Pub Date : 2023-07-01DOI: 10.4103/JOACC.JOACC_28_23
V. Jannu, Meghana Hanagandi, Raghavendra Kalal, C. Sabari
Context: Uterine atony is the commonest cause for postpartum haemorrhage in majority of cases. Oxytocin remains the first-line uterotonic agent but, is associated with significant cardiovascular effects like hypotension and tachycardia after intravenous administration. Carbetocin, a synthetic heat-stable oxytocin analogue combines the safety and efficacy profile of oxytocin with the sustained uterotonic activity. Aims: The aim of this study was to compare intravenous oxytocin and carbetocin for haemodynamic responses during caesarean section under subarachnoid block. Settings and Design: Randomized controlled trial. Methods and Material: We performed a prospective randomized, controlled study on 142 pregnant patients undergoing elective cesarean section under subarachnoid block. Patients were randomly assigned to receive either 3U of intravenous oxytocin followed by infusion of 10U/hour for 4 hours or 100 μg intravenous carbetocin after the delivery of anterior shoulder. Heart rate and mean intra-arterial blood pressures were recorded at every 15 s during the study period of 5 min. Statistical Analysis Used: Data were analyzed using Student's unpaired test, Chi-squared test, and Fischer's exact test. A P < 0.05 was considered statistically significant. Results: Oxytocin produced clinically significant tachycardia (>20%) with peak effects over 180 s after injection (P < 0.0001). It also demonstrated a significant decrease in mean arterial pressure within 30 s of bolus injection and hypotension persisted throughout the study period (P < 0.0001). Carbetocin produced no significant changes in heart rate and mean blood pressure responses. The requirement of additional uterotonics and total intraoperative blood loss were similar among both the groups. Conclusions: Intravenous carbetocin is better tolerated without significant haemodynamic adverse effects in comparison to oxytocin during cesarean section.
{"title":"Comparison of haemodynamic effects of intravenous carbetocin and oxytocin during caesarean section under subarchanoid block","authors":"V. Jannu, Meghana Hanagandi, Raghavendra Kalal, C. Sabari","doi":"10.4103/JOACC.JOACC_28_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_28_23","url":null,"abstract":"Context: Uterine atony is the commonest cause for postpartum haemorrhage in majority of cases. Oxytocin remains the first-line uterotonic agent but, is associated with significant cardiovascular effects like hypotension and tachycardia after intravenous administration. Carbetocin, a synthetic heat-stable oxytocin analogue combines the safety and efficacy profile of oxytocin with the sustained uterotonic activity. Aims: The aim of this study was to compare intravenous oxytocin and carbetocin for haemodynamic responses during caesarean section under subarachnoid block. Settings and Design: Randomized controlled trial. Methods and Material: We performed a prospective randomized, controlled study on 142 pregnant patients undergoing elective cesarean section under subarachnoid block. Patients were randomly assigned to receive either 3U of intravenous oxytocin followed by infusion of 10U/hour for 4 hours or 100 μg intravenous carbetocin after the delivery of anterior shoulder. Heart rate and mean intra-arterial blood pressures were recorded at every 15 s during the study period of 5 min. Statistical Analysis Used: Data were analyzed using Student's unpaired test, Chi-squared test, and Fischer's exact test. A P < 0.05 was considered statistically significant. Results: Oxytocin produced clinically significant tachycardia (>20%) with peak effects over 180 s after injection (P < 0.0001). It also demonstrated a significant decrease in mean arterial pressure within 30 s of bolus injection and hypotension persisted throughout the study period (P < 0.0001). Carbetocin produced no significant changes in heart rate and mean blood pressure responses. The requirement of additional uterotonics and total intraoperative blood loss were similar among both the groups. Conclusions: Intravenous carbetocin is better tolerated without significant haemodynamic adverse effects in comparison to oxytocin during cesarean section.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49222098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/JOACC.JOACC_38_23
Heena Garg, Shashi Singh, Rashmi Ramachandran, A. Trikha
