Abstract: Background and Aim: Comparison of the efficacy of epidural labour analgesia and programmed labour analgesia in controlling labour pain. Objectives: Primary objectives are VAS score, vitals and any untoward effects. Effect on ambulation, APGAR score and incidence of intervention as secondary objectives. Methods: A total of 80 parturients in active labour were allocated into two equal groups by using random allocation software.Group (G1) was given epidural injection of 15 ml of ropivacaine 0.2% with 2mcg/ml fentanyl. Top up was given with same dose regimen in graded manner.Group (G2) was given programmed labour analgesia with Inj. Pentazocine 6mg IV+Inj. Diazepam 2mg IV+Inj. Tramadol 1mg/kg deep i.m and thereafter Inj. Drotaverine 40mg IV half hourly (maximum of 3 doses). Inj. Ketamine 0.25-0.5 mg/kg IV was given as resque analgesia. Quality of pain relief was assessed with VAS score. Results: Labour analgesia was better in epidural group (G1) with VAS decreased significantly at 5 min (p <.00001). It was<3 till end of delivery in group (G1).In Group (G2) VAS was mostly>3 and they required resque analgesia with ketamine. There were no significant changes in hemodynamics. Side effects were mild without needing any intervention.There was no effect on ambulation in group (G1). Local anaesthetics were needed for episiotomy in all cases in group (G2). No adverse effects were seen on neonate in either group. Conclusion: Epidural labour analgesia with 0.2% ropivacaine plus fentanyl 2mcg/ml is better for labour analgesia in terms of VAS score, safety profile and side effects. There was no increase in duration of labour with epidural labour analgesia.
Abstract: Coronavirus disease 2019 (COVID-19) is primarily a respiratory tract disease but involves other organ systems too, especially gastrointestinal system. Acute pancreatitis is one of the manifestations of COVID-19, as pancreatic gland also expresses the angiotensin-converting enzyme 2 receptors. We present two cases, where none of them presented with symptoms of pancreatitis on admission. Our first patient presented with severe acute respiratory distress syndrome secondary to COVID-19 and during her stay necrotizing pancreatitis was incidentally detected on CT scan. Our second patient presented as an acute fatty liver of pregnancy and was incidentally found to be COVID-19 positive and later developed symptoms of acute pancreatitis.
Comparison of Quality of Labor Analgesia by NPRS Score Upon Single Dose Intrathecal Labor Analgesia Between Bupivacaine With Adjuvants (Fentanyl And Dexmedetomidine) And Bupivacaine With Adjuvants (Fentanyl And Morphine): A Randomized Comparative Double Blind Study
Dr. Gian Chauhan, Dr. Kartik Syal, Dr. Rajeev Sood, Dr. Geetika Gupta Syal, Dr. Sanjay Rathod, Dr. Rajeev Bansal, Dr. Manoj Maitan, Dr. AnshitAbhi Pathania, Dr. Anu Shree Bansal, Dr. Madhav Verma , D
EAS J Anesthesiol Crit Care, 2020; 2(5):160-164
Background: Intrathecal analgesics using (ITA) local anesthetics and adjuvants like narcotics are safe and effective alternative to epidural anesthesia. The objective of the study is toassess and compare quality of labor analgesia through NPRS Score upon single dose ITA between bupivacaine with adjuvants (fentanyl and dexmedetomidine) and bupivacaine with adjuvants (fentanyl and morphine).Material & Methods: The present study was a prospective, randomized and double blinded controlled study.120 parturients allocated into two equal groups (G-D& G-M) of 60 patients using block Randomization Technique. Group G-D received Bupivaciane, Fentanyl &Dexmedetomedine while G-Mreceived Bupivaciane, Fentanyl & Morphine. Quality of analgesia was assessed through NPRS Scale and and analyzed using Epi Info V7.Results:. Difference in mean NPRS score between both Group(G-D) and Group(G-M)was found to be non- significant at baseline as well as at various time interval till 5 hours. At 0 minutesi.e.the mean NPRS was comparable (p>.05) in both the groups, (8.65±0.48 inGroup(G-M)and 8.58±0.49 inGroup(G-D)respectively).After 3 minutes Itdecreased to 3.03±0.18 in Group(G-M)and 3.10 ± 0.35 minutes inGroup(G-D)respectively,however itremained less than 5 (3.05±0.229 inGroup(G-M)and 3.12±0.331 inGroup(G-D) respectively till 4 hoursof intrathecal injection. Further itincreased to 4.75±0.50 inGroup(G-M)and 5.00 ± 0.00 inGroup(G-D)respectivelybut the mean NPRS was comparable (p>.05) in both the groups. Conclusion: we found that intrathecallabour analgesia is an effective and safe mode of analgesia. The mean NPRS score remained less than 5 in both the groups till 4.5 hours and was comparable throughout.
