survey of obstetric anesthesia practices in district level and government teaching hospitals in Punjab, Pakistan

Objectives: Maternal mortality rate remains unacceptably high in Pakistan. Nearly 200 women die in Pakistan for every 100000 live births as compared to 8 in Europe. According to Pakistan Demographic and Health Survey [PDHS] 2006-2007, anesthesia is one of the contributing factors to this high mortality rate. The aim of this survey was to find out what standards and guidelines in obstetric anesthesia are followed by anesthesiologists in teaching and district hospitals in Punjab, which is the largest province of Pakistan

Methodology: From January 2016 to March 2016, seventeen teaching hospitals and twenty-four district hospitals in Punjab were asked to take part in telephonic or face-to face survey. Questions were asked regarding the availability of internationally acceptable guidelines and protocols for managing obstetric emergencies like massive hemorrhage and failed intubation. Questions were also asked about the availability of equipment for difficult airway, blood products and regional anesthetic techniques used for cesarean sections. Data were collected in Microsoft Excel format and analyzed using simple statistics

Results: Overall availability of guidelines was lowest for massive hemorrhage [12%] and highest for managing difficult intubation [29%]. For the management of difficult airway only 36% had endotracheal tube introducers. For major obstetric hemorrhage, 68% of the hospitals could get blood in 30 min and 24% could get fresh frozen plasma [FFP] in 30 min. Regional anesthesia was the preferred technique in all the government hospitals. For performing spinal anesthesia all of the anesthesiologists used sterile gloves while 51% used masks and gowns and only 39% washed their hands before spinal. Sensation of pain and leg raising were the main modalities used to test the spinal block with 41% anesthesiologists considering block up to T8 a good level to start cesarean section. 85% anesthesiologists used 25G Quincke spinal needle

Conclusion: Our survey showed a grim state of affairs as far as obstetric anesthesia in government hospitals of Punjab is concerned. However; a comprehensive survey is needed to draw final conclusions and make further recommendations

An unusual presentation of postoperative malignant hyperthermia

An anesthesiologist may have only one odd occasional encounter with malignant hyperthermia throughout his or her clinical career, but it is always a reminder of our professional inadequacies, may it be clinical management, or availability of essential drugs or equipment. Malignant hyperthermia strikes when one least expects, as it happened in a child in postop recovery in a cleft camp. Quick decision and ready availability of dantrolene controlled the syndrome

Myocardial infarction

To assess the frequency of hyperhomocysteinemia in patients of first attack of ST-segment elevated myocardial infarction under age of 40 years. Cross sectional study. December 2009 to June 2010. Ch. Pervaiz Elahi Institute of Cardiology, Multan. A total of 65 patients of acute myocardial infarction were included in the study on the basis of chest pain, ECG changes and increased cardiac enzyme. A total of 65 patients fulfilled the inclusion criteria were included the study. Mean age was 35.68 years. Out of the 65 patients, 87.7% were male and 12.3% were female, 41.5% patients has increased homocysteine level while 68.5% had normal homocysteine level. Plasma Hcy is an important risk factor for the development of the acute myocardial infarction

Cardiovascular risk in patients without known cardiovascular disease

To estimate the risk factors among patients with known cardiovascular disease. This prospective study was conducted in Multan Institute of Cardiology, Multan as outdoor basis. A total of 100 patients aged 18-60 years were included in the study during the period from November 2005 to April 2006. After an average follow-up of 6 months, the low risk patients had a significantly lower CHD mortality [0.2 to 8.8 versus 1.5 to 38 percent for those with 1 risk factor] and lower all cardiovascular disease mortality [0.3 to 15.8 versus 2.1 to 53 percent]. Estimated greater life expectancy for low risk men and women was 9.5 and 5.8 years, respectively. The frequency and predictive value of five major risk factors [blood pressure, low-density lipoprotein [LDL] and high-density lipoprotein [HDL] cholesterol, glucose intolerance, and smoking] was evaluated in a study or white non- Hispanic individuals without CHD in the Framingham Heart Study and the Third National Health and Nutrition Examination Survey [NHANES III] who were 35 to 74 years of age. The frequency of high-risk patients increased with age and was greater in men than women. It has been suggested that determination of a patient's risk profile should improve physician recognition and treatment of modifiable risk factors. Because under recognition of hypertension, hyperlipidemia and other risk factors is a common problem, routine risk assessment may be an effective approach to improving their identification

Hypertension - major risk for cardiovascular

Hypertension is quantitatively the major risk factor for premature cardiovascular disease, being more common than cigarette smoking, dyslipidemia, and diabetes, the other major risk factors. To evaluate the cardiovascular risks of hypertension. This prospective study was carried out in outdoor of Multan Institute of Caardiology, Multan during the period from 11-1-2007 to 11-4-2007. A total of 100 individuals were included in the study who were attending outdoor of the hospital. Current risk status of the 100 subjects who developed cardiovascular disease [myocardial infarction, angina, coronary bypass surgery, angioplasty, or stroke] during the study period was compared with healthy subjects, there were few differences. However, the results were different when the original risk status was used. Those patients who remained healthy had had significantly lower blood pressure [121/79 versus 134/83 mmHg] and plasma cholesterol levels [211 versus 226 mg/dL [5.45 versus 5.84 mmol/L]] 25 years before. Antihypertensive drugs should be instituted if, after several different blood pressure measurements, the average blood pressure is above 140/90