A Retrospective Study in 12-Year cohort of 216 Parturients with Invasive Placentation in a Tertiary Care Centre in Oman: Clinical Outcomes Indicate Severe Maternal Morbidity

Placenta accreta spectrum (PAS) comprising placenta accreta, increta, and percreta, is 1 of the leading causes of peripartum hemorrhage and accounts for up to 50% of all cesarean hysterectomies (CH). We analyzed the data of 216 parturients with PAS who underwent cesarean delivery (CD) and/or CH. Intraoperative surgical complications were noted in 215 (99.5%). The mean estimated blood loss was 2743 (1790) mL, and 105 parturients (48.6%) lost ≥2500 mL. The patients experienced high rates of severe acute maternal morbidity [162 (75%)], hysterectomy [82 (38%)], large volume blood loss, blood transfusion, peripartum anemia, and prolonged hospital stay.

A comparative study of induction and recovery characteristics of propofol and midazolam

Propofol and midazolam were compared in 40 adult patients in A.S.A. 1 or 2 presenting for short surgical procedures (< 70 minutes) with respect to induction time, pain on injection, apnoea, heart rates, blood pressure, oxygen saturation, time to eye opening on command. The first group was induced with midazolam (0.15-0.20 mg/kg) while the second was induced with propofol (2-2.5 mg/kg) intravenously. In all other respects except for the surgery that patients had the same treatment. The mean induction time was 55.25 + 26.66 and 69.75 + 24.72 for propofol and midazolam groups respectively. In the midazolam group apnoea occurred in 10% of patients compared to 80% of patients in the propofol group. Local reaction (phlebitis) was absent in the midazolam compared with 20% incident rate observed in the midazolam group. Propofol lowered blood pressure more than midazolam after three minutes of induction at a statistically significant level (P < 0.05). Recovery was significantly more rapid following propofol (P < 0.05).

A study of co-induction of anaesthesia U.B.T.H. experience

Co-induction is the concurrent administration of two or more drugs that facilitate induction of anaesthesia. Some combinations have been shown to have pharmacological advantages. In addition to the safety and comfort of the patient, it is also important to find a cost effective combination in view of the rather stringent economy of the times. This project was undertaken to study the response of Nigerian patients to co-induction (midazolam and propofol) by comparison with the traditional thiopentone or propofol alone, and to study the cost implications. 45 patients who came in for various surgical procedures were randomly assigned to three different groups. The first group was induced with thiopentone alone. The second group had a combination of midazolam and propofol and the third group had propofol alone. In all other respects except for the surgery the patients had the same treatment. The induction was satisfactory in all groups. The cardiovascular and respiratory changes were within clinically acceptable limits but the emergence was best with propofol, followed by midazolam/propofol and thiopentone in that order. Although thiopentone was the cheapest in terms of absolute cost, the combination of midazolam and propofol was most cost-effective.