Effect of intravenous dexmedetomidine and small dose fentanyl on shoulder tip pain in gynecological laparoscopic surgeries under spinal anaesthesia

Background: Shoulder tip pain and discomfort due to peritoneal stretching is the major limiting factor of spinal anaesthesia in laparoscopic surgeries. Aim of the study was to evaluate the effect of intravenous dexmedetomidine along with small dose fentanyl in abolishing the shoulder tip pain during gynaecological laparoscopic surgery and to assess its respiratory and hemodynamic effects.Methods: 50 ASA grade I and II, with age 18-50 yrs and weight 45-70 kgs, who were undergoing elective gynecological laparoscopic surgeries with estimated pneumoperitoneum time of one hour or less, were included in the study. Injection dexmedetomidine 1 mcg/kg was infused over a period of ten minutes before spinal anaesthesia with 3.5 ml of injection ropivacaine (0.75%) in lateral position. Injection fentanyl 0.5mcg/kg was given intravenously before intraperitoneal insufflation. Shoulder tip pain, peri-operative heart rate, noninvasive blood pressure, end tidal carbon dioxide, respiratory rate and sedation level using Ramsay sedation score were assessed at frequent intervals.Results: 35 patients were comfortable with no complaints, 11 patients had mild and two patients had moderate shoulder tip pain which was relieved by reducing abdominal pressure or/and an additional dose of fentanyl (25 mcg). One patient had severe pain and had to be converted to general anaesthesia. Ready sedation score was 2 or 3 for all the patients except one who was deeply sedated and had to be intubated. The drug combination used reduced the shoulder tip pain in gynaecological laparoscopic surgeries performed under spinal anaesthesia while maintaining the stable intra-operative hemodynamics.Conclusions: This study has provided the preliminary evidence of feasibility of use of dexmedetomidine along with low dose fentanyl to reduce the discomfort and shoulder tip pain during gyanaecological laparoscopic procedures of short duration under spinal anaesthesia in selected patients

Design and implementation of an innovative electronic magnetic gearingmotor

This paper presents an innovative electronic magnetic geared (EMG) motor. The motor is designed and tested. This electronic EMG motor assembles parallel, serial or hybrid connections of stator windings into gears to accommodate the different speed and torque demands in the drive cycle. The objective of EMG is to increase the maximum speed and maximum torque range of the motor. A 1.5 kW prototype EMG motor was built up and tested on a test rig. The test results prove that the theory of EMG is correct. It will have a large positive impact on the energy efficiency of electric vehicles

Graded epidural anaesthesia for Caesarean section in a parturient with Shone’s syndrome: a case study

Pregnancy with underlying heart disease is a unique challenge both to the obstetrician and the anesthesiologist. Asymptomatic women with mild to moderate single lesions can successfully carry a pregnancy to term and undergo vaginal delivery. However, pregnancy can result in rapid clinical deterioration, which may lead to maternal and/or foetal mortality in symptomatic patients with complex heart diseases, like Shone’s syndrome. A thorough understanding of the impact of pregnancy on the haemodynamic response to the patient’s cardiac lesion is required for the management of labour and delivery. A meticulous approach is needed when planning anaesthesia for Caesarean section in such a case as the associated haemodynamic effects of both regional and general anaesthesia can have a serious deleterious effect on both the mother and infant.We report on the successful management of a parturient known to have Shone’s syndrome undergoing Caesarean section under graded epidural anaesthesia.Keywords: Caesarean section, epidural anaesthesia, pregnancy, Shone’s syndrom

The right of freedom of press under the Printing Presses and Publication Act 1984 / Ahmad al-Hady Abdul Razak … [et al.]

