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Vasopressors in obstetric anesthesia: A current perspective

World Journal of Clinical Cases 2015年第1期3卷 58-64页

作者： Deb Sanjay Nag Devi Prasad Samaddar Abhishek Chatterjee Himanshu Kumar ankur dembla Department of Anaesthesiology and Critical Care Tata Main HospitalJamshedpur 831011 India

Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetalacid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.

关键词： Vasopressor agents Obstetrics Cesarean section Hypotension Spinal anesthesia

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Comparative analysis of APACHE-Ⅱ and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy

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World Journal of Clinical Cases 2019年第16期7卷 2227-2237页

作者： Deb Sanjay Nag ankur dembla Pratap Rudra Mahanty Shashi Kant Abhishek Chatterjee Devi Prasad Samaddar Parul Chugh Department of Anaesthesiology and Critical Care Tata Main HospitalJamshedpur 831001India Department of Anaesthesiology and Critical Care Darya Ram HospitalSonipat 131001India Department of Biomedical Statistics Sir Ganga Ram HospitalNew Delhi 110060India

BACKGROUND Laparotomy remains one of the commonest emergency surgical *** prognostic evaluation would aid in selecting the high-risk patients for an aggressive treatment. Awareness about risks could potentially contribute to the quality of perioperative care and optimum utilization of resources. Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity(P-POSSUM) and the acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ) have been the most widely used scoring systems for emergency laparotomies. It is always better to have a single scoring system to predict outcomes and audit healthcare *** To compare the ability of APACHE-Ⅱ and P-POSSUM to predict postoperative morbidity and mortality in patients undergoing emergency *** All patients undergoing emergency laparotomy at the Tata Main Hospital,Jamshedpur between December 2013 and November 2014 were included in the study. In this observational study, P-POSSUM and APACHE-Ⅱ scoring were done, and the outcome analysis evaluated with mortality being the primary *** For P-POSSUM, at a cut off value of 63 to predict mortality using receiver operating characteristics curve analysis, the area under the curve was 0.989; and for APACHE-Ⅱ, at the cut off value of 24, the area under the curve was *** Because the ability of APACHE-Ⅱ to predict mortality was similar to P-POSSUM and APACHE-Ⅱ does not need scoring for intra-operative findings and histopathology reports, APACHE-Ⅱ can be used pre-operatively to assess the risk in patients undergoing emergency laparotomy. However, for audit purposes,either of the two scoring systems can be used.

关键词： Laparotomy Emergencies Acute physiology and chronic health evaluation Ⅱ Morbidity Mortality

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