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Ambi U.,SN Medical College and HSK Hospital | Koppal R.,SN Medical College and HSK Hospital | Joshi C.,SN Medical College and HSK Hospital | Prakashappa D.S.,SN Medical College and HSK Hospital | Iyer H.,T N Medical College And B Y L Nair Ch Hospital
Journal of Clinical and Diagnostic Research | Year: 2011

Introduction: Airway management is a fundamental aspect of the anaesthesia practice and of emergency and critical care medicine.The proseal laryngeal mask airway (PLMA), a modified version of the classic laryngeal mask airway (LMA), is being considered as an alternative airway device for a wide range of surgical procedures. The aim of the study was to assess the use of the PLMA as a ventilatory device in anaesthetized, paralyzed patients for various elective procedures. Materials and Methods: This prospective study comprised of 50 patients between the ages of 18-60 years, of either sex and belonging to the physical status ASA I and ASA II. We assessed the haemodynamic responses to the insertion of the PLMA, ventilatory parameters, the ease of the gastric tube placement, gastric insufflation and any postoperative complications. Results: The statistically analyzed results showed that the PLMA caused minimum haemodynamic responses to the insertion and that it was a reliable airway management device which ensured adequate ventilation and provided an effective glottic seal. Conclusion: We conclude that the Proseal LMA is capable of achieving a better seal than the LMA and facilitating gastric placement, but later is more difficult to insert.


Koppal R.,SN Medical College and HSK Hospital | Adarsh E.S.,SN Medical College and HSK Hospital | Ambi U.,SN Medical College and HSK Hospital | Anilkumar G.,SN Medical College and HSK Hospital
Journal of Clinical and Diagnostic Research | Year: 2011

Background: The role of effective premedication in children is of utmost importance in the conduct of paediatric anaesthesia. Midazolam is a proven and safe sedative anxiolytic in the paediatric group. Objective: To evaluate the safety and effectiveness of Midazolam by the transnasal and oral routes for paediatric sedation. Materials and Methods: We evaluated 60 ASA grade I and II children who were randomized to receive either oral (0.5mg/kg) or transnasal (0.5mg/kg) midazolam. The demographic details, the sedation score and the separation score were noted by a blinded observer and were statistically analysed. Results: Both the routes were equally effective in achieving the adequate sedation and the separation scores. The transnasal route showed a faster onset of the adequate sedation scores. The oral route was better accepted by children.


Shaileshkumar M.E.,SN Medical college and HSK Hospital | Mirji P.,SN Medical college and HSK Hospital | Vishwanath G.,SN Medical college and HSK Hospital | Basarkod S.I.,SN Medical college and HSK Hospital | And 2 more authors.
Journal of Clinical and Diagnostic Research | Year: 2012

Introduction: In spite of newer advances, split thickness skin grafts (STSG) still have an important place in many areas of general and plastic surgery. Though the technique of skin grafting is more or less standardized, the treatment of the donor site differs greatly and has been a topic of debate. The management of split-thickness skin graft donor site is targeted towards promoting the healing process, while minimizing adverse effects and complications. Objective: To compare the percentage of epithelialization achieved by Hydrocolloid in comparison to Standard meshed Paraffin gauze on the Split thickness donor site on 12th post operative day. Design: Clinical control trial Setting: H S K hospital, Bagalkot Population: 30 adult patients requiring STSG for various etiologies between April 2011 to August 2011. Materials and Methods: The study included 30 adult patients. Half of the skin graft donor site in the proximal thigh was dressed with Hydrocolloid dressings and the rest with Standard paraffin Gauze dressing. The extent of epithelialization achieved by each of these dressings was assessed on 12th post op day after skin grafting. Results: The number of donor areas that achieved complete (100%) epithelialization on the 12th post operative day by Paraffin gauze dressing was 7 (23.3%), whereas Hydrocolloid dressing achieved complete epithelialization in 18 donor sites (60%) (P = 0.016). Conclusion: Hydrocolloid dressings are superior to Standard meshed Paraffin gauze dressings in the treatment of Split thickness skin graft donor areas.


Mirji P.,SN Medical College and HSK Hospital | Emmi S.,SN Medical College and HSK Hospital | Joshi C.,SN Medical College and HSK Hospital
Journal of Clinical and Diagnostic Research | Year: 2012

Varicose veins are a common condition that the current paper elaborates the features of the condition in a local Indian population. Methodology: Over a two year period all admitted patients to a government tertiary level district hospital of varicose veins were evaluated for demographics, clinical manifestations, treatment and outcome. Results: This study reveals that the disease is more prevalent during the active adult life in their 3rd and 4th decades and males were more affected. The occupations needing prolonged standing and use of violent muscular efforts is found to be a contributing or precipitating factor for varicose veins. Hereditary factors may play an important role in the development of varicose veins. 25% of patients had a family history of varicose veins occurring in close relatives. Majority of patients presented to the hospital for complications of the disease (60%) rather than for cosmetic purposes. The commonest symptoms in the study were prominent swellings in the lower limb and pain. Majority of the patients had combined valvular incompetence (71%). The most common post-operative complication observed was wound infection (25%).


