Use of a Combined Anaesthetic Technique and Minimally Invasive Hemodynamic Monitoring in a Primigravid with Uncorrected Tetralogy of Fallot for Caesarean Section

@#<p style="text-align: justify;">Tetralogy of Fallot (TOF) in pregnancy is a rare occurrence which poses a high risk for detrimental effects on both mother and fetus. This paper reports a 21-year-old primigravid diagnosed with uncorrected TOF who had a successful caesarean section at 32 weeks of gestation. To address the hemodynamic challenges, the anaesthetic management involved the use of a minimally invasive hemodynamic monitor, controlled mechanical ventilation and a combined technique of intravenous anaesthesia using remifentanil and lumbar epidural anaesthesia using levobupivacaine.</p>

Evaluation of lumbo-sacral epidural anaesthesia or analgesia with lidocaine-acepromazine combination in dogs undergoing cystotomy

Background:Epidural anaesthesia is one of the most frequently used regional anesthetic techniques recommended for surgical procedures caudal to the umbilicus in dogs. However, the use of lignocaine alone for epidural regional analgesia has been discovered to have shorter duration of analgesia and prolong onset of action, hence there is need to explore combinations of agents that will overcome this challenge. This study aimed to evaluate the anaesthetic/analgesic effect of cranial epidural anaesthesia in dogs undergoing cystotomy using Lignocaine in combination with acepromazine at the dose rates of 7 mg/kg and 0.05 mg/kg respectively.Methods:Eight apparently healthy matured, male and female dogs were used for the experiment. The onset and duration of analgesia was determined. The pulse rates, respiratory rates, mean arterial blood pressure, rectal temperature, complete blood count and the oxygen saturation level were determined at baseline, intra operative and post-operative.Results:There were no significant differences in all the parameters measured before and after the epidural administration of the agents. The onset of anaesthesia was rapid and the duration of anaesthesia was sufficient enough for the procedure to be carried out. However, there was significant difference in PCV, Hb and total RBC count between the baseline and other timing intervals. There were no significant differences in leucocytic and cardiopulmonary parameters between the baseline and other timing intervals.Conclusions:The epidural administration of lignocaine and acepromazine combination at the doses indicated can produced sufficientepidural anaesthesia with rapid onset for the purpose of cystotomy in dogs without major systemic influence on hemodynamic and cardiopulmonary changes

Comparative Analysis of the Efficacy of Epidural Dexmedetomidine and Clonidine with Bupivacaine in Patients Undergoing Infraumbilical Surgeries

Introduction: Pain was defined by Mountcastle in the year1968 as “that sensory experience evoked by stimuli thatinjures”. It is a subjective feeling and failure to relieve pain inany procedure cannot be accepted, both ethically and morally,and adequate pain relief must be treated as basic human right.Pain relief both in peri-operative and post-operative period isthe crux of anaesthesia. The aim of the study was to evaluatethe efficacy of epidural Dexmedetomidine and Clonidine as anadjuvant to Bupivacaine in patients undergoing infraumbilicalsurgeries.Material and Methods: Seventy (70) patients aged 20-60years (ASA I-II) undergoing infraumbilical surgery wererandomly allocated to two groups- Group BD receivingepidurally 15ml Bupivacaine (0.5%) + Dexmedetomidine(1mg/kg) and Group BC receiving 15ml Bupivacaine (0.5%)+ Clonidine (1mg/kg). After securing I/V line, infusionstarted with R/L and under strict aseptic condition, patientswere administered epidural block via 18G Tuohy needlein the sitting or lateral position at L3-L4 intervertebralspace.Results: We observed that the time taken for the onset ofsensory block at T10 level, time for sensory block upto T6 andthe time taken for maximum motor block is less in Group BDcompared to Group BC. Regarding the post-operative block,the time to sensory two segment regression, time to sensoryregression to S1, time for recovery of motor block and timeto first rescue analgesia were more in Group BD compared toGroup BC. And the difference between the two groups weresignificant (p<0.001).Conclusion: On the basis of the findings of our present clinicalstudy, we can come to conclusion that Dexmedetomidine ismore effective epidural adjuvant compared to Clonidine inpatients undergoing infraumbilical surgery.

