ABSTRACT
Background: Preeclampsia occurs in presence of placenta. Blood supply distribution within the uterus is not similar in central versus lateral sites implicating that, the site of placenta is likely to have a profound effect on the pregnancy outcome. In the light of these observations, a prospective study was designed to find out if the lateral location of placenta as seen by ultrasound between 18-24 weeks of gestation can be used to predict the development of preeclampsia.Methods: This prospective study was conducted in the department of Obstetrics and Gynaecology in IGGMC, Nagpur between January 2017 and June 2018. Pregnant women, with singleton pregnancy and without any risk factor, attending the antenatal clinic were subjected to USG between 18-24 weeks of gestation. Accordingly, patients were divided into 2 groups, 51 with lateral placenta and 51 with central placenta. All 102 women were followed till term. The end point of the study was development of preeclampsia i.e. BP >140/90 and urine albumin >300 mg in 24 hours sample. The data obtained was analysed using appropriate statistical tests.Results: Out of 102 patients, 80.9% were from lateral placenta group and only 19.1% were from central placenta. Sensitivity of this as screening test for preeclampsia was 80.9% while specificity was 58%, Odds ratio being 5.875. In predicting preeclampsia, lateral placenta had a meaningful effect with p value <0.001.Conclusions: Placental laterality, as determined by USG between 18-24 weeks of gestation, is a simple and cost-effective screening test for development of preeclampsia.
ABSTRACT
Background: Propofol as sole induction agent is often insufficient for the laryngeal mask airway insertion and higher doses are at times required. The present study proposes to assess the effectiveness of 0.25mg/kg mini dose succinylcholine towards facilitation of laryngeal mask airway (LMA) insertion.Methods: In a single blinded randomized controlled trial, 68 patients posted for elective general and orthopaedic surgery were equally assigned to two groups during LMA insertion: Group S (Study group)- patients received a bolus of succinylcholine 0.25mg/kg diluted in 2 ml of 0.9% sodium chloride. Group C (Control group)-patients received a bolus dose of 2 ml of 0.9% sodium chloride. The number of attempts required and ease of LMA insertion, hemodynamic parameters and adverse responses were noted and compared between the groups.Results: The LMA was inserted in first attempt in 32 (94.11%) patients in group S and in 24 (70.58%) patients in group C. The control group had 67.62% grade 1, 32.38% grade 2 and 0% grade 3, while succinylcholine group had 73.53% grade 1, 26.47% grade 2 and 0% grade 3. Hemodynamic parameters didn’t differ significantly between the two groups at any point, but significant difference was observed between occurrence of fasciculation, head and limb movements, sore throat and coughing.Conclusions: Succinylcholine does seem to help in insertion of the laryngeal mask airway but the results could not gain the level of statistical significance, partly attributed to small sample size.
ABSTRACT
Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.