Effect of Pipecuronium Bromide on Relation between Presentation And I-D and U-D Interval

 

Dhruv (Thakur) Shashikala1, Bansal A.2, Dhruv V.K.3, Kar P.K.4, Sachdev D 5 and Nayak K.5

1Deptt. of Pathology, Govt. Medical College, Jagdalpur (Bastar) – 494001, India.

2Deptt. of OBG, Govt. Medical College, Jagdalpur (Bastar) – 494001, India.

3Deptt. of Anaesthesia, Govt. Medical College, Jagdalpur (Bastar) – 494001, India.

4Dean, Govt. Medical College, Jagdalpur (Bastar) – 494001, India.

5Deptt. of Pharmacology, Govt. Medical College, Jagdalpur (Bastar) – 494001, India.

 

ABSTRACT:

Research Questions: Is there any relationship between presentation and I – D and U – D interval. Material and Methods: Eighty five mothers were included this study who have undergone emergency and elective LSCS in a Medical College Hospital. Statistical Analysis: Chi-square test, Standard deviation were applied. Observations: On analysis of the collected data, it has been revealed that insignificant differences were noted in I.D. interval of study and control group. As far as in U. D. interval a significant difference in favour of control group was observed. On further analysis, U. D. interval in breech, transverse lie and vertex presentation were 69.54, 77.00 and 50.12 Second respectively. Conclusion: No significant relationship was noted between presentation and I – D and U – D interval.

 

KEYWORDS: Presentation, Interval.

 

INTRODUCTION:

Recently Pipecuronium Bromide was added to the expanded list of non depolarizing muscle relaxants having longer duration of action than the existing one .Pipecuronium Bromide, [2 beta-16 beta-bis (4-dimethyl - 1- peperazing 1) 3-alfa-17-beta-diacetoxy-5-alpha-androstan dibromide] is a chemically novel compound that belongs to the bis- quaternary steroids and is a new long acting, non-depolarizing muscle relaxant. Early studies originally done in Hungry (Boros et. al. 1980 Newton et. al. 1982) suggest that pipecuronium dose not induce haemodynamic change due to release of histamine, vagolytic action or sympathetic stimulation.

 

The compound carries the quaternary groups on the farther nitrogen of the piperazion groups substituted at position 2 and 16 of the androstane skeleton (C35H62N4O4Br2).

 

The structural modifications in pipecuronium are designed to improve its specificity by maintaining the neuromuscular blocking effect while reducing the nicotinic side effects on the cardiac vagus nerve.

 

There is a structural similarity of pipecuronium bromide, to the existing drugs pancuronium bromide and vecuronium bromide. All three drugs have the same steroid nucleus. Pipecuronium bromide and pancuronium bromide are bisquaternary structures, differing in the type of side chains.

 

The pka of pancuronium bromide in water at 250C is 3.38 + 0.4. After reconstitution, pH should not exceed 7. The compound is a nearly white, odourless, crystalline powder should in 12 parts of water, 25 parts of 96% alcohol and in 100 parts chloroform.

 

 

Very few reports of clinical study were available in literature and studies have been conducted in India, so far to assess the determinants of C. S. Studies of such nature will be useful tool to make appropriate interventional measures.

 

In this context and in 1957 a study group of World Health Organization has expressed the view that in order to get a comprehensive picture of disease (health problem) more and more studies have to be carried out, Garg Narendra K.(1). This prompted the authors to under take this study to elucidate some of the major risk factors for C.S.

