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Journal of Obstrectic Anaesthesia and Critical Care
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   2012| July-December  | Volume 2 | Issue 2  
    Online since December 17, 2012

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Comparison between phenylephrine and ephedrine in preventing hypotension during spinal anesthesia for cesarean section
Iqra Nazir, Mubasher A Bhat, Syed Qazi, Velayat N Buchh, Showkat A Gurcoo
July-December 2012, 2(2):92-97
Background: Maternal hemodynamic changes are common during spinal anesthesia for cesarean delivery. Many agents are used for treating hypotension. In this study we compared the efficacy of ephedrine and phenylephrine in preventing and treating hypotension in spinal anesthesia for cesarean section and their effect on fetal outcome. Materials and Methods: A total of 100 ASA Grade I patients undergoing elective cesarean section under spinal anesthesia with a normal singleton pregnancy beyond 36 weeks gestation were randomly allocated into two groups of 50 each. Group I received prophylactic bolus dose of ephedrine 10 mg IV at the time of intrathecal block with rescue boluses of 5 mg. Group II received prophylactic bolus dose of phenylephrine 100 μg IV at the time of intrathecal block with rescue boluses of 50 μg. Hemodynamic variables like blood pressure and heart rate was recorded every 2 minutes up to delivery of baby and then after every 5 minutes. Neonatal outcome was assessed using Apgar score at 1 and 5 minutes and neonatal umbilical cord blood pH values. Results: There was no difference found in managing hypotension between two groups. Incidence of bradycardia was higher in phenylephrine group. The differences in umbilical cord pH, Apgar score, and birth weight between two groups were found statistically insignificant. Conclusion: Phenylephrine and ephedrine are equally efficient in managing hypotension during spinal anesthesia for elective cesarean delivery. There was no difference between two vasopressors in the incidence of true fetal acidosis. Neonatal outcome remains equally good in both the groups.
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Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block
Samina Ismail
July-December 2012, 2(2):67-68
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Ipsilateral Horner's syndrome associated with epidural anaesthesia in a emergency cesarean section
Gaurav Chauhan, Pavan Nayar, Chandni Kashyap
July-December 2012, 2(2):112-113
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The analgesic efficacy of ultrasound-guided modified rectus sheath block compared with wound infiltration in reduction of postoperative morphine consumption in women undergoing open hysterectomy or myomectomy: A randomized controlled trial 14/09/2012 trial
Mukesh Kumar Shah, Sandeep S Kulkarni, Wendy Fun
July-December 2012, 2(2):74-78
Introduction: As ultrasound allows more accurate placement of local anesthetic (LA), ultrasound-guided modified rectus sheath block (MRSB) was compared with wound infiltration (WI) in women having open hysterectomy or myomectomy for fibroids via a Pfannenstiel incision under general anesthesia. Materials and Methods: Forty-two American Society of Anesthesiologists Class ASA I,II and III patients were recruited into two groups in a randomized patient-blinded controlled trial excluding those with coagulopathy, infection, or LA allergy. At the end of surgery, in the study group (Group U), an MRSB, under ultrasound guidance, was administered with 20 ml 0.25% levobupivacaine through a single skin puncture in the midline, 2 cm below the umbilicus, on either side of the midline, above the posterior sheath. In the control group (Group W), WI with 20 ml 0.5% levobupivacaine was done by the surgeon. The primary outcome measure was the amount of morphine consumed in the first 24 h after the surgery in the ward. Statistical analysis was performed with SPSS v.14.0. Results: Morphine consumption in the intraoperative and recovery periods was 10 mg and 0.0 mg, respectively, in both groups. In both the groups, pain measured by visual analog scale correct (VAS) (both at rest and on movement), morphine consumption (12.0 mg [18.0 mg] vs. 12.0 mg [23.0 mg], median interquartile range [IQR], p = 0.950), and the number of oral analgesic doses administered during the study period were comparable. However, number of patients who were "extremely satisfied" compared to "satisfied" with the analgesia were more in the Group U than in Group W (15/6 vs. 4/17, P-0.001). Sedation, nausea and vomiting, and antiemetic doses given were minimal and comparable in both groups. Conclusion: Ultrasound-guided MRSB does not show any significant difference in the 24 h morphine consumption as compared to WI.
