Pak J Med Sci
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To summarize our experience in the anesthetic management of conjoined twins undergoing one-stage surgical separation. ⋯ Medical records of conjoined twins admitted to our hospital for treatment and considered for surgical separation from 1996 to present were retrospectively reviewed. Four cases of conjoined twins underwent one-stage surgical separation under general anesthesia. Preoperative evaluation was performed to determine the extent of anatomical conjunction and associated anomalies. Anesthesia was simultaneously induced in all conjoined twins. The intubation procedure was successfully performed with the head slightly rotated to each baby's side, followed by the administration of vecuronium. Anesthetic agents were administered according to the estimated weight of each baby. One case of conjoined twins underwent surgical separation with cardiopulmonary bypass due to shared hearts. Results : All conjoined twins were successfully separated. No significant respiratory or cardiac events occurred during surgery except for one twin, which died after separation because of complicated congenital heart disease. Conclusions : Accurate preoperative evaluation, respiratory and circulatory management, and close cooperation of the multidisciplinary team are important aspects of anesthetic management of conjoined twins surgery.
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Inadequate postoperative pain relief after cesarean section can increase complications. In this study, we evaluated the effect of intrathecal betamethasone as an adjunct to bupivacaine on postoperative pain in patients undergoing cesarean section. ⋯ Intrathecal betamethasone reduced pain and decreased the required dose of diclofenac in 24 hours after cesarean section.
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To assess the accuracy of emergency physicians (EPs) in the interpretation of non-contrast CT Brain (NCCT Brain) by examining the inter rater reliability between EPs and radiology specialists. ⋯ A four months prospective cohort study was conducted at emergency department of King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. We studied the daily performance of our EPs, and compared it to the radiological report issued within the week after. Data were analyzed by calculating sensitivity, specificity, accuracy and agreement (kappa statistic), using radiology report as the reference standard. Results : Out of 241 cases eligible for the study, 210 (87.14%) were concordant, and 31 (12.86%) were discordant. The agreement (kappa) was to be 0.64. Conclusion : We concluded that our EPs are moderately accurate at interpreting NCCT Brain studies. Further education and training programs were necessary for all our EPs to improve the accuracy. Further studies are required to determine the most cost-effective method of minimizing consequential misinterpretations.
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To compare the postoperative complications between Laryngeal Mask Airway (LMA) and endotracheal tube (ETT) during low-flow anesthesia with controlled ventilation. ⋯ If careful measures regarding insertion techniques, correct LMA position and routine monitoring of LMA cuff pressure are taken, LMA can be used as a safe alternative with lower incidence of post operation complication compared with ETT during low-flow controlled anesthesia with modern anesthetic machines.
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Vancomycin resistance is due to change in ligase enzyme that destroys the binding of the drug. The gold standard is culture; but now molecular methods have also been developed. The aim was to detect the VRE rate at ICUs by culture and BD GeneOhm™ VanR and compare the results of both assays. ⋯ This study showed low VRE positivity due to factors like inhibition in PCR or culture negativity due low inoculum for bacterial growth. Early detection of VRE is an important issue especially in ICUs and molecular techniques are important tools; but against all, we still need to confirm this method with culture based techniques and in order to do this further studies with higher number of patients with VRE colonisation are required.