Anaesthetic Management of a Patient During Transurethral Resection of Prostate with Iatrogenic Intraperitoneal Bladder Explosion: An Atypical Event

Transuretheral resection of prostate (TURP) is one of the most commonly performed urological procedure. Though considered to be safe, it is sometimes associated with atypical complications. We hereby report a successful anaesthetic management of bladder explosion, a very rare complication of TURP, occuring towards the end of the procedure at the time of removal of resectoscope. The prompt recognition and management of the same led to uneventful postoperative course.

Anesthetic Management of A Patient with Hypertrophic Cardiomyopathy Posted For Non朇ardiac Surgery � Case Report

Hypertrophic cardiomyopathy (HOCM) is a complex cardiac disorder of genetic origin. Though the patients may be asymptomatic the stress of surgery and anaesthesia is known to exacerbate the left ventricular outflow tract (LVOT) obstruction leading to catastrophic complications. We hereby report a successful anaesthetic management of a patient with left intertrochantric fracture diagnosed with HOCM. Careful and meticulous strategies to prevent LVOT obstruction led to entire uneventful introperative and perioperative course.

Tuberous sclerosis in pregnancy: a rare genetic disease requiring multidisciplinary approach in pregnancy

Tuberous sclerosis complex (TSC) is a multisystemic, autosomal dominant genetic disorder with complete penetrance, that can evolve with hamartomas in multiple organs, such as skin, central nervous system, kidney and lung. Penetrance in genetics is the proportion of individuals carrying a particular variant (or allele) of a gene (the genotype) that also express an associated trait (the phenotype). Due to the wide phenotypic variability in TSC, the disease is often not recognized. The diagnostic criteria for tuberous sclerosis were reviewed in 2012, at the second International tuberous sclerosis complex consensus conference. The diagnosis is based on genetic criteria, by the identification of inactivating pathogenic mutation of tumour suppressor genes TSC1 and TSC2, and clinical criteria, including cutaneous, renal, pulmonary, cardiac and neurological manifestations. Authors present with a rare case report of a patient with TSC presenting at term.

A study of high-risk factors in ante-natal women at a tertiary care centre

Background: High-risk pregnancy refers to any condition in pregnancy that increases risk for morbidity or mortality in mother, fetus and neonate. Globally, nearly 5,29,000 women die due to pregnancy related complications. In India, 20-30% of the pregnant patients contribute to high risk group. This study was conducted to determine different high-risk factors prevalent in antenatal women in Haryana. Objective of this study was to find out prevalence of different high-risk factors in antenatal women.Methods: Data of all antenatal high-risk patients attending OPD during one year was taken from hospital record registers. Maternal characteristics such as age, gravida/parity, gestational age, and gestational age at the time of first visit were noted. High risk factors identified were noted.Results: The records of total 10073 antenatal women were analyzed, 1283 were included in the high-risk group. Most prevalent high-risk factors found were previous cesarean section (31.04%), anaemia (31.02%), malpresentation (12.93%) and thyroid disorders (13.09%).Conclusions: Antenatal surveillance for the high-risk factors complicating pregnancy may prevent or treat most of the complications. Authors should develop strategies for early screening of high-risk pregnancy cases to prevent maternal and perinatal mortality and to improve the maternal and perinatal outcome.

Uterus didelphys with a successful term pregnancy

Mullerian duct anomalies are congenital defects of female genital system that arise from abnormal embryological development of mullerianducts. Uterusdidelphys also known as double uterus is one of the least mulleriananomalies. Here we present a case of a woman with uterus didelphys and her successful full pregnancy. Patient came to our hospital with diagnosis of G1P0L0 with 39 weeks with antepartum hemorrhage with active bleeding. On ultrasound she was found to be type iv placenta previa, in view of same we had done her lower segment cesarean section with delivery of a 2.5 kg female baby with intraoperative findings of two uterus and two cervix i.e uterus didelphys in which pregnancy was present in right uterus, placenta covering os. Post operative period was uneventful. Patient who have uterus didelphys due to mullerian defect not associated with difficulty in conception but there is increase incidence of preterm labour, malpresentation and malposition. Howeverwith appropriate antenatal and intrapartum surveillance pregnancy outcome are good.

