We investigated the influence of the pressure generated by low lumbar extradural injection of bupivacaine on the development of block in a randomized double-blind study. Thirty patients (aged 17-66 yr) received one of two volumes of 0.75% bupivacaine. Group I (n = 15) received 10 ml (75 mg) and group II (n = 15) 15 ml (112.5 mg). Injection of the larger volume resulted in a greater pressure at the end of injection, but within 1 min this decayed to the same plateau pressure that was produced by the smaller volume. Mean maximum cephalad spread of block was the same in each group (group I, T9.5; group II, T8.4) and there was no correlation between individual level of block and maximum or plateau extradural pressure, or with patient characteristics.

The plasma concentration of hepatic glutathione S-transferase (GST) was measured in matched groups of patients who received halothane, enflurane or isoflurane anaesthesia for elective minor surgery. The GST concentrations increased significantly at 3 h after anaesthesia in patients who received halothane or enflurane, but not in patients who were given isoflurane. A secondary increase in GST concentration, at 24 h, was seen in a small number of individuals who received halothane or enflurane. Abnormal GST concentrations were found in 50% of patients following halothane anaesthesia, 20% following enflurane and 11% after isoflurane. The small but significant increases in GST concentrations in patients receiving halothane or enflurane suggests an impairment of hepatocellular integrity following the administration of these anaesthetics. In contrast, isoflurane anaesthesia did not appear to be associated with this effect.

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Objective: Static monitors for assessing the fluid status during major surgeries and in critically ill patients have been gradually replaced by more accurate dynamic monitors in modern-day anaesthesia practice. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are the two commonly used dynamic indices for assessing fluid responsiveness. Methods: In this prospective observational study, 50 patients undergoing major surgeries were monitored for PPV and SPV: after the induction of anaesthesia and after the administration of 500 mL of isotonic crystalloid bolus. Following the fluid bolus, patients with a cardiac output increase of more than 15% were classified as responders and those with an increase of less than 15% were classified as non-responders. Results: There were no significant differences in the heart rate (HR), mean arterial pressure (MAP), PPV, SVV, central venous pressure (CVP) and cardiac index (CI) between responders and non-responders. Before fluid bolus, the stroke volume was significantly lower in responders (p=0.030). After fluid bolus, MAP was significantly higher in responders but there were no significant changes in HR, CVP, CI, PPV and SVV. In both responders and non-responders, PPV strongly correlated with SVV before and after fluid bolus. Conclusion: Both PPV and SVV are useful to predict cardiac response to fluid loading. In both responders and non-responders, PPV has a greater association with fluid responsiveness than SVV. Keywords: Fluid management, pulse pressure variation, systolic pressure variation, fluid responsiveness Amaç: Günümüzde anestezi pratiğinde, büyük ameliyatlarda ve ağır hastalarda sıvı durumunun değerlendirilmesi için kullanılan statik izlem yöntemlerinin yerini, daha doğru sonuçlar veren dinamik izlemler almıştır. Nabız basıncı değişimi (PPV) ve sistolik basınç deği-şimi (SPV) sıvı yanıtını değerlendirmek amacıyla yaygın bir şekilde kullanılan dinamik indekslerdir. Yöntemler: Bu prospektif gözlemsel çalışmada, major cerrahi geçire-cek 50 hastada anestezi indüksiyonundan ve 500 mL izotonik verildikten sonra PPV ve SPV monitörize edildi. Bolus sıvı uygulamasını takiben, %15'ten fazla kardiyak debisi artışı olan hastalar yanıt verenler olarak, %15'ten daha az artışı olanlar ise yanıt vermeyenler olarak sınıflandırıldılar. Bulgular: Yanıt verenler ve vermeyenler arasında kalp atım hızı (HR), ortalama arter basıncı (MAP), PPV, SVV, santral venöz basınç (CVP) ve kardiyak indeks (CI) açısından anlamlı bir fark bulunmadı. Bolus sıvı uygulaması öncesinde, atım hacmi yanıt verenlerde anlamlı derecede daha düşüktü (p=0,030). Bolus sıvı uygulaması sonrasında, MAP yanıt verenlerde anlamlı ölçüde daha yüksek bulundu, ancak HR, CVP, CI, PPV ve SVV açısın-dan anlamlı fark gözlenmedi. Bolus sıvı uygulaması öncesinde ve sonrasında, hem yanıt veren hem de yanıt vermeyen hastalarda, PPV değeri ile SVV değeri arasında güçlü bir ilişki saptandı. Sonuç: PPV ve SVV sıvı yüklenmesine verilen kardiyak yanıtı tahmin etmede yararlıdır. Hem yanıt veren hem de vermeyen hastalarda ...

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Objective:Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is diagnosed for the first time during pregnancy. This prospective study was undertaken to validate the single-step non-fasting 75 gm Diabetes in Pregnancy Study Group of India (DIPSI) criteria of GDM in Indian patients in comparison with the two-step fasting 100 gm glucose challenge through the Carpenter Coustan criteria (CCC).Materials and Methods:Two hundred patients underwent comparative testing using the DIPSI criteria and CCC. Plasma venous blood glucose levels were estimated using the hexokinase method; values ≥140 mg/dL at 2 hours were considered positive according to the DIPSI criteria. Any two values from ≥95 mg/dL for fasting, ≥180 mg/dL at 1 hour, ≥155 mg/dL at 2 hours, and ≥140 mg/dL at 3 hours were considered positive with the CCC.Results:The mean age and body mass index were 24.26±3.75 years and 20.7±3.07 kg/m2. The sensitivity, specificity, and positive and negative predictive values of the DIPSI guidelines were found as 100%, 97.14%, 83.87%, and 100%, respectively. The positive and negative likelihood ratios were 35.8 and zero. Diagnostic accuracy was found as 97.56%.Conclusion:DIPSI having high sensitivity, specificity, negative predictive value and diagnostic accuracy. DIPSI offers simplicity, feasibility, convenience, and repeatability while economizing universal screening and diagnosis of GDM on a mass-scale. The DIPSI procedure has the potential to be applied to the entire obstetric population, in the implementation of public health programs to diagnose GDM in the community, thus reaching the needs of the developing world.

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Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain management interferes with early discharge of patient. Administration of opioid for pain relief is a concern because of its side effects. To avoid this problem, we planned our study to find out the best alternative of opioid in patients undergoing laparoscopic cholecystectomy. Methods: 68 patients were enrolled for this study in a stipulated time of 1 year in a tertiary level hospital. A questionnaire was responded by patients and a chart was maintained for pain score in visual analogue scale (VAS) and for side effects. We used paracetamol and diclofenac as post operative analgesic in two different groups and data was recorded in Excel panel and was analyzed by standard statistical test by software MINITAB 1513 with a significant p-value of <0.05. Results: We have found the significant outcome (p-values are 0.0005 at 0 hrs, 0.003 at 2 hrs, 0.001 at 6 hrs, 0.0005 at 12 hrs) in VAS pain score in between the two groups at different intervals. Patients who were administered paracetamol had shown better outcome with less requirement of rescue analgesia and side effects. Conclusion: Administration of intravenous paracetamol in the intra operative period 30 minutes prior to the completion of surgery followed by administration of 1g paracetamol every 8 hourly in the post-operative period gives better quality of analgesia.