Annals of Allied Health Sciences

COMPLICATIONS ASSOCIATED WITH ANESTHESIA DURING PREGNANCY

2023-12-04T03:59:19+00:00

A wide range of obstetric and non-obstetric emergencies during pregnancy may need surgical interventions and thus administration of anesthesia may be required. Although the risk of surgery is similar to that of the general population, administering anesthesia during pregnancy is challenging.¹ Anesthesiologists need to take special precautionary measures to ensure the safety of both the mother and the growing fetus. To perform safe anesthesia, anesthesiologists must have a thorough understanding of all the physiological changes associated with pregnancy because small changes in the dose or type of anesthetic agent can affect maternal and fetal safety.²

Respiratory and cardiovascular issues are the most fatal anesthetic complications in pregnant women. Due to the hormonal and mechanical effects of pregnancy, the respiratory system undergoes several changes and therefore pregnant women often have a lower oxygen reserve than the general population. Anesthesia further reduces functional residual capacity because it decreases respiratory drive and respiratory muscular function.³ Consequently, even brief episodes of apnea can be fatal. Anesthesia can lead to reduced lung capacities, atelectasis, pulmonary edema, and acute respiratory distress syndrome in pregnant women. Aspiration of gastric contents to the airway is also one of the most prevalent anesthetic complications during pregnancy. Aspiration can further lead to chemical pneumonitis and thus can further compromise the respiratory function in pregnant women.⁴

Cardiovascular problems such as hypotension, bradycardia, cardiac arrhythmia, and even cardiac arrest can occur in pregnant women during anesthesia. Evidence suggests that anesthetic agents significantly reduce cardiac function and lead to hemodynamic instability during anesthesia.⁵ Hence, closely checking the mother's cardiovascular functions during the anesthesia process is recommended. Furthermore, because hypercoagulability is common in pregnancy, pregnant women who underwent anesthesia are at higher risk of deep venous thrombosis, stroke, and pulmonary embolism.⁶

In addition to respiratory and cardiovascular complications, other major anesthetic complications include post-dural puncture headache, neurological compromise, epidural abscess/hematoma, and convulsions. Though these anesthetic complications are less prevalent but have the potential for considerable morbidity and mortality. Post-dural puncture headache is more prevalent in pregnant women who receive anesthesia via central neuraxial blockades. If untreated, post-dural puncture headache can lead to life-threatening subdural hematoma.⁷ Neurological complications, though rare, can occur due to direct injury to the spinal cord, spinal nerves, and cauda equina during anesthesia administration. Furthermore, epidural abscess and/or hematoma during the administration of anesthesia can lead to neurological complications, if not managed on emergency basis. Similarly, convolutions are a less common complication of anesthesia in pregnant women but can occur if concentration of anesthetic agents exceed the critical brain tissue threshold.^8,9 Nausea, vomiting, back pain, shivering, short term amnesia and headache are some additional anesthetic complications, however, these mild complications are generally self-limiting and spontaneously resolve withing few hours to days.¹⁰

Though anesthetic agents have the potential to cross the placenta, however, there is no high-quality evidence available which support the teratogenic effects of the commonly applied anesthetic agents. Spontaneous abortion is the most commonly reported fetus related complication, particularly in women who underwent surgery and anesthesia in the first trimester of their pregnancy.¹¹ Some research studies reported that fetal hypoxia resulting from administration of anesthesia can be fatal in the first trimester of pregnancy and therefore it is safer to postpone surgery until the 1st trimester. Besides miscarriage, other obstetric related complications of administering anesthesia during pregnancy reported in the literature includes preterm labor, premature neonate, lower birth weight, eclampsia, septic shock and still birth.^12,13

To sum up, it can be concluded that administration of anesthesia during pregnancy presents unique challenges to anesthesiologists because it can have potential side effects, some of which may be uncommon but can be lethal or permanently incapacitating. The risk of complications can be minimized by following the standard operating procedures and by ensuring that the patient is monitored closely throughout the procedure. It is important to note that the risks and benefits of anesthesia during pregnancy should be discussed with the patient and her obstetrician on a case-by-case basis.

