Asian Journal of Medical Research

Evaluation of Outcome of Traumatic Hepatobiliary Injury

Abnish Kumar Karn — 2021-09-21

Background: To evaluate outcome of traumatic hepatobiliary injury. Subjects & Methods: One hundred ten patients with traumatic hepato- biliary injury of both genders were recruited in present study. Hepatic injury grade, associated injuries, indication for operative intervention, failure of nonoperative management and complications were recorded. Results: Grade of liver injury was I in 14, II was in 22, III in 35, IV in 20 and V in 19 patients. Associated injury was maxillofacial injury in 32, head injury in 45, spine injury in 11, chest injury in 52 and pelvic injury in 8. Management was operative liver related in 32, operative liver unrelated in 10 and non- operative in 68 patients. Complications were persistent bile leak in 10 and angioembolization in 4. Death occurred in 7 patients. Conclusion: Hepato- biliary injury are common nowadays and liver injuries are severe. Both operative and non- operative management should be employed. Persistent bile leak and angioembolization were common complications.

A Randomized, Placebo Controlled Study of Peri-Operative Pregabalin for Early and Late Post-Operative Pain in Patients Undergoing Open Urological Surgery

Pratik B Tantia — 2021-09-21

Introduction: Pregabalin has been used in the peri-operative period for a variety of surgeries and in variable doses. Some studies favor while others refute its role as a pre-emptive and protective analgesic. We hypothesized that Pregabalin would reduce the severity of acute post-operative pain as well as chronic post-surgical pain. Subjects and Methods: A randomized double-blind placebo-controlled study including a total of 120 patients was designed to find the efficacy and safety of Pregabalin in reducing acute as well as chronic post-surgical pain after open urological surgery. Results: The time to rescue analgesic (NRS > 4) was 356.2+101.3 minutes in study group and 267.2+67.79 minutes in control group (p< 0.01). The total dose of rescue analgesic required (mg of Tramadol) in study group (320 + 50.5 mg) was less than the control group (462 + 35.4 mg). Conclusion: Oral Pregabalin was effective in reducing the severity of acute post-operative and chronic post-surgical pain and reducing the dose of rescue analgesic required. However, the incidence of side effects, though minor, was higher in the study group.

Airway Management of a Child with Penetrating Neck Injury: A Case Report

Ashish Yadav — 2021-09-21

Injuries of upper airway can lead to hazardous consequences. After penetrating trauma these injuries may lead to hoarseness of the voice which can be managed conservatively or it can also lead to respiratory distress for which emergency tracheostomy is required. 18 Year old female child suffered from penetrating neck injury while playing with chain of cart. In presence of respiratory distress and hemodynamic instability immediate surgical exploration and securing airway may be required. Managing the airway can be a nightmare for any anaesthesiologist. Fibreoptic bronchoscopy aids to assess the airway injuries and is the safest possible option but cannot be used in uncooperative patients and children. Securing the airway in awake patients is although the safest option in such situations.

Anaesthetic Management of Tracheal Stenosis Posted for Resection and Reanastomosis: A Case Report

Parul Gupta — 2021-09-21

A 38 years old male patient diagnosed with tracheal stenosis was posted for resection and anastomosis of the stenotic part. Keeping cardiothoracic surgeon on standby with femoral vessels ready for emergency bypass, awake fiberoptic intubation was done with cuffed flexometallic tube. After making a nick in the stenotic part by the surgeon, cuffed flexometallic tube of ID 4.5 mm was inserted in the distal part and further ventilation continued with that tube while leaving oroendotracheal tube in situ. At the end of surgery the surgeon had difficulty placing sutures around the large tube so ETT of smaller ID of 5mm was inserted after removing the previous ETT of ID 7.5 mm. Once the anastomosis was over, the tube was removed from the distal part of trachea and ventilation was continued from the oroendotracheal tube placed at the start of the procedure. The patient maintained well throughout the procedure. The patient was extubated uneventfully.

Nasal Intubation via Laryngoscope in Maxillofacial Surgeries: Changes in Hemodynamic Parameters

Archna Sharma — 2021-09-21

Background: The purpose of the present study was to check the hemodynamic response of conventional nasal intubation in oral and maxillofacial surgeries. Subjects and methods: After taking approval of the hospital ethical committee on research, 30 consenting adult patients, of either sex, of ASA physical status 1 and 2, in the age group of 18-60 years coming for oropharyngeal and maxillofacial surgery were included in the study. After induction of general anaesthesia patients were intubated by conventional nasal intubation technique. Results: When heart rate and mean arterial pressure were compared before and after intubation, significant increase in heart rate and mean arterial pressure were observed. Conclusion : From this study it was concluded that conventional nasal intubation can cause significant change in hemodynamic parameters.

Retinal Complications After Lateral Rectus Transpositional Squint Surgeries: A Review of Literature

Prashant Kumar — 2021-09-21

In oculomotor nerve palsy, four of the ocular muscles is affected and the eye is in hypotropia and abducted position. The goal of the squint surgery is to bring the eye in primary position. Supramaximal recesession resection have been tried but of limited benefit. Transpositional squint surgeries have been described for the same to bring the eye in orthophoric position. These surgeries have been in practice since 1989 when it was first described by Taylor et al. Later on several modifications of this surgery was done by Kaufman et al (1992), Morad et al (2000), Graf M et al (2010), Abbas et al (2010), Gokyigit b et al(2013), Erbagci et al (2016) and Saxena et al (2016). Here we reviewed all the reported cases of lateral rectus transpositional squint surgeries done between 1989 and 2021, the reported retinal complications, their explanation and resolution. Pubmed library was used as a database.

Evaluation of Deep Choroidal Vascular Changes Using Enface Oct in Central Serous Choroidopathy

Nasiq Hasan — 2021-09-21

Background: To detect changes in deep choroidal vasculature following resolution of CSC using Enface SSOCT. Subjects and Methods: Nine eyes of patients with CSC were studied during the acute phase and following resolution. OCT-A scans were obtained and the deep choroidal layer was segmented between 150 to 300 microns below the RPE. The dilated deep choroidal vessels visible on EnFace OCT corresponding to the leak on FA were localized and the area and width of the vessel was compared using imageJ software. Other parameters like best corrected visual acuity and central choroidal thickness was also measured and compared before and after resolution of CSC. Results: Mean age of the patients was 41.22 7.45 years. There was a significant decrease in width (0.89 0.48mm vs 0.662 0.27mm, p=0.007) and area (0.81 0.61mm² vs 0.56 0.46mm²,p=0.009) of the dilated vessel post resolution of CSC ) however the overall decrease in choroidal thickness from 428.22 73.11 to 419 69.77 microns was not significant. (p=0.365). Conclusion: EnFace SSOCT scans can be used as a tool to identify anatomical changes in the deep choroidal vessels during the course of the disease and to help monitor the response of treatment in CSC

Association of Sympathetic Activity with Body Mass Index in Male Adults of North Indian by Hand Grip Dynamometer

Rovins Kumar — 2021-09-21

Background: The most significant determinants of hypertension have been established as obesity and overweight. The positive relationship between handgrip intensity and Blood Pressure could be clarified by several mechanisms. Subjects and Methods: Body mass index, Hand grip dynamometer and Blood pressure of the n= 120 subjects, age =18-25. The blood pressure and hand grip dynamometer test was recorded by following standard procedure. Results: The finding of this study is sympathetic activity was increased in overweight and in obese as compared to normal body mass index hand grip dynamometer test. Conclusion: The sympathetic activity was increased in overweight and in obese subjects as compared to normal body mass index after hand grip dynamometer test.