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Complex regional pain syndrome and pregnancy
Anjan Trikha, Dalim Kumar Baidya, PM Singh
July-December 2012, 2(2):69-73
Complex regional pain syndrome (CRPS) is a chronic pain condition predominantly affecting females of the reproductive age group. Association of CRPS and pregnancy has been increasingly reported in recent literature. Anesthesiologist and chronic pain physician may be involved in the management of CRPS during pregnancy and for peripartum anesthesia management for vaginal delivery or cesarean section. Any woman suffering from CRPS should be counseled about the limited therapeutic options available during pregnancy. Medical management of CRPS is complicated by risk to breast-fed babies and teratogenicity to fetus. However, interventional management in the form of transcutaneous electrical nerve stimulation and spinal cord stimulation may be used with due precautions. Multidisciplinary involvement of obstetrician, anesthesiologist, pain physician, and neonatologist is important to ensure successful outcome.
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Ondansetron-induced ventricular tachycardia in a patient of caesarian section
Arpita Saxena, Trilok Chand, SK Arya, Rajeev Puri, Apurva Mittal, Vinay Shukla
July-December 2012, 2(2):103-104
We report a rare adverse effect of ondansetron in a 24-year-old female undergoing caesarian section, presenting as ventricular tachycardia and ectopics. Patient was treated with cardioversion and intravenous Amiodarone 150 mg.
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Anesthesia for cesarean section in a parturient with acute varicella: Is general anesthesia better than neuraxial anesthesia?
Bikash R Ray, Deepak Singhal, Anil Kumar, Anuradha Borle, Dalim K Baidya
July-December 2012, 2(2):105-108
The incidence of varicella infection during pregnancy is low. However, it is associated with a significant risk of morbidity and mortality, both to the mother and the fetus. The risk for any complication is highest for the mother during the third trimester and pneumonia is the leading cause of maternal mortality. Anesthetic management in these patients depends upon the extent of involvement of the disease, associated complications of varicella, duration of antiviral therapy and natural course if the disease. We present the anesthetic management of a case of cesarean section in a patient with acute varicella infection, and discuss the various concerns regarding the choice of anesthesia.
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Effect of QTc interval on prediction of hypotension following subarachnoid block in patients undergoing cesarean section: A comparative study
Sampa Dutta Gupta, Suddhadeb Roy, Koel Mitra, Sudeshna Bhar Kundu, Sunanda Maji, Aniruddha Sarkar, Saikat Bhattacharya, Chaitali D Roy, Sreyasi Sen, Mina Basu
July-December 2012, 2(2):79-85
Background: Previous studies have revealed that QTc interval is prolonged in pre-eclamptic parturients. Another study reflected the relationship between the sympathetic block and QTc interval. Subarachnoid block was safely administered in patients with severe pre-eclampsia. It has also been noticed that hypotension in response to spinal anesthesia is relatively less in pre-eclamptic patients than normal parturients. Aim: To compare the QTc values in normal and pre-eclamptic term parturients and to establish whether any correlation exists between the QTc interval and the systemic hypotension following subarachnoid block. Materials and Methods: Twenty-five pre-eclamptic patients (Group A) and 25 normotensive patients (Group B) were included in this study. QTc interval was recorded for each patient before subarachnoid block for cesarean section. Changes in arterial blood pressure and heart rate were measured in both the groups and compared. Results: Baseline QTc was significantly higher in the pre-eclamptic group (Group A: 0.47 ± 0.11) with that of control (Group B: 0.36. ± 0.02). Significant fall in blood pressure was seen only in one group with QTc between 0.38 and 0.39 in Group A. Hypotension was significantly more in normotensive mothers (Group B). However, no statistical correlation could be drawn from this study between QTc interval and hypotension, although a trend toward increasing hypotension with decreasing QTc was present. Discussion : The prolonged QTc intervals seen in pre-eclamptic patients may be due to the contributory effects of sympathetic hyperactivity, hypertension, and hypocalcemia secondary to underlying vasoconstriction. Decreased vagal control of heart in pre-eclampsia may have produced the difference in change in hemodynamic status between pre-eclamptic and normotensive parturient. Conclusion: Any consistent correlation between QTc and hypotension following subarachnoid block could not be derived from this study. To achieve a statistical significance a larger sample size may be required.
