scholarly journals COMPARISON OF TWO LOW DOSE REGIMENS OF SUBARACHNOID BLOCK ANESTHESIA FOR LOWER SEGMENT CAESARIAN SECTION

2020 ◽  
pp. 1-4
Author(s):  
Manoj Kumar Mishra ◽  
Sunny Eapen
Keyword(s):  
Spinal Anesthesia ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Fixed Dose ◽  
Gravid Uterus ◽  
Tertiary Care Centre ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Induced Hypotension ◽  
Perioperative Analgesia

Hypotension and bradycardia due to sympathetic blockade are two commonest complications of spinal anesthesia leading to maternal and neonatal morbidity and mortality. Aorto caval compression due to gravid uterus also contributes to the development of hypotension. Wedge under right buttock to provide 250 sideways tilt is used to prevent aortocaval compression by gravid uterus.Low dose bupivacaine heavy with intrathecal fentanyl is recommended as strategy to prevent spinal anesthesia induced hypotension and related complications. The present study was done in our tertiary care centre to compare the effects of fixed dose of Fentanyl 20μg (0.4ml) administered along with two low doses 1.6 ml(8mg) and 1.8 ml(9mg) of 0.5% hyperbaric bupivacaine (heavy) and assess the adequacy of surgical anaesthesia for caesarean section and hemodynamic changes intra operatively. There was faster onset of sensory blockade, better haemodynamic stability and prolonged postoperative analgesia in patients administered with1.6ml of 0.5% Bupivacaine heavy (8mg) & 20μg Fentanyl (Gp I) compared with patients administered with 1.8ml of 0.5% Bupivacaine heavy (9 mg) & 20μg Fentanyl (Gp II) . Perioperative analgesia was excellent in both the groups. No patient who developed bradycardia or hypotension in Gp I and only 2 patients in Gp II developed hypotension.Post-operative analgesia was for a longer period in Group II as compared to Gp I.

scholarly journals A COMPARISION OF INTRATHECAL HYPERBARIC BUPUVACAINE WITH BUPRENORPHINE AND HYPERBARIC BUPIVACAINE ALONE IN GYNAECOLOGICAL SURGERIES FOR POSTOPERATIVE ANALGESIA

2021 ◽  
Vol 9 (06) ◽  
pp. 773-777
Author(s):  
Archana Jadhav ◽  
◽  
Rashmi Bengali ◽  
Keyword(s):  
Blood Pressure ◽  
Respiratory Rate ◽  
Spinal Anaesthesia ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Duration Of Surgery ◽  
Group B ◽  
Effective Analgesia

This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P<0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.

scholarly journals Neonatal candidiasis: clinical spectrum and epidemiology in a tertiary care centre

2017 ◽  
Vol 4 (2) ◽  
pp. 438
Author(s):  
Bhavana Koppad ◽  
Kulkarni Poornima Prakash
Keyword(s):  
Candida Albicans ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Candida Guilliermondii ◽  
Clinical Spectrum ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Neonatal Candidiasis

Background: Candidial infections are a serious problem in neonatal intensive care units (NICU) which increases the mortality and morbidity in addition to increasing health care costs. Confirming the diagnosis by laboratory tests is difficult and a high index of suspicion is required. The objective of this study was to identify the clinical spectrum and epidemiology of neonatal candidiasis in a tertiary care NICU.Methods: The present study was carried out in the NICU of SDM medical college and hospital, Dharwad. All babies who were admitted to NICU and who had positive blood culture for Candida were included in the study. One year Data (1st December 2015 to 31st November 2016) was collected retrospectively from NICU case records. Statistical test used was chi square test.Results: Total admissions to the NICU during the study period were 2591. Blood cultures were positive in 132 babies. Among these, Candidial sepsis was noted in 39.39% (52) babies. Out of the 52 positive fungal cultures, 15 were Candida albicans, 35 were Candida non albicans and 2 were mixed cultures (Candida albicans and non albicans) showing an increasing incidence of non-albicans Candida infections. Among the non albicans Candida, Candida tropicalis and Candida guilliermondii were the predominant species (11 each) followed by Candida famata (6), Candida krusei (6) and Candida parapsilosis (3). Candidial sepsis was seen to be more common among preterm and low birth weight babies. Usage of antibiotics, Total parenteral nutrition (TPN) and mechanical ventilation were common risk factors noted in our study.Conclusions: Systemic Candidiasis is a disease of modern neonatal intensive care. It deserves urgent attention for its prevention as well as effective treatment in order to minimize neonatal morbidity and mortality.

