Background:Cancellation of operations in hospitals is a significant problem with far reaching consequences. This study was planned to evaluate reasons for cancellation of elective surgical operation on the day of surgery in a 500 bedded Government hospital.Materials and Methods:The medical records of all the patients, from December 2009 to November 2010, who had their operations cancelled on the day of surgery in all surgical units of the hospital, were audited prospectively. The number of operation cancelled and reasons for cancellation were documented.Results:7272 patients were scheduled for elective surgical procedures during study period; 1286 (17.6 %) of these were cancelled on the day of surgery. The highest number of cancellation occurred in the discipline of general surgery (7.1%) and the least (0.35%) occurred in Ear-Nose-Throat surgery. The most common cause of cancellation was the lack of availability of theater time 809 (63%) and patients not turning up 244 (19%) patients. 149 cancellations (11.6%) were because of medical reasons; 16 (1.2%) were cancelled by the surgeon due to a change in the surgical plan; 28 (2.1%) were cancelled as patients were not ready for surgery; and 40 (3.1%) were cancelled due to equipment failure.].Conclusion:Most causes of cancellations of operations are preventable.

Hanging is a common method of suicide/homicide in the Indian scenario. We report three successive cases of attempted suicidal hangings seen over a period of 4 months in our intensive care wards. All of them presented gasping with poor clinical status and required immediate intubation, resuscitation, assisted ventilation and intensive care treatment. None had cervical spine injury, but one patient developed aspiration pneumonia. All the three patients received standard supportive intensive care and made full clinical recovery without any neurological deficit. We conclude that the cases of near hanging should be aggressively resuscitated and treated irrespective of dismal initial presentation. This is well supported by the excellent outcomes in our cases despite their poor initial condition.

A total of 85% of patients who self-extubate during the weaning process did not require reintubation in our study. Those who have an FiO2 >50%, a lower PaO2/FiO2 ratio, had UEE occur by accident, or were not being weaned when UEE occurred required reintubation more frequently. These data suggest that some of our SICU patients are intubated longer than necessary, which may translate into more ventilator related complications, longer ICU stays and increased cost.

The present study compared the efficacy of two different doses of labetalol, for attenuation of hemodynamic response to laryngoscopy and intubation in hypertensive patients. Patients and methods: 75 hypertensive patients, aged 18-60 years undergoing elective surgical procedures, require general anesthesia and orotracheal intubation. Patients were allocated to any of the three groups (25 each), Group C (control) 5 ml 0.9% saline. Group L1 (labetalol) 0.15 mg/kg diluted with 0.9% saline to 5 ml. Group L2 (labetalol) 0.3 mg/kg diluted with 0.9% saline to 5 ml. In the control group 5 ml of 0.9% saline was given i.v. 5 min prior to intubation. In the L1 group 0.15 mg/kg of labetalol was given i.v. 5 min prior to intubation. In the L2 group 0.3 mg/ kg of labetalol was given i.v. 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP) and rate pressure product (RPP) were calculated. Results: Compared to placebo both the doses of labetalol (0.15 mg/kg) and (0.3 mg/kg) significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant between both doses of labetalol at intubation, 1 min, 3 min and 10 min post-intubation. Conclusion: Both doses of labetalol (0.15 mg/kg and 0.3 mg/kg) attenuate hemodynamic response to laryngoscopy and intubation in dose dependent manner.

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