A Study between Lumbar Epidural and Spinal Anesthesia in Elective Caesarean Section in Rural Women in Bangladesh

Objective: Present study was conducted to evaluateeffectiveness of lumbar epidural and spinal anaesthesia inelective caesarean section.Methods: This experimental study is conducted at tertiarymedical college hospital, Gopalgong. Written informed consentfrom 100 patients were obtained for this experimental study.Purposive sampling technique was used.Results: During the study, where in group-A 52.02% womenwere in their first pregnancy followed by 28.28% were 2ndpregnancy, 19.7% were multi gravid women. where in group-A,35% had hypotension where as in group-B it was 11%. groupA, 30% patients were Highly satisfied where as in group-B itwas 65%. The patients selected for the study was divided intotwo groups: Group – I (Spinal): 50 Patients selected, Group – II(Epidural): 50 patients selected.Conclusion: From our result and study we can conclude that,continuous epidural technique which allowed mother earlybreastfeeding and ambulation. Further studies are needed forbetter outcome.

Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective   and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies.  Incorporation   of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019.  They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B.  The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block.  There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.

Emergency open cholecystectomy in a patient with severe aortic stenosis under epidural anaesthesia

Goldman and colleagues identified severe aortic stenosis (AS) as a risk factor for perioperative cardiac complications in non-cardiac surgery. Although patients with aortic stenosis are at an increased risk of perioperative cardiac events, they can undergo non-cardiac surgery relatively safely provided that the condition is recognized and appropriate monitoring and management put in place. The early detection and treatment of hypotension and arrhythmias are essential. We present a case of severe aortic stenosis posted for emergency open cholecystectomy which was successfully managed under epidural anaesthesia and had an uneventful recovery.

Morphometric Measurements Of Sacral Hiatus In South Indian Dry Human Sacra For Safe Caudal Epidural Block

Introduction: The sacral hiatus is located on the posterior aspect of the lower end of the sacrum, where theextradural space ends . The clinically significant features of the posterior surface of the sacrum are the triangularor inverted ‘U’ shape sacral hiatus and the sacral cornua.The knowledge of Anatomical variations of Sacralhiatus is significant while administration of Caudal Epidural Anaesthesia and it may help to improve its successrate.Aim: The purpose of this study is to recognize anatomical variations and additional landmarks of sacral hiatusin cases where the sacral cornua could not be identified and to assess proportions that may magnify the locationof the apex of the sacral hiatus and thus to find a practical solution for Caudal epidural block (CEB).Materials and methods: The present study was conducted on unknown sixty one complete and undamaged adult,dry sacral bones . The material was of undetermined age and gender. Anatomical measurements was carried outon these bones using a vernier calliper to the accurate of 0.1mm.Results: Variations in the shapes and their percentages of Sacral hiatus were observed namely Elongated, InvertedU, Irregular, Inverted V, Dumbbell and Bifid along with their distances and Angles of use in detecting the Apexwere measured. The location of Apex of Sacral hiatus was found at varying levels from upper end of S2 to lowerpart of S5 vertebrae. Also we measured the angles between the margins of the triangle formed by the twosuperolateral sacral crests and the sacral hiatus. Our measurements reveal this to be an equilateral triangle.Conclusion: This knowledge of variations in Human sacral hiatus provides a safe caudal epidural block beforesurgery and complications can be avoided.We believe that the equilateral character of the sacral triangleformed connecting the two posterior superior iliac spines and the apex of the sacral hiatus will be practicaladvantage to the clinician in ascertaining the location of the sacral hiatus during CEB.

Is 075% Ropivacaine More Efficient than 05% Bupivacaine for Prolonged Sensory Blockade in Epidural Anaesthesia for Orthopaedic Hip Surgeries?

The efficiency of 0.75% Ropivacaine as a single shot epidural anaesthetic in comparison to 0.5% Bupivacaine is less studied. Our study focuses on comparing the efficiency of sensory block between 0.75% ropivacaine and 0.5% bupivacaine for epidural anaesthesia. Methods: The study was done with 0.75% Ropivacaine and 0.5% Bupivacaine in epidural anaesthesia in orthopedic hip surgeries given as a single shot technique for which 60 patients of ASA I/II each were chosen and 15ml of the drug was given. Onset of the sensory sensations at T12 and regression at the same level were measured with the aid of response to pin prick and thus duration of epidural anaesthesia was calculated individually in group B and group R respectively. Results: Onset of sensory block was faster in group R than in group B and regression was slower in group R than in group B. Conclusion: It can be concluded that duration of epidural anaesthesia was prolonged and longer with 0.75% Ropivacaine than 0.5% Bupivacaine.

