ABSTRACT
Objective: To assess the incidence of blood transfusions required in Caesarean section [CS] and evaluate the rationale of routinely arranging cross matched blood for every patient
Study Design: A chart review retrospective descriptive study
Place and Duration of Study: This study was conducted at the Anesthesia Department of Combined Military Hospital [CMH], Lahore, from June 2011 to May 2013
Patients and Methods: In this retrospective study we reviewed all singleton CS performed using data from blood bank registry and all CS patient's charts obtained from the Records Department of the hospital. Clinical variables including demographic characteristics, estimated blood loss, indications for CS, preoperative haemoglobin and indications for transfusion were gathered. Patients transfused with blood had their medical records reviewed by two reviewers to confirm accuracy and identify risk factors for haemorrhage
Results: A total of 6250 caesareans deliveries were performed over the study period. Out of these 381 patients were transfused [6.09%]. Blood typing and screening was done for 3260 cases [52%] and blood was arranged for 2320 [37%]. Among blood receiving patients 250 patients [65.62%] were emergencies. Ninety eight patients [25.72%] were primigravida. Indications for transfusion mentioned in the charts were preoperative anaemia [18.37%], repeat caesarean sections [39.37%], placenta previa [6.56%], severe preeclampsia [17.06%], failed progress in labor and other rare causes [18.37%]
Conclusion: Transfusion risk in patients undergoing routine CS is low. Factors indicating risk for transfusion include preoperative anaemia, repeat caesareans, severe preeclampsia, obstructed labor and placenta previa. In the absence of these risk factors routine arrangement of the blood does not enhance patient care
ABSTRACT
To evaluate the benefits, efficacy and safety of local cervical plexus block in the performance of carotid endarterectomy, in the absence of sophisticated cerebral perfusion monitoring. This study was carried out at Combined Military Hospital [CMH] Lahore, Pakistan from January 2012 to May 2013. Quasi-experimental study. A total of 45 cases of ASA II and ASA III physical status were operated for carotid endarterectomy under local block of cervical plexus. After thorough preanaesthetic assessment, the patients physical conditions were optimized before surgery. Premedication was given with midazolam and sedated during operation with small doses of propofol. Local anaesthesia [LA] was completed by injecting bupivacaine in cervical plexuses C2, C3 and C4 areas. During operation vital signs and adequacy of cerebral perfusion were monitored by keeping the patient awake and making clinical neurological observations. Verbal contact was maintained with the patient. Breathing patterns and motor power were assessed in contralateral upper and lower limbs. Postoperatively patients were interviewed and analgesia during operation was assessed with visual analogue scale. Surgeon's satisfaction regarding intraoperative analgesia was also noted. Patients who required added sedation or local anesthetic agent were also noted. Average duration of surgery time was two hours and average stay of the patients in hospital was five days. Out of 45 patients, 37 patients [82%] had smooth and comfortable anaesthesia and analgesia. In only 1 patient [2.2%] LA had to be converted into general anaesthesia [GA]. In 3 cases [7%] LA was supplemented. One patient [2.2%] developed hoarseness and difficulty in breathing and 1 patient [2.2%] developed hemiparesis intra-operatively; while 1 patient [2.2%] developed hypotension in the immediate postoperative period. One patient [2.2%] developed haematoma at infiltration site. Surgeon satisfaction was excellent in 40 [89%] cases. Surgery of carotid endarterectomy can be performed adequately and comfortably under LA. In centers where sophisticated facilities for intraoperative cerebral blood flow measurements are not available, clinical intraoperative assessment of cerebral functions is of immense benefit, which is only possible under LA