Takotsubo cardiomyopathy (TTCM) has been described as a new entity of cardiomyopathy at the turn of the century. Takotsubo, a Japanese word, denotes an “octopus pot,” a fishing jar that has a narrow neck and wide base for trapping an octopus. This correlates with the shape of the heart on left ventriculography with apical ballooning and basal hypokinesia. The first case was defined in 1990 by Sato et al. and a plethora of literature exists about TTCM ever since. While believed to be an occurrence in elderly postmenopausal females, various reports have been found in recent literature highlighting its occurrence during the antenatal, perinatal, and postpartum periods. It is high time that TTCM is kept in the purview of diagnosing acute cardiopulmonary symptoms in pregnancy. Only an accurate and timely diagnosis of TTCM in pregnancy can lead to an early intervention and prevent countless morbidities and mortalities. A multidisciplinary approach with psychological rehabilitation is recommended to prevent recurrence. We present a concise review of the diagnosis, clinical features and management of this condition and the salient differentiating features from peripartum cardiomyopathy (PPCM). We found 26 cases of TTCM and 16 cases of reverse TTCM. There is a void in knowledge about estrogen levels and the corresponding levels of catecholamines in due course of pregnancy. Future studies to correlate between declining estrogen levels and catecholamine levels at the onset of symptoms of TTCM need to be done to get more insights into this phenomenon.
{"title":"Takotsubo cardiomyopathy in pregnancy: A focused review","authors":"Heena Garg, Shashi Singh, Rashmi Ramachandran, A. Trikha","doi":"10.4103/JOACC.JOACC_38_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_38_23","url":null,"abstract":"Takotsubo cardiomyopathy (TTCM) has been described as a new entity of cardiomyopathy at the turn of the century. Takotsubo, a Japanese word, denotes an “octopus pot,” a fishing jar that has a narrow neck and wide base for trapping an octopus. This correlates with the shape of the heart on left ventriculography with apical ballooning and basal hypokinesia. The first case was defined in 1990 by Sato et al. and a plethora of literature exists about TTCM ever since. While believed to be an occurrence in elderly postmenopausal females, various reports have been found in recent literature highlighting its occurrence during the antenatal, perinatal, and postpartum periods. It is high time that TTCM is kept in the purview of diagnosing acute cardiopulmonary symptoms in pregnancy. Only an accurate and timely diagnosis of TTCM in pregnancy can lead to an early intervention and prevent countless morbidities and mortalities. A multidisciplinary approach with psychological rehabilitation is recommended to prevent recurrence. We present a concise review of the diagnosis, clinical features and management of this condition and the salient differentiating features from peripartum cardiomyopathy (PPCM). We found 26 cases of TTCM and 16 cases of reverse TTCM. There is a void in knowledge about estrogen levels and the corresponding levels of catecholamines in due course of pregnancy. Future studies to correlate between declining estrogen levels and catecholamine levels at the onset of symptoms of TTCM need to be done to get more insights into this phenomenon.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43233426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/JOACC.JOACC_69_22
Neelam Singhal, Amol Bansal, Rashmi Duggal
Background: In parturients undergoing lower segment cesarean section (LSCS) following spinal anesthesia hypotension is the most common side effect that may cause severe adverse effects in mothers such as nausea, vomiting, and dizziness. Very few studies have been done in the Indian population wherein multiple non-invasive hemodynamic parameters have been studied as predictors of hypotension following spinal anesthesia in parturients undergoing cesarean section. So we hypothesized that multiple non-invasive hemodynamic parameters like Perfusion Index (PI), Pleth Variability Index (PVI), and heart rate (HR) can predict hypotension following spinal anesthesia in parturients undergoing an elective cesarean section. Methods: We enrolled 40 parturients in this prospective observational study. Spinal anesthesia was performed with 10 mg of injection bupivacaine 0.5% (hyperbaric) at the L3–L4 or L2–L3 interspaces. Hypotension in parturient was defined as decrease in systolic blood pressure of greater than 20% from its baseline value. Baseline HR, PVI, and PI were recorded. Statistical analysis was performed using Unpaired t-test/Mann–Whitney test and Chi-Square test/Fisher's exact tests. Area under the receiver operating characteristic (ROC) curve (AUC) was used to determine the sensitivity, specificity, and the cut-off value for the parameters. Results: Hypotension occurred in 57.5% of the parturients. It was observed that only PI could predict the development of post spinal hypotension in parturients undergoing LSCS (AUC = 0.835, 95% confidence interval [CI] 0.684–0.933, P = 0.001). The analysis of ROC curve was done and a new cut-off value of PI of >2.58 was found with 100% sensitivity and 70.6% specificity for predicting post-spinal hypotension, which was highly statistically significant, P value <0.001. Conclusion: The baseline PI is a useful predictor for hypotension in parturients undergoing spinal anesthesia. Other non-invasive hemodynamic parameters, that is baseline HR and PVI, however, could not anticipate hypotension in these parturients.
