#Caesarean sections without anesthetic

[coochiequeens]

“So women with access to emergency care are the ones that live,” she said. “Women that don’t, die.”

https://www.washingtonpost.com/world/2024/01/21/gaza-childbirth/

JERUSALEM — Walaa didn’t expect the birth of her fourth child to spark abject fear. But by the time her contractions started, the whole family was frantic.

There were no ambulances to be seen in the streets of Gaza’s Rafah City, she said, now so crammed with displaced families that there was barely any food left available for the 27-year-old.

When her uncle Wissam, a doctor, reached the tent where she had lived for weeks in the cold, he said, he could see they had run out of time. “I’m having the baby now,” she kept telling him. It was dark, and she was scared.

His cellphone flashlight was all they had to see by.

The humanitarian catastrophe caused by Israel’s three-month military campaign against Hamas in Gaza counts some 52,000 pregnant women among its greatest victims. As airstrikes push 1.9 million people into an ever-smaller corner of the besieged enclave, disease is spreading, famine is looming and levels of anemia are so high that the risk of postpartum hemorrhage has soared and breastfeeding is often impossible. Forty percent of pregnancies are high-risk, CARE international estimates.

Prenatal care is almost nonexistent — what remains of Gaza’s hospital network is on its knees, at 250 percent capacity and consumed with treating mass casualties from Israeli bombing. Far more women are giving birth outside of medical facilities — in displacement camps, even in the street — than inside them.

Damage to facilities and communications blackouts — the strip lost cellphone service for a week this month — have left Gaza’s health ministry unable to compilereliable data for infant or maternal mortality during the conflict. But doctors and aid groups say miscarriage and stillbirths have spiked.

“What we know about pregnancy-related complications is that it’s hard to prevent them in any setting, but the way that we save a woman and newborn’s life is we treat the complication quickly,” said Rondi Anderson, a midwifery specialist for the Project HOPE aid group.

“So women with access to emergency care are the ones that live,” she said. “Women that don’t, die.”

The only place that Wissam could find to deliver his terrified niece’s baby was a spot of cold earth between the tents. Aid workers hung bedsheets to give the woman a modicum of privacy. No one had been able to contact Walaa’s husband, and her mother was so scared that at times she had to look away. They cut the boy’s umbilical cord with an unsterilized scalpel and they filled tin cans with hot water to keep him warm. He weighed 7 pounds and Walaa named him Ramzy.

The family spoke on the condition that only their first names be used because they feared for their safety in the event that Israeli troops entered the town.

Baby Ramzy is 5 days old. (Loay Ayyoub for The Washington Post)

They fled their home in northern Gaza so abruptly that no one thought to grab clothes for the baby. This week, Ramzy was swaddled in a onesie outgrown by another child in the camp. He wailed as Walaa, still in pain from tearing during the birth, gingerly pulled herself upright.

The 16-year blockade imposed by Israel and Egypt after Hamas won control of Gaza had already made pregnancy and childbirth more difficult for expecting mothers. Before the current conflict, hospitals often lacked adequate equipment and training for neonatal staff, according to Medical Aid for Palestinians, and more than half of pregnant women were anemic.

Hamas fighters streamed out of the enclave on Oct. 7 to kill around 1,200 people in Israel and take another 240 hostage. Israel responded with a bombing campaign and ground war to eradicate Hamas, killing almost 25,000 Palestinians, most of them civilians, to date.

The South African legal team that accused Israel before the International Court of Justice this month of committing genocide during the conflict argued that the obstruction of lifesaving treatment since Oct. 7 amounts to preventing births.

A lawyer for Israel called allegations that it is obstructing the delivery of food, water, fuel and other supplies critical for Gaza “tendentious and partial,” and said it was working “around-the-clock” to help scale up the volume of aid making it into the enclave.

Hanaa al-Shawa, 23, gave birth to her first child, Ayla, during the coronavirus pandemic, and the little girl, she said, brought her family a “glimmer of hope.” Shawa and her husband Mustafa, 25, were ecstatic when they learned in July that another child was on the way. The war began in October, and the future they dreamed of fell apart. “I had felt overwhelming joy,” Shawa recalled. “I did not realize that this joy would turn into great suffering.”

Nearly 20,000 babies were born in Gaza during the first 105 days of the war, UNICEF reported Friday. Delays in the delivery of lifesaving supplies, the U.N. children’s agency said, have left some hospitals performing Caesarean sections without anesthetic. Spokeswoman Tess Ingram said she met a nurse at Gaza’s Emirati maternity hospital who had helped with postmortem caesarians on six dead women.

“Seeing newborn babies suffer while some mothers bleed to death should keep us all awake at night,” Ingram told reporters Friday. “In the time it has taken to present this to you, another baby was likely born, but into what?”

“Becoming a mother should be a time of celebration,” she said. “But in Gaza it’s another child delivered into hell.”

For the five pregnant women interviewed by Washington Post reporters, fear that mother or baby might not survive suffused their waking thoughts — and made appearances in nightmares, too.

Shawa and Mustafa left their home in Gaza City’s Yarmouk Street in the second week of October. The Israel Defense Forces had ordered 1.1 million people in northern Gaza to move south for what it described as their own safety.

“I was afraid that I would miscarry because of the power of the rockets,” she said.

Displaced Palestinian families from the northern and central Gaza Strip evacuate toward southern Gaza on Oct. 13. (Loay Ayyoub for The Washington Post)

Many pregnant women made the 20-mile journey from north to south on foot, their legs swollen and joints heavy as they carried their luggage, three women who made the journey told The Post.

When Ayla was born, her family had a room full of toys ready for her. The room in which Shawa’s second child, a girl, will spend her first weeks, in a friend’s home in the Tel al-Sultan area, is tainted with asbestos, she said.

“We carried Ayla here in just the clothes she was wearing, and we don’t even have anything warm for her,” Shawa said. “If I’m unable to provide for her, what will I do for my next child?”

Rising food scarcity and malnutrition can cause potentially life-threatening complications during childbirth and lead to low birth weight, wasting, failure to thrive and developmental delays.

Shawa said she had only eaten tinned food, with no access to fruit or vegetables, since she left her home three months ago. Doctors have said her iron levels are low and her blood pressure is high. Mustafa searches daily but has found no suitable medication to control it.

