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Home > A Randomized Control Trial Comparing Train of Four Ratio ≥0. 9 to Clinical Assessment of Return of Neuromuscular Function Before Endotracheal Extubation on Critical Respiratory Events in Adult Patients Undergoing Elective Surgery at the Aga Khan University Hospital, Nairobi

A Randomized Control Trial Comparing Train of Four Ratio ≥0. 9 to Clinical Assessment of Return of Neuromuscular Function Before Endotracheal Extubation on Critical Respiratory Events in Adult Patients Undergoing Elective Surgery at the Aga Khan University Hospital, Nairobi

Thesis Info

Author

Isaac, Adembesa

Department

Anaesthesiology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2015

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728033561

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Background: There is increasing evidence that the incidence of postoperative residual paresis after using neuromuscular blockers ranges from 24 to 50% in post anaesthesia care unit and is associated with postoperative complications such as critical respiratory events as evidenced by hypoxia, hypoventilation and upper airway obstruction. Quantitative neuromuscular monitoring (such as the assessment of Train of four (TOF) ratio) and reversal of neuromuscular blockers has been shown to reduce postoperative residual paresis. There are very few outcome studies on effect of residual paresis in Post anaesthesia care unit (PACU). There are no published randomised control trials investigating whether using a TOF ratio ≥0.9 before endotracheal extubation compared to clinical assessment of return of neuromuscular function reduces the incidence of critical respiratory events in PACU. Primary Objective: To determine whether using TOF ratio ≥0.9 compared to clinical assessment of return of neuromuscular function before endotracheal extubation reduces the incidence of critical respiratory events in PACU Secondary objectives: To determine incidence and severity of hypoxia in PACU. To determine incidence of upper airway obstruction in PACU Study Design: Randomised, prospective, double blinded control trial Setting: Operating theatres of the Aga Khan University hospital Nairobi Population: Adults, aged 18-65 years ASA physical status I and II undergoing elective surgery under general anaesthesia. Sample size: 168 patients randomised to TOF ratio group and clinical assessment group, 84 per group. Methods: Patients requiring general anaesthesia for elective surgery with cisatracurium as the muscle relaxant were randomised into 2 groups using computer generated numbers. Group 1 were patients who required a TOF ratio of ≥0.9 before extubation. Group 2 patients were extubated based on clinical assessment of return of adequate neuromuscular function by the anaesthetist as is the standard of practice at the Aga Khan University hospital Nairobi. General anaesthesia was standardised in both groups. Both the investigators and patients were blinded during the study. Once the patient was transferred to PACU, oxygen saturation (SP02), respiratory rate and any signs of upper airway obstruction as demonstrated by stridor, laryngospasms or requirement of any airway manipulation was recorded for the first 30 minutes. Duration of anaesthesia and surgery was also recorded. Patient demographics were recorded and analysed. vii Results: There was no statistical difference between the 2 groups in terms of patient demographics, duration of surgery and anaesthesia and duration since last muscle relaxant was given. In terms of hypoxia on arrival in PACU, the incidence of
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سر ہرمان دیبر

سر ہرمان دیبر

            سر ہرمان دیبر، جنھوں نے ۹۷ سال کی عمر میں وفات پائی ہے اور جن کے قواے جسمانی و دماغی آخر وقت تک پوری تندرستی کی حالت میں رہے، ان کی کتاب ’’طویل العمری‘‘ سے متعلق حال میں دوبارہ شایع ہوئی ہے، طویل العمری کے مختلف نسخے مختلف اشخاص نے تجویز کیے، لیکن سر ہرمان دیبر کے نزدیک اس کا راز صرف تین چیزوں میں شامل ہے، اولاً جسمانی محنت و ورزش، یعنی انسان کاہل نہ ہو، بلکہ تازہ ہوا میں کافی طور پر چلتا پھرتا رہے، دوسرے یہ کہ اپنی طبیعت کو قانع رکھے، قناعت کا لازمی نتیجہ یہ ہوگا کہ فکر و مایوسی اس کے پاس نہ آئے گی اور طبیعت بشاش رہے گی، تیسری اور سب سے اہم شرط یہ ہے کہ کھانے پینے میں بے اعتدالی نہ کرے، بلکہ ہمیشہ اعتدال ملحوظ رکھے، شرائط بالا کی پابندی کے ساتھ مصنف مرحوم کا دعویٰ ہے کہ ہر شخص انہی کی سی عمر و صحت حاصل کرسکتا ہے۔ (اپریل ۱۹۲۰ء)

 

خواتین كی ملازمت تعلیمات اسلامی كی روشنی میں

Women employment is a practical issue of the modern age. It is adopted by almost all the nations and countries of the world. In the western countries rights of women including employment, trade, property, education etc were recognized after the efforts ofWomen Liberation Movement. However, in Islam these were declared their basic rights since the first day. A western woman is bound to earn her livelihood as it is not the duty ofa western man to provide her basic needs. However, in Islam a woman is legally protected for the provision of all her basic needs and it is the duty of her father, brother, husband and son to provide these to her. Islam permits a woman to do a job or carry out trade activities and earn money subject to some conditions. These may be carried out by the permission of her husband, father, etc. Besides employment, a woman should perform her obligations at her home and family, which is her basic duty. She must be careful about her husband and children rights. She must observe Hijab and abstain from mixing with non-mehram men and should follow other social teachings of Islam. Wealth earned by her is considered her property and she can spend it any way at her discretion. Study of Islamic History revealed that many of the wives of the prophet (Sallalla ho alaihe wassalam) and Sahabiyat (RA) carried out business activities and performed other jobs and thus earned money. They spent it to assist the Prophet's noble cause and to assist their husbands and to care their children. These activities were considered authorized and endorsed by the prophet (Sallalla ho alaihe wassalam)

Psychological Construct As Core Determinant of Effective E-Learning Process

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