ABSTRACT
Background: Timely administration of vaccines, particularly for hepatitis B birth dose within 24 hours of birth is of immense importance. It is considered as an indicator of quality of immunization programme. This study aimed to assess effect of mode of delivery and type of hospital on immunization among newborns.Methods: This large multi-site study was conducted in Pune district having population of 9.43 million. A total of 13 hospitals were selected which included all government hospitals performing more than five cesarean sections per month, and one government and one private medical college hospital. Cesarean section and vaginally deliveries were enrolled in 1:1 ratio. Their children were followed till discharge. Data were collected by obstetrician or qualified nurse.Results: During study period 3,112 women were enrolled. The relative risk of not getting vaccine Hepatitis B birth dose before 24 hours among cesarean delivered newoborns was 1.08. The relative risk of not getting zero polio and BCG among cesarean delivered newborns was 0.71 and 0.76 respectively. All these differences were significant. The coverage for all vaccines was better in sub district hospitals than others. Coverage of all vaccines in government teaching hospital was better than private.Conclusions: Cesarean section enabled better coverage among newborns probably due to length of stay. Whereas the physical and mental stress after cesarean section resulted lesser coverage of hepatitis B birth dose within 24 hours. Opportunities of timely Hepatitis B birth dose administration were missed probably due to lack of knowledge among health workers about ideal timing.
ABSTRACT
Background and Objectives: Dexmedetomidine is increasingly being used in regional anesthesia as an adjuvant but there is no consensus on exact minimal and safe dose when used intrathecally. The present study was conducted to evaluate the efficacy of three different doses of dexmedetomidine when given intrathecally as an adjuvant to bupivacaine in patients undergoing lower abdominal surgery
Methodology: After taking ethical committee approval, and obtaining patients consent, 60 American Society of Anesthesiologist [ASA] physical status I and II patients in the age group of 25-60 years undergoing lower abdominal surgeries were divided randomly into three groups in this randomized double blind study. An intrathecal dose of 2.5 ml of 0.5% hyperbaric bupivacaine was administered to all patients supplemented with dexmedetomidine. In Group A 5 microg, Group B 7.5 microg and in Group C 10 microg of dexmedetomidine was administered with a volume of 3ml of study drug in each group. The onset time, time to peak sensory level, motor blockade, sedation, duration of motor block, analgesia and any adverse effects were noted. At the end of the study, data were compiled and analyzed with appropriate statistical tests
Results: Demographic profile was comparable in all the three groups. The time to onset of sensory block in Group C [1.55 +/- 0.510 mm] was significantly lower than Group A [2.15 +/- 0.745 min] and Group B [2.20 +/- 0.410 min]. Sensory regression by two segments was significantly higher in Group C [220.65 +/- 25.86 min] as compared to Group A [104.7 +/- 25.5min] and Group B [145.10 +/- 24.54 min]. [p < 0.05] The duration of motor block was shortest in Group A [243.8 +/- 22.0 min] as compared to Group B [305.4 +/- 35.8 min] and Group C [387.0 +/- 39.4 min]. The visual analogue scale score for pain was lesser in Group C as compared to the other two groups
Conclusion: Optimal dose of dexmedetomidine is difficult to define especially with prolonged duration of sensory and motor blockade in a dose dependent manner with minimal increase in side effects with higher doses. However, we conclude that 7.5 ug seems to be just optimal intrathecal dose of dexmedetomidine and can be used safely and effectively in lower abdominal surgeries