BackgroundSubarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study.Patients and methodsThe study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting.ResultsAmong Group I, prevalence of hypotension, bradycardia, and hypotension together with bradycardia was 152 (41.83%) patients, eight (2.20%) patients, and seven (1.92%) patients, respectively. In Group II, the prevalence of hypotension, bradycardia, and hypotension with bradycardia was 93 (50.5%) patients, five (2.71%) patients, and six (3.2%) patients, respectively. The difference between the two groups was statistically significant for hypotension. For Group I, 152 patients (41.87%) experienced one, 23 patients (6.33%) experienced two, and three patients (0.82%) experienced three episodes of hypotension. In Group II, 93 (50.5%), 19 (7.89%), and two (1.08%) patients experienced such episodes. The difference was significant with respect of one and two episodes. The prevalence of intraoperative nausea was 11.01% (40 patients) in Group I, whereas 11.41% (21 patients) in Group II. Intraoperative vomiting occurred in 19 patients (5.23%) of Group I and 14 patients (7.60%) of Group II. The height of the block was comparable in both the groups for T6, and the difference was significant in respect to T4 level.ConclusionIncidence of hypotension is more in pregnant females with breech fetal presentation.
BACKGROUND Electroconvulsive Therapy is associated with hyperdynamic response which can lead to cardiac dysrhythmias, myocardial ischemia or infarction. Dexmedetomidine is alpha-2 agonist with anxiolytic, sedative, sympatholytic and analgesic effects which can attenuate the hyperdynamic response and also reduce post ictal agitation in patients. Ketamine is considered in ECT for preserving cognitive function and antidepressant effects. Side effects of ketamine like hallucinations and hyperdynamic response are relieved by combining propofol which is associated with faster emergence and better psychomotor recovery. METHODS 100 patients were randomly allocated into 2 groups of 46 each. Group A-dexmedetomidine (0.5 µg/kg) infusion premedication with ketamine-propofol (10 mg/kg each, 1:1 combination); Group B-normal saline infusion prior to ketamine-propofol (10 mg/kg each 1:1). Patients undergo ECT using ketamine-propofol according to randomly allocated groups and pre and post ECT agitation and depression scores were calculated and compared. RESULTS Out of 92 cases done, (group A-46, group B-46), best results regarding hemodynamic stability and recovery parameters were achieved in Group A without any significant side effects. CONCLUSIONS Ketofol-dexmedetomidine combination for ECT is associated with a longer mean seizure time, effective antidepressive effect following 1 st session, lower incidence of agitation, more patient satisfaction, and acceptable decrease in heart rate and blood pressure when compared to ketofol and without any significant side effects. HOW TO CITE THIS ARTICLE: Kumar R, Sethi C, Saxena P, et al. Randomized control trial to evaluate the role of dexmedetomidine premedication & ketamine-propofol combination for attenuation of post ECT depression and agitation.
The human body is an amalgamation of many fundamental units put together. Amongst these hands have got a very distinct and important role. Injuries, diseases, and surgical interference therefore do much more harm than interfere with grip, touch, it expresses the personality itself. In disabilities of the Hands, the finest surgery and after care is more essential than in any other region of the body. JOSHI'S EXTERNAL STABILIZING SYSTEM, (JESS), provides a stable skeletal environment aiding rapid healing of soft tissue with establishment of microvascular circulation, immediate active and passive mobilization of the uninjured adjacent joints. It allows management and care of soft tissue injuries without disturbing the fracture site in compound injuries, which is not possible using other methods. AIMS AND OBJECTIVES: Evaluation of the role of Dr Joshi's external fixator in management of complex and compound mutilating injuries of hands and forearm. MATERIALS & METHODS: 40 cases of injuries of hand and forearm attending Orthopaedic OPD and Emergency Department of Orthopedics, M.L.B. Medical College, Jhansi between feb 2010 to feb 2012 were treated by Joshi's external stabilizing system. The patients were followed at regular interval and the results were evaluated clinically and radiographically. CRITERIA FOR SELECTION OF PATIENTS: All the patients of open/closed fractures of metacarpals and phalanges of hand irrespective of age and sex willing to undergo this procedure were selected with permission of ethical committee of medical college. PREOPERATIVE ASSESSMENT OF HAND: Done with 1. History 2. Routine investigations Results will be evaluated on the criteria's laid down:
Introduction: Patient undergoing caesarean section suffer significant postoperative pain. Transversus Abdominis Plane Block is an effective method of providing postoperative analgesia in patient undergoing lower segment caesarean section. We evaluated the efficacy of (0.25%) Bupivacaine and (0.5%) Ropivacaine for providing effective postoperative analgesia using TAPB in lower segment caesarean section. Material and Methods: Randomized controlled double blinded study was carried out in 90 female patients belonging to ASA grade 1 or 2, aged 20-35 years undergoing lower segment caesarean section. Patients were randomly allocated in two groups of 45 each (n=45). After all aseptic precautions patients were administered subarachnoid block bupivacaine heavy (0.5%) , 10mg, by 25G Whitacre spinal needle. After completion of surgery , they received TAP block with Group 1-0.5% ropivacaine (1.5mg/kg) Group 2-0.25% bupivacaine (1mg/kg) Patients were monitored for Visual Analogue scale (VAS) ,heart rate, blood pressure, SpO 2 , nausea ,vomiting, need of supplemental analgesia with in 24 hours. Results: After LSCS the Transversus Abdominis Plane Block with 0.5% ropivacaine reduced postoperative Visual Analog Scale pain scores compared to 0.25% Bupivacaine. Conclusion: 0.5% Ropivacaine provide better and long duration of analgesia as compared with 0.25% Bupivacaine and also decrease first 24 hours analgesic requirement postoperatively.
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