Management of eclampsia in Assiut University Hospital, 15 years experience

The aim of this study was to evaluate the protocol used for management of eclampsia in Assiut University Hospital. This study was carried out in the Department of Obstetrics and Gynecology and Intensive Care Unit [ICU], Department of Anaesthesia; Assiut University Hospital. A prospective cross-sectional study from January 1990 till January 2005, all patients with eclampsia were included [1332 patients]. Patients studied were 1032 ante partum eclampsia, 75 intrapartum, 16 intercurrent and 209 postpartum eclampsia. The regimen included the use of Nifedipine as an antihypertensive, Magnesium sulfate as anticonvulsant, rapid termination of pregnancy and admission to the intensive care unit. Magnesium sulfate was effective in controlling convulsions in 98.1% of the cases. Nifedipine initiated a smooth decline in blood pressure [P > 0.0001]. The dose of Nifedipine needed to control the blood pressure was variable in the different groups of patients. There are 55 cases of maternal deaths [4.12%]. Maternal morbidity occurred in about 23% of cases. Vaginal delivery occurred in 23.3% of cases [most of them were admitted postpartum]. Perinatal morality was variable in the four groups with the highest rate in the antepartum group [7.9%]. The incidence of low Apgar score at 5 minutes was higher in the antepartum group. Combination of Niftdipine as an antihypertensive drug, magnesium sulfate as an anticonvulsant, rapid termination of pregnancy and managing the patients in the intensive care unit resulted in marked improvement of the outcome for both the mother and fetus

Cerebral metabolic rate of oxygen, intracranial tension and blood flow equivalent during isoflurane or sevoflurane anaesthesia in brain surgery

This study included 28 patients of ASA physical status I-II, aged 18-55 years, subjected to craniotomies for supratentorial brain tumor. They were randomly allocated into two groups to receive either isoflurane [group I] or sevoflurane [group II] anesthesia. Cerebral venous monitoring through bulb catheterization to allow assessment of global oxygen delivery adequacy. A fiberoptic extradural sensor was inserted in extramural space to monitor the ICP. Anesthesia was induced by thiopentone/fentanyl/pepecurium/isoflurane in group I, and thiopentone/pepecurium/sevoflurane in group II. Anesthesia was maintained with 1.5 MAC [1.5%] isoflurane in group I and 1.5 MAC [3%] sevoflurane in group II in FiO2 100%. The patients were mechanically ventilated in such a rate to maintain PaCO2 between 32-35 mmHg. Mean arterial blood pressure [MAP], intracranial pressure, arterial and jugular venous blood gases, arterial and jugular venous lactate concentrations were measured and times of recovery parameters were recorded. Cerebral perfusion pressure [CPP], arterial oxygen content [CaO2], jugular venous oxygen content [VjvO2], arteriojugular venous oxygen content difference [AJVDO2], cerebral oxygen extraction ratio [OER], arteriojugular lactate difference [AJVLS], lactate oxygen index [LOI], cerebral blood flow equivalent [CBF equivalent] were calculated. Times elapsed, till recovery parameters occurred, were recorded

Sevoflurane versus isoflurane in normal and pre-eclamptic parturients undergoing cesarean delivery

One hundred and twenty pregnant women were randomly assigned to receive either isoflurane two groups] or sevoflurane [two groups] using on open [non-blinded] study design. Anesthesia was maintained with either isoflurane 0.5% end tidal or sevoflurane 1% end tidal in combination with nitrous [N2O] 50% in oxygen. Liver functions, kidney functions, complete blood count and coagulation profile were measured and recorded. Pharmacokinetic study included serum inorganic fluoride concentration and kinetics of serum inorganic fluoride. Also, blood pressure, heart rate, central venous pressure [CVP] monitoring, ECG, estimation of intra-operative blood loss, uterine tone, recovery profile and urine in 24 hours were also studied. Infant outcome was also evaluated by Apgar score, neurologic adaptive capacity score [NACS], umbilical artery blood gas, acid base status and serum fluoride level. From the results obtained, it was concluded that sevoflurane appears to be similar to isoflurane with a few exceptions. It appears similar to isoflurane in its effect on regional blood flows including the hepatic and renal circulation. The use of sevoflurane resulted in faster emergence than after isoflurane. The high serum fluoride levels associated with administration of sevoflurane anesthesia were not dangerous, because it did not reach the level that cause nephrotoxicity. Neonatal outcomes were similar after anesthesia with either isoflurane or sevoflurane. So, sevoflurane 1.0% is a suitable alternative to isoflurane 0.5% for maintenance of anesthesia in such cases, but in this era of cost containment and rationing of health resources, it remains to be seen whether sevoflurane will supplant isoflurane for obstetrical anesthesia