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Methodological Issues in Nonpharmacological Trials for Chronic Pain
By Professor Michael I. Bennett, Professor S. Jose Closs
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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7 views | Related Articles |
126-132 Page(s)
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Abstract
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Nonpharmacological interventions are best regarded as complex interventions, and it is important to understand
their mechanism of action more fully and test study methodology before formal evaluation. These aspects
can be achieved through process evaluations, both by undertaking feasibility studies and monitoring trial
processes along with outcomes, particularly through the use of qualitative interviews. Many of these interventions
can, and often do, help, particularly as a supplement to pharmacological intervention, but they need rigorous
evaluation in order to show how to implement them in routine practice... |
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Keywords
Bennett MI, Closs SJ. Methodological issues in nonpharmacological trials for chronic pain (Review
Article). Anaesth Pain & Intensive Care 2011;15(2):126-132.
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Safety Concerns Start well before Anesthesia Machine
By Mansoor Aqil, MBBS, FCPS, Altaf Hussain, MBBS, FCPS
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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123-125 Page(s)
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Abstract
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We report a case of sudden onset of an unfamiliar, continuous sound in the operating room during an elective
surgical procedure, which was found to be due to leakage of nitrous oxide from a hole in the ballooned up
part of the flexible hose pipeline of the anesthesia machine. A slowly leaking hose pipe may be hazardous
to the safety of patients as well as staff; a sudden burst of a hose pipe can result in confusion among the busy
staff. A need to have guidelines regarding routine checking of hose pipes and printing date of expiry indicating
life span of these pipes is stressed... |
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Keywords
Hose pipe; Leakage; Operating room hazards
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Acute Massive Pulmonary Edema and Myocardial
Infarction after Intranasal Infiltration of Adrenaline
during Septorhinoplasty
By Indira Kumari, MD, Udita Naithani, MD, Sandeep Arora, MBBS, Pradeep Gupta, MBBS
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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118-122 Page(s)
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Abstract
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We present a case report of 13 years old male child undergoing septorhinoplasty under general anesthesia,
who developed acute massive pulmonary edema following intranasal infiltration of 330 micrograms of inj.
adrenaline by the ENT surgeon. Echocardiography showed local wall hypokinesia with ejection fraction (EF)
reduced to 20% and raised troponin-T levels (10 times of normal) suggesting it was adrenaline induced acute
myocardial infarction and subsequent cardiogenic pulmonary edema. The surgery was postponed and the
patient was successfully treated in ICU with positive pressure ventilation, frusemide and ionotropic support... |
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Keywords
Cardiogenic pulmonary edema; Acute myocardial infarction; Adrenaline; APE (adrenaline induced
Pulmonary edema).
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Acute Pulmonary Edema after Evacuation of Molar Pregnancy
By Sonali Bhatia, M.D, Udita Naithani, MD, Yogesh Kumar Chhetty, M.B.B.S,
Narendra Prasad, M.B.B.S, Shweta R Jagtap, M.B.B.S, Ila Agrawal, M.D
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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2 views | Related Articles |
114-117 Page(s)
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Abstract
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Cardiopulmonary dysfunction has been observed after the removal of benign hydatidiform mole which can
lead to substantial morbidity and mortality. We report a 20 year old woman who came to casualty with a gush
of per vaginal bleeding; associated findings were hypotension, anemia and tachypnoea. Evacuation of the
mole was done under general anesthesia as an emergency procedure. Immediately after evacuation she developed
acute massive pulmonary edema that progressed to adult respiratory distress syndrome. In spite of extensive
peri-operative management in the form of vasopressors and ventilatory support, mortality occurred after 12
hours post operatively... |
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Keywords
Cardiopulmonary distress; Hydatidiform mole; Adult respiratory distress syndrome; Molar
pregnancy
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Our Experience of Anesthetic Management for Separation of
Craniopagus Conjoined Twins
By Muhammad Iqbal Memon, MBBS, MCPS, FCPS, Nusrat Ali, MBBS, DA,
Rehmat Ali, MBBS, MCPS , Akhtar Afzal Sabzwari, MBBS
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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3 views | Related Articles |
111-113 Page(s)
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Abstract
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Summary: We describe the anesthetic/airw ay management for surgical operations in conjoined twins
(Craniopagus) in Children Hospital, PIMS, Islamabad, in January 2011. The anesthetic technique and associated
problems are summarized.