Background: Fluctuations in glucose levels and prolonged hyperglycaemia is associated with poor outcomes concerning morbidity and mortality in cardiac surgery patients. Paediatric patients are more susceptible to adverse effects of hyperoxaemia during cardiopulmonary bypass (CPB) on glucose homeostasis. In this study, we tried to find out changes in blood glucose and the Insulin requirements intraoperatively in paediatric patients undergoing cardiac surgery requiring CPB. This is a prospective, single-centre study performed among 130 paediatric patients of either sex in the age group below 12 years with congenital heart disease scheduled for cardiac surgery requiring CPB. The parametric data were analyzed by paired t-test for intragroup comparison and unpaired t-test for intergroup comparisons. Differences were significant when the probability was less than 0.05 (p-value). Chi-square test was used for inferential data analysis. Blood glucose was meticulously monitored at various points of time as at baseline, after 10 min, then every half-hourly during bypass, 30 minutes after bypass, and after 10 min at intensive care unit (ICU). To control blood glucose on CPB inj. Insulin was used as per study protocol. Group I (n= 97) patients required insulin due to hyperglycaemia on CPB while Group II (n=33) no insulin was required on CPB. 74% of paediatric patients required insulin on cardiopulmonary bypass out of the 43% required insulin 30 min after starting CPB. There is significant blood glucose rise in children of congenital cardiac disease after induction of anaesthesia, and on CPB. The duration of CPB might not significantly affect the insulin requirement of patients. CPB significantly affected glucose homeostasis in children. Hence it seems prudent to administer a small amount of intravenous dextrose in the pre-bypass period to avoid hypoglycaemia. The insulin administration rate and dose should be adjusted on CPB as per patient requirements
Tuberculosis is a common problem in developing countries and provides a number of challenges for the anaesthetist. Patients may present in a variety of ways. Constitutional and pulmonary symptoms are the most common. These may impact on fitness for surgery and choice of anaesthesia. Tuberculosis treatment has the potential for a number of significant drug interactions. These are primarily mediated through induction of the cytochrome P450 enzyme system by rifampicin. Guidelines for the prevention of tuberculosis in the theatre environment need to be followed to avoid placing staff and other patients in danger.
Nutrition is modifiable factor highly associated with COVID-19 severe illness and deaths. So many people falling ill due to corona virus unhealthy food habits contributes to preexisting health conditions. Diets are crucial to the health status of people around the world. People with pre-existing, diet-related conditions such as obesity, heart disease, and diabetes, are suffering more serious consequences from COVID-19, including more severe illness and a greater need for intensive health care, such as respirators. Malnutrition also severely weakens people’s immune systems, increasing people’s chances of getting ill, staying ill, and dying because of illness. One should follow safe food handling practices.
One of the primary aims of anaesthesia is to render adequate pain relief, thereby permitting the performance of surgical procedures without stress and discomfort. General anaesthesia does not abolish the stress response completely. The local anaesthetics when used intrathecal or epidural, abolishes the response to a great extent, particularly in lower abdominal operations. The present study designed to compare the clinical efficacy of hyperbaric solution of Ropivacaine (0.5%) with that of hyperbaric Bupivacaine (0.5%) in spinal anaesthesia.The aims and objectives of this study were to study the characteristics of spinal blockade in terms of sensory and motor blockade (onset, extent, regression and duration), hemodynamic stability, the recovery profile and side effects of both the drugs if any. In present randomized double blind prospective comparative study, after approval of ethical committee, 100 patients of either sex, ASA grade I and II, aged 20 – 60 years scheduled for different surgical procedures on abdomen, genitourinary region and lower extremity were included in this study. The sample size was determined by power analysis. The patients were randomly allocated into two groups. Pre-anaesthetic evaluation was done one day prior to surgery and all necessary investigations done. An informed consent was taken. Group R - Received inj. Ropivacaine 3 ml of 0.5% hyperbaric (in glucose 8.3%) solution. Group B - Received injection Bupivacaine 3 ml of 0.5% hyperbaric (glucose 8%) solution. Following observations were made - Time of onset of sensory block, maximum cephalic spread (dermatome), time to maximum cephalic spread, two segment regression time (min) and total duration of sensory block. Degree of motor block was assessed by Bromage scale. Intraoperatively, pulse rate, systolic and diastolic blood pressure, respiratory rate and SPO2 monitored at induction, 2, 5, 10, 15, 20, 25, 30, 45, 60 min with help of multipara monitor. In this study, for quantitative data o