ABSTRACT
Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look into the effects of labour analgesia on maternal and fetal outcomes and compare the same with that of opioid analgesics.Methods: It was a prospective randomized controlled trial on 100 patients where parturients were randomly allocated to either group 1-( n=50 patients) who received epidural analgesia or group 2 (n=50) who received intramuscular tramadol. The two groups were compared for duration of labour, analgesic efficacy as assessed by using Visual Analogue Scale (VAS) ,type of delivery – normal/instrumental/operative interventions ,1 and 5 min neonatal Apgar score and neonatal breast-feeding behavior between the two groups.Results: Epidural analgesic gave better pain relief than tramadol which was found to be stastically significant (p<0.001) on comparing the VAS scores and also gave statistically significantly higher satisfaction levels. Duration of both first and second stage of labor was comparable between the two groups and instrumental deliveries and caesarean sections were also comparable to that in tramadol group. There was a trend of higher neonatal Apgar scores in the epidural group than in the tramadol group.Conclusions: Use of effective analgesia in labour, does not prolong second stage of labor and may facilitate good labour outcome both for the mother and the fetus and should be offered to patients in tertiary setups and equipped centres when the patients are apprehensive about labor pains.
ABSTRACT
Objective: To determine whether fractional exhaled nitric oxide (FENO) has a utility as a diagnostic or predictive maker in acute exacerbations of asthma in children. Design: Analysis of data collected in a pediatric asthma cohort. Setting: Pediatric Chest Clinic of a tertiary care hospital Methods: A cohort of children with asthma was followed up every 3 months in addition to any acute exacerbation visits. Pulmonary function tests (PFT) and FENO were obtained at all visits. We compared the FENO values during acute exacerbations with those at baseline and those during the follow up. Results: 243 asthmatic children were enrolled from August 2009 to December 2011 [mean (SD) follow up - 434 (227) days]. FENO during acute exacerbations was not different from FENO during follow up; however, FENO was significantly higher than personal best FENO during follow up (P < 0.0001). FENO during acute exacerbation did not correlate with the severity of acute exacerbation (P=0.29). The receiver operating characteristics curve for FENO as a marker for acute exacerbation had an area under the curve of 0.59. Cut-off of 20 ppb had a poor sensitivity (44%) and specificity (68.7%) for acute exacerbation. Conclusions: FENO levels during acute exacerbation increase from their personal best levels. However, no particular cut off could be identified that could help in either diagnosing acute exacerbation or predicting its severity.