ABSTRACT
Major obstetric hemorrhage is an extremely challenging obstetric emergency associated with significant morbidity and mortality. Pharmacological treatment of uterine atony has not altered much in recent years apart from the increasing use ofmisoprostol, although controversy surrounds its advantages over other uterotonics. Placenta accreta is becoming more common, a sequel to the rising caesarean section rate. Interventional radiology may reduce blood loss in these cases. Uterine compression sutures, intrauterine tamponade balloons and cell salvage have been introduced in the last decade.
Subject(s)
Obstetric Labor Complications/therapy , Postpartum Hemorrhage/therapy , Uterine Hemorrhage/therapy , Cesarean Section/adverse effects , Female , Humans , Misoprostol/therapeutic use , Obstetric Labor Complications/etiology , Obstetric Labor Complications/mortality , Oxytocics/therapeutic use , Placenta Accreta/etiology , Placenta Accreta/physiopathology , Postpartum Hemorrhage/mortality , Pregnancy , Uterine Hemorrhage/etiology , Uterine Hemorrhage/mortalityABSTRACT
BACKGROUND: Opioids continue to remain the primary analgesics in children undergoing ophthalmic surgery, and their use may be associated with adverse effects like vomiting and respiratory depression. Topical anesthesia avoids these adverse effects and also complications of regional blocks. We designed this study to verify whether topical anesthesia with lignocaine gel is a feasible alternative to intravenous (IV) fentanyl for pediatric cataract surgery. METHODS: One hundred ASA I and II children aged 3-12 years, scheduled for cataract surgery were included in this study. After induction of anesthesia, children were randomized to Group F (fentanyl), who received 2 mcg.kg(-1) IV fentanyl for analgesia and Group G (lignocaine gel), who received 2% lignocaine gel applied over the cornea of the operative eye. Anesthesia was maintained with isoflurane and oxygen in nitrous oxide. All children received intramuscular ketorolac. Intraoperative supplementary analgesia was provided with 0.5 mcg.kg(-1) IV fentanyl to manage increases in heart rate or blood pressure of 20% above baseline. In the postoperative period, Aldrete score and objective pain score were assessed. Rescue analgesia was provided with fentanyl in the postanesthesia care unit and syrup ibuprofen in the ward. RESULTS: Significantly more children in group F (8/48) required intraoperative supplementary fentanyl as compared with group G (1/48) (P = 0.0291). In the PACU, 7/48 children of group G needed fentanyl as compared with 5/48 children in group F. Time to reach Aldrete 10 was significantly longer in group F (P = 0.01). CONCLUSIONS: Topical lignocaine gel is an effective analgesic and may be used as an adjunct to fentanyl during cataract surgery in children.
