Objective To explore the clinical and programmatic feasibility of using 800 μg of sublingual misoprostol to prevent and treat postpartum hemorrhage (PPH) during home delivery. Methods The present double‐blind randomized controlled trial included women who underwent home deliveries in Chitral district, Khyber Pakhtunkhwa province, Pakistan, after presenting at healthcare facilities during the third trimester of pregnancy between May 28, 2012, and November 27, 2014. Participants were randomized in a 1:1 ratio to receive either 800 μg of misoprostol or placebo sublingually if PPH was diagnosed, having previously received a prophylactic oral dose of 600 μg misoprostol. The primary outcome, hemoglobin decrease of 20 g/L or greater from pre‐ to post‐delivery assessment, was compared on a modified intention‐to‐treat basis. Results There were 49 patients allocated to receive misoprostol and 38 allocated to receive placebo; the incidence of a 20 g/L decrease in hemoglobin was similar between the groups (20/43 [47%] vs 19/33 [58%], respectively; P=0.335). Conclusion There was no significant difference in clinical outcomes between the two trial arms. ClinicalTrials.gov:NCT01485562.

OBJECTIVES:The purpose of present study was to evaluate the reliability of central venous blood gas monitoring as an alternative to arterial blood gas monitoring and to assess that the central venous catheter is convenient and reliable source of blood for repetitive measurement of pH bicarbonate and PCO2 in critically ill patients admitted in surgical intensive care unit (SICU). METHODS:We took one hundred patients who required ABG analysis between 20-60 years of age. The cases were divided in four groups which constituted major admissions in SICU in one year. Out of one hundred patients for the study there were 19 Poisoning patients, 15 Trauma patients, 40 Major abdominal surgery patients, 26 Hypovolemic shock patients and others. Central Venous blood drawn within 5 min of an ABG measurement and the samples analyzed immediately on automated ABG analyzer were compared. RESULTS: Bland Altman plots demonstrated a high degree of agreement between the two corresponding sets of measurements of arterial and venous blood with coefficient of correlation 0.979 for pH. The coefficient of correlation was highly positive i.e. 0.926 for PCO2 and 0.955 for HCO3 -which is statistically significant. There was also positive correlation for saturation between arterial and venous blood i.e. 0.57 with clinically acceptable difference and is statistically significant. The difference in pO2 measurements was however higher with correlation coefficient of 0.259 although the arterial saturation and finger oximetry reveals a good degree of agreement with clinically acceptable bias. CONCLUSION: Venous blood gas (VBG) analysis clearly does not replace ABG analysis in determining exact pO2 status and arterial puncture may still be required for invasive arterial BP monitoring. With positive correlation and regression plots obtained, venous samples can be used as an alternative to arterial samples depending on the significant positive correlation values obtained for each parameter separately. Given the well accepted accuracy of pulse oximetry, VBG analysis may be a safer alternative to ABG analysis for determining acid-base status.

Ropivacaine has recently been introduced in Indian pharmacopeia. Ropivacaine, the S-enantiomer of Npropylpipecolic acid 2,6-xylidine, is an amide local anaesthetic 1 that is less cardio toxic than bupivacaine. Like other local anaesthetics ropivacaine elicits nerve block via reversible inhibition of sodium ion influx in nerve fibres. It has lower lipid solubility and is less likely than bupivacaine to penetrate large myelinated motor fibres. The degree of ropivacaine induced 2,3 sensory and motor block are dose and age dependant. Ropivacaine presumably produces less central nervous toxicity 2,3 and cardiac toxicity than bupivacaine. It blocks C-fibres faster than A fibers, but the blockade of A fibers is less with ropivacaine than a similar concentration of bupivacaine, whereas the degree 4,5 of C-fibre block was similar with both drugs. The analgesic potency of ropivacaine is similar to that of bupivacaine while 6,7 motor block is less pronounced and of shorter duration. This study was designed in a randomized double blind fashion to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower extremity and lower abdominal surgeries.BACKGROUND: Ropivacaine, a derivative of mepivacaine like its older counterpart Bupivacaine, has recently been introduced in Indian pharmacopeia. Ropivacaine is an amide local anaesthetic but less cardiotoxic than bupivacaine. OBJECTIVE: To compare the clinical effectiveness of ropivacaine versus bupivacaine in patients undergoing lower extremity and lower abdominal surgeriesMETHODS: 50 patients were randomized to receive 20ml of 0.5% ropivacaine or 0.5% bupivacaine through epidural catheter. Sensory (pinprick) and motor (bromage) measurements were made while the block was in effect, haemodynamic changes; use of additional analgesics and sedatives was noted. RESULTS:The quality and extent of sensory and motor blockade between the two groups was comparable, although bupivacaine was found to be slightly longer acting. Both had similar motor blocking characteristics, with the exception that bupivacaine had a blockade of slightly longer duration but statistically not significant (p>0.05). CONCLUSION:Ropivacaine being lesser cardio toxic is the preferred agent for clinical epidural anaesthesia. JMS 2011;14(1):15-18

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Background: Gabapentin, an antiepileptic has over the years been used as an analgesic. It is known to have opioid sparing properties thereby reducing the use of narcotic analgesic in the perioperative period. Method : 50 patients each of ASA I-II were randomly allocated to two study groups-one group received gabapentin (1200mg) and other group received placebo 1 hour prior to surgery. Both groups received morphine (0.1mg/kg) as intraoperative analgesic at induction of anaesthesia. After the completion of mastectomy postoperative analgesia was assessed with visual analogue scale (VAS) method (0cm-no pain and 10cm-worst possible pain). Rescue analgesic was administered to patients whose VAS was above 3 (morphine 0.1mg/kg).Apart from VAS haemodynamic parameters and oxygen saturation were regularly recorded half hourly for first two hours, then hourly for next 4 hours and then 2 hourly till the patient requested for analgesia postoperatively. Result : There was a statistically significant difference (p < 0.05) among the two groups as regards the intraoperative and postoperative heart rates. Systolic blood pressure showed significant variation (p < 0.05) among the two groups. Conclusion : Prophylactic use of oral gabapentin prior to surgery reduced the incidence of pain and significant degree of analgesia was achieved in such patients as compared to placebo group. Prophylactic use of oral gabapentin before mastectomy reduced the overall consumption of morphine as well as incidence of postoperative pain.