ABSTRACT
Background: Health care in India is a complex amalgam involving various stakeholders. For decades it has been a neglected area with reluctance in increasing the inputs such as finance or infrastructure required to drive this system. Utilization and access to this health system is a key indicator and major determinant of health seeking behaviour.Methods: This community based cross sectional study was conducted from January-February 2016 in, the urban slum located in a metro city using a pretested, semi-structured questionnaire. The data was analyzed using SPSS 22.Results: More than half of the participants preferred to seek treatment from a public health care facility compared to a private. One of the most predominant determining factors on choosing a particular health facility was affordability. Main barriers perceived in utilization of health services were long waiting time at the health facility and expenditure on treatment.Conclusions: The key for ensuring adequate and appropriate utilization of health care services is in having an efficient government health care delivery system which can offer quality and affordable medical care to one and all.
ABSTRACT
Objective: We aimed to compare C-MAC videolaryngoscope [VLC] with Macintosh laryngoscope with regard to the laryngoscopic view, the need for external laryngeal manipulation, requirement of airway adjuncts like stylet, time required to complete the tracheal intubation and the hemodynamic changes in Mallampati class 2 and 3 patients
Methodology: Sixty patients who were admitted for elective surgery requiring general anesthesia with endotracheal intubation were randomly allocated to proceed with endotracheal intubation using the conventional Macintosh laryngoscope [Group A] or the C-MAC VLC [Group B]. Following a standardised general anesthetic protocol, time for intubation, laryngoscopic view, need for external manipulation, and hemodynamic parameters during and after intubation were registered during study period
Results: It was observed that C-MAC VLC improves the laryngoscopic view in predicted difficult airway setting, and thus reduces the need for external laryngeal manipulation and the use of stylet. However, the hemodynamic stress response was significant with C-MAC VLC than Macintosh laryngoscopy. There was significant reduction in time taken for intubation with conventional Macintosh laryngoscope when compared with C-MAC® VLC. The median total intubation time for the Macintosh and C-MAC® VLC were 23.8 and 35.33 sec respectively [p = 0.000]
Conclusion: C-MAC® videolaryngoscope improves laryngoscopic view in difficult airway settings compared to the conventional Macintosh laryngoscope, but at the cost of prolonged time taken for intubation and increased hemodynamic stress response. Large scale studies may be required to determine the ultimate success of intubation with this new tool
ABSTRACT
Ropivacaine and bupivacaine were compared in various combinations for orthopedic and obstetrics patients. We have compared the clinical efficacy of two combined spinal epidural drug regimens using equal volume of 0.75% isobaric ropivacaine to 0.5% hyperbaric bupivacaine intrathecally, and 0.125% of the plain drug along with epidural opioid for elective lower abdominal surgeries. 50 patients of ASA I or II of either sex, between 18 to 60 years of age scheduled for elective surgery under combined spinal and epidural anesthesia [CSEA] were randomly allocated into two groups. Bupivacaine group [B] received 3 ml of 0.5% bupivacaine intrathecally and 0.125% bupivacaine with fentanyl 2 microg/ml epidurally while Ropivacaine group [R], received 3 ml of 0.75% ropivacaine intrathecally and 0.125% ropivacaine with fentanyl 2 microg/ml epidurally. The two groups were compared for the onset of analgesia, onset of motor blockade, duration of analgesia, time for motor recovery and the haemodynamic variables. There were no significant haemodynamic changes in both the groups. The onset of motor block was similar in both groups [4 min] but the onset of sensory block was faster with group B patients [4 min] as compared to group R [6 min]. The duration of analgesia and the time till the need for start of epidural infusion was longer in group B [221.60 +/- 10.677 min] when compared to group R [198.40 +/- 23.216 min]. However, the time for regression of motor blockade was faster in group R [172.20 +/- 10.712 min] as compared to group B [205.20 +/- 13.423 min], facilitating early ambulation of the patients. This study illustrates that both the regimens were comparable in terms of level of block, analgesia and haemodynamic stability. Intrathecal ropivacaine and epidural ropivacaine with fentanyl was shown to result in adequate level of block, complete analgesia and haemodynamic stability. The onset of analgesia however was faster in patients who received intrathecal bupivacaine
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Alkaptonuria is a rare inherited autosomal recessive disorder of metabolism due to deficiency of homogentisic acid oxidase. This results in deposition of homogentisic acid in almost all the collagenous structures of the body leading to progressive multisystem involvement [alkaptonuric ochronosis] and poses a big challenge in anesthetizing such patients. We present one such case posted for total hip replacement and its successful management under general anesthesia
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We describe an interesting case of a patient who had Takayasu's arteritis and apical hypertrophic cardiomyopathy. Electrocardiogram, and transthoracic and transesophageal echocardiograms showed classical features of apical hypertrophic cardiomyopathy which is particularly uncommon outside Japan. To the best of our knowledge, the presence of apical hypertrophic cardiomyopathy in patients with Takayasu's arteritis has not been reported till date.