Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study.

BACKGROUND: Maternal obesity is increasing in prevalence and is associated with an increased risk of perioperative complications. This study evaluates the impact of obesity on perioperative outcomes in parturients undergoing caesarean delivery. METHODS: In this prospective observational study of 1477 consecutive caesarean deliveries, data collected included body mass index, co-morbidities, anaesthetic technique, perioperative complications and patient satisfaction. Outcome measures included obesity prevalence, association of obesity with caesarean delivery, co-morbidities, perioperative complications and patient satisfaction and were compared between the obese and non-obese groups. RESULTS: The prevalence of obesity was 54.3%, including 7.2% morbidly obese. About 61% of parturients who underwent caesarean delivery because of failure to progress in labour or previous caesarean were obese. The overall prevalence of co-morbidity was 10.2% of whom 57.3% were obese. Neuraxial anaesthesia was used in 73.4% and general anaesthesia in 26.6%, similar in obese and non-obese. The epidural failure rate was 4.3% and the spinal failure rate 2.9%. Difficulty in performing neuraxial anaesthesia was greater in obese patients (P=0.004). There was no association between obesity and laryngoscopy grades. Patient satisfaction was similar in the obese and non-obese groups. Postoperative complications were minimal and similar. CONCLUSIONS: Neuraxial anaesthesia was effective for caesarean deliveries in obese and non-obese, in elective and emergency cases. Maternal obesity is associated with increased difficulty in performing neuraxial anaesthesia, but not with increased failure rate. Our study found no differences between obese and non-obese parturients in rate of caesarean deliveries, co-morbidities, indications for delivery or anaesthesia complications.

Novel phthalazinone and benzoxazinone containing thiazolidinediones as antidiabetic and hypolipidemic agents.

We report here the synthesis of a series of 5-[4-[2-[substituted phthalazinones-2(or 4)yl]ethoxy]phenylmethyl]thiazolidine-2,4-diones and 5-[4-[2-[2,3-benzoxazine-4-one-2-yl]ethoxy]phenylmethyl]thiazolidine-2,4-diones and their plasma glucose and plasma triglyceride lowering activity in db/db mice. In vitro PPARgamma transactivation assay was performed in HEK 293T cells. In vitro and in vivo pharmacological studies showed that the phthalazinone analogue has better activity. PHT46 (compound 5a), the best compound in this series, showed better in vitro PPARgamma transactivation potential than troglitazone and pioglitazone. In insulin resistant db/db mice, PHT46 showed better plasma glucose and triglyceride lowering activity than the standard drugs. Pharmacokinetic study in Wistar rats showed good systemic exposure of PHT46. Subchronic toxicity study in Wistar rats did not show any treatment-related adverse effect.

Tracheal intubation without muscle relaxant--a technique using sevoflurane vital capacity induction and alfentanil.

This randomized controlled study examined intubating conditions and haemodynamic changes following sevoflurane nitrous oxide induction in four groups: three different doses of alfentanil compared with low-dose alfentanil and suxamethonium. All patients received atropine 0.3 mg i.v. before induction of anaesthesia with vital capacity breaths of sevoflurane 8% (more than 7% in the inspiratory gas) in 60% nitrous oxide and oxygen. Patients were allocated randomly to four groups of intravenous supplements: group SA20, alfentanil 20 microg x kg(-1); group SA25, alfentanil 25 microg x kg(-1); group SA30, alfentanil 30 microg x kg(-1); group SSA, alfentanil 10 microg x kg(-1) and suxamethonium 1 mg x kg(-1). Orotracheal intubation and assessment of intubating conditions was performed by one of the investigators who was blinded to the subject's group. Intubating conditions were satisfactory or excellent in 83%, 80%, 92% and 96% of patients in groups SA20, SA25, SA30 and SSA respectively. These differences were not statistically significant. The increase in heart rate associated with laryngoscopy and tracheal intubation was effectively attenuated in all groups. Mean arterial pressure decreased significantly and similarly after induction in all groups. Two minutes after intubation the mean arterial pressure was increased significantly (P<0.05) compared to the post-induction value in group SSA. The intubating conditions obtained with sevoflurane plus alfentanil 30 microg x kg(-1) were comparable to those provided by the sevoflurane, suxamethonium and alfentanil 10 microg x kg(-1) combination.

Conditions for laryngeal mask insertion. A comparison of propofol versus sevoflurane with or without alfentanil.

