Comparison of phenylephrine and norepinephrine for treatment of spinal hypotension during elective cesarean delivery- A randomised, double-blind study.

Background and Aims: Hypotension following subarachnoid block for cesarean delivery (CD) is common. We compared the effect of bolus administration of norepinephrine and phenylephrine on umbilical artery pH (primary objective) and their efficacy for the treatment of maternal hypotension (secondary objective) in term parturients undergoing elective CD under spinal anesthesia. Material and Methods: In a randomized, double-blinded study, parturients received 1 mL boluses of either phenylephrine 100 µg/mL (group phenylephrine; n = 45) or norepinephrine 7.5 µg/mL (group norepinephrine; n = 45) whenever maternal systolic blood pressure decreased to ≤80% of baseline. Maternal hemodynamic changes, vasopressor, and atropine requirement and neonatal outcome (umbilical cord blood gas analysis, Apgar scores, neonatal neurobehavioral response) were assessed. Results: The Apgar scores and umbilical cord blood gas analysis were comparable between groups. The neurobehavioral scale score was significantly higher in group NE compared with that in group PE at 24 h and 48 h; P = 0.007 and 0.002, respectively. The number of vasopressor doses and time to the first vasopressor requirement for maintaining systolic pressure >80% of baseline was comparable in both groups. Incidence of bradycardia (P = 0.009), reactive hypertension (P = 0.003), and dose requirement of atropine (P = 0.005) was higher in group PE compared with group NE. Conclusions: In term normotensive parturients who received bolus norepinephrine 7.5 µg or phenylephrine 100 µg for the treatment of post-spinal hypotension during CD, neonatal umbilical cord blood gas analysis and Apgar scores were comparable. Norepinephrine use was associated with a lower incidence of maternal bradycardia and reactive hypertension compared with phenylephrine.

A Rare Case of Primary Pyogenic Ventriculitis in a Patient with Community-acquired Meningitis.

Pyogenic ventriculitis is defined as the inflammation of the ependymal lining of the cerebral ventricular system. It is characterized by the presence of suppurative fluid in the ventricles. It mostly affects neonates and children but rarely can be seen in adult population. In adults, it usually affects the elderly population. It is usually healthcare associated and occurs secondary to ventriculoperitoneal shunt, external ventricular drain, intrathecal drug delivery, brain stimulation devices, and neurosurgical intervention. Primary pyogenic ventriculitis though rare should be considered as one of the differential diagnoses in patients who do not improve despite an appropriate antibiotic regimen in bacterial meningitis. Our case report on primary pyogenic ventriculitis secondary to community-acquired bacterial meningitis in an elderly diabetic male patient illustrates the importance of utilization of multiplex polymerase chain reaction (PCR), repeated neuroimaging, and prolonged course of antibiotics for the successful management and outcome. How to cite this article: Maheshwarappa HM, Rai AV. A Rare Case of Primary Pyogenic Ventriculitis in a Patient with Community-acquired Meningitis. Indian J Crit Care Med 2022;26(7):874-876.

Relevance of Troponin I Elevation among Individuals with Hypertensive Emergency.

How to cite this article: Maheshwarappa HM, Rai AV. Relevance of Troponin I Elevation among Individuals with Hypertensive Emergency. Indian J Crit Care Med 2022;26(7):767-769.