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Biomedical subjects

A K Soni

Publications and source records attributed to A K Soni.

11 recordsLinked to original sources
PubMed2000

An association between severe labor pain and cesarean delivery.

UNLABELLED: The relationship between epidural analgesia and cesarean delivery remains controversial. Several studies have documented an association, although others have not. This inconsistency may result from an association between severe labor pain and dystocia. We hypothesized that dystocia causes severe labor pain, such that more epidural medication is required to maintain comfort. We examined the relationship between labor outcome and severe pain, defined by the number of supplemental epidural boluses. We retrospectively reviewed the anesthesia records of 4493 parturients who received small-dose labor epidural analgesia. An independent association was found between operative delivery and maternal age, body mass index, nulliparity, fetal weight, induction of labor, and the number of boluses required during labor. By using multivariate analysis, the odds ratio of cesarean delivery among women who required at least three boluses was 2.3 compared with those who required two boluses or less. No association was found between the concentration of bupivacaine in the epidural infusion and operative delivery. Because women with cesarean deliveries appeared to have more pain, degree of labor pain may be a confounding factor in studies examining epidural analgesia and outcome. IMPLICATIONS: This is a retrospective observational study demonstrating an association between labor pain and cesarean delivery. Our results provide an alternative explanation of why epidural analgesia is associated with cesarean delivery.

Adult↗
PubMed1997

High sensitivity of tubifex for ultraviolet-B.

Phytoplankton and zooplankton serve as major food material for primary and secondary consumers in the marine food web. Although phytoplankton are primary targets to UV radiation damaging effects, we have demonstrated that stratospheric ozone depletion will affect zooplankton to contribute to inhibition in biomass production. In this study, an annilid Tubifex was irradiated under UVA, UVB, UVC or direct sunlight to demonstrate behavioral changes (motility and mortality). The organism showed varying degrees of sensitivity towards UVB and UVC. Even a small increment in UVB resulted in high degree of mortality. Interestingly, water turbidity seems to have a protective effect against UV exposure. These results strongly suggest that a change in UVB flux has direct impact on biomass production.

Animals↗
PubMed1997

Snoring and oral submucous fibrosis.

Forty patients above the age of 40 years with oral submucous fibrosis were studied to determine the frequency and severity of snoring. The results were compared with a controlled group of similar sex and age for presence of snoring. The present study indicates that patients with oral submucous fibrosis having a short and fixed uvula and scarred soft palate are less likely to develop snoring. Thus it is suggested that in laser surgery or in classical uvulopalatopharyngeal surgery, the uvula and soft palate should be reduced in size and volume to the extent of that found in oral submucous fibrosis.

Adult↗
PubMed1997

Intravenous oxytocin in patients undergoing elective cesarean section.

The objective of this study was to compare four different doses of oxytocin to determine its minimal effective dose during elective cesarean section. A prospective, double-blind, randomized study was undertaken in 40 healthy term parturients presenting for elective cesarean section under regional anesthesia. Subjects were assigned to one of four groups. Group I received 5 IU, Group II 10 IU, Group III 15 IU, and Group IV 20 IU of oxytocin after clamping of the umbilical cord. Uterine tone was assessed by palpation on a linear analog scale (LAS) of 0 to 10 (0 = completely atonic, 10 = fully contracted) at 5, 10, 15 and 20 min after the start of oxytocin infusion. Estimated blood loss (EBL) and the difference in pre- and postoperative hematocrit (delta Hct) were also recorded. At alpha = 0.05, the study design had a power of 95% to detect a 25% difference in the LAS between the four groups. There were no differences in the uterine tone in the four groups at any of the four intervals. EBL and delta Hct were similar in all four groups. There appears to be no benefit in terms of degree of uterine contraction and amount of blood loss to administering more than 5 IU of intravenous oxytocin to term parturients undergoing elective cesarean section with a neuraxial block.

Adult↗
PubMed1996

Prevalence of coagulation abnormalities associated with intrauterine fetal death.

PURPOSE: The purpose of this study was to determine factors associated with abnormal coagulation in the setting of intrauterine fetal death (IUFD). METHODS: We reviewed the charts of 238 patients diagnosed with IUFD over ten years. Data included demographics, co-existing obstetric disease and coagulation studies. A coagulation score was assigned based on the platelet count, prothrombin time, activated partial thromboplastin time and plasma fibrinogen concentration. Approximately 90% of the study population had coagulation scores < 4. A score of > or = 4 was considered abnormal. RESULTS: Complete coagulation analysis was available in 183/238 patients (77%) within 24 hr of delivery. One hundred and sixty-four of these (89.6%) had a coagulation score, < 4 and 19 had a score > or = 4 (10.4%). No relationship between the coagulation score and age, parity, gestational age at delivery, and number of days the dead fetus remained in utero was found. A coagulation score > = or 4 was associated with the presence of a pregnancy-related disease (P < 0.05), notably abruption (P < 0.001) and uterine perforation (P < 0.05). Four patients without co-existing disease (3.2%), had a coagulation score > or = 4. CONCLUSION: In most pregnancies complicated by fetal demise, the fetus and placenta are delivered within one week of fetal demise. The previously reported severe coagulation disturbances are largely eliminated by early delivery. Our study shows that coagulation abnormalities occur in some patients with uncomplicated IUFDs (3.2%) and that this number rises in the presence of abruption or uterine perforation.

