ABSTRACT
One of the commonest non-obstetric problem that will require surgical intervention during pregnancy is acute appendicitis. Laparoscopic appendectomy in parturient has many challenges to anesthesiologists like preterm labour, foetal morbidity, and maternal morbidity. Providing safe anaesthesia is such cases is challenging and necessary. The anaesthesiologist has to ensure maintenance of maternal oxygenation, perfusion, and homeostasis, with the least extensive anaesthetic for the best outcome for the foetus.Laparoscopy in pregnancy is challenging both for the surgeon and anaesthesiologist. Challenges faced by the anaesthesiologist includes laryngoscopy and tracheal intubation associated pressor responses haemodynamic changes associated with gravid uterus causing aortocaval compression and increased in intraabdominal pressures due to pneumoperitoneum, maternal CO2 monitoring to avoid maternal and foetal acidosis, considerations of avoiding foetal exposure to unnecessary medications & foetal heart rate monitoring. Whenever practically feasible regional anaesthesia is usually preferred over general anaesthesia in pregnancy whenever it is practically feasible. Regional anaesthesia in this case involves discomfort to the patient, need to take a higher level for surgical anaesthesia, hemodynamic changes associated after induction, risk of uterus manipulation by surgeons all of which can predispose to preterm labour. In our case we have opted for general anaesthesia over regional anesthesia due to fore mentioned reasons.
ABSTRACT
Propofol is one of the safest drugs for induction of general anaesthesia. Routinely available preparation in the market being propofol LCT (long chain triglycerides) has the disadvantage of pain on injection. This pain is very discomforting for the patient and also to the anaesthesiologist. So, they are coming up with a new preparation propofol MCT (medium chain triglycerides) which causes less pain on injection. We wanted to compare the occurrence of pain on injection of Propofol MCT with Propofol LCT.METHODSAfter obtaining institutional ethical committee approval, 150 patients undergoing various elective surgeries under general anaesthesia where propofol was used as an induction agent, aged between 18 and 65 years of ASA I & II were enrolled in the study. The study patients were divided into two groups. Group M, who received Propofol MCT and group L, who received Propofol LCT as an induction drug. The intensity of pain was evaluated by using Visual Analogue Score (VAS). Similarly change of triglyceride levels after single induction dose of Propofol MCT and Propofol LCT were observed.RESULTSGroup M showed reduced pain score (4.15±1.90) after injection along with less incidence of pain compared to Group L (6.37±2.49). Serum triglyceride levels had no significant difference in preoperative and postoperative values.CONCLUSIONSPain on injection with Propofol MCT (4.15 ± 1.90) is less compared to Propofol LCT (6.37± 2.49) & no evidence of change of triglyceride levels was seen after a single induction dose in the study.