Effect of spinal and general anaesthesia over APGAR score in neonates born after elective cesarean section

Objective: To compare the effects of general anaesthesia and spinal anaesthesia on APGAR SCORES in neonates born to full term elective cesarean sections

Design: Randomized prospective study.

Place and Duration of Study: The study was carried out at Abbasi Shaheed Hospital from March 2009 to July 2009

Material and Methods: The study was performed on 60 healthy full term patients lying in American Society of Anaesthesiologist-1 category presenting for elective lower segment cesarean section. Thirty patients were given general anaesthesia and other 30 patients received spinal anaesthesia. The Apgar scores were recorded at 1 minute and 5 minutes interval after each delivery

Results: Patients undergoing general anesthesia, who had short time interval between induction of anaesthesia and delivery, gave birth to neonates having Apgar Score >/=7 at 5 minutes interval and there was less difference in the effects of general and spinal anaesthesia on the Apgar Score of such neonates

Conclusion: There was no significant difference between the effects of general anaesthesia and spinal anaesthesia on Apgar score of neonates at 5 minutes interval after birth, born after full term elective cesarean section

Post dural puncture headache after spinal anesthesia in orthopaedic patients, using 25 gauge quincke - babock spinal needles

To find out the frequency of Post Dural Puncture Headache in patients under going for ortho-paedic lower limb surgery with 25 Gauge Quincke spinal needle in patients ranging from 18 to 40 years of age. In the previous studies the incidence was high as more then 8%. Cross-sectional study. This study was conducted in orthopaedic operation theatre and ward of Abbasi Shaheed Hospital, from January, 2004 to July 2005. A total of 200 patients were included in study with ASA I, li III. Both male and female were included in equal proportions. All patients both male and female ranging from 18-45 years of age were included. To assess the Post Dural Puncture Headache a questionnaire was filled on 2[nd] 4[th] and 7[th] post operative day. Post Dural Puncture Headache assessed by using visual analogue and pain rating scale. Two hundred [200] patients were studied, male and female were in equal proportion. The over all incidence of Post Dural Puncture Headache was 4.5% in our study, which is less than the previousstudies. The Occurence of Post Durai Puncture Headache [4%] in male and [5%] female. All Post Dural Puncture Headache occurred on 2[nd] day of surgery, with maximum duration of 4 - 7 days. Treatment consist of, bed rest, enhanced oral / Intra venous fluid and simple analgesic. No patient required blood patch. Occurence of Post Dural Puncture Headache is high in young patients with 25 gauge Quincke needle in the previous studies. But in our study the incidence was 4.5%. there are enough that both size and shape of spinal needle tip influenced the incidence of Post Dural Puncture Headache. The frequency of Post Dural Puncture Headache can be reduced by using small gauge cutting needle or pencil point non-cutting needle. The failure rate may be high by using a small gauge Quincke type spinal needle. The technique is some what difficult with cutting spinal needle

Comparison of different concentration of bupivacaine [0.1%] / 0.2% with fentanyl 2 micro gram/ml by epidural infusion for labor analgesia

To evaluate the efficacy of 0.1% Bupivacaine versus 0.2% Bupivacaine with fentanyl 2 microg/ml via epidural for analgesia in labour. Randomized study. Single centre study of 80 patients conducted at gynae unit of Imam Clinic and General Hospital Karachi. from Jan 2002 to April 2005. In a randomized study, 80 nulliparous parturients in labour had epidural analgesia initiated with 0.2% bupivacaine and fentanyl and were then randomized to receive either 0.1% Bupivacaine with fentanyl 2microg/ml at 10m1 /hr [Group B1.n = 38] or 0.2% Bupivacaine with fentanyl 2microg/ml at 8ml/hr [group B2 n= 39] as epidural infusions. Bupivacaine 0.2% 5m1 as an epidural bolus was provided on request as Supplementary analgesia. There were no significant differences between the visual analogue pain scores either with respect to motor or sensory block. The amount of local anaesthetic used was lower in 0.1% Bupivacaine group then in 0.2% Bupivacaine group [P = 0.001] Side effects, patient satisfaction, labor outcome and neonatal outcome were similar in both groups. Epidural infusions of 0.1% Bupivacaine with fentanyl 2 microg/mI at 10-m1/ hr provided adequate analgesia in the first stage of labour. The level of analgesia was similar to that obtained using 0.2% Bupivacaine with fentanyl 2 microg/ml and with no differences with regard to sensory or motor block

