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degree of urgency, maternal status and desire of patient. Use of regional anesthesia has dramatically increased and use of general anesthesia for cesarean section has been steadily decreasing. [1] Risk of general anesthesia includes failed endotracheal intubation, failed ventilation, aspiration pneumonitis, postoperative nausea and vomiting, neonatal depression, and maternal awareness. [2] Although spinal block provide excellent anesthesia for cesarean section it is frequently accompanied by hypotension generally proportional to the degree (level) of sympathectomy (height of block). [3] Many methods to decrease the risk of hypotension have been studied, which include ensuring proper maternal position with uterus displaced off vena cava, infusion of fluids to increase effective blood volume, administration of Original Article A B S T R A C TBackground: Spinal block provides excellent anesthesia for cesarean section, but it is frequently accompanied by hypotension, which if untreated can pose serious risks to mother and baby. Over the years, many interventions have been tried to prevent hypotension, but no single technique has proven to be effective and reliable. This study was carried out with the aim to find if wrapping the legs with elastic crepe bandage in addition to traditional methods was effective in preventing post spinal hypotension. Materials and Methods: A total of 60 full-term parturients with an uncomplicated pregnancy belonging to American Society of Anesthesiologists I or II were allocated randomly (30 in each group) to have their legs wrapped with elastic crepe bandage or no wrapping was done. All patients received intravenous (IV) crystalloid (20 ml/kg) 15 min prior to spinal injection and were placed in left lateral position. Electrocardiography and oxygen saturation was monitored continuously and heart rate, blood pressure was measured every 2 min until delivery of baby and every 5 min thereafter until end of cesarean section. Significant hypotension was treated with IV phenylephrine 50 µg bolus doses. Results: The frequency of hypotension was significantly less (P = 0.009) in Group B (legs wrapped group) 3 (10%) patients when compared with Group A (nonleg wrapped) 13 (43.33%). In Group A 10 (33.33%) patients and in Group B 3 (10%) patients required rescue dose with phenylephrine which was statistically significant (P = 0.0003). Difference in the "mean change of arterial pressure" between Group A and B was highly significant (P < 0.001) recorded at 4, 6, and 8 min. Conclusion: Incidence of hypotension can be reduced by wrapping the legs with elastic crepe bandage with a subsequent reduction in the use of potent vasopressor. Since leg wrapping with crepe bandage is cheap, easy, readily available, noninvasive, and nonpharmacological method, it can be recommended for preventing post spinal hypotension in a developing country like ours.

Blockchain is an emerging technology framework for creating and storing transaction in distributed ledgers with a high degree of security and reliability. In this paper, we present a blockchain-based platform to create and store contracts in between students and their higher education sponsors facilitated by intermediary brokers denoted as fundraisers. The sponsorship might be in any form, such as scholarship, donation, or loan. The fund will be arranged and managed by a group of competitive fundraisers who will hold the distributed ledgers and act as the miners in the blockchain network.

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We report on a patient who developed subcutaneous emphysema with hypercarbia during an endoscopic, totally extraperitoneal (TEP) repair of an inguinal hernia. The possible mechanisms of carbon dioxide (CO2) insufflation causing emphysema of the subcutaneous tissues are discussed and ways to prevent it are proposed.

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