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Sankalecha, Sunita
- Omphalocele: a Case Report
Abstract Views :290 |
PDF Views:102
Authors
Affiliations
1 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College, Nashik, IN
1 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College, Nashik, IN
Source
MVP Journal of Medical Sciences, Vol 1, No 1 (2014), Pagination: 42–43Abstract
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- Effects of Ephedrine Infusion for the Prevention of Hypotension during Spinal Anesthesia for Elective LSCS
Abstract Views :313 |
PDF Views:107
Authors
Affiliations
1 Department of Anaeshthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
1 Department of Anaeshthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
Source
MVP Journal of Medical Sciences, Vol 6, No 1 (2019), Pagination: 34-38Abstract
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.References
- Kol IO, Kaygusuz K, Gursoy S, Cetin A, Kahramanoglu Z, Ozkan F, Mimaroglu C. The effects of intravenous ephedrine during spinal anesthesia for caesarean delivery: A randomized controlled trial. J Korean Med Sci. 2009 Oct; 24(5):883–8. https://doi.org/10.3346/jkms.2009.24.5.883 PMid:19794988 PMCid:PMC2752773
- Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrineversus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2002; 94:920–6. https://doi.org/10.1097/00000539-200204000-00028 PMid:11916798
- Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006; 4:CD002251. [PubMed]. https://doi.org/10.1002/14651858.CD002251.pub2
- Bhattacharya D, Chaudhary M, Biswas B, Gazi N. Comparison of ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia for elective caesarean section. Indian J Anaesth. 2001; 45(4):290.
- Rout CC1, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Br J Anaesth. 1992 Apr; 68(4):394–7. https://doi.org/10.1093/bja/68.4.394 PMid:1642918
- Ngan Kee WD, Khaw KS, Ng FF, Lee BB. Prophylactic phenylephrine infusion for preventing hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2004; 98:815–21. https://doi.org/10.1213/01. ANE.0000099782.78002.30 PMid:14980943
- Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005; 103:744– 50. https://doi.org/10.1097/00000542-200510000-00012 PMid:16192766
- Dyer RA, Reed AR. Spinal hypotension during elective cesarean delivery: Closer to a solution. Anesth Analg. 2010; 111:1093–5. https://doi.org/10.1213/ ANE.0b013e3181ea5f77 PMid:20971959
- Gunusen I, Karaman S, Ertugrul V, Firat V. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care. 2010 Jul; 38(4):647–53. PMid:20715726
- Aragão FF, Aragão PW, Martins CA, Salgado Filho N, Barroqueiro Ede S. Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia. Rev Bras Anestesiol. 2014 Sep-Oct; 64(5):299–306. https://doi.org/10.1016/j.bjan.2013.07.014 PMid:25168433
- Kansal A, Mohta M, Sethi AK, Tyagi A, Kumar P. Randomised trial of intravenous infusion of ephedrine or mephentermine for management of hypotension during spinal anaesthesia for Caesarean section. Anaesthesia. 2005 Jan; 60(1):28–34. https://doi.org/10.1111/j.1365-2044.2004.03994.x PMid:15601269
- Gulhas N, Tekdemir D, Durmus M, Yucel A, Erdil FA, Yologlu S, Ersoy MO. The effects of ephedrine on maternal hypothermia in caesarean sections: A double blind randomized clinical trial. Eur Rev Med Pharmacol Sci. 2013; 17(15):2051–8. PMid:23884826
- Comparative Study of I-GEL and Endotracheal Tube in Elective Laparoscopic Gynecological Surgeries under General Anesthesia
Abstract Views :287 |
PDF Views:116
Authors
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
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
Source
MVP Journal of Medical Sciences, Vol 6, No 2 (2019), Pagination: 139-144Abstract
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,References
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- Marlow J. History of laparoscopy, optics, fiber optics, and instrumentation. Clin Obstet Gynecol. Jun 1976; 19(2):261– 275. https://doi.org/10.1097/00003081-197606000-00003.