Comparison of Epidural Levo Bupivacaine (0.5%) with Racemic Bupivacaine (0.5%) for Lower Abdominal Surgery

Introduction: Levobupivacaine, the pure S (-) isomer ofbupivacaine, is attributed to have less cardiotoxicity whencompared to racemic bupivacaine. Levobupivacaine increasethe margin of safety for epidural anaesthesia. Study aimed toinvestigate the clinical efficacy of levoupivacaine comparedwith racemic bupivacaine for epidural anaesthesia.Material and Methods: We conducted an observationalmulticentric study comparing sensory and motor blockproduced by 0.5% levobupivacaine (17 ml, 85 mg) withthat of 0.5% racemic bupivacaine in 60 patients undergoingelective lower abdominal surgery under epidural anaesthesia.Result: No statistically significant difference was foundbetween the groups in terms of sensory and motor blockade.The time to onset of adequate sensory block (T10dermatome)was similar in both treatment groups (6.20+/-2.23 min forlevobupivacaine and 6.17+/-2.61 min for bupivacaine).Average peak block height reached was T4 for both group.Time for sensory block to reach T6 level was comparable.(10.97+/-2.89 for bupivacaine and 11.23 +/-5.99 forlevobupivacaine.) Time for regression of sensory block to T10level was similar (224.17+/-30 for bupivacaine and 224.83 +/-23 for levobupivacaine). There was no difference in theonset and intensity of motor block between two groups.Conclusion: 0.5% levobupivacaine and 0.5% bupivacaineproduced effective epidural anaesthesia and their effects wereclinically indistinguishable. Levobupivacaine could be a goodalternative to bupivacaine in patients administered epiduralanaesthesia

Efficacy of Unilateral Spinal Anaesthesia and Sequential Combined Spinal Epidural Anaesthesia for Surgery of Lower Limb - A Prospective and Comparative Study

Background: Orthopaedic anaesthesia plan requires customi-zation as per patient’s need for safe outcome. Sequential Combined Spinal Epidural Anaesthesia (Sequential CSEA) and Unilateral Single Shot Spinal anaesthesia (Unilateral SA), both have advantages over conventional spinal anaesthesia that they provide longer lasting block with less hypotension. Aim: To compare safety and efficacy of unilateral spinal anaesthesia with sequential combined spinal epidural anaesthesia for lower limb orthopaedic surgery. Methods: This prospective randomized study was conducted on sixty ASA I-III patients aged 18- 65 years undergoing lower limb orthopaedic surgeries of approximately two hours duration. Sequential CSE group received spinal with 5 mg of 0.5 hyperbaric bupivacaine followed by incremental epidural top up of 2 cc of 0.5% isobaric bupivacaine to achieve and maintain T10 level. In unilateral SA group, unilateral spinal anaesthesia was given with 10 mg of 0.5% hyperbaric bupivacaine. Haemodynamic parameter, anaesthesia readiness time and block characteristics were recorded and results were analysed using unpaired Student's t-test. Results: There was no failure of block, surgical anaesthesia with T10 sensory level and bromage score three motor block was achieved by all patients in both groups. Anaesthesia readiness time was less in unilateral SA (p<0.001) Incidences of hypotension (p-0.0059) and mean ephedrine dose were significantly less in sequential CSEA. Five patients of unilateral SA required supplementation with general anaesthesia. Conclusion: Thus, our study concludes that unilateral SA is a cost-effective and rapidly performed anaesthetic technique. Unilateral SA with 10 mg bupivacaine and sequential CSEA with 5 mg spinal and incremental epidural top up, both provide good quality sensory and motor block for lower limb orthopaedic surgery but sequential CSEA provides significantly more stable haemodynamics with feasibility to prolong block. Thus sequential CSEA should be preferred over unilateral SA in high risk patients especially for major lower limb orthopaedic surgeries.

Pneumocephalus Following Combined Spinal Epidural Anaesthesia for Total Knee Arthroplasty: A

The authors describe a case of pneumocephalus following epidural anaesthesia for total knee arthroplasty. Multiple attempts in locating the epidural space for the anaesthesia and the use of loss of resistance to air (LORA) technique were identified as the source of air entry. Supportive management was given including high flow oxygenation therapy and spontaneous reabsorption of air was noted five days after surgery. The presence of pneumocephalus should be kept in mind if patient develops neurological complications postoperatively following epidural anaesthesia.