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Keywords
Conjoined twins; Anesthesia; Airway management
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Combined Spinal Epidural Anesthesia for an Unusually
Prolonged Caesarean Section in a Morbidly
Obese Patient
By Amer Majeed, FCARCSI, Mark Tindall, FRCA, Iftilhar Ahmed, FCPS, FCARCSI, FRCA
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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2 views | Related Articles |
106-110 Page(s)
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Abstract
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Summary: We present a case re port of elective Caesarian section of a morbidly obese par turient under
combined spinal epidural (CSE) technique, which, somehow, lasted for more than five hours. The patient
remained awake of her own desire and she refused conversion to general anesthesia. The course of anesthesia
required careful titration of the local analgesic solutions, well beyond the usual admissible total doses, and
maintenance of her hemodynamic parameters.
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Keywords
Morbid obesity; Caesarian section; Combined spinal epidural (CSE)
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Assessment of Utilization and Outcomes of Drotrecogin Alpha
(Activated) for Critically Ill Patients with Sepsis at a Government
Acute Care Hospital: A Retrospective Study
By Said Abuhasna, Zakarya Hussein Harb, Amer H.Al Jundi, BPharm, BCNSP, BCPS
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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3 views | Related Articles |
102-105 Page(s)
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Abstract
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Objectives: Several quality improvement projects have documented the positive outcome of protocol-driven
sepsis care. Drotrecogin Alpha Activated (DAA) (recombinant human activated protein C) has been advocated
and used in the treatment of septic shock in suitable patients. The primary objective of this retrospective
study was to evaluate the utilization of DAA guidelines at our institution, and the financial impact of
inappropriate use of this agent due to any cause. The secondary objectives were to assess outcome in terms
of mortality at 28-days and the incidence of serious bleeding events during the infusion... |
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Keywords
Drotrecogin alpha; Outcome; Sepsis; Medication-use evaluation; APACHE II
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Job Satisfaction in Pakistani Anesthesiologists
By Tariq Hayat Khan, MCPS, FCPS
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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93-101 Page(s)
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Abstract
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AIMS: The purpose of this study is to provide empirically-based evidence about Pakistani anesthesiologists
job satisfaction, upon which recommendations can be made to physicians, managers, and policy makers.
Type of study: A questionnaire based, cross-sectional study.
Place & Duration: Islamabad; July 2008-January 2010.
Methodology: A questionnaire was designed so as to accumulate evidence about the level of JS, mailed by
post to known addresses of all anesthesiologists across the country and was also e-mailed to anesthesiologists
via direct e-mailing... |
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Keywords
Anaesthetists; Job satisfaction; Working conditions
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One Year Prospective Analysis of Morbidity and Mortality
Associated with Thoracic Surgery
By Udita Naithani, M.D., Pramila Bajaj, M.D., F.I.C.S., F.A.M.S., Neelesh Bhatnagar, M.D.,
Narendra Prasad C. M.B.B.S.
© 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 2
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1 views | Related Articles |
86-92 Page(s)
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Abstract
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Objectives: To evaluate the morbidity and mortality associated with thoracic surgery in adult patients over a
period of one year.
Design: Prospective, descriptive, clinical study.
Methodology: Thirty patients (24 men and 6 women), who underwent various thoracic surgeries over a period
of one year (1 December 2008 to 31 December 2009), w ere studied. The primary outcome was discharge
from the hospital within 14 days after surgery.