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Ultrasound-guided transversus abdominis plane block does not improve analgesia after elective caesarean section when intrathecal diamorphine is used-A randomised double-blind controlled trial
Elizabeth Puddy, Sireesha Aluri, Ian Wrench, Ben Edwards, Fleur Roberts
July-December 2012, 2(2):98-102
Context: Previous studies comparing transversus abdominis plane (TAP) block and opioids for postoperative analgesia for caesarean section under spinal anaesthesia have been performed in the absence of a long-acting intrathecal opioid or with intrathecal morphine. In our unit, we use spinal diamorphine for caesarean sections under spinal anaesthesia. We wished to establish whether the performance of ultrasound-guided TAP blocks should be introduced into routine practice. Materials and Methods: Following local ethics committee approval, 53 parturients presenting for elective caesarean section were recruited. All patients received a spinal anaesthetic with 0.5% heavy bupivacaine and 300 mcg diamorphine. The study was completed by 48 patients who were randomised to undergo postoperative TAP blocks with 20 mL to each side of either 0.25-0.5% bupivacaine (n = 23) or normal saline (n = 25). Standard postoperative analgesia comprised of regular diclofenac and paracetamol, and subcutaneous morphine on request via an indwelling subcutaneous cannula. A blinded investigator assessed each patient at 2, 6, and 24 h postoperatively. Results: There were no statistically significant differences in postoperative morphine requirements or visual analogue pain scores between the two groups. The incidence of side effects was similar. Conclusions: We conclude the ultrasound-guided TAP block does not improve analgesia following elective caesarean section under subarachnoid block with intrathecal diamorphine and its routine implementation during utilisation of a multimodal analgesic regimen may not be beneficial.
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Obstetric Anesthesia and Analgesia- Practical Issues
Anjan Trikha
July-December 2012, 2(2):115-116
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Parturient with double outlet right ventricle without pulmonary stenosis: Perioperative management
Akhil Kant Singh, PM Singh, Shubhangi Arora, Vimi Rewari, Anjan Trikha
July-December 2012, 2(2):109-111
Double outlet right ventricle (DORV) is a rare cardiac condition in which the heart demonstrates single ventricle physiology. The management of these patients depends upon the presence or absence of pulmonary stenosis. They can present as congestive cardia failure on one end and as cyanotic disease on the other extreme. We present a case of DORV without pulmonary stenosis for cesarean section and highlight specific management issues in these patients.
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A rare fatal catastrophe during caesarean section: Amniotic fluid embolism
Nishant Kumar, Suman Saini, Sunny Kumar, Sonia Wadhawan
July-December 2012, 2(2):113-114
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Determination of optimal dose of succinylcholine to facilitate endotracheal intubation in pregnant females undergoing elective cesarean section
Mohd Asim Rasheed, Urmila Palaria, Umesh K Bhadani, Abdul Quadir
July-December 2012, 2(2):86-91
Aims: The study was carried out to find the optimal dose of succinylcholine for pregnant females, undergoing elective cesarean section under general anesthesia, in order to achieve excellent intubation conditions for a successful endotracheal intubation. Materials and Methods: One hundred and twenty pregnant females aged between 20 and 35 years were randomly allocated into 4 groups of 30 patients each. Group I received Inj. succinylcholine 0.5 mg/kg, Group II received 0.6 mg/kg, Group III received 1.0 mg/kg, and Group IV received 1.5 mg/kg intravenously. The response to ulnar nerve stimulation at the wrist was recorded using the peripheral nerve stimulator. Grading of intubation conditions was done 60 s after Inj. succinylcholine administration. Peak effect, peak time, and duration of absent respiratory movement (apnea time) was noted. Statistical Analysis: One-way analysis of variance (ANOVA) with post hoc analysis (Bonferroni test) has been applied to see significance among groups for continuous variables and the Chi-square test was performed for categoric variables. SPSS v 16 was used for statistical analysis for the study. Results: Peak effect achieved was similar with 0.6, 1.0, and 1.5 mg/kg. There was no statistically significant difference (P >0.05) in the time taken to achieve the peak effect (peak time) between 1.0 and 1.5 mg/kg. Apnea time was 242.7 ΁ 7.1 s with 1.0 mg/kg and 377.7 ΁ 28.9 s with 1.5 mg/kg (P < 0.001). Intubating conditions were poor with 0.5 mg/kg, good with 0.6 mg/kg, and excellent with 1.0 and 1.5 mg/kg. Conclusion: The dose of 1.0 mg/kg of succinylcholine produces excellent intubation conditions in pregnant females similar to the conventional dose of 1.5 mg/kg and is associated with a significantly shorter duration of action.
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