Dexmedetomidine is a highly selective α-2 agonist, which when used in recommended dose in the form of an infusion, has several desirable properties like sedation, anxiolysis, sympatholysis, analgesia, decreased anesthetic requirements, maintains cardiovascular stability and provides a smooth recovery. Anesthesiologists have used this drug with great reluctance in parturients due to possible uteroplacental transfer, thereby, causing undesirable effects in the baby. However, literature shows that as dexmedetomidine has a high placental extraction, it doesn't ge transferred to the baby. We tried to review the available literature so as to find in what circumstances it has been used in parturients and in future what are the possible indications of its use in labor analgesia, cesarean section, and non-obstetric surgeries.

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Background: Spinal anesthesia is the technique of choice in cesarean sections, but it is not widely accepted in severe pre-eclampsia due to fear of sudden and extensive sympathetic blockade. The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), phenyl ephrine requirement, and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Materials and Methods: A total of 30 healthy (group 1) and 30 severe pre-eclamptic (BP > 160/110 mmHg) parturients (group 2) above 18 years of age, meeting inclusion criteria undergoing elective cesarean section, were included in the study. After preloading with 10 ml/kg of ringer lactate solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine. Also, SBP, DBP, MAP, and HR were recorded before spinal anesthesia and then at every 2-min interval after spinal block for the first 30 min and thereafter every 5 min until completion of surgery. Phenylephrine was administered in 50 μg bolus dose when MAP decreased below 30% of base line. Apgar score was noted 1 and 5 min after birth. Results: The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1 ± 70) was significantly greater (P < 0.0001) than that of pre-eclamptic group (48.3 ± 35). Apgar scores at 1 and 5 min after birth were comparable in both the groups. Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores.

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Background: Minimum effective concentration of local anesthetics for providing optimal labor epidural analgesia and the strategies aiming to reduce their consumption are continuously being searched. Objectives: The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine both mixed with fentanyl 2 mcg/ml for epidural labor analgesia. Materials and Methods: A total of 80 parturients in active labor were randomly assigned to two groups of 40 each, to receive an epidural injection of 15 ml ropivacaine 0.125% with fentanyl (2 mcg/ml) in group R1 and 15 ml of ropivacaine 0.2% with fentanyl (2 mcg/ml) in group R2 as initial bolus dose. Same dose regimen was used as subsequent top-up dose on patients demand for pain relief. The duration and quality of analgesia, motor block, top-up doses required consumption of ropivacaine and fentanyl and feto-maternal outcome in both groups were compared. Results: Effective labor analgesia with no motor blockade was observed in both groups with no failure rate. Onset of analgesia was significantly faster in group R2 (75% parturients in 0-5 min) as compared to group R1 (25% parturients in 0-5 min), P < 0.001. Duration of analgesia after initial bolus dose was also significantly longer in group R2 (132 ± 56.81 min) than in group R1 (72.25 ± 40.26 min), P < 0.001. Mean VAS scores were significantly less in group R2 than in group R1 at 5, 60, and 90 min, P < 0.01. Requirement of top-up doses was significantly less in group R2 (0.05 ± 0.22) as compared to group R1 (0.80 ± 0.65), P < 0.001. Consumption of ropivacaine was comparable in both the groups (33.75 ± 12.16 mg in group R1 and 31.50 ± 6.62 mg in group R2 P > 0.05), but consumption of fentanyl was significantly more in group R1 (54.00 ± 19.45) as compared to group R2 (31.50 ± 6.62), P < 0.001. There were no significant changes in hemodynamics, nor adverse effects related to neonatal or maternal outcomes in both groups. Conclusion: We conclude that both the concentrations of ropivacaine (0.2% and 0.125%) with fentanyl are effective in producing epidural labor analgesia. However, 0.2% concentration was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids.

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Background: Hypotension during subarachnoid block for caesarean section (CS) is the most common and potentially dangerous complication. Bupivacaine has been implicated for this effect in a dose dependent manner. Hypotension can be prevented by using lower doses of bupivacaine with intrathecal midazolam as an adjuvant drug, though the optimum dose-ratio of bupivacaine with midazolam remains unaddressed. Materials and Methods: A prospective, randomized, double-blind study was conducted enrolling 120 consecutive ASA grade I obstetric patients undergoing elective CS in a tertiary care hospital. A baseline supine position noninvasive blood pressure (BP) was recorded. All patients were preloaded with 500 ml of lactated Ringers' solution. Varying doses of 0.5% hyperbaric bupivacaine were used (7.5mg in group II, 6mg in group III and 5mg in group IV), in combination with 2mg midazolam in each group. Appropriately matched controls were given 11mg bupivacaine alone (Group I). Intra-operatively, BP was measured at every 2 minutes till 30 minutes and every 10 minutes thereafter. Hypotensive episodes [Systolic BP (SBP) < 100 mmHg] were recorded in each group. Quality of surgical anesthesia was graded as "excellent", "good" and "poor" as per the validated scoring system. The outcomes in different groups were compared by one-way ANOVA . intra group comparisons were done with t test Results: All the four groups had 30 patients each. The incidence of hypotension was significantly lower in the groups using low-dose bupivacaine and midazolam, with a lesser fall in SBP than group I. Onset of sensory and motor blocks, and quality of surgical anesthesia were unaffected in group II while significant deterioration was noticed in groups III and IV. Conclusion: We found that 7.5 mg bupivacaine with 2 mg midazolam is the optimum dose ratio combination to be used in subarachnoid block for caesarean section.

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Acute abdomen following an uneventful vaginal delivery is a rare occurrence. Diagnosis may be delayed due to pregnancy related comorbid conditions such as preeclampsia, hemolysis elevated, liver enzymes, low platelet (HELLP) count syndrome, acute fatty liver of pregnancy (AFLP), etc. We describe a 21-year-old woman with pre-eclampsia, HELLP syndrome and AFLP with acute abdomen that was managed successfully in our intensive care unit.

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Perimortem cesarean section is being recommended in pregnant women beyond 20-week gestation who are in extremis or cardiac arrest and in whom resuscitation appears to be failing. Aortocaval compression is removed by the delivery that promotes cardiac output in response to chest compressions. Feto-maternal outcome is thought to improve if the delivery is accomplished within 5 min of arrest. We describe the use of a public call announcement to minimize the time to delivery by bringing together a multidisciplinary team with the required equipment to the patients location and are able to perform a timely perimortem cesarean delivery if required, potentially improving the survival.

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The article presents a case of successful spontaneous vaginal delivery with the use of epidural analgesia in a patient with orthotopic liver transplant. The importance of the multidisciplinary approach is highlighted in management of such cases.

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Factor XI deficiency is a rare coagulation disorder associated with bleeding tendency and prolonged APTT. Parturients can have increased bleeding during vaginal delivery or cesarean section. Patients with severe factor XI deficiency should receive prophylactic fresh frozen plasma or factor XI transfusion in the peripartum period to maintain a near normal APTT. Limited evidence based on case reports and series is inconclusive as to the choice of anesthesia technique for cesarean section. We describe the anesthesia management of a parturient with severe factor XI deficiency for cesarean section and discuss the relevant literature.

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Electrocautery has become an indispensable tool in the operating room mainly, to achieve a bloodless surgical field. At the same time, the use of alcohol-based antiseptics, like spirit, is commonly used these days for skin preparation before surgery. However, it does carry several risks including fire burns, with the use of electrocautery in a field smeared with spirit. Here, we report a case of pregnant patient undergoing elective cesarean-section under spinal anesthesia who suffered 17% second degree-superficial partial thickness burns due to electrocautery where spirit was used for skin preparation resulting in circulatory shock managed by inducing general anesthesia. Perioperative management was uncomplicated and both mother and newborn were discharged without any untoward problem. This report highlights general safety issues relating to the risk of fire in all surgical patients and the preventive measures for such injury.

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The incidence of failed intubation in the pregnant population is 1 in 250-300 patients, which is 8 times higher than non-pregnant patients. Regional anesthesia is the technique of choice in a parturient with recognized potentially difficult airway for cesarean section; however, it may be controversial in the presence of anticipated intraoperative hemodynamic instability. We describe anesthetic management of 23-year-old female, gravida 2, para 1 admitted in the labor ward with central placenta previa and severe post burn contracture of neck for elective cesarean delivery.

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The advancements in medicine have made early detection and management of medical diseases possible especially during the pregnancy. The physiologic alterations of pregnancy have important implications for renal structure and functions, which may possibly lead to diagnostic dilemmas and wrong interpretation of various investigations carried out during the gestational period. Renal diseases are extremely challenging to treat during pregnancy as various drugs can have adverse effect on the pregnancy outcome. In general, these patients may either progress to normal delivery or may have to undergo surgical delivery under anesthesia. Apart from these anticipated challenges, many other renal problems can develop during the pregnancy in patients with normal renal functions such as urinary tract infections, acute kidney injury or renal trauma. Planning of pregnancy in renal diseases is also associated with increased potential risks especially in patients on dialysis as well as in patients who had undergone renal transplantation.

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