Assessment of blood loss during cesarean section under general anesthesia and epidural analgesia using different methods

Obstetric blood loss is usually a big issue when dealing with obstetric morbidity and mortality. Blood loss during cesarean section [CS] is usually underestimated; therefore this study addressed that problem by comparing 3 different methods for assessment of blood loss during CS under general anesthesia and epidural analgesia. The study included 100 informed and consented full-term pregnant women undergoing elective CS fulfilling the inclusion criteria. Intraoperatively, for each patient blood loss was assessed by: subjectively by visual estimation by the attending staff [obstetrician, anesthetist and the scrub nurse], by weighing of blood-soaked surgical swabs and by calculation using the formula described by Bourke and Smith [15]. The results showed that visual estimation of blood loss gave the lowest estimated value while the calculation gave the highest estimate of blood loss. Anesthetists gave more accurate visual estimation of blood loss than obstetricians, while scrub nurses gave the lowest estimation. Past history of CS, breech presentation, placenta previa and manual separation of the placenta were associated with more blood loss during CS. Neither the type of anesthesia nor the patients' parity had a positive correlation with blood loss while, the weight of the patient had a positive correlation with blood loss. Conclusively, the present study pointed out that calculation of intraoperative blood loss during CS was overestimated by the formula used and was underestimated visually by the obstetricians and scrub nurses involved. Reliably, anesthetists gave a close estimation to that obtained by weighing of swabs method. The study recommended spontaneous removal of the placenta to reduce intraoperative blood loss during elective CS

Effect of different Analgesic modalities during normal labor on changes in peripheral leucocytic counts and interleukin - 2 and - 6 serum concentrations in healthy parturients

Many analgesic techniques are nowadays applied during labor; each has its own advantages and drawbacks. Little has been reported about the immunologic impact of analgesia during labor. Many immunologic changes occurring during labor may be affected by pain relief. Cytokines such as IL-2 and IL-6 and white blood cell count may give a clue about such immunologic changes during labor. Thirty parturients in labor were investigated and divided into 3 equal groups according to the analgesia offered during labor: epidural group I, pethidine group II, and N2O group III. The results revealed good analgesic outcome and fetal profile in group I whereas fetal outcome in group II was the worst. IL-2 was lowest in cord blood of group I while it increased in both cord blood and postpartum samples in group III.IL-6 increased in cord blood in group I and II and decreased at cervical full dilatation in group I and III. Leucocytosis was significantly increased in group I and II with neutrophilia specially at full cervical dilatation. Cord blood showed neutropenia in group II cord blood. Lymphocytosis was highest in group II while lymphopenia was significant in cord blood of group I.The present study showed that epidural analgesia during labor offered good labor milieu regarding pain relief and neonatal outcome with better immunological condition.Nitrous oxide had significant immunosuppressive effect, while pethidine did not show any significant immunologic impact during spontaneous labor. Further studies are recommended to include more immune parameters and to establish reference values for assessment of peripartum immunologic status for both mother and newborn during labor under different analgesic techniques

relation between serum leptin and blood lipids in type 2 diabetic patients with ischemic heart disease

Background: the occurrence of ischemic heart disease in type 2 diabetic patients is very common and the cause is still not clear. Serum leptin had been accused to be the missing link between diabetes and coronary heart disease, but the mechanism is still not known. Serum lipids may contribute in this mechanism

Objective: This study has been performed to seek the possible relationship between serum leptin concentration and blood lipid concentration in diabetic patients with ischemic heart disease

Material and methods: The study included sixty subjects from the Internal Medicine Department inpatients of the Medical Research Institute Hospital who were previously admitted and diagnosed as group I: Type 2 diabetes with stable angina [15 patients], group II: Type 2 DM with unstable angina, group III: Type 2 DM with myocardial infarction and group IV: was 15 patients chosen as control group. All patients and controls were subjected to complete clinical and endocrinological examination. All patients and controls were subjected to estimation of fasting and post prandial blood glucose, high density lipoprotein cholesterol [HDL-ch], low density lipoprotein cholesterol [LDL-ch], total cholesterol [TC], and triacylglycerol [T G]. All patients and controls have been subjected to estimation of tasting serum leptin level

Results: No statistically significant correlation has been found between serum leptin and both fasting and post prandial blood glucose in all patients groups but when blood lipids were added, the correlation becomes positive. A statistically significant positive correlation has been found between [FBG, PPBG] and LDL-ch, TC, TG in all patients groups, whereas the correlation with HDL-ch was negative. A statistically signiticant positive correlation has been found between serum leptin and LDL-ch, TC and T6. The correlation was negative with HDL-ch

Conclusion: Increased levels of leptin together with decreased HDL-ch and increased TC, TG and LDL-ch are associated with unstable angina and acute mayocardial infarction. These findings support the theory that leptin levels should be monitored amongst other markers of cardiovascular risk

Does the addition of nitrous oxide improve sevoflurane induction of anesthesia in children?