 

MATERIAL AND METHODS:

The present study was designed to study the I. D. and U. D. interval under general anaesthesia using Pipecuronium Bromide Eighty five women (Sixty in study and twenty five in group )undergoing Caesarean Section were selected. All women were of ASA grade – I and II Age weight, pulse rate, blood pressure, respiratory rate of all the mothers recorded. Premedication was done with inj. Atropine 0.6 mg. intramuscular, thirty minutes before operation. After preoxygenation for three minutes, anaesthesoa was induced with intravenous Pentothal 5 mg./kg. body weight followed by muscle relaxant injection Pipecuronium Bromide 0.08 mg./kg. body weight. An endotracheal intubation was done with a proper size cuffed E.T. tube and the respiration was controlled using 60% N2O and 40% O2 with Bain’s circuit Inj. Pentazocaine 15 to 30 mg. was administered intravenously after double clamping of the cord of the baby after delivery. 0.01 mg. /kg. increment dose of Pipecuronium administered if required during surgery .Residual muscle relaxant (Paralysis ) was reversed with inj. Atropine 0.6 mg. and neostigmine 0.5 mg. to 1.0 mg. intravenously ( The study group received Pipecuronium 0.08 mg. /kg. body weight and control group  spinal anaesthesia – xylocaine 5 % , 1 to 1.2 ml. ).Change in maternal pulse rate and mean arterial pressures were noted after 5 minute of induction. The I – D interval (induction to delivery time) and U D intervals (Uterine incision to delivery time) were assessed in a pre drawn proforma .The observations were tabulated and analyzed. Statistical analysis was expressed in terms of Chi – square test, standard deviation.

 

OBSERVATIONS:

I-D interval: - induction to delivery time was recorded from the time of induction of anaesthesia (Inj. of pentothol) up to the complete delivery of neonate. The U-D interval is the time taken from uterine incision to the delivery of the neonate. The I-D interval was 11.78 min. in study group and 12.48 min. in control group both group showing insignificant difference (P < 01), the U-D interval was 50.6 sec. in study group and 78.68 sec. in control group showing significant (P > 01) longer U-D interval in control group which may be because of the junior surgeon who operated these cases (Table - I).

 

Table –I: I-D interval and U-D interval in these two groups

S. No.

Groups

I-D interval (in min. ± S.D.)

U-D interval (in sec. ± S.D.)

1

Study

11.78 ± 2.26

50.6 ± 23.76

2

Control

12.48 ± 8.6

78.68 ± 68.61

 

 

 (Table – II ) Relationship between presentation and U-D interval. The U-D interval was significantly longer 77 second in both groups having transverse lie. 69.54 second in Breech presentation and 50.12 second in Vertex presentation.

 

Table –II: Relationship between presentation and U-D interval

S. No.

Presentation

U-D interval (in sec.)

1

Vertex

50.12

2

Breech

69.54

3

Transverse lie

77.00

 

DISCUSSIONS:

Obstetric anaesthesia in itself is a unique field ,as simultaneously two individuals are undergoing the effects of drugs and are prone to its side effect.Due to these reasons ,the enthusiasm which greeted Morton’s demonstration of anaesthesia for surgery was missing when J.Y. Simpson suggested its use in Obstetrics. The early reaction to Obstetric anaesthesia differ widely ,from that of Walter Channing who believed ,it had neglible effect on foetus to that of Sir John Snow Francis Rambothan and C.C. Hutter who favoured the concept of placental transfer of anaesthetic drugs.

 

Balanced anaesthesia is an optimum technique for Caesarean Section, as it provides light necrosis with minimum central depression and full oxygenation of infants. To the early works, the placenta seemed to be complete barrier or drug transfer, though subsequent work showed it to be an incomplete and selective barrier. The non depolarizing relaxants at the normal Ph range are highly ionized and relatively insoluble in fat, so they are not expected to pass easily across the placental barrier. In the present study longer U – D interval were recorded in breech (69.54 Seconds), transverse lie (77.00 Seconds) and in vertex presentation (50.12 seconds). These were less than 90.00 Seconds noted by Crowford et. al. (2). From above observations and discussions the authors reached to the conclusion that Pipecuronium Bromide can be used safely during Caesarean Section without any adverse effect on I – D and U – D interval

 

REFERENCES

1.       Garg Narendra K. Evaluation of the impact of emesis and emesis plus purgation therapy; Research J. Pharmacology and Pharmacodynamics: 2 (2) March – April 2010; 201-202.