Blood Coagulation Disorders↗
PubMed1996

Doctor Dee's ether apparatus.

In the early 1940s, Dr M. H. Armstrong-Davison devised an apparatus for inhalational anaesthesia. The apparatus was essentially a combination of Water's to-and-fro soda-lime canister and Hewitt's ether inhaler. The description of the apparatus is followed by a brief historical note on Dr Armstrong-Davison.

Anesthesia, Inhalation↗
PubMed1995

Paravertebral blockade. Failure rate and complications.

The failure rate and complications were studied prospectively in 367 paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1%; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1.1%; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.

Adolescent↗
PubMed1994

Videothoracoscopic operation for secondary spontaneous pneumothorax.

Thoracotomy for the management of a secondary spontaneous pneumothorax is associated with a high perioperative risk related to the presence of underlying lung disease. Videothoracoscopy offers the potential therapeutic benefits of a minimally invasive approach. We report on a series of 22 patients (19 men and 3 women) with a mean age of 70 years (range, 46 to 92 years) who underwent videothoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. All patients had emphysema; their mean preoperative forced expiratory volume in 1 second was 48% of predicted and their mean forced vital capacity was 64% of predicted. Eighteen patients presented with a persistent air leak and their mean preoperative hospital stay was 18 days (range, 6 to 40 days). Pleurectomy was performed in all 22 patients, together with bullectomy in 20 patients, with a mean overall operating time of 57 minutes (range, 24 to 90 minutes). General anesthesia was used in each patient. Single-lung ventilation, used in the majority, was found to be superior to high-frequency jet ventilation. The postoperative analgesic requirement was minimal (average, 15 mg of morphine in the first 12 hours), and no patient required reventilation. A revisional thoracotomy for the management of a persistent postoperative air leak was required in 4 patients, one of whom subsequently died in respiratory failure. The mean postoperative stay was 9 days (range, 3 to 26 days). At a mean follow-up of 8.6 months (range, 2 to 15 months), no pneumothorax had recurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Video-assisted thoracoscopic placement of paravertebral catheters: a technique for postoperative analgesia for bilateral thoracoscopic surgery.

Paravertebral catheters were placed bilaterally through a Tuohy needle under direct video control in a patient undergoing video-assisted thoracoscopic (VAT) surgery for recurrent, bilateral pneumothoraces. Postoperative analgesia was produced by infusing bupivacaine through the catheters. This provided good analgesia. VAT placement of paravertebral catheters is easily accomplished and may be a part of the surgical procedure.

Adult↗
PubMedDate not supplied

Low dose intrathecal ropivacaine with or without sufentanil provides effective analgesia and does not impair motor strength during labour: a pilot study.

PURPOSE: Although ropivacaine has been used to provide spinal anesthesia in the surgical population, its intrathecal administration for labour analgesia has only recently been described. We evaluated the effects of low dose intrathecal ropivacaine with or without sufentanil for labour analgesia. METHODS: Thirty-six term parturients in active labour were randomly assigned to receive 3 mg of intrathecal ropivacaine (group R) or 3 mg ropivacaine with 10 microg of sufentanil (group RS). Patients were evaluated by a blinded observer for hypotension, linear analogue score (VAS 0-100) for labour pain, motor power in the lower limbs, onset of analgesia, sensation to cold and pin prick, duration of analgesia, and neonatal Apgar scores. The following day patients were assessed for satisfaction, headache and neurologic deficit. RESULTS: The mean duration of analgesia in the R group was 41.4 +/- 4.9 min and 95.0 +/- 6.1 min in the RS group (mean +/- SEM, P=0.0001). All subjects had satisfactory analgesia at five minutes, although analgesia from the ropivacaine- sufentanil combination was superior to that provided by ropivacaine alone. Total duration of labour was no different between the groups (R- 306 +/- 34, RS- 384 +/- 44 min, P=0.17). No patient showed evidence of motor block. All patients were satisfied with the labour analgesia. No neurological complications were observed. CONCLUSIONS: Low dose ropivacaine provides effective analgesia during labour via the intrathecal route. It can be mixed with sufentanil in the above-mentioned concentrations to improve both the quality and duration of analgesia. Fetal outcome remains favourable. It may provide minimal or no motor block, to facilitate ambulation.

Adjuvants, Anesthesia↗