{"title":"Non - Invasive hemodynamic parameters as predictors for hypotension following spinal anesthesia in parturients undergoing lower segment cesarean section: A prospective observational study","authors":"Neelam Singhal, Amol Bansal, Rashmi Duggal","doi":"10.4103/JOACC.JOACC_69_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_69_22","url":null,"abstract":"Background: In parturients undergoing lower segment cesarean section (LSCS) following spinal anesthesia hypotension is the most common side effect that may cause severe adverse effects in mothers such as nausea, vomiting, and dizziness. Very few studies have been done in the Indian population wherein multiple non-invasive hemodynamic parameters have been studied as predictors of hypotension following spinal anesthesia in parturients undergoing cesarean section. So we hypothesized that multiple non-invasive hemodynamic parameters like Perfusion Index (PI), Pleth Variability Index (PVI), and heart rate (HR) can predict hypotension following spinal anesthesia in parturients undergoing an elective cesarean section. Methods: We enrolled 40 parturients in this prospective observational study. Spinal anesthesia was performed with 10 mg of injection bupivacaine 0.5% (hyperbaric) at the L3–L4 or L2–L3 interspaces. Hypotension in parturient was defined as decrease in systolic blood pressure of greater than 20% from its baseline value. Baseline HR, PVI, and PI were recorded. Statistical analysis was performed using Unpaired t-test/Mann–Whitney test and Chi-Square test/Fisher's exact tests. Area under the receiver operating characteristic (ROC) curve (AUC) was used to determine the sensitivity, specificity, and the cut-off value for the parameters. Results: Hypotension occurred in 57.5% of the parturients. It was observed that only PI could predict the development of post spinal hypotension in parturients undergoing LSCS (AUC = 0.835, 95% confidence interval [CI] 0.684–0.933, P = 0.001). The analysis of ROC curve was done and a new cut-off value of PI of >2.58 was found with 100% sensitivity and 70.6% specificity for predicting post-spinal hypotension, which was highly statistically significant, P value <0.001. Conclusion: The baseline PI is a useful predictor for hypotension in parturients undergoing spinal anesthesia. Other non-invasive hemodynamic parameters, that is baseline HR and PVI, however, could not anticipate hypotension in these parturients.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47147029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/JOACC.JOACC_20_23
N. Puthenveettil, Sobha S. Nair, Fathima Chenganakattil, J. Paul
{"title":"Anesthetic management of a patient with uncorrected tetralogy of fallot's for postpartum sterilization","authors":"N. Puthenveettil, Sobha S. Nair, Fathima Chenganakattil, J. Paul","doi":"10.4103/JOACC.JOACC_20_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_20_23","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47244080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/JOACC.JOACC_16_23
Antima Phogat, Neeta Kavishvar
Spinal Induced Hypotension: Hypotension is one of the most common side effects of spinal anesthesia for lower segment cesarean section (LSCS). The most commonly used vasopressors for the treatment of spinal-induced hypotension (SIH) are phenylephrine, ephedrine, and norepinephrine. Aim: This study aimed to compare the efficacy of boluses of ephedrine and norepinephrine for the treatment of SIH in cesarean section. Methods and Material: A prospective observational study was conducted on 160 women undergoing elective and emergency cesarean section receiving spinal anesthesia with injection of bupivacaine heavily. Whenever hypotension (fall in systolic blood pressure (SBP) <20% from baseline value or SBP <80 mm Hg, whichever is less) occurred, either ephedrine (6 mg) or noradrenaline (6 μg) was given intravenous (IV) bolus as per the availability. Primary outcomes were maternal hemodynamic parameters, number of episodes of