ABSTRACT
Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer's lactate [RL] or tetrastarch hydroxyethyl starch [HES] or succinylated gelatin [SG] in the patients undergoing cesarean section under spinal anesthesia. It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL [n = 32 each] and received 10 ml/kg HES 130/0.4; 10 ml/kg SG [4% modified fluid gelatin] and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure [BP], oxygen saturation was measured. The fall in systolic blood pressure [SBP] [<100 mm Hg] noted among 5 [15.63%], 12 [37.5%] and 14 [43.75%] parturients in groups HES, SG, RL respectively. Vasopressor [phenylephrine] was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor
ABSTRACT
Concern about the grim nature of postoperative acid aspiration syndrome grew among the anesthesiologist over the years warranting the need for preemptive intervention. The aim of the study is to compare the effects of preoperative oral ranitidlne versus pantoprazole given in regulating gastric pH in elective surgery. This prospective, parallel group, controlled, randomized, single-blind study was conducted at a tertiary care postgraduate teaching institute at Kolkata, involving 120 participants of either sex, aged 18-60 years of American Society of Anesthesiologists physical status I and II, who were scheduled for elective surgery under general anesthesia lasting for more than 2 h. The participants were divided into three groups. In group A [n = 40] participants received placebo tablet, in group B [n = 40] participants received ranitidine tablet while in group C [n = 40], participants received pantoprazole tablet and their gastric pH estimated serially. The participants in the three groups were comparable in terms of age, sex, body weight, duration of surgery and type of surgery distribution. In regard to changes in gastric pH trends, there was no statistically significant difference between serial pH values in group A [Friedman test; P>0.05] and group C participants. [P>0.05]. However, the mean preoperative gastric pH values [7.140 +/- .7652] were significantly lower than mean pH values [7.253 +/- .7514] after 2 h postoperatively in group B participants [P<0.05]. From the observations and analyses of the present study, it can be inferred that ranitidine is more effective than pantoprazole to raise the gastric pH for prevention of aspiration pneumonitis