No abstract

BACKGROUND Subarachnoid block has been widely used for caesarean sections and is found to be safe. Hypotension being the most common complication may adversely affect both the mother and foetus. Different measures used to treat this hypotension include preloading with crystalloids/colloids and treatment with vasopressors. The standard choice of vasopressor agents such as ephedrine and phenylephrine is still a controversial issue. It is therefore important to compare the efficacy of the two drugs in the prevention and treatment of maternal hypotension after subarachnoid block and particularly assess their effect on the foetus. The purpose of this study was to assess and compare the foetal acid-base status and APGAR score following administration of bolus dose of ephedrine or phenylephrine that was given intravenously for maintenance of arterial blood pressure during lower segment caesarean section (LSCS) under a subarachnoid block. METHODS 100 parturients (18 to 35 years) scheduled for elective caesarean section under subarachnoid block were selected and divided into two groups of 50 each. Group P received 50 mcg i.v bolus of phenylephrine and Group E received 6 mg of ephedrine IV bolus whenever the blood pressure dropped 20 % from baseline or systolic blood pressure ˂ 90 mmHg. Haemodynamic parameters were measured in all patients. APGAR scores at 1 and 5 minutes following delivery of baby were assessed and cord blood was obtained for acid-base status analysis immediately following delivery. RESULTS Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure did not show any significant difference between the two groups, however, Group E showed higher heart rates. The difference in umbilical artery pH (P-value < 0.001) and base excess (P-value = 0.004) was statistically significant with Group E showing lower pH and higher base excess values than Group P. There was no statistically significant difference in neonatal APGAR scores between the two groups. CONCLUSIONS Phenylephrine and ephedrine are equally efficient in managing hypotension during subarachnoid block for caesarean delivery. Thus, either vasopressor can be used although phenylephrine may be a better choice. KEY WORDS Caesarean Section, Phenylephrine, Ephedrine.

No abstract

In the practice of paediatric anaesthesia, intubation of trachea without using neuromuscular blocking agents is becoming commoner more so in conditions in which muscle relaxants are not preferred. Different combinations of drugs including opioids, intravenous agents and inhalational agents are being used for facilitating endotracheal intubation when muscle relaxants are not used. In this study we compared intubating conditions in paediatric patients after sevoflurane induction and propofol in two different doses. Materials and Methods: 80 children of 2 to 12 years age undergoing elective surgeries were divided into two groups P2 and P3 of 40 each. After sevoflurane induction and fentanyl 2mcg/kg I.V. group P2 received propofol 2mg/kg and group P3 received propofol 3mg/kg I.V. The two groups were compared with respect to intubating conditions and haemodynamic parameters. Results: Clinically acceptable intubating conditions were seen in all patients in both groups. Excellent intubating conditions were more in group P3 (87.5%) than group P2 (80%). Haemodynamic parameters showed no significant difference between the two groups. Conclusion:In paediatric patients, endotracheal intubation can be comfortably performed without muscle relaxants by using propofol and fentanyl with sevoflurane induction with no respiratory or haemodynamic adverse events. Propofol in a dose of 3mg/kg gives better intubating conditions than 2mg/kg without adverse haemodynamic effects, although 2mg/kg propofol also gives acceptable intubating conditions.