ABSTRACT
Spinal anesthesia [SA] was combined with general anesthesia [GA] for achieving hemodynamic stability in laparoscopic hysterectomy. The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile. We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study. Patients were randomly assigned to receive SA with GA [group SGA] or plain GA [group GA]. Group SGA received 10 mg bupivacaine [heavy] for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied. Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance [ANOVA] was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate [HR], mean arterial pressure [MAP], SPO2, and etCO2 was done with Student's t-test or Mann-Whitney test, wherever applicable. Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant [P < 0.01]. Group GA showed additional requirement of metoprolol [53.33%] and higher concentration of isoflurane [P < 0.001] to combat the increased MAP. Recovery was early and quick in group SGA as against group GA [P = 0.000]. There were no adverse/residual effects of SA. The hemodynamic repercussions during pneumoperitoneum can be effectively attenuated by combining SA and GA, without any adverse effects
ABSTRACT
Obstetric hemorrhage, a preventable condition, is one of the leading causes of death in developing countries. The role of anesthesiologist in the management of obstetric hemorrhage is very critical. The crux of management of obstetric hemorrhage is a consensual planning with formation of a multidisciplinary team and formulating a logistic protocol that can be disseminated locally for managing catastrophes. This review highlights the optimum preoperative care to assess the risk factors and isolate the patients prone to develop peripartum hemorrhage and also deals with the most recent guidelines and management protocols including conservative and interventional modes of treatment. Details of anticipated and unanticipated obstetric hemorrhage, fluid and blood transfusion strategies are discussed