- Paul Hayden, Sarah Cowman. Anaesthesia for laparoscopic surgery. 1st Oct 2011; 11(5):177–180. https://doi.org/10.1093/bjaceaccp/mkr027.
- Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel U., Dahms TE, Kaminsk DL. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch. Surg. 1991; 126:997–1001. https://doi.org/10.1001/archsurg.1991.01410320083011.
- Whalen FX, et al. Best Pract Res Clin Anaesthesiol. Sep. 2005; 19(3):323–30. https://doi.org/10.1016/j.bpa.2005.02.001.
- Brandt L. The history of endotracheal anesthesia, with special regard to the development of the endotracheal tube. Anaesthesist. Sept 1986; 35(9):523–30.
- Michálek P, Miller DM. Airway management evolution - in a search for an ideal extra glottic airway device. Prague Med Rep. 2014; 115:87–103. https://doi.org/10.14712/23362936.2014.40.
- Liu S-Y, Bongard FS. In: White RA, Klein SR, eds. Cardiopulmonary pathophysiology of laparoscopy and pneumoperitoneum, Endoscopic Surgery. St Louis: Mosby Year- Book Medical Publishers, 1991; p. 159–69.
- Brain AJ. The development of the Laryngeal Mask--a brief history of the invention, early clinical studies and experimental work from which the Laryngeal Mask evolved. Eur J Anesthesiol 1991; 4:5–17.
- Shiraishi Zapata CJ. I-Gel airway for advanced uses: a case of successful utilization of this second generation supraglottic airway device for controlled ventilation during general anesthesia in lateral decubitus position. Minerva Anestesiol. Feb 2017; 83(2):219-220.
- Lai CJ, Liu CM, Wu CY, Tsai FF, Tseng PH, Fan SZ. I-Gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelen sburg position. BMC Anesthesiol. 6 Jan 2017; 17(1):3. https://doi.org/10.1186/ s12871-016-0291-1.
- Cook TM, Howes. B. Supraglottic airway devices: recent advances. 1st Apr 2011; 11(2):6–61. https://doi.org/10.1093/ bjaceaccp/mkq058.
- Gatward JJ, Cook TM, Seller C, Handel Jet al. Anaesthesia. Oct 2008; 63(10): 1124-30. Evaluation of the size 4 I-Gel® airway in one hundred non-paralysed patients. https://doi.org/10.1111/j.1365-2044.2008.05561.x.
- Teoh WH1, Lee KM, Suhitharan T, Yahaya Z. Comparison of the LMA Supreme vs the I-Gel in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia. Dec 2010; 65(12):1173-9. https://doi.org/10.1111/j.1365-2044.2010.06534.x.
- Ishwar Singh, Monika Gupta, and Mansi Tandon. Comparison of Clinical Performance of I-Gel™ with LMA–Proseal™ in Elective Surgeries. Indian J Anaesth. Jun 2009; 53(3): 302–305.PMCID: PMC2900120, PMID: 20640137.
- Sharma B, Sehgal R, Sahai C, Sood J. PLMA vs. I-Gel: A comparative evaluation of respiratory mechanics in laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2010; 26: 451–7.
- Uppal V, Fletcher G, Kinsella J. Comparison of the I-Gel® with the cuffed tracheal tube during pressure controlled ventilation. Br. J Anaesth. Feb 2009; 102(2):264. https://doi.org/10.1093/bja/aen366.
- Bishop MJ, Bedford RF, Kil HK. Physiologic and pathophysiologic responses to intubation. In: Benumof JJ, editor. Airway Management and Principles and Practice.1st ed. Philadelphia: Mosby, Saunders; 1996.
- p. 102–17.
- Brimacombe JR, Watanabe S, Kihara S. et al. Tracheal intubation through Macintosh laryngoscope versus intubating laryngeal mask airways in normal patients. Anaesthesia and Intensive care 2000; 28(3):281. https://doi.org/10.1177/0310057X0002800305.
