Acid aspiration prophylaxis during anaesthesia for caesarean section: a survey among anaesthetists at Hyderabad.

BACKGROUND: Pulmonary aspiration of gastric contents leading to acid aspiration syndrome (AAS) is a well recognized risk factor during general anaesthesia (GA) for Caesarean section (CS). The cross sectional observational study was conducted during July 2008 to October 2008 at Department of Anaesthesiology and Intensive Care, Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan. The objective was to assess anaesthetic practice patterns and measures to prevent aspiration of acid gastric contents in full-term pregnant women undergoing anaesthesia for Caesarean section. METHODS: A structured questionnaire regarding practice of anaesthesia for Caesarean section was distributed among anaesthetists working and practicing at Hyderabad. Results from the completed questionnaires were transferred to a Microsoft Excel spreadsheet and the responses represented as percentages. RESULTS: General anaesthesia was preferred by 75.4% anaesthetists for caesarean section, 83.6% anaesthetists used rapid sequence induction with cricoid pressure during general anaesthesia, 29.5% respondents restricted clear fluids for 2-3 hours. Antacids were used by 90% of the anaesthetists, while about 50% anaesthetists performed extubation when patients were fully awake. CONCLUSION: Recommended practice patterns and measures to prevent aspiration of acid gastric contents during anaesthesia for caesarean section are not observed by most of the anaesthetists working at Hyderabad.

Recovery profile - a comparison of isoflurane and propofol anesthesia for laparoscopic cholecystectomy.

OBJECTIVE: To compare the recovery profile in terms of time of extubation, eye opening, orientation and mobility and frequency of Postoperative Nausea and Vomiting (PONV) between propofol and isoflurane based anesthesia in patients undergoing laparoscopic cholecystectomy with prophylactic antiemetic. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Anesthesia, Civil Hospital and Dow University of Health Sciences, Karachi, from January to April 2007. PATIENTS AND METHODS: After informed consent, a total of 60 ASA I-II patients scheduled for laparoscopic cholecystectomy were divided in two equal groups I and P. Anesthesia in all patients were induced by Nalbuphine 0.15 mg/kg, Midazolam 0.03 mg/kg, Propofol 1.5 mg/kg and Rocuronium 0.6 mg/kg. Anesthesia was maintained with Isoflurane in group I and propofol infusion in group P, while ventilation was maintained with 50% N2O/O2 mixture in both the groups. All patients were given antiemetic prophylaxis. Hemodynamics were recorded throughout anesthesia and recovery period. At the end of surgery, times of extubation, eye opening, orientation (by modified Aldrete score) and mobility (recovery profile) were assessed. PONV was observed and recorded immediately after extubation, during early postoperative period (0-4 hours) and late period (4-24 hours). Antiemetic requirements were also recorded for the same periods in both the groups. RESULTS: Propofol provided faster recovery (extubation and eye opening times) and orientation in immediate postoperative period with statistically significant differences between the groups (p<0.0001). Recovery characteristics were comparably lower in group I. More patients achieved full points (8) on modified Aldrete score at different time until 30 minutes in group P. Postoperative nausea and vomiting in early and late periods were significantly reduced in group P. Moreover, requirement of rescue antiemetic doses were significantly lower in group P in 24 hours (p<0.0001). CONCLUSION: In this series, recovery was much faster with earlier gain of orientation with propofol anesthesia compared to isoflurane in the early recovery periods. Propofol is likely to be a better choice of anesthesia because of its better antiemetic property that persists long into postoperative period and reduces the risk of PONV.

Intrathecal fentanyl as adjunct to hyperbaric bupivacaine in spinal anesthesia for caesarean section.

OBJECTIVE: To compare the effect of adding fentanyl to intrathecal bupivacaine on the onset, duration and quality of spinal anesthesia and its effect of mother and neonate. DESIGN: Single blind randomized controlled clinical trial. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2003 to June 2004. PATIENTS AND METHODS: Sixty young adult females, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml normal saline or 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml fentanyl (12.5 microg). Blood pressure, heart rate, respiratory rate, oxygen saturation, sensory level, motor block, pain score and side effects were observed every 2 minutes for first 20 minutes, then at-5 minute interval throughout the surgery, thereafter at 30 minutes interval until the patient complained of pain. RESULTS: Comparing the bupivacaine group, time to achieve highest sensory level was significantly shorter in fentanyl group (*p < 0.05), while the duration of complete analgesia (time from injection to first report of pain) lasted significantly more longer in fentanyl group (184+/-20 minutes) than bupivacaine group (126+/-10 minutes). Duration of effective analgesia was also significantly more prolonged in fentanyl group (p < 0.05). There was no significant difference in the incidence of side effects between the two groups. CONCLUSION: Addition of fentanyl to intrathecal bupivacaine results in faster onset with improved peri-operative anesthesia without increasing the side effects.