Anaesthesia-related maternal mortality.

Complications of anaesthesia leading to death in young pregnant women might be prevented if more experienced personnel could be entrusted with the job. The contribution of anaesthesia to maternal mortality in the United Kingdom is 1.7 per million pregnancies with almost similar incidence from United States. The commonest single factor responsible for anaesthesia-related death is difficult or failed intubation. A pregnant woman with a potentially difficult airway should receive aspiration prophylaxis (mechanical or pharmacological) as soon as operative delivery is anticipated. Anaesthetists should make a plan that comes into effect as soon as failure to view the larynx or to intubate the trachea becomes evident. Unsuspected difficult airway can be managed if the skill of the anaesthetists is of high standard. Pulmonary aspiration is one cause of death in obstetric anaesthesia. Regurgitation and vomiting prevention can minimise pulmonary aspiration. In regional anaesthesia, local anaesthetics toxicity is another cause of concern. This should be tackled with some safe local anaesthetics. Preventing a high spinal or epidural block involves ways to detect inadvertent injection of local anaesthetic into the cerebrospinal fluid. Postoperative care after anaesthesia in obstetric cases is very important.

Water quality assessment of Ganga river in Bihar Region, India.

A study was carried out on Ganga river in Bihar region in and around Patna to assess the impact of sewage pollution on the water quality of the river. The drain water samples from the confluence point of outfall drains to the river were collected and studied for key parameters. Parameters such as BOD, COD, TDS, TSS, total and faecal coliform (MPN) were observed high in drain water. The physicochemical analysis of Ganga river shows that the water has high TDS, TSS, BOD, and COD. The coliform bacteria were found to be alarmingly high in the river. Most of the parameters analyzed were found high near the bank in comparison to the water in the middle stream of that station. The XRF analysis of sediments of the Ganga river showed that Si, Fe, Ca, Al and K are the major elements of the Ganga sediment. The study revealed that due to discharge of untreated sewage into the Ganga, the water quality of Ganga has been severely deteriorated and the potable nature of water is being lost.

Long-term performance of single-pass physiological pacing.

BACKGROUND: Single-pass physiological pacing has several advantages over dual-lead physiological pacing. The present study evaluated the long-term performance of single-pass pacing using the overlapping biphasic impulse stimulation technique. METHODS AND RESULTS: A total of 30 patients with single-pass VDD pacing and 8 patients with single-pass DDDC pacing were followed up for 1 year by basal and magnet electrocardiograms and real-time telemetry. All the patients showed satisfactory atrial sensing and pacing capture threshold. The atrial sensing thresholds at implant and at 1 month, 3 months, 6 months and 12 months of follow-up were 2.5+/-0.67 mV, 1.6+/-0.6 mV, 1.1+/-0.5 mV, 1.0+/-0.5 mV and 1.0+/-0.04 mV, respectively. The corresponding values for atrial pacing threshold at a pulse wave of 0.5 ms were 2.5+/-1.0 V, 4.4+/-0.9 V, 3.8+/-1.2 V, 3.6+/-1.4 V and 3.8+/-1.4 V. Of the patients with DDDC pacing, 88% showed stable pacing capture in the supine position, 75% in the upright position and 62% in both positions. Diaphragmatic contraction was seen in 25% of cases with DDDC pacing. No such event was seen in patients with VDD pacing. CONCLUSIONS: Single-pass pacing is safe, technically easy and cheap as compared to dual-lead systems. However, it would be prudent to recommend DDDC pacing in patients who require predominantly VDD pacing and only occasionally atrial pacing, as the latter showed a low percentage of stable atrial pacing capture in both upright and supine positions as well as a significant percentage of diaphragmatic contraction.

Venous obstruction after permanent pacing.

In a 10-year prospective study of 6,256 patients (5,812 males, 444 females) with permanent pacemaker, 25 had presented with features of venous obstruction such as pain, swelling or dilated superficial veins of face, upper limb(s) or upper chest wall without congestive heart failure. When subjected to contrast venography, 22 (0.35%) of the cases demonstrated subclavian and/or superior vena cava thrombotic/fibrotic obstruction. Each patient had non-progressive dilated veins over upper chest wall which developed after an average period of six months of implantation and none had embolic events or cephalad propagation of thrombus. Nine patients had subclavian, eight superior vena cava and five had both the vein obstructions. Seven patients of venous obstruction were treated with heparin followed by oral anticoagulants and three patients with oral anticoagulants alone. Three of seven patients got relief of obstruction with combined therapy group (heparin followed by oral anticoagulants) only. Two patients with superior vena cava obstruction needed epicardial pacing during subsequent lead revision. Therefore, before revision of permanent pacemaker leads in patients with signs of venous obstruction, venography can be useful to assess the obstruction and to determine the route of new lead insertion.

Effect of vasodilator therapy on mortality in chronic congestive heart failure.

We compared the effects of Hydralazine and Isosorbide dinitrate (ISDN) with those of an angiotensin-converting-enzyme inhibitor, captopril on mortality in patients with chronic congestive heart failure (NYHA class III and IV). Patients receiving conventional treatment with digoxin and diuretics were randomly assigned to receive either placebo (n = 51), hydralazine-ISDN. (n = 50) or captopril (n = 52) in a double blind trial. At the end of 6 months there were 14 deaths in the placebo group (27.4%) as compared with 11 deaths in the hydralazine-ISDN group (22%)--a mortality reduction of 20% (P > 0.05) and 10 deaths in the captopril group (19.2%)--a mortality reduction of 30% (p > 0.05). At the end of one year, mortality was 50%, 42% and 30% in the placebo, hydralazine-ISDN and captopril groups respectively with a mortality reduction of 16% in the hydralazine-ISDN group (p > 0.05) and 40% in the captopril group (p < 0.05) compared to the placebo group. The mortality reduction was mainly due to reduction in deaths attributed to progressive heart failure. The data suggests that the addition of captopril to conventional treatment significantly reduces mortality in patients with severe congestive heart failure. Hydralazine-isorobide dinitrate also reduced mortality but statistically this was not significant.