General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.
High-performance polymers based on aromatic rings are desirable not only because of the high primary bond strengths, but also because their rigid (stiff) polymer chains offer increased resistance to deformation and thermal softening. The choice of s-triazine nucleus is based on its high thermal stability derived from its molecular symmetry and aromaticity. It is well known that s-triazine is heat resistant. Modification of monomer structures by introduction of aromatic pendent groups or heterocyclic rings into the polymer backbone provides good solubility and thermal stability. A new set of polyamides with —CO—NH— groups were synthesized by the Yamazaki’s phosphorylation reaction 2-(morpholino)-4,6-bis (6-napthoxy-2-carboxy)-s-triazine with various aromatic diamines. The polyamides had inherent viscosities in the range 0.549—0.685 dL g-1 in dimethylformamide at room temperature (30 °C) and density 1.135—1.208 g cm - 3 . All the polyamides showed good thermal stability and most of them were readily soluble at room temperature in polar solvents such as N,N-dimethylacetamide, 1-methyl-2-pyrrolidone and dimethylformamide. Polyamides were synthesized successfully with the favourable properties of higher thermal stability along-with good processibility.
Seven polyamides containing s-triazine rings in the main chain were synthesized by high temperature polycondensation of 2-(b-naphthylamino)-4,6-bis(naphthoxy-3-carbonyl chloride)-s-triazine [NANCCT] with various aromatic diamines such as 4,4 0 -diaminodiphenyl [DADP], 4,4 0 -diaminodiphenylamide [DADPA], 4,4 0 -diaminodiphenylsulphone [DADPS], 4,4 0 -diaminodiphenylsulphonamide [DADPSA], 4,4 0 -diaminodiphenyl methane [DADPM], 2,4-diamino toluene [DAT] and p-phenylene diamine [PPDA]. All the polyamides were characterized by solubility tests, density measurements, viscosity measurements, IR spectra, NMR spectra, and thermogravimetric analysis. The polyamides had inherent viscosities in the range 0.88-1.16 g=dL in N,N 0 -dimethyl formamide at room temperature (30 C). All the polyamides showed good thermal stability at high temperatures and most of them were soluble readily at room temperature in polar solvents.
The most traumatic experience for a gravid woman, her husband and their family is, undoubtedly, the unheralded birth of deformed child, precipitating feeling of horror, inadequacy and failure in parents. 1 Congenital malformation represents defects in morphogenesis during early fetal life. According to the World Health Organization (WHO) document of 1972, the term congenital malformations should be confined to structural defects at birth. 2 The leading causes of infant morbidity and mortality in poorer countries are malnutrition and infections, whereas in developed countries they are cancer, accidents and congenital malformations. Congenital anomalies account for 8-15% of perinatal deaths and 13-16% of neonatal deaths in India. 3,4
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