Background: Various adjuvants have been used with local anaesthetics in spinal anaesthesia for lower segment caesarean section (LSCS) to provide better haemodynamics & prolonged postoperative analgesia. The aim of this study was to compare onset & duration of sensory & motor block with haemodynamic stability of intrathecal ketamine and fentanyl added to Bupivacaine in spinal anaesthesia for two different group of patients posted for LSCS Method: Sixty patients of age between 18-35 years and ASA grade I and II were included and randomly divided in to two groups of 30 each. Group K received injection bupivacaine 10 mg with 10 mg Ketamine and Group F received injection Bupivacaine 10 mg with 12.5 mcg Fentanyl. The sensorimotor characteristics, haemodynamic parameters, neonatal outcome and side effects were noted and compared between two groups. Results: Group K showed higher sensory level (<0.05), rapid sensory (P<0.05) and motor (P<0.05) onsets, prolonged sensory (P<0.05) and motor (P<0.05) blocks as compared to group F.Hyperbaric bupivacaine-Ketamine had better haemodynamic stability and significantly reduced incidence of hypotension (P<0.05) and bradycardia (P<0.05). Apgar scores at 1 and 5 min were comparable in both groups (P = 0.2734 and 0.6731 respectively).Tachycardia was found in 16.66% cases in group K, whereas no patient developed tachycardia in group F.
Conclusion:The combination of hyperbaric bupivacaine (0.5%) 10mg with ketamine (10mg) can be used as a safe and effective alternative to hyperbaric bupivacaine (0.5%) 10mg with fentanyl 12.5mcg for spinal anaesthesia in LSCS.
Lack of awareness about isolated tubercular osteomyelitis of the sternum resulted in a delay in diagnosing the condition in an eleven-year-old girl who presented with a gradually increasing swelling over the sternum. Radiological, histological, and microbiological investigations helped diagnose the condition and the child responded well to antitubercular therapy (ATT) and surgical debridement. The report provides a brief description about the various management options available.
Congenital aneurysms of the sinus of Valsalva are rare lesions. These can rupture into any cardiac chamber, depending upon the site of origin of the aneurysm, forming aortocardiac fistulas. We encountered a 30-yearold male, with aneurysm of the right sinus of Valsalva, which through the infundibulum, projected into the pulmonary artery, and presented with right ventricular outflow tract obstruction (RVOTO)
Case ReportCongenital aneurysms of the sinus of Valsalva are rare lesions. These aneurysms follow predictable intracardiac course, usually rupturing into adjacent lowpressure chamber. Patients present either with aortocardiac fistulas with large shunts and congestive cardiac failure or with signs of ventricular septal defect (VSD) and/or aortic incompetence (A1). It is extremely rare for an aneurysm to rupture into the pulmonary artery or to project into the pulmonary artery to cause right ventricular outflow tract obstruction.We encountered a 30-year-old male, who presented with dyspnea on exertion (NYHA class II) and palpitations. Clinical examination revealed signs of right ventricular overload. A grade 1V/V1 systolic murmur was found in the left parastemal area in the 2 nd and 3 rd interspaces. Echocardiography revealed obstruction to the right ventricular outflow tract at the valvar level. There was no VSD or AI.The patient was posted for cardiac catheterization and possible balloon dilatation of the RVOTO, however on cardiac catheterization a 4 cm large aneurysm arising from the right sinus of Valsalva was found obstructing the pulmonary artery at the level of the valve annulus.The patient underwent an elective operation. Through a median sternotomy ascending aortic and bicaval cannulation was done and cardiopulmonary bypass started. A vent was placed through the right superior pulmonary vein. Aorta was cross-clamped and a transverse aortotomy was made. Warm sanguinous direct intracoronary cadioplegic infusion was used to arrest the heart. The aneurysm found to be arising form the right sinus of Valsalva, and was projecting through the infundibulum into the pulmonary artery. Aneurysm Fig. 1. Left ventriculogram showing opacification of the aneurysm.Fig. 2. Right ventriculogram showing filling deflect in outflow tract. 030-02.p65 145 8/24/2003, 12:40 PM
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