2.       Crawford, J. S. Principles and practice of Obstetrics anaesthesia; 4th, Edition.

3.       Canton D.; Obstetric anaesthesia: The first ten years, Anaesthesiology 1970; 33; 102.

4.       Canton D.; Obstetric anaesthesia and concepts of placental transport: A historical review of the nineteenth century, Anaesthesiology 1977; 46; 132.

5.       Bansal A.K. and Chandorkar R.K. (1993) knowledge, Belief and Practice: A study of Tribal mothers about feeding of infants; Tribal Health Bulletine (ICMR); Vol. – 2, No. – 3 & 4: 1-2.

6.       Bansal A.K. and Chandorkar R.K. (1993) effectiveness of ICDS in child care in Rural and Tribal areas of Chhattisgarh (M.P.) J. Ravi Shankar uni; Vol. – 6, No.-B (Science) 61-65.

7.       Bansal A.K. and Saxena V.B. (2000) impact of I.C.D.S. on Pregnancy pattern of Tribal and Non Tribal women. J. Ravi Shankar uni; Vol. – 13, No.-B (Science) 54-58.

8.       Bansal A.K. and Chandorkar R.K. (1993) utilization of Health Care delivery by Tribal and Non Tribal women of an ICDS block (1993) J. Ravi Shankar uni; Vol.-6, No.-B (Science) 57-60.

9.       Bansal A.K., Agarwal Ashok K. and Govila A.K. (1998-99) Status of girl child amongst Tribal and Non Tribal in the unreached rural India; J. Ravi Shankar uni; Vol. – 11-12, No.-B (Science) 31-36.

10.     Bansal A.K. and Agarwal A.K. (1994) impact of training the knowledge of Tribal and Non Tribal Anganwade workers; J. Ravi Shankar uni; Vol. – 7, No.-B (Science) 51-54.

11.     Bansal A.K. and Chandorkar R.K. (1997) Immunization status of Tribal and Non Tribal Children of Raipur district, Madhya Pradesh; Tribal Health Bulletin (ICMR) Vol. – 3, No.-2; 12-14.

12.     Bansal A.K. and Chandorkar R.K. Impact of I.C.D.S. on morbidity due to Nutritional deficiency Diseases amongst Tribe and Non Tribe Children; Research J Science and Tech.; 2009: 1(2); 82-84.

13.     Masani K.M.: A Text Book of Obstetrics (1964) Caesarean Section; pp 705 – 718.

14.     Dutta ,D.C. : Text Book of Obstetrics  ( 2004 ) 6th.Edition ; published :New Central Book Agency (P) Ltd.,8/1,Chintamoni Das Lane .Calcutta 700 009 (INDIA) ; Caesarean Section : 588 -590.

15.     Masani K.M.: A Text Book of Gynaecology (1973) 7th Edition Bombay Popular Prakashan, History taking; pp-69-73.

16.     Collins V.J.; Principle of Anaesthesiology 2nd edition.

17.     Datta S et. al. Anaesthesia for caesarean section, Anaesthesiology; 1980; 53; 142.

18.     Lundy J.S.; Balanced anesthesia; Survey of Anaesthesiology; 1981; 25; 272.

19.     Marx G.F., et. al.; Newer aspects of general anesthesia for caesarean section, N.Y.St. J. of Med. 1971; may 15; 1084.

20.     Ong By et. al.; Anaesthesia for caesarean section, Effects on neonates, Amaesth. Analg. 1989; 68; 270.

 

 

Received on 31.01.2011

Modified on 25.02.2011

Accepted on 15.03.2011           

© A&V Publication all right reserved

Research J. Science and Tech.  3(3): May-June. 2011: 151-153