INTRODUCTION: Anaesthesia and surgery promote significant thermal disorder in the human body. Spinal anaesthesia causes lower limb vasodilation and redistribution of body heat from central to the peripheral compartments.
MATERIALS AND METHODS: This was a prospective, randomised, double-blind clinical study to compare the effectiveness of IV ketamine and tramadol in the prevention of shivering associated with spinal anaesthesia. We prospectively studied 150 ASA classification I and II patients between 18 and 70 years old scheduled for any elective surgery performed under spinal anaesthesia. Patients were randomly allocated to receive either prophylactic IV ketamine 0.5 mg/kg (Group K), IV tramadol 0.5 mg/kg (Group T) or normal saline as control (Group P) after intrathecal injection of 0.5% hyperbaric bupivacaine 12.5 mg (2.5 ml) and 25 mcg fentanyl. The frequency and degree of shivering, haemodynamic parameters, core body temperature and side effects of the studied drugs were recorded for the first 30 minutes.
RESULTS: The incidence of shivering was 8% in Group K, 16% in Group T and 24% in Group P. This result was statistically significant between Groups K and P. Patients from Group K also exhibited significantly higher mean arterial blood pressure and heart rate at 5 and 15 minutes post intrathecal injection while their mean core temperature was also significantly higher. Side effects such as nausea, vomiting, hallucination, agitation and sweating were comparable between all three groups. Patients from Group K however, had significant higher incidence of behavioural changes (blunted affect or catatonic state) and nystagmus.
CONCLUSIONS: Prophylactic use of IV ketamine 0.5 mg/kg significantly reduced the frequency and the intensity of perioperative shivering associated with spinal anaesthesia but also exhibited some side effects of the drug. Lower doses of prophylactic ketamine should be studied.
KEYWORDS: ketamine; shivering; spinal anaesthesia; tramadol
Levobupivacaine is the S(-)enantiomer of bupivacaine, a long acting amino-ester local anaesthetic agent. Cocktail mixture of levobupivacaine and fentanyl infusion is commonly given via epidural for post-operative analgesia. The concentration of levobupivacaine for optimal pain relief with least side effects remained uncertain.
We present a rare case of a multifocal sclerosing haemangioma of the lung in a 49-year-old lady. A left pneumonectomy with complete excision of the tumour seems to be the curative treatment. The recent literature on this unusual presentation is reviewed.
A middle-aged lady presented with a three-month history of chronic cough. After a long and extensive investigation, CT thorax revealed collapse consolidation of the right lower lung lobe and bronchoscopy showed a polypoidal tumour within the involved bronchus. Thoracotomy and segmental lung resection revealed a peanut in the airways of the fibrotic and infected lung tissue. In view of the rarity of the food particle aspiration in a healthy adult, the delay in presentation and diagnosis in our patient, we would like to highlight this particular case. A high index of suspicion of FBA is necessary to avoid unnecessary anxiety, extensive investigations and overzealous treatment as well as to promote lung conservation.
Acute aortic dissection is a life-threatening condition, warranting prompt diagnosis and treatment. Management of which incorporates multidisciplinary expertise from the medical, surgical and intensive care. If left untreated, the mortality rate of acute aortic disease exceeds 50% within 48 hours and 80% within two weeks, with a 5-year survival rate of 19%. The most common cause of death in untreated acute aortic dissection, regardless of aetiology, is aortic rupture. We would like to share our successful experience of cases at the two extreme ages of acute aortic dissection. Literature review with their pathogenesis are discussed.
The safety, feasibility and post-operative outcome are the main concern in Off-pump Coronary artery bypass graft (OPCAB) surgery as compared to conventional technique especially in multi-vessels coronary artery disease.
The effect of the duration of ischaemic myocardial time to left ventricular ejection fraction (LVEF) after valve replacement surgery has been attributed. This study aims to look at the correlation between myocardial ischaemic time and changes LVEF post valve replacement surgery up to 6 months period.
The incidence of primary hyperhidrosis ranges between 2-5%. This condition is more common than previously thought of and has been linked to a familial predisposition. It is socially disabling to the affected individuals. In the current era of minimally invasive surgery, the video assisted thoracoscopic sympathectomy has become the definitive treatment with minimal complications. We report on a case of two siblings with primary hyperhidrosis that was treated successfully at our institution with the aim to share our experience and attract awareness among medical practitioners of the availability of a cure for this condition.
This study was conducted to evaluate the practicability, effectiveness, and potential complications of a newly improvised pocket-sized Heimlich valve named the Pneumostat (Atrium Medical Corp, Hudson, NH).
A 23 year old female with a past history of a lung abscess diagnosed at the age of 13 years presented with recurrent episodes of productive cough. Chest radiograph and a high resolution CT scan of the thorax led to the diagnosis of a left lower lobe lung abscess. She underwent a successful thoracotomy and a left lower lobe lobectomy. Histopathological examination revealed the diagnosis of an infected congenital bronchogenic cyst. The recent literature on this is reviewed.