Saja Al-Shaer, 19, started to feel like she was too young to become a mother. Her weight had dropped below 110 pounds, she was anemic, and her husband had not managed to get her medication, either. “He spent three days knocking on the doors of pharmacies,” she said. “I do not know if I will see this child or not.”

In late December, doctors at the al-Aqsa Hospital, 11 miles to the north, received a pregnant woman whose high blood pressure caused eclampsia and bleeding to her brain, according to Deborah Harrington, a British obstetrician who volunteered at the hospital with a Medical Aid for Palestinians team.

The baby was delivered by a C-section, Harrington said. The mother was still on life support when the physician left two weeks later.

“These women are presenting it in much more extreme condition,” Harrington said. “They’re just not getting hypertensive treatment. They’re not being screened for diabetes. If they’re diabetic, they’re not getting treatment for their diabetes.

“They know that actually accessing care, as it often is for women in conflict, is really difficult and fraught with danger. At night, there is often no light, so moving around is really difficult. You can’t call an ambulance because there’s no signal. The women I saw were really frightened.”

Walaa with her uncle Wissam, who helped deliver her newborn son. (Loay Ayyoub for The Washington Post)

From the corner of the damp room where Walaa was tending to Ramzy on Friday, she worried about where they would find clean water or baby formula. Her family had looked everywhere for diapers, but come up empty. In Tel al-Sultan, Shawa was fixating on rumors that Israel’s army would direct them to evacuate again. The walking, the carrying, the sense that nothing around her was hygienic — it all frightened her.

But she had made one decision that no shortage or military orders could change. She would name her daughter after her sister-in-law, killed in an Israeli airstrike weeks earlier while trying to find shelter for her own children.

The girl, she said, would be called Heba. In Arabic, it means blessing from God.

Mahfouz reported from Cairo and Harb reported from London. Loay Ayyoub in Rafah contributed to this report.

[samar-world-1]

Spokesperson for the International Committee of the Red Cross, Suhair Zaqout, speaks on Arab TV about caesarean sections for women in the Gaza Strip without anesthesia or with a simple anesthetic.

الناطقة باسم اللجنة الدولية للصليب الأحمر سهير زقوت، تتحدث على التلفزيون العربي، عن عمليات ولادة قيصرية للنساء في قطاع غزة من دون بنج أو بمخدر بسيط

[altiushospital]

Laparoscopic Cervical Encerclage

Cervical incompetence is characterized by painless dilatation of the incompetent cervix and results in miscarriages and preterm delivery during second trimester.

Cervical incompetence occurs in 0.5% to 1% of all pregnancies and has a recurrence risk of 30%. Patients typically present with cervical dilatation in the absence of uterine activity after first trimester usually.

Cervical cerclage can be placed via transvaginal, open -transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy.

A laparoscopic approach is superior to the transabdominal approach in terms of surgical outcomes, cost, and postoperative morbidity.

A laparoscopic approach to cervical cerclage placement is a potentially effective adjunct to the treatment of women at high risk of recurrent preterm birth.

Laparoscopic and transabdominal approaches both yield similar obstetric outcomes, and laparoscopic cerclage may be a superior method in terms of surgical outcomes, as suggested by several studies.

Laparoscopic surgical techniques have now increasingly replaced traditional abdominal approaches to gynecologic surgery.

laparoscopic cervical cerclage is a minimally invasive, extremely safe , cosmetically better pain and bleeding is lesser, intraabdominal adhesions are less, patient feels better postoperatively effective procedure in properly selected patients and should replace the traditional laparotomy technique.

When To Time Procedure ?

LAPAROSCOPIC cerclage placement can be performed prior to conception or in early pregnancy. Preconception placement provides optimum exposure and reduces risks of excessive bleeding and injury to the pregnancy

Is It better than a vaginal Approach ?

DEFINITELY .Time and again laparoscopy is the best method in treatment of various disease states in this modern medicine.

When the stitch has to be removed ?

The cerclage remains inside till delivery.it is released during the caesarean section in the operation theatre.

Will it harm the fetus?-

No it is necessary for the pregnancy to go on without which patient might end up in preterm delivery.

What Are The Risks Of Having A Cerclage Placed?

The likelihood of risks occurring is very minimal, and most health professionals feel a cerclage is a life-saving procedure that outweighs the possible risks involved.

what anaesthesia is given ?

its general anaeasthesia preferably.

What will be the recovery period?

Generally 2-3 days as with all the Laparoscopy procedures depending on your ability to recover.

who are the candidates for laparoscopic cerclage?

Previous failed vaginal cerclage with scarring or lacerations rendering vaginal cerclage technically very difficult or impossible.

Absent or very hypoplastic cervix with history of pregnancy loss fitting classical description of cervical insufficiency.

Which trimester it has to be planned?

The procedure is planned at the end of the first trimester or the early second trimester, after fetal viability has been documented and initial ultrasound evaluation of the pregnancy and preliminary blood tests have ruled out any major congenital malformation.

When not to have a cerclage?

Active labor.

Active vaginal bleeding.

Abruptio placenta.

Premature rupture of membranes.

Chorioamnionitis.

Prolapsed membranes.

Vaginal spotting .

What Can I Expect After The Procedure?

You may stay in the hospital for a few hours or overnight to be monitored for premature contractions or labor.

Immediately after the procedure, you may experience light bleeding and mild cramping, which should stop after a few days. This may be followed by an increased thick vaginal discharge, which may continue for the remainder of the pregnancy.

You may receive medication to prevent infection or preterm labor.

For 2-3 days after the procedure, plan to relax at home; avoid any unnecessary physical activity.

Your doctor will discuss with you when would be the appropriate time to resume regular activities.

Abstinence from sexual intercourse is often recommended.

what about postoperative care?

Elective cerclage is typically an ambulatory procedure. The patient is discharged after recovery from the anesthetic and when she is able to ambulate and void.

how to follow up?

Frequent visits as informed by your doctor report immediately in case of pain or spotting or bleedind or leaking.

What is the success rate?

Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 85% to 90% of cases. Cervical cerclage appears to be effective when true cervical incompetence exists

Why Doesn't Every Woman Who Has Had A Preterm Baby Need A Cerclage?

