Spinal anaesthesia for cesarean delivery; study of different doses of IV ephedrine as prophylaxis to prevent hypotension during

To determine the effective dose of intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. A randomized, double-blinded dose finding study. The study was carried out in Combined Military Hospital Gujranwala from March 2009 to March 2010. Total patients were 80 full term women who were randomly allocated into four groups and were given Ringer lactate 10 ml per kg body weight intravenously. One minute after the spinal injection, patients were given saline control or ephedrine 0.1 mg per kg body weight, 0.25mg per kg body weight, or 0.4mg per kg body weight for 30 seconds. The study period started at the time of spinal injection and continued for 15 minutes. Systolic arterial pressure and heart rate were recorded at 1 -min intervals. Side effects like hypotension, hypertension, tachycardia, bradycardia, nausea and vomiting were also recorded. Total rescue ephedrine and total dose of used ephedrine in all groups were measured. Neonates were assessed by APGAR score. There was less incidence of hypotension in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group as compared with ephedrine 0.1 mg per kg body weight and the control group, 5[25%], 13[65%] vs. 16[80%], 18 [90%] respectively. Systolic arterial pressure [SAP] in the first 15 min after the spinal injection was statistically significant greater in the 0.4mg per kg body weight group compared with other groups [P <0.001]. Reactive hypertension occurred in 9[45%] in the 0.4mg per kg group, compared with control group, 0[0%], ephedrine 0.1 mg, 1[5%] and ephedrine 0.25 mg 3[15%] patients. The Heart rate in the first 15 minutes in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group was statistically significant higher than those of ephedrine 0.1 mg per kg body weight and control group [P<0.001]. The incidence of tachycardia was more in ephedrine 0.4 mg per kg body weight and 0.25 mg per kg body weight groups as compared to ephedrine 0.1 mg per kg body weight and the control group, 9 [45%], 6 [30%] vs. 3 [15%], 2 [10%] respectively. There were significant decrease in total doses of rescue ephedrine required in the ephedrine 0.4mg per kg body weight group as compared to other three groups. Total doses of used ephedrine in all groups were similar. We conclude that although ephedrine 0.25 mg per kg body weight reduces the hypotension but the smallest effective dose of ephedrine to reduce the incidence of hypotension significantly was 0.4mg per kg body weight

Management of third stage of labour: use of intramuscular syntometrine and intravenous oxytocin

The routine prophylactic administration of an uterotonic agent is an integral part of active management of the third stage of labor, helping to prevent postpartum haemorrhage [PPH]. The two most widely used uterotonic agents are: ergometrine-oxytocin [Syntometrine _] [a combination of oxytocin, 5 international units [iu] and ergometrine, 0.5 mg] and oxytocin, [Syntocinon _] 10 international units [iu]. To compare the efficacy and safety of intravenous oxytocin, with intramuscularly syntometrine in the managementof third stage of labor. Experimental study. Department of obstetrics and gynaecology Combined Military Hospital Peshawar. Over one year period from March 2005 to March 2006. A total 200 women having singleton pregnancy and vaginal delivery admitted in maternity ward were divided in two treatment groups by simple random sampling using random number tables, 100 patients received 2 ml Syntometrine, [a combination of oxytocin, 5iu and ergometrine meleate 0.5mg] intramuscularly and 100 patients received 10iu of intravenous syntocinon at the delivery of anterior shoulder of the fetus. The use of intravenous oxytocin,, was associated with a reduction in postpartum blood loss [P<0.001] but there was no difference in the risk of post partum hemorrhage, in the need for repeated oxytocin injections and the drop in peripartum hemoglobin level between the two groups, and need for blood transfusion. There was also no difference in the risk of prolonged third stage, or manual removal placenta. The use of syntometrine was associated with a higher risk of hypertension [RR 2.39,95% Cl 1.00-5.70] other side effects were mild in nature with no differences between the two groups. There are no important clinical differences in the effectiveness of intramuscular syntometrine and. Intravenous oxytocin for the prevention of post partum blood loss. Intravenous oxytocin is less likely to cause hypertension and other side effect profiles are low

Circumcision; caudal epidural block with single dose bupivacaine compared with tramadol for post operative analgesia in children

To compare the quality of postoperative analgesia with single dose Bupivacaine and that of Tramadol in caudal epidural block for circumcision in children. Interventional experimental study. This study was carried out in the department of anaesthesia and pain management at Combined Military Hospital Peshawar. Jun 30, 2004 to Mar 2005 and then from Dec 2006 to Feb 2007. Sixty [60] children between the ages of 2-6 year were included in study. They were divided into two groups by convenience non- probability technique and each group had 30 children. Group A [n=30] was given 1.25mg/kg Bupivacaine, 0.25% solution, whereas Group B [n=30] received 2mg/kg of Tramadol. The volume of drug in each group was 0.5ml/kg. Standard monitoring was done perioperatively. The analgesic effects were evaluated by using Hannallah pain score scale6, which had maximum score of 10 arid mininium of 0 [zero]. The score of 3 or <3 was considered as adequate analgesia. Sedation was assessed by using 5-point sedation test. 0 - Awake, 1 - mild sedation, 2 - feeling sleepy, 3- sleepy but able to wake, 4 - Deep sleep difficult to wake. Both the groups were comparable with respect to age, sex and duration of surgery. Insufficient pain control was observed in 4 patient's in-group B [Tramadol group], 13% and 7 patient's in-group A [Bupivacaine group], 23%, 30 minutes atter caudal administration of drug. Adequate postoperative analgesia was maintained in all other patients for 12 hrs. Only 6 patients in Tramadol group had light sedation [p=0.012]. Weakness of lower limbs was found in 4 patient's in-group A there was no difference in vital signs and there was no complication related to technique in both groups. Caudal administration of Tramadol in the dose of 2mg/kg when compared with 0.25% Bupivacaine in children under going circumcision provided similar quality of analgesia for 12 hours with out any requirement of rescue analgesic