hypotension, requirement of bolus vasopressors, and Apgar score. Other outcomes were episodes of tachycardia, bradycardia, hypertension, and maternal side effects such as nausea, vomiting, shivering, and arrhythmia. Data analysis was performed with the help of Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 25. A P- value of <0.05 was considered statistically significant. Results: The mean SBP of both groups was comparable (P < 0.05). The mean heart rate (HR) was significantly higher in group E than in group N at 8 minutes and after till 60 minutes (P < 0.001). No statistical difference was found between the two groups in the Apgar score (P > 0.05). The mean dose requirement of ephedrine in group E was 1.94 and in group N was 2.04. Conclusions: Ephedrine (6 mg) and norepinephrine (6 μg) boluses are efficacious in treating hypotension after spinal anesthesia in obstetric patients. Norepinephrine appears to be favorable in view of HR than ephedrine.
{"title":"Comparison of norepinephrine with ephedrine boluses for the treatment of maternal hypotension during cesarean section under spinal anesthesia: A prospective observational study","authors":"Antima Phogat, Neeta Kavishvar","doi":"10.4103/JOACC.JOACC_16_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_16_23","url":null,"abstract":"Spinal Induced Hypotension: Hypotension is one of the most common side effects of spinal anesthesia for lower segment cesarean section (LSCS). The most commonly used vasopressors for the treatment of spinal-induced hypotension (SIH) are phenylephrine, ephedrine, and norepinephrine. Aim: This study aimed to compare the efficacy of boluses of ephedrine and norepinephrine for the treatment of SIH in cesarean section. Methods and Material: A prospective observational study was conducted on 160 women undergoing elective and emergency cesarean section receiving spinal anesthesia with injection of bupivacaine heavily. Whenever hypotension (fall in systolic blood pressure (SBP) <20% from baseline value or SBP <80 mm Hg, whichever is less) occurred, either ephedrine (6 mg) or noradrenaline (6 μg) was given intravenous (IV) bolus as per the availability. Primary outcomes were maternal hemodynamic parameters, number of episodes of hypotension, requirement of bolus vasopressors, and Apgar score. Other outcomes were episodes of tachycardia, bradycardia, hypertension, and maternal side effects such as nausea, vomiting, shivering, and arrhythmia. Data analysis was performed with the help of Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 25. A P- value of <0.05 was considered statistically significant. Results: The mean SBP of both groups was comparable (P < 0.05). The mean heart rate (HR) was significantly higher in group E than in group N at 8 minutes and after till 60 minutes (P < 0.001). No statistical difference was found between the two groups in the Apgar score (P > 0.05). The mean dose requirement of ephedrine in group E was 1.94 and in group N was 2.04. Conclusions: Ephedrine (6 mg) and norepinephrine (6 μg) boluses are efficacious in treating hypotension after spinal anesthesia in obstetric patients. Norepinephrine appears to be favorable in view of HR than ephedrine.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48985522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/JOACC.JOACC_68_22
Darshna Patel, Chintan Patel
Context: Spinal anesthesia using bolus dose of bupivacaine has rapid onset of action but it may precipitate hypotension, whereas fractionated dose will provide hemodynamic stability as well as prolong the duration of analgesia. Aims: We aimed to compare the hemodynamic stability as our primary objective and block characteristics and duration of effective analgesia as our secondary objectives. Methods: The study was carried out in eighty patients with ASA I or II undergoing elective lower segment caesarean section (LSCS) under spinal anesthesia after institutional ethical clearance. Patients were divided into two groups. Group B patients received spinal anesthesia