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.
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Background: The number and variety of procedures done onday care basis has rapidly increased in recent past. For daycare anaesthesia, the use of anaesthetics that provide fast andsmooth induction, allow quick changes in depth whilemaintaining anaesthesia, early recovery and less postoperative nausea and vomiting are recommended. The aim ofthis study to compared the haemodynamic characteristics ofsevoflurane and desflurane anaesthesia and Fast track criteriaof recovery after ambulatory surgery.Materials & Methods: A double blind randomized study in theDepartment of Anaesthesiology and Intensive Care Unit atGovt. Medical College, Amritsar. 100 patients of AmericanSociety of Anaesthesiologist grade I or II in the age group of 20to 50 years undergoing short surgical procedure under generalanaesthesia were included. Continuous monitoring of vitalswas started after attaching Multipara monitor. In first 15minutes of intra-operative period monitoring of BP, HR, SPO2and ECG pattern were done every 5 minutes after that timeinterval was changed to 10 minutes till completion of surgery.After completion of surgery emergence time was noted. Inrecovery room assessment of variables required for fast trackscoring system were recorded after every 5 minutes. All theresults were be compiled, analyzed statistically and theappropriate test was applied and the blinding of the study wasopened at the end.Results: Our study showed that the mean age of patients inboth the groups was found to be statistically insignificant(p>0.05). The mean duration of surgery in both the groups wasfound to be statistically insignificant (p>0.05). The fast trackscore in group S and D at different time interval wasstatistically insignificant (p>0.05) and the maximum number ofpatients achieving PADDS score between 60-120 minutes.83% patients were ready to go home at 120 minutes.Conclusion: We concluded that both the inhalationalanaesthetics i.e. sevoflurane and desflurane provide similarhaemodynamic stability, but desflurane is associated withfaster emergence as compared to sevoflurane.
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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.
ABSTRACT
Background: Laryngoscopy and intubation may cause undesirable increase in blood pressure and heart rate. The aim of the present study was to investigate the effect of Pregabalin premedication on hemodynamic responses to laryngoscopy and intubation. Methods: Sixty ASA physical status I or II patients undergoing elective surgery under general anesthesia were randomly allocated into two equal groups who received either oral Pregabalin 150 mg (Group PB)or placebo (Group PL)1 hour prior to surgery. Heart rate, Systolic, Diastolic and Mean arterial blood pressures were recorded preoperative, at laryngoscopy and 0,1,3,5 and 10 minutes after tracheal intubation. Results: Demographic data and base-line values for Heart rate, Systolic, Diastolic and Mean arterial blood pressures were comparable between groups. During laryngoscopy and intubation there was significant attenuation of SBP, DBP and MBP in PB group as compared to PL group. Although increase in heart rate was less in pregabalin group during laryngoscopy and intubation but it was not statistically significant. Conclusion: In the present study design, oral Pregabalin premedication at a dose of 150 mg one hour prior to surgery attenuates pressor response associated with laryngoscopy and endotracheal intubation but not the tachycardia significantly.