Online ISSN: 2515-8260

Keywords : hypotension


The Effect Of Prophylactic IM Inj.Glycopyrrolate In Pregnant Patients For Prevention Of Hypotension Under Spinal Anaesthesia Posted For Lscs”

Dr BHAVINI SHAH, Dr. JAYALAKSHMI MOHAN

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 766-774

Delivery by caesarean section has become very common nowadays.Lower segment caesarean sections (LSCS) are now commonly performed using spinal anaesthesia. In parturients, hypotension is aggravated by compression of the inferior vena cava by gravid uterus. Its incidence has been reported as high as 40-70% and affects 90% women. For reducing the severity of maternal hypotension, many pharmacological and non-pharmacological methods are employed.
Glycopyrrolate,an anticholinergic drug with a quaternary amine structure that limits its ability to cross the blood-brain barrier and placenta and therefore has no effect on the variability of foetal heart rate (FHR) and maternal heart rate (HR).During spinal anaesthesia glycopyrrolate is expected to attenuate hemodynamic changes which makes it a popular choice for obstetric patients.

Impact of RUSH protocol in post-cardiac surgery patients in ICU: A prospective study

Dr. Anandteerth R Mathad, Dr. Rohit Ramesh, Dr. Jagadish B Alur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 191-195

RUSH (Rapid Ultrasound in Shock) Protocol is an easily learned and quickly performed shock ultrasound protocol, involving a 3-part bedside physiologic assessment of cardiovascular system simplified as “the pump,” “the tank,” and “the pipes.” Data was collected including demographics, admission diagnosis, surgery, triggers (indications) for RUSH protocol, hemodynamic parameters, time from ICU admission to applying RUSH protocol in hours, conclusion of RUSH protocol and interventions applied. Most common trigger (indication) for RUSH protocol was hypotension (87%), followed by drop in urine output (15%), peripheral signs of shock (13%), drop in haematocrit (11%), altered mental state (4%). More than one trigger were present in 35% of patients, most of which were CABG patients (68%).

A study of clinical profile of community acquired pneumonia at a tertiary care hospital

Dr. Sireeshkumar CH; Dr. Vilas Honnakatti; Dr. Pratap Budhya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 1453-1458

Causes of CAP include bacteria, viruses, fungi, and parasites. After achieving a correctdiagnosis,thesecondstepistodefineifthepatientwill receive outpatient treatment or hospitalization. Ours was a clinical, prospective, observational and open study. The study subjects were community acquired Pneumonia patients admitted with signs and symptoms suggestive of Pneumonia. After obtaining a detailed history, complete general physical examination and clinical examination the patients were subjected to relevant investigations. The complete data was collected in specially designed case recording form and transferred into a Master chart which is then subjected to statistical analysis.We studied 100 cases of Pneumonia, out of which 5 patients presented with Confusion, 69 patients presented with raised Blood Urea Nitrogen,11 patients with raised Respiratory rate, and 9 patients with Hypotension. CURB AGE score of 0 was observed in 26 patients, score 1 in 22 patients, score 2 in 24 patients, score 3 in 20 patients, score 4 in 2 patients, score 5 in 4 patients and score 6 in 2 patients. Prognosis was good in patients aged less than 50 years and those without any comorbidity. Fever was the most common symptom of presentation.

Analysis of mephentermine and intravenous norepinephrine for maintenance of blood pressure during spinal anaesthesia for caesarean section

Dr.Pawan Agrawal, Dr.Shalini Agrawal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 1090-1095

Background: Regional anaesthesia for caesarean delivery is associated with a high incidence of maternal hypotension and may result in fetalacidaemia due to decreased uteroplacental blood flow. The present study was compared mephentermine and intravenous norepinephrine for maintenance of blood pressure during spinal anaesthesia for caesarean section.
Materials & Methods: 80parturients scheduled for elective caesarean section under subarachnoid blockwere divided into 2 groups of 40 each. Group I received 6 mg mephentermine for SAIH and group II received8 µg boluses of intravenous norepinephrine. Parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), Apgar score and maternal complications were recorded.
Results: Group I received 6 mg mephentermine for SAIH and group II received8 µg boluses of intravenous norepinephrine. The mean age in group I was 24.7 years and in group II was 25.2 years, height was 152.2 cm in group I and 156.8 cm in group II, weight was 62.8 kgs in group I and 63.2 kgs in group II, duration of surgery was 45.2 minutes in group I and 46.8 minutes in group II, APGAR score at 1st minute was 7.28 in group I and 7.24 in group II and at 5 minutes was 9.05 in group I and 9.04 in group II. The number of requirement of doses were 1 time seen in 15 in group I and 4 in group II, 2 times seen 14 in group I and 11 in group II, 3 times seen 8 in group I and 13 in group II, 4 times seen 3 in group I and 5 in group II, 5 times seen 0 in group I and 4 in group II, 6 times seen 0 in group I and 2 in group II. The difference was significant (P< 0.05). Side effects reported were Nausea/ vomiting seen 7 in group I and 4 in group II, headache seen 7 in group I and 5 in group II, shivering seen 4 in group I and 3 in group II and hypertension seen in 1 in group II. The difference was non- significant (P> 0.05).
Conclusion: Mephentermine was comparable with intravenous norepinephrine in maintenance of blood pressure during caesarean section.

