Common complaints associated with caesarean section during spinal anaesthesia

To identify common complaints associated with caesarean section under spinal anaesthesia and manage them, in order to decrease the anxiety and distress level of the patients. Cross sectional observational study was conducted at Department of Anaesthesia, Liaquat National Hospital and Medical College from October 2011 to December 2012. Hundred patients aged from 20-36 years underwent elective caesarean section under spinal anaesthesia. Patients received nothing per oral for 6 hours. Metoclopramide and Ranitidine IV were given half hour before surgery Colloid 10ml/kg was given IV before induction of spinal anaesthesia. All patients were placed in sitting position and under aseptic conditions lumbar puncture was done at L3-L4 or L4-L5 interspaces with 25 gauge pencil point needle lo administer local anaesthetic over 20 seconds slowly. Oxygen 4 Iiters/minute as administered via a Hudson mask. All the patients were asked for any complaint during caesarean section under spinal anaesthesia. More than five common complaints were considered and similar complaints which are less than five were not included in the study. Out of 100 patients, 67% patients had no complaints and 33% patients presented common complaints. Visceral pain or abdominal discomfort was 19%, shivering 11%, nausea and vomiting 10%, epigastric pain 6%, backache 5% and headache 5%. Spinal anaesthesia is an excellent technique for caesarean section in majority of patients. Patients have various complaints during spinal anaesthesia which may increase anxiety and distress levels in patients

Comparison of haemodynamic changes in patients undergoing unilateral and bilateral spinal anaesthesia

To assess the haemodynamic changes in patients receiving unilateral and bilateral spinal anaesthesia with their pre-anaesthesia recordings. Quasi-experimental study. Main Operation Theater, Liaquat National Hospital, Karachi, from May 2006 to February 2007. Sixty patients meeting the inclusion criteria were randomly allocated in two groups of 30 patients each. One and a half ml of 0.75% hyperbaric bupivacaine was injected with free flow of cerebrospinal fluid using a 23 gauge quincke needle. Lumbar puncture was performed in the sitting position at 3 - 4 or 4 - 5 lumbar interspace. Patients were then assigned to the supine or lateral decubitus position for 10 minutes. Heart rate, systolic, mean and diastolic blood pressures of patients were recorded with their pre-anaesthesia readings in the 1[st], 5[th], 15[th], 30[th] and then at every 15[th] minute till the end of procedure. Recovery room readings were also taken. The systolic, mean and diastolic blood pressure changes were significant in both groups. But from 1[st] minute to recovery room, statistically significant difference [p < 0.05] was found at each time interval, the unilateral groups [group A] being more stable with respect to pre-anaesthesia readings. The decrease in heart rate was comparable in both groups. Unilateral spinal anaesthesia was associated with a more stable cardiovascular profile, therefore, it is a valuable technique for high risk patients

Public awareness about anaesthesia and anaesthesiologist: a survey

Anaesthesiologists are playing a decisive role in patient management. Present day anaesthesio-logy is based on the use of newer and safer drugs, better patient monitoring, pain management and critical care. General public knows little of these developments. An awareness programme for general public and medical students was conducted on "Public awareness regarding Anaesthesia and Anaesthesiologist" in September 2009 at Liaquat National Hospital and Medical College Karachi. Audience of this well attended programme was provided with the questionnaire to conduct this survey. Study was conducted on 100 individuals between the ages of 20 - 70 years. They were divided into three groups according to their educational status and age. According to education level 39% were group 1 [Matric and above], 54% were group 2 [graduates] and 7% were group 3 [medical undergraduates]. It was revealed that educational level showed a clear cut influence in their response. People were more concerned about the immediate postoperative problems. 70% of the population evaluated had exposure of surgery for themselves or their relatives and friends and therefore had knowledge about anaesthesia and anaesthesiologist. This study proves that awareness programme is one of the ways to improve public knowledge regarding anaesthesia and anaesthesiologist

Combined thoracic epidural and light general anaesthesia for upper abdominal surgery in high risk patients

The goal of the study was to assess the safety and effectiveness of the thoracic epidural anesthesia [TEA] in high risk patients undergoing upper abdominal surgery. Quasi Experimental. Department of anaesthesia, Liaquat National Hospital, Karachi from August 2002 - July 2003. 20 adult patients aged between 50 - 70 years were selected with ASA status III and IV. TEA was performed in sitting position at the level of T7 -T8 using hanging drop method. Titrated doses of 0.25%. Bupivacaine and 1% Xylocaine was injected 1 ml / dermatome through the catheter, anesthetic levels achieved were found to be T4 - T10. Light general anesthesia was instituted by using I/V propofol 50 - 60 mg, I/V Nalbuphine 5 - 7.5 mg and Midazolam 1.5 - 2 mg I/V. Total dose of local anesthetic varied from 12 -18 ml [mean 16 ml]. Two patients had bradycardia with heart rate less than 60 beats/min treated with atropine. Two patients had hypotension treated with titrated doses of ephedrine and I/V Ringer's solution. Our results were very promising and we can state confidently that thoracic epidural is a viable option and safe alternative, reducing morbidity in high risk patients

To compare changes in serum electrolytes during turp, while using 5% dextrose water and glycine as irrigation fluids in two groups

To compare changes in serum electrolytes during TURP, while using 5% dextrose water and gly-cine as irrigation fluids in two groups. Experimental study design. Department of Anaesthesiology, Liaquat National Hospital, Karachi, from January 2004 to Jun 2004. 60 ASA I and II patients who presented for TURP under spinal anaesthesia were divided in two groups. 30 patients were included in each group. Patients in group A received 5% dextrose water as irrigation fluid while patients in group B received 1.5% glycine as irrigation fluid. Serum electrolytes were checked preoperatively, intraoperatively at every 15 minutes interval and postoperatively every hour for 2 hours. Serum Na+ level was decreased in both groups, but it was more marked in group A, maximum change being recorded at 45 minutes interval. These changes returned towards baseline with in 2 hours. Serum K[+], Cl and HCO[3] were also decreased in both the groups with more marked changes in group A. However, these changes were statistically insignificant. After comparing 1.5% glycine with 5% dextrose water as irrigation fluids during TURP, we concluded that glycine was found to be better irrigation fluid as dextrose water causes more evident hyperv-olemia, hyponatremia and hemodilution than glycine