Anesthesia for fetoscopic intervention

This is the first case report on anesthesia for fetoscopy performed in Saudi Arabia. Epidural anesthesia was given to the mother in her late second trimester for the fetoscopic intervention. The anesthesia related issues such as physiological and anatomical changes in pregnancy, tocolytic medications and their interactions with anesthesia, anesthetizing/sedating the primary patient are discussed

Placebo controlled comparison of the opioid sparing effect of meloxicam and diclofenac after abdominal hysterectomy

To compare the opioid sparing effect of meloxicam, diclofenac, and placebo after abdominal hysterectomy. This study was conducted at the Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from February 2004 to November 2006. Women of American Society of Anesthesiologist's classification I or II of ages 25-60 years scheduled for abdominal hysterectomy were included. Those with significant systemic disease or contraindication to opioid or non-steroidal anti-inflammatory drugs were excluded from the study. All patients received general anaesthesia and intravenous IV morphine, and were intubated and ventilated for the operation. The patients were randomized and rectally received meloxicam 15 mg, diclofenac 100 mg, or placebo suppository. Patients, anesthetists, and nurses managing the patients postoperatively were blinded to these drugs. In the recovery room, IV patient controlled morphine was commenced. The information sought included patient characteristics age, weight, duration of operation, and doses of morphine consumed in 24 hours. Seventy-five patients 25 in each group participated in this study and only 5 patients dropped out. There was no difference in age and body weight of the patients, and duration of the operation. All underwent either total or sub-total hysterectomy. The mean SD morphine consumption in the 24-hour postoperative period was 37.7 11.1 mg for the diclofenac group, 40.1 7.8 mg for the meloxicam group, and 45.2 9.8 mg for the placebo group. As compared to placebo, the mean morphine consumption in diclofenac but not in meloxicam group was significantly p<0.05 reduced. Our study demonstrates a significant opioid sparing effect after abdominal hysterectomy with diclofenac, but not with meloxicam

Obstetric admissions to the intensive care unit

To describe clinical characteristics, interventions required, and outcome of critically ill obstetric patients admitted to a general intensive care unit [ICU]. All obstetric patients admitted to ICU at Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia from 1997 to 2002 were included in the study. The data related to demographics, obstetric history, pre-existing medical problems, indications for ICU admission, intervention required, length of stay, and outcome of ICU admission were collected by retrospective review of medical records. The 99 obstetric admissions to ICU were represented by 0.2% of all deliveries and 1.6% of all ICU admissions. Most patients were young [median age of 30 years] with parity [median] of 3 and stayed in ICU for an average of 2 days. All except one patient were admitted during the postpartum period. The majority [76%] were admitted after cesarean section. Obstetric hemorrhage [32%] and hypertension [29%] were the 2 most common indications for admission. The majority [59/99] of patients also had pre-existing medical problem and most common [16/59] was rheumatic heart disease. Preeclampsia [23/99] and eclampsia 10/99 were the most frequent obstetric complication. Thirty-six% of our patients required ventilatory support. In the majority of patients, direct arterial [81%] and central venous [73%] pressure monitoring was carried out. Pulmonary arterial and left atrial pressure was monitored in 4%. Almost one third of patients received antihypertensive therapy. Inotropic support was given to 9% and blood [and its products] was given to 46% of patients. Antibiotics [28%] and magnesium sulphate [25%] were the most frequently used medicines. Out of the total 99 admissions, one patient died and 16 patients developed complications. In our survey, the 2 most common indications for admitting obstetric patients to ICU were hemorrhage and hypertension. Invasive hemodynamic monitoring and ventilatory support are the 2 main interventions. Improving quality of care before and after admission to ICU may reduce maternal morbidity