European Journal of Molecular & Clinical Medicine

Introduction:The subarachnoid block is a safe and time-tested technique for
administering anesthesia for cesarean section due to its rapid onset and effective
sensory and motor blockade. Bupivacaine is available as a racemic mixture of its
enantiomers, dextrobupivacaine and levobupivacaine [1] and is the most frequently used
anesthetic agent for cesarean section.
Aims: This study was performed to compare the anaesthetic efficacy and safety of two
local anaesthetic agents: Hyperbaric Bupivacaine and Isobaric Levobupivacaine, in
patients undergoing elective caesarean section.
Methods and materials: It is prospective study in 100 patients, ASA I-II, were
randomized to receive an intrathecal injection of Hyperbaric Bupivacaine or Isobaric
Levobupivacaine. Group B (n = 50) received 2 ml of Hyperbaric Bupivacaine 5 mg/ml
(10 mg). Group L (n = 50) received 2 ml of Isobaric Levobupivacaine 5 mg/ml (10 mg).
The onset and duration of sensory and motor blockade, recovery parameters,
hemodynamic changes and side effects for the two agents were compared.
Results: The time of onset of sensory block was faster in Group B (1.80 ± 0.404) when
compared with Group L (2.02 ± 0.473). In Group B the time to two segment regression
was prolonged (74.68 ± 12.916) when compared with Group L (69.08 ± 3.349) and it is
statistically significant. Duration of motor blockade was prolonged in Group B (135.52
± 4.781) when compared with Group L (100.04 ± 9.165). Hemodynamic variables were
more stable in Group L than Group B. Twenty patients in Group B had adverse effects
when compared with ten patients in Group L.
Conclusion: 0.5% Isobaric Levobupivacaine 10mg for intrathecal injection of caesarean
section produces adequate sensory and motor blockade and stable hemodynamic
parameters with minimum adverse effects than 0.5% Hyperbaric Bupivacaine 10mg.
We concluded that Isobaric Levobupivacaine is a better alternative for caesarean
section.

Aim: Evaluate The Intraoperative Anaesthesia Management and Postoperative Pain Scores
after Caesarean Section.
Methods: This analytical observational study conducted in the Department of
Anaesthesiology, Madha Medical College Kovur Chennai, India during Feb 2021 to Feb
2022. All patients either receiving GA or spinal anaesthesia for CS receive IV tramadol
infusion for post-operative pain control, which is started either at the request for first
analgesia in the PACU or at 60 min, whichever comes first. Patients are assessed for pain
using numerical rating scale (NRS) immediately in the PACU and at regular intervals. Any
patient having NRS >4 is given rescue analgesia.
Results: Percentage of patients having NRS >4 and who required rescue analgesia on
immediate assessment (time zero) was 15 (15%). After that, 13 patients (13%) at 30 min, 10
(10%) patients at 45 min and 5 (5%) patients at 60 min had NRS of >4 and required first
rescue analgesia. There was no statistically significant difference among patients in PACU
having NRS >4 from those having NRS <4 in terms of the type of incision, ASA grading and
duration of surgery. Patients receiving RA had a statistically significant (P-value < 0.01) low
percentage of patients with NRS >4 and need for first rescue analgesia at time zero and at 30
min when compared to the percentage of patients operated under GA. The difference became
insignificant after 30 min. Overall, 18% of patients received some sort of co-analgesia,
mainly in the form of IV paracetamol 15% and only two patients received TAP block.
Conclusion: The pain management in the PACU was adequate as all patients were given
rescue analgesia if they had NRS of >4 and no patient was shifted from PACU with NRS of
>4.

Caesarean sections are routinely done under spinal anaesthesia using 0.5% hyperbaric bupivacaine that has a long duration of action. As most of the caesarean sections are of short duration, we decided to compare 1% 2-chloroprocaine with routinely used bupivacaine as chloroprocaine has rapid onset of action, producing an excellent sensory and motor blockade. After ethical committee clearance and informed written consent, 70 uncomplicated singleton parturients of ASA I and II posted for elective caesarean section were randomised into chloroprocaine (CP) and bupivacaine (B) group of 35 each.
Onset of sensory block in group CP was 1.71±0.62min and in group B was 2.31±0.63min. Onset of motor block in group CP was 2.54±0.88min and in group B was 2.66±0.76min. Mean time for maximum sensory block in group CP was 12.77±3.52min and in group B was 22.34±6.46min and time for maximum motor block in group CP was 9.14±2.23min and in group B was 10.86±2.18min. Two segment regression time in group CP was 39.34±4.46min and in group B was 63.14±4.7min. Mean duration of sensory block in group CP was 2.08±0.25hr and in group B was 3.60±0.27hr and duration of motor block in group CP was 1.07±0.14hr and in group B was 3.42±0.41hr. VAS scores in first 6hrs were lesser in group CP than group B. Onset, maximum time, duration of sensory and motor block were lower in group CP than group B. hemodynamic parameters were comparable between the groups with no side effects.