Mirji P.,SN Medical College and HSK Hospital | Joshi C.,SN Medical College and HSK Hospital | Mallapur A.,SN Medical College and HSK Hospital | Vishwanath G.,SN Medical College and HSK Hospital | Emmi S.,SN Medical College and HSK Hospital
Journal of Clinical and Diagnostic Research | Year: 2011

Introduction: A corrosive injury to the upper gastrointestinal tract is a common problem and has a wide spectrum of presentations. We have prospectively evaluated 16 patients who ingested corrosive substances for the location, extent and the severity of injury and its outcome. The best time to assess the injury is by 12-48 hours of ingestion of the corrosive substances. Upper gastrointestinal (GI) endoscopy is the single most important investigation which helps to grade the injury and to plan the further management. Materials and Methods: All the patients who presented to the Casualty and to the Out patients Department of the H S K hospital, Bagalkot, during August 2009 to July 2010, with a history of corrosive agent ingestion were admitted and resuscitated. In the indicated cases, upper GI endoscopy was done to assess the severity of the injury. The following grading system was used. Grade 0- Normal mucosa, Grade1(superficial)- Superficial hyperaemia and oedema, Grade2A (Transmucosal)- Haemorrhage, exudates, linear erosions, blisters, shallow ulcers involving the mucosa and the submucosa, Grade2B- Circumferential burn present, Grade3-Deep ulceration, eschar formation with necrosis, full thickness injury with and without perforation. Results: Out of the 16 patients, 10 were females and most were of the age group of 10-30 years.10 had consumed acid and 3 alkalis and in another 3 cases, the substance which was ingested was not elicitable. 15 patients had consumed the substances with suicidal intentions and in only one patient it was accidental. The predominant symptom was pain and most had oesophageal injuries. The grade 2 injury was the most common type of injury. 13 patients were managed conservatively and 3 required surgery. The most common complication was a stricture in the oesophagus. Conclusion: The corrosive injury is more common in females. Most of the patients were of younger ages. Acid ingestion was more common than alkali ingestion, and most had suicidal intentions. Early upper G.I. endoscopy has a definite role in diagnosing the severity of the injury and in planning the management. Most of the patients with corrosive injuries can be managed conservatively with follow up for the stricture, which is the most common complication that is often treated by dilatation.


Goudar B.V.,SN Medical College and HSK Hospital | Ambi U.,SN Medical College and HSK Hospital | Lamani Y.,SN Medical College and HSK Hospital | Telkar S.,SN Medical College and HSK Hospital
Journal of Clinical and Diagnostic Research | Year: 2011

Small bowel injury following blunt abdominal trauma has been widely reported. Isolated jejunal perforation which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Here, we present two cases of isolated jejunal perforation due to raised intra abdominal pressure in the form of abdominal tightening by the dhoti after it was caught in the belt of an engine and a fall from the stairs while stepping down. Explorative laparotomy revealed the slit-like perforation on the anti mesenteric border. Early surgical intervention led to good recovery in both the cases. A high index of suspicion, repeated clinical examination and the proper utilization of investigational tools definitely helped us in managing these kinds of rare cases.


Ambi U.,SN Medical College and HSK Hospital | Bhanupriya P.V.V.,SN Medical College and HSK Hospital | Hulkund S.Y.,SN Medical College and HSK Hospital | Prakashappa D.S.,SN Medical College and HSK Hospital
Indian Journal of Anaesthesia | Year: 2015

