Uterine atony; association of low serum vitamin D

Uterine atony is one of the causes of postpartum hemorrhage, resulting in increased maternal morbidity and mortality. To determine the association of low serum vitamin D level with uterine atony, among women delivering in a tertiary care hospital. Case control Study. Gynae and Obstetrics department of Sheikh Zayed Medical College, Rahim Yar Khan. 1st January to 31st December, 2013. A total of 130 patients were recruited and grouped as A [Cases] including patients with uterine atony [100 patients] and group B [Controls] patients having no uterine atony [30 patients] after cesearean section or vaginal delivery and fulfilling the inclusion or exclusion criteria. The test for 25 OH vitamin D was performed on Elecsys 2010 Roche by using electrochemiluminescence technique. Oral informed consent was taken from all subjects and approval from institutional ethical committee was obtained. Chi square test was applied to compare atony and non atony groups in terms of presence or absence of vitamin D deficiency. The data was entered and analysed on SPSS version 17. It was noted that those who have uterine atony 87% were having vitamin D deficiency or insufficiency as compared to 68% in group with no uterine atony. This difference was statistically significant. [p=0.02] so uterine atony was significantly associated with vitamin D deficiency or insufficiency. In atony group mean age was 25+/-4 years, gravida 2.64+/-1.2, gestational age, 37+/-1.2, blood loss 1032+/-400, and serum vitamin D level 15.9+/-6, ng/ml. In non atony group, group mean age was 26+/-3 years, gravida 2.7+/-1, gestational age, 38+/-.8, blood loss 309+/-92, and serum vitamin D level 23+/-9 ng/ ml. The mean level of serum vitamin D level was significantly low [15.9+/-6 ng/ml] in atony group as compared to non atony group[23+/-9 ng/ml]. Mean blood loss was significantly high [1032ml] in atony group as compared to non atony group [309ml]. Our results revealed that low vitamin D level is strongly associated with uterine atony and hence is a risk factor for uterine atony

Comparison of LMA Classic and i-gel in anesthetized, spontaneously breathing patients during elective surgical procedures

The primary objective of this study was to compare two supraglottic airway devices regarding mean insertion time. Secondary objective was to assess the devices regarding first attempt success and ease of insertion. Tertiary objectives were to compare the post removal cough, laryngospasm and blood on device. Interventional quasi experimental study conducted in Department of Anesthesiology, ICU and Pain Management Sheikh Zayed Hospital, Rahim Yar Khan from April 2012 to October 2012. 100 adult patients aged 15 to 70 years, ASA-I and II, Mallampati I and II, who were scheduled for various elective surgical procedures under general anesthesia were taken. Study was conducted in anesthetized spontaneously breathing patients. The patients were divided into i-gel and LMA groups by draw method. SPSS 16 was applied for analysis. No statistically significant difference was reported between the groups, regarding mean insertion time, first attempt success, ease of insertion, cough and laryngospasm. Blood on LMA after removal had significantly greater incidence than on i-gel [10% on LMA group while none in i-gel group]. Both i-gel and LMA Classic can be used safely and effectively in selected patients under general anesthesia with spontaneous breathing

Analgesic efficacy; Comparison of ketorolac and diclofenac sodium

To compare the analgesic efficacy of a single dose preoperative intramuscular Ketorolac versus diclofenac sodium for prevention of postoperative pain after third molar surgery. This Experimental comparative study. Department of Anesthesia, Pakistan Atomic Energy Commission, AI-Zahra Hospital, Geo Care, and Maryam Maternity Hospital, DG Khan. October 2011 to March 2012. Patients undergoing elective third molar surgery were randomly assigned into one of the two groups. ln each group, 60 patients completed the study properly. Group-l received diclofenac sodium 75 mg lM 20 min preoperatively and group-ll received Ketorolac 30 mg lM 20 min preoperatively. Patient in Ketorolac group reported significantly lesser pain intensity scores in the 3rd hour pain than the Diclofenac group [p-value lesser than 0.0001]. Patient also reported significantly longer mean time to rescue analgesic 7.5 h versus 4.8h [p lesser than 0.001., student t test] that is approximately 2.5 h longer duration of preventive analgesic consumption [p=0.006, student t test]. Preoperative intramuscular injection of Ketorolac 30 mg is more effective than Diclofenac 75 mg in the prevention of postoperative 3rd molar pain.