Background: Regional anesthesia is being utilized as the preferred anesthetic technique for cesarean delivery worldwide. This study was performed to review cesarean delivery anesthetic practice in our institute which represents a tertiary care regional hospital. Methods: Data was collected regarding the number of cesarean delivery performed during the period of six months from January 2017 to June 2017 at Western Regional Hospital. Number of elective versus emergency cesarean delivery, mode of anesthesia and the reason for general anesthesia and complications was recorded. Results: The number of cesarean delivery was found to be 1174(26.41%) of total deliveries during the study period. Out of which, 64.82% were for emergency indication and 35.18% were elective cesarean delivery. Spinal anesthesia was utilized in 99.03% of elective cesarean section and 97.63% of emergency cesarean section. The percentage of cases performed under general anesthesia was 1.87%. Reasons for general anesthesia included inadequate subarachnoid block, fetal malpresentation, eclampsia and maternal comorbidities. Complications related to general anesthesia like failed intubation, airway difficulty related to general anesthesia and anesthesia related mortality was not encountered. Conclusion: Spinal anesthesia is utilized widely and safely in obstetric practice at our hospital. Use of labour epidural analgesia should be introduced and encouraged in our setting to minimize the side effects of single shot spinal anesthesia and to avoid general anesthesia when indicated.

Background: Monitored anaesthesia care is a specific anaesthesia service for diagnostic or therapeutic procedures performed under local anaesthesia along with sedation and analgesia titrated to a level with the provision to convert into general anaesthesia when required. We conducted a retrospective study to determine patient satisfaction in middle ear surgery under monitored anaesthesia care. Materials and Methods: The number of patients undergoing middle ear surgery under monitored anaesthesia care, over a period of one year were included. They received sedation with midazolam 0.02 mg/kg and fentanyl 1 mcg/kg along with local anaesthetic infiltration. Patient’s satisfaction was measured using a five point Likert scale. Intraoperative pain, nausea, vomiting and other discomforts were inquired. Results: The total number of patients was 64. Fifty-one patients (79.7%) were satisfied, 10 were neutral (15.6%) and 3 patients (4.7%) were dissatisfied with the technique. Earache (4.7%), followed by dizziness (3.1%) and bodyache (3.1%) were the most common cause of discomfort. Nausea occurred in 6 patients (9.4%) and vomiting in 5 patients (7.8%). Conclusion: Middle ear surgeries can be performed under monitored anaesthesia care with good patient satisfaction.

Background: Dreaming during anaesthesia is a common phenomenon. Dreams can occur with both inhalational agents as well as intravenous agents (IVA) like propofol and ketamine. But there are concerns like patient awareness, dreams and other untoward effects that may be associated with IVA. We have conducted this study to quantify the incidence of dreaming during IVA with propofol or ketamine. Methods: Sixty-nine patients aged 18 to 60 years scheduled for short procedures lasting from 5 to 25 minutes under IVA were randomized into two groups – group propofol or group ketamine. All the patients received midazolam and fentanyl intravenously. Then, patients in group propofol received propofol and those in ketamine group received ketamine for induction and maintenance of anaesthesia. After the end of surgery, when the patient were fully recovered from anaesthesia, patients were interviewed about occurrence of dreams and their ability to recall the dreams. Results: There were 35 patients in group propofol and 34 patients in group ketamine. The incidence of dreaming during anaesthesia was greater in patients of ketamine group, 23 (67.65%), when compared to propofol group, 7 (20%) (p < 0.001). Among the dreamers, 6 patients in the ketamine group and only 1 patient in the propofol group were able to recall their dream. Conclusion: Dreaming is quite common during IVA for short surgical procedure, more so following ketamine than propofol anaesthesia.

Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded.Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) andApgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion:In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.