Evaluation of Anaesthesia Technique in Emergency Caesarean Section in a Teaching Hospital of Sub Himalayan Belt - A Prospective Analysis.

The number of Caesarean Deliveries has shown a rapid increase in modern obstetric practice. This study was done to evaluate the choices of anaesthetic techniques for the lower segment caesarean section (LSCS) following the patient's clinical condition and its correlation with maternal and foetal outcomes in Dr. Sushila Tiwari Govt. Hospital, Haldwani, Uttarakhand, India. METHODSWe conducted a prospective observational study for one year. We recorded patient's age, parity, American Society of Anaesthesiologist (ASA) physical classification, chronic diseases or any other preoperative comorbid condition, caesarean indication, maternal outcomes, and foetal outcomes. We grouped the anaesthetic techniques used in LSCS as General Anaesthesia (GA) and Subarachnoid Block (SAB). RESULTSOut of a total of 2161 emergency caesarean sections were performed during the study period, 53 were under GA, 2096 under under SAB and in 12 cases SAB was converted to GA. Unlike previous studies, the most common indication of LSCS was previous caesarean (40.1%). In comparison, foetal distress is the second most common cause of emergency LSCS (37.1%). Maternal mortality was 16.9% (11/65) and 0.1% (3/2096) in GA and SAB, respectively (p-value 0.001). Neonatal mortality was 10.8% (7) and 2.4% (50) in GA and SAB, respectively. CONCLUSIONSMaternal and neonatal mortality and complications were higher in the GA group as compared to the SAB group. Also, increased incidence of violence against health care providers and rising lawsuits has led to a sense of insecurity amongst the health care providers which is evident via preference of LSCS in patients with previous history of caesarean section. This is evident from the trend that now previous LSCS is becoming most common indication of LSCS instead of foetal distress as is found in various studies done earlier.

Comparative Study of IV Esmolol, IV Diltiazem, and IV Lignocaine Hydrochloride in Attenuating Pressure Response to Laryngoscopy and Intubation.

Not many studies have compared more than two drugs in attenuating pressor responses to laryngoscopy and intubation. This study compares four groups of considerable size. The present study compared intravenous esmolol, diltiazem, and lignocaine, for their efficacy to abate pressure response to laryngoscopy and intubation. METHODSThis is a prospective, randomized, double-blinded, controlled clinical study conducted among 220 patients of ASA grade I/II (age 18–60 years), undergoing elective surgical procedure requiring general anaesthesia with endotracheal intubation over a period of 15 months at a tertiary hospital setup. Study subjects were categorised as Groups D, E, L, and N that received diltiazem (0.2 mg/Kg IV), esmolol (2 mg/Kg IV), lignocaine (1.5 mg/Kg IV), and normal saline, respectively; each group had 55 patients. Haemodynamic parameters were recorded at baseline, after drug administration, immediately after intubation, and at 1-, 3-, and 5-minutes after intubation. Data entry and analysis were performed using MS Excel and SPSS-PC-17 version, respectively. One-way ANOVA and the chi-square test were used to evaluate the difference. P < 0.05 was considered significant. RESULTSA maximum increase in haemodynamic parameters occurred immediately after intubation. The increase in heart rate and rate pressure product were significantly lower in Group E (+2.93% & +15.31%), whereas the increase in blood pressure was lower in Group D (8.51%). CONCLUSIONSHaemodynamic stability during laryngoscopy and endotracheal intubation is an integral and essential goal of any anaesthetic management plan and was more effectively maintained with esmolol and diltiazem than with lignocaine.

Performance of Easytube,Esophageal-Tracheal Combitube and Laryngeal Tube Suction : a Comparative Study