Anaesthetic Management of Patients with Dilated Cardiomyopathy Undergoing Non-Cardiac Surgery.

The anaesthetic management of a patient with dilated cardiomyopathy (DCM) undergoing non-cardiac surgery has always posed a challenge for Anaesthesiologist either due to pre-existing or a risk of precipitating congestive heart failure. Hereby, we report a case of an elderly patient with Dilated cardiomyopathy and Ejection Fraction less that 35%, MET criteria more than 5 for mid- Ureteric calculus removal surgery under Epidural Anaesthesia.

Epidural Anaesthesia for LSCS in Hypertrophic Cardiomyopathy: A Better Choice.

Hypertrophic cardiomyopathy (HCM) is a complex cardiovascular disorder with autosomal dominant inheritance, having an incidence of 0.1-0.5% in pregnant females. Anesthetic management of female with HCM posted for caesarean section is a challenge, as even minor alteration in hemodynamic status during the perioperative period may endanger the life of the patient. Here we report successful management of one patient with HCM for LSCS using epidural anaesthesia.

Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour / Hematoma subdural agudo potencialmente fatal após anestesia combinada raqui-peridural em parto

ABSTRACTBACKGROUND AND OBJECTIVES: Only few reports in literature have pointed out to the possibility of a cranial subdural haematoma formation associated with dural puncture during spinal or epidural analgesia. We herein describe such a rare case who was diagnosed to have acute subdural haematoma after combined spinal-epidural anaesthesia used in labour.CASE REPORT: A 34-year-old, primigravid women with a gestation of 38 weeks underwent caesarean section under combined spinal-epidural anaesthesia and gave birth to a healthy boy. Thirty-two hours after delivery, her moderate headache progressed to a severe headache associated with nausea and vomiting and later was more complicated with a generalized tonic-clonic seizure and ensuing lethargy. Computed tomography of the brain demonstrated a right-sided fronto-temporo-parietal acute subdural haematoma with diffuse cerebral oedema. She underwent urgent FTP craniotomy and evacuation of the haematoma. Early postoperative cranial computed tomography showed a clean operative site. Eight days after subdural haematoma surgery, she became lethargic again, and this time cranial computed tomography disclosed an extradural haematoma under the bone flap for which she had to undergo surgery again. Two days later, she was discharged home with Karnofsky performance score of 90/100. At follow-up exam, she was neurologically intact and her cranial computed tomography and magnetic resonance were normal.CONCLUSIONS: As conclusion, with the use of this combined spinal-epidural anaesthesia, it should be kept in mind that headache does not always mean low pressure headache associated with spinal anaesthesia and that a catastrophic complication of subdural haematoma may also occur.

RESUMOJUSTIFICATIVA E OBJETIVOS: Apenas alguns relatos na literatura mencionaram a possibilidade de formação de hematoma subdural craniano associada à punção durante a raquianestesia ou anestesia epidural. O presente relato descreve um caso tão raro que foi diagnosticado como hematoma subdural agudo após anestesia combinada raqui-peridural usada em parto.RELATO DE CASO: Paciente primípara, 34 anos, com 38 semanas de gestação, submetida à cesariana sob anestesia combinada raqui-peridural, deu à luz um menino saudável. Após 32 horas do parto, a dor de cabeça moderada da paciente progrediu para dor de cabeça intensa associada a náusea e vômito e se complicou subsequentemente com crise convulsiva generalizada tônico-clônica e consequente letargia. Tomografia computadorizada do cérebro revelou hematoma subdural agudo do lado direito em região frontotemporoparietal (FTP) com edema cerebral difuso. A paciente foi submetida à craniotomia FTP de urgência e evacuação do hematoma. Tomografia computadorizada do crânio no pós-operatório precoce mostrou um sítio operatório limpo. Oito dias após a cirurgia do hematoma subdural, a paciente voltou a ficar letárgica e, dessa vez, a tomografia computadorizada revelou um hematoma extradural sob o retalho ósseo que exigiu outra cirurgia. Dois dias depois, a paciente recebeu alta hospitalar com classificação de desempenho Karnofsky de 90/100. Ao exame de acompanhamento, a paciente apresentou-se neurologicamente intacta e sua tomografia computadorizada e ressonância magnética estavam normais.CONCLUSÃO: Ao usar a anestesia combinada raqui-peridural deve-se ter em mente que dor de cabeça nem sempre significa dor de cabeça hipotensiva associada à raquianestesia e que uma complicação catastrófica de hematoma subdural também pode ocorrer.

