Normal pregnancy is characterised by unique physiological changes. It is mandatory for an anaesthesiologist to understand these changes and their anaesthetic implications. Pregnancy-Induced Hypertension (PIH) is a disorder of unknown aetiology affecting 5-10% of all pregnancies characterised by the development of hypertension with proteinuria after 20 weeks of gestation. Hypertension is defined as sustained systolic pressure of at least 140 mmHg or a sustained diastolic pressure of at least 90 mmHg that occurs after 20 weeks of gestation in a woman with previously normal blood pressure. Maternal complications of severe pregnancy-induced hypertension include pulmonary oedema, intracerebral haemorrhage, and renal failure. Foetal complications include Intrauterine Growth Retardation (IUGR), perinatal mortality. Management of severe pregnancy-induced hypertension requires multidisciplinary approach. Definitive treatment consists of termination of pregnancy along with prevention of seizures and control of blood pressure. The drugs used in the control of blood pressure are oral anti-hypertensives like alpha-methyldopa and intravenous agents like hydralazine, labetalol, nitroglycerin, etc. Intravenous labetalol injection is a unique drug with both alpha and beta-adrenergic receptor blocking properties. It has both blood pressure and heart rate reducing properties. This makes it a good choice in treating high blood pressure in severe pregnancy-induced hypertension patients. AIM OF THE STUDYThe aim of this study is to find out and compare the efficacy of intravenous labetalol injection with the routinely used regimen of oral antihypertensives combination of tablet alpha-methyldopa and tablet nifedipine in the acute management of high blood pressure in severe pregnancy-induced hypertension patients. METHODSForty patients with severe PIH were randomly allocated to receive either inj. labetalol (Group L) (n=20) or oral antihypertensives combination namely Tab. nifedipine 10 mg and Tab. alpha-methyldopa 500 mg (Group A) (n=20). Administration of drugs with respect to Age, Gravid Status, Blood Pressure, Urine Albumin Levels, Side Effects, Drug Dosage, Additional Treatment, Prolongation of Pregnancy, Foetal monitoring, mode of termination, Indication of Caesarean Section, and APGAR Scores were studied. The statistical level of significance was taken at P <0.05. RESULTSOral antihypertensive combination of tablets alpha-methyldopa and nifedipine achieved blood pressure control that often necessitated intravenous nitroglycerin as rescue drug. Intravenous labetalol achieves adequate and faster blood pressure control with better heart rate maintenance than the routinely used oral antihypertensive combination. There was no difference in the groups with regard to obstetric intervention. Neonatal outcomes were same in both groups. CONCLUSIONIn conclusion, intravenous labetalol achieves adequate and faster blood pressure control with better heart rate maintenance than the routinely used oral antihypertensive combination of tablets alpha...

BACKGROUNDSubarachnoid block is a popular anaesthetic technique because of its rapid onset, safety and simplicity. A special technique of subarachnoid block named spinal hemi-block was described for one-limb surgeries, which was also known as spinal hemianalgesia or unilateral spinal anaesthesia. Addition of fentanyl to bupivacaine is an established technique to reduce the dose of anaesthetic and to maintain haemodynamic (1) stability. FACTORS AFFECTING UNILATERAL SPINALFive main factors should be considered when trying to restrict spinal block (2) to the operative side. 1. The density of local anaesthetic solution compared with CSF. AIMTo compare the efficacy of classical subarachnoid block using 0.5% bupivacaine, unilateral subarachnoid block using 0.5% bupivacaine and low-dose subarachnoid block using 0.5% bupivacaine 1.5 mL with 0.5 mL of fentanyl (2) (25 micrograms) in highrisk patients undergoing unilateral lower limb surgeries (6) based on the following parameters. 1. Haemodynamic stability in the intraoperative period. 