REFERENCES

Bloom SL, Spong CY, Weiner SJ, et al. Complications of anesthesia for cesarean delivery. Obstetrics & Gynecology. 2005;106(2):281-287.
D’Angelo R, Smiley RM, Riley ET, Segal S. Serious complications related to obstetric anesthesia: the serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2014;120(6):1505-1512.
Sobhy S, Dharmarajah K, Arroyo-Manzano D, et al. Type of obstetric anesthesia administered and complications in women with preeclampsia in low-and middle-income countries: A systematic review. Hypertension in pregnancy. 2017;36(4):326-336.
Wlody D. Complications of regional anesthesia in obstetrics. Clinical obstetrics and gynecology. 2003;46(3):667-678.
Hoefnagel A, Yu A, Kaminski A. Anesthetic complications in pregnancy. Critical care clinics. 2016;32(1):1-28.
Ramirez V, Valencia G, Catalina M. Anesthesia for nonobstetric surgery in pregnancy. Clinical Obstetrics and Gynecology. 2020;63(2):351-363.
Ankichetty SP, Chin KJ, Chan VW, et al. Regional anesthesia in patients with pregnancy induced hypertension. Journal of anaesthesiology, clinical pharmacology. 2013;29(4):435.
Cheesman K, Brady JE, Flood P, Li G. Epidemiology of anesthesia-related complications in labor and delivery, New York State, 2002-2005. Anesthesia and analgesia. 2009;109(4):1174.
Tsen LC. Neurologic complications of labor analgesia and anesthesia. International Anesthesiology Clinics. 2002;40(4):67-88.
Harris M, Chung F. Complications of general anesthesia. Clinics in plastic surgery. 2013;40(4):503-513.
Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesia-related maternal mortality in the United States: 1979–2002. Obstetrics & Gynecology. 2011;117(1):69-74.
Munnur U, de Boisblanc B, Suresh MS. Airway problems in pregnancy. Critical care medicine. 2005;33(10):S259-S268.
Polley LS. Anesthetic management of hypertension in pregnancy. Clinical obstetrics and gynecology. 2003;46(3):688-699.

RESILIENCE, SELF-EFFICACY AND QUALITY OF LIFE AMONG ASSISTIVE AND NON-ASSISTIVE TECHNOLOGY USERS: A MIXED METHOD STUDY

2023-10-16T08:22:18+00:00

Objective: To compare the resilience, self-efficacy and quality of life among assistive and non-assistive technology users.

Material & Methods: A mixed-method research design was used to collect the data. The quantitative data was collected from a total of 154 (Male n = 63; Female n = 91) individuals with disabilities by using the translated version of Self-efficacy Scale, Brief resilience Scale and Quality of Life Scale. The qualitative data was collected by conducting interviews with six individuals including two male and four females.

Results: The quantitative findings showed a significant difference between assistive and non-assistive technology users in terms of resilience and self-efficacy (p<.01). Further, the themes emerged from interviews including 1) self-empowerment, 2) influence on psychological health, 3) satisfaction in life and 4) facilitation in life, subsequently supported the quantitative results.

Conclusion: Assistive technology not only improves physical functioning, but it also improves psychological health and well-being of people with disabilities.

EFFECTS OF CORE MUSCLES STRENGTH TRAINING ON BALANCE AND TRUNK STABILITY IN STROKE PATIENTS: A RANDOMIZED CONTROLLED TRIAL

2023-10-18T09:03:05+00:00

Objective: To determine the effects of core stability exercises compared to conventional physical therapy in improving balance and trunk control in stroke survivors.

Material & Methods: A randomized controlled trial was conducted. A sample size of thirty- six patients was taken in this current study by using 90% power of study and 10% level of significance with 20% dropout was included in it. So, each group contained 18 participants. The routine physical therapy program for stroke patients were followed by all patients that was provided by rehabilitation centre for an 8-week period, this program was consisted of one hour session a day, 3 times per week for 8 weeks (24 sessions). The core stability exercises were discerning, selective, repetitive movements and convoluted tasks without resistance to recover and improve endurance, strength and synchronization of the core. The outcome was calculated and evaluated by using Berg balance scale and trunk impairment scale.