scholarly journals A comparative clinical study of intrathecal hyperbaric bupivacaine with and without fentanyl for hysterectomy

2020 ◽  
Vol 11 (2) ◽  
pp. 59-63
Author(s):  
Hari Poudel ◽  
Surinder Nath Bawa ◽  
Surendra Mohan Sharma
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Maximum Height ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Spinal anaesthesia has been widely used for lower abdominal surgeries like hysterectomy.Hyperbaric bupivacaine is the most extensively used local anesthetic. Addition of fentanyl can allow the reduction in the dose of bupivacaine, increase the height and duration of sensory blockade, and reduces complications of spinal anesthesia. Aims and Objective: The aim of the study was to examine whether adding fentanyl to hyperbaric bupivacaine would increase the height of sensory blockade, accelerate the onset of sensory blockade and increase the duration of the sensory blockade. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal that included hundred patients who underwent total abdominal hysterectomy. The patients were randomly allocated in two groups; Group I: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus normal saline 0.5 ml. Group II: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus 0.5 ml fentanyl (25 μg). Hemodynamic variables, onset of motor and sensory blockade, duration of sensory and motor blockade and any side effects were observed and recorded. Results: The highest and lowest sensory block in Group I was T-7 and T-9 whereas in Group II was T-5 and T-9 respectively. In group I, the mean onset till maximum height of sensory blockade was 7.04 min whereas in group II it was 5.96 min (P<0.00).There was no significant statistical difference in the incidence of side effects in both the groups. Conclusion: Intrathecal fentanyl with hyperbaric bupivacaine for spinal anesthesia significantly accelerated the onset of sensory blockade and increased its maximum height and duration.

scholarly journals A Randomized Double-Blinded Dose-dependent Study of Metaraminol for Preventing Spinal-Induced Hypotension in Caesarean Delivery

2021 ◽  
Vol 12 ◽  
Author(s):  
Fei Xiao ◽  
Wen-Ping Xu ◽  
Han-Qing Yao ◽  
Jia-Ming Fan ◽  
Xin-Zhong Chen
Keyword(s):  
Clinical Practice ◽  
Effective Dose ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Caesarean Delivery ◽  
Ph Value ◽  
Probit Regression ◽  
Hyperbaric Bupivacaine ◽  
Fixed Rate ◽  
Induced Hypotension

Purpose: Prophylactic infusion of a vasopressor is preferred as a rational choice in clinical practice in Cesarean delivery. Metaraminol is one of most common vasopressors used in obstetric clinical practice. However, the dose-response of metaraminol has not been fully determined and the optimal infusion dose is unknown. Therefore, this study aimed to determine the median effective dose (ED50) and 90% effective dose (ED90) of weight-based fixed-rate metaraminol infusions for preventing spinal-anesthesia-induced hypotension in patients having combined spinal-epidural anesthesia for elective Caesarean delivery.Methods: One hundred and seventeen patients with singleton pregnancies were enrolled and randomly allocated into one of five groups in this study. Patients received prophylactic metaraminol infusion at a fixed rate of 0, 0.25, 1.0, 1.75 or 2.5 μg/kg/min in each group immediately after induction with intrathecal 10 mg of hyperbaric bupivacaine mixed with 5 μg of sufentanil. An effective prophylactic dose was defined as no occurrence of hypotension during the period of spinal introduction and neonatal delivery. Values for ED50 and ED90 of prophylactic infusion of metaraminol were calculated using probit regression. Characteristics of spinal anesthesia and side effects were recorded.Results: The ED50 and ED90 values of weight-based fixed rate of metaraminol infusion were 0.64 (95% CI, 0.04–1.00) μg/kg/min and 2.00 (95% CI, 1.58–2.95) μg/kg/min respectively. The incidence of hypotension decreased with an increased infusion rate of metaraminol in the five groups (test for trend, p &lt; 0.001). The incidence of hypotension was similar between group 0 and 0.25, but significant higher than other groups; the incidence of hypotension was also similar between group 1.0 and 1.75, but higher than group 2.5. The incidence of reactive hypertension was significantly higher in group 2.5 compared to the other groups. Physician interventions were more frequent in group 0, 0.25 and 2.5 than in group 1.0 and 1.75 (adjusted p &lt; 0.001). No difference was found in neonatal outcomes, including Apgar score and pH value of the umbilical artery.Conclusion: In summary, we have compared four different prophylactic weight-based infusion doses of metaraminol for preventing post-spinal hypotension in Cesarean delivery. The ED50 and ED90 values of metaraminol infusion for preventing spinal anesthesia-induced hypotension were 0.64 μg/kg/min and 2.00 μg/kg/min, respectively. This finding may be helpful for guiding clinical practice and further research.