Gabapentin Versus Dexamethasone for Prophylaxis of Post-Operative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

Post-operative nausea and vomiting (PONV) is one of the commonest complications in anaesthesia accounting for 20-30% cases but number may rise to 70% in laparoscopic surgeries.1,2 Laparoscopic cholecystectomy is carried out as day care surgery but PONV prolongs hospital stay. Several studies have documented role of Gabapentin and Dexamethasone for prophylaxis of PONV but none has compared them for the same. This study aimed at comparing the efficacy of oral gabapentin and dexamethasone for prophylaxis of PONV and need for rescue anti-emetics in first 24 hours. Methods: This prospective, single blind randomized trial enrolled 100 ASA physical status I and II patients assigned into two groups: Group G (Gabapentin group, n=50) received 600 mg of Gabapentin oral formulation with sip of water on the morning of surgery whereas Group D (Dexamethasone group, n=50) received 8 mg of Dexamethasone oral formulation with sip of water on the morning of surgery. Following parameters were noted: time to first rescue anti-emetic drug (Injection Ondansetron), total number of rescue anti-emetic doses, complications if any. Results: The two groups i.e the Gabapentin group and the dexamethasone group were comparable with regards to the demographic profile (age, weight and sex). However the mean duration of surgery was more in Gabapentin group compared to Dexamethasone group, the difference being statistically significant (P< 0.05). Time between extubation and first rescue antiemetic was also comparable in the two groups the results being statistically non significant (P > 0.05). The mean of total number of rescue antiemetics in 24 hours as well as grading of Wilsons score for PONV in the two groups was also statistically non significant (P > 0.05). Conclusion: Both the drugs gabapentin and dexamethasone are equally effective in preventing postoperative nausea and vomiting.

Post Dural Puncture Headache (PDPH) - A Prospective Study in Tertiary Care Hospital in Solan District (HP)

Spinal Anaesthesia is widely practiced anaesthetic technique for sub - umbilical surgical procedures. However the technique is not without complications and Post Dural Puncture Headache (PDPH) remains important amongst such complications. Aims and Objectives: The present study was prospective , was conducted to study the overall incidence of PDPH using 26 G Quincke type spinal needle and to establish its relations( if any) with the age of patient, type of surgery and time to ambulate following the surgery. Methods: A total of 500 patients of ASA I and II were studied. These patients underwent various orthopaedic, general surgical, obstetrical/ gynaecological surgical procedures under Spinal Anaesthesia using 26 G Quincke type spinal needle. All the patients were followed upto 72 hours post operatively for evaluation of PDPH. Results: The incidence of PDPH in the present study was 1.6%. The incidence was higher in female patients (75%). Among the female patients, 50% of patients were those who underwent Caesarean Section. Conclusion: The present study concludes free and widespread use of 26 G Quincke type needle in all patients who require Spinal Anaesthesia irrespective of type of surgery

A study to evaluate serum 25-hydroxy vitamin D3 and calcium levels in maternal and cord blood and their effect on pregnancy outcome