Results: Out of 36 participants 21 were male and 15 were female. After treatment, the core exercise group showed statistically significant difference (p < 0.05) on TIS and BBS. The TIS and BBS score increased in experimental group as equated to control group after performing core stability enhancing exercises when comparing base lines.

Conclusion: Core stability exercise plus conventional physical therapy has shown better results in trunk control and balance as compared to routine physical therapy alone.

ASSOCIATION BETWEEN BIOCHEMICAL PARAMETERS AND ARTHRITIS AMONG MENOPAUSAL FEMALES: A POPULATION-BASED STUDY

2023-11-01T08:11:56+00:00

Objective: To determine the prevalence of arthritis and its correlation with biochemical markers in pre- and postmenopausal women.

Material & Methods: A cross-sectional observational questionnaire and laboratory-based study with 350 female participant was conducted. Using commercially available kits and laboratory tests, various biomarkers (BMI, uric acid, creatinine, cholesterol, triglyceride, HbA1c, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and anticyclic Citrullinated protein) were measured among pre- and postmenopausal female population.

Results: Overall prevalence of osteoarthritis (32%) followed by rheumatoid arthritis (31.4%) was recorded among pre and post-menopausal females. 49% of patients were belonging to age group 51-60 years. The levels of biochemical parameters were found significantly important (P˂0.0001) for menopausal arthritic female patients.

Conclusion: Biochemical parameters that show co-morbidities such as diabetes, cardiovascular and renal diseases, hypertension, obesity, and osteoporosis have borderline mean levels in women with different types of arthritis.

STUDY OF NON-COMPLIANCE AND ITS REASONS IN OUTDOOR PATIENTS WITH HYPERTENSION: A QUESTIONNAIRE-BASED SURVEY

2023-11-29T09:39:56+00:00

Objective: To determine the factors for non-compliance in patients with hypertension who are treated at a public hospital.

Material & Methods: The study involved individuals with hypertension who were visiting Paharpur THQ Hospital. The study recruited patients who were willing to engage in conversations with pharmacists regarding their concerns about medication. Data was gathered by distributing questionnaires to evaluate adherence. A total of 50 patients, consisting of 32 males and 18 females, were picked at random based on their prescriptions.

Results: Although 18 (36%) of patients reported unfavourable pharmacological effects, 34 (68%) did not inform their doctors. Noncompliance was induced by side effects in 41 cases (82%). 39 (78%) of patients are given drug explanations by their doctors. 43 (86%) of patients were unable to pay for their medications. 39 people (78%) stuck to their usual regimen. 42 (84%) of those polled ignored their prescriptions, and 36 (72%) stopped taking their medications when their symptoms improved.

Conclusion: The study revealed that hypertension patients who visit the outpatient department of the public hospital in Paharpur are prone to non-compliance. This is mostly attributed to their economic condition, the side effects of their medicine, the absence of nearby pharmacies, the complexity of their treatment regimen, and their job schedule.

FEASIBILITY AND VALIDITY OF A MOBILE APPLICATION GONIOMETER FOR ASSESSING KNEE JOINT RANGE OF MOTION

2023-11-22T09:35:06+00:00

Objective: To determine the feasibility and validity of Goniometer Records (GR), a mobile app goniometer for knee joint range of motion (ROM).

Material & Methods: A total of 72 undergraduate physiotherapy students participated in this study. Knee flexion and extension was taken simultaneously with the Universal goniometer (UG) and GR, and the Mobile Application Rating Scale (MARS) and System Usability Scale (SUS) were used to assess the feasibility of GR.

Results: The mean age of participants was 22.2 ± 1.6 years. There was a weak but significant correlation between UG and GR (r = 0.251; p = 0.030) for knee flexion but not for extension (r = 0.105; p = 0.37). The feasibility ratings of GR on MARS for all the sections were 17.6±2.7 (out of 25), 15.4±2.0 (out of 20), 11.4±1.3 (out of 15), 25.4±2.6 (out of 35), 14.8±2.2 (out of 20) and 21.2±2.1 (out of 30) for engagement, functionality, aesthetics and information respectively. Based on SUS statements about app usage, 63.9% of the respondents rated the App low.

Conclusion: GR showed weak validity in knee flexion assessment but none with extension compared to UG. GR for knee ROM assessment had moderate feasibility but low usability rating.