SUMMARY Bupivacaine 0°5% when used as a local anaesthetic for ocular cataract surgery does not give absolute ocular akinesia but provides adequate and prolonged pain relief. In comparison lignocaine provides good ocular akinesia at operation but pain relief is short lived. In the present study the adequacy of analgesia, operating conditions, and complications were compared for three drug regimens under standard operating conditions. The retrobulbar block was performed with either lignocaine or bupivacaine or a mixture of lignocaine and bupivacaine according to a predetermined protocol.The success of any nerve block depends on the operator, who requires a thorough knowledge of the anatomy. Diffusion of drugs is restricted by anatomical boundaries, and correct placement of drugs leads to a smaller dose being necessary. The study was therefore designed for blocks to be performed solely by the operator, so as to use the minimal doses of the various local anaesthetics to give acceptable ocular anaesthesia and akinesia. Material and methodsNinety adult consenting patients were allocated randomly to one of three groups (A, B, and C), 30 patients in each group. Group A had their cataract surgery performed under bupivacaine as the local Correspondence to Rcvd Professor E 0 Oji, FRCS, University of Jos Medical School, Jos, Plateau State, Nigeria.anaesthetic. Group B had their cataract surgery under lignocaine, and in group C a mixture of lignocaine and bupivacaine was administered.Each patient received 75 mg of pethidine intramuscularly one hour preoperatively to provide minimal sedation and analgesia. Thirty minutes before surgery each patient also received topical drops of 0*4% oxybuprocaine to the eye for surgery every 5 to 10 minutes till the operation began.Group A patients received 1-5 ml of 0-5% bupivacaine through a retrobulbar needle, 4-0 ml of 0-5% bupivacaine at the stylomastoid foramen and around the parotid distribution of the facial nerve for the seventh cranial nerve block, band 0-5 ml of 0-5% bupivacaine each to the upper and lower lids for paralysis immediately before surgery.Similarly, group B patients received 1-5 ml of 2% lignocaine retrobulbarly, 4-0 ml of 2% lignocaine for the facial nerve block and 0-5 ml of 2% lignocaine each to the upper and lower lids.For the group C patients a mixture of 0-5% bupivacaine 3-5 ml and 2% lignocaine 3 5 ml was used. The two were thoroughly mixed before the C~H3 -m >~~~NH C t CH3N bupivacaine C H9 ACH3~1
Vasa previa is a rare condition; it occurs in approximately 1:2500 deliveries. Fetal blood vessels, unsupported by placental tissues or umbilical cord, run through the fetal membrane over the internal cervical os below the presenting segment. This article is protected by copyright. All rights reserved.
Aim Intraoperative cell salvage and autotransfusion (ICSA) is a useful technique for women undergoing cesarean sections who are predicted to experience significant bleeding. This method can reduce allogeneic transfusions as well as its associated risks and costs. Amniotic fluid embolism (AFE) is an abnormal maternal response to ICSA similar to the classic systemic inflammatory response syndrome, but its mechanism is not well understood. This study was conducted to investigate the biochemical aspects of AFE. Methods A prospective case–controlled pilot study was conducted in a general perinatal hospital in Japan. ICSA was performed using a two‐step retransfusion process. Blood samples were collected presurgery, immediately postsurgery, and 24 h after surgery. Changes in sialyl Tn antigen (STN), complement C3 and C4, fibrinogen, and fibrin degradation product and D‐dimer, C1 esterase inhibitor, and interleukin‐8 (all considered AFE‐related markers) activities were compared between patients who underwent cesarean sections with ICSA (ICSA group) versus without ICSA (control group). Results Fibrinogen levels were significantly lower in the ICSA group than in the control group before surgery but not immediately after or 24 h after surgery. D‐dimer was significantly higher immediately after surgery but not 24 h later. STN was significantly lower only before surgery. None of the AFE‐related markers showed significant differences between the groups after 24 h. No adverse events were observed in the ICSA group. Conclusions There is no clinical evidence that ICSA alters the biochemical statuses of AFE‐related markers in a manner that could lead to adverse maternal responses.
The applicability of cardiotocography (CTG) to improved fetal outcomes remains controversial. Therefore, this study aimed to determine the clinically optimal duration for CTG assessment using the iPREFACE score to predict fetal acidemia. This single-center, retrospective observational study included 325 normal full-term singleton vaginal deliveries at the Toho University Omori Medical Center, from September 2018 to March 2019. The iPREFACE scores were calculated at 10, 30, and 60 min immediately before delivery, iPREFACE(10), iPREFACE(30), and iPREFACE(60), respectively. The primary outcome was fetal acidemia (umbilical artery blood pH < 7.2). The secondary outcome was the correlation between all iPREFACE and the umbilical cord arterial blood pH, base excess (BE), and lactate values. The area under the curve (AUC)s of the receiver operating characteristic curves were 0.69, 0.85, and 0.79 for iPREFACE(10), iPREFACE(30), and iPREFACE(60), respectively. There was a significant difference between the AUC of iPREFACE(30) and iPREFACE(10), and no significant differences were found between the other arms. All iPREFACE showed significant correlations with umbilical artery blood pH, BE, and lactate. The predictive capacity of the iPREFACE score for fetal acidemia was the highest in iPREFACE(30), suggesting that 30 min immediately before delivery may be useful in clinical practice as the scoring time.
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