ABSTRACT
The number of Caesarean Deliveries has shown a rapid increase in modern obstetric practice. This study was done to evaluate the choices of anaesthetic techniques for the lower segment caesarean section (LSCS) following the patient's clinical condition and its correlation with maternal and foetal outcomes in Dr. Sushila Tiwari Govt. Hospital, Haldwani, Uttarakhand, India. METHODSWe conducted a prospective observational study for one year. We recorded patient's age, parity, American Society of Anaesthesiologist (ASA) physical classification, chronic diseases or any other preoperative comorbid condition, caesarean indication, maternal outcomes, and foetal outcomes. We grouped the anaesthetic techniques used in LSCS as General Anaesthesia (GA) and Subarachnoid Block (SAB). RESULTSOut of a total of 2161 emergency caesarean sections were performed during the study period, 53 were under GA, 2096 under under SAB and in 12 cases SAB was converted to GA. Unlike previous studies, the most common indication of LSCS was previous caesarean (40.1%). In comparison, foetal distress is the second most common cause of emergency LSCS (37.1%). Maternal mortality was 16.9% (11/65) and 0.1% (3/2096) in GA and SAB, respectively (p-value 0.001). Neonatal mortality was 10.8% (7) and 2.4% (50) in GA and SAB, respectively. CONCLUSIONSMaternal and neonatal mortality and complications were higher in the GA group as compared to the SAB group. Also, increased incidence of violence against health care providers and rising lawsuits has led to a sense of insecurity amongst the health care providers which is evident via preference of LSCS in patients with previous history of caesarean section. This is evident from the trend that now previous LSCS is becoming most common indication of LSCS instead of foetal distress as is found in various studies done earlier.
ABSTRACT
Not many studies have compared more than two drugs in attenuating pressor responses to laryngoscopy and intubation. This study compares four groups of considerable size. The present study compared intravenous esmolol, diltiazem, and lignocaine, for their efficacy to abate pressure response to laryngoscopy and intubation. METHODSThis is a prospective, randomized, double-blinded, controlled clinical study conducted among 220 patients of ASA grade I/II (age 18–60 years), undergoing elective surgical procedure requiring general anaesthesia with endotracheal intubation over a period of 15 months at a tertiary hospital setup. Study subjects were categorised as Groups D, E, L, and N that received diltiazem (0.2 mg/Kg IV), esmolol (2 mg/Kg IV), lignocaine (1.5 mg/Kg IV), and normal saline, respectively; each group had 55 patients. Haemodynamic parameters were recorded at baseline, after drug administration, immediately after intubation, and at 1-, 3-, and 5-minutes after intubation. Data entry and analysis were performed using MS Excel and SPSS-PC-17 version, respectively. One-way ANOVA and the chi-square test were used to evaluate the difference. P < 0.05 was considered significant. RESULTSA maximum increase in haemodynamic parameters occurred immediately after intubation. The increase in heart rate and rate pressure product were significantly lower in Group E (+2.93% & +15.31%), whereas the increase in blood pressure was lower in Group D (8.51%). CONCLUSIONSHaemodynamic stability during laryngoscopy and endotracheal intubation is an integral and essential goal of any anaesthetic management plan and was more effectively maintained with esmolol and diltiazem than with lignocaine.
ABSTRACT
Background: The aim of study is to compare easytube, etc,and lts in terms of - difficulty of device insertion, time to achieve airway, insertion success rate, haemodynamic parameters following device insertion and frequency of adverse effects. Methods: This randomised single blind study was conducted on 90 patients of age 18-60 years, undergoing elective surgery requiring general anaesthesia. Patients were randomly allocated in three groups- Group ETC: (n= 30), Group EzT (Esophageal Tracheal Combitube) : (n=30). After preoxygenation, induction and muscle relaxation appropriate ETC, Easy Tube,LTS was inserted and all parameters were noted by an independent observer. For statistical analysis, Student t-test was employed to compare the means and Chi-square test was used for categorical variables. Results: The demographic profile of patients in all groups was similar. Amongst each group device was placed in single attempt in all patients . The mean time for effective placement of the device was longer in group EzT (49.13±7.49 ) compared to groupETC and LTS(48.76±7.15). Conclusion: The intraoperative ventilation was equally effective and safe with all three devices. The intubation response was similar in magnitude with all devices and more importantly it was transient, not interfering with intraoperative usage. We also conclude that placement of ETC and LTS is easier than Easytube.