Results: The mean age of the patients was 28.37±14.12 yrs. The surgical procedures were as follows: 13(43%)
decortications, 6(20%) thoracoplasty, 6(20%) excision of a cyst, 2(7%) segmentectomy, 2(7%) lobectomy, and
1(3%) pneumonectomy... |
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Keywords
Lung surgery; Outcome; Mortality; Postoperative complications
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The Causes, Prevention and Management of
Post Spinal Backache: An Overview
By Mohammad Kashif Rafique, FCPS, Arshad Taqi, FCPS © 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 1
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3 views | Related Articles |
65-69 Page(s)
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Abstract
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Back pain is one of humanitys most frequent complaints, a common reason for physician visits and a major
psychological, physical and economical burden. Although the frequency of backache is as high as 46% even
after general anaesthesia, it was the major cause for 13.4% patients refusing spinal anaesthesia. Multiple factors
are involved in the pathogenesis of postoperative back pain and include type and duration of surgery, duration
of immobilization, and the position of the patient during spinal puncture... |
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Keywords
Backache; Postoperative back pain; Spinal needle; Transient neurologic symptoms
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Interventional Pain Management Techniques can be
Helpful in Headache Management
By Ishrat Bano, PhD, Waqas Ashraf Chaudhary, MD
Mohammed Ashfaq, MD, PGAc, LicWHO © 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 1
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7 views | Related Articles |
60-64 Page(s)
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Abstract
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In this case series we present three different interventional procedures used to treat headache. The procedures,
e.g. occipital nerve block, cervical injection and trigger point injection, are described and the suppor ting
literature is reviewed. |
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Keywords
Emergency department (ED); migraine; cervical injections; trigeminovascular system; cephalgia;
occipital nerve block; trigger point injection.
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Tension Pneumothorax Caused by Ventilating Rigid
Bronchoscopy for Removal of Foreign Body
By Safdar Hussain, MCPS, Riaz Ahmed Khan, MCPS, FCPS,
Muhammad Iqbal, FCPS © 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 1
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57-59 Page(s)
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Abstract
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Tension pneumothorax during ventilating bronchoscopy for foreign body removal is a rare but life threatening
complication, which if not promptly diagnosed and treated can pro ve fatal. We present a case of tension
pneumothorax, due to a laceration in the right main bronchus caused by bronchoscope, in a one year old child,
who underwent bronchoscopy for removal of foreign body (bead). The child was successfully treated and
managed by immediate insertion of 14 gauge IV cannula in the pleural cavity followed by chest tube insertion... |
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Keywords
Ventilating bronchoscopy; Tension pneumothorax
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Anesthetic Management of the Parturient with
Combined Protein C and S Deficiency
By Tahira Batool, Bushra Babur, Shahida Tasneem © 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 1
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54-56 Page(s)
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Abstract
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Protein S is a vitamin K de pendent co-factor of protein C. Deficiency of Protein C and S results in a
hypercoagulable state, which is treated with anticoagulation. This is the first report of a patient with combined
protein C and S deficiency, who underwent a Cesarean section under spinal anesthesia in KRL Hospital
Islamabad (Pakistan). |
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Keywords
Protein C and S deficiency; spinal anesthesia; caesarean section
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Dental Braces Bracing a Throat Pack to Cause
Difficulty in its Removal
By Mansoor Aqil, MBBS, FCPS © 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 1
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51-53 Page(s)
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Abstract
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We present an unusual case of dental braces entangled into a throat pack, thus making it impossible to remove
it from the mouth cavity of a patient. The patient, who was emerging from anesthesia, had to be reanesthetised,
to enable removal of the pack. |
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Keywords
Throat pack; anesthesia complication; dental braces
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Removal of a Large Hydatid Cyst in Spleen
By Maqsood Ahmad, FCPS, Muhammad Saqib, FCPS, Mumtaz Ahmad, FCPS,
Muhammad Raees, FCPS © 2011. Anaesthesia, Pain & Intensive Care
Anaesthesia, Pain & Intensive Care, Volume 15, Issue 1
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48-50 Page(s)
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Abstract
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Hydatid disease is caused by the infestation of larvae of Taenia Echinococcus (TE). Humans are infected
through faeco-oral route by the ingestion of food and milk, contaminated by dog faeces containing the ova
of parasite or direct contact with dogs. After coming out of eggs in the gut, larvae get into the portal circulation
and pass through the liver which acts as the first filter. Most of the larvae settle in the liver and lungs, rarely
passing to other organ like brain, spleen and mesentery. We describe an incidental finding of huge hydatid
cyst spleen in an old lady who presented with long standing g eneralized vague complaints... |
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Keywords
Hydatid cyst; splenectomy; laparotomy; old age
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