Morphometrical study of sacral hiatus in dry human sacra.

Background: The sacral hiatus is the site for caudal epidural anaesthesia during perineal surgery and also for a painless delivery. It is also used for three dimensional colour visualization of lumbosacral epidural space in orthopaedic practice for diagnosis and treatment. Sacrum is one of the bones which exhibit variations. Therefore the importance of the normal sacral hiatus and its variations is of great clinical significance. The reliability of caudal epidural anaesthesia is 70% - 80% in the literatures. The objective of the study was to examine, measure and record the morphometry of sacral hiatus under the following headings in order to study the anatomical variations which would be useful for caudal epidural anaesthesia and improve the reliability of the same. a) Shape of sacral hiatus, b) level of apex, c) level of base, d) length of the sacral hiatus, e) transverse width at the base, and f) anteroposterior depth at the apex. Methods: A total of 200 dry, complete, undamaged human sacra of unknown sex were used in this study. Measurements were taken using vernier calipers. In this study six parameters were taken. All the readings were tabulated and subjected to analysis. Results: Various shapes of sacral hiatus were observed which included Inverted-U (50%), Inverted-V (27.5%), Irregular (15.5%), Dumb bell (2%), and Bifid (2%). The mean anteroposterior depth of sacral canal at the level of apex of sacral hiatus was 4.25mm. The mean length of sacral hiatus was 19.63 mm and the mean transverse width of sacral hiatus at the level of base was 11.42 mm. There was complete spina bifida in 4 (2%) and absence of sacral hiatus in 2 (1%) cases. Conclusion: The sacral hiatus has anatomical variations. Understanding of these variations may improve the reliability of caudal epidural anaesthesia.

Study of Sacral Hiatus in Dry Human Sacra in Nepal, Parsa Region.

Introduction: The sacrum is a large triangular bone, formed by the fusion of five sacral vertebrae. The opening at the caudal end of sacral canal is known as sacral hiatus. It is formed due to the failure of fusion of laminae of the fifth (occasionally fourth) sacral vertebra. Sacrum is one of the bones which exhibit variations and the variation of sacral hiatus is of great clinical significance because it may also leads tomechanical low back pain. Previousworks on themorphometrical study on the sacral hiatus is limited, especially in Nepal, Parsa population. The present study was undertaken to help in filling this gap at least to a certain extent and also made an attempt to find out the variations of sacrum. Materials: One hundred dry human sacra were collected from the Department of Anatomy of National medical college & Teaching Hospital, Nepal. Methods& Observations: Themorphometrical studieswere done, and the parameters (Shape, length, Transverse width & Antero-posterior width of sacral hiatus and level of apex & base of sacral hiatus) were measured with the help of divider, the observations were recorded, tabulated & analyzed. Result: The study showed a significant co-relation between anatomical variations of sacral hiatus with the previous studies.

Sacral Hiatus Study in Dry Human Sacra

Background and objectives: The sacral hiatus is the site for caudal epidural anaesthesia during perineal surgery and also for a painless delivery. It is also used for three dimensional colour visualization of lumbosacral epidural space in orthopaedic practice for diagnosis and treatment. Work on the morphometrical study of the sacral hiatus is limited, especially in south indian population. So this study is carried to examine, measure and record the morphometry of sacral hiatus in order to study the anatomical variations which will be useful for caudal epidural anaesthesia. Material and Methods: The study was conducted in the Department of Anatomy, Prathima Institute of Medical Science, Naganur, Andhra Pradesh. 93 dry sacra with complete sacral hiatus were taken for the study. The shape of the sacral hiatus was noted by naked eye. Level of the apex and base of the sacral hiatus was noted with respect to the sacral vertebra. The length of sacral hiatus was measured from apex to the midpoint of base, the anteroposterior depth of sacral hiatus at the apex was measured with the help of vernier calipers. The transverse width of sacral hiatus at the base was measured between the inner aspects of inferior limit of the sacral cornu with the help of divider and then adjusted, and calculated with vernier caliper. Results: In 47 (50.53 %) sacra the shape was Inverted-U and in 25 (26.9 %) sacra Inverted-V. The irregular shaped of sacral hiatus was observed in 11 (11.8 %) cases. A “Dumbbell” shaped sacral hiatus was observed in 5 (5.4%) cases with a nodular bony growth projecting medially from both margins. The dorsal wall of sacral canal was entirely absence in 4 (4.3%) cases. Absence of sacral hiatus, a rare phenomenon, was observed in 1 (1%) specimens only. Conclusion: In the present study, elongated hiatus and narrowing of the sacral canal at apex of sacral hiatus was found in a significant percentage, which should be kept in mind while giving the caudal anaesthesia in Andhra Pradesh region.