2. Onset and Quality of subarachnoid block. MATERIALS AND METHODSA total of 60 high-risk patients undergoing surgery on one lower limb were divided into three groups. Control Group-Received 2 mL of 0.5% Bupivacaine intrathecally and turned to supine position immediately. Study Group I: Received 1.5 mL of 0.5% Bupivacaine with 25 µg (0.5 mL) Fentanyl intrathecally and kept in lateral decubitus position for 10 minutes and then turned supine. Study Group II: Received 2 mL of 0.5% Bupivacaine intrathecally and kept in lateral decubitus position for 10 minutes and then turned supine. Heart rate, Systolic and Diastolic blood pressure were recorded before and after the spinal every five minutes for 60 minutes and in the recovery room and thereafter every 30 minutes till the time oral analgesic was given. Sensory blockade was assessed in the dependent as well as non-dependent limb separately. Using Modified Bromage scale, both the dependent as well as non-dependent limbs were assessed separately for the motor blockade at 0, 5, 10, 15 and every 5 minutes after surgical position. Side effects such as nausea, vomiting, and pruritus were recorded in the intraoperative and postoperative period. RESULTSThe occurrence of hypotension requiring treatment was more in the control group (30%) versus Study Group I(15%) and Study Group II(15%) which is statistically significant(p<0.02). The occurrence of bradycardia requiring treatment was more in the Control group (30%) versus Study Group I(15%) and Study Group II(15%) which is statistically significant (p<0.02). An analysis of motor blockade in the 3 groups showed that Study Group I and Study Group II produced lesser degree of motor blockade when compared to the Control Group. This difference was found to be statistically significant (p<0.05). CONCLUSIONWe conclude that in high-risk patients undergoing unilateral lower limb surgeries: 1. Unilateral low-dose subarachnoid block offers better haemodynamic stability during the intraoperative period. 2. ...

BACKGROUNDInduction of general anaesthesia in children (1) is accomplished by either intravenous or inhalations route or rarely by the rectal route. The choice will depend on the anaesthetist's preference, the ease of venous puncture and the child's level of co-operation, sedation and clinical condition. Intravenous agents (2) are used more commonly than inhalational agents to induce anaesthesia, as induction is more rapid and smoother. Inj. Propofol and Inj. Thiopentone sodium are common intravenous induction agents in our hospital. The aim of the study was to compare the induction characteristics of Inj. Thiopentone and Inj. Propofol in premedicated children namely, 1. Onset time of induction of general anaesthesia. 2. Haemodynamic changes (3) during induction. MATERIALS AND METHODSThis prospective clinical study was conducted at Government Vellore Medical College, Adukkamparai, Vellore in 50 patients aged between 6 to 10 yrs. undergoing tonsillectomy and adenoidectomy. They were divided into 2 groups of 25 each. Group P: children who received propofol 3 mg/kg gas induction agent. Group T: children who received thiopentone (4) 5 mg/kg as induction agent. Preinduction and post-induction parameters like onset of induction time, blood pressure, heart rate, incidence of apnoea, etc. were recorded. In analysing the data student's 'L' test, chi-squared test with Yates correction for small numbers were used where appropriate. P value ≤ 0.01 is considered statistically significant. RESULTSThe mean age, weights and sex of the patients were similar in both groups. The mean induction time in Group P was 36.8±7.90 seconds and in Group T was 29±3.44 seconds and the difference is not statistically significant. In Group T, mean systolic pressure increased from 112±4.8 mmHg to 117±4.2 mmHg during the second minute and 99±3.2 mmHg at 10th minute. In Group P, mean systolic pressure reduced from 112±4.8 mmHg to 102±4.4 mmHg during the second minute and 91±2.8 mmHg at 10th minute and the reduction is statistically significant. Following induction and intubation, the mean diastolic pressure in Group T increased from 73±4.7 mmHg to 79±4.3 mmHg in the second minute and 62±3.2 mmHg in the 10th minute. In Group P, the mean diastolic pressure fell from 70±4.6 mmHg to 66±4.8 mmHg in the second minute and 58±2.2 mmHg in the 10th minute. The fall in mean diastolic pressure was greater in Group P, statistically significant (p < 0.01). Mean arterial pressure in Group T increased from 86±4.7 mmHg to 91±4.6 mmHg in the second minute. In Group P, the mean arterial pressure fell from 84±4.6 mmHg to 77±5.2 mmHg in the second minute. The fall in mean systolic pressure in Group P is statistically significant (P=0.01). The pre-induction mean pulse rate Group T was 110±4.5 per minute, while pre-induction mean pulse rate Group P was 116±4.7 per minute. The mean pulse rate in Group P reduced to 108±4.6 per minute in the second minute and gradually reached 100±4.4 per minute in 10 minutes. The mean pulse rate in Group T increased to 118±4.4 pe...