Objective: To compare the hypotension in lateral verses sitting positions during induction of spinal anaesthesia for caesarean section. Study Design: This is a Randomized control trial (RCT) study. Setting: Study carried out at Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of health sciences Karachi, from December 2018 to June 2019. Materials and Methods: All women age 18 to 45 underwent elective caesarian section having ASA I and II, singleton pregnancy on ultrasound with parity ≤3 were enrolled. Patients were randomized to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S) through lottery methods. Using the L3-4 interspace, patients received intrathecal plain bupivacaine, 10mg or 12 mg according to their height, after which they was placed immediately in the supine position with left uterine displacement. Maternal blood pressure was measured with the help of Non-invasive BP apparatus. BP was recorded at baseline then every 5 min till 30 minutes by anesthetist who was unaware of parturient group. Any single or more reading of SBP of <90 mmHg was considered as Hypotension. Results: Mean age of the patients in lateral group was 31.49 ±10.87 years and mean age of the patients in sitting group was 31.80 ±10.77 years (p-value 0.869). Majority of the patients 35 (62.5%) with hypotension were presented with sitting position. Chi square test was applied and statistically significant difference was observed between groups (p-value 0.012). Conclusion: We concluded that less frequency of hypotension was observed when spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position.
Objective:To evaluate the efficacy of Metoclopramide versus Dexamethasone for prevention of postoperative nausea and vomiting during general anesthesia. Study Design:This is a Randomized control trial (RCT) study. Setting: Study carried out at Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Clinic, Dow University of Health Sciences and Dr. Ruth Pfau Hospital Karachi, from December 2018 to June 2019. Materials and Methods:110 patients undergoing elective surgeries, who fulfilled the inclusion criteria and gave informed consent were included in the study. They were randomly assigned to either group M or group D, with 55 patients in each group. All patients were then administered either intravenous dexamethasone (8mg) in group D or intravenous metoclopramide (10mg) in group M at the time of induction of anesthesia. The main outcome measure was postoperative nausea and vomiting, at the end of 6th hour postoperatively. The SPSS version 21 was applied to the data. Results: Majority of the patients 66 (60%) were of age 35 years or less. Mean age of the patients was 35.09±11.55 years. There were more females than males, with male to female ratio being 1:1.03. Overall, in patients receiving metoclopramide, 12(21.8%) had postoperative nausea and vomiting, while in patients who received dexamethasone, only 4 (7.3%) patients had post-operative nausea and vomiting. When comparing two groups, there was statistically significant (p= 0.02) reduced postoperative nausea/vomiting among those patients who had received intravenous dexamethasone. Conclusion: Intravenous dexamethasone is more effective than Metoclopramide in preventing postoperative nausea and vomiting in patients during general anesthesia.
Objective: To compare mean time taken for tracheal intubation with Airtraq versus Macintosh laryngoscope in elective surgeries. Study Design: This is a Randomized control trial (RCT) study. Setting: Study carried out at Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Clinic, Dow University of Health Sciences and Dr. Ruth Pfau Hospital Karachi, from June 2016 to November 2016. Materials and Methods: A total of 60 patients divided 30 in each group randomly i.e. Macintosh laryngoscope Group A and Airtraq laryngoscope Group B who scheduled for elective surgery and fulfill the inclusion criteria. All patients were received intravenous glycopyrolate 0.2 mg, tramadol 2 mg/kg, and midazolam 0.03 mg/kg 10 minutes before induction of anesthesia. Induction was done with propofol 2-2.5 mg/kg, minimum 3 minutes were given to maximum effect of muscle relaxant. Time taken to intubate the trachea were noted in seconds and entered into the predesigned proforma. Results: The analysis included data on all the patients between 18 to 50 years of age who scheduled for elective surgery during the study period after applying the exclusion criteria. Mean ± SD of age in group A were 36.85±8.47 years and in group B were 37.49±9.32 years. In Gender distribution of group A 11 (36%) were male and 19 (64%) were female and in group B the distribution of male and female were 8 (27%) and 22 (73%) respectively. By comparing both the groups for time taken in tracheal intubation in seconds Mean ± SD of group A was 35±7.8 and in group B was 21±4.2 and P value found to be highly significant i.e. (0.0001). Conclusion: It is to be concluded that Airtraq laryngoscope is more effective instrument than Macintosh Laryngoscope for use in routine airway management and duration of successful tracheal intubation was shorter in the Airtraq group.
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