Devyani Desai

Abstract

Covid-19 disease created a havoc since 2019, affected large number of number of people over worldwide. As the second wave is receding, we will be receiving patients with the long-term effects of Covid-19 for the surgeries either for their primary disease or for the complications arising from the Covid-19. Primarily, the Covid-19 is a disease affecting the pulmonary and cardiac system, many other systems including renal, hematology, central nervous, endocrine etc. also damaged with the same. Various endocrine glands are being involved in Covid-19 disease like pancreas, thyroid, pituitary, adrenals, reproductive system etc. as they are highly expressed with ACE. This may even lead to the permanent damage. Because of the unfamiliarity with the disease, plausible impact on the endocrine functions is still unclear. This article elaborates various endocrine manifestations of SARS Cov and SARS Cov-2 for better understanding and management of Covid-19 recovered patients.   Keywords: SARS Cov, SARS Cov­2, Covid­19, Endocrinopathies.

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Introduction: Currently phenylephrine is a preferred 1 line vasopressor for maintenance of blood pressure during spinal anaesthesia, may be associated with reflex bradycardia and decreased cardiac output, posing risk to mother or foetus. Norepinephrine may be an useful alternative as being potent alpha with weak beta adrenergic agonist activity. Aims: This study compared the effectiveness of prophylactic and treatment boluses of norepinephrine and phenylephrine to maintain systolic blood pressure at or above 80% of baseline value during spinal anesthesia for cesarean delivery with the primary aim to compare cardiac output. Secondary aims were total doses of study drug required, neonatal outcome and perioperative complications. Materials and Methods: Total 100, term pregnant women with ASA status II undergoing caesarean delivery under spinal anaesthesia were enrolled in this prospective, double blind controlled study. Patients were randomized to receive prophylactic bolus dose of norepinephrine (6 µg) or phenylephrine (100 µg) immediately after spinal anaesthesia. Systolic blood pressure, cardiac output and heart rate were monitored. Intermittent bolus doses were repeated whenever required. Student ‘t’ test and chi square test were used for analysing the data. Results: Both the drugs were able to maintain the systolic blood pressure ? 80% of baseline (p=0.356). Significant difference observed in cardiac output while comparing both the groups from 3 to 15 minutes after spinal anesthesia (p=0.014). The incidence of bradycardia was lower in norepinephrine group as compared to phenylephrine group (P=0.018). Conclusion: Norepinephrine is as effective as phenylephrine for maintenance of blood pressure after spinal anaesthesia for caesarean delivery with stable heart rate and cardiac output.   Keywords: Caesarean delivery, Norepinephrine, Phenylephrine, Spinal anaesthesia, Vasopressor.

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Introduction: P-LMA has proved its superior ability to be used reliably with or without positive pressure ventilation. The new Air-Q ILA is relatively a new supraglottic device, easy to insert because of pre-shaped curve. Materials and Methods: 80 patients undergoing short elective surgeries under general anaesthesia were randomly allocated to group A (Air Q) or group P (PLMA).  General anaesthesia was given with standard dose of Propofol and supraglottic airway devices were inserted according to groups. Lungs were ventilated with control mode of mechanical ventilation.  Parameters observed were effective airway time, ease and attempt of device insertion, airway seal pressure, ventilatory parameters, fibreoptic evaluation of vocal cords, vitals and perioperative complications. Statistical analysis was done with Medcalc software using ‘Z’ test and Chi square test. Results: The mean airway seal pressure of Air- Q was lower (23.95±1.709 cm of H?O) as compared to P-LMA (25.53±2.07 cm of H?O) which was statistically highly significant (p=0.0004). The fibreoptic evaluation of vocal cords revealed grade I/II/III view in 37/2/1 cases of Air-Q and in 1/30/9 cases of P-LMA (p=0.0001). Conclusion:  The newer supraglottic device Air-Q is easy to insert and has an acceptable airway sealing pressure, hence can be used for controlled ventilation for short duration surgeries. Keywords: Air-Q ILA, P-LMA, Controlled ventilation, Elective surgeries.

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Background and Aims: Conventional technique of supraclavicular block is associated with direct injury to the vessels, nerves and pleura, which can be minimized with lateral approach. Here, we compared lateral with conventional approach supraclavicular block given for forearm surgeries. Materials and Methods: After getting approval from ethical scientific committee, SSG hospital, Vadodara, this randomized prospective single blinded study was conducted from October 2014 to October 2015. 60 patients of either gender between 18 to 60 years, of ASA grade I and II undergoing forearm surgeries were enrolled. Those who refused, having anatomical distortion or infection of local site and pregnant patients were excluded. After doing randomization by computer method, Group C (n=30) received conventional and Group L (n= 30) received lateral approach supraclavicular block using nerve locator and total 35 ml of Inj. Lignocaine with adrenaline (1:200000)7mg/kg, Inj. Bupivacaine 2 mg/kg with Inj. Sterile water was injected. Patients were evaluated for technical difficulty, characteristics of sensory and motor blockade, duration of postoperative analgesia and complications. Results: Statistical analysis was done using student ‘t’ test with Medcalc software. P Conclusion: Lateral approach of supraclavicular block is a safe alternative to conventional approach.  Keywords: Supraclavicular block, Forearm orthopaedic surgeries.

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