Rapid sequence spinal anesthesia versus general anesthesia: A prospective randomized study of anesthesia to delivery time in category-1 caesarean section

Background and Aims: Spinal anesthesia is the preferred technique over general anesthesia in caesarean section. General anesthesia is still used for category-1 emergency caesarean section because of time constraints. We usually follow rapid sequence general anesthesia in obstetrics to avoid aspiration. However, this technique poses several problems. An approach of spinal anesthesia termed as rapid sequence spinal anesthesia has been described. The present study was designed to compare the time intervals (time for anesthesia, time to surgical readiness, incision to delivery time, emergence time) and Apgar score between rapid sequence spinal anesthesia and rapid sequence general anesthesia during category-1 caesarean section and to evaluate whether rapid sequence spinal anesthesia is a better option in category-1 caesarean section. Materials and Methods: In this prospective randomized study, 60 patients of American Society of Anesthesiologists physical status (ASA-PS) I posted for category-1 emergency caesarean section were randomly allocated into two equal groups and received either of the two techniques. Demographic data, respective time intervals, and Apgar scores were noted and compared. Results: The time for anesthesia, surgical readiness, and emergence were significantly longer (P < 0.001) in rapid sequence general anesthesia group as compared to rapid sequence spinal anesthesia group (144.80 ± 3.42 vs 131.20 ± 3.40 s, 178.76 ± 4.09 vs 169.93 ± 3.08 s, 512.13 ± 34.33 vs 222.10 ± 12.80 s). No significant difference was found in incision to delivery time and Apgar scores between the two groups. Conclusion: Because anesthesia to delivery time is shorter in rapid sequence spinal anesthesia, this technique may be equivalent to rapid sequence general anesthesia in category-1 emergency caesarean section

Regional anesthesia in transurethral resection of prostate (TURP) surgery: A comparative study between saddle block and subarachnoid block

Background: Spinal anesthesia is the technique of choice in transurethral resection of prostate (TURP). The major complication of spinal technique is risk of hypotension. Saddle block paralyzed pelvic muscles and sacral nerve roots and hemodynamic derangement is less. Aims and objectives: To compare the hemodynamic changes and adequate surgical condition between saddle block and subarachnoid block for TURP. Material and methods: Ninety patients of aged between 50 to 70 years of ASA-PS I, II scheduled for TURP were randomly allocated into 2 groups of 45 in each group. Group A patients were received spinal (2 ml of hyperbaric bupivacaine) and Group B were received saddle block (2 ml of hyperbaric bupivacaine). Baseline systolic, diastolic and mean arterial pressure, heart rate, oxygen saturation were recorded and measured subsequently. The height of block was noted in both groups. Hypotension was corrected by administration of phenylephrine 50 mcg bolus and total requirement of vasopressor was noted. Complications (volume overload, TURP syndrome etc.) were noted. Results: Incidence of hypotension and vasopressor requirement was less (P < 0.01) in Gr B patients.Adequate surgical condition was achieved in both groups. There was no incidence of volume overload, TURP syndrome, and bladder perforation. Conclusion: TURP can be safely performed under saddle block without hypotension and less vasopressor requirement