Regional anaesthesia safe for surgeries

by Shanika Sriyananda

Manisha eagerly waited for the feeling of 'labour pains' which her mother said it would be terrible which can not described what was it. She proudly announced that she was ready to feel the 'pain'.

But her swollen legs made her gynaecologist to get her admitted immediately to a hospital and recommended a C-section as her blood pressure shot up at the last moment.

The doctor then decided to give her a regional anaesthesia, whereby she could watch the medical team get the baby out. Her parents asked the doctor to give her a general anaesthesia as they believe that regional anaesthesia may cause more complications later.

The doctor referring to her condition decided on a regional anaesthesia and now Manisha recalls happily how she heard the baby's first cry and how the doctors handled the case. And she was even conscious enough to feel her babies little feet.

"No, there are no such complications related to regional anaesthesia. It is more safer than the general when in an emergency to perform surgery, especially the C-sections", Consultant Anaesthetist of the National Hospital Colombo Dr. Ms. Kumuduni Ranatunge says.

She says that some pregnant mothers ask for regional anaesthesia because they want to see the baby coming out, so the maternal bond is immediate and both are awake to get the true feeling.

According to Dr. Ms. Ranatunge, under general anaesthesia the patient goes to asleep. "But sleeping is not adequate. Standard anaesthesia is a combination of three requirements the patient is unconscious, adequately pain re-lived and muscles are relaxed". she adds.

She says that muscle relaxation depends on the condition and sometimes the patients do not get paralysed the muscles and they are breathing on their own. "But with anaesthesia there should always be an anaelgicia, which means pain relief, as well. If you just give one drug to make the patient only to become unconscious but when you perform the surgery though the patient may not realise while the surgery is on he or she could feel the pain.

So, when the patient is still with the pain even though he is unconscious he will start secreting some hormones, which can bring bad effects to the body. So, while he is asleep he will have high blood pressure, very high pulse rate and may sweat. But when he or she wakes up the patient won't realised it. That is bad for the body", she points out.

Dr. Ranatunge says that the post operative recovery patients, who suffered pain during surgery might have problems and during the surgery, pressure, may shoot up. She says that this condition will give bad effects on the vital organs like brain, kidneys and heart.

Because, if the patient, is already a hypertension patient, pressure may go up during the surgery and due to this the patient may get a heart attack or suffer brain haemorrhage. So balanced anaesthesia is very important. Responsibility of the anaesthetist is to give a balanced anaesthesia", she says.

The regional anaesthesia also known as spinal or epidural is injected to a particular area of the body. Here, according to the wish of the patient he can be sedated or kept awake. But only the area which needs anaesthesia will be anaesthetized. According to Dr. Ranatunge, there are some requirements to fulfil before anaesthetizing a patient.

"The patient should be examined by an anaesthetist to see whether there could be any problems with the patient which might complicate the surgery. So, the problems should be ruled out. If the patient has any problem with the drugs, this should be checked by going through the patients' history of any reaction to anaesthesia. This is very important".

"Patients have fast before anaesthesia, especially before a general anaesthesia. The period is six hours for solid meals and milk. For clear fluids, like water and plain tea, it is four hours. You should not take anything within that time period. Because of the risk of gastric aspiration is there.

Aspiration of stomach contains will pass into the lungs during the anaesthesia because the patient is unconscious and the muscles in the throat and larynx are relaxed.

When the stomach is full it can aspirate into the lungs. This condition is called aspiration numalitist, which has a very high death rate, because the patient is aspirating solid particles into the lungs" she explained.

Dr. Ranatunge says that this is the very serious condition during the pregnancy. A pregnant mother should fast for six hours before undergoing the surgery. But there are situation where you have to do C-section in an emergency, when the foetus is not doing well and they need to take the baby out. In a such a situation you have to make sure that the stomach is empty.

"Here, the regional anaesthesia is very much preferred and the patient needs to fast for six hours. As the pregnant mother, in an emergency, can not fast for six hours, it is safer to give regional anaesthesia.

On the other hand, the patients stomach is pushed up and with enlarge abdomen and as the risk of aspiration is high, it is always safer whenever possible to give a regional anaesthesia, especially when performing a C-section.

This is mostly safer when there is no contra-indications like spinal cord problems, deformity in the spine and infections. We have to get the patient's consent as well. If there is a risk they should be explained", she adds.

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Yoga may help treat depression, anxiety disorders

Yoga's postures, controlled breathing and meditation may work together to help ease brains plagued by anxiety or depression, a new study shows.

Brain scans of yoga practitioners showed a healthy boost in levels of the neurotransmitter gamma-aminobutyric (GABA) immediately after a one-hour yoga session. Low brain levels of GABA are associated with anxiety and depression, the researchers said.

"I am quite sure that this is the first study that's shown that there's a real, measurable change in a major neurotransmitter with a behavioral intervention such as yoga," said lead researcher Dr. Chris Streeter, assistant professor of psychiatry and neurology at the Boston University School of Medicine.

She believes yoga could prove a useful tool to help people battling depression and anxiety disorders. "We're not advocating that they chuck their medication, but I would advise that they could use it as an adjunct and see how they are doing," Streeter said. Her team published its findings in the May issue of the Journal of Alternative and Complementary Medicine.

