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ABSTRACTS OF PAPERS PRESENTED AT THE 69TH RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY, 9TH AUGUST 1999, 2.30 PM IN THE SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)

1.INTRATHECAL MIDAZOLAM AND BUPRENORPHINE : A COMBINATION FOR POSTOPERATIVE PAIN RELIEF

Pai Dhungat, K Baheti


To find out the efficacy of combination of intrathecal inj. midazolam and inj. buprenorphine for postoperative pain relief.

Sixty patients received inj. midazolam 2 mg (preservative free) initially and then inj. buprenorphine 150 mcg and with inj. Buprivacaine was injected intrathecally for variety of lower abdominal surgeries. The degree and duration of postoperative pain relief was assessed by visual analogue scale (VAS). The respiratory rate, pulse rate and blood pressure were monitored at regular intervals for 36 hours. Inj. ketonov intramuscularly was given for relief of postoperative pain as and when required.

Sixty patients of ASA I and II undergoing lower abdominal surgeries such as general surgical (30), urological (10) and gynaecological (20) operations were included in this study. In 31 (56%) of cases no analgesic was required even after thirty six hours. Inj. ketanov 2 ml i.m. was given in 5(8.33%) after 12 hours and in 24(35.66%) patients after 24 hours. Two patients of abdominal hysterectomy had nausea and vomiting, which was controlled with inj. ondansetron. None of the patients had post spinal headache or urinary retention in this study.

The pain relief score on visual analogue scale (VAS) was between 9 and 10 in 56% (n-31); 3-4 in 5 and 7-8 in 29 patients and other vital parameters were within normal limits. All the patients were calm or sleeping as if they are sedated during surgery and no patient required sedation in postoperative period.

The combination of intrathecal Inj. midazolam 2 mg and Inj. buprenorphine 150 mcg is useful for relief of postoperative pain as :

1. The pain relief was excellent in 31 (56%) and good in remaining 29 (44%) for 36 hours. 2-Inj. ketanov was required only once in five patients after 12 hours and twice in 24 patients after 24 hours after surgery. It's a positive point in favour of this combination, as intensity of pain is usually less after first 12 hours of surgery. 3-All the patients were either calm or sleeping as if they are sedated during surgery and none of the patients required any sedation in postoperative period.

In this initial study the results are encouraging when compared with routine fixed dose of intramuscular analgesic regime, where analgesic vary in postoperative period.


2.INTUBATIVE CONDITIONS : A COMPARATIVE STUDY BETWEEN VECURONIUM AND ROCURONIUM IN CABG SURGERY

N Patil, MM Sharma, DK Baheti

This study was conducted in 40 patients, who underwent coronary artery bypass grafting (CABG). These patients were divided into two groups of twenty each, group I-Inj. Vecuronium and group II - Inj. Rocuronium. Both the groups were compared and evaluated for intubating conditions. The criterion used were relaxation of jaw, vocal cord and reaction to intubation. The haemodynamic variables were mean pulse rate, systolic pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MABP).

The results show that there was slight increase in the (P < 0.001) mean pulse rate, MABP, SBP, and DBP after intubation, in both the groups. This could be due to stress response to intubation.

There was slight increase (P < 0.001) in mean pulse rate, SBP and DBP in group II at the end of 2 minutes, however there after the changes in these variables were not statistically significant (P > 0.05) at all time intervals.

While comparing the two groups, the change in heart rate was not significant (P > 0.05) up to the 5 minutes. But there was significant (P < 0.05) fall in heart rate in group I at the end of 10 minutes.

There were no significant (P > 0.05) changes in MAP and DBP at all intervals when two groups were compared. There was a significant (P < 0.01) fall in SBP in group I, as compared to the fall in group II at the end of 2, 5, and 10 minutes.

Overall there was slight increase (P < 0.001) in mean pulse rate, MAP, SBP and DBP in group II upto 2 minutes, thereafter the changes were not significant (P > 0.05). It could be due to the mild chronotropic and inotropic actions of Inj. Rocuronium, which is an advantage, especially with the use of, relatively high doses of opioids. This could be of a slight advantage over Inj. Vecuronium, which lacks chronotropic action and has been implicated, in severe bradycardia in certain situations.

The intubating conditions were satisfactory in group II as compared to group I. These findings are in consistence with earlier researches.1,2,6

The intubating conditions were satisfactory in group II as compared to group I. These findings are in consistence with earlier researches.1,2,6

It was observed that Inj. Rocuronium does not cause significant (P > 0.05) change in haemodynamic variables as compared to its baseline values. Interestingly the group II 80% (n - 17) of patients had low ejection fraction between 0.25% - 0.40%.

In our study none of the patients had any side effects such as flushing of skin, rashes or complications such as laryngo or bronchospasm either during or after intubation.

Thus we conclude that Inj. Rocuronium is a safe steroidal non-depolarizing muscle relaxant in the patients undergoing CABG surgery because :

1. It gives good to excellent intubating conditions at the end of 90 seconds with 2X ED90 dose i.e. 0.6 mg/kg.

2. Inj. Rocuronium has mild to nil (statistically not significant P > 0.05) effects on cardiovascular parameters.

3. Inj. Rocuronium can also be safely used in the patients, with low ejection fraction (0.25%-0.40%) under going CABG surgery.


3.ROLE OF SHOULDER RECONSTRUCTIVE SURGERY IN THE PRESENT DAY

Pradeep Moonot, Anant Tambe, Arun Mullaji


Shoulder surgery till date was limited to fractures and dislocations. With an improvement in diagnostic modalities for shoulder pathology more occult lesions are diagnosed and the scope of shoulder reconstructive surgery is increasing. In this paper we aim to present a spectrum of various shoulder pathologies varying from the obvious to the occult and the reconstructive procedures used.

The paper includes a large number of cases of shoulder pathology treated by us. These cases were evaluated by means of X-rays, ultrasonography, MR scan and arthroscopy as indicated. They were then treated surgically or conservatively.

A brief introduction about the anatomy and the biomechanics of shoulder will be presented followed by examples of various shoulder lesions including -

A short description of the pathoanatomy of these above conditions will be discussed along with their respective clinical features, diagnostic aids and treatment.

In this present day, a finely tuned shoulder is an absolute necessity not only for sports but also daily activities. A properly done shoulder reconstructive procedure goes a long way in bringing and ensuring the above.


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