Background: The aim of study is to compare easytube, etc,and lts in terms of - difficulty of device insertion, time to achieve airway, insertion success rate, haemodynamic parameters following device insertion and frequency of adverse effects. Methods: This randomised single blind study was conducted on 90 patients of age 18-60 years, undergoing elective surgery requiring general anaesthesia. Patients were randomly allocated in three groups- Group ETC: (n= 30), Group EzT (Esophageal Tracheal Combitube) : (n=30). After preoxygenation, induction and muscle relaxation appropriate ETC, Easy Tube,LTS was inserted and all parameters were noted by an independent observer. For statistical analysis, Student t-test was employed to compare the means and Chi-square test was used for categorical variables. Results: The demographic profile of patients in all groups was similar. Amongst each group device was placed in single attempt in all patients . The mean time for effective placement of the device was longer in group EzT (49.13±7.49 ) compared to groupETC and LTS(48.76±7.15). Conclusion: The intraoperative ventilation was equally effective and safe with all three devices. The intubation response was similar in magnitude with all devices and more importantly it was transient, not interfering with intraoperative usage. We also conclude that placement of ETC and LTS is easier than Easytube.

Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study.

Background: Laryngoscopy and intubation may cause undesirable increase in blood pressure and heart rate. The aim of the present study was to investigate the effect of Pregabalin premedication on hemodynamic responses to laryngoscopy and intubation. Methods: Sixty ASA physical status I or II patients undergoing elective surgery under general anesthesia were randomly allocated into two equal groups who received either oral Pregabalin 150 mg (Group PB)or placebo (Group PL)1 hour prior to surgery. Heart rate, Systolic, Diastolic and Mean arterial blood pressures were recorded preoperative, at laryngoscopy and 0,1,3,5 and 10 minutes after tracheal intubation. Results: Demographic data and base-line values for Heart rate, Systolic, Diastolic and Mean arterial blood pressures were comparable between groups. During laryngoscopy and intubation there was significant attenuation of SBP, DBP and MBP in PB group as compared to PL group. Although increase in heart rate was less in pregabalin group during laryngoscopy and intubation but it was not statistically significant. Conclusion: In the present study design, oral Pregabalin premedication at a dose of 150 mg one hour prior to surgery attenuates pressor response associated with laryngoscopy and endotracheal intubation but not the tachycardia significantly.

A Comparative Study Evaluating I-gel and Air-Q LMA for Ventilation in Anaesthetised and Paralysed Patients.

Background: The aim of study is to compare I-gel and Air-Q supraglottic airways in terms of - success rate of device insertion, number of attempts taken, haemodynamic parameters before and after device insertion, incidence of trauma and postoperative sore throat, dysphagia. Methods: This randomised single blind study was conducted on 90 patients of age 18-60 years, undergoing elective surgery requiring general anaesthesia. Patients were randomly allocated in two groups- Group I: I-gel (n= 45), Group II: Air-Q (n=45). After preoxygenation, induction and muscle relaxation appropriate size I-gel or Air-Q was inserted and all parameters were noted by an independent observer. For statistical analysis, Student t-test was employed to compare the means and Chi-square test was used for categorical variables. Complications were compared using Fisher’s exact test. Results: The demographic profile of patients in both groups was similar. In all patients supraglottic airway device was inserted within 3 attempts. Mean insertion time in first attempt for I-gel (25.85 ±1.7 sec) was found to be significantly lower than Air-Q (26.73±1.51 sec) [P=0.0128]. Conclusion: We conclude that I-gel is easier and safer than Air- Q when ventilation through LMA is intended during surgery.

Effect of Gabapentin on Pressor Response to Laryngoscopy and Tracheal Intubation: A Double Blind Randomized Placebo Controlled Study.

The effects of gabapentin on arterial pressure and heart rate were compared at induction of anaesthesia and at tracheal intubation in a prospective randomized double blind study. Fourty patients of American society of Anaesthesiologists (ASA) physical status I undergoing elective surgery were divided in two groups of twenty each. Twenty patients received oral placebo (Group P), and 20 patients received 900 mg of gabapentin (Group G), 2 hours prior to induction of anaesthesia. Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Heart rate (HR) were recorded one minute before and after induction of anaesthesia, immediately after intubation and 1,3,5 and 10minutes after intubation. Changes in SBP were statistically insignificant in both the groups. In the gabapentin group, at 0 and 5 minutes, the DBP was significantly less than the placebo group (p<0.05). There was a significant decrease in heart rate in Group G as compared to Group P (p<0.05).Pre medication with 900 mg gabapentin, 2 hours before induction of anaesthesia attenuates the tachycardia associated with laryngoscopy and intubation but not the pressor response completely.