In the study, the Boston researchers used high-tech magnetic resonance spectroscopic imaging to gauge levels of GABA in the brains of eight long-time yoga practitioners and 11 non-practitioners. The participants were healthy, and none was diagnosed with a major psychiatric condition.

Brain scans were taken before the beginning of the experiment. Then, the yoga group was asked to engage in the meditative practice for 60 minutes, while the non-yoga group simply read. The researchers then re-scanned each participant's brain, looking specifically at GABA levels.

"We showed a 27 per cent increase in the brain GABA levels of those doing yoga - a really significant increase," Streeter said. No such change was noted in the non-practitioners who had just read.

She said the style or school of yoga practiced didn't seem to matter. "We had hatha, ashtanga, bikram, vinyasa, and kripalu" practitioners included in the yoga group, Streeter said, "and many had been trained in several different schools." According to Streeter, "this all gives us one of the mechanisms by which yoga may be having a beneficial effect. There could be other mechanisms." But another expert pointed to what he considered flaws in the research.

Zindel Segal, chairman of psychotherapy and a professor of psychology and psychiatry at the University of Toronto, has for years studied the use of behavioral interventions to alleviate psychological woes.

He said the Boston researchers were to be commended for using brain scan imaging technologies to investigate the effectiveness of these techniques. But he questioned why the yoga group was simply compared to a sedentary reading group and not to another movement-based group.

"Exercise itself may have some effects on GABA, so I think in this study, you'd really want that comparison," he said. Including such a control group would make it clear that it was yoga and not just an hour of physical exertion that was responsible for the brain changes.

He also pointed out that all of the people in the study were mentally healthy, and clinical depression and anxiety disorders involve more than the "daily fluctuations in stress and tension" that healthy individuals are prone to.

"We know that yoga can have a profound effect" on smoothing out life's daily ups and downs, Segal said. "But so does working out on a Stairmaster for an hour." Segal also questioned the role of GABA in depression.

While it may play a role in anxiety disorders, "GABA is not one of the main neurotransmitters that seems to be a part of the depression story," he said. Other neurochemicals - most notably serotonin - play much bigger roles in the disorder, he said.

None of this means that the study's findings are without merit, Segal said. "In fact," he said, "we have a program called 'mindfulness-based cognitive therapy,' where we do use yoga, as well as mindfulness meditation," as therapeutic tools. Streeter's findings "suggest the need for more study of these practices," he said.

Streeter agreed that her study is probably just a beginning.

"I think what's important about this study is that it shows that by using really cutting-edge neuroimaging technology, we can measure real changes in the brain with behavioral interventions - changes that are similar to those that we see with pharmacologic treatments," she said.

Would other mind-body practices - Tai Chi, for example - produce similar effects? "I think that's very possible," Streeter said. "I suspect that all roads lead up the mountain.

HealthDay News

Risks during pregnancy

by Dr.B.G.A.Vidyatilake, Consultant, Obstetrician and Gynaecologist

Pregnancy and childbirth are biological acts necessary for the propagation of human race. Hence most people believe that they should occur normally and without complications.

Whenever a disaster occurs in pregnancy or childbirth there is lot of commotion and often accusations of negligence against the healthcare personnel involved.

Is it unnatural for a pregnancy which was normal throughout, to end up in a complication or even a disaster. Every experienced obstetrician can quote many such examples. A pregnant mother can become seriously ill due to severe hypertension, liver or kidney disease or premature separation of the placenta (afterbirth). Mother may have to undergo a caesarean section due to the baby developing distress.

Her womb may rupture due to obstructed label, she can have profuse bleeding after delivering the baby or the womb can turn inside out (acute inversion). These are grave risks faced by a mother in labour and can come without warning. Infection can creep into the womb and she can become seriously ill. In the pre-antibiotic era, a large number of maternal deaths was due to infection.

These words of the WHO regarding the risks of pregnancy and childbirth should be an eyeopener. "What is the greatest threat to a woman's life in developing countries? Complications of pregnancy and childbirth".

The worst complication associated with pregnancy and childbirth is maternal death. According to the WHO, about 585000 women die annually throughout the world due to complications of pregnancy and childbirth. It means one maternal death per minute, somewhere in the world.

In developing countries 24% of maternal deaths occur in pregnancy, 16% in labour and 60% after the childbirth. It is clear that the risks of pregnancy continue even after childbirth.

It is not always possible to predict the complications of pregnancy and childbirth. Identification of high risk pregnancy is the responsibility of the doctors and maternity healthcare workers. Some of these risks can be identified on the first clinic visit (short stature, previous caesarian section, hypertension, diabetes, etc). New risks may arise in pregnancy and could be identified in subsequent visits. However majority of complications in pregnancy and labour arise without warning.

Therefore it is prudent to consider that every pregnancy faces risks and should receive quality care in the antenatal period, during labour and after childbirth.

How can a woman prepare herself to face the risks of pregnancy and childbirth?
1. Awareness of risk situations.
2. Regular antenatal clinic attendance.
3. Strict adherence to medical advice.
4. Preparing for childbirth in hospital.
5. Proper management of postpartum period.
6. Avoiding unwanted pregnancy and not seeking unsafe abortions.