Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery

Introductions: Catheter-related bladder discomfort (CRBD) is common in patients with urinary catheterization. Centrally acting intravenous opioid like Tramadol inhibits detrusor activity and incidence of CRBD. Present study aims to analyze efficacy of intravenous (IV) Tramadol in prevention of CRBD in patients undergoing upper urinary tract surgery. Methods: Adult patients undergoing elective open upper urinary tract surgeries at Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal, over a period of six months, requiring urinary catheterization were randomly divided into Control (C) and Tramadol (T) groups. After general anesthesia, patients in T-group received IV Tramadol 1.0 mg/kg and C-group received normal saline 30 minutes before extubation. In post-operative ward, CRBD was graded as mild, moderate or severe at 0, 1, 2 and 6 hours. Post-operative Ramsay sedation score and nausea vomiting were compared in two groups.  Results: There were total 70 patients, 35 in each of groups-T and C. Incidence of CRBD in T-group was significantly low compared to the C-group at all points of evaluation (p<0.05). Postoperative sedation score, analgesic requirement and nausea vomiting were not significantly different in two groups. Conclusions: Intravenous Tramadol administered before extubation in upper urinary tract surgery reduces the incidence of CRBD. Keywords: catheter related bladder discomfort (CRBD), detrusor activity, tramado

Breakage of stylet inside endotracheal tube following intubation

A 52-year-old lady was scheduled for hemithyroidectomy for right colloid goitre. After the preanesthetic check-up, she was classified as an American society of anesthesiologists (ASA) physical status I.1 Her baseline vitals parameters were within normal limits. After receiving premedication, she was induced and intubated with a 7.0 mm ID flexometallic endotracheal tube (ETT) preloaded with a malleable aluminium stylet. Shortly afterwards, while fixing the ETT, the size of the stylet was noticed to be shorter than initial length. Immediately, ETT was removed and replaced with a new one. The broken piece of stylet was found inside the removed ETT. Keywords: endotracheal tube; hemithyroidectomy, style

Efficacy of prophylactic intravenous ondansetron for attenuation of pain on propofol injection

Introductions: Propofol is a popular intravenous anesthetic agent. One disadvantage of propofol is pain on its injection which can be excruciating at times. Various agents and methods have been tried to attenuate this unpleasant effect. Ondansetron, primarily used as an antiemetic has also been studied to reduce it.   Methods: This randomized, prospective, double-blinded, placebo-controlled study was conducted on patients of either sex, American Society of Anesthesiologists (ASA) physical status I & II, undergoing elective surgeries requiring general anesthesia. The patients were randomly divided into ondansetron and placebo groups. Manual occlusion of venous drainage was done at mid‑arm by an assistant for 1 minute after which 25% of the calculated dose (2 mg/kg) of propofol (1% w/v in lipid base) was injected. Patients were asked by a blinded investigator to score the pain on injection of propofol on 4-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain and compared in between two groups. The p<0.05 was considered significant. Results: There were 96 adult patients, 48 in each group of Ondansetron placebo. Pain on propofol injection was found significantly higher in the placebo group compared to the ondansetron group. (62.5% vs 35.4%). Most of the patients in the ondansetron group had mild pain only, whereas, a significant number of patients in the placebo group had higher degrees of pain on propofol injection. Conclusions: Prophylactic intravenous 4 mg ondansetron is a safe and simple method of attenuating pain on propofol injection. Keywords: general anesthesia, ondansetron, pain on propofol injectio

Does the male gender govern conversion of laparoscopic cholecystectomy?

Introductions: Laparoscopic cholecystectomy (LC) occasionally demands conversion to open cholecystectomy (OC) because of multiple risk factors. This study was conducted to find out whether male gender is a stand-alone risk factors for conversion of LC to OC. Methods: This was a comparative analysis of conversion of LC to OC in patients operated for symptomatic cholelithiasis during June 2017 to May 2018 at Bir hospital, National Academy of Medical Sciences, Kathmandu, Nepal. The patients were divided into two groups: male (group 1) and female (group 2). Study variables included gender, America Society of Anesthesiologist class, history of upper abdominal pain within six weeks prior to surgery, upper abdominal surgery, emergency department visit due to upper abdominal pain, adhesion of gallbladder to adjacent structure and body mass index. Binominal logistic regression analysis of risk factors for conversion was conducted. Odds ratio (95% CI) was calculated. The p value ≤ 0.05 was considered statistically significant. Results: Among 151 patients (male 39, female 112), 7 (4.6%, male 3 and female 4) had conversion from LC to OC. Male gender itself as an isolated risk factor had no significant association to conversion (p=0.303). There was no significant difference found for age, operating time and hospital stay. Previous emergency visit (p=0.020) and adhesion (p<0.030) were associated with conversion. Conclusions: Male gender had no significant association for conversion of LC to open. Previous emergency visit due to upper abdominal pain and adhesion of gallbladder were associated risk factors for conversion. Keywords: conversion, laparoscopic cholecystectomy, male gende

Intraoperative anaphylaxis

A 24 years lady was scheduled for tonsillectomy for recurrent tonsillitis had anaphylaxis and asystole before extubation, she was revived successfully. She had no known history of allergy and exposure to anesthetic agents and was classified as an American Society of Anesthesiologists, ASA I. In the operating theatre, her baseline vitals were unremarkable and remained hemodynamically stable on receiving antibiotic and anesthetic drugs. The anesthetic course remained uneventful throughout the surgery. Upon removal of surgical drapes, upper eyelid swelling was noted, that rapidly progressed to facial area within minutes, and she developed cardiac arrest which was managed with standard protocol and resuscitated successfully. Keywords: anaphylaxis, anesthetic agents, cardiac arres

Efficacy of dexamethasone in reducing the incidence of postoperative sore throat: a double blind randomized study

Introductions: Postoperative sore throat (POST) is a commonly seen adverse event after general anesthesia with endotracheal intubation. Dexamethasone, a potent corticosteroid with anti-inflammatory action is the most popular steroid studied in this regard with positive results. Methods: This randomized, prospective, double-blinded, placebo-controlled study was conducted on one hundred and ten adult patients of either sex, undergoing elective surgeries requiring endotracheal tube intubation. After obtaining written informed consent, they were randomly divided into Control (A, n=55) and Dexamethasone (B, n=55) groups and received either an injection of Dexamethasone (Group B) 8 mg intravenously or an equivalent volume of Normal Saline (Group A) just before entering the operating theatre. All the patients received a similar anesthesia with endotracheal tube intubation and at the end of surgery, extubated and transferred to the post-anesthesia care unit. The incidence and severity of sore throat were assessed at 1, 6 and 24 hours post-extubation. Severity of sore throat were graded on a 4 point scale, p <0.05 was considered significant. Results: Incidence of POST in Dexamethasone group was found significantly low compared to the control group up to six hours (p<0.05) but was comparable at 24 hours post extubation. Severity of POST in the study group was of lower grade in compare to control group. Conclusions: Prophylactic intravenous Dexamethasone 8 mg administered to patients undergoing elective surgeries requiring endotracheal tube intubation significantly reduces the incidence and severity of POST up to six hours post-extubation. Keywords: dexamethasone, general anesthesia, post-operative sore throat (POST