Spinal (Intrathecal) Ketamine Anaesthesia for Upper Abdominal Surgery : Case Report

Intravenous ketamine is usually administered for the induction of general anaesthesia. Spinal ketamine for lower abdominal and lower limb surgery is sporadically reported in the literature. However; the use of spinal ketamine for upper body surgery is rare. We describe the case of a 35-year old man; with a retroperitoneal tumour and severe intercurrent cardiovascular morbidity; that had exploratory laparotomy and tumour biopsy with Intrathecal ketamine administered through the L4/L5 interspace. The patient had good surgical analgesia; with stable vital signs throughout the surgery. After surgery; the spinal catheter was left in place; and withdrawn 48 hours later. The patient did well in the immediate postoperative period; although he gradually succumbed to the primary illness (malignant retroperitoneal cancer) on the 15th postoperative day

Incidence of obesity in parturients scheduled for caesarean section, intra-operative complications, management and outcome.

OBJECTIVES: To determine the incidence of obesity in parturients scheduled for Caesarean section, identify intra-operative complications, management and outcome. DESIGN: A prospective observational study. SETTING: University of Benin Teaching Hospital, a university-affiliated tertiary centre. SUBJECTS: Parturients scheduled for Caesarean section excluding patients in American Society of Anaesthesiologists (ASA) health status 4 and 5. RESULTS: Three hundred patients were recruited in the study. One hundred and forty eight (49.3%) were non-obese (BMI < 30kgm2) while 152 (50.7%) were obese (BMI >30kgm(-2)). The incidence of obesity was extremely significant P<0.0001, t = 19.721 and 95% C.I. = 11.998 - -9.820. Twenty four percent of the obese and 6% of the non-obese parturients had intercurrent medical diseases. 40.5% of the non-obese parturients had general anaesthesia while 13.1% of the obese parturients were offered general anaesthesia. The incidence of intra-operative complications was higher in the obese group. P<0.0001; extremely significant. Odds ratio = 3.647; 95% C.I. of 2.0007 - 6.626. The most common complications were hypotension (n = 14), shivering (n = 12) and inadequate anaesthesia (n = 8). CONCLUSION: There is a high incidence of obesity in parturients. This group of patients constitutes a high risk group in obstetric anaesthesia. The incidence of complications was higher in the obese than in the non-obese.