Only women with an abnormal or "incompetent" cervix can be helped by a cerclage. However, even with the help of a cerclage, other problems can cause labor to begin too early.

What About Future Pregnancies?

Most women who need a cerclage in one pregnancy will need to have a cerclage placed in future pregnancies.

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[lotterymains]

C section due date calculator

#C SECTION DUE DATE CALCULATOR SKIN#

#C SECTION DUE DATE CALCULATOR TRIAL#

Previous classical (longitudinal) caesarean section.

An outbreak of genital herpes in the third trimester (which can cause infection in the baby if born vaginally).

HIV infection of the mother with a high viral load (HIV with a low maternal viral load is not necessarily an indication for caesarean section).

Other complications of pregnancy, pre-existing conditions, and concomitant disease, include:

Umbilical cord abnormalities ( vasa previa, multilobate including bilobate and succenturiate-lobed placentas, velamentous insertion).

Large baby weighing > 4,000 grams ( macrosomia).

#C SECTION DUE DATE CALCULATOR TRIAL#

Failed instrumental delivery (by forceps or ventouse (Sometimes, a trial of forceps/ventouse delivery is attempted, and if unsuccessful, the baby will need to be delivered by caesarean section.).

Placenta problems ( placenta praevia, placental abruption or placenta accreta).

Tachycardia in the mother or baby after amniotic rupture (the waters breaking).

Uncontrolled hypertension, pre-eclampsia, or eclampsia in the mother.

Uterine rupture or an elevated risk thereof.

Prolonged labor or a failure to progress ( obstructed labour, also known as dystocia).

Abnormal presentation ( breech or transverse positions).

C-sections are also carried out for personal and social reasons on maternal request in some countries.Ĭomplications of labor and factors increasing the risk associated with vaginal delivery include: Ī seven-week-old caesarean section scar and linea nigra visible on a 31-year-old mother: Longitudinal incisions are still sometimes used.Ĭaesarean section is recommended when vaginal delivery might pose a risk to the mother or baby. With the introduction of antiseptics and anesthetics in the 19th century, survival of both the mother and baby, and thus the procedure, became significantly more common. Descriptions of mothers surviving date back to 1500 AD, with earlier attests to ancient times (including the apocryphal account of Julius Caesar being born by caesarean section, a commonly stated origin of the term). The surgery has been performed at least as far back as 715 BC following the death of the mother, with the baby occasionally surviving. In the United States as of 2017, about 32% of deliveries are by C-section. Efforts are being made to both improve access to and reduce the use of C-section. More than 45 countries globally have C-section rates less than 7.5%, while more than 50 have rates greater than 27%. Some evidence finds a higher rate of 19% may result in better outcomes. The international healthcare community has previously considered the rate of 10% and 15% to be ideal for caesarean sections. In 2012, about 23 million C-sections were done globally. The method of delivery does not appear to have an effect on subsequent sexual function. Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother. They also typically take longer to heal from, about six weeks, than vaginal birth. Ĭ-sections result in a small overall increase in poor outcomes in low-risk pregnancies. Often, several days are required in the hospital to recover sufficiently to return home. A woman can typically begin breastfeeding as soon as she is out of the operating room and awake. The uterus is then opened with a second incision and the baby delivered. An incision of about 15 cm (6 inches) is then typically made through the mother's lower abdomen.

#C SECTION DUE DATE CALCULATOR SKIN#

A urinary catheter is used to drain the bladder, and the skin of the abdomen is then cleaned with an antiseptic. It may be done with a spinal block, where the woman is awake, or under general anesthesia. Ī C-section typically takes 45 minutes to an hour. Some C-sections are performed without a medical reason, upon request by someone, usually the mother. The World Health Organization recommends that caesarean section be performed only when medically necessary. A trial of vaginal birth after C-section may be possible. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, and problems with the placenta or umbilical cord. Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mother at risk.

[siva3155]

300+ TOP ANESTHESIOLOGY Objective Questions and Answers

ANESTHESIOLOGY Multiple Choice Questions :-

1.Local anesthetic causing Methaemoglobinaemia a)Lignocaine b)Prilocaine c) Bupivacaine d) All of the above Ans: b 2.Which of the following anesthetic have half life more than 2hrs? a) Bupivacaine b) Lignocaine c) Mepivacaine d) Etidocaine e) Chlorprocaine Ans:a 3.Bier block is used for a) Sub arachnoid block b) IV regional block c) Extradural block d) Local anesthesia Ans:b 4.During epidural analgesia the following points suggests that needle is in the extradural space a) Loss of resistance sign b) Negative pressure sign c) Mackintosh extradural space indicator d) All of the above Ans:d 5.Epidural block is indicated in all except: a) Patients in hypovolemia b) Patients with asthma and bronchitis c) Post-operative pain relief d) Obstetric analgesia Ans:a 6.Epidural anesthesia is preferred to spinal anesthesia because a) Hypotension is absent b) Dura is not penetrated c) Low dose of anesthetic is used d) Level of block easily changed Ans:b 7.Hypersensitive xylocaine used for spinal anesthesia means a) 5% xylocaine b) 2% xylocaine with adrenaline c) 2% xylocaine with dextran d) 2% xylocaine Ans:a 8.Post-spinal headache is prevented by a) Use of thinner needle b) NS AIDs c) Preanaesthetic medication d) Plenty of oral fluids Ans:a 9.Lignocaine can be used in all except a) Ventricular fibrillation b) Spinal anaesthesia c) Epidural anaesthesia d) Convulsions Ans:d 10.Local anesthetic with vasoconstrictor effect a) Procaine b) Cocaine c)Lidocaine d)Dubicaine Ans:b