Background and Aims: Ultrasound (US)-guided regional blocks are becoming increasingly popular as its use increases success rate, shortens block onset time and reduces complications. Currently, there exist two methods to perform US-guided axillary brachial plexus block (US-ABPB), the perivascular (PV) and the perineural (PN) techniques. We compared the two techniques to study the block characteristics and other variables using levobupivacaine. Methods: In this prospective, randomised trial, 60 patients were randomly allocated to receive a PV (n = 30) or PN (n = 30) US-ABPB. The local anaesthetic agent, 0.5% levobupivacaine and total volume of 36 ml of solution were identical in all the subjects. For both the groups, the musculocutaneous nerve was first located and then anaesthetised with 6 ml. Subsequently in the PV group, 30 ml was deposited dorsal to the axillary artery (6 o’clock position). In PN group, the median, ulnar and radial nerves were individually anaesthetised with volumes of 10 ml each. The onset and duration of sensory block, the onset and duration of motor block, number of failed blocks and complications were noted. Results: No difference was observed between the two groups in terms of success rate (PV - 93.33%, PN - 96.66%), sensory onset (PN: 8.07 (standard deviation [SD] ± 0.651) min and PV: 8.14 [SD ± 1.079] min; P = 0.754), motor onset (PN: 14.62 [SD ± 2.077] min and PV: 14.93 [SD ± 1.844] min; P = 0.557) and total duration of anaesthesia. No complications were observed in both groups. Conclusion: The PV technique provides a simple alternative for PN US-ABPB. In the light of emerging needling positions for PV and PN techniques, this study calls for large scale trials and much research in this area before one defines best or safe approach. PV technique may be considered as an alternative method for US-ABPB in patients with anatomical variation or difficulties in identifying the individual nerves. © 2015, Indian Journal of Anaesthesia.


Suresh B.,SN Medical College and HSK Hospital | Ambi U.S.,SN Medical College and HSK Hospital | Anilkumar G.,SN Medical College and HSK Hospital | Shaileshl E.,SN Medical College and HSK Hospital | Lamani Y.P.,SN Medical College and HSK Hospital
Journal of Clinical and Diagnostic Research | Year: 2012

Objectives: To assess the post-operative analgesic requirement of non-closure of the visceral and parietal peritoneum at open appendectomy as compared to suture peritonization. Design: A randomized double-blind controlled trail was performed on 100 patients who underwent open appendectomy. Main outcome measures: Post-operative pain scores as assessed by visual analogue scale and analgesic requirement. Results: Pain scores at 24 hours were less in non-closure than closure group and analgesic requirement was signifcantly lesser in non-closure than closure group after 24 hours. Conclusion: In conclusion, not suturing the peritoneum at the appendectomy has benefcial effects on post-operative pain and we also emphasise the absence of short term morbidity when peritoneum is not closed. Therefore we recommend the non-closure of peritoneum at appendectomy.


Goudar B.V.,SN Medical College and HSK Hospital | Lamani Y.P.,SN Medical College and HSK Hospital | Kalburgi E.B.,SN Medical College and HSK Hospital
Journal of Clinical and Diagnostic Research | Year: 2011

Jejunal diverticulosis (JD) is a rare disease of elderly people. A majority of the diagnosed individuals are asymptomatic and are found incidentally on laparotomy. The disease is clinically significant because of the associated potential risk of serious complications. Due to the variable presentation and the rarity of this clinical entity, its diagnosis is often difficult and delayed, resulting in unnecessary morbidity and mortality. In our institute, we came across a case of jejunal diverticulae - which presented as acute intestinal obstruction.


PubMed | SN Medical College and HSK Hospital
Type: Journal Article | Journal: Indian journal of anaesthesia | Year: 2015

Ultrasound (US)-guided regional blocks are becoming increasingly popular as its use increases success rate, shortens block onset time and reduces complications. Currently, there exist two methods to perform US-guided axillary brachial plexus block (US-ABPB), the perivascular (PV) and the perineural (PN) techniques. We compared the two techniques to study the block characteristics and other variables using levobupivacaine.In this prospective, randomised trial, 60 patients were randomly allocated to receive a PV (n = 30) or PN (n = 30) US-ABPB. The local anaesthetic agent, 0.5% levobupivacaine and total volume of 36 ml of solution were identical in all the subjects. For both the groups, the musculocutaneous nerve was first located and then anaesthetised with 6 ml. Subsequently in the PV group, 30 ml was deposited dorsal to the axillary artery (6 oclock position). In PN group, the median, ulnar and radial nerves were individually anaesthetised with volumes of 10 ml each. The onset and duration of sensory block, the onset and duration of motor block, number of failed blocks and complications were noted.No difference was observed between the two groups in terms of success rate (PV - 93.33%, PN - 96.66%), sensory onset (PN: 8.07 (standard deviation [SD] 0.651) min and PV: 8.14 [SD 1.079] min; P = 0.754), motor onset (PN: 14.62 [SD 2.077] min and PV: 14.93 [SD 1.844] min; P = 0.557) and total duration of anaesthesia. No complications were observed in both groups.The PV technique provides a simple alternative for PN US-ABPB. In the light of emerging needling positions for PV and PN techniques, this study calls for large scale trials and much research in this area before one defines best or safe approach. PV technique may be considered as an alternative method for US-ABPB in patients with anatomical variation or difficulties in identifying the individual nerves.

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