COMPARISON OF FRACTIONATED DOSE VERSUS BOLUS DOSE INJECTION OF HEAVY BUPIVACAINE WITH FENTANYL IN SPINAL ANAESTHESIA FOR PATIENTS UNDERGOING ELECTIVE CAESAREAN SECTION: ONE YEAR RANDOMIZED CLINICAL TRIAL

Dr. Ashwini K, Dr. Lakshmi KS, Dr. Kedareshvara KS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3324-3330

Background and Aim: Maternal hypotension is the common complication encountered after subarachnoid block (SAB).
This needs attention and treatment for the better maternal and foetal outcome. Administration of SAB with bolus dose of local anaesthetic produce faster onset and precipitate maternal hypotension. Injecting fractionated dose provides dense block and haemodynamic stability. Aim of this study was to compare fractionated and bolus dose of SAB in terms of haemodynamic stability and duration of analgesia.
Methodology: Eighty parturients undergoing caesarean delivery under SAB were included in the study. They were divided into Group B or F according to computer randomization. Group B parturients received bolus dose SAB with 2ml of 0.5% hyperbaric bupivacaine and 10µg of fentanyl. Group F parturients received fractionated dose of 2ml of 0.5% hyperbaric bupivacaine and 10µg of fentanyl. In which, from the total dose two-third was given initially. After 90 sec remaining one third of the dose was injected. Haemodynamic parameters and analgesia period were analyzed using Student’s unpaired t‑test. 
Results: The haemodynamic parameters were better in group F than group B. The number of patients required vasopressor in group F were six and group B were seventeen. There was a prolonged analgesia period in group F than group B (214.40 + 15.48 and 195.95 + 8.98 min respectively).
Conclusion: The patients in fractionated dose group were haemodynamically better with longer analgesia period than bolus dose group. It is a newer technique to prevent maternal hypotension after SAB.

Hospital based study to know the effectiveness of ondansetron over spinal anesthesia induced hypotension & bradycardia

Dr. Naga Satya Suryanarayana Ruttala, Dr. Padmalatha Seelam, Dr. Nalli Venkata Krishna Mallik, Dr. Vengamamba Thummala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1869-1878

Introduction: Spinal anaesthesia is simple, rapid and most reliable anaesthetic technique. It is the most common regional anaesthesia technique, practiced worldwide. It is an efficient technique, which is easy to perform. However, associated with side effects like hypotension, bradycardia and also post-operative nausea, vomiting and chills. Decrease in vascular resistance caused by sympathetic blockade leads to drop in arterial pressure. Bradycardia is caused due to parasympathetic over activity, increase in baroreceptor activity and Bezold Jarish reflex (BJR). Ondansetron is a well-tolerated drug with 5HT3 antagonising effects which is used most commonly for peri-operative nausea and vomiting with minor side effects. Ondansetron poorly penetrates the blood brain barrier with minimal influence on central serotogenic mechanisms. Hence has less chances of causing cognitive side effects like headache, agitation and confusion. The objectives of this study is to assess the effect of intravenous ondansetron on spinal anaesthesia induced hypotension and bradycardia and the effect of ondansetron on Peri-operative nausea, vomiting and chills.

Comparison of the Effects of Midazolam (1mg) and Fentanyl (25 Mcg) as Additives to Intrathecal 3ml of 0.5% Bupivacaine (15mg) For Spinal Anaesthesia

Srikanth Allam, D Amrutha Lakshmi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 9921-9936

