The pain in the abdomen during pregnancy presenting to the emergency department (ED) is a big diagnostic challenge. A pregnancy that occurs most commonly in the fallopian tube, outside of the uterus is known as ectopic pregnancy. Acute appendicitis and ectopic pregnancy are the two most common causes of pain in the abdomen during pregnancy presenting to the emergency department. At 11 weeks of gestational period, 27-years-old gravida 2 para 1 presented with a 3-day history of right iliac fossa pain which was not associated with vaginal bleeding, fever, diarrhea, and vomiting. The vitals were stable on general examination. There was mild tenderness and guarding at the lower abdomen. An elevated beta-human chorionic gonadotrophin (βhCG) levels, cervical motion tenderness on digital vaginal examination, and transvaginal ultrasonography found a single live gestation with fetal heartbeat of 170 beats/min and a single placenta. The right live tubal ectopic pregnancy was diagnosed in the patient. Open right salpingectomy was performed on the patient. The patient remained stable in the postoperative period and was discharged uneventfully from the hospital.
Patients admitted to the intensive care unit with moderate to severe acute pancreatitis carry significant morbidity and mortality. A few unfortunate patients in whom the initial line of treatment fails to show clinical improvement develop multiorgan dysfunction involving lungs (adult respiratory distress syndrome), renal failure, intra-abdominal infections, sepsis, and septic shock, which ultimately leads to prolonged hospitalization and a substantial cost of treatment. The acute abdominal pain experienced by these patients is excruciating and requires multimodal analgesia. Continuous epidural analgesia has been found to provide good quality, opioid-sparing analgesia in these patients. A few studies have also demonstrated that segmental sympathectomy resulting from epidural blockade could lead to lowering of serum amylase and lipase levels improve paralytic ileus, and thus hastens the process of recovery. The present paper aims to discuss the advantages of continuous epidural analgesia in patients with acute pancreatitis of varying severity and to review the existing literature using specific keywords.
Introduction: TM The intubating laryngeal mask airway (ILMA) or LMA Fastrach was invented as a ventilatory device,and
TM
as a conduit for blind tracheal intubation. However, intubation through LMA Fastrach requires multiple attempts. LMA
TM TM CTrach is a modification of LMA Fastrach and allows intubation under direct vision via an integrated fibreoptic bundle
and a detachable liquid crystal display viewer.This study was undertaken to compare the first attempt success rate of
TM tracheal intubation through the CTrach laryngeal mask and LMA Fastrach .
Methods and Materials:This prospective randomized study was conducted on 100 adults,ASA physical status I and II
patients of either sex, scheduled to undergo general anaesthesia requiring tracheal intubation for elective surgery.The
patients were randomly allocated to two groups of 50 patients each, to be intubated via CTrach (GROUP CT, n=50) or
ILMA (GROUP FT,n=50).The first-attempt and overall success rates of tracheal intubation,the times taken and incidence
of pharyngo-laryngeal morbidity,were recorded.
Results: Tracheal intubation was successful on the first attempt in 96% of patients with the LMA CTrach™ and 84% of
patients with the LMA Fastrach™ (p= 0.045). The success rates within three attempts were 100% in both groups
(p=0.124).The mean time taken for the complete tracheal intubation process was 109.6 ± 38.679 seconds with the LMA
CTrach™ and 118.68 ±22.342 seconds with the LMA Fastrach™ (p= 0.154).
Conclusion: To conclude, both airway devices are comparable and efficacious and the overall success of tracheal
intubation was 100% in both groups.
Introduction:
Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding manipulation of the maternal airway, maternal satisfaction, and good postoperative analgesia. However, in situations like fetal distress (fetal heart rate abnormalities), obstetric indications (abruption of placenta, antenatal placental bleeding, cord prolapse), maternal refusal for RA, contraindications to neuraxial anesthesia (anticoagulation, coagulopathy), and at times failed RA general anesthesia (GA) is administered. Several studies have demonstrated greater mortality and morbidity when LSCS is done under GA when compared to neuraxial block.
Methods:
After necessary approval, we retrospectively reviewed data over a period of 1 year (January 1, 2020–December 31, 2020) of LSCS under GA versus RA. The aim was to compare immediate postoperative complications, postoperative pulmonary complications up to 4 weeks from the time of elective and emergency LSCS under either RA or GA.
Results:
Of the 753 patients who underwent LSCS in one calendar year, there were 272 (36.12%) elective and 481 (63.87%) emergency LSCS. The number of elective LSCS under neuraxial block was 219 (29.09%) and under GA were 53 (7.03%). Emergency LSCS done under neuraxial block were 268 (35.59%) and under GA were 213 (28.28%). There were no adverse pulmonary complications at the end of 4 weeks in either group.
Conclusion:
RA provides maternal satisfaction and excellent perioperative analgesia in LSCS. Safe GA can be achieved with proper airway planning, if case is attended by at least two anesthesiologist with adequate preoperative fasting, and postoperative monitoring.
Vaginal delivery for breech presentation is always associated with a higher risk of injury to the newborn as compared to caesarean delivery. A male infant was delivered by elective caesarean section at 40 weeks of gestation for breech presentation. During extraction, the newborn sustained a right femur shaft fracture. A simple splint with immobilization along with leg raise led to complete healing without complication. Caesarean delivery is associated with a reduced risk of newborn birth injuries as compared to vaginal and instrumental delivery but rare accidental complication can be possible.
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