Outcome of caesarean section under spinal versus epidural for women with pre-eclampsia.

Background: Pre-eclampsia is a major cause of maternal and perinatal mortality worldwide. Women with pre-eclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress and prematurity. Objective: To compared the outcome of Cesarean section for pre-eclampsia using sub-arachnoid block and epidural anesthesia Methods: The present retrospective study was carried out in one of the tertiary care hospital of Bareilly district from Jan.2011 to July 2013. Unit of study were all the women with preeclampsia who underwent caesarean section for delivery under spinal or epidural anaesthesia and their babies. chi squire test and student t-test test were applied for statistical analysis. Results: There was no significant difference between two groups in overall maternal mortality (0.0% vs 2.4%, p>0.05), perinatal mortality (5% vs 7.1%, p>0.05), Apgar score less than 7 at 1 minute (25% vs 21%, p,0.05)and Apgar score less than 7 at 5 minute (5% vs 14.3%). Conclusion: no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with preeclampsia who had epidural and those that had spinal anaesthesia.

A retrospective study of the outcome of cesarean section for women with pre-eclampsia under spinal versus epidural anaesthesia in hospital of Northern India.

Back ground: Pre-eclampsia is a major cause of maternal and perinatal mortality worldwide. Women with pre-eclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress and prematurity. Objective: To compared the outcome of Cesarean section for pre-eclampsia using sub-arachnoid block and epidural anesthesia Methods: The present retrospective study was carried out in one of the tertiary care hospital of Bareilly district from Jan.2011 to July 2013. Unit of study were all the women with preeclampsia who underwent caesarean section for delivery under spinal or epidural anaesthesia and their babies. chi squire test and student t-test test were applied for statistical analysis. Results: There was no significant difference between two groups in overall maternal mortality (0.0% vs 2.4%, p>0.05), perinatal mortality (5% vs 7.1%, p>0.05), Apgar score less than 7 at 1 minute (25% vs 21%, p,0.05)and Apgar score less than 7 at 5 minute (5% vs 14.3%). Conclusion: no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with preeclampsia who had epidural and those that had spinal anaesthesia.

Comparative study on combined spinal-epidural anesthesia and combined epidural anesthesia in uterine myomectomy / 中国医学装备

Objective:To comparative study the clinical effect of combined spinal-epidural anesthesia and combined epidural anesthesia in uterine myomectomy.Methods:Totally 90 cases of patients with uterine myomectomy in our hospital from March 2012 to March 2013 were randomly divided into observation group and the control group, 45 patients in the control group were given epidural anesthesia, and observation group were given combined spinal-epidural anesthesia. BP, HR and surgical traction reaction were monitored in the operation and the effects of anesthesia and adverse events of the two groups were compared.Results: (1) Blood pressure of patients in two groups was decreased during anesthesia. Systolic pressure (x2=5.232,P<0.01) and diastolic blood pressure (x2=6.251,P<0.05) of patients in observation group were lower than control groups. The difference was statistically significant. (2)Patients of observation group showed shorter anesthesia onset time (x2=6.278,P<0.05) and completing time (x2=9.674,P<0.05), lower local anesthetics dosage (x2=12.256,P<0.05), better evaluation of anesthesia, and fewer adverse reactions. The difference was statistically significant (x2=16.576,P<0.01). (3)Anesthesia excellent rate in observation group were higher than that of control group, the difference was statistically significant (P<0.01).Conclusion: Combined spinal-epidural anesthesia has better anesthesia effects in uterine myomectomy than epidural anesthesia. And it is a worthy use of anesthesia.