A comparative study to assess I-gel as an alternative to endotracheal tube in laparoscopic surgeries

Background: This study was conducted to compare and evaluate the effectiveness of I-gel over endotracheal tube with regards to respiratory and  hemodynamic parameters  in laproscopic surgeries. Methods: In this study 60 adult patients of either sex, of ASA status I or II, aged 16 to 60 years, undergoing laparoscopic surgeries under general anesthesia were randomly studied. In Group-A (I-gel) appropriate sized I-gel was inserted, and in Group-B (ETT) patient’s airway was secured with laryngoscopy-guided endotracheal intubation. Monitoring of PR, MBP, SpO2 and EtCO2 was done throughout the peri-operative period. Haemodynamic and ventilatory parameters were recorded before induction (baseline), just after intubation, then at 1, 3 and 5 min after I-gel insertion/intubation, after pneumoperitoneum, after change of position, before and 5 min after release of pneumoperitoneum and after I-gel removal/extubation. Results: Following the insertion of airway device there was significant rise in PR (3 min after intubation [P = 0.011, df-58, CI-95%]) and MBP (3 min after intubation [P = 0.02, df-58, CI-95%], 5 min after intubation [P = 0.04, df-58, CI-95%]) in Group-B patients when compared to Group-A patients. Following insertion of airway device there was no significant difference in EtCO2 (3 min after intubation [P = 0.778, df-58, CI-95%]), 5 min after intubation [P = 0.75, df-58, CI-95%]) in Group-B patients when compared to Group-A patients. Conclusions: I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel can be a safe and suitable alternative to ETT for laparoscopic surgery

Pregnancy outcome after first trimester vaginal bleeding

Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome