Anaesthesia Case Study

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Spinal anaesthesia is the most common technique in LSCS and several adjuvants have been tried along with local anaesthetic for prolongation postoperative analgesia. (1) And better postoperative analgesia will improve mother child interaction and improved breastfeeding and infant well-being. Regional anaesthesia for LSCS has distinct advantages over General anaesthesia via avoidance of pulmonary aspiration and difficult in ventilation and intubation due to physiological changes of pregnancy and better postoperative analgesia, less neonatal exposure to drugs. Bupivacaine is being more preferred because of its long acting action and more potent, less neurotoxic than lignocaine. Ketamine a phencyclidine derivative anaesthetic agent
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In both groups, no adverse effect was noted in neonates up to 5 minutes.
Addition of adjutants to local anaesthesia is well established as it reduces the severity of postoperative pain and prolongs analgesia which’s improving patient comfort.
In 1962, ketamine was synthesized by Dr. Calvin Stevens at the Parke Davis laboratories in Ann Arbor, Michigan . (5) Ketamine a phencyclidine derivative is an age old anaesthetic agent most commonly used via intravenous access. It was first used intrathecally by BION (2). It possesses some definite advantages over the conventional local anaesthetic as it stimulates cardiovascular system and respiratory system. (3,4,6) ketamine acts on nucleus reticularis gigantocellularis in brain stem and affinity for N-methyl D- aspartate (NMDA) and opioid receptors which on activation causes hyperalgesia and ketamine act as antagonist on these receptors.
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Murali Krishna T, Panda NB, Batra YK, Rajeev S. Combination of low doses of intrathecal ketamine and midazolam with bupivacaine improves postoperative analgesia in orthopedic surgery. Eur J Anaesthesiol 2008; 25:299e306.
4. Kathirvel S, Sadhasivam S, Saxena A, Kanan TR, Ganjoo P. Effects of intrathecal ketamine added to bupivacaine for spinal anaesthesia. Anaesthesia 2000; 55: 899e910.
5. Paul G Barash, Bruce F. Cullen, Robert k Stoelting. Clinical anaesthesia: The history of anesthesia; 6th edt, Lippincott Williams &Wilkins 2009;p.15
6. Singh SP, Sinha AK, Jha AK. Evaluation of intrathecal ketamine for intraoperative and postoperative analgesia. Indian Journal of Anaesthesia. 1997; 41(4): 15-8.
7. Ren K, Williams GM, Hylden JLK, Ruda MA, Dubner R. The intrathecal administration of excitatory amino acid receptor antagonists selectively attenuated carrageenan-induced behavioral hyperalgesia in rats. Eur J Pharmacol, 1992; 219:235e43.
8. . Unlugenc H, Ozalevli M, Gunes Y et al. A double blind comparison of intrathecal S (+) ketamine combined with bupivacaine 0.5% for caesarean delivery. Eur J Anaesthesiology.2006; 23(12): 1018-24.
9. Iida H Dohi S, Tanahashi T, Watanabe Y & Takenaka M.Anesth

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