Eisenmenger's syndrome is a cyanotic congenital heart disease that includes pulmonary hypertension with reversed or bidirectional shunt associated with septal defects or patent ductus arteriosus. The decreased systemic vascular resistance associated with pregnancy increases the degree of right to left shunting, thereby carrying substantial risk to both the mother and the foetus. The maternal mortality rate of pregnancy in the presence of Eisenmenger's syndrome is reported to be as high as 30–70%. We present a case of a 22-year-old primigravida with Eisenmenger's syndrome who gave birth at 37 weeks of gestation via caesarean section to a live female baby under general anaesthesia. On the third post-operative day, the patient developed tachycardia, tachypnoea, hypotension and decrease in oxygen saturation despite supplemental oxygen, clinically suspected pulmonary thromboembolism. We describe the anaesthetic management for caesarean section and its complications in a patient with Eisenmenger's syndrome. Although pregnancy should be discouraged in women with Eisenmenger's syndrome, it can be successful.
Background and Aims:Anaesthesia practice demands medical knowledge and skills as essential components for patient management in peri-operative emergencies. Since all residents are not exposed to such situations during their residency, training them using simulation technology could bridge this knowledge and skill gap. The aim of this study was to train and evaluate residents to manage anaesthesia emergencies on high fidelity simulators.Methods:Kirkpatrick model of program evaluation was carried out. Resident reaction was captured using a satisfaction questionnaire and the change in knowledge was assessed using pre-test and post-test Multiple Choice Questions (MCQs). Six scenarios were created and executed on a human patient simulator (HPS). All 22 residents participated in this teaching learning method. The steps of simulation teaching included pre-test, pre-briefing, orientation to manikins, performing/scribe, debriefing, feedback questionnaire, and post-test. The satisfaction questionnaire was administered following the second and fourth scenario.Results:95% residents agreed on overall satisfaction, that it helps in building team dynamics and clinical reasoning. All students agreed that this teaching had positive professional impact. 14% residents felt they were anxious during the class. The items in the questionnaire had a Cronbach's α value of 0.9. The mean score for pre-test was 24.22 ± 7 (Mean ± SD) and the post-test was 47.18 ± 5.6, the difference between the scores were statistically significant (P = 0.007).Conclusion:The use of high-fidelity simulation to train anaesthesia residents resulted in greater satisfaction scores and improved the residents' reasoning skills.
Background: Spine surgery is associated with significant blood loss, often requiring blood transfusion. The objective of this double blind study was to evaluate the efficacy of tranexamic acid (TXA) on perioperative blood loss in patients undergoing thoracic spine fixation.
Materials and Methods:Sixty adult patients were randomized into two groups of 30 each. Group I received a bolus of 15 mg/kg i.v. of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr up to closure of skin and Group II received an equivalent volume of normal saline after induction followed by a maintenance infusion of saline up to closure of skin. Outcome measures included perioperative blood loss, amount of blood transfusion, postoperative haemoglobin and haematocrit levels.
Results:The mean perioperative blood loss was less in the TXA group compared to the placebo group (p value<0.001). The PRBCs transfusion was lower in the TXA group compared to the placebo group but there was no statistically significant difference between the two groups. The postoperative haemoglobin level was lower in the control group as compared to TXA group (p value <0.05).
Conclusion:TXA is effective in reducing peri-operative blood loss and blood transfusion.
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