ANESTHESIOLOGY MCQs 12.Black tongue, black teeth, visual and tactile hallucinations seen in poisoning due to a) Opium b) Heroin c) Cocaine d) Cannabis Ans:c 13.Longest acting local anesthetic solution is a) Lignocaine b) Chlorprocaine c) Amethocaine d) Bupivacaine Ans:d 14.Post spinal headache can be prevented by a) Preventing fall of blood pressure b) Encouraging early ambulation c) Weaker solution of local anesthetic d) Finer lumbar puncture needle Ans:d 15.The following statements about Bupivacaine are true except a) Must never be injected into a vein b) More cardiotoxic than Lignocaine c) 0.25 percent is effective for sensory block Ans:c 16.The effect of spinal anesthesia on bowels includes a) Increased peristalsis b) Contraction c) Dilatation d) Atony Ans:b 17.All are Amide linked Local anesthetics except a) Procaine b) Bupivacaine c)Lidocaine d)Dibucaine Ans:a 18.Percentage of xylocaine used in spinal anesthesia a)1% b)2% c)4% d)0.5% e)0.5% Ans:d 19.Extradural anesthesia decreases risk of a) Headache b) Hypotension c) Meningitis d) Arachnoiditis Ans:a 20.The complication seen more often in Epidural anesthesia is a) Hypotension b) Headache c) Urinary retention d) Meningitis Ans:c 21.The first of the following to be blocked in spinal anesthesia includes a) Pre-ganglionic sympathetic fibers b) Sensory fibers c) Motor fibers d) Fibers carrying proprioceptive sensation Ans:a 22.Spinal anesthesia is preferred in lower abdominal surgeries because it: a) Gives deep analgesia b) Gives good relaxation of abdominal muscles c) Shrinks intestines so that other viscera are seen well d) Patient is conscious and co-operative Ans:c 23.The pathway to be blocked earliest in spinal anesthesia is a) Autonomic b) Motor fibers c) Fine sensory fibers d) Coarse sensory fibers Ans:a 24.All of the following are effective topically except a) Procaine b) Cocaine c)Lidocaine d) Amefhocaine Ans:a 26.The site of action of an intra thecal narcotics is the a) Axonal membrane b) Dorsal horn of the spinal cord c) Ventral horn of the spinal cord d) Opiate receptors within the brain Ans:b 27.The local anesthetic which is not useful for tropical use a) Procaine b) Xylocaine c)Prilocaine d) Cocaine Ans:a 28.Epidural analgesia is suitable for a) Analgesia in a patient with fractured ribs b)Trans-urethral resection of the prostrate gland c) Intra-operative and post-operative pain relief in cholecystectomy d) All of the above Ans:d 29.Post spinal hypotension all are true except a) Paralysis of nerve supply from Tl -L2 b) Leakage of CSF through puncture site c) Trendelenberg position is good d) Elevation of lower limbs without head low position is useful Ans:a 30.Which of the following is an ester linked local anesthesia? a) Cocaine b) Lidocaine c) Bupivacaine d) Dubicaine Ans:a 31. The administration of local anesthesia may result in the following except a) Tachycardia b) Vasodilatation c) Myocardial depression d) Seizures Ans:a 32.Shortest acting local anesthetic a) Procaine b) Xylocaine c) Bupivacaine d)Chloprocaine Ans:d 33.Local anesthetics act by a) Forming area of nerve block along a neuron b) Binding to calcium receptor on nerve membrane c) Blocking calcium channels of nerve membrane d) Inhibiting the sodium pump Ans:d 34.Subarachnoid block as anesthesia is contraindicated in a) Diabetic gangrene b) Burgers disease c) Atherosclerotic gangrene d) Full stomach e) Hemophilia Ans:e 35.All are vasodilator except a) Procaine b)Lidocaine c) Cocaine d) Chlorprocaine Ans:c 36.Epidural narcotic is preferred over epidural LA because it causes a) Less respiratory depression b) No retention of urine c) No motor paralysis d) Less dose required Ans:c 37.Last to recover in spinal anesthesia is a) Pain b) Motor c) Proprioception d) Pre-ganglionic sympathetic fibers Ans:d 38.Cranial nerve not involved in spinal anesthesia a) 1 st and 10th b) 3rd and 6th c) 2nd and 4th d) 7th and 8th Ans:a 39.A local anesthetic that is ineffective topically is: a) Cocaine b) Mepivacaine c) xylocaine d) Lidocaine e) Tetracaine Ans:b 40.Which of the following local anesthetic is more safe in surface and infiltrating anesthesia a) Procaine b) Cocaine c) Lidocaine d) Amethocaine Ans:c 41.Side effects of lignocaine are all except a) Sedation b) Vomiting c) Convulsion d) Tinnitus Ans:a 42.All are pierced in Lumbar Puncture except a) Post longitudinal ligament b) Ligamentum Flavum c) Interspinous Ligament d) Supraspinous ligament Ans:a 43.The most common complication in spinal anesthesia is a) Post spinal headache b) Hypotension c) Meningitis d) Arrhythmia Ans:b 44.An increased dose of spinal anesthetic is indicated in a patient who has a) Ascites b) Increased height of the patient c) Is pregnant d) Obese Ans:b 45.All are surface anesthetics except a) Lignocaine b) Bupivacaine c) Procaine d) Cinchocaine Ans:b 46.aximum dose of xylocaine for local anaesthesia a)200mg b)250mg c)300mg d)650mg e)700mg Ans:a 47.Epidural space lies between a) Pia and arachnoid b) Dura and arachnoid c) Dura and vertebral column d) Pia mater and grey mater Ans:c 48.Commonest Cranial nerve affected in spinal anaesthesia a) 2nd b) 3rd c) 4th d) 6th e) 10th Ans:d 49.Cauda Equina syndrome can be caused by * a) Spinal anaesthesia b) Epidural anaesthesia c) Both d) None Ans:a 50.Index of potency of general anesthesia a) Minimum alveolar concentration b) Diffusion coefficient c) Deed space concentration d) Alveolar blood concentration + blood concentration Ans:a ANESTHESIALOGY Objective Questions with Answers 51.Thiopentone if injected accidentally into an artery, the first symptom is: a) Analgesia b) Pain c) Paralysis d) Skin ulceration Ans:b 52.Loss of pharyngeal reflex is more with