Maternal obesity and outcome of pregnancy, are they related?

To show the increased risk of adverse outcomes in labour and fetomaternal morbidity in obese women [BMI > 30]. A population-based observational study. Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation of 37 or more weeks of gestation with accurate information regarding height and weight recorded at the booking visit [measured by the midwives] were included in the study. Comparisons were made between women with a body mass index of 2030 and those with more than 30. SPSS version 10 was used for statistical analysis. Student's t test, chi[2] and Fisher's exact tests were used wherever appropriate. Labour outcomes assessed were risk of postdates, induction of labour, mode of delivery, macrosomia and shoulder dystocia. Fetal wellbeing was assessed using Apgar <7 at 5 minutes, trauma and asphyxia, cord pH < 7.2, babies requiring neonatal ward admissions, tube feeding and incubator. We report an increased risk [quoted as odds ratio [OR] and confidence intervals CI]] of postdates, 1.4 [1.21.7]; induction of labour, 1.6 [1.31.9]; caesarean section, 1.8 [1.42]; macrosomia, 2.1 [1.62.6]; shoulder dystocia, 2.9 [1.45.8]; increased neonatal admissions with complications such as neonatal trauma, feeding difficulties and incubator requirement. Obese women appear to be at risk of intrapartum and postpartum complications. Induction of labour appears to be the starting point in the cascade of events. They should be considered as high risk and counseled accordingly

Cardiopulmonary resuscitation: Knowledge and personal experience in Iranian dentists

This work describes the knowledge and experience of dentists about cardiopulmonary resuscitation [CPR]. A total of 273 dentists working at Shiraz, Iran were interviewed: 55% felt that they are able to define CPR, although only 37% had a correct concept; 51% believed they were able to perform CPR, however, none of them had received practical training in CPR; 4% of the interviewed professionals mentioned the occurrence of cardiopulmonary arrest in their dental office. The authors feel that dental surgeons in Shiraz, Iran should be better trained to manage medical emergencies which they may face in dental practice

efficacy of Epley manoeuver in the treatment of posterior canal paroxysmal positional vertigo

Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. Canalith repositioning manoeuvers are an established method for treatment of this disorder but efficacy of these maneuvers, including Epley canalith repositioning manoeuver are reported differently in various studies. In this study the efficacy of the Epley canalith repositioning maneuver has been evaluated in 43 patients. 43 patients with a history and physical examination consistent with posterior canal benign paroxysmal positional vertigo were studied. Patients were treated with a modified Epley canalith repositioning manoeuver. Patients were provided with a preprinted diary in which they had to circle the answers most relevant to their symptoms for 7 days after the manoeuver. Patients were reevaluated at one week after the manoeuver, The Hallpike manoeuver was performed at this time to corroborate the response to therapy. The mean duration of the BPPV before treatment was 7 weeks. A resolution of vertigo as a result of the manoeuver was obtained during the first 24 hours in 59% of the patients after one canalith repositioning manoeuver. 20% of patients had a resolution of vertigo during the first week however it is not evidently possible to conclude that these patients definitely benefited from the canalith repositioning manoeuver. In 21% of the patients vertigo persisted after the first week. Residual symptoms of lightheadedness, imbalance or both, were frequent [55% of cases] but rarely required any intervention. Epley canalith repositioning manoeuver resulted in immediate resolution of vertigo in 59% of our cases after one treatment. This manoeuver is safe and requires no special equipment or investigations; and it should be regarded as the treatment of choice for BPPV

Comparison of intrathecal meperidine and lidocaine in transurethral resection of the prostate

The anaesthetic effect of 2 ml of 5% lidocaine or 5% meperidine in water were evaluated and compared in 64 ASA class 1 or 2 patients. Patients were randomly assigned to one of the two groups [32 patients in each] according to the anaesthetic agent, which was injected into the lumbar subarachnoid space in the sitting position. The patients remained sitting for 5 min before being placed in the supine position. Times of onset of sensory blockade were significantly more rapid with Lidocaine. The extenet of maximum cephalad spread of analgesia and the time to maximum height of analgesia in the two groups were not different. Duration of analgesia at the T-7 [48.96 =/- 6.64 min with Lidocaine, 44.74 +/- 6.14 min with meperidine, means +/- SEM] and L-1 [94.37 +/- 7.42 min with Lidocain,e 76.19 +/- 5.64 min with meperidine] dermatomes was not different in the two groups but was statistically longer at the T-10 dermatome with Lidocaine [66.83 +/- 6.72 min] than with meperidine [46.66 +/- 6.26 min]. Complications in both groups included decrease in blood pressure and nausea and vomiting intraoperatively, and urinary retention nausea and vomiting and mild headache postoperatively. Complications that occurred only in the meperidine group were intraoperative drowsiness, respiratory depresstion, and itching. The frequency of complications was greater with meperidine

Comparison of analgesic effects of tramaddol and lidocaine in reduction of propofol induced pains

Propofol is frequently associated with pain on injection. Numerous methods were introduced to alleviate the pain. This study was designed to assess the effectiveness of Lidocaine compared with tramadol in reducing pain on propofol injection. In a randomized, double blind study, 60 patients were selected for this study and divided into two equal groups of A and B based on receiving tramadol and lidocaine respectively. Following venous occlusion by a pneumatic tourniquet placed on the arm and inflated to 50 mmHg above the baseline systolic pressure, a dose of 50mg [10cc] of tramadol was injected in group A [n= 30] and 50 mg [10cc] of lidocaine in group-B [n=30] and the tourniquet pressure was released after one minute. A dose of 2.5 mg/kg of propofol [20[degree sign] C - 25 [degree] C] was then administered as bolus dose over 30 seconds. Pain assessment was made 30 seconds after the start of the injection. There was a significant reduction in the incidence of propofol-induced pain when administered in both groups. The incidence of pain was 13.34% in group-A as compared to 16.66% in group-B without any significant difference. Pretreatment with tramadol is an effective as lidocaine in reducing pain on propofol injection

[ effect of suppository diclofenac na on post operative shivering in elective caesarian section surgery]

Introduction and Objective: post-operative shivering is a common complication of general anesthesia with a reported incidence of 40-70 percent. It increases metabolic rate of oxygen demand, cardiac output, intracranial pressure, surgical incision retracture and post-operative pain. Various drugs such as NSAIDS have been used to treat or prevent post-anesthetic shivering. The aim of this study was to determine the effect of Diclofenac Na suppository on post-anesthetic shivering

Materials and Methods: this is a double? blind randomized clinical trial performed on 120 primiparous women undergone elective Caesarian delivery. They were randomly divided into two case and control groups. Vital signs of all the patients were measured before anesthesia and recorded. Drugs used for premedication, induction and maintenance of anesthesia were the same in both groups. Just before the induction of general anesthesia, patients in case group received one suppository [100 mg] of diclofenac Na. Shivering was evaluated during 60 minutes after extubation and vital signs were measured as well. The data were analyzed by SPSS software

Results: post anesthetic shivering was observed in 61/7% of control group and 5% of case group [p< 0. 0001]. Post anesthetic hypothernia was much more frequent in control group in comparison with Diclofenac Na group [p<0. 0001]. In comparison with control group, case group had more stability in body temperature

Conclusion: results of this study indicate that a single dose of suppository Diclofenac Na [100 mg] prevents post-anesthetic shivering without significant effect on body temperature. Accordingly, it can be suggested that suppository Diclofenac Na can be used for the management of post operative shivering