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The Effect of Saline Flush After Rocuronium Bolus on the Proportion of Patients With Excellent Intubating Conditions in Adult Patients Undergoing Elective Surgery at Akuh-N

Thesis Info

Author

Odari, Ian

Department

Anaesthesiology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2019

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728069518

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Background: In emergency surgeries requiring endotracheal intubation, the time to effect of neuromuscular blocking drugs is a crucial time in which patients are predisposed to hypoxia and aspiration into the lungs. Various strategies have been undertaken to shorten this time, including the timing and the priming techniques, dose changes and use of a flush following the muscle relaxant. All these methods had positive results but some are associated with side effects. The effectiveness of a muscle relaxant can either be assessed using the train of four or intubating conditions on the Goldberg scale. In this study, the plan is to investigate the effects of a 20 ml saline bolus following intravenous rocuronium at 0.6 mg/kg on the proportions of patients with excellent intubating conditions at one minute. Methodology: Fifty-two patients were randomly allocated to the saline bolus group or the no saline flush group. Anaesthesia was induced using propofol and remifentanil via target-controlled infusion (TCI) and maintained with the same. Rocuronium 0.6 mg/kg intravenous (IV) was administered followed by a 20 ml saline flush in the study group compared to administration of 0.6 mg/kg rocuronium without a saline bolus in the control group. Intubation conditions were assessed using the Goldberg scale filled by the intubating doctor. The onset of neuromuscular block was assessed by the train of four T1 height depression with an accelerometer attached to the adductor pollicis muscle. Results: There were 25 patients in each group. Patients in both groups were comparable with respect to demographic profiles. In the group with a flush, 18(62.1%) patients had “excellent” and seven (33.3%) patients had “good” intubating conditions as opposed to 11 (37.9%) having “excellent” and 14 (66.7%) having “good” intubating condition in the group without a flush. The distribution of intubating conditions for the two groups showed a difference of 24.2% in the proportion of patients with excellent intubating conditions which was statistically significant (P=0.042). There was no association between twitch height at one minute and intubating conditions. Conclusion: In this group of patients studied, the administration of a 20 ml saline flush after 0.6mg/kg rocuronium significantly increases the proportion of patients with excellent intubating conditions as compared to rocuronium without a saline flush.
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دیت کا معنی و مفہوم

لغوی معنی :خون بہا ادا کرنا دیت کہلاتا ہے ،جیسا کہ ابن فارس لکھتے ہیں
الواو والدال والحرف المعتل: ثلاثُ كلماتٍ غير منقاسة: الأولى وَدَى الفرسُ ليَضرِبَ أو يبول، إذا أدْلَى. ومنه الوَدْي: ماءٌ يخرج من الإنسان كالمَذْي. والثانية: وَدَيْتُ الرّجلَ أُدِيهِ دِيةً.والثالثة: الوَدِيُّ: صِغار الفُسلان.وإذا هُمز تغيَّرَ المعنى وصار إلى بابٍ من الهَلاك والضَّياع. يقولون: المُوَدَّأة المَهْلَكة، وهي على لفظ المفعول به. ويقولون: ودَّأْتُ عليه الأرضَ، إذا دَفَنْتَه. ووَدَّأ بالقوم، إذا أرْدَاهم۔ 162
"مادہ " وَدَیَ " اور اس کے تین معنی ہیں جو جدا جدا ہیں پہلا معنی یہ ہے کہ گھوڑے نے ٹانگوں کو اکٹھا کیا کہ وہ مارے یا پیشاب کرے اور اسی سے ودی ہے جو انسان سے نکلتی ہے مذی کی طرح اور دوسرا معنی ہے کہ میں نے فلاں شخص کو خون بہا ادا کیا اور تیسرا معنی ہے دودھ پینے والے بچے اور جب یہ مہموز سے آئے تو اس کا معنی تبدیل ہو جائے گا یعنی ہلاک اور ضائع کرنے کے معنی میں آئے گا ہلاک ہونے والی چیز کو المھلکۃ کہتے ہیں۔یہ مفعول بہ کے وزن پر ہے اور کہتے ہیں کہ میں نے اسے زمین میں دفن کردیا اور ودا بالقوم کا معنی قوم کو ہلاک کر دیا ۔ "
قتل کے بدلے خون بہا ادا کرنے کو دیت کہتے ہیں، جیسا کہ ابن منظور کے نزدیک دیت سے مراد
"الدِّيةُ واحدة الدِّيات والهاءُ عوض من الواو تقول ودَيْتُ القَتِيلَ أَدِيةَ ديةً إِذا أَعطيت دَيَتَه واتَّدَيْتُ أَي أَخذتُ دِيَتَه وإِذا أَمرت منه قلت دِ فلاناً وللاثنين دِيا وللجماعة دُوا فلاناً۔"163
"الدِّيات کا واحد الدِّيةُ ہے اور ھا واو کے عوض میں ہے جیسے تو کہے کہ میں نے مقتول کا خون بہا ادا کیا ۔میں نے فلاں کی دیت وصول کی اور جب تو دیت دینے کا حکم کرے گا تو مخاطب مفر د کو...