Recently, with the introduction of sevoflurane and owing to its ease and speed of induction together with the lack of the pungent irritating odour, all these factors made sevoflurane ideal for inhalation induction in children. Nitrous oxide was known to augment the effect of all inhaled anesthetic agents. The present study tested the hypothesis that N[2]O could facilitate induction and tracheal intubation conditions with 8% sevoflurane in children. The study included 60 children aged 3-10 years divided into 3 groups to undergo inhalation induction with 8% sevoflurane in 50% N[2]O, 66% N[2]O, and 100% oxygen for the three involved groups. Induction time was shortest in group II [66% N[2]O] [46.4 +/- 6.08 s] and longest in group III [100% O[2]] [72. 75 +/- 11.09 s]. Intubation conditions were best in group II with the least complication rate [15%] while group III reported 60% complication rate. Hemodynamically, no clinically important changes were recorded. The study concluded that the use of inhalation induction with 8% sevoflurane in 66% N[2]O was safe in a sense of fast and least eventful induction with easy and favourable intubating conditions in children undergoing elective surgery

Clinical evaluation of intraperitoneal bupivacaine, or combined with morphine and pethidine for analgesia after laparoscopic gynecologic procedures

Pain after laparoscopic gynecology is an important factor that increases hospital admission after day-case laparoscopy. The study compared the postoperative analgesic effect of intraperitoneal instillation of bupivacaine, bupivacine + pethidine, bupivacaine + morphine and saline in 48 patients after laparoscopic gynecologic procedures. Each group had 12 patients. The study showed that in the pethidine added group, the duration of analgesia was longest with the lowest VAS scores and the least side-effects. Adding morphine to bupivacaine added no clinically additional analgesic advantage, however, it increased the incidence of side-effects. The study concluded that intraperitoneal instillation of 20 ml. of 0.5% bupivacaine + 100 mg. pethidine after laparoscopic gynecologic procedures proved simple, safe, effective technique with minimal side-effects and is recommended to be applied at the designated sites at the end of gynecologic laparoscopy

Clinical evaluation of 2 years experience of epidural analgesia for labor: a retrospective study

The use of epidural analgesia [EA] for labour was introduced to clinical practice in 1931 hesitantly. By time, this method of pain relief has become the first choice for many labouring women. This retrospective study was planned to assess the degree of patient's satisfaction and the incidence of side effects related to EA for labour which was done in United Doctors Hospital in Jeddah over 2 years period. The study demonstrated that maternal satisfaction was affected by maternal age, weight, the source of information about EA, previous experience with epidurals before and the length of delivery. AE did not affect the rate of caesarean delivery and the fetal outcome was excellent. Side-effects recorded included: backache, itching, shivering and vomiting. The overall satisfaction with EA was 93.3% which was comparable to results from other institutions. Epidural analgesia for labour is a well established method of pain relief during labour and should be encouraged to be practiced by anesthetists and to be accepted by more patients as well

Blunt pancreatic trauma: prompt diagnosis and early surgical intervention with possible splenic preservation yields good results.

The aim of this study was to assess the value of computed tomography [CT] in the diagnosis of pancreatic injury and to show the results of the early surgical intervention rather than conservation and the feasibility of splenic preservation in those patients. Seven patients [five males and two females with a mean age of 13.8 years] presenting with history of blunt abdominal trauma were included in this study. The patients were resuscitated, then abdominal ultrasonographic scan and computed abdominal tomography were performed. Those patients who were suspected to have major pancreatic trauma as evidenced by CT were explored. CT detected abnormalities in the pancreas in all patients and distal pancreatectomy was carried out. When the spleen was intact, splenic preservation was attempted and it was successful in four patients. The morbidity rate was 28.6%. Pancreatic injuries should be searched for in any patient with blunt trauma of the abdomen. Computed tomography proved to be the main method of diagnosis and is fairly accurate

Management of common bile duct stones in the laparoscopic era: an alternative pathway

The aim of this study was to evaluate a modified pathway of management of stones in the common bile duct. Twenty-five patients with gallstone disease were included in this study. All had clinical and/or chemical evidence of bile duct obstruction. For each patient, an abdominal ultrasound was done, followed by magnetic resonance cholangiography. The results were compared. Then, endoscopic retrograde cholangiography was performed, essentially for the removal of bile duct stones. Ultrasound revealed bile duct stones in 11 patients; while, in the rest of the patients, it was inconclusive. Magnetic resonance examination was normal in four patients [i.e. no obstruction found]; while it confirmed the presence of biliary obstruction in 21 patients; 17 due to stones and 2 due to other causes and in 2 patients, there was no obvious cause of obstruction. Endoscopic retrograde cholangiography was attempted in 23 patients. It was possible to insert endoscopic stents in two patients with malignant obstruction who needed no further surgery. The stones were endoscopically removed in 18 patients. Laparoscopic cholecystectomy was successfully performed in 20 patients. Open cholecystectomy and bile duct exploration were done in three patients