Aperito Journal of Surgery and Anaesthesia

Introduction Trauma represents a major cause of death in patients presenting in Emergency Department .Abdomen represents a commonly injured region which may often by missed in cases of blunt trauma particularly when compounded with other obvious musculoskeletal injuries. The role of trauma team is to assess, resuscitate and manage all poly-trauma patients in a systematic manner to avoid missing intra-abdominal injuries and manage such patients aggressively.

Materials and Methods This retrospective study was conducted in Liaquat National Hospital, Karachi which is a level 2 Trauma centre. All the data was obtained from the hospital’s registry for the period of 1 year from January 2014 to December 2014. Trauma victims who fulfilled Trauma team activation criteria were included in study with following criteria. Inclusion - 1 – Patients with abdominal trauma with obvious penetrating injury either in the form of gunshot injury, stab wound or any object penetrating the abdomen with or without an exit wound. 2 - Patients with blunt trauma with Ultrasound Fast/ CT scan showing free fluid, hemoperitoneum or visceral injury. 3 – Adult patients more than 18 years of age. 4 – Poly trauma patients with associated abdominal injury. Patients excluded from study were 1 – Trauma patients less than 18 years of age. 2 – Poly trauma patients who had no abdominal injury. 3 – Patients who expired with 10 minutes of presentation within Emergency Department or brought Dead. 

Results A total of 150 trauma calls were generated during the year 2014. Out of these 150 trauma calls, 25 (16.6%) patients met the inclusion criteria of having intra-abdominal injury. Male to Female Ratio was 24:1. Among the patients who sustained abdominal injuries, 9 (26%) patients had blunt trauma to abdomen while 16 (64%) patients had penetrating abdominal injuries. In penetrating Injuries, 15 (60%) cases were due to gunshot injuries while 1 (4%) was due to an assault. 16 (64%) patients required immediate laparotomy. 15 of these patients had penetrating injuries and 1 had blunt trauma, 8 patients were managed conservatively and 1 patient underwent Angio-embolization of splenic artery. Time required to shift patient from ER to OT was variable between 36 minutes to 69 minutes with a mean value of 50 minutes. Patients who were managed conservatively had an ED stay time varying from 40 minutes to 160 minutes with Mean value of 130 minutes. Of 25 patients who had abdominal injuries, 21 (84%) patients survived and 4 (16%) patients expired. Among the patients who went immediate surgical intervention, 3 patients expired. And 1 patient who underwent Angioembolization of splenic artery expired.

 
Conclusion :  Because of the concealed nature of intra-abdominal hemorrhage, one is likely to miss abdomen as a potential source of bleeding until patient decompensates to unresuscitable state of shock. Thus, appropriate management of severe trauma patients can only be achieved by a systematic evaluation by Trauma team according to ATLS guidelines. Our study concluded that the time factor for activation of trauma team and shifting of patient was not the major factor among patients who expired. Although the shifting time was fairly long for patients who were managed conservatively, it was not identified as a cause of death.

Purpose: Recently, a multimodal strategy using various medications and non-pharmacological methods has been recommended for treating Postoperative Nausea and Vomiting (PONV). Cold water gargling may be helpful as one of the nonpharmacological methods. 

Methods: A total of 49 patients were randomly divided into a control group (Group C, n = 25) and a gargling group (Group G, n = 24). When postoperative patients experienced nausea after awaking from the anesthesia, anti emetics were administered to Group C, while Group G patients gargled 2-3 times with 50cc cold water (2-8℃). The extent of nausea in the two groups was measured straight after the treatment and in 30/60 minutes and 24 hours later using the Visual Analogue Scale (VAS) Findings: Immediately after the treatment, the degree of nausea in Group G was lower than in Group C (P = 0.002). However by 30/60 minutes and 24 hours after the treatment, there was no significant difference between the two groups. The number of anti emetics administered after discharge from the PACU was significantly greater in Group C than in Group G.  

Conclusions: Cold water gargling is helpful in reducing postoperative nausea. 

Background: Recently developed strategies (valve repair, homograft implantation) may improve clinical outcome in surgical treatment of infective endocarditis. Careful TEE examination may allow to choice the proper surgical treatment in relation to observed anatomic abnormalities. Aim of present investigation was to analyse survival and recurrent endocarditis in patients in whom surgical strategy was planned by TEE examination.  

Methods: 80 consecutive patients with active infective endocarditis (52 males, 28 females, mean age 59.2 years) were investigated. All patients underwent TEE examination within 24 hours from hospital admission. 78 patients underwent surgery, 2 patients died before intervention.  

Results: Aortic was involved more frequently than mitral valve (38 vs. 28 patients). In 10 both valves were involved. Four had tricuspid endocarditis. 24 underwent aortic valve replacement, 12 aortic homograft implant, 2 aortic valve repair, 18 mitral valve replacement and 13 mitral valve repair. Five underwent mitral and aortic replacement. In tricuspid endocarditis valve was repaired in 2 and replaced in 2. Only in one patient surgical exploration induced to change planned strategy. Hospital mortality was 10.2%. 3 discharged patients died at 18 months follow-up. Endocarditis recurred in 4, 2 being S. Aureus prosthetic tricuspid endocarditis in drug addicts. All patients who underwent valve repair or homograft implant were alive and free of recurrence.  Conclusion: Our results suggest that TEE guided surgical treatment of active infective endocarditis is associated with a low mortality and recurrence rate. 

Patient with Tetralogy of Fallot (TOF) may sometimes present for noncardiac surgery. These patients may have lots of other congenital anomalies, which may need repeated surgeries for their correction. Anaesthetic management in this sort of cases for noncardiac surgeries may pose a real challenge to the anaesthesiologists because of the high incidence of perioperative complications. Cyanotic spell is one among them. Cyanotic spells are usually managed by drugs. But there is report of use of non-pharmacological measures also. In this case report we present successful management of the intraoperative cyanotic spell with intravenous fluids and blood.

Obstructive Sleep Apnea (OSA) is associated with accelerated atherosclerosis, cardiovascular and cerebrovascular disease. Carotid artery Intima-Medial Thickness (CIMT) measurement has recently evolved as an important non-invasive diagnostic tool in atherosclerosis. In the current review, we have analysed the association of increased CIMT values with OSA, correlation of increased CIMT with the severity of OSA and the role of CIMT measurement as a prognostic marker in monitoring disease progression and response to therapy. Although some studies in the last few years have tried to address this issue, more randomised controlled trials recruiting larger number of patients are required to define its exact role in regular clinical practice.