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Introduction: Blood transfusion remains the cornerstone of managing volume depletion and blood loss during surgeries. There are always patients and situations which clearly benefit from blood transfusion intraoperatively. Crystalloids and colloids cannot replace blood, as a substitute when the patient's oxygen carrying capacity has been compromised. Anaemia in acute and chronic conditions is associated with increased risk of morbidity and mortality. Thus, blood transfusion has a very important role in the perioperative management of the patient. Aim: To ascertain the common indications for which anaesthesiologists start perioperative blood transfusion, the rates of intraoperative overtransfusion, and to assess the variation in the blood transfusion practices at the study Institution from standard guidelines. Materials and Methods: A prospective cross-sectional study was conducted on 168 patients patients operated at Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India, from February 2017 to July 2017. The patients were adult American Society of Anaesthesiologists Physical Status (ASA-PS) I and II, undergoing elective surgeries and required transfused blood intraoperatively. Operating room anaesthesiologists completed a record form for each of the patient. The form included details of the patient like age, gender, weight, type and duration of surgery, preoperative haemoglobin (done within 48 hours preoperatively), intraoperative blood loss, fluids and blood, and blood products transfused intraoperatively. The postoperative Haemoglobin (Hb) levels (done between 6 hours-24 hours postoperatively) were also recorded. Results: The study showed that, 76 out of the 168 (45.2%) patients, who were transfused blood intraoperatively had been overtransfused, i.e., their postoperative Hb values were more than 10 g/dL. Blood loss was the sole indication for transfusion in 41 out of 168 (24.4%) patients. Blood was transfused in patients with low preoperative Hb in 21/168 (12.5%) patients, while it was done on surgeon's request in 13/168 (7.7%) cases. Pallor, hypovolaemia and haemodynamic instability as sole indications included only 4.8%, 2.4% and 1.2% cases, respectively. Conclusion: The present study revealed that a significant number (45.2%) of patients were overtransfused. A wide variation exists from the standard guidelines among anaesthesiologists. Implementation of restrictive transfusion strategies and a protocol-based intraoperative transfusion is required to optimise patient outcome. [ABSTRACT FROM AUTHOR]

Introduction: Hypotension remains one of the most common problems associated with subarachnoid blockade. A number of strategies have been developed for its prevention, of which administration of fluids prior to subarachnoid block holds the importance. Gelatin is a colloidal plasma volume expander obtained from degraded gelatine. It is as effective as albumin solution in the treatment of spinal induced hypotension. Aim: To compare the incidence and frequency of hypotension after subarachnoid block in patients receiving colloid (polymerised gelatin) or crystalloid (0.9% normal saline) as prehydration and compare side-effects of colloid and crystalloid prehydration. Materials and Methods: A total of 60 patients scheduled for elective Transurethral Resection of Prostate (TURP) surgery were selected to participate in this prospective randomised double-blind study for a period of two years from April 2006 to April 2008. Patients were randomly allocated into two groups of 30 patients each. Group H received 500 mL of polymerised gelatine (Haemaccel) solution and group N received 1000 mL of 0.9% normal saline15 minutes prior to subarachnoid block. Intraoperative monitoring includes SBP, DBP, MAP and HR for 30 minutes. Incidence of hypotension and number of mephentermine boluses were noted. Statistical analysis of data was determined with Mann-Whitney U test and analysis of variance for repeated measures (ANOVA). Chi-square test was used to find out possible associations. Result: After spinal anaesthesia mean systolic blood pressure decreased in both the groups and was lower in group N compared to group H (97±18.9 vs 102±9.26 mmHg). There was fall in diastolic blood pressure in both the groups and was maximum at 20th minute in group N and group H (66.37±5.47 vs 64.67±10.30). There was highly significant (p<0.01) fall in mean arterial pressure in group N. The change in the heart rate was highly significant (p<0.01) at different time interval in both the groups. Vasopressor was required in 90% and 60% patients in group N and group H, respectively. No statistical difference in the incidence of nausea and vomiting in both the groups. Conclusion: The present study showed that preloading of fluids either with colloids or crystalloids prior to subarachnoid block reduces the incidence of hypotension but not completely eliminating it, also showed that colloids offset hypovolemia and hypotension more effectively than crystalloids in patients undergoing TURP surgery. [ABSTRACT FROM AUTHOR]

