The results support the findings of previously published studies postulating ropivacaine to be 40-50% less potent for labour epidural analgesia compared to bupivacaine. However, we observed an increased frequency of instrumental deliveries with ropivacaine. To evaluate the clinical relevance of these findings, further investigations are warranted.

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Background: Thrombocytopenia may result from mechanisms such as marrow hypoplasia, increased destruction of platelets, and splenic sequestration. The gold standard method for discriminating the causes of thrombocytopenia is bone marrow examination, but it is invasive and expensive. Therefore, an alternative method should be introduced as a first-line diagnostic procedure. Of late, the automated blood cell analyzer has made it possible to assess the cause of thrombocytopenia through various machine-derived parameters, known as platelet indices, which include the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), which are provided as a part of routine complete blood count. Objectives: The objectives of the present study are to study the variation and effectiveness of platelet indices in establishing the etiology of thrombocytopenia. Method: An observational, prospective, and comparative study was conducted on 134 patients with thrombocytopenia, and 67 cases were taken as the normal group. The study group was classified into two groups: hypo-productive and hyper-destructive. Platelet indices were recorded and compared in the two groups along with the normal group. Results: The mean platelet count (10^3 μL) in the normal, hypo-productive, and hyper-destructive groups was 232.03 ± 74.84, 73.00 ± 36.52, and 68.28 ± 38.24, respectively. The MPV and mean PCT in the normal, hypo-productive, and hyper-destructive groups were 9.46 ± 1.68fL, 8.99 ± 1.49fL, and 11.35 ± 1.35fL and 0.22 ± 0.06%, 0.07 ± 0.04%, and 0.08 ± 0.05%, respectively. The mean PDW in the normal, hypo-productive, and hyper-destructive groups was 15.66 ± 1.76fL, 17.63 ± 1.01fL, and 18.32 ± 1.10fL, respectively. Conclusion: In the present study, platelet indices such as MPV, PCT, and PDW are higher in the hyper-destructive group and may discriminate hyper-destructive from hypo-productive causes of thrombocytopenia.

IntroductionPatients undergoing neurosurgery are at risk of significant blood loss and resulting hemodynamic changes. In case of sudden blood loss, volume of blood in arteries is maintained at expense of that in veins, manifesting as low central venous pressure (CVP) 1 associated with tachycardia initially and, a fall in arterial pressure is a late sign of hypovolemia. Monitoring of CVP is, therefore, of great assistance during hypovolemia.CVP is the pressure within the intrathoracic venae cavae, measured by insertion of catheter via the internal jugular or subclavian vein, which is normally equal to the right atrial pressure, unless there is obstruction in the venae cavae. The value used in clinical practice is the pressure recorded at the base of c-wave, at the end of expiration, while the subject is supine. This represents the pressure in the right atrium immediately before the start of ventricular systole. 2 CVP is often used to estimate right ventricular preload, which 15Background and Objectives Central venous pressure (CVP) and peripheral venous pressure (PVP) are strongly correlated during various surgeries. This study was designed to examine the consistency of CVP-PVP relationships in circumstances of rapidly fluctuating hemodynamics in neurosurgical patients. Prime objective of this study was to determine if PVP can be an effective alternative to invasive CVP for assessing volume status during neurosurgical procedures when expertise, equipment, and patient's condition contraindicate invasive monitoring. Subjects and Methods After the approval by the Institutional Ethics Committee, CVP and PVP were measured in 50 neurosurgical patients of the American Society of Anesthesiologists grade I and II operated in supine position. Paired measurements of CVP and PVP were made every 20 minutes, from the starting of anesthesia until the end of surgery; however, in situations of hemodynamic instability, the readings were taken every 5 minutes of interval. Results The study showed a strong correlation between CVP and PVP (Pearson's correlation coefficient between CVP and PVP, r = 0.89; 95% CI: 0.81-0.93; p < 0.001). Mean CVP was 5.7 ± 0.8 mm of Hg, mean PVP was 10.4 ± 0.6 mm of Hg, and bias between CVP and PVP was 4.7 ± 0.4 (95% CI: − 4.61 to − 4.83). The Bland-Altman analysis showed that limit of agreement to be 4.0 to 5.5 mm of Hg. Conclusion This study demonstrated a strong correlation between CVP and PVP. Therefore, PVP monitoring may be a reliable alternative to CVP monitoring during neurosurgery.