Knowledge and Attitude about Labor Epidural Analgesia among Pregnant Women Attending Antenatal Clinic.

BACKGROUND: Labour pain is one of the most painful experiences that a woman faces in her lifetime. There are various options for labour pain management. Epidural analgesia is the gold standard method for pain management during labour. In developing and under-developed countries there are many challenges to provide this service, a very important one being knowledge about epidural analgesia among the parturients and the physicians. METHODS: A prospective cross-sectional study was carried out among 384 pregnant women attending Antenatal clinic of a tertiary level teaching hospital using pretested structured questionnaire prepared by a team of anaesthesiologists and obstetricians. Non-probability purposive sampling technique was used. The data was analysed by using SPSS version 20.0. Descriptive and inferential statistical methods were used for analysis. RESULTS: Of the 384 pregnant women, only 29.4% had knowledge about some form of labour analgesia techniques and only 16% of the participants were aware of labour epidural analgesia. Also, only 6.2% were aware that epidural service is available at our hospital. Regarding acceptance, only 42.4% were willing to use epidural analgesia in their present pregnancy. CONCLUSIONS: The present study findings revealed that a significant number of participants had very limited knowledge about labour epidural analgesia and were also unaware of the availability of the service in our hospital. Educational programs need to be provided to all the pregnant women for enhancement of knowledge and awareness about epidural labour analgesia to increase its acceptability among them.

Anaesthetic Management of a Patient with Fontan Circulation for Laparoscopic Cholecystectomy.

Fontan circulation is a complex surgical procedure carried out in infants in a staged fashion, where caval circulation is connected to the pulmonary circulation, bypassing the heart. The ventricular activity will drive the blood to pulmonary circulation, which, after oxygenation, will return to heart and then will distribute through-out the body. The pulmonary vascular resistance determines the preload, which further depends upon the volume status of the body. This physiology is further complicated by the presence of arrythmia, liver cirrhosis, caval-pulmonary shunt thrombosis and low ventricular activity. Anaesthetic implication of such case includes challenges to manage preload, maintenance of pulmonary vascular resistance, preservation of the single ventricular function and avoidance of circuit thrombosis. Here we present a case of 15 years female who presented to our centre for laparoscopic cholecystectomy. Keywords: Cholecystectomy; Circulation; Laparoscopic.

Outcome of Pregnant Patients with Cardiac Diseases Delivered in Tribhuvan University Teaching Hospital.

BACKGROUND: Pregnant women with cardiac disease pose a unique challenge to both the anaesthesiologists and obstetrician because of high morbidity affecting the maternal and fetal outcomes. Our research aims to provide an overview of pregnant women with heart disease coming for delivery in Tribhuvan University Teaching Hospital over one year, the occurrence of adverse maternal and neonatal outcome (mortality and morbidity) and correlation of certain maternal factors associated with adverse outcome. METHODS: This is an observational cross-sectional study conducted in Tribhuvan University Teaching Hospital from 2075/11/01 to 2076/10/30 where data of pregnant women beyond 28 wks period of gestation with diagnosed cardiac disease was recorded from secondary sources. RESULTS: The prevalence of pregnant women with cardiac disease presenting for delivery over one-year period was found out to be 120 (2.49%). Among them, almost 85 cases (71%) had valvular heart disease and 27 had mitral stenosis. The mortality was 2.5%. The complication rate among such patients was 30%, the patients requiring ICU admission was 20.7% and requiring mechanical ventilation was 6.7%. The neonatal mortality in such patients was 3.2% and 20.5% were premature, 27% had weight <2.5 kgs at birth and 10.7% required NICU admission. There was statistically significant association between history of prior cardiac event and NYHA with adverse maternal event with p value of <0.001. CONCLUSIONS: History of prior cardiac event and higher NYHA grading in a pregnant patient with cardiac disease are major determinants for adverse maternal outcome.

Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report.

INTRODUCTION: Brachial plexus blocks are frequently practiced and safe mode of anaesthsia. Although minor complications may occur, major complications are a rarity. However, we report a rare case of prolonged supraclavicular brachial plexus block which required almost 4 months to recover without a perceivable cause. CASE PRESENTATION: A 22-year-old gentleman posted for open reduction and internal fixation of both forearm bones was administered an ultrasound-guided supraclavicular brachial plexus block. The intra-operative period was uneventful. However, the block persisted for a very prolonged period of time. All perceivable causes were ruled out. A total of 19 weeks was required for the entire block to regress with no residual neurological deficits thereafter. CONCLUSION: Although peripheral neuropathies are known complications of peripheral nerve blocks, such a prolonged brachial plexus block is a rare event. The only plausible cause for the patient's condition could have been the prolonged drug effect; however, it has been rarely documented.

Effect of Head Elevation to Different Heights in Laryngeal Exposure with Direct Laryngoscopy.

BACKGROUND: The purpose of this study was to determine the optimal pillow height for the best laryngoscopic view in adult patients scheduled for elective surgery under general anaesthesia. METHODS: 150 adult patients undergoing surgery under general anaesthesia with endotracheal intubation with no features suggestive of difficult airway were enrolled for the study. After induction of anaesthesia the assessment of direct laryngoscopic views was done at head positions without a pillow and with non-compressible pillows of heights 5cm and 10cm. RESULTS: The laryngoscopic view with the 5cm pillow was significantly superior to other head position (p<0.01). The incidence of difficult laryngoscopy (Cormack and Lehane grade III) was 32.7% without a pillow which improved to (Cormack and Lehane grade III) 4% with 10cm pillow and there were no cases of difficult laryngoscopy with 5cm pillow. CONCLUSIONS: The use of 5cm pillow in the 'sniffing' position obtains the best laryngoscopic view during direct laryngoscopy.