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AbstractBackground: The common adverse effects of spinal anaesthesia include hypotension and bradycardia are due to sympathetic nerve blockade and activation of the Bezold-Jarisch reflex. The Bezold-Jarisch reflex in spinal anaesthesia may be mediated by peripheral 5-HT3 type serotonin receptors. We hypothesized that blockade of type 3 serotonin receptors by using intravenous Granisetron might reduce hypotension and bradycardia induced by spinal anaesthesia. Methodology: Sixty American Society of Anesthesiologists Physical Status I and II patients undergoing lower abdominal surgeries were randomized to receive either Normal Saline (control) or Granisetron 40 mcg/kg intravenously five minutes before subarachnoid block. Heart rates, systolic blood pressure, diastolic blood pressure, mean arterial pressure was recorded every two minutes for ten minutes and then every five minutes for another twenty minutes. Hemodynamic parameters were compared with baseline in each group. Results: There was decrease in all measured variables when compared with baseline values in both groups. There was less reduction in diastolic blood pressure in Granisetron group statistically significant at 10, 15, 20, 25 and 30 minutes. However, the less decrease in mean arterial pressure was statistically significant at 30 minutes only. There were no significant differences in systolic blood pressure and heart rate values between the groups. Conclusions: Granisetron given intravenously does not decrease the incidence of hypotension and bradycardia following subarachnoid block in patients undergoing lower abdominal surgery. However, it attenuates the fall of diastolic and mean arterial pressure spinal anaesthesia.
Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management.
Keywords: anaesthetic management; takayasu’s arteritis.
An 18‐month‐old boy weighing 6 kilograms developed complete collapse of left lung following total correction of Tetralogy of Fallot on the next day of extubation. He received extensive chest physiotherapy, along with lung recruitment maneuver by using bubble CPAP, which failed to show any improvement in lung expansion in 2 days. He was then electively intubated on 3rd postoperative day (POD3) for the purpose of suctioning tracheobronchial secretions and maintaining positive airway pressure to open up the left lung. Good results were obtained immediately after intubation, and he was extubated 9 h later. His lung showed complete aeration afterward. He was transferred out of ICU on POD5 and discharged home on POD10.
Background and Aims: Cardiovascular comorbidities are common in patients with COVID-19 and these patients are at higher risk of morbidity and mortality. It is not known if the presence of cardiovascular co-morbid conditions poses independent risk or whether this is mediated by other factors.
Methods: This is a retrospective follow up study done at Shahid Gangalal National Heart Centre (SGNHC). The main objective of this study was to study the clinical profile, baseline comorbidities, and outcome of cardiac patients and health care worker diagnosed with COVID 19. This study retrospectively evaluated case records of all cardiovascular disease (CVD) patients admitted at SGNHC with COVID 19 cases from 1st case diagnosed on July at SGNHC till September 2020.
Results: During this study period, 90 patients with COVID 19 with cardiovascular disease were admitted. The mean age of the study population was 52.3±19 years with 65.6% being male. Among the study population 52 (57.8%) had past history of cardiovascular disease, hypertension in 18 (20%) cases, diabetes in 8 (8.9%) cases. Among the patients with cardiovascular diagnosis, acute coronary syndrome was most common cardiovascular diagnosis in 23 (25.6% cases) followed by rheumatic heart disease in 21 (23.4%) cases, dilated cardiomyopathy in 7 (7.8% cases), ischemic cardiomyopathy with reduced ejection fraction (EF) in 7 (7.8%) cases, post coronary artery bypass graft (CABG) in 8 (8.9%), post valve replacement in 5 (5.5%), congenital heart disease in 3.3% cases and complete heart block in 3.3% cases. Most of the cases were symptomatic with moderate illness in 46.7% cases, mild illness in 41.4% cases and severe/critical illness in 11.1% cases. Among COVID patients with cardiovascular disease, the mortality was 11.1%.
Conclusion: Patients with cardiovascular disease with COVID 19 have more severe COVID 19 symptoms and has higher COVID 19 related death, so strict vigilance and early intervention is needed to improve its outcome.
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