Spinal anesthesia is widely used for emergency and elective C/S delivery. However its main drawback is hypotension which may cause nausea, vomiting and cardiovascular collapse and loss of consciousness in mother as well as fetal hypoxia and acidosis due to placental hypo perfusion. AIMS AND OBJECTIVE: To compare the incidence of hypotension in intraoperative period and to compare the fetal outcome in two groups (Preloading and co loading group). STUDY DESIGN: Prospective randomized double blind study. MATERIALS AND METHOD: This study was conducted in the obstetric emergency OT of Malda Medical College. 100 primi gravid mothers aged between 18-29 years with ASA-1 physical status posted for emergency C/S for fetal distress was randomly allocated for either preloading (Group P) or co loading (Group C). RESULT AND ANALYSIS: Fluid requirement is significantly less in group C. There was no significant difference in the incidence of hypotension and ephedrine use. Fetal outcome in 1 min Apgar score in group C is significantly better as the baby could be delivered quickly in group C. CONCLUSION: Our study revealed that preloading can be safely avoided for spinal anesthesia in C/S for fetal distress. By using co loading method we can save valuable time required to deliver the baby and avoid circulatory overload without increasing the incidence of hypotension.
Background:Prevalence of subclinical hypothyroidism (SCH) in pregnancy varies widely in different parts of our country, but it has multiple adverse outcomes in both the mother and fetus.Objectives:This study was conducted to evaluate the prevalence of SCH in pregnant women during the first trimester and to identify the prevalence of thyroid autoimmunity in pregnant women.Materials and Methods:This cross-sectional study (March 2014 to February 2015) was conducted among the pregnant women attending antenatal clinic in their first trimester at a tertiary care center. Morning samples of study participants were analyzed for free thyroxin (FT4), thyroid stimulating hormone (TSH), and thyroid peroxidase antibody (TPO Ab). Data expressed as mean ± standard deviation and percentage (%) as applicable.Results:Of the 510 subjects, 168 had TSH value >2.5 μIU/ml (32.94%) with normal FT4 and they were diagnosed as SCH. TSH level >4.5 μIU/ml was estimated in 13.92% (71) of the subjects. TPO Ab was positive in 57 (33.93%) of subclinical hypothyroid and 5 (1.47%) of normal subjects. 70.42% (50) of the subjects with TSH >4.5 μIU/ml had positive TPO Ab.Conclusions:Prevalence of SCH is high in South Bengal and routine thyroid screening at the first antenatal visit should be done to reduce the social and financial burden caused by SCH.
Background:Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anesthesia for cesarean section fails to obtain any sensory or motor block. Very few studies and literature are available regarding repeat administration of spinal anesthesia and its drug dosage, especially after first spinal failure in cesarean section lower segment cesarean section (LSCS) due to fear of the excessive spread of drug. The aim of our study is to compare the outcome between two different doses of 0.5% hyperbaric bupivacaine repeated intrathecally after failed spinal.Materials and Methods:After taking informed consent and Ethical Committee approval this prospective, randomized single-blinded study was conducted in 100 parturients of American Society of Anesthesiologists I-II who were posted for elective LSCS and had Bromage score 0 and no sensory block even at L4 dermatome after 10 min of first spinal anesthesia; were included in the study. Group A (n = 50) patients received 2.4 ml and Group B (n = 50) patients received 2 ml of 0.5% hyperbaric bupivacaine respectively for administering repeat spinal anesthesia. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation, respiratory rate and electrocardiogram were monitored both intra- and post-operatively and complications were recorded.Results:Incidence of high spinal, bradycardia, hypotension, respiratory complications, and nausea vomiting are significantly higher in Group A compared to Group B (P < 0.05). SBP, DBP, and HR were significantly low in Group A patients compared to Group B in the first 10 min (P < 0.05).Conclusion:Spinal anesthesia can be safely repeated in the cesarean section with 10 mg of 0.5% hyperbaric bupivacaine provided after first spinal anesthesia, the level of sensory block is below L4 and motor power in Bromage scale is 0.
BACKGROUND:The study was to evaluate the surgical outcomes of arthroscopic repair of post-traumatic Bankart lesions with the use of suture anchors. Patients with >20% bony lesions, SLAP (superior labral tear from anterior to posterior) lesions and multi-directional instability were excluded. The patients were followed up for a period of minimum 4 years. MATERIALS AND METHODS: We evaluated the results of arthroscopic Bankart repair with use of suture anchors in 35 patients with traumatic recurrent anterior instability of the shoulder. The mean age at operation was 25.71 years. The patients were evaluated pre-operatively and at follow-up using the UCLA (University of California Los Angeles) shoulder scoring system and the modified Rowe scores, which were 6.2 and 29.3 respectively pre-operatively. RESULTS: The UCLA shoulder scoring system and the modified Rowe scores at follow-up were 32 and 72.57 respectively and both improvements were significant. The Modified Rowe Shoulder Scoring System showed 14 patients having excellent results, 12 patients good, 6 patients fair and 3 patients with poor results. One patient had subluxation and another had positive apprehension test. Five patients had discomfort/pain with arm in abducted and externally rotated position but negative apprehension test. Remaining 28 patients had negative apprehension test; no subluxation. Significant improvements occurred for each motion tested for each follow up visit. CONCLUSION: We conclude that arthroscopic Bankart lesion repair with suture anchors is an effective surgical technique for the treatment of an isolated Bankart lesion having good results with respect to pain relief, stability and function. KEYWORDS: Arthroscopic Bankart repair, Anterior shoulder instability, UCLA (University of California Los Angeles) shoulder rating scale. INTRODUCTION:The shoulder, by virtue of its anatomy and biomechanics, is one of the most unstable and frequently dislocated joints in the body, accounting for nearly 50% of all dislocations. According to one estimate, up to 96% of acute shoulder dislocations were traumatic in origin. (1) Anterior instability is the most common form of shoulder instability. (2) Recurrent anterior shoulder instability results in a functional disability for the patient, in terms of both shoulder function and general health status. (3) The use of arthroscopy has improved the recognition of pathologic findings in shoulder instability and allowed a better understanding of the etiology of instability and the correlation between symptom and lesion patterns.Arthroscopic treatment of shoulder instability due to Bankart lesion introduced some advantages compared with open Bankart lesion repair procedure. The Arthroscopic method offers a less invasive technique of Bankart repair.
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