Dipakkumar Ruparel

Abstract

Introduction: The most prevalent consequence after a caesarean surgery is post-spinal hypotension. To avoid this, crystalloid or colloid cohydration might be utilized. We aimed to see how crystalloid and colloid coloading affected hemodynamics and neonatal outcome in patients undergoing elective caesarean section, following spinal anesthesia. Materials and Methods: A total of 100 pregnant women were enrolled in this study, which were split into two groups of 50 each. Group A was given 10ml/kg Ringer Lactate (RL) And Group B patients received 10ml/kg 6% hetastarch coloading. Patients were monitored for Mean SBP, DBP, MAP, HR, SPO2, mean APGAR score of newborn at 1 and 5 minutes post delivery, the prevalence of nausea and vomiting as well as Vasopressor requirement. Results:  The incidence of hypotension was higher in the crystalloid group, as was the need for Vasopressor, compared to the colloid group. The crystalloid group had a higher rate of nausea and vomitingIn the colloid group, hemodynamics such as SBP, DBP, MAP, and HR were more stable. However, as demonstrated by the APGAR score of 1 in both groups, there was no difference in neonatal outcome. Conclusion: Colloid coloading is more effective method of preventing post spinal hypotension in patients undergoing caesarean section however combined use of Vasopressor and fluids seems to be more effective way of managing post spinal hypotension.   Keywords : Spinal anesthesia, Colloid, Crystalloid, Hypotension, Cesarean section

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Abstract

Background and Aims: Subarachnoid block (SAB) using Bupivacaine lacks postoperative analgesia. Aim of present study was to assess safety and efficacy of 50 m and 100m intrathecal Neostigmine for postoperative analgesia. Materials and Methods: Ninety patients of age 18 to 65 were allocated randomly to three groups of 30 each and studied prospectively by double blind controlled trial. Patient posted for lower limb and lower abdominal surgeries were given SAB using 3 ml Bupivacaine 0.5% in group A, 2.9 ml Bupivacaine + 50 m Neostigmine in B and 2.8 ml Bupivacaine and 100m Neostigmine in C. Patients were monitored for onset, regression of sensory and motor block, blood pressure and heart rate. Postoperatively patients were assessed for pain score using visual analogue scale (VAS) and duration of analgesia by rescue analgesia requirement. Results: 90 patients enrolled were analysed. VAS pain score was more in group A compared to B which had higher than group C. Analgesia was prolonged in group C than in B which had better analgesia than group A. Incidence of nausea, vomiting and bradycardia was higher with 100m Neostigmine than 50 m. Conclusion: Intrathecal Neostigmine 50 m dose as an adjuvant to Bupivacaine is associated with good postoperative analgesia and hemodynamic stability while 100 m dose was associated with more prolonged analgesia and higher incidence of adverse effects. Keywords: Intrathecal Neostigmine, Postoperative analgesia, VAS pain score 1.

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Abstract

Background: Proseal laryngeal mask airway (PLMA) is being used increasingly apart from its gold standard alternative endotracheal tube (ETT) in airway management during paediatric laparoscopy. Limited data is available on effects of carboperitoneum on hemodynamics and pulmonary mechanics in paediatric patients. We aimed to assess effect of carboperitoneum on hemodynamics and pulmonary mechanics in paediatric patients undergoing video-endoscopic surgeries when PLMA and ETT are used. Materials and Methods: After ethics committee approval and consent, 60 patients aged 1-10 years scheduled for laparoscopic surgeries were included in study and randomly allocated to two groups of 30 each. Airway maintained with PLMA in first group and ETT in group II. Hemodynamic parameters and ventilatory parameters were recorded at different time intervals from prior to insertion of airway device till deflation of carboperitoneum. Results: Statistically significant increased heart rate, systolic, diastolic, mean blood pressure was observed in ETT group as compared to PLMA group during airway insertion and during rest of study period changes were analogous in both groups. Ventilatory parameters saturation, peak inspiratory pressure (PIP), plateau pressure (PP) and ETCO2 were comparable in both groups except during post deflation period where PP, PIP and ETCO2 remained elevated. Conclusion: Proseal-LMA can be equally good option in paediatric laparoscopy with better hemodynamic stability and ventilatory parameters as degree of changes caused by carboperitoneum in PLMA group was insignificant compared to ETT. Keywords: Proseal-LMA, Endotracheal tube, Paediatric laparoscopy, Airway pressure, Carboperitoneum.

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