Sunita Sankalecha ¹, Alka Koshire ¹, Mrinal Anand ¹, Bhooshan Gondse ¹

Affiliations
1 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College, Nashik, IN

Abstract

A neonate with giant omphalocele was posted for repair on 3rd day of life. Anesthesia management was challenging as liver and intestines herniated through the anterior abdominal wall defect. Anticipating post-operative respiratory embarrassment, the child was kept on ventilatory support for two days, recovered fully.

Keywords

Gaint Omphalocele, Abdominal Wall Defects

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Rewati Khairnar ¹, Sunita Sankalecha ¹

Affiliations
1 Department of Anaeshthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Spinal anesthesia provides a fast, profound and symmetrical sensory and motor blockade of high quality in patients undergoing LSCS1. However, the most common serious adverse effect of spinal anesthesia for LSCS is hypotension. Maternal hypotension has detrimental effects on uterine blood flow causing fetal hypoxia and acidosis. Preloading with crystalloids and use of vasopressors is widely recommended to prevent hypotension. We designed a study to determine the effects of ephedrine infusion for control of hypotension in women undergoing elective LSCS. In this observational study 80 parturients in the age group of 20 to 40 years, posted for elective caesarean section and belonging to ASA class 1 and 2 were selected. After preloading with 500 ml of ringer lactate solution, all the patients received spinal anaesthesia with 2ml inj.bupivacaine 0.5% (heavy). Immediately after institution of subarachnoid block the infusion of ephedrine at the rate of 1.25 mg/min via an infusion pump was started and was continued till clamping of the umbilical cord. The incidence of hypotension was 11% which was found to be lower when compared with other studies. Average dose of ephedrine used was 17±2 mg. Average APGAR score in our study were found to be 8 and 9 at 1 and 5 minutes. No neonate had an APGAR score below 7. The incidence of nausea and vomiting was 6% and that of reactive hypertension was 2%. None of the patients had tachycardia, bradycardia or shivering. We concluded that, prophylactic intra-venous ephedrine infusion immediately after spinal anesthesia is a quick, simple, safe and effective technique in preventing hypotension without unwanted side effects such as nausea, vomiting and hypertension in women posted for elective LSCS and can be of great value in routine practice. Being an observation study, comparison with a control group is recommended for comments on efficacy.

Keywords

Cesarean Section, Ephedrine Infusion, Hypotension, Spinal Anesthesia.

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Sushant Dhawan ¹, Sunita Sankalecha ²

Affiliations
1 P.G. Resident, Department of Anaesthesia, Dr. Vasantrao Pawar Medical College, Hospital & Research Centre, Nashik – 422003, Maharashtra, IN
2 Professor, Department of Anaesthesia, Dr. Vasantrao Pawar Medical College, Hospital & Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Introduction: Laparoscopic procedures have become the need of the hour. Pneumoperitoneum and positional variations in laparoscopy causes alterations in hemodynamic and ventilatory parameters, which results in making the task of anesthesiologist more challenging. Endotracheal tube (ETT) has been the gold standard for induction of general anesthesia but the newer supraglottic airway devices (SADs) (LMA, I-Gel) has increased the armamentarium of anesthesiologists. Our main aim was to compare I-Gel and endotracheal Tube and to consider I-Gel as safe and effective alternative to endotracheal tube for general anesthesia in elective laparoscopic surgeries. Materials and Methods: It was a comparative prospective randomized study conducted on 128 patients (ASA I/II) after consent from institutional ethical committee. Patients were divided in two groups 64 each. Group A induced with I-Gel without muscle relaxant and Group B with endotracheal tube after laryngoscopy and muscle relaxant. Alterations in pulse rate, blood pressure were noted down and ease and time of insertion were compared. Results: The ease of insertion and the attempts of insertion were comparable but the time of insertion was less with I-Gel with results being statistically significant. The rise in hemodynamic parameters from baseline was more in endotracheal tube intubated patients and so was the incidence of postoperative complications. Conclusion: We concluded that I-Gel requires less time for insertion with minimal hemodynamic changes in comparison to endotracheal tube. I-Gel also provided adequate positive-pressure ventilation, comparable with endotracheal tube. Thus I-Gel can be considered safe and suitable alternative to endotracheal tube for laparoscopic surgeries.

Keywords

Endotracheal Tube, General Anesthesia, Hemodynamic Parameters, I-Gel, Laparoscopy,

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Sunita Sankalecha ¹, Neha Kishor Jaiswal ²

Affiliations
1 Former PG Resident, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Professor, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Spinal anaesthesia for cesarean section has been the preferred technique for majority of anaesthesiologist. The finite duration of spinal anaesthesia is the only drawback as compared to general anaesthesia. Therefore combination of local anaesthetics with intrathecal opioids makes it possible to achieve prolonged post-operative analgesia without affecting the mother and the baby. Aims And Objectives: 1)To compare the effectiveness of plain bupivacaine with bupivacaine plus fentanyl for post -operative analgesia among the two groups. 2)To compare the adverse effects among both the groups. Materials and Methods: 154 patients undergoing elective cesarean section under spinal anaesthesia were randomly allocated to two equal groups; Group B patients received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine and Group B + F received 9mg (1.8mL) of 0.5% hyperbaric bupivacaine plus 10 ug (0.2 mL) preservative free fentanyl. The clinical profile of subarachnoid block in two groups, duration of effective analgesia and its effect on maternal and neonatal outcome was studied. Results: The duration of effective analgesia was significantly more in Group B +F (225.03+2.81)mins compared to Group B (119.90+2.76)mins. The incidence of side effects was less in Group B + F than Group B. Conclusion: We can conclude that the addition of fentanyl to 0.5% hyperbaric bupivacaine for spinal anaesthesia in cesarean section provides effective and prolonged post-operative analgesia with less side effects.

Keywords

Bupivacaine, Cesarean Section, Fentanyl, Spinal Anaesthesia

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Sunita Sankalecha ¹, Jyotsna Mali ²

Affiliations
1 Professor, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN
2 Former PG Resident, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN

Abstract

Background: Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) is a core skill in which all health care professionals should be proficient, in case of an emergency to save lives. It is logical to provide BLS training during undergraduate years ensuring basic competence in all graduating healthcare students. Objectives: The present research was undertaken with an objective to know the knowledge of BLS and awareness about BLS among medical students in Nashik. Methods and Materials: This cross sectional study was carried out among randomly selected 358 medical undergraduate students. Pre-tested semi-structured questionnaire was used to collect data. The questionnaire included the following parts: 1. Basic characteristics of the study participants, 2. Knowledge about BLS/CPR, 3. Awareness about BLS/CPR. The components of knowledge and awareness based questions were scored. The data was analyzed using SPSS version12. Results: The majority (87.8%) of students had heard of BLS/CPR, among them 40.6% could give the correct order of performing CPR as per the AHA guidelines (Year 2010). Only 20% of students had undergone prior training in BLS while 19.7% had been in a situation that needed BLS/CPR. Overall awareness was not favorable and approximately 68.9% of the students were no tconfident of performing BLS/CPR. Only 46.5% of students had adequate knowledge about BLS/CPR. Conclusions: The major lack of knowledge and awareness is due to lack of training. Hence it is essential to train the students in CPR/BLS early in the curriculum to improve their knowledge and repeated training would increase their confidence.

Keywords

Awareness, Medical Students, Basic Life Support, Cardiopulmonary Resuscitation, Knowledge

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