which anaesthetic? a) Isoflurane b) Ketamine c) N20/02/Narcotic d) None of the above Ans:a 55.Highest analgesic effect is a feature of a) Ketamine b) Thiopentone c) Propofur d) Ethomidate Ans:a 56.Treatment of inadvertent injection of pentothal intra arterially a) Injection of procaine into the artery b) Papavarine intra arterially c) Heparin IV d) Stellate ganglion block e) All of the above Ans:e 57.Succinyl choline is short acting due to a) Rapid excretion b) Poor absorption c) Rapid hydrolysis d) None Ans:c 58.All are true regarding Halothane except a) Non-inflammable b) Boils at 50 C c) It is stable when exposed to light d) Heavy, colorless with characteristic sweet odour Ans:c 59.Best Uterine relaxation is seen with a) Chloroform b) Nitrous Oxide c)Ether d)Halothne Ans:d 60.The d-tubocurarine acts at a) Myoneural junction b) Pre-synoptic of parasympathetic nerves c) Post-synoptic of parasympathetic nerves d) Post-synoptic of sympathetic nerves Ans:a 62.Which of the following is eliminated by Hoffmann elimination a) Althesin b) D-tubocurarine c) Pancuronium d) Atracurium Ans:d 63.Mechanism of action of D-tubocurarine is a) Depolarizing b) Non-depolarizing c) Blockage of sodium channels d) Blockage of potassium influx Ans:b 64.Which of the following anesthetic agent sensitizes the heart to adrenaline a) Halothane b) Enflurane c) Isotherane d) Nitrous oxide Ans:a 65.Definitive sign of plane 1 of anaesthesia is a) Fixation of eyeball b) Papillary dilatation c) Blurring of vision d) Intercostal paralysis Ans:a 66.Which of the following anaesthetic agents has been superseded because of cardiotoxicity a) cyclopropane b) Halothane c) Chloroform d) Diethyl ether Ans:c 67.The following is a steroidal anesthetic agent a) Althesin b) Propanidid c) Methohexitone d) Di-isoprophyl Ans:a 68.Ketamine causes all except: a) Potent analgesic effect b) Muscle relaxation c) Completely excreted by liver d) Used in hypotension Ans:b 69.Intubation dose of pancuronium is a)0.02mg/kg b)0.06mg/kg c)0.08mg/kg d)1.2mg/kg Ans:c 70.Which of the following anesthetics can be self-administered by the patient during labor a) Trichloroethylene b) Ethyl chloride c) Halothane d) Enflurane Ans:a 71.Not an intravenous anaesthetic a) Etomidate b) Thiopentone c) Ketamine d) Cyclopropane Ans:d 72.One of the following causes delirium during recovery phase: a)Ketamine b) Thipentone sodium c) Halothane d) Cyclopropane Ans:a 73.Best analgesic is a) Ether b) Halothane c) Trilene d) Chloroform Ans:a 74.The most common cause of death of mother undergoing emergency caesarean section when general anaesthesia is being administered is a) Over dose of inhalational anaesthetic agent b) Circulatory failure c) Acid aspiration of stomach contents into the lungs d) Renal failure Ans:c 75.The activity of muscles of eyeball during ether anaesthesia is well marked a) Stage I b) Stage II c) Stage III d) Stage IV Ans:a 76.Regarding halothane, the correct statement is a) Large range of safety b) Maintenance of anaesthesia c) Does not cause arrhythmias d) Can be given in hepatitis patients Ans:b 77.Anesthetic agent that predisposes to maximum arrhythmias a)Isoflurane b) Enflurane c) Halothane d) Ether Ans:c 78.The following has the most potent analgesic action a) Chloroform b)Halothane c) Diethyl ether d) Trichloroethylene Ans:d 80.In which of the following is thiopentone contra indicated a) Head injury b) Retinal Surgery c) Diabetes d) Porphyri Ans:d 81.Color of Halothane cylinder is a) Red b) Purple c) White d) green Ans:a 82.Shortest acting muscle relaxant a) Pancuronium b) Atraurium c) Mivacuriun d) vecuonium Ans:c 83.Phase II blocker is a) Suxamethonium b) Atracuronium c) DTC d) Pancuronium Ans:a 84.Dose of ketamine by IV Route is a) 0.5 mg/kg b) 1 mg/kg c) 2 mg/kg d) 5mg/kg Ans:c 85.The following are muscle relaxants except a) Decamethonium b) Suxamethonium c) Hexamethonium d) Pancuronium Ans:c 86.The reversal of neuromuscular blockade with d-TC is done with a) Scoline b) Neostigmine c) Atropine d) Dantrolene Ans:b 87.Reversal of muscle relaxation is needed for the following a) Pancuronium and curare b) Succinyl choline c) Both d) none Ans:a 88.Depolarizing agents are associated with all of the following, except a) Muscle fasciculation's preceding the onset of block b) Absence of post tetanic potentiation c) Potentiation of block by anticholinesterases d) Reversal by anticholinesterases Ans:d 89.Thiopentone is used for induction anesthesia, because it is a) Smooth induction b) Rapidly redistributed c) Easy to administer d) Easy to monitor Ans:a 90.Maximum emesis causing anaesthetic a) N20 b) Diethyl ether c) Chloroform d) Thiopental Ans:c 91.Liver damage can be induced by a) Halothane b) Ether c) Trilene d) Nitrous oxide Ans:a 92.Muscle relaxant contra indicated in CRF a) Gallamine b) Succinyl choline c) Tubocurare d) Pancuronium Ans:a 93. Neuromuscular blocker used in hepatic and renal failure a) Scoline b) Tubocurarin c) Decamethonium d) Atracuronium Ans:d 94.Tubocurarine action is easily reversed! by a) Atropine b) Neostigmine c) Edrophonium d) Galathamin Ans:b 95.All are seen in ketamine anesthesia except a) Hypertension b) Hallucinations c) Bronchospasm d) Analgesia Ans:c 97.Colour of Nitrous oxide cylinder is a) Grey b) French Blue c) Black d) Black with white arms Ans:b 98.An anaesthetic agent with boiling temperature more than 75 C is: a) Ether b) Halothane c) Cyclopropane d) Methoxyfluorane Ans:d 99.The following antagonize the visceral side effects of neostigmine used in eversal of DTC blockade a) Atropine b) Nicotine c) Pilocarpine d) Pyridostigmine Ans:a ANESTHESIOLOGY Questions and Answers pdf Download Read the full article