Anxiety and depression in pre-operative catractectomy patients: a pilot study

The objective of this study is to use the hospital anxiety and depression scale which is a valid scale to rule out whether these patients are undergoing anxiety or depression prior to surgery. A random surveillance [prospective]. The department of psychiatry conducted a random survey of all the patients reporting for cataract elective surgery in the Department of Ophthalmology during the months of August and September 2004. In total 52 patients were interviewed, after informed consent out of which fourteen had clinical levels of anxiety where as fourteen had depression. All these patients were rated on a standardized urdu version of hospital anxiety and depression scale. Those suffering from anxiety there were ten females and three males whereas depressed were six males and nine females. In all there was a morbidity of twenty-seven cases out of fifty-two which had either anxiety or depression. Local studies as well as international studies carried out have indicated the importance of recognizing and intervening before surgery. This is to enhance recovery and achieve level of satisfaction in surgery patients. The limitation of this study was the small number of cases selected to conduct the study. Anxiety and depression is very common in patients undergoing surgery. Reassurance and counseling is necessary before surgery

Validity of visual analogue scale in assessment of anxiety: a comparative study in anesthesia clinic

To compare the level of Pre-Operative anxiety in patients reporting 24 to 72 hours before Surgery in Government Hospital, with patients assessed 24 to 72 hours before Surgery in Private Hospital. Comparative study. Out patient Anaesthesia clinic at Karachi Medical and Dental College, Abbasi Shaheed Hospital and Imam Clinic and General hospital North Nazimabad Karachi from January 2004 to October 2004. Two groups of 20 patients each were studied who underwent Abdominal hysterectomy. Group-A patients were assessed in Pre-Anaesthesia out patient Clinic 24 to 72 hours before admission in Abbasi Shaheed Hospital [Government hospital] and Group-B had Pre-Anaesthesia assessment 24 to 72 hours before surgery in private sector hospital. The visual analogue scale of anxiety [VAS] was used to assess anxiety in patients participated in study and p-value was derived by using independent t-test: The median anxiety score is 4[2-6] in Group A and 6[4-9] in Group-B. This anxiety score [VAS] is significantly lower Group-A when compared with Group-B [P< 0.01]. We conclude that Pre-Anaesthetic assessment in Anaesthesia clinic 24 to 72hours before Surgery in Government Sector hospital reduces Pre-Operative anxiety more when compared with an Pre-Anaesthesia assessment in private sector hospital

Failed endotracheal intubation

A middle-aged lady suffering from a huge goiter was scheduled for subtotal thyroidectomy. After giving inhalation anaesthesia, when patient went into surgical plain of anaesthesia, oral endotracheal intubation was attempted, but failed she was then managed by laryngeal mask airway. Recovery and follow-up were uneventful

Comparison of equipotenet doses of butorphanol and pethidine for intraoperative analgesia, postoperative requirement and its adverse effects

This double blind randomized study was conducted in forty ASA I and ASA II patients aged 20 to 60 years, scheduled for total abdominal hysterectomy. Butorphanol 20 micrograms/ Kilogram proved to be an adequate analgesic supplement to nitrous oxide, oxygen and relaxant anaesthesia with 0.5% halothane, for total abdominal hysterectomy surgery in the majority of our patients. The patients remained stable intraoperatively, excessive cardiovascular response to surgical stimuli, were sufficiently suppressed and the technique provided satisfactory analgesia in the postoperative period. Recovery of consciousness and spontaneous ventilation presented no problem and the incidence of side effects was no different from pethidine

Death registration in Pakistan

To review the existing system of death registration in Pakistan and its problem in relation to forensic medicine. The current death registration procedure both from Local Government and Cantonment boards of Pakistan were obtained and reviewed and its medico-legal aspect was attempted to ascertain. The maintenance of records and compilation of death registry data by the Local Bodies and Cantonment Boards is for demographic purpose. The degree of precision of the deceased particulars are correct. However cause of death statement is not in accordance to the standard classification. It is therefore essential to emphasize the importance of the death certification process to the medical profession. This is a review article