A prospective observational study involving three fixed infusion regimens of phenylephrine for hemodynamic support during spinal anaesthesia for caesarian delivery

Background: Spinal anaesthesia used in caesarian section is associated with hypotension which can have maternal and fetal side effects. To determine the efficacy and ideal dosing of Phenylephrine in attenuating the hypotensive episodes during caesarean section under spinal anaesthesia.Methods: 100 patients were allocated to four groups, placebo group (PE 0) and 3 fixed phenylephrine infusion regimens, phenylephrine 25 μg/min-1 (PE 25), phenylephrine 50 μg/min-1 (PE 50), and phenylephrine 75 μg/min-1 (PE 75). Blood pressure, heart rate were noted among primary variables and fetal parameters like umbilical blood pH and lactate were recorded as secondary parameters.Results: There was a significant reduction in heart rate with increasing the infusion dosage of phenylephrine, with a mean of 86.8 beats/min at the end of procedure in placebo group and 69.4 beats/min in 75 μg group (p value <0.001). There was significant statistical difference among systolic blood pressure in the four groups after 7 min of the procedure and p-value of <0.05 with better attenuation of hypotension in infusion groups as compared to placebo. Similarly there was significant statistical difference in diastolic blood pressure among the four groups after 8 min of the procedure with p values <0.05.Conclusions: Prophylactic phenylephrine infusions reduced the incidence and severity of maternal pre-delivery hypotension. Among the fixed rate phenylephrine infusion regimens investigated, infusion rates of 50 μg/min-1 were associated with greater maternal hemodynamic stability compared with 25 and 75 μg/min-1, with minimal side effects and intervention.

Manejo anestésico de un paciente hemofílico con trombofilia / Anaesthetic management of a haemophiliac patient with thrombophilia

Haemophiliac patient are known to have increased mortality and morbidity in the past due to previous non existence of practice of blood banking. Mainly morbidity increased due to the complications arises such as recurrent bleeding episodes, painful haemarthroses and permanent disability secondary to ankylosed joints. This case enlightens the role and impact of undetected changes in Hemophilia A patient with Buerger’s disease, highlighting the importance of vigilance on the part of the anesthesiologist, who must ensure the adequacy of hemostatic monitoring in these patients. The clinical presentation of Haemophilia A disease with Buerger’s disease is a rare entity and can be challangeable for practicing anaesthesiology.

En el pasado, los pacientes hemofílicos han tenido una mortalidad y morbilidad aumentada debido a la inexistencia de los bancos de sangre. La morbilidadaumentada está dada principalmente porlas complicaciones como episodios de sangrados recurrentes, hemartrosis dolorosas y discapacidad permanente secundaria a articulaciones anquilosadas. Este caso ilustra el rol y el impacto de los cambios no detectados en un paciente con hemofilia A que cursa también con enfermedadde Buerger, lo que enfatiza la importancia de la vigilancia por parte del anestesiólogo quien debe garantizar una monitoría adecuada de la hemostasia en estos pacientes. La aparición clínica de un caso de hemofilia A asociado a la enfermedad de Buerger es muy infrecuente y es un reto parael anestesiólogo.