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.
Aims:To evaluate the efficacy of intrathecal isobaric Ropivacaine and its comparison with intrathecal isobaric Bupivacaine in elective inguinal hernia repair surgeries.Settings and Design:A prospective, randomized study was conducted in a tertiary care hospital with 80 patients of ASA grade I-III undergoing elective inguinal hernia repair surgery under spinal anaesthesia. Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the Ropivicaine group (Group R) and to theBupivicaine group (Group B). Parameters observed were onset and duration of sensory and motor block, maximum sensory level achieved degree of motor blockade, two segment regression, and haemodynamic changes.Results:The development of sensory block was faster with Isobaric Ropivicaine (12.1 ± 4.9 minutes) as than isobaric Bupivicaine (13.94 ± 4.52 minutes) but the difference was not statistically significant. Onset of Grade III Motor block was longer with Isobaric Ropivicaine (8.51 ± 3.39 minutes) as compared to isobaric Bupivicaine (8.51 ± 3.39 minutes), but the difference was not statistically significant. Time of Complete Sensory Regression was significantly shorter with Isobaric Ropivicaine (212.69 ± 27.31 minutes) with statistical significance. Time to complete motor recovery was significantly shorter in Ropivacaine group (253.38 ± 27.13 minutes)as compared to Bupivacaine group (258.55 ± 35.81min), with statistical significance. Time to achieve discharge criteria was relatively shorter with Isobaric Ropivicaine. Haemodynamic Parameters did not differ significantly in both the groups during the entire study period.Conclusion:Intrathecal administration of isobaric Ropivacaine (0.75%) 15 mg provides similar quality of spinal anaesthesia but of significantly shorter duration, maintaining similar hemodynamic stability and discharge criteria without significant adverse effects when compared to isobaric Bupivicaine (0.5%) 10 mg.
Background: Laryngoscopy and intubation are associated with intensesympathoadrenal stimulation resulting in hypertension, tachycardia & arrhythmias consequent to the release of catecholamines. Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel blockers, vasodilators etc. Dexmedetomidine is a highly selective alpha 2 receptor agonist having eight times higher affinity and alpha 2 selectivity compared to clonidine and has a shorter duration of action than clonidine.Material and Method: 60 patients scheduled for elective surgical procedures under general anaesthesia belonging to ASA Grade I and II, in the age group of 18 to 60 years were divided into two study groups, D1 and D0.5 received dexmedetomidine 1 µg/kg and 0.5 µg/kg intravenously (iv) over 10 minutes before induction. Hemodynamic responses were compared in both groups by measuring Heart rate (HR),Systolic blood pressure (SBP),Diastolic blood pressure(DBP),Mean arterial pressure (MAP) and SpO 2 before giving the test drug (base line values),just before induction,during intubation and at 1 minute, 3 minutes, 5 minutes,10 minutes after intubation. Statistical data were analyzed by using student's unpaired t test.Observation and Results: Group D1 had 4.70% rise in HR and Group D0.5 had 9.59% rise during intubation which was statistically significant(p<0.05). Maximum rise in SBP and DBP in Group D0.5 was 14.53% and 12.84% respectively, whereas in Group D1 it was 5.55% and 8.90% respectively. In Group D0.5, rise in BP lasted longer after intubation compared to Group D1. Conclusion:The present study demonstrated that ivdexmedetomidine 1µg/kg was better than dexmedetomidine 0.5µg/kg in attenuation of the pressor response of laryngoscopy and intubation without any significant side effects.
Incidence of Atrial Septal Defect (ASD) in acyanotic congenital heart disease is about 10%. This condition is commonly diagnosed in childhood, although in some cases it is detected in later stages of life. Patients with ASD and Pulmonary Hypertension (PHT) pose a great challenge to anaesthetic management. Authors are presenting a case of general anaesthetic management of 39-year-old lady having ASD with mild to moderate PHT undergoing abdominal hysterectomy, a noncardiac surgery. The patient was induced with Inj. Propofol slow Intravenous (IV) and intubation was achieved with succinylcholine and maintenance was done with atracurium and isoflurane. The primary goal of general anaesthesia was to avoid increase in PHT and to maintain systemic vascular resistance.
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