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Article
Day Case Tonsillectomy in Children.
إجراء عملية استئصال اللوزتين لدى الأطفال كحالة يومية

Author: Ahmed Humadi (FICMS) د.احمد حمادي اختصاص الانف الأذن والحنجرة
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2013 Volume: 9 Issue: 2 Pages: 57-60
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Day case surgery has become widely accepted as a safe alternative to the inpatient care in up to 70% of the cases at a children’s hospital. It has the advantage of minimizing the psychological trauma of hospitalization, decreasing nosocomial infection, less costly and frees up hospital beds.Objectives: To assess the advantages and disadvantages of this type of surgery.Methods: this is a prospective study, in which two hundred thirty childhood tonsillectomies were performed as a day-case in the department of otolaryngology at Al Shaheed Gazi hospital, Medical City Complex during the period from October 2009 to September 2010. The patients age range from 3-12 years (Mean 7.2 years).Results: 46.08% males and 53.91% females were included. A total of two hundred twenty three patients were discharged home six hours after the operation. It's found that the incidence of reactionary hemorrhage was 0.8% and the cases presented within 5 hours after leaving the theater. In 99.2% of cases, there was no evidence of serious reactionary hemorrhage.Conclusions: day case tonsillectomy in children is likely to be safe if the patients are discharged after 6 hours period of postoperative observation in day-case unit.

في هذه الدراسة المستقبلية تم دراسة ٢٣٠ طفل أجريت لهم عملية استئصال اللوزتين في م. الشهيد غازي الحريري - مدينة الطب للفترة من تشرين الأول ٢٠٠٩ ولغاية أيلول ٢٠١٠.عمر المرضى يتراوح بين ٣ إلى ١٢ سنة ( المعدل كان ٧،٢ سنة).وهذا يشمل ٤٦،٠٨ ٪ طفل ذكر و ٥٣،٩١ طفل أنثى .تم إخراج ٢٢٣ طفل من المستشفى أجريت لهم عملية استئصال اللوزتين بعد ٦ ساعات من إجراء العملية.وجدنا أن نسبة النزف كانت ٠،٨ ٪ وكانت معظم حالات النزيف حصلت خلال ٥ ساعات بعد مغادرة العملية.٩٩،٢٪ من الحالات لم يكن هناك أي دليل لنزف جدي وخطير.وبناء على ذلك فأن إجراء عملية استئصال اللوزتين كحالة يومية لدى الأطفال من المرجح أن يكون آمنا إذا المريض تم إخراجه بعد ٦ ساعات من المراقبة في وحدة الرعاية للحالات اليومية


Article
Time to Discharge Patients From Day-Case Clinic Comparison Study between Patients Receivedspinal Versus General Anaesthesia

Author: Raghad Hannon Shinen Alsudani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 488-493
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACK GROUND:Day case surgery issurgery where patient returns home on same day of surgery, saving resources, money decreases in-patients number with rapid turnover. Question about the ideal type of anasthesia for such surgery is of interest of many studies.OBJECTIVE:To comparing time to discharge after perianal surgery for patient received spinal anasthesia versus patients received general anasthesia, sample was taken between February 2007,and July 2010, in a private day clinic in Baghdad.PATIENTS AND METHODS:Study included 200 patients ASA(I-II), age 18-60 years. One hundred patients had been received spinal anasthesia with small dose lidocaine 2%, other 100 were received general anasthesia with either propofol or pentothal.RESULTS:Indicate thatspinal anaesthesia with small dose lidocaine achieves shorter time to discharge patients versus general anasthesia; mean time for spinal anasthesia was 105.69min and for general was147.57 min.CONCLUSION: Spinal anaesthesia is a good option for outpatient surgery in comparison to general anasthesia regarding time to discharge patients, and we can achieve better results by simple manipulation in techniques and drug dosage which might decrease unwanted side effects of S.A.


