A Comparative Study of Analgesic Efficacy of Intrathecal Bupivacaine with Ketamine Versus Bupivacaine with Magnesium Sulphate in Parturients Undergoing Elective Caesarian Sections.

Background and Aims: Spinal anaesthesia is the most preferred technique of anaesthesia in parturient, undergoing lower segment caesarean sections (LSCS) which provides effective pain relief during intra operative and early postoperative period. However, recent studies demonstrate that about 50%-70% of patients experience moderate to severe pain after LSCS indicating that postoperative pain remains poorly managed. The aim of our study was to compare intrathecal magnesium sulphate (Mgso4) and ketamine as adjuvants to hyperbaric bupivacaine in parturients posted for elective caesarean sections under spinal anaesthesia to determine their effectiveness in extending the duration of analgesia. Materials and Methods: After institutional ethical committee approval, 82 parturient undergoing elective LSCS were enrolled into the prospective randomized double blinded study. Group BK (n = 41) received intrathecal ketamine (25 mg) as additive to hyperbaric bupivacaine and group BM (n = 41) received magnesium sulphate (75 mg) as additive to hyperbaric bupivacaine. Time of onset of sensory analgesia, motor blockade, duration of analgesia was noted down. Intraoperative hemodynamics and any adverse effects of study drugs were noted. Results: The mean duration of analgesia in group BK was significantly longer (P < 0.05) than in Group BM. The onset of sensory and motor blockade was significantly early in Group BK compared to Group BM. Hemodynamics was better maintained in Group BK with less requirement of ephedrine compared to Group BM. The visual analog scale scores were significantly lower without side effects in both the groups. Conclusion: The present study demonstrated that the duration, quality of analgesia, hemodynamic stability was better with intra thecal ketamine as an adjuvant to bupivacaine compared to intrathecal MgSo4 without any significant side effects on mother and child.

Correlation between Weight of the Baby and the Level of Sensory Blockade in Spinal Anaesthesia for Caesarean Section: An Observational Study.

BACKGROUND: The spread of local anaesthetics during spinal anaesthesia is affected by various factors and can be unpredictable especially in parturients undergoing caesarean section. Factors like abdominal girth, symphysis fundal height etc have to studied to know their impact on level of sensory blockade. We hypothesized a study to find any correlation between weight of the baby and the level of sensory blockade. METHODS: 46 parturients posted for elective caesarean section belonging to American Society of Anaesthesiologists (ASA) physical status 1 and 2 were included in the study. Maternal height and weight were noted down before entering operation theatre. All patients were instituted subarachnoid block with 2 cc of 0.5% of hyperbaric bupivacaine in sitting position. Level of sensory blockade was assessed with pin prick along midline of the patient every min till 5th minute and 5 minutes till 15th minute. The birth weight of baby was recorded soon after delivery. RESULTS: The weight of the baby and height of the mother were correlated with the sensory blockade of T4. The number of babies weighing more than 3.5 kgs were 3 in our study out of which 2 babies were associated with maximum sensory blockade at 15th minute. It amounts to 66.7% when compared with 14.7% in babies weighing 2.5 to 3.5 kgs which is suggestive of significance ('P' value of 0.093). CONCLUSION: There is no statistically significant correlation between weight of the baby and the level of sensory blockade.

Anaesthetic management of beta thalassemia major with hypersplenism for splenectomy in pediatric age group: Report of four cases.

Beta thalassemia is the most common cause of hemolytic anemia in India. Hereby we are reporting four cases of beta thalassemia major aged between 5 and 10 years posted for splenectomy over a period of 2 months. These patients were on repeated blood transfusions since the day of diagnosis, and two patients had a history of cardiac failure. In addition to emphasizing the anesthetic challenges, the purpose of reporting such cases is to raise the awareness of the disease and prevention of the same by aggressive screening and prenatal diagnosis.

Salivary sialic acid levels and dental health in children with congenital heart disease.

Congenital cardiac disease is one of the most common developmental anomalies in children. Higher caries prevalence and gingivitis compared to healthy children have been shown in children with congenital heart disease which has a significant implication in the medical care of these patients associated with bacteraemia and endocarditis. Sialic acids being terminal sugar components and marker of chronic inflammatory response are found to be present at higher levels in children with poor oral health status. So the present study aimed to evaluate the oral health status and salivary sialic acid levels among the children with congenital heart disease and normal healthy siblings. A total of 71 children with heart diseases aged 6-10 years attending various heart institutes were examined for oral hygiene status, gingival status and dental caries status by using modified WHO oral assessment form. A case-matched control group of 50 children were also examined. Salivary flow rate, pH and sialic acid levels were measured after saliva collection. The results were subjected to Unpaired t test and Pearson's Correlation Coefficient Test. The salivary pH, salivary flow rate, dental caries status, oral hygiene and the gingival status were significantly compromised with a positive correlation with the sialic acid levels in saliva, leading to increased treatment needs in the study group. Therefore the amount of sialic acid in the saliva can be a useful index of the severity of oral disease.