Background:This clinical study was undertaken to compare the effects of intrathecal
midazolam and fentanyl as additives to intrathecal bupivacaine 0.5 % for spinal
anaesthesia.
Materials and Methods: This prospective, randomized, comparative study was
conducted on 100 adult patients of ASA physical status 1 & 2 in the age group of 18
years to 60 years, at MAMATA GENERAL HOSPITAL, KHAMMAM. on patients
admitted for elective surgery from the period october 2017 - september 2019. Patients
belonging to Group A received 3 ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.2 ml
(1 mg) of preservative free midazolam + 0.3 ml of normal saline and Group B received 3
ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.5 ml (25 μg) of fentanyl. Patients were
preloaded with intravenous Ringer’s lactate solution 15 ml / kg just before
administering subarachnoid block. Subarachnoid block was administered in L3-L4
intervertebral space with 25G Quincke’s needle. Standard monitoring was carried out
in the form of pulse oximetry, ECG and non-invasive arterial blood pressure
monitoring. Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation
were recorded every 5mins for first 10mins, every 10mins for next half an hour and
then every 15mins intra operatively. The following parameters were observed - onset
and duration of sensory blockade, maximum level of sensory blockade achieved, two
segment regression, onset and duration of motor blockade, duration of effective
analgesia and any side effects associated with these drugs like nausea, vomiting,
pruritis, bradycardia, and hypotension. Computer generated randomization was used
to allocate patients into two groups. Statistical analysis was done using T-test and
fischers exact test. P value of less than 0.05 was considered to be significant
Results: The present study concludes that there were no differences in the onset of
sensory and motor blockade, maximum level of sensory blockade achieved, and time for
two segment regression. 25μg intrathecal fentanyl was found to provide a longer
duration of sensory and motor blockade and prolonged the time for first rescue
analgesia as compared to 1mg intrathecal midazolam. There was no significant
difference between the two groups with respect to the occurrence of side effects.
Conclusion: Hence, we suggest that addition of intrathecal fentanyl is excellent additive
to Bupivacaine for prolongation of duration of anaesthesia without any deleterious
effects.

Falciparum Malaria and Acute Renal Failure

Golla Vahini, Yerraguntla Shashidhar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 914-924

Background: Aim & Objectives: To study the ABG and electrolyte disturbances in
severe malaria. To assess the prognostic significance of these parameters.
Materials and Methods: The present study is a prospective study of 50 patients above
the age of 12 yrs. The patients were selected from those who were admitted with severe
malaria in Acute Medical Care Unit, Ganndhi Hospital, Secunderabad. Patients who
came with symptoms or signs of severe malaria like coma, convulsions, hypotension,
decreased urine output, anemia, jaundice, respiratory distress are assessed. Out of them
who fit the exclusion criteria are excluded.
Results: Acidosis is commonly seen with malaria and this most often high anion gap
metabolic acidosis contributed by lactic acidosis, renal failure and other anions.
Electrolyte abnormalities are common in malaria with hyponatremia, eukalemia,
hypochloremia, hypocalcemia and hypophosphatemia being the commonest.
Conclusion: Finally, we conclude, Strong predictors of mortality include acidosis, high
anion gap, hyperlactatemia and hyperkalemia

Comparison Of Two Methods Of Administration Of Phenylephrine For The Prevention And Treatment Of Hypotension In Caesarean Section Under Spinal Anaesthesia

Harishbabu Ravulapalli; Laxman N; Rajitha Anga; Busetty Prithviraj; Mushahida .

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 4823-4833

Background & Aim: Phenylephrine induces maternal bradycardia in 50% of mothers when used for prevention and treatment of spinal anaesthesia-induced hypotension during caesarean delivery. Rapid fluid administration immediately after initiation of the spinal block (co-loading) may have a vasopressor sparing effect. Even though phenylephrine infusion was active as a vasopressor, there was a fall in heart rate occasionally as a reflex action, but it was not statistically significant. There was no incidence of bradycardia or change in rhythm. Aim of the study is to assess the efficacy of prophylactic and therapeutic phenylephrine when administered by different methods as a vasopressor.
Method: 60 mothers scheduled for elective caesarean section were recruited in this randomized controlled trial. The primigravida included in the study were divided into two groups; group 1 (n = 30) received intravenous prophylactic phenylephrine infusion at 100 micrograms/min for 3 minutes immediately after subarachnoid block and group 2(n = 30) received phenylephrine as boluses of 100 microgram for the treatment of hypotension following subarachnoid block. Vital signs (blood pressure, heart rate, and arterial oxygen saturation) were recorded throughout the surgery. Maternal and neonatal perioperative complications were also controlled and recorded.
Results: There was an insignificant difference in demographic data between the groups. In Group I, only 6.7% incidence of hypotension episodes, whereas in Group II, 96.7% incidence of hypotension episodes were seen, indicating phenylephrine infusion was more effective in preventing hypotension episodes. In both, the groups had similar pre-induction systolic blood pressure, but the mean systolic blood pressure was higher in the infusion group and was statistically significant. In both groups DBP was higher in the infusion group and was statistically significant. Mean arterial pressure pre-induction was similar in both the groups, but mean arterial pressure was higher in the infusion group and was statistically significant. Phenylephrine does much higher in Group I (infusion group) when compared to Group II (bolus group), which was statistically significant (P-value <0.001).No significant side effects were observed in the study (nausea, vomiting). There was no significant difference between the two groups in APGAR score.Conclusion: Administration of prophylactic phenylephrine infusion is more effective as vasopressor compared to therapeutic Boluses in elective caesarean section done under subarachnoid block. Prophylactic phenylephrine infusion was associated with lower heart rates occasionally when compared to bolus doses. There is no significant reduction in APGAR scores at 1st and 5th min in both groups. Prophylactic infusion of phenylephrine can effectively decrease spinal anesthesia related hypotension without any significant complication for mother or her fetus.