ABSTRACT
Objective: Objective of study is to compare peri-operative complications between exteriorization and intra-abdominal repair of uterus after cesarean delivery
Study Design: Randomized controlled trial
Place and Duration of Study: Obstetrics and Gynecology Department of Pakistan Ordinance Factory Hospital, Wah Cantt, from 1[st] April 2010 to 30[th] September 2010
Material and Methods: Patients planned for 1st cesarean section under spinal anesthesia were randomly allocated by lottery method to exteriorized [A] or in situ uterine repair [B] group. Patients with history of uterine surgeries and cesarean section were excluded from study. Variables analyzed were operation time, peri-operative hemoglobin [Hb] fall, nausea and vomiting during the cesarean delivery
Results: The study analyzed 170 patients and divided them in 2 groups, having no significant difference with respect to maternal demographics, procedure statistics and indication of cesarean section. Significant difference was observed in operation time being 32.78 min in exteriorized group and 36.38 min in situ uterine repair group [p-value 0.0001]. Hb% fall was 0.85 g/dl and 0.92 g/dl respectively in both groups [p-value 0.62] Nausea and vomiting was 23.5% in group A and 11.8% in group B [p-value 0.02, 0.04 respectively]
Conclusion: Peri-operative complications like operative time and Hb fall are less in uterine repair after temporary exteriorization as compared to intra-abdominal repair of uterus after cesarean delivery. Nausea and vomiting were increased in exteriorized group but proper regional anesthetic technique and achieving adequate analgesia can reduce patient discomfort
ABSTRACT
A 20 years primigravida presented in emergency with history of pulmonary edema after caesarean hysterectomy under spinal anesthesia, complicated by cardiac arrest. On examination, the patient was conscious, anxious and restless, pale, cyanosed, had edema face and feet, distended neck veins and was orthopnoeic. X-ray chest showed diffuse homogenous opacities in both lung fields. A provisional diagnosis of over transfusion pulmonary edema was made. She was placed on ventilatory support on synchronized intermittent mandatory ventilation [SIMV] along with positive end expiratory pressure [PEEP]. Her endotracheal suction had to be performed quite frequently due to exuberant amount of edema fluid. She was given diuretics, antibiotics and analgesics
Subject(s)
Humans , Female , Pulmonary Edema , Pregnancy Complications, Cardiovascular , Postpartum Period , EchocardiographyABSTRACT
This is a double blind placebo controlled study of 120 patients conducted in the department of anesthesiology POF's Hospital Wah Cantt: from October 2002 to April 2003 to evaluate the post-operative analgesia and side effects of IT neostigmine, morphine and their combination in patients undergoing elective caesarean section under spinal anesthesia. These patients were randomly divided into neostigmine, morphine, combined and saline [control] groups of 30 patients each. Morphine group had the longest analgesia as compared to other groups. The combined group too had a statistically significant prolongation of analgesia as compared to neostigmine [p = .01] and saline group [p = .00]. Nausea and vomiting were more frequent in neostigmine group [53%] and combined group [53%] than in the morphine group [36%] and saline group [26%]. The frequency of pruritus was not significantly different in combined [50%] and morphine group [46.66%] this study demonstrates that the combination of IT neostigmine 12.5 microgram and IT morphine 50 microgram results in post-operative analgesia for longer duration than IT neostigmine 25 microgram alone but not longer than IT morphine 100 microgram alone. The side effects seen with either drug alone are not overcome by combining the drugs in half the doses