Background:Cholestasis is defined as impairment of bile flow due to intrahepatic or extrahepatic
causes, leading to retention of hepatotoxic compounds; specifically bile acids. The present study was
conducted to evaluate the feto-maternal outcome in patients with intrahepatic cholestasis of
pregnancy.
Materials & Methods:It included 190 subjects in the study. Group A consisted of 95 women who
presented with pruritis in their second & third trimester of pregnancy with associated abnormal liver
function in the absence of other liver and skin disease. 95 women with uncomplicated pregnancy and
no history of pruritis& with normal liver function test were taken as Group B/control.
Results: out of 95 participants total induction were 45 (47.36%) in group A and 13 (13.68%) in group
B. Out of 45 (47.36%) total induction, 30 (31.57%) had vaginal delivery and 15 (15.78%) had LSCS
in group A. Similarly, out of 13 (13.68%) total induction, 11 (11.57%) had vaginal delivery and 2
(2.10%) had LSCS in group B. ICP was significantly associated with induction of labour. There is
higher incidence of caesarean section in induced patients. There is significant correlation in group A
and group B in terms of fetal complications (p<0.001). 1 (1.05%) participants of APGAR score <7 at
5 minutes of age in group A and group B each. The risk of adverse fetal outcomes increases with
increasing levels of maternal serum bile acid. 24 (25.26 %) babies of group A and 7 (7.36 %) babies
of group B were admitted in NICU.
Conclusion: Higher rates of gestational diabetes and pre-eclampsia are new findings, and need to be
considered in management of ICP pregnancies. Caesarean section as mode of delivery found
significantly associated with ICP. Maternal outcomes have good prognosis but foetal outcomes can be
improved by timely and effective interventions.

Background: Midazolam and propofol by virtue of their antiemetic effect were found
individually to reduce the incidence of intraoperative nausea and vomiting. This study
compares the effects of midazolam and propofol in decreasing the incidence of nausea and
vomiting in pregnant women undergoing lower segment caesarean section (LSCS) under
spinal anaesthesia. It also assesses maternal sedation, neonatal outcome and other side effects.
Aim: To compare the effects of subhypnotic dose of midazolam and propofol in prevention
of intraoperative nausea and vomiting in lower segment caesarean section under subarachnoid
block.
Methods: With ethical committee permission the 60 pregnant women were randomly
allocated into 2 groups after taking informed consent. Group M received 0.03mg/kg
midazolam immediately after cord is clamped, Group P received 10 mg propofol immediately
after cord is clamped. Incidence of nausea and vomiting was not according to Bellville
scoring system (0-novomiting, 1-Nausea, 2-Retching, 3_vomiting). The degree of sedation,
hemodynamic changes were noted baseline, after induction, after drug administration, 30
mins after drug administration, 60 mins after drug administration, neonatal out come and side
effects were recorded.
Results: Statistically significant decrease in intraoperative nausea and vomiting in patients
undergoing LSCS under spinal anaesthesia with 10 mg propofol compared to 0.03 mg
midazolam is observed. Degree of sedation, respiratory rate, mean mephentermine
consumption were comparable between two groups and no difference found.
Conclusion: Propofol significantly decreases incidence of intraoperative nausea and
vomiting inches are in section under spinal anaesthesia as compared to midazolam.