[csectionbaby-blog]

What happens after c-section baby is born

Knowing About the Caesarean Born c-section baby Section Process

Fetal distress- the heartbeat of the baby is falling or presence of meconium is detected

Retrieval Time

There are a growing number of cesarean deliveries nowadays. Some parents opt for an elective cesarean delivery rather than a vaginal delivery in order to prevent severe labour pains. Though people are divided about the advantages and disadvantages, nobody can deny that cesarean deliveries have helped rescue many babies and their mothers!

The recovery time is about 4 days. It is seen that over 4 months of a c-section delivery, the mother regains complete mobility. Yes, this retrieval time is more than a vaginal delivery. Nonetheless, it spares the patient an uncomfortable episiotomy or a torn muscle which is not uncommon in vaginal deliveries. In any case, you are spared from intense labor pains and long waiting hours at the chilly hospital ward.

Natural childbirth advocates think that the act of giving birth is a natural occurrence and typically there isn't any good reason for medical intervention. Even though many believe birth should happen naturally whenever possible, there are medical risks that sometimes warrant a Caesarian Section or (C-Section) birthing alternative.

If the mother decides to have a c-section, she has the choice of being awake for the encounter by taking a local anesthetic or taking a general anesthetic, which would result in her being unconscious for the entire encounter. During natural childbirth mothers can decide to get a pain numbing

If not intended, this birthing process is undertaken if:

In USA, epidural can be used on individuals through a cesarean. Together with epidurals, the mother is awake while the surgery takes place but is numb down waist. This lets the mother and the father to see the infant immediately after birth. Yes, your spouse is allowed enter the surgery theater to support you. You don't need to be concerned about feeling pain during surgery. Epidurals or Spinals as they're also known as are used in greater than 95\% of the cesareans and very few have really complained of discomfort, let alone pain. If you're still concerned, you can ask the doctor to provide you with a light medicine, which will prevent you in a daze while the operation is on.

The Procedure

The position of the baby Isn't suitable- breech position

But you as parents have to decide on the delivery procedure premature during pregnancy. Discuss your preference with your OB. He might have the ability to show you a really different perspective!

The mom is no longer in a situation to tolerate the strain of vaginal delivery

Infectious vaginal disease which can be moved into the baby during delivery is detected

Types Of Incisions

Barring cases of fetal distress, C-sections can be predicted during the third trimester of this pregnancy.

Baby is too big for the mother's pelvis

Cesarean deliveries using epidural somewhat lowers the disappointment some mothers feel for not being able to shipping vaginally. The entire process generally takes 30 to 45 minutes. General anesthesia is used only in emergencies where is there is no time to get an epidural or when the individual has a prior record of spine injury, heart or lung disorders.

There are two types of Cesarean incisions- skin incision and uterine incision. The abdomen muscles are not cut in some of the incision kinds. On the other hand, the fashion of the cut, vertical or traverse is based on conditions. The skin and uterine incision, are quite low from the patient's abdomen around the bikini line. Some women will need a c section and others will not, however it's sometimes mandatory to have a c-section. Some conditions were cesarian section could be compulsory are recorded below:

Planned Caesarian sections births are often much quicker than natural childbirth. Many women are opting for scheduled c-sections to choose as it's that they will give birth. Opponents of unnecessary c-sections assert that it not in the best interest of the child not to be given the chance to put in the world in his or her own time.

Epidural or give birth with no drugs in any way.

If you need a cesarian section, you'll be given an anesthetic medication. If you're in emergency scenario, you will be placed to sleep completely, differently epidural or spinal anesthesia will be utilized which will keep you conscious without needing any pain. Most hospitals today allow your husband to be in the delivery room, unless you

With natural childbirth a regular vaginal delivery occurs, though there is a stretching of the uterus. The female body is designed to resist the procedure and the body will return to its previous shape not long after the arrival. With natural childbirth many women experience extreme pain through delivery. Many also say that the minute the baby is born that the pain is forgotten.

Your infant is in strange position such as breech presentation wherever your infant is upside down and his mind is facing upwards instead of downwards.

Planned or Organic Deliveries

Cesarian section is considered as a big surgery and consequently its risk is greater than a normal vaginal delivery. Some of these risks include greater incidence of wound infection, more bleeding, more pain as well as more hospital stay. Since the surgical incision is very close to the bladder, there's a rare chance that it could be injured. Retrieval time to get a c section is also longer than a vaginal delivery.

It's also worth mentioning that a cesarian section will impact you potential pregnancies. The risks of having a placenta previa [ a condition where the job of the placenta in the uterus is unnatural is raised.

Advances in the techniques of tracking your baby during shipping provide crucial information about the health of your baby and when she can tolerate labor and delivery. If it's clear your baby may be in danger, most obstetricians are quick to do a c section. Also, improvements in the operation itself, in anesthesia, and in antibiotics make the operation safer for the mother and her infant.

Cesarian section is a surgical process through which your infant is delivered through an abdominal incision. Cesarian section can be optional and scheduled beforehand or it may be emergency, if an attempted vaginal delivery has failed.

The Pain of Childbirth

If you're pregnant with more than 1 infant [twin pregnancy], and tried vaginal delivery has failed.

If you had a cesarian section previously where the incision in the uterus has been vertical.

If you underwent a previous surgery on your own uterus like removal of a benign tumor.

During a Caesarian Section, the physician cuts an incision through the abdomen and into the uterus. C-sections may be less painful during the shipping process but also the incision, like with any invasive surgical procedure, will be painful afterwards for a couple of weeks or longer as the recovery process occurs.

Your infant is predicted to be big and this very frequent in infants whose moms are diabetic. Blood loss is double when compared to regular shipping. It's obviously increased as fresh blood cells are constantly being shaped. There is rarely any requirement of blood transfusions

"it's indeed exciting to now hear different girls and members of the obstetric community stating what I have said for the last six years," she explained. "I

Respiratory problems like pneumonia can be gotten by general anesthetic procedure.

Premature birth: When due date is miscalculated, an ancient delivery can occur. The week infant then is stored in a unique caring unit unless it accomplishes normal weight and completes the normal term.

Cesarean Section or C-section is a operation carried out to deliver a baby. When there are numerous babies or some other troubles, the girl is not able to have normal vaginal delivery, then her abdomen is medically trimmed to take the baby out. Mostly C-section is operated when unexpected complications happen during delivery. These can be:

Longer recovery period is just another risk that's surely faced by every girl experiencing a C-section childbirth.