واقعہ 11/9 کے پاکستانی معیشت پر اثرات اور اسلامی تعلیمات: تجزیاتی مطالعہ

After the Incident of 9/11 Pakistan decided to become the ally of America and play an important role in fighting terrorism on both domestic and global fronts. This war has destroyed the peace of Pakistan and has affected the Economy of Pakistan desperately. The decision of Pakistani government to fight the so called war on terror with America only to get the financial and political support of America was clearly against the teachings of Islam. However, Pakistan did receive financial benefits in this war. The important development in the wake of 9/11 is that Pakistan became the biggest beneficiary of US economic aid in the South Asian region. Despite the GDP growth, foreign aid, foreign investment, better record of foreign exchange reserve, worker remittances and debt rescheduling Pakistan’s economy did not show the desired results. The change in the Pakistan’s economy during this period is not sustainable in economic term. Due to the war on terror law and order situation has become worst. At present Pakistan is facing most unique, difficult and gruesome faces of terrorism. In this situation fiscal policy in Islamic perspective is prerequisite for the peace and economic development of Pakistan.

Synthesis, Characterization and Biological Activities of Some Novel Five and Six Membered Heterocycles and Biheterocycles

This thesis describes the synthesis, characterization and bioassay of some novel five and six membered heterocyles and biheterocycles. Some new 2-(3,5-dimethoxy-4-methylphenyl)-4-aryl-1,3,4-oxadiazoles (1a-h) were synthesized by microwave irradiation of 3,4-dimethyoxy-4-methylhydrazide (6’) with substituted benzoic acids in the presence of thionyl chloride. Compound (1b) exhibited significant bacterial inhibition while compounds (1a), (1e) and (1f) showed significant antifungal activities. Except for compounds (1e), (1f) and (1h), the rest were active for their phytotoxic activities. Some N-aminomethyl substituted aryl-5-aryl-1,3,4-oxadiazole-2-thiones (2a-j) were synthesized. 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The triazoles (3a-f) were converted into corresponding 3-aryl-6-phenyl-1,2,4- triazolo-[3,4-b][1,3,4]-thiadiazines (8a-f) by the condensation with 2-bromo acetophenone. Compound (8a) and (8e) showed maximum antibacterial and antifungal inhibition respectively. All compounds except (8d) and (8e) showed positive phytotoxic activity. The substituted hydrazides (1’-8’) were also microwave irradiated with acetyl acetone to afford 3,5-dimethylpyrazoles (4a-h). Compound (4b) was most active antibacterial whilst (4a) and (4d) were most active antifungal agents. All compounds were phytotoxic except (4a), (4f) and (4h). i 1-Aroyl-3,5-diarylpyrazolines (5a-h) were synthesized by cyclization of substituted hydrazides (1’-8’) with suitably substituted chalcones (a-b). Compounds (5a) and (5c) showed maximum inhibition in case of antibacterial activities and maximum percentage inhibition in case of antifungal activities. All pyrazolines were active for their phytotoxic activities. Microwave accelerated oxa-Pictet Spengler reaction of 2-chlorophenyl ethanol with various aryl aldehydes afforded some 1-aryl-5-chloroisochromans (6a-j). Standard homologation sequence of the 2-cholobenzoic acid afforded the 2-chlorophenylacetic acid which was on esterification and reduction with sodium borohydride in tetrahydrofuran and methanol furnished the 2-chlorophenylethanol. The latter was irradiated with substituted benzaldehydes in the presence of p-TsOH acid to afford 1- aryl-5-chloroisochromans (6a-j). Isochroman (6c) showed maximum inhibition against B. subtilis whereas (6e) showed against maximum inhibition E. coli. Isochromans (6a) and (6d) were most active as antifungal agents. All compounds were active for their phytotoxic activities except (6a), (6d) and (6g). Some N-substituted morpholines (7f-j) were also prepared. 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