Media plays a crucial role in shaping and altering public opinion through various means of reporting. Freedom of press is not a right exclusive for the media community only. Malaysian citizen also should be attentive to fight for freedom of press as it should be their right to freedom of expression. Freedom of expression includes one right to receive information. In other country such as India, freedom of press is included under freedom of speech and expression. In Malaysia, the situation is different where by press freedom is not clearly protected as one of the fundamental liberties in Federal Constitution. The extent of freedom of press in Malaysia can be seen in one of the legislation in the country, i.e. Printing Presses and Publications Act 1984(the Act). The Act has attracted much criticisms and disapproval especially among media community and Malaysian journalists. Their rights to express opinion and information are always oppressed by the extensive scope imposed under the Act. The absolute discretionary power of the Home Minister is seen as a hindrance to the pave of press freedom. With exclusion of judicial review and principles of natural justice under the Act, it strengthens the power of the Home Minister and consequently weakened press freedom. This project paper composed of in-depth study of the position of freedom of press under Article 10 (1) (a) of the Federal Constitution and the extent of freedom of press under the Act

Effect of intravenous dexmedetomidine and small dose fentanyl on shoulder tip pain in gynecological laparoscopic surgeries under spinal anaesthesia

Background: Shoulder tip pain and discomfort due to peritoneal stretching is the major limiting factor of spinal anaesthesia in laparoscopic surgeries. Aim of the study was to evaluate the effect of intravenous dexmedetomidine along with small dose fentanyl in abolishing the shoulder tip pain during gynaecological laparoscopic surgery and to assess its respiratory and hemodynamic effects.Methods: 50 ASA grade I and II, with age 18-50 yrs and weight 45-70 kgs, who were undergoing elective gynecological laparoscopic surgeries with estimated pneumoperitoneum time of one hour or less, were included in the study. Injection dexmedetomidine 1 mcg/kg was infused over a period of ten minutes before spinal anaesthesia with 3.5 ml of injection ropivacaine (0.75%) in lateral position. Injection fentanyl 0.5mcg/kg was given intravenously before intraperitoneal insufflation. Shoulder tip pain, peri-operative heart rate, noninvasive blood pressure, end tidal carbon dioxide, respiratory rate and sedation level using Ramsay sedation score were assessed at frequent intervals.Results: 35 patients were comfortable with no complaints, 11 patients had mild and two patients had moderate shoulder tip pain which was relieved by reducing abdominal pressure or/and an additional dose of fentanyl (25 mcg). One patient had severe pain and had to be converted to general anaesthesia. Ready sedation score was 2 or 3 for all the patients except one who was deeply sedated and had to be intubated. The drug combination used reduced the shoulder tip pain in gynaecological laparoscopic surgeries performed under spinal anaesthesia while maintaining the stable intra-operative hemodynamics.Conclusions: This study has provided the preliminary evidence of feasibility of use of dexmedetomidine along with low dose fentanyl to reduce the discomfort and shoulder tip pain during gyanaecological laparoscopic procedures of short duration under spinal anaesthesia in selected patients

Foetomaternal Outcomes of Jaundice in Pregnancy at a Tertiary Care Centre: A Prospective Cohort Study

Introduction: Jaundice complicates 3 to 5% of pregnancies and is one of the important causes of maternal and neonatal morbidity and mortality worldwide. It is responsible for approximately 10% of maternal deaths. Aim: To study the prevalence of jaundice in pregnancy, evaluate the important causes of jaundice encountered in pregnancy, and study the effects of jaundice during pregnancy on both maternal and foetal outcomes. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India, from March 1, 2021, to August 31, 2022. A total of 90 cases of pregnancy with jaundice were included in the present study. Detailed history, clinical examination, laboratory investigations, diagnosis, management, and outcomes in terms of maternal and perinatal morbidity and mortality were recorded. Data were analysed using the Chi-square test, with a statistical significance level set at p<0.05. Results: The total number of deliveries was 20,087, out of which 90 (0.45%) patients had jaundice. The prevalence of jaundice in pregnancy was 4.5 per 1000. The aetiologies of jaundice were viral hepatitis in 23 cases (25.55%), followed by intrahepatic cholestasis in 22 cases (24.44%), preeclampsia in 13 cases (13.33%), and Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome in 6 cases (6.66%). There were 12 (13.33%) maternal deaths and 17 (18.88%) neonatal deaths. Two (2.22%) babies were stillborn, and 1 (1.11%) case experienced Intrauterine Foetal Death (IUFD). The maternal death rate due to HELLP syndrome was 66.66% (4 deaths out of 6 cases). Conclusion: Viral hepatitis is the most common cause of jaundice in pregnancy. Although viral hepatitis due to the faecooral route is more common in India, the present study showed that Hepatitis B is more common during pregnancy