of oral aprepitant has comparable effects to injection ondansetron administered eighth hourly in preventing PONV, the severity of nausea, number of rescue antiemetics, and the time to first emetic episode in the 24-h postoperative period. CTRI Reg No: REF/2017/06/014637

Profile and outcome of sudden cardiac arrests in the emergency department of a tertiary care hospital in South India

Background: Sudden cardiac arrest (SCA) requiring cardiopulmonary resuscitation (CPR) is one of the common emergencies encountered in the emergency department (ED) of any hospital. Although several studies have reported the predictors of CPR outcome in general, there are limited data from the EDs in India. Materials and Methods: This retrospective study included all patients above 18 years with SCA who were resuscitated in the ED of a tertiary care hospital with an annual census of 60,000 patients between August 2014 and July 2015. A modified Utstein template was used for data collection. Factors relating to a sustained return of spontaneous circulation and mortality were analyzed using descriptive analytic statistics and logistic regressions. Results: The study cohort contained 254 patients, with a male predominance (64.6%). Median age was 55 (interquartile range: 42-64) years. Majority were in-hospital cardiac arrests (73.6%). Only 7.4% (5/67) of the out-of-hospital cardiac arrests received bystander resuscitation before ED arrival. The initial documented rhythm was pulseless electrical activity (PEA)/asystole in the majority (76%) of cases while shockable rhythms pulseless ventricular tachycardia/ventricular fibrillation were noted in only 8% (21/254) of cases. Overall ED-SCA survival to hospital admission was 29.5% and survival to discharge was 9.9%. Multivariate logistic regression analysis showed age ≥65 years (odds ratio [OR]: 12.33; 95% confidence interval [CI]: 1.38-109.59; P = 0.02) and total duration of CPR >10 min (OR: 5.42; 95% CI: 1.15-25.5; P = 0.03) to be independent predictors of mortality. Conclusion: SCA in the ED is being increasingly seen in younger age groups. Despite advances in resuscitation medicine, survival rates of both in-hospital and out-of-hospital SCA remain poor. There exists a great need for improving prehospital care as well as control of risk factors to decrease the incidence and improve the outcome of SCA