Amritsar, India
Amritsar, India

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PubMed | BJ Medical College and Civil Hospital, SGRDIMS and R and Paras Hospital
Type: Journal Article | Journal: Anesthesia, essays and researches | Year: 2015

Perioperative fluid management in elderly poses considerable challenge to the anesthesiologist. The conventional crystalloid loading may not be a preferred regime in this subgroup of patients since an exaggerated hemodynamic response is expected due to blunted sympathetic response and compromised cardiorespiratory system.This study was designed in the elderly patient for comparing efficacy, side-effects and limitations of prophylactic ephedrine 30 mg (intramuscular [i.m.]) versus polygeline 3.5% 500 ml (intravenous [i.v.]) for the maintenance of blood pressure after subarachnoid block (SAB).The sample size of 100 elderly (age > 50 years) patients undergoing orthopedic surgeries was administered SAB using bupivacaine 0.5% heavy. The primary outcome of this study was the attenuation of hypotension due to SAB using ephedrine or polygeline 3.5%.A total of 100 patients were randomly allocated to receive ephedrine 30 mg i.m. 10 min before the institution of SAB in Group I and preloading with 500 ml of polygeline 3.5% i.v. over 10 min prior to SAB in Group II. Patients in both groups were closely monitored for pulse rate, systolic blood pressure; any hypotension, requirement of rescue therapy and adverse effects.Results were interpreted using Students t-test for parametric and Chi-square tests for nonparametric data.The incidence of hypotension and requirement for rescue therapy was statistically less in Group I compared with Group II (P < 0.05). Heart rates were better maintained in Group I than Group II, with few hemodynamic adverse effects in both groups.Ephedrine 30 mg i.m. given as pretreatment before SAB in elderly patients was more effective for the prevention of post-SAB hypotension.


Piplani S.,SGRDIMS and R | Mannan R.,SGRDIMS and R | Bhasin T.,SGRDIMS and R | Manjari M.,SGRDIMS and R | Gill K.,SGRDIMS and R
Journal of Clinical and Diagnostic Research | Year: 2014

Distant metastasis of thyroid neoplasm as an initial presentation is rarely encountered. The present case report describes a chance diagnosis of follicular carcinoma thyroid (FCT) metastasis in a 75-year-old female who was presented with symptoms related to pelvic mass. This is a rare site of reporting as only three cases have been reported previously at the first diagnosis. It is important to identify the presence of distant metastasis as it is the most important prognostic indicator (associated with 50% mortality). This is significant as this has a direct bearing upon its treatment and managing the patient. Hence more awareness is required by both diagnosticians and clinicians regarding this.


Singh K.,SGRDIMS and R | Singh S.,SGRDIMS and R | Singh S.,Sri Guru Ram Das Institute of Medical science and Research | Thukral C.L.,SGRDIMS and R | Singh A.,SGRDIMS and R
Radiography | Year: 2014

Esophageal fibrovascular polyps are rare benign tumors usually arising from proximal 1/3rd of the esophagus. Clinically they are asymptomatic or present with varying degree of digestive and respiratory symptoms depending upon their structure. The diagnosis usually requires multimodality approach including invasive endoscopy. We report a case of mobile cervical esophageal polyp where plain radiography alone was diagnostic; further workup included barium studies, computed tomography and therapeutic endoscopy. © 2014 The College of Radiographers.


Gupta R.,SGRDIMS and R | Kaur S.,SGRDIMS and R | Singh S.,SGRDIMS and R | Aujla K.S.,SGRDIMS and R
Journal of Anaesthesiology Clinical Pharmacology | Year: 2011

Background: Post operative analgesia in patients undergoing lower limb surgery is very essential for immediate postoperative pain relief which can be provided by oral or parentral medication, epidural analgesia, local blocks etc. The study was designed to evaluate the efficacy of epidural butorphanol and tramadol for postoperative pain relief. Patients & Methods: This was randomized, prospective, double blind study was conducted on 60 patients, ASA grade I&II, age 18-60 undergoing lower limb surgeries after approval from hospital ethics committee. Group allocation - Group I (n=30) received 2 mg butorphanol as bolus epidurally, 1 mg for top up dose. Group II (n=30) received 100mg tramadol as bolus, 50 mg for top up. All the drugs were diluted to 10 ml normal saline & the observer was blinded to the drugs given. Postoperatively VAS, sedation score, vitals & side effects were observed. Top ups were given on achieving VAS>4. Diclofenac 75mg was given as rescue analgesia. Results: Duration of analgesia was 5.35±0.29 hr and 6.25±1.58 hrs in Butorphanol and Tramadol groups respectively and the difference was found to be statistically significant. Pain scores were also significantly lower statistically in Group I as compared to Group II. Sedation scores were significantly higher in butorphanol group, whereas nausea vomiting was seen in tramadol group only (4 patients).No other side effects were observed. Conclusions: Both butorphanol and tramadol were effective for relieving postoperative pain, however quality of analgesia & patient satisfaction was more with butorphanol.


Singh A.,SGRDIMS and R | Gupta R.,SGRDIMS and R | Vashisth M.,SGRDIMS and R | Singh S.,SGRDIMS and R | And 2 more authors.
Journal of Anaesthesiology Clinical Pharmacology | Year: 2010

Background: Various approaches of Brachial plexus block (BPB) such as supraclavicular & axillary have their own indications. In order to achieve the added advantages, these techniques were combined and a study was conducted to assess the efficacy of block using combined techniques compared to individual technique. Patients & Methods: This prospective randomized study was conducted on 75 patients of age 18-60 years and ASA grade I and II scheduled for upper limb surgery. The patients selected were allocated into three groups of 25 each, Group I: given brachial plexus block via supraclavicular approach, Group II: given brachial plexus block via axillary approach, Group III: given brachial plexus block via combined approach (supraclavicular and axillary). All patients received 40ml of xylocaine with adrenaline in the dose of 7mg kg -1 body weight, after identification with nerve stimulator. The present study was designed to compare these three techniques of brachial plexus block for onset of anesthesia; degree , duration of sensory & motor block and their complications. Results: On statistical analysis the results showed that the onset of anesthesia was significantly short in combined and supraclavicular approach i.e. 7.56 ± 2.161 minutes and 7.913 ± 2.29 minutes respectively compared to axillary approach (16.18 ± 2.648 minutes). The combined and supraclavicular groups had significantly lower sparing of axillary nerve and musculocutaneous nerve as compared to axillary group. The combined group was better than supraclavicular group in terms of reduced incidence of ulnar nerve sparing, though the difference was insignificant statistically. The difference in duration of sensory & motor blockade in all three groups was statistically insignificant. The extent of motor blockade was significantly higher in the combined group. Block failure was significantly lower in the combined group as compared to other groups. In all the three groups no statistically significant difference was there regarding complications related to haemodynamics and procedure. Conclusion: Combining supraclavicular and axillary approach for brachial plexus block is more effective than individual techniques.

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