Online ISSN: 2515-8260

Keywords : hypotension


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 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.

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 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.