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- Maltby JR, Beriault MT, Watson NC, Liepert D, Fick GH. The LMA-ProSeal is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. J Anaesth. Oct 2002; 49(8):857–62. https://doi.org/10.1007/BF03017420.
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- Comparative Study of Intrathecal Bupivacaine versus Bupivacaine With Fentanyl for Post-Operative Analgesia in an Elective Cesarean Section at a Tertiary Care Centre
Abstract Views :303 |
PDF Views:87
Authors
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
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
Source
MVP Journal of Medical Sciences, Vol 7, No 2 (2020), Pagination: 175-181Abstract
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 AnaesthesiaReferences
- Manoj Kumar N. Gajbhare, Neha P. Kamble,Comparative Study of Intrathecal Bupivacaine versus Bupivacaine with Fentanyl for Cesarean Section in 2016. Indian J ClinAnaesth. 2016;3(2):271–277. https://doi.org/10.5958/2394- 4994.2016.00049.4
- Pollock JE, Neal JM, Stephenson CA, Wiley CE.Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anaesthesia. Anaesthesiology 1996;84:1361–1367. https://doi.org/10.1097/00000542- 199606000-00012
- Tan PH, Chia YY, Lo Y, Yang LC, Lee TH. Intrathecal bupivacaine with morphine or neostigmine for postoperative analgesia after total knee replacement. Can J Anesth. 2001;48(6):551–6. https://doi.org/10.1007/ BF03016831
- Panchal S, Arria AM, Labhsetwar SA: Maternal mortality during hospital admission for delivery: Aretrospective analysis using a state-maintained database. Anesth Analg. 2001;93:134–141. https://doi.org/10.1097/00000539- 200107000-00028
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- Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecalfentanyl and bupivacaine in spinal anaesthesia for caesarean section. BMC Anesthesiol. 2005;5:5. https:// doi.org/10.1186/1471-2253-5-5
- Geetanjali T, Ajay K, Aruna J. Low dose intrathecal bupivacaine with fentanyl for caesarean delivery. JAnaesthClinPharmacol. 2008;24(1):201–204.
- Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anaesthesiology. 1993;79;766– 73. https://doi.org/10.1097/00000542-199310000-00019
- Agarwal A, Agarwal S, Asthana V, PayalYS.Comparison of intrathecalfentanyl and sufentanil inaddition to bupivacaine for caesarean section under spinal anaesthesia. J Anaesth Clin Pharmacol. 2009;25(2):154–56.
- Dahlgren G, Hulstrand C, Jakobson J, Norman M. Intrthecalsufentanil, fentanyl or placebo added to bupivacaine for caesarean section. Anesth Analg. 1997;85:1288–93. https://doi.org/10.1097/00000539- 199712000-00020
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- De Witte, Jan MD, Sessler. Perioperative shivering: physiology and pharmacology. Anaesthesiology. 2002;96,467–84. https://doi.org/10.1097/00000542- 200202000-00036
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- Belzarena S.D. Clinical effect of intrathecal administered fentanyl in patient undergoing caesarean section. Anaesth Analg. 1992;74:653–7. https://doi.org/10.1213/00000539- 199205000-00006
- Study on Awareness of Basic Life Support/ Cardio Pulmonary Resuscitation among Medical Undergraduate Students in Nashik
Abstract Views :136 |
PDF Views:89
Authors
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
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
Source
MVP Journal of Medical Sciences, Vol 8, No 1 (2021), Pagination: 147–152Abstract
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, KnowledgeReferences
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- Mastoridis S, Shanmugarajah K, Kneebone R. Undergraduate education in trauma medicine: The students’ verdict on current teaching. Med Teach. 2011; 33:585–7. PMid: 21696289. https://doi.org/10.3109/01421 59X.2011.576716
- Tan EC, Hekkert KD, vanVuqt AB, Biert J. First aid and basic life support: A questionnaire survey of medical schools in the Netherlands. Teach Learn Med. 2010; 22:112–5. PMid: 20614376. https://doi.org/10.1080/10401331003656538