with single bolus dose of bupivacaine heavy (0.5%) and Group F patients received fractionated dose with two-third of the total dose of bupivacaine heavy (0.5%) given initially followed by one-third dose after 90 seconds. Statistical Analysis Used: Time of onset and regression of sensory and motor blockage, intraoperative hemodynamics, and duration of analgesia were recorded and analyzed using student's t test. Results: Six patients in group F developed hypotension as compared to 16 patients in group B which were statistically significant (p < 0.05). There was statistically highly significant difference in duration of effective analgesia. It was longer for group F (338.25 ± 19.824 minutes), in comparison with group B (266.875 ± 19.861 minutes). Duration of sensory and motor block were also longer in group F as compared to group B (p < 0.0001). Conclusions: Fractionated dose of spinal anesthesia provides greater stability in terms of hemodynamic parameters and prolonged duration of analgesia as compared to bolus dose.
{"title":"Comparison of fractionated versus bolus dose of bupivacaine heavy (0.5%) in spinal anesthesia for elective caesarean section—A prospective, randomized, single blind, and clinical trial","authors":"Darshna Patel, Chintan Patel","doi":"10.4103/JOACC.JOACC_68_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_68_22","url":null,"abstract":"Context: Spinal anesthesia using bolus dose of bupivacaine has rapid onset of action but it may precipitate hypotension, whereas fractionated dose will provide hemodynamic stability as well as prolong the duration of analgesia. Aims: We aimed to compare the hemodynamic stability as our primary objective and block characteristics and duration of effective analgesia as our secondary objectives. Methods: The study was carried out in eighty patients with ASA I or II undergoing elective lower segment caesarean section (LSCS) under spinal anesthesia after institutional ethical clearance. Patients were divided into two groups. Group B patients received spinal anesthesia with single bolus dose of bupivacaine heavy (0.5%) and Group F patients received fractionated dose with two-third of the total dose of bupivacaine heavy (0.5%) given initially followed by one-third dose after 90 seconds. Statistical Analysis Used: Time of onset and regression of sensory and motor blockage, intraoperative hemodynamics, and duration of analgesia were recorded and analyzed using student's t test. Results: Six patients in group F developed hypotension as compared to 16 patients in group B which were statistically significant (p < 0.05). There was statistically highly significant difference in duration of effective analgesia. It was longer for group F (338.25 ± 19.824 minutes), in comparison with group B (266.875 ± 19.861 minutes). Duration of sensory and motor block were also longer in group F as compared to group B (p < 0.0001). Conclusions: Fractionated dose of spinal anesthesia provides greater stability in terms of hemodynamic parameters and prolonged duration of analgesia as compared to bolus dose.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49095654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/JOACC.JOACC_44_23
Unnati Bhatia, M. Hulgur, Jennifer Hannigan, Arul Nallapillai
Budd-Chiari syndrome, though rare, can have devastating consequences during pregnancy. The presence of varied anatomical and physiological changes in pregnancy can worsen this condition. Owing to the rarity of this condition, the understanding of this disease process is limited and still evolving. Due to the acute clinical manifestations, it would be prudent to keep a close watch on women with hepatic vascular events in the peripartum period. We describe the anesthetic management of a primigravida who suddenly deteriorated in the immediate postpartum period following an uneventful forceps delivery with a high vaginal tear repair under spinal anesthesia. The challenges faced, including difficulty in establishing a diagnosis, have been discussed.
