Original Article IntroductionT he control of pain should forms an integral part of the management of labour, yet pain relief in labour is a controversial subject. Pregnant woman have a right to basic information about pain and its relief in labour. Labour analgesia, is rapidly catching up in the Armed Forces, and it would still be a while, before all women in labour are offered this service. Amongst the various modalities of pain relief in labour, epidurals have gained popularity. The aim of this study was to compare a relatively less utilised opioid, butorphanol with the timetested fentanyl in epidural labour analgesia. MethodThe study was approved by our hospital ethics committee and informed consent was obtained from each patient. 64 women with American Society of Anaesthesiologists physical status I and II, between the ages of 18 and 40 years who opted for epidural labour analgesia were enrolled. Participants had singleton pregnancy of greater than 36 weeks of gestation with vertex presentation. All women were in active labour with cervical dilatation of 3 to 5 cm at the time of epidural catheter placement. The women had a pre dose Visual Analog Score (VAS) for labour pain of ≥ 30mm measured on two occasions, when two consecutive uterine contractions occurred.Patients with known hypersensitivity to local anaesthetics, neurologic, neuromuscular or psychiatric disorders, blood dyscrasias, weight greater than 110 kg, height less than 144 cm, cephalopelvic disproportion, known foetal abnormalities or multiple pregnancy were excluded from the study.Randomisation was done by the toss of a coin and patients were allocated to two groups. The first group (n=32) received 15ml of 0.1% bupivacaine with 0.1mgml -1 butorphanol (1.5mg) and the second group (n=32) received 15ml of 0.1% bupivacaine with 2μgml -1 of fentanyl. The patient and anaesthesiologist were blind to the drug combination, which was prepared by a trained assistant.All patients were started on an intravenous infusion of ringer lactate. An 18 gauge epidural catheter was placed 3 to 4 cm inside the epidural space via an 18-gauge Tuohy epidural needle at the L2-3 or L3-4 level. If there was any evidence of entry into an epidural vein or cerebrospinal fluid the patient was excluded from the study. After negative aspiration, a bolus of 15 ml of either drug was given over 5 minutes. A test dose was omitted.The efficacy of the drug was assessed using a 100 mm visual analogue scale, where 0 represented no labour pain and 100 represented the worst possible pain, at five minute intervals and during contractions for the first 20 min, at 20 minute intervals for the first hour, at 30 minute intervals for the next hour, and hourly thereafter, till the end of labour or when patient complained of pain. -1 of fentanyl. Results: The times of onset and offset of analgesia were comparable. More patients of the butorphanol group were sedated but arousable. The patient satisfaction levels were good in both groups and APGAR scores were comparable. Conclusion: Butorphanol and fe...

A 20 G intravenous (IV) cannula was started. Inj metoclopramide 10mg and inj ranitidine 50mg IV were administered half an hour before the procedure. Inj glycopyrollate 0.2 mg, inj midazolam 1mg and inj pethidine 20mg IV were given prior to induction. The patient was induced with inj propofol 150mg IV and maintained with 50% Oxygen and Nitrous oxide administered via a facemask. Isoflurane in concentrations ranging from 0.6 to 1% was used as the inhalational anaesthetic agent. Positioning the patient in the lithotomy position was difficult due to the over all stiffness. A paediatric size Sims speculum had to be used. The cervical os was restrictive and dilatation was performed with difficulty. 10 units of inj pitocin in 500ml Ringer Lactate (RL) was infused IV at 20 drops per minute. Recovery was uneventful.The arterial pressure, ECG and capnograph were monitored continuosly. Pulseoximetry was impossible due to involvement of fingers and toes in the disease process. Extremities were warmed with blankets, "Gamgee" pads and hot water bags. Warm IV fluids were infused. The air conditioner of the OT was switched off. A heat convector was used to increase the ambient temperature.

A 20 years old ASA I full term primigravida in labor, underwent an emergency lower segment cesarean section under spinal anesthesia, the indication being fetal distress. Immediately following delivery of fetus, she complained of severe breathlessness and suffered a cardiovascular collapse. A presumptive diagnosis of high spinal anesthesia was made and she was managed accordingly. Thirty minutes later she developed angioedema which increased in severity over the next two hours and a diagnosis of anaphylactic reaction was made. The patient responded to intravenous adrenaline and recovered over next 24 hours. The aim of this case report is to discuss cardiovascular collapse and its etiological factors, such as anaphylaxis, amniotic fluid embolism and high spinal anesthesia during cesarean section.

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This is a case report of a 29 years old primigravida who at 32 weeks of gestation presented with severe pain abdomen and backache. She had a massive concealed placental abruption that led intrauterine fetal death. Due to the progressively deteriorating maternal condition a cesarean section was performed under general anesthesia to deliver the dead fetus. After five days the patient developed acute respiratory failure and needed mechanical ventilation. The common causes of respiratory failure associated with pregnancy are discussed.