Introduction: Both crystalloids and colloid preloading is recommended for spinal anaesthesia. Preloading of intravenous fluids increases circulating volume and cardiac output; thus preventing spinal anaesthesia-induced hypotension. Crystalloids have a short intravascular half-life, poor plasma expanders and large volumes are thus required. Aim: To compare the efficacy of 5 mL/kg of 6% Hetastarch (colloid) to that of 15 mL/kg of Plasmalyte (crystalloid) solution to prevent hypotension during spinal anaesthesia in patients undergoing lower abdominal surgeries. Materials and Methods: This was a randomised clinical trial from June 2016 to April 2017 on a total 80 patients, belonging to American Society of Anaesthesiologist (ASA) Grade I and II scheduled for lower abdominal surgeries under spinal anaesthesia. They were divided into two groups-Group H and Group P. Patients in group H were preloaded with 5 mL/kg solution of 6% Hetastarch, whereas those in group P were preloaded with 15 mL/kg of Plasmalyte solution. After institution of spinal anaesthesia with 3.0 mL of hyperbaric Bupivacaine using 25G Quincke's needle, Blood Pressure (BP) and other vital parameters were monitored intraoperatively every 3 minutes for first 30 minutes and then every 5 minutes till the end of surgery. Descriptive statistics, frequency (n) and percentages (%) were calculated and the variables between the groups were compared by Students t-test, Fischers exact test and Mann Whitney U-test. Results: Both the groups showed a fall in Mean Blood Pressure (MBP) immediately after the block. Group P showed more decline in MBP and Diastolic Blood Pressure (DBP) after the block and the difference was statistically significant at 9, 12, 15, 18 and 21 minute (p-value <0.05). A 30% patients in group P as comparison to 10% in Group H required ephedrine for the treatment of hypotension and found significant (p-value=0.025). Systolic Blood Pressure (SBP), pulse rate changes and nausea and vomiting among both groups was non-significant (p-value >0.05). Conclusion: Pre-loading with 5ml/kg of 6% Hetastarch is more effective than 15ml/kg of Plasmalyte in preventing hypotension in patients undergoing lower abdominal surgeries under spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of fluid preloading is in doubt, so co-loading has been attempted to reduce the incidence of spinal anaesthesia induced hypotension in caesarean patients. Aim: To compare crystalloid preloading, colloid preloading and colloid co-loading for prevention of maternal hypotension in caesarean delivery. Settings and Design: Study conducted in tertiary level hospital on 90 ASA I/II term parturients posted for elective caesarean section. Patients were randomly allocated to three Groups. Materials and Methods: Group A (n=30) was given 10 ml/kg of 6% hydroxyethyl starch (HES) 20 minutes prior to spinal anaesthesia, Group B (n=30) was given 10 ml/kg of 6% HES by rapid infusion in 10 minutes immediately after spinal anaesthesia and Group C (n=30) was given 10 ml/kg of Ringer's Lactate 20 minutes prior to spinal anaesthesia. Intraoperatively, Heart rate, systolic, diastolic and mean arterial pressure were recorded every five minutes. Episodes of hypotension were recorded and treated with bolus of 5 mg of ephedrine and total amount of ephedrine was noted. Adverse effects, if any were recorded. Statistical Analysis: ANNOVA for Quantitative Analysis and chi-Square test and Z-test for Qualitative Analysis. Results: Baseline parameters were similar in all the three Groups. Heart rate decreased from the baseline in all the three Groups, however, mean heart rate was highest in Group C. Heart rate was statistically similar in Groups A and B. MAP decreased in all three Groups from baseline, however, highest fall was recorded in Group C whereas, MAP was statistically similar in Groups A and B. Incidence of hypotension was 66.66% in Group C as compared to 36.66% in Groups A and 40% in Group B respectively. Group C patients received 5.33±4.54 mg of ephedrine as compared to 2.00±2.82 mg in Group A and 2.33±3.14 mg in Group B. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in Group C as compared to Groups A and B whereas, this difference was statistically not significant among Groups A and B. Conclusion: Colloid preloading and co-loading are equally effective and both are superior to crystalloid preloading for prevention of maternal hypotension in caesarean section patients. [ABSTRACT FROM AUTHOR]