scholarly journals Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

2017 ◽  
Vol 4 (6) ◽  
pp. 1653
Author(s):  
Amitha S. ◽  
Pradeep R.
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Double Blind ◽  
Sensory Blockade ◽  
Exact Test ◽  
Interlocking Nailing ◽  
Group 3

Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia.Methods: The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant.Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups.Conclusions: We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

scholarly journals The Association of Various Placental Lesions with Perinatal Outcome in Preterm Births

2021 ◽  
Vol 8 (5) ◽  
pp. 357-364
Author(s):  
Ashwini Sarode ◽  
Anil R Joshi ◽  
Anjali S Kulkarni
Keyword(s):  
Perinatal Mortality ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Vascular Lesions ◽  
Placental Pathology ◽  
Tertiary Care Centre ◽  
Inflammatory Lesions ◽  
Clinical Records

Objective: Present study was designed to identify various lesions in placenta and investigate their impact on neonatal and perinatal outcome and also to determine the frequency of various inflammatory lesions in placenta. Materials and Methods: Placentae of 60 singleton nonanomalous preterm births were examined at Department of pathology at Tertiary care centre. Complete placental examination including both macroscopic and microscopic examination with the help of Haematoxylin and Eosin staining done. Thereafter placental lesions were classified according to Redline criteria for classification of placental pathology. Thereafter placental lesions were correlated with perinatal mortality and neonatal morbidity in early neonatal period. The relevant clinical details were collected from the obstetric clinical records and neonatal clinical records. Result: We found placental vascular processes as most frequent (73.33%) pathological lesion in our study. Most common inflammatory lesion in our study was chorioamnionitis (15%). Also among placentae of stillbirths, placental vascular lesions were predominant finding present in 85.7% of placentae of stillbirths. Other lesions found in placentae of stillbirths were Immune inflammatory lesions, maternal floor infarction and placenta accreta. Out of total placentae with vasculopathy, 19.2% cases developed neonatal sepsis, in chorioamnionitis group 66.6% live births were having sepsis. In present study we observed higher frequency of resuscitation in babies with placentae having chorioamnionitis. Discussion: This study revealed that the placental pathological findings appear to be correlated with perinatal mortality and early neonatal morbidity. So, examination of the preterm placentae gains importance in early determination of morbidity in infants. Placental findings can help neonatologist in routine diagnosis and management. Keywords: Placenta, Placental pathology, Preterm births, Perinatal outcome.

scholarly journals Prevalence of congenital anomalies in a tertiary care centre in North Kerala, India

2018 ◽  
Vol 7 (3) ◽  
pp. 864
Author(s):  
Jayasree S. ◽  
Smitha D'Couth
Keyword(s):  
Congenital Anomalies ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Maternal Diabetes ◽  
Ambiguous Genitalia ◽  
Structural Defects ◽  
Tertiary Care Centre ◽  
Common System ◽  
Number Of Children ◽  
Icd 10

Background: Congenital anomalies have emerged as an important cause for neonatal morbidity and mortality. The prevalence as well as pattern of anomaly varies from place to place. Literature search reveals that India has the highest number of children with birth defects.Methods: This is a cohort study conducted in the Department of Obstetrics and Gynecology during the period 2009-2015. All mothers admitted with congenital structural defects to the fetus diagnosed by imaging and those who delivered anomalous babies were included in this study. The anomalies were classified based on ICD-10 system.Results: There were a total of 911 anomalous babies born during the study period of which 554 were males and 338 were females.19 babies had ambiguous genitalia. Anomalies were more common in multigravidae and in mothers of age group 20-29 years. Maximum number of babies were born between 37-40weeks. Maternal diabetes was associated with increased incidence of anomalies. Most common system involved was urinary system followed by musculoskeletal system.Conclusions: The prevalence of structural anomalies in the present study is 0.84%. Patients with risk factors for anomalies should undergo pre-pregnancy counselling. Routine antenatal anomaly screening with ultrasound before viability should be done for all patients so that early termination of lethal anomalies can be done.

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