Background: Relaparotomy (RELAP) after caesarean section is a serious complication and is associated with maternal morbidity and mortality. The data of re-laparotomy after caesarean section is limited. So in the present study, we will evaluate the risk factors and outcome of relaparotomy after cesarean section in our study population.
Objective: To identify the risk factors and complications and outcomes associated with re- laparotomy after caesarean section.
Materials and Methods: It is a retrospective study, a total of 16 relaparotomy cases were included in this study. Data such as age, parity, period of gestation, comorbidities, indication for C-section and relaparotomy, a procedure during relaparotomy and the interval between two surgeries are recorded. Using SPSS software statistical analysis is done.
Results: Incidence of re-laparotomy is found to be 0.25% and the mean age was found to be 25.5±4.2 years with 37.5% primigravidae. The Major indication for C-section and Relaparotomy was Placenta previa (37.5%) and hemoperitoneum (37.5%). The mean time interval between C-section and relaparotomy was 6.8 ± 1.2 days and the major procedure done during relaparotomy is tension suture (31.25%). The rate of recovery and maternal death was found to be 93.8% and 6.3% respectively.
Conclusion: Caesarian section will be done due to clinical complications in delivery. After C-section, women are treated conservatively, but in some cases, there is a need for relaparotomy. It will be performed when the patient’s condition is too critical. Relaparotomy is a life-saving procedure to save the life of patients. Proper care should be taken during primary and secondary surgery to prevent postoperative infection and other complications which will decrease the clinical complication and mortality rate.

Background: Pain management following caesarean section still remains a challenge in our
environment. Diclofenac suppository is an effective adjunct analgesic for post-operative pain
control. Over the last two decades the number of caesareans being performed has increased
dramatically. High quality postoperative analgesia is important because the new mother has
to recover from major intra-abdominal surgery while also caring for her newborn baby. Many
options are available but tailoring the method to the individual can be problematic because it
has been difficult to predict the severity of postoperative pain or the individual response to a
regimen.

Aim: To determine the demographic profile of pregnant females with COVID-19 infection.
The outcome and prognosis in pregnant women with COVID-19 infection was also
evaluated.
Method and material:The study included 38 pregnant women with COVID-19 infection and
hospital admission for at least 24 hours. Cause of admission was classified as obstetric and
COVID-19-related. All the patients were COVID positive and were referred from other
centres/ hospital to this facility andwas admitted to this hospital for delivery. Primary
outcomes included maternal admission to intensive care unit (ICU), COVID-19 pneumonia,
maternal mortality. The information on socio-demographic factors, pre-gestational chronic
diseases (including cardiac, renal, endocrine, psychiatric, hematologic and autoimmune
disease, cancer and HIV)and mode of delivery was collected.
Results:The mean age of the patients was 28.8±6.2 years. The mode of delivery for
60.5%patients(23) was normal vaginal delivery and lower segmentcaesarean section in
39.5%(15) patients.94.7%(36) patients were asymptomatic in the present study. Maximum
patients in the present studywere hospitalized for 3-5 days.
Conclusion: COVID-19 infection was associated with higher rates of caesarean section in
pregnant women. However, COVID-19 cannot be considered as an indication for
caesareansectiondelivery. Patients with increased age have more days of hospitalization than
younger patient.

Background: The physiological changes of pregnancy deem nausea and vomiting infallible complications associated with obstetric anaesthesia, resulting in significant morbidity and longer recovery time. The aim of our randomised control trial was to investigate the efficacy of propofol in addition to the currently accepted regimen of ranitidine and metoclopramide in the prevention of nausea and vomiting in this high risk group undergoing spinal anesthesia during caesarean section.
Methods: Eighty fasted term pregnant women scheduled for elective caesarean section were given ranitidine 150mg and metoclopramide 10mg orally 2 hours prior to spinal anaesthesia following which they received either propofol 200µg /kg IV or placebo as a single bolus dose. Intraoperative and post-delivery emetic episodes experienced were recorded at intervals and the intensity of nausea was assessed using the visual analogue scale (VAS).
Results: The incidence of nausea during the intraoperative period in propofol group was 5 % as compared with placebo group in which it was 32.5%, while that of vomiting in propofol group was 5% as compared with placebo group in which it was 22.5%. Both were found to be statistically significant (p= 0.002, p= 0.023 respectively). The incidence of nausea and vomiting during the entire postoperative period of 0-24 hours between the two groups was found to be statistically insignificant.
Conclusion: The prophylactic administration of a subhypnotic dose of propofol with ranitidine and metoclopramide was effective in the prevention of nausea and vomiting after neuraxial blockade during the intraoperative period but not during the postoperative period.