Anaesthesia for caesarean section in patients with cardiac disease

This review contains material sourced from med-line and pub-med, search year 2002-2004. Material selected was pertaining to common cardiac ailments in pregnancy. Congenital cardiac problems i.e. Tetralogy of Fallot [TOF], Atrial Septal Defect [ASD], Ventricular Septal Defect [VSD], Eisenmengers syndrome, valvular heart disease, i.e. mitral stenosis, mitral regurgitation, aortic stensois and aortic regurgitation are discussed. Other cardiac conditions associated with pregnancy are pulmonary hypertension and peri-partum cardio-myopathy. Arrhythmias during pregnancy, vary from isolated premature to supra-ventricular and ventricular tachycardia, management is similar to non-pregnant patients. This review summarizes the current management of a parturient with cardiac disease requiring surgical delivery. Regional anaesthesia techniques are preferred as reflected in the current literature for patient with cardiac disease with minor alterations such as slow establishment of epidural for caesarean section or continuous spinal anaesthesia with very small incremental doses of local anaesthesia, maintaining the patient's SVR with vasopressors and fluid, monitoring of the fluid regimen with CVP and in some cardiac function with Swan Ganz catheter. Patients with Eisenmenger syndrome, pulmonary hypertension, should be advised to avoid pregnancy. In conclusion with vast advancements in obsterics care, improvements in cardiac surgery, many patients with cardiac disease can now be safely delivered surgically by skillful anaesthesiologists who are aware of the common potential intra-operative problems and the ability to respond to undesired events immediately

Intravenous tramadol vs ketorolac in laparoscopic dye test

To compare the quality of analgesia and side effects of I/V tramadol with a non-steroidal anti-inflammatory drug ketorolac in patients undergoing laparoscopic dye test. A single dose, double blind, randomized clinical trial. The Day Care Surgical Unit at the Aga Khan University Hospital, Karachi. The duration was initially planned for 6 months but was completed from January 2001 to February 2002. Sixty patients coming for laparoscopic dye test were randomized by convenient sampling. Patients were divided into two groups, A and B, who received intravenous tramadol or ketorolac respectively before induction of general anaesthesia. Patients were assessed in the postanaesthesia care unit for pain using the visual analogue scale [VAS], frequency of postoperative nausea and vomiting was observed by the investigator who remained blinded to the treatment given. Any patient found to have pain score >5 was given bolus of 10 mg pethidine in titrated doses. Study was continued for 6 hours postoperatively. Pain scores were analyzed by applying Chi-square test. Students impaired t-test was used to analyze demographic data, recovery time and hospital discharge, Mann Whitney was applied to analyze VAS scores. Categorical data i.e. nausea and vomiting was analyzed by using the Chisquare test [p-value >0.05]. Study showed that tramadol is a better analgesic compared to ketorolac for patients undergoing day care gynaecological laparoscopic procedure