{"title":"Acute onset budd-chiari syndrome in the postpartum period","authors":"Unnati Bhatia, M. Hulgur, Jennifer Hannigan, Arul Nallapillai","doi":"10.4103/JOACC.JOACC_44_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_44_23","url":null,"abstract":"Budd-Chiari syndrome, though rare, can have devastating consequences during pregnancy. The presence of varied anatomical and physiological changes in pregnancy can worsen this condition. Owing to the rarity of this condition, the understanding of this disease process is limited and still evolving. Due to the acute clinical manifestations, it would be prudent to keep a close watch on women with hepatic vascular events in the peripartum period. We describe the anesthetic management of a primigravida who suddenly deteriorated in the immediate postpartum period following an uneventful forceps delivery with a high vaginal tear repair under spinal anesthesia. The challenges faced, including difficulty in establishing a diagnosis, have been discussed.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46172096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/JOACC.JOACC_35_22
Swapnil Tuteja, Apoorva Gupta, S. Choudhary, Roshni Panwar, Rajeshwar Zala, Ravina R Bhokan
Background: Intrathecal magnesium sulfate is now emerging as a safe and effective adjuvant for spinal anesthesia (SA). The aim of the present study was to compare the efficacy of two doses of intrathecal magnesium in parturients with pre-eclampsia. Methods: This prospective randomized double-blind study was conducted on 105 parturients undergoing elective cesarean section (CS) who were randomized into three groups of 35 each: Group C, M50, and M75. Group M50 and group M75 received 50 mg of 50% (0.1 ml) and 75 mg of 50% (0.15 ml) magnesium sulfate, respectively. All of the groups received 10 mg of 0.5% heavy bupivacaine with normal saline accordingly to make a total volume of 2.2 ml. The sensory and motor block characteristics, visual analogue scale (VAS) score, post-operative analgesic requirements, hemodynamic parameters, and adverse effects were compared. Results: The sensory and motor block characteristics were significantly delayed in group M75 compared to group M50 and the control group (P < 0.05). VAS scores were significantly high in the control group up to 6 h as compared to group M50 and group M75 (P < 0.05). The time to first rescue analgesia was significantly extended in group M75 (222.86 ± 12.502 min) as compared to group M50 (221.14 ± 13.671 min) and the control group (127.43 ± 11.464 min) (P < 0.05). Conclusion: Intrathecal magnesium sulfate at doses of 50 mg and 75 mg in pre-eclamptic parturients undergoing elective CS results in prolonged duration of analgesia, decreased VAS scores and also delays the first rescue analgesic requirement with a favorable adverse effect profile in terms of decreased incidence of nausea and shivering.
{"title":"Comparison of two different doses of magnesium sulfate as an adjuvant to intrathecal bupivacaine in patients with pre-eclampsia undergoing elective cesarean section: A prospective double-blind randomized study","authors":"Swapnil Tuteja, Apoorva Gupta, S. Choudhary, Roshni Panwar, Rajeshwar Zala, Ravina R Bhokan","doi":"10.4103/JOACC.JOACC_35_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_35_22","url":null,"abstract":"Background: Intrathecal magnesium sulfate is now emerging as a safe and effective adjuvant for spinal anesthesia (SA). The aim of the present study was to compare the efficacy of two doses of intrathecal magnesium in parturients with pre-eclampsia. Methods: This prospective randomized double-blind study was conducted on 105 parturients undergoing elective cesarean section (CS) who were randomized into three groups of 35 each: Group C, M50, and M75. Group M50 and group M75 received 50 mg of 50% (0.1 ml) and 75 mg of 50% (0.15 ml) magnesium sulfate, respectively. All of the groups received 10 mg of 0.5% heavy bupivacaine with normal saline accordingly to make a total volume of 2.2 ml. The sensory and motor block characteristics, visual analogue scale (VAS) score, post-operative analgesic requirements, hemodynamic parameters, and adverse effects were compared. Results: The sensory and motor block characteristics were significantly delayed in group M75 compared to group M50 and the control group (P < 0.05). VAS scores were significantly high in the control group up to 6 h as compared to group M50 and group M75 (P < 0.05). The time to first rescue analgesia was significantly extended in group M75 (222.86 ± 12.502 min) as compared to group M50 (221.14 ± 13.671 min) and the control group (127.43 ± 11.464 min) (P < 0.05). Conclusion: Intrathecal magnesium sulfate at doses of 50 mg and 75 mg in pre-eclamptic parturients undergoing elective CS results in prolonged duration of analgesia, decreased VAS scores and also delays the first rescue analgesic requirement with a favorable adverse effect profile in terms of decreased incidence of nausea and shivering.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42605226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/JOACC.JOACC_12_22
C. Ali, J. Bajaj
Background: To compare the efficacy and safety of prophylactic intravenous infusions of phenylephrine (0.1 μg/kg/min) and norepinephrine (NE) (0.05 μg/kg/min) for the management of maternal hypotension under spinal anesthesia for cesarean delivery. Methods: A prospective randomized comparative interventional study was conducted on 100 pregnant patients who underwent elective/emergency cesarean section under the sub-arachnoid block. The study patients were randomly allocated into two equal groups comprising of Group P (n = 50): who received phenylephrine 0.1 μg/kg/min infusion prophylactically and Group N (n = 50): who received norepinephrine 0.05 μg/kg/min infusion prophylactically. The data of outcome measures were compared among the two groups by SPSS ver 21.0. Results: A significant difference was seen in the incidence of bradycardia between groups P and N (20% vs 4%, P value = 0.028). The blood pressure was significantly higher in Group N (systolic-120.5 vs 104 mm of Hg, P = 0.026; diastolic-66 vs 61 mm of Hg, P = 0.019). Group N patients had no complications whereas Group P patients experienced nausea (8%) and vomiting (4%), P = 0.027. Neonatal outcomes in terms of Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score and umbilical arterial/venous blood gases were similar among the two groups (P > 0.05). Conclusion: In conclusion, the study results show that NE is better in maintaining the hemodynamic parameters (BP and HR) during spinal anesthesia for cesarean delivery with minimal side effects. It can be suggested that NE may be advantageous in pregnancies especially those complicated with pregnancy-induced hypertension.
背景：比较预防性静脉输注苯肾上腺素（0.1μg/kg/min）和去甲肾上腺素（0.05μg/kg/min.）治疗剖宫产腰麻下产妇低血压的有效性和安全性。方法：对100例在蛛网膜下腔阻滞下进行选择性/紧急剖宫产的孕妇进行前瞻性随机对照干预研究。研究患者被随机分为两组，分别为P组（n=50）：预防性输注0.1μg/kg/min的苯肾上腺素。两组患者的结果测量数据采用SPSS版本21.0进行比较。结果：P组和N组的心动过缓发生率有显著差异（20%vs 4%，P值=0.028）。N组的血压显著升高（收缩度-120.5 vs 104 mm Hg，P=0.026；舒张度-66 vs 61 mm Hg，P=0.019），N组患者没有并发症，而P组患者出现恶心（8%）和呕吐（4%），P=0.027。两组新生儿在外观、脉搏、Grimace、活动和呼吸（APGAR）评分以及脐动脉/静脉血气方面的结果相似（P>0.05）。结论：总之，研究结果表明，NE在剖宫产腰麻期间更好地维持血液动力学参数（BP和HR），副作用最小。提示NE可能对妊娠有利，尤其是对合并妊娠高血压的妊娠有利。
{"title":"A randomised comparative study to compare the prophylactic use of phenylephrine and norepinephrine in caesarean delivery under spinal anaesthesia","authors":"C. Ali, J. Bajaj","doi":"10.4103/JOACC.JOACC_12_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_12_22","url":null,"abstract":"Background: To compare the efficacy and safety of prophylactic intravenous infusions of phenylephrine (0.1 μg/kg/min) and norepinephrine (NE) (0.05 μg/kg/min) for the management of maternal hypotension under spinal anesthesia for cesarean delivery. Methods: A prospective randomized comparative interventional study was conducted on 100 pregnant patients who underwent elective/emergency cesarean section under the sub-arachnoid block. The study patients were randomly allocated into two equal groups comprising of Group P (n = 50): who received phenylephrine 0.1 μg/kg/min infusion prophylactically