Background: To determine the prevalence of vitamin D deficiency among pregnant mothers and their neonates and to study the effect of vitamin D deficiency on maternal and perinatal outcome.Methods: This prospective cohort study conducted in a teaching hospital included 223 pregnant mothers and their offspring born in 2017. Detailed history was taken to ascertain the causes of vitamin D deficiency.   vitamin D3 and calcium levels were estimated in maternal and cord blood samples. To study the association between the vitamin D status and the various maternal and neonatal parameters.Results: 91.9 % of women were house wives involved in indoor activities. Pre-eclampsia and GDM were seen in 4.5% of cases each. 5.41% were obese and 84%  were of medium complexion,  and 8% were  dark. 93.7% were non- vegetarians,  and fish, egg and milk consumption was adequate in 61.3% , 64% and 71% respectively. Only 5.40% of women had adequate exposure to sunlight.  The mean birth weight was 3.08± 0.36 Kg. and 14 babies were admitted to NICU for neonatal asphyxia.77.40% had deficient levels of vitamin D  <20 ng/ml. Only four pregnant mothers (1.8%) had sufficient levels vitamin D. There was no statistically significant association between vitamin D deficiency and various maternal and neonatal parameters.Conclusions: This study has shown that the prevalence of vitamin D deficiency among south Indian pregnant mothers and their newborn is very high and the ways to improve the vitamin D status among pregnant mothers should be looked at.

An Observational Study To Compare The Effect Of Metformin Versus A Combination Of Metformin, Calcium And Vitamin D Supplementation On Menstrual Cycle, Body Mass Index And Hyperandrogenic State In Polycystic Ovarian Syndrome

Introduction: Polycystic Ovarian Syndrome was originally described in seven women in whom the syndrome could at best be described as the combination of hirsutism, obesity, amenorrhea, and enlarged bilateral polycystic ovaries.(1) Since then, our understanding of PCOS has evolved so far that none of the originally described features is considered to be a consistent finding in PCOS—not even the appearance of numerous tiny ovarian “cysts” for which the syndrome was named.(2) Materials and Methods: After obtaining approval of the ethics committee, a prospective, randomized, clinical controlled study was conducted for 1 and 1/2 years. Patients were randomly allocated to one of the two groups, group D (n=50), received oral Tab Metformin 500mg BD, Tab Calcium 500mg OD, Tab Vitamin–D–1000 IU OD for 3months and group M (n=50), received oral Tab Metformin 500mg BD for 3months. Age, Menstrual irregularties, BMI, Hirsutism score Cases with hirsutism score >8, Acne, Alopesia, USG ovarian volume, S.LH, S.FSH, S. Total Calcium, S. Vitamin D and Free insulin were recorded both before treatment and after treatment in both groups. Patients were also observed for adverse reaction. Data was statistically analyzed using Epi info 7 computer software version: 7.2.1.0. Results: Both groups were comparable with regard to demographic characteristics (p>0.05). There was statistically significant difference between the two groups regarding Body Mass Index, USG ovarian volume and S.Vitamin D. However there was no statistically significant difference between the two groups regarding Menstrual irregularties, Hirsutism score Cases with hirsutism score >8, Acne, Alopesia, S.LH, S.FSH, S. Total Calcium and Free insulin. Conclusion: This study showed the positive effects of metformin, calcium & vitamin D supplementation on Body Mass Index, Serum Vitamin D and Ovarian volume in women with polycystic ovary syndrome.

Comparison of Tramadol and Butorphanol for Analgesic Efficacy and Safety.

The objective of the present study was to compare the analgesic efficacy and side effects of butorphanol and tramadol.Equianalgesic doses of butorphanol (1mg) and tramadol (1mg/Kg) were compared in 50 adult patients (ASA-I) undergoing any kind of surgery requiring general anesthesia. The patients were divided into two groups of 25 each (n = 25). One of the study drugs (butorphanol/tramadol) was given intravenously just prior to induction of anesthesia in a double blind fashion. Following induction with standard doses of propofol/thiopentone Na and succinyl choline and intubation, anaesthesia was maintained with N2O/O2/Halothane. Heart rate and blood pressure were recorded from preoperative to post operative period in the recovery room and the frequency of side effects was noted by the trained nursing staff on duty following direct questioning of the patients. The proportion of patients with moderate to severe pain during postoperative period was significantly higher in tramadol group as compared to butorphanol group (p< 0.05). Time to first rescue analgesic was significantly prolonged in butorphanol group compared to tramadol group. The incidence of side effects was comparable in both the groups.To conclude according to our study, butorphanol is a very effective analgesic and contributes to balanced anaesthesia.