ABSTRACT
Background & objectives: Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods: All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results: A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions: SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness.
ABSTRACT
Background: McCoy laryngoscope and video laryngoscopes are being increasingly used and have a definitive advantage over conventional laryngoscopes in management of potentially difficult airways. The aim of our study was to compare relative effectiveness of McCoy laryngoscope and True view PCDTM video laryngoscope in patients undergoing oral tracheal intubation. Methods: Fifty patients of American Society of Anaesthesiologists (ASA) grade I and II, aged 20 – 50 years, posted for elective surgery under general anaesthesia were randomly allocated into Group T (Truview group, n=25) and Group M (McCoy group, n=25). The two groups were compared for demographic data, intubation difficulty score (IDS), Cormack-Lehane (CL) grade, POGO score, time to intubation, number of intubation attempts and haemodynamic parameters. Results: The demographic data and ASA status was comparable in both the groups. Group T had a significantly less IDS score as compared to Group M (p < 0.001). Seventeen patients in Group T and 8 patients in Group M had IDS = 0. The CL grade and POGO scores were better in Group T than in Group M. Intubation was successful in the first attempt in 94% patients in Group T and 88% patients in Group M. There was a transient increase in HR and NIBP after intubation in both the groups which returned back to the baseline within 5 minutes. No incidence of hypoxia and airway trauma was noted in the two groups.Conclusion: Truview PCDTM video laryngoscope resulted in better glottic visualization with lower IDS than McCoy laryngoscope in patients undergoing oral tracheal intubation.
ABSTRACT
Antiphospholipid antibody (APLA) syndrome is an acquired autoimmune disorder characterized by venous or arterial thrombosis. It causes recurrent fetal losses in females of reproductive age group. However, with appropriate anticoagulant therapy in antepartum and the postpartum period, favourable pregnancy outcomes are possible. Elective caesarean sections are quite common in view of bad obstetric history. Here we discuss the anaesthetic management of a 25 year old female patient with APLA syndrome scheduled for elective caesarean section.
ABSTRACT
Background: We studied the sedative and analgesic effect of intravenous dexmedetomidine in patients posted for meshplasty for the repair of inguinal hernia under subarachnoid block with 0.5% hyperbaric bupivacaine. Methods: Fifty patients of the American Society of Anaesthesiologists (ASA) physical status I or II of either sex (20 – 50 years) presenting for meshplasty for inguinal hernia were included in the prospective double-blind randomized study. All patients received 2.5 ml of 0.5% hyperbaric bupivacaine intrathecally. Patients were randomly allocated on the basis of a sealed envelope technique to receive one of the following after subarachnoid block: Group D (n=25) - Loading dose of 1 μg kg-1 dexmedetomidine over 10 minutes started 20 minutes after spinal block + maintenance dose of 0.4 μg kg-1 hr-1 dexmedetomidine till the end of surgery; Group P (n=25) - same calculated volume of normal saline as a loading dose over 10 minutes + maintenance till end of surgery. Data regarding the VAS score, duration of analgesia were recorded. Results: Patients in group D had a significantly higher sedation score than those in group P (p< 0.001). Dexmedetomidine significantly reduced the requirement of diclofenac injection for pain relief in 24 hours postoperative period (p< 0.001). Conclusion: Intravenous dexmedetomidine resulted in significant prolongation of time to VAS ≥ 4, reduced postoperative analgesic requirement and produced good sedation levels without significant haemodynamic compromise.