and Group N (n = 50): who received norepinephrine 0.05 μg/kg/min infusion prophylactically. The data of outcome measures were compared among the two groups by SPSS ver 21.0. Results: A significant difference was seen in the incidence of bradycardia between groups P and N (20% vs 4%, P value = 0.028). The blood pressure was significantly higher in Group N (systolic-120.5 vs 104 mm of Hg, P = 0.026; diastolic-66 vs 61 mm of Hg, P = 0.019). Group N patients had no complications whereas Group P patients experienced nausea (8%) and vomiting (4%), P = 0.027. Neonatal outcomes in terms of Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score and umbilical arterial/venous blood gases were similar among the two groups (P > 0.05). Conclusion: In conclusion, the study results show that NE is better in maintaining the hemodynamic parameters (BP and HR) during spinal anesthesia for cesarean delivery with minimal side effects. It can be suggested that NE may be advantageous in pregnancies especially those complicated with pregnancy-induced hypertension.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42963503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/JOACC.JOACC_4_22
Y. Patil, Abhilasha D Motghare, Dhwani Walavalkar, I. Chincholi
Introduction: Placenta accreta is a general term, when part of the placenta or the entire placenta invades and is inseparable from the uterine wall. The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around 1 in every 20 such women. Resorption of the retained, poorly perfused placenta can be augmented by concurrent treatment with methotrexate when fertility is desired. In cases where operative measures are required, placement of Internal Iliac artery (IIA) balloons preoperatively and their inflation intraoperatively, reduces maternal morbidity and mortality. Materials and Methodology: We present a case series of 14 patients with placenta accreta diagnosed preoperatively, 7 of whom had IIA balloons placed before undergoing Caesarean section and 7 did not have such an intervention. The maternal and foetal morbidity and mortality were studied, including the need for blood and blood product transfusions. Results: Internal Iliac Balloon placements did not change the requirement for blood and blood product transfudion in both groups. The group who had IIA balloon placed preoperatively had better maternal and fetal outcome as compared to the group who had no such intervention.
{"title":"Retrospective observational case series of management of placenta accreta at tertiary care institution","authors":"Y. Patil, Abhilasha D Motghare, Dhwani Walavalkar, I. Chincholi","doi":"10.4103/JOACC.JOACC_4_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_4_22","url":null,"abstract":"Introduction: Placenta accreta is a general term, when part of the placenta or the entire placenta invades and is inseparable from the uterine wall. The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around 1 in every 20 such women. Resorption of the retained, poorly perfused placenta can be augmented by concurrent treatment with methotrexate when fertility is desired. In cases where operative measures are required, placement of Internal Iliac artery (IIA) balloons preoperatively and their inflation intraoperatively, reduces maternal morbidity and mortality. Materials and Methodology: We present a case series of 14 patients with placenta accreta diagnosed preoperatively, 7 of whom had IIA balloons placed before undergoing Caesarean section and 7 did not have such an intervention. The maternal and foetal morbidity and mortality were studied, including the need for blood and blood product transfusions. Results: Internal Iliac Balloon placements did not change the requirement for blood and blood product transfudion in both groups. The group who had IIA balloon placed preoperatively had better maternal and fetal outcome as compared to the group who had no such intervention.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47364253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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