Article
Comparison between Total Intravenous Anesthesia (TIVA) and Conventional General Anesthesia in Day Case Surgical Procedures

Authors: Iyad Abbas Salman --- Ali Yousif Mohammad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: supplement Pages: 700-705
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Day case surgery should be of short duration, rapid recovery, and with low incidence of postoperative complications. For long time was done with conventional inhalational based anesthesia, in last year's, TIVA began to be used in these surgeries.OBJECTIVE:To evaluate total intravenous anesthesia (TIVA), as an aesthetic technique for day case procedures and to compare it with conventional inhalational based technique in terms of intra and postoperative hemodynamic and respiratory changes, postoperative recovery and postoperative vomiting.PATIENTS AND METHODS: This is a prospective randomized study has been done on 100 patient who underwent general anesthesia for short duration surgical procedure in AL- Jumhory teaching hospital in Al-Mosul city in Iraq, during the period between Nov 1st, 2011 and March 1st, 2012 , All patients were allocated into either TIVA or inhalational (INH) groups, of 50 patient each. In TIVA group: induction and maintenance of anesthesia done by propofol. While in INH group: maintenance of anesthesia done by halothane. Blood pressure, pulse rate, respiratory rate were monitored at a specific time. Recovery time was recorded according to Aldrete score. Any episode of vomiting was recorded.RESULTS: Aldrete score of ≥ 9 was achieved earlier in the TIVA group than in the INH group. It was also observed that there was initial fall in HR, MAP and respiratory rate in the both group, and post operative vomiting was less in the TIVA group.CONCLUSION: The time needed for recovery and episodes of postoperative vomiting in TIVA is less than in inhalational anesthesia.KEYWORDS: TIVA, propofol, day case surgery.


Article
A Comparison of Using Ketamine Versus Combination of Ketamine and Thiopentone in Short Painful Procedures in Pediatrics

Authors: Iyad Abbas Salman --- Saba J. AL-Wardi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 1 Pages: 103-109
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Short painful procedures in pediatric age group like bone marrow aspiration (BMA) and biopsy taking are day case operations which demand rapid recovery and minimal incidence of postoperative complications.OBJECTIVE: To compare between intra & postoperative complications & the time of stay in the recovery room for pediatrics undergoing short painful procedures under general anesthesia with either "ketamine and thiopental" or "ketamine alone".PATIENTS AND METHOD: THIS IS A PROSPECTIVE RANDOMIZED clinical trial done in Children Welfare Hospital in Medical City, Baghdad, Iraq, from August - November 2010 on 89 children patients who were scheduled for short painful procedures. All patients were allocated randomly into 2 groups: the 1st group (KT) received I.V ketamine 1% (1mg/kg) plus I.V thiopental 1% 3-5 mg/kg (anesthetizing dose) on induction and maintained on intermittent I.V doses of thiopental 1% in case of need. While the 2nd group(K) received I.V ketamine 1% (1.5mg/kg) alone on induction and maintained on intermittent I.V doses of ketamine 1%(0.5mg/kg) in case of need. Any intra or postoperative complications & the duration of recovery for all patients were recorded. RESULTS:It was found that the intraoperative complications (temporary & mild decrease in arterial O2 saturation and its associated breath holding, & cough) occurred more in the KT group, while the occurrence of (mild involuntary movements and verbal responses) occurred more frequently in the K group. The postoperative complications (nausea, vomiting, verbal hallucinations and dizziness) occurred only in the K group. The duration of recovery is more prolonged in the (KT) group.CONCLUSION: The use of combination of thiopentone and ketamine is associated with more mild and temporary intraoperative decreased arterial oxygen saturation, breath holding, and postoperative cough than using ketamine alone, while the use of ketamine alone is associated with more mild involuntary movements and verbal responses, postoperative nausea &/or vomiting, hallucinations, and dizziness. The duration of recovery is prolonged by the use of thiopental.KEY WORDS: ketamine, thiopental, TIVA, pediatrics, day case.

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