For baby:

It is the latest thing. As trendy as Kabbalah, with the studying. Madonna did it. So did Elizabeth Hurley. Cesarean section by choice has become almost a fad of sorts. Do Yoga a.m. Have your baby at 10 a.m.. It not only fits your program, but your physicians and you get the added benefit of avoiding anything remotely like a labour pain.

A number of other problems can also be observed but these are rare or mild to be easily cured.

Breathing complications: Transient tachypnea, a disorder characterized by abnormally rapid breathing during first several days after birth can render adverse affects on infant.

C-section can pose these dangers to mother:

Additional surgeries: It is quite likely to possess the need for more surgeries because of such as bladder repair, hysterectomy as well as many others.

The incision made during operation may leave a week spot in the wall of the uterus. This in turn may cause complications in vaginal delivery after next pregnancy. But over half of women who previously have been operated on for childbirth may have normal deliveries later but with a few issues that may be nicely managed.

Any flaws in the baby

Injury:Fetal harm is infrequent but possible. The surgeon can wrongly influence the infant whilst making a breast implants.

Threats with C-Section

It is better to prevent any complication until it accomplishes a serious level to avoid C-section as much as possible. The chances of death are one in every 2,500 women as compared to one in every 10,000 in delivery. Risks are higher so is the passing rate. Despite that one in every four pregnant women in US gets infant delivered by C-section. How strange!

It is usually safe for the mother and baby but is a significant surgery with several risks.

For mom:

Health problems in mom that might be long-term

Congested room for the infant to go through vagina

Carrying more than 1 infant

Precautions

A few dangers can be prevented but not all.

Infection in uterus or neighboring pelvic organs such as the kidney or bladder is likely to happen.

Abnormal position of the fetus

There are particular risks to the baby as well during a surgical delivery. These are:

Reaction to anesthesia: Mother's health could be in a dangerous stage due to the use of many drugs during surgery. Blood pressure quickly drops sometimes that is hard to treat at this moment. A total of 169 women or 84.5 percent demonstrated highly significant increases in organ mobility. Moreover, the period of the next phase of labor correlated with an increase in pelvic organ uterus, indicating that vaginal delivery is a major contributor to pelvic organ prolapse.

Some research and physicians claim that elective Cesarean is just as secure if not more than a vaginal shipping and that the potential side effects of a vaginal delivery create c-section even more attractive.

"Had I seen patients with these kinds of issues before Max was born, I'd have chosen to have a c-section with him, too. I determined I did not want to risk more incontinence or prolapse in the future."

Had an elective Cesarean section with my pregnancy since I had a wonderful female OB who admired my desire to avoid vaginal and pelvic floor injury. My part was awesome - wide awake and no hassle, I had been up walking in under 8 hours"

"My second reason for picking c-section stems from the work I have done as a urologist. Throughout a cosmetic surgery Dentistry this past year, I watched women who suffered the consequences of incontinence and prolapse. These outcomes are directly related to vaginal delivery.

"In cases where women are prone to incontinence and prolapse, doctors are ready to perform c-section. I experienced incontinence for seven weeks after Max's birth and it started to recur during this pregnancy.

Diverse attitudes involving doctors and mothers about the "right" way to provide a baby are not just causing confusion for new mothers who are scared in their initial labor and delivery expertise, but divisiveness among feminists. For several years feminists fought for the right to take control of their bodies once again and deliver infants naturally with no unnecessary medical intervention that girls throughout much of the twentieth century have been subjected to. Now, a new generation of feminists assert that it is also their right to choose to deliver their baby without any pain. But how safe is an elective Cesarean section?

"Max was supposed to have been a seven-pound infant, but was actually nine pounds, eight ounces. His head and shoulders got stuck in the birth canal and he endured fetal distress. Given my entire body habitus, he should have been delivered c-section, but I persevered and delivered vaginally.

"I had a very difficult time with the delivery of my son, Max at December, 1999. I was in labor for 18 hours, which had been made more challenging by the fact that I had an epidural too early, which subsequently led to the arrival process to slow down.

This seems to be true for all 3 vaginal compartments. All forms of cesarean delivery were associated with relatively less pelvic organ descent. These findings may partly explain the protective effect of elective cesarean delivery for potential symptoms of pelvic floor disorders.

[juniperpublishersanesthesia]

Total Spinal Blockage after Spinal Anaesthesia for Perianal Fistula-Juniper Publishers

Abstract

Total spinal block is one of the rare complications of regional anaesthesia. It can occur after spinal, epidural or nerve plexus block. Early detection and treatment is essential to prevent mortality. We report a case of total spinal block occurring in a man with perianal fistula after receiving uneventful spinal anaesthesia for caesarean section treated successfully with prompt cardiovascular resuscitation and general anaesthesia.

Introduction

Spinal anaesthesia is being increasing used as a mode of anaesthesia for performing treatment for perianal fistula [1]. Although it is a safe and effective means of giving anaesthesia, at times it can lead to complications like hypotension, shivering, respiratory distress, unconsciousness, etc [2]. Total spinal block is a rare complication of spinal anaesthesia. It is a life threatening complication presenting with symptoms of unconsciousness, hypotension, bradycardia and respiratory failure [3].

We report a case of total spinal block occurring in young man after receiving uneventful spinal anaesthesia for perianal treatment. The patient was successfully treated with prompt cardiovascular resuscitation and general anaesthesia.

Case Description

We report a case of 33 years old man, ASA 1 admitted for treatment of perianal fistula that has evolved since 3 years.

In surgical history, he was operated two times for perianl abcess, first time in 2012, and second time one year ago, the two operations were made under general anesthesia without any intraoperative complications. No history of any medical illness or allergy.

On pre-anesthetic examination patient was in good general condition with weight of 88 kg, height 1.80 m, and body mass index of 27.16 kg/m2. Respiratory and cardio vascular examination were unremarkable. Patient had thoracolumbar scoliosis since the age of 18 years.

Laboratory tests include: hemoglobin: 10.8 gm%, platelets count: 2.36 x 105/mm3, glucose: 0.81 mumol/, blood group: O negative.

