Journal of College of Medical Sciences-nepal, Dec 31, 2021
Introduction Hypotension is one of the most common complications associated with spinal anaesthes... more Introduction Hypotension is one of the most common complications associated with spinal anaesthesia. Maternal hypotension during caesarean section is more dangerous as it can compromise fetal outcome. Serotonin (5-HT3) has been found to induce Bezold Jarisch Reflex (BJR) causing bradycardia and hypotension in background of decreased blood volume. Ondansetron, a serotonin antagonist may play important role in prevention of spinal induced hypotension. The aim of this study is to determine the effect of intravenous ondansetron to prevent spinal induced hypotension during caesarean section. Methods A prospective randomised double blind study was done among singleton parturients scheduled for elective caesarean delivery under spinal anaesthesia from 2 nd July 2020 to 31 st October 2021 in College of Medical Sciences Teaching Hospital. One hundred and thirty patients were randomised by lottery method into two groups (group S and group O) each with 65 patients to receive either 4 mg of intravenous (IV) ondansetron diluted in 10 ml of normal saline or 10 ml of normal saline alone. Various haemodynamic parameters like systolic and diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation (Spo 2) and vasopressor requirement were compared between the two groups using SPSS 20. Student's t test and chi-square test were used for comparison of parametric and non-parametric data. Results Incidence of hypotension was 28 (43.07%) in saline group and 11 (16.92%) in ondansetron group. There were statistically significant differences in SBP, DBP and MAP at three, six, nine twelve, fifteen and eighteen minutes. Incidence of shivering was 15 (23.07%) in ondansetron while 28 (43.07%) in saline group which was statistically significant. No other benefit of ondansetron was observed in present study. Conclusions Prophylactic administration of IV ondansetron could significantly reduce the incidence of spinal induced hypotension during caesarean section.
Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotrac... more Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotracheal intubation. Laryngoscopy and endotracheal intubation cause exaggerated hemodynamic response which may be detrimental to hypertensive patients and those with cardiac issues. I-gel, a second generation supraglottic airway device mitigates this effect and can be safely used under general anesthesia. Methods: This was a prospective comparative study consisting of 64 patients undergoing laparoscopic surgery. The patients were divided into endotracheal tube group and I-gel group, each group with 32 patients, which was done according to convenience sampling method. Patient's baseline heart rate, systolic, diastolic and mean arterial blood pressure was recorded. These parameters were recorded at one, three and five minutes of placement of airway device, after creating caboperitonium and after extubation which were compared statistically. Results: Exaggerated hemodynamic response was observed in endotracheal tube group after endotracheal intubation and immediately after extubation as compared to I-gel group which were more stable. However, both the group had similar hemodynamic response during carboperitonium. Conclusions: I-gel can be safely used in laparoscopic surgeries under general anesthesia and also lessens the hemodynamic response as compared to endotracheal tube during laryngoscopy and intubation.
Introduction Hypotension is one of the most common complications associated with spinal anaesthes... more Introduction Hypotension is one of the most common complications associated with spinal anaesthesia. Maternal hypotension during caesarean section is more dangerous as it can compromise fetal outcome. Serotonin (5-HT3) has been found to induce Bezold Jarisch Reflex (BJR) causing bradycardia and hypotension in background of decreased blood volume. Ondansetron, a serotonin antagonist may play important role in prevention of spinal induced hypotension. The aim of this study is to determine the effect of intravenous ondansetron to prevent spinal induced hypotension during caesarean section. Methods A prospective randomised double blind study was done among singleton parturients scheduled for elective caesarean delivery under spinal anaesthesia from 2 nd July 2020 to 31 st October 2021 in College of Medical Sciences Teaching Hospital. One hundred and thirty patients were randomised by lottery method into two groups (group S and group O) each with 65 patients to receive either 4 mg of intravenous (IV) ondansetron diluted in 10 ml of normal saline or 10 ml of normal saline alone. Various haemodynamic parameters like systolic and diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation (Spo 2) and vasopressor requirement were compared between the two groups using SPSS 20. Student's t test and chi-square test were used for comparison of parametric and non-parametric data. Results Incidence of hypotension was 28 (43.07%) in saline group and 11 (16.92%) in ondansetron group. There were statistically significant differences in SBP, DBP and MAP at three, six, nine twelve, fifteen and eighteen minutes. Incidence of shivering was 15 (23.07%) in ondansetron while 28 (43.07%) in saline group which was statistically significant. No other benefit of ondansetron was observed in present study. Conclusions Prophylactic administration of IV ondansetron could significantly reduce the incidence of spinal induced hypotension during caesarean section.
Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotrac... more Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotracheal intubation. Laryngoscopy and endotracheal intubation cause exaggerated hemodynamic response which may be detrimental to hypertensive patients and those with cardiac issues. I-gel, a second generation supraglottic airway device mitigates this effect and can be safely used under general anesthesia. Methods: This was a prospective comparative study consisting of 64 patients undergoing laparoscopic surgery. The patients were divided into endotracheal tube group and I-gel group, each group with 32 patients, which was done according to convenience sampling method. Patient’s baseline heart rate, systolic, diastolic and mean arterial blood pressure was recorded. These parameters were recorded at one, three and five minutes of placement of airway device, after creating caboperitonium and after extubation which were compared statistically. Results: Exaggerated hemodynamic response was observ...
Introduction: Leaving Against Medical Advice (LAMA) can cause a state of dilemma among the treati... more Introduction: Leaving Against Medical Advice (LAMA) can cause a state of dilemma among the treating physician whether to continue the treatment or to de-escalate from the treatment. It can deteriorate the primary disease of the patient, leading to an increase rate of re-admission to the hospital, increased morbidity and mortality. This is a worldwide phenomenon and the prevalence of LAMA varies between various countries and between different region, religion, and the socioeconomic status of the patient in the same country.Methods: The hospital records from 1st December 2018 to 30th November 2019 of a tertiary care teaching hospital were studied. Patient demography, disease characteristics and length of ICU stay and the factors leading to LAMA were noted and statistically analysed.Results: During the study period, 14.5% of patients asked for LAMA. The mean age was 51.22 ± 22.39 years (range 8 months to 97 years) with Male predominance (n= 288, 62.60%) over Female (n= 172, 37.39%). Pa...
Journal of College of Medical Sciences-nepal, Dec 31, 2021
Introduction Hypotension is one of the most common complications associated with spinal anaesthes... more Introduction Hypotension is one of the most common complications associated with spinal anaesthesia. Maternal hypotension during caesarean section is more dangerous as it can compromise fetal outcome. Serotonin (5-HT3) has been found to induce Bezold Jarisch Reflex (BJR) causing bradycardia and hypotension in background of decreased blood volume. Ondansetron, a serotonin antagonist may play important role in prevention of spinal induced hypotension. The aim of this study is to determine the effect of intravenous ondansetron to prevent spinal induced hypotension during caesarean section. Methods A prospective randomised double blind study was done among singleton parturients scheduled for elective caesarean delivery under spinal anaesthesia from 2 nd July 2020 to 31 st October 2021 in College of Medical Sciences Teaching Hospital. One hundred and thirty patients were randomised by lottery method into two groups (group S and group O) each with 65 patients to receive either 4 mg of intravenous (IV) ondansetron diluted in 10 ml of normal saline or 10 ml of normal saline alone. Various haemodynamic parameters like systolic and diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation (Spo 2) and vasopressor requirement were compared between the two groups using SPSS 20. Student's t test and chi-square test were used for comparison of parametric and non-parametric data. Results Incidence of hypotension was 28 (43.07%) in saline group and 11 (16.92%) in ondansetron group. There were statistically significant differences in SBP, DBP and MAP at three, six, nine twelve, fifteen and eighteen minutes. Incidence of shivering was 15 (23.07%) in ondansetron while 28 (43.07%) in saline group which was statistically significant. No other benefit of ondansetron was observed in present study. Conclusions Prophylactic administration of IV ondansetron could significantly reduce the incidence of spinal induced hypotension during caesarean section.
Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotrac... more Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotracheal intubation. Laryngoscopy and endotracheal intubation cause exaggerated hemodynamic response which may be detrimental to hypertensive patients and those with cardiac issues. I-gel, a second generation supraglottic airway device mitigates this effect and can be safely used under general anesthesia. Methods: This was a prospective comparative study consisting of 64 patients undergoing laparoscopic surgery. The patients were divided into endotracheal tube group and I-gel group, each group with 32 patients, which was done according to convenience sampling method. Patient's baseline heart rate, systolic, diastolic and mean arterial blood pressure was recorded. These parameters were recorded at one, three and five minutes of placement of airway device, after creating caboperitonium and after extubation which were compared statistically. Results: Exaggerated hemodynamic response was observed in endotracheal tube group after endotracheal intubation and immediately after extubation as compared to I-gel group which were more stable. However, both the group had similar hemodynamic response during carboperitonium. Conclusions: I-gel can be safely used in laparoscopic surgeries under general anesthesia and also lessens the hemodynamic response as compared to endotracheal tube during laryngoscopy and intubation.
Introduction Hypotension is one of the most common complications associated with spinal anaesthes... more Introduction Hypotension is one of the most common complications associated with spinal anaesthesia. Maternal hypotension during caesarean section is more dangerous as it can compromise fetal outcome. Serotonin (5-HT3) has been found to induce Bezold Jarisch Reflex (BJR) causing bradycardia and hypotension in background of decreased blood volume. Ondansetron, a serotonin antagonist may play important role in prevention of spinal induced hypotension. The aim of this study is to determine the effect of intravenous ondansetron to prevent spinal induced hypotension during caesarean section. Methods A prospective randomised double blind study was done among singleton parturients scheduled for elective caesarean delivery under spinal anaesthesia from 2 nd July 2020 to 31 st October 2021 in College of Medical Sciences Teaching Hospital. One hundred and thirty patients were randomised by lottery method into two groups (group S and group O) each with 65 patients to receive either 4 mg of intravenous (IV) ondansetron diluted in 10 ml of normal saline or 10 ml of normal saline alone. Various haemodynamic parameters like systolic and diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation (Spo 2) and vasopressor requirement were compared between the two groups using SPSS 20. Student's t test and chi-square test were used for comparison of parametric and non-parametric data. Results Incidence of hypotension was 28 (43.07%) in saline group and 11 (16.92%) in ondansetron group. There were statistically significant differences in SBP, DBP and MAP at three, six, nine twelve, fifteen and eighteen minutes. Incidence of shivering was 15 (23.07%) in ondansetron while 28 (43.07%) in saline group which was statistically significant. No other benefit of ondansetron was observed in present study. Conclusions Prophylactic administration of IV ondansetron could significantly reduce the incidence of spinal induced hypotension during caesarean section.
Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotrac... more Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotracheal intubation. Laryngoscopy and endotracheal intubation cause exaggerated hemodynamic response which may be detrimental to hypertensive patients and those with cardiac issues. I-gel, a second generation supraglottic airway device mitigates this effect and can be safely used under general anesthesia. Methods: This was a prospective comparative study consisting of 64 patients undergoing laparoscopic surgery. The patients were divided into endotracheal tube group and I-gel group, each group with 32 patients, which was done according to convenience sampling method. Patient’s baseline heart rate, systolic, diastolic and mean arterial blood pressure was recorded. These parameters were recorded at one, three and five minutes of placement of airway device, after creating caboperitonium and after extubation which were compared statistically. Results: Exaggerated hemodynamic response was observ...
Introduction: Leaving Against Medical Advice (LAMA) can cause a state of dilemma among the treati... more Introduction: Leaving Against Medical Advice (LAMA) can cause a state of dilemma among the treating physician whether to continue the treatment or to de-escalate from the treatment. It can deteriorate the primary disease of the patient, leading to an increase rate of re-admission to the hospital, increased morbidity and mortality. This is a worldwide phenomenon and the prevalence of LAMA varies between various countries and between different region, religion, and the socioeconomic status of the patient in the same country.Methods: The hospital records from 1st December 2018 to 30th November 2019 of a tertiary care teaching hospital were studied. Patient demography, disease characteristics and length of ICU stay and the factors leading to LAMA were noted and statistically analysed.Results: During the study period, 14.5% of patients asked for LAMA. The mean age was 51.22 ± 22.39 years (range 8 months to 97 years) with Male predominance (n= 288, 62.60%) over Female (n= 172, 37.39%). Pa...
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