Effect of general anaesthesia versus spinal anaesthesia on apgar score in elective caesarean section

To compare the effects of general versus spinal anaesthesia on Apgar score of neonates in elective Caesarean section. Randomized control trial. The Department of Anaesthesia and Intensive care CMH Lahore over duration of six month from 20-02-07 to 19-08-07. A total of 100 pregnant patients undergoing elective Caesarean section were divided into two groups: Group-A [General anaesthesia], Group-B [spinal anaesthesia]. In both the groups the patients were randomly divided using random number table and were blind to the technique of anaesthesia used. Mean Apgar score at one minute in group-A was 6.4 +/- 1.1 and in group-B was 8.4 +/- 1.1. The difference between two groups was statistically significant [p< 0.001]. Mean Apgar score at 5 minute was observed 9.4 +/- 0.7 in group-A and 9.5 +/- 0.6 in group-B. The difference between these two groups was not statistically significant [p=0.202]. Apgar score of neonates whose mothers received spinal anaesthesia was better at 1 minute than neonates whose mothers received general anaesthesia but there was no significant difference in Apgar score after 5 minutes in both techniques

Comparison of median and paramedian techniques of spinal anaesthesia

To compare median and paramedian technique of spinal anaesthesia in terms of success rate, number of attempts, paresthesia, bloody tap and length of needle. Comparative cross-sectional study. Department of Anaesthesia and Intensive care PNS Shifa Karachi over duration of one year from March 2007 to Feb 2008. This was a comparative cross-sectional study and 100 patients undergoing spinal anaesthesia for lower abdominal and lower limb surgeries were included. Hundred patients were divided into two separate groups. Group I was given spinal anaesthesia with median approach and Group II was given spinal anaesthesia with paramedian approach. In both the groups the patients were divided using non probability convenience sampling and patients were blind to the choice of technique of spinal anaesthesia used, however consent was obtained from every patient to be included in study. The success rate of median approach was found to be 84%, with the first attempt success rate of 48%. Paresthesia was felt by 38% of patients and incidence of bloody tap was 6%. Length of needle required most of the time was between 4-6 cms. The success rate of paramedian approach was found to be 96%, with first attempt success rate of 70%. Paresthesia was felt by 20% of patients and incidence of bloody tap was 12%. Most of the time length of needle required was between 6-8 cms. Paramedian approach is associated with higher success rate with lesser number of attempts and decreased incidence of paresthesia

Postdural puncture headache; comparison between lumbar puncture needle no 25 G and 27 G

To evaluate the role of needle diameter in causing postdural puncture headache [PDPH] in patients undergoing elective caesarian section. Comparative cross-sectional study. This study was conducted in Department of Anaesthesia and Intensive care PNS Shifa Karachi over duration of six months. It was a cross sectional study of 100 patients, which were divided into two separate groups. Group I and Group II were given spinal anaesthesia with 25 gauge and 27 gauge Quincke needles respectively. In both the groups the patients were randomly selected and were blind to size of the spinal needle used. The data was analyzed using Chi-square test. A P value of <0.05 was considered statistically significant. Two patients in 25-G group and one in 27-G group required additional general anaesthesia because of inadequate spinal anaesthesia. Thus, a total of three patients were excluded from the study. Five out of forty-eight patients in group 1 and one out of forty-nine patients in Group II suffered from post spinal headache. The proportion of patients with post spinal headache with 25 G needle is significantly more than those with 27 G

Comparison of tramadol with bupivacaine as local anaesthetic in postoperative pain control

To determine the effectiveness and duration of postoperative pain relief after local infiltration of tramadol in comparison with bupivacaine, in adult hernia surgery. Quasi experimental study. Department of Surgery, Combined Military Hospital Rawalpindi. Study was conducted on 60 patients aged between 20-60 years with elective mesh repair of inguinal hernia. Patients were divided into two groups of 30 patients for 0.25% bupivacaine [group A] and tramadol [group B]. Patients were assessed for pain at 1, 6, 12, 18 and 24 hours following surgery using visual analogue pain score [VAPS]. Patients with score =5 were given rescue analgesia in the form of 75 mg intramuscular diclofenac sodium. Comparison of first analgesia requirement time and the VAPS between the two groups was done using "t" test taking a p-value of <0.05 as significant. Patients in group A had a mean age of 46 +/- 11.03 years whereas in group B the mean age was 46 +/- 11.39 years. Mean visual analogue pain score after 1 and 6 hours of operation was 2.73 and 4.7 respectively in group A while it was 1.43 and 3.43 in group B. VAPS after 24 hours of operation was 3.47 in group A and 2.53 in group B. Mean time when 1st dose of rescue analgesic used was 8.20 hours in group A and 11.60 hours in group B. independent sample t-test for VAPS between the 2 groups revealed a highly significant difference [p-value <0.05] at 1, 6, 12 and 24 hours but no significant difference was seen at 18 hours. Independent sample t-test for time required for rescue analgesia and total number of doses required was also highly significant [p-value <0.05] between the two groups. Locally infiltrated tramadol provided an improved postoperative analgesia in comparison to bupivacaine and decreased the requirement of postoperative analgesics with early patient mobility and discharge

Measles in children younger than 9 months in Pakistan.

Pakistan has one of the highest burden of measles and measles-related deaths in the world. We compared the clinical course and outcomes of measles in infants aged £9 months with those >9 month old amongst children admitted to a tertiary care hospital. Data were collected by a retrospective chart review, and compared between age £9 months (Group A) and age >9 months (Group B). Severe malnutrition (P=0.039, adjusted odds ratio=3.02), anemia (P=0.017), leukocytosis (P<0.001, adjusted odds ratio 4.1), and conjunctivitis (P=0.021) were higher in Group A children. All four deaths occurred in Group B.

relationship of skin to epidural space depth with different physical parameters in obstetric patients

The objective of the study was to find out the correlation between the skin to epidural space depth and different physical parameters like age, height, parity, weight and Body mass index in obstetric patients. Prospective non-probability purposive correlational study. This study was conducted in Department of Anaesthesia and Intensive care, Combined Military Hospital, Quetta, over duration of one year from may 2005 to April 2006. This was prospective correlational study and total of 100 obstetric patients belonging to ASA-I and II class were included. All patients received epidural anaesthesia with 16/18G Tuohy's needle and an epidural catheter was passed at the level of L3-L4/L4-L5 interspace. The skin-to-epidural space depth was marked on the Tuohy's needle with a marker and was subsequently measured with a scale. This study was conducted on parturients undergoing Caesarean section having ages between 18-40 years with mean 27.27 + SD 4.90 years, weight between 44-92 kg with mean 62.73 + SD 9.37 kg, height 142-166 cm with mean 153 + SD 5 cm, parity between primigravida to gravida 9 with mean 2.43 + SD 2.24 and body mass index of 19-38 kg/m2 with mean 27 + SD 4 kg/m2. The skin-to-epidural space depth ranging between 31 mm to 78 mm with mean of 41.59 + SD 6.49 mm was noted. Pearson correlation coefficient for the relation of skin to epidural space depth with patient's age was r=0.317 [p=0.001], with weight was r=0.618 [p=0.0001], with height was r= -0.004 [p=0.966], with body mass index was r=0.623 [p=0.0001] and with patient's parity was r=0.210 [p=0.028]. It was concluded that the skin-to-epidural space depth had statistically significant strong correlation with weight and body mass index but statistically significant weak correlation with age and parity, and statistically insignificant correlation with height