Patient was explained about the procedure of spinal anaesthesia. During induction, patient was placed in lateral decubitus, with standard hemodynamic monitoring. At induction his hemodynamic condition was stable (blood pressure: 120 / 80 mmHg, pulse rate: 75b / min, SPO2: 100%). Intravenous access was taken in the peripheral vein of both arms with 18 G vein flow needle and prefilled with 750 ml of 0.9% normal saline. Classic single shot spinal anesthesia was given with 27G  spinal needle in the first attempt level of block. Slow injection of 08mg of 0.5% isobaric bupivacaine + fentanyl 20gamma was given. His blood pressure and pulse rate were monitored every 2 minutes. After 4 minutes of spinal anesthesia, and before anal dilatation, patient started experiencing respiratory discomfort, nausea and vomiting. There was sudden fall in blood pressure (BP) to 60/30 mmHg and desaturation (SPO2: 70%) with pulse of 70b / min. Patient became unconscious. There was bilateral nystagmus, and mydriasis on pupil examination. Subsequently patient became dyspneic followed by apnea. Hence ephedrine was administered intravenously 9 mg bolus every 2 minutes along with mask ventilation with 100% pure oxygen.

The hemodynamics further worsened to unrecordable BP and SpO2 (oxygen saturation) between 60-70% despite mask ventilation. As patient failed to respond to any medication, we went ahead with rapid induction (drugs used: 300mg pentothal + 300mg gamma fentanyl + 50mg rocuronium) and orotracheal intubation. After intubation, SpO2 improved to 80-90%. But hemodynamics continued to remain unstable (systolic BP: 50-80mmHg, pulse rate: 120b / min). Repeated adrenaline injections (0.2mg / every 05min) were given along with intraoperative volume replacement rate of 2.5 macromolecules litre. Throughout the duration of resuscitation, pulmonary auscultation was normal without any evidence of bronchospasm. The diagnosis of complete spinal block was made.

After 120 minutes of continued hemodynamic and respiratory support, improvement in the hemodynamic state and respiration was noted (BP: 80-120 / 30-50mmHg, heart rate: 100-120 b / min, SPO2 90-95%)

As the hemodynamics stabilized with signs of respiratory efforts, we gradually withdrew vasoactive narcotic drugs. After 5 hours of spinal anesthesia, there was regain of consciousness with spontaneous breathing efforts. Patient kept under artificial assisted controlled intermittent ventilation and pressure support for two hours and then extubated.

Subsequently, pure oxygen was administered through the nose for 05 hours and analgesic medications were given for pain relief. Patient was discharged on postoperative day 3 without any neurological or clinical sequelae. Patient was advised to avoid spinal anesthesia in future.

Discussion

Spinal anaesthesia is one of the preferred procedures for proctology as it is safe, effective and provides good postoperative analgesia [4]. Cardio-respiratory failure after spinal anaesthesia for perianal fistula is rare. It can occur due to total spinal block, anaphylactic reaction to anesthetic drugs, etc. In the present case, since there was cardio-respiratory failure followed by unconsciousness, total or high spinal blockage was suspected. But considering the fact that the procedure of spinal anesthesia was uneventful and the drugs were used in the routine doses, the cause of total spinal block could not be ascertained.

Total spinal block has been reported after epidural test dose [5], lumbar plexus block [2], etc. It occurs because of various technical reasons like use of higher dose of anesthetics, accidental subdural puncture, rapid change of posture, etc. Thoracolumbar scoliosis may have acted as an indirect risk factor for development of total spinal anesthesia.

Conclusion

To conclude, total spinal block is a rare complication which should be kept in mind while monitoring patient after spinal anaesthesia. Immediate resuscitation with intravenous fluids, inotropic and respiratory support can help tide over the acute crisis.

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com

For more articles in Journal of Anesthesia & Intensive Care Medicine please click on: https://juniperpublishers.com/jaicm/index.php

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[rhinoplastyplano]

Why Are Rhinoplasty So Expensive?

Contents

Rhinoplasties. "if you

With the shape

Plastic surgery offers

Takes approximately two and

That are easily corrected

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[kittyisgo-blog]

Note: the mode of delivery affects the child's future

A few years ago, "British Medical Journal" magazine published a research report of University of Southampton researchers: a few months before the baby weight on average after birth, adult after suffering from mental depression, and these baby weight factors because of intrauterine growth retardation, premature delivery, postpartum malnutrition caused by. The report confirms, in some ways, the findings of an American psychologist, Verkh, who published years ago that the mode of delivery might determine the future of a child.

The study found that the process of childbirth, although relative to the child's life, is very brief, but this process will affect a person's future personality, temper and temperament. He believes that if the birth suffered a head injury or forceps has suffered long-term pain difficult births may exhibit melancholy future, and prone to mental retardation; cesarean section infants, because no experiencing labour bursts of uterine contraction, grow up to lack of patience, brash feet before; hip delivery of the fetus, the future often lively; hypoxia or anesthetic effect in infants during childbirth, personality may be withdrawn, and not good at communication.

Study on by western medicine, especially in obstetrics and Gynecology, pediatric experts and psychologists concern, and has made a lot of research, not only confirmed Fuhe view, but there are many new discoveries. Stress, adrenaline, and norepinephrine surge in the fetus before birth and during childbirth, it is noted. These rapidly increasing stress hormones prevent the fetus from suffocating in the birth canal and prepare the baby for the first breath after birth. Therefore, the normal delivery of the baby than not experienced childbirth Caesarean baby lung capacity and a lower risk of respiratory disease; normal children amblyopia incidence rate was only 4%, but by the forceps delivery and cesarean section, breech delivery and other ways of children's amblyopia dystocia rate was as high as 15%.

Due to dystocia were considered: amblyopia may be related to fetal hypoxia or asphyxia in intrauterine, eye and brain tissue hypoxia damage, or obstetric apparatus hurt the fetus head and face; premature birth defects will lead to physical weakness and nervous system; prolonged pregnancy will cause the baby brain hypoplasia, dementia and so on. Even different ways of giving birth affect the baby's nutritional status. Japanese doctors have confirmed that the traditional supine posture can inhibit the secretion of milk. The parturient with sitting posture has an average secretion of nearly 1000 ml of milk per day within 5 days after delivery, more than 1/3 of the level of delivery, and the amount of milk determines the nutritional status of the parturient.

Therefore, in order to eugenics, pregnant women do self health care in the perinatal period should check regularly to outpatient hospital health care, prenatal, labor as possible without equipment delivery, without anesthetic to cesarean section and so on.