One hundred unpremedicated ASA 1 or 2 patients scheduled for elective surgery were divided equally into four groups and recruited into this prospective, randomised parallel groups study. Induction was with propofol 2.5 mg.kg-1 or vital-capacity breath induction with sevoflurane (> 7% in the inspiratory gas) in 65% nitrous oxide and oxygen, or gaseous induction with sevoflurane plus alfentanil 5 micrograms.kg-1 or propofol 2.5 mg.kg-1 and alfentanil 5 micrograms.kg-1. The conditions for laryngeal mask insertion were assessed and graded on a three-point scale using six variables. The overall condition for laryngeal mask insertion was assessed as excellent, satisfactory or poor on the basis of total score in each group. Excellent or satisfactory conditions were observed in 25 (100%) patients in the sevoflurane-alfentanil group, 22 (88%) in the propofol-alfentanil group and 16 (64%) patients each in the propofol and sevoflurane groups (p < 0.001). A sevoflurane-alfentanil combination provides better conditions for laryngeal mask insertion when compared with sevoflurane alone, or a propofol-alfentanil combination.

Novel euglycemic and hypolipidemic agents. 1.

A series of [[(heterocyclyl)ethoxy]benzyl]-2,4-thiazolidinediones have been synthesized by the condensation of corresponding aldehyde 1 and 2,4-thiazolidinedione followed by hydrogenation. Both unsaturated thiazolidinedione 2 and its saturated counterpart 3 have shown antihyperglycemic activity. Many of these compounds have shown superior euglycemic and hypolipidemic activity compared to troglitazone (CS 045). The indole analogue DRF-2189 (3g) was found to be a very potent insulin sensitizer, comparable to BRL-49653 in genetically obese C57BL/6J-ob/ob and 57BL/KsJ-db/db mice. Pharmacokinetic and tissue distribution studies conducted on BRL-49653 and DRF-2189 (3g) indicate that these drugs are well-distributed in target tissues. On the basis of euglycemic activity as well as enhanced selectivity against reduction of triglycerides in plasma, DRF-2189 (3g) has been selected for further evaluation.

Crosstalk resistant adaptive noise cancellation.

Presence of signal components in the reference input is detrimental to the performance of practical adaptive noise cancellation systems. Using a modeling approach, we analyse the performance of adaptive noise cancellation in the presence of signal cross talk. We demonstrate a crosstalk resistant adaptive noise cancellation method. After showing that the original signal cannot be recovered if the ability to prevent adaptation does not exist, we discuss the use of a weighted exact least squares lattice algorithm in the joint estimation form, where adaptation can be controlled. Using stimulated data, it is shown that signal can be estimated with good accuracy, even when there is significant signal crosstalk in the reference input.

Synthesis and antiviral evaluation of 6'-substituted aristeromycins: potential mechanism-based inhibitors of S-adenosylhomocysteine hydrolase.

New carbocyclic adenosine analogues substituted at the 6'-position with fluorine, hydroxyl, methylene, or hydroxymethyl have been synthesized as potential mechanism-based inhibitors of S-adenosylhomocysteine (AdoHcy) hydrolase. The synthetic routes began with a functionalized (+/-)-azidocyclopentane 2, which was elaborated to the adenosine analogue, or with functionalized cyclopentane epoxides 11, 20, and 27, which were opened directly with adenine in the presence of base. The 6' alpha-fluoro, 6' beta-fluoro, and 6'-methylene carbocyclic adenosine analogues were potent inhibitors of AdoHcy hydrolase. None of the compounds displayed significant activity against herpes simplex virus type 1 or type 2, but several demonstrated potent inhibition of vaccinia virus replication.

Classification of brain-stem auditory evoked potentials by syntactic methods.

A syntactic pattern recognition procedure for classification of brain-stem auditory evoked potential (BSAEP) is presented. A pre-processing stage of zero-phase bandpass filtering enhances the peaks and suppresses the noise. A finite-state grammar was designed to identify the peaks. Attributes of the peaks (latencies and amplitudes) that are identified are checked for their acceptability. A training run on 70 subjects of known diagnosis was performed to fine-tune the system and build up necessary acceptance criteria. Peak latency differences are used for the classification rather than absolute peak latencies. Acceptance criteria for peak latency differences were empirically optimized. A data base of normal BSAEPs, created during the training run, was updated and used during the test run. Test of the classifier using 60 subjects yielded a classification accuracy of 83%. The classifier has acceptable accuracy and can be modified for other evoked potentials such as visual and somatosensory by establishing relevant attribute tables.