Loading Dose Of Magnesium Sulfate Research Articles

Atypical eclampsia at primary health care in a remote area: A case report

BACKGROUND Eclampsia is a generalized tonic-clonic seizure induced by pregnancy. It contributes to a high rate of maternal and neonatal morbidity and mortality worldwide. Eclampsia is characterised by classic signs such as elevated blood pressure, proteinuria, and seizures. However, it may occur in the absence of hypertension and/or proteinuria. The uncommon appearance of eclampsia makes it difficult to immediately assess and treat it. In addition, the occurrence of this case in a remote area makes it more challenging to handle. The objective of this case report is to increase awareness of uncommon manifestations of eclampsia, particularly in limited-resource settings. CASE SUMMARY A young primigravida experienced a generalised seizure without hypertension and/or proteinuria. Sudden hearing loss, blurred vision, and vomiting were complained about before the seizure attack. The patient was diagnosed with eclampsia. A loading dose of magnesium sulphate was administered immediately. The patient was referred from community healthcare to a hospital and discharged without any complications. CONCLUSION Atypical eclampsia may be a diagnostic challenge. However, other symptoms may be beneficial, such as awareness of eclampsia signs.

Comparison of magnesium sulfate loading dose on ability to achieve a therapeutic level

Intravenous magnesium sulfate is used for the prevention of eclamptic seizures, fetal neuroprotection, and tocolysis for preterm labor. It is recommended that a 4-6 g load be administered followed by a 2 g/hr maintenance dose. A therapeutic range of 4.8-8.4 mg/dL has been targeted, at least for the prevention of eclamptic seizures. The purpose of this study was to compare 4- vs. 6-gram loading and ability to achieve a therapeutic level.

The effect of magnesium sulfate loading dose and body mass index in achieving therapeutic levels

Due to the increased volume of distribution in obesity, many medications are weight-based including anticoagulation and prophylactic antibiotics for cesarean delivery. Intravenous magnesium sulfate, used for the prevention of eclamptic seizures, fetal neuroprotection, and tocolysis is administered via a 4-6 g load followed by a 2g/hr maintenance dose, but there are no specific recommendations for dosing as a function of body mass index (BMI). The purpose of this study was to investigate the effect of magnesium loading dose on side effect profile and ability to achieve therapeutic levels, as a function of BMI.

Comparative Study between Nitroglycerine, Magnesium Sulfate and Dexmedetomidine to Induce Hypotension During Functional Endoscopic Sinus Surgery (FESS)

Abstract Background Functional Endoscopic Sinus Surgery (FESS) has been employed as a surgical intervention to treat chronic rhinosinusitis in patients with no response to drug therapy, during which the surgical vision may be greatly reduced by a small amount of bleeding. There by, the intraoperative controlled hypotension can improve the visibility. While excessive bleeding intraoperative cause serious complications in the postoperative period, including eye socket infections, visual acuity damage, meningeal infections, and other. Objective Induced hypotension limits intra operative (IO) blood loss provides better visibility of the surgical field and diminishes the incidence of major complications during Functional Endoscopic Sinus Surgery (FESS). We aimed at comparing Nitroglycerine; Magnesium Sulfate and Dexmedetomidine for inducing controlled hypotension and evaluate narcotic used, mac of inhalational anesthesia, and Ramsay Sedation Scale (RSS) in the recovery and pre-anesthetic time in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Patients and Methods This study was conducted on 75 patients who underwent elective functional endoscopic sinus surgery (FESS) who matched the inclusion criteria and were randomly allocated into 3 groups each containing 25 patients. The first group received loading dose of dexmedetomidine 1μg/kg infused over 10 min before induction of anesthesia then 0.7 μg/kg/h via syringe pump, second group received nitroglycerine infusion at a dose of 2μg/kg/min according to the response started after induction, intubation, positioning and sterilization of the patient and third group received a loading dose of magnesium sulfate 40 mg/kg over 10 minutes followed by an infusion 15mg/kg/h via syringe pump. Results The result of our study showed that dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Conclusion Dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Dexmedetomidine also showed shorter duration of surgery with less blood loss and favorable frommer score with more surgeon satisfaction. Dexmedetomidine showed longest time to 1st analgesic rescue in PACU comparing with magnesium sulfate and nitroglycerine. So, it’s advised to use dexmedetomidine to induce hypotension than magnesium sulfate and nitroglycerine. However, dexmedetomidine should be used with caution as it caused hypotension and bradycardia, t had sedative effect with low aldert score comparing with nitroglycerine and magnesium sulfate.

Impact of a Magnesium Sulfate Loading Dose on Fetal Umbilical Artery Doppler Parameters in Women with Severe Preeclampsia

Background:Preeclampsia isthe most significant reason of maternal mortality throughout the world, as well asgolden way to perinatal mortality and morbidity, affecting 2–8% of pregnancies.Objective:To see how magnesium sulfate affects fetal umbilical artery Doppler changesin women suffering from extreme preeclampsia.Methods: It is interventional (experimental) non-randomized study wascarried out in the department of gynecology of the al-hussein university hospital according to sample size.50 women in this study weredrawn from the emergency department and the Obstetrics outpatient clinic. Between April 2020 and January 2021, they were all diagnosed with extreme preeclampsia.Results:The treatment of magnesium sulfate to pregnant women having serious preeclampsia and eclampsiaminimize umbilical artery Doppler velocimetry indices by a statistically significant amount. In terms of different Doppler parameters, there was a considerable difference in the study group's umbilical artery Doppler parameters before and after magnesium sulfate treatment (mean values of Resistance Index, PulsatilityIndex, and Systolic/Diastolic ratio in the study group). The conclusion:to diagnose complications and evaluate fetal well-being in pregnant women suffering preeclampsia, clinical examinations should be backed up and verified by laboratory tests and ultrasonography. Doppler flow tests should be included in the sonographic review since they can help predict preeclampsia and determine fetal condition.

Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study

The authors aimed to test whether a bolus of magnesium followed by continuous intravenous infusion might prevent the development of atrial fibrillation (AF) after cardiac surgery. Sequential, matched, case-controlled pilot study. Tertiary university hospital. Matched cohort of 99 patients before and intervention cohort of 99 consecutive patients after the introduction of a continuous magnesium infusion protocol. The magnesium infusion protocol consisted of a 10 mmol loading dose of magnesium sulphate followed by a continuous infusion of 3 mmol/h over a maximum duration of 96 hours or until intensive care unit discharge. The study groups were balanced except for a lower cardiac index in the intervention cohort. The mean duration of magnesium infusion was 27.93 hours (95% confidence interval [CI]: 24.10-31.76 hours). The intervention group had greater serum peak magnesium levels: 1.72 mmol/L ± 0.34 on day 1, 1.32 ± 0.36 on day 2 versus 1.01 ± 1.14 and 0.97 ± 0.13, respectively, in the control group (p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the intervention group and 40 patients (40.4%) in the control group (odds ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox proportional hazards model, the hazard ratio for the development of AF was significantly less in the intervention group (hazard ratio 0.45, 95% CI, 0.26-0.77; p = 0.004). The magnesium delivery strategy was associated with a decreased incidence of postoperative AF in cardiac surgery patients. These findings provide a rationale and preliminary data for the design of future randomized controlled trials.

DIFFERENT REGIMENS OF MAGNESIUM SULFATE FOR MANAGEMENT OF WOMEN WITH SEVERE PREECLAMPSIA

Background: Preeclampsia is serious syndrome that can affect human pregnancy causing serious complications. Preeclampsia is pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. Objective: To assess the comparative effects of three regimens for the administration of the magnesium sulfate when used for the care of women with severe preeclampsia to determine the minimal effective dose of magnesium sulfate in controlling cases with severe preeclampsia and prevention of eclampsia and to determine whether only loading dose of magnesium sulfate is effective in prevention of eclampsia or not. Patients and Methods: 240 patients were recruited and divided into three groups. Each group contains 80 patients, the first group received only the loading dose of MgSO4 and the second group received loading dose plus 12 hours maintenance dose while the last group received the loading dose and the full maintenance dose of MgSo4 for 24 hours. Results: Although strong evidence supports the use of magnesium sulfate for prevention and treatment of eclampsia, there was no significant difference between occurrence of eclampsia in the three groups after either administration of loading dose of MgSO4 only or administration of loading dose with maintenance dose for 12 hours or maintenance dose for 24 hours in the studied patients. Conclusion: Magnesium sulfate proved to cause many hemodynamic changes as it has vasodilator effect on maternal and fetal blood vessels; however, magnesium sulfate should be given to all patients with severe preeclampsia.

Dexmedetomidine versus magnesium sulfate for induced hypotension during functional endoscopic sinus surgery: A randomized, double-blind study

Background: Bleeding during functional endoscopic sinus surgery (FESS) can compromise surgical field quality. Intraoperative controlled hypotension by various hypotensive agents can reduce blood loss and improves surgical field visibility with less need for intraoperative blood transfusions. This study compared the hypotensive effectiveness and safety of dexmedetomidine and magnesium sulfate in patients undergoing elective FESS. Patients and Methods: Sixty adult patients posted for elective FESS were randomly assigned to two groups. Group A received a loading dose of dexmedetomidine 1 μg/kg, followed by infusion of 1 μg/kg/h, and Group B received a loading dose of magnesium sulfate 40 mg/kg, followed by 15 mg/kg/h infusion. Surgical field quality, emergence time, sedation score, Visual Analog Scale score, recovery profile, and vital signs were recorded. Mean arterial pressure (MAP) was kept above 65 mmHg during induced hypotension. Results: Both the groups achieved the target MAP (65–70 mmHg) and improved the surgical field visibility with reduced blood loss. Hemodynamics was superior in the dexmedetomidine group with the additional advantage of postoperative conscious sedation and analgesia (P 0.05). Conclusions: Both dexmedetomidine and magnesium sulfate are safe agents for controlled hypotension for improving surgical field quality. Dexmedetomidine provides an additional benefit of reducing the analgesic requirements and providing postoperative sedation.

Healthcare workers\u2019 clinical knowledge on maternal and newborn care in Ethiopia: findings from 2016 national EmONC assessment

BackgroundImproving maternal and newborn health indicators are key if Ethiopia is to achieve the Sustainable Development Goals. To do so, women need access to skilled attendance at birth and emergency obstetric and newborn care. To maximize their impact, understanding gaps in workers’ knowledge is required to remedy the weakness. This assessment determines knowledge levels of clinical management of maternal and newborn healthcare and factors that influence knowledge.MethodsThis study used data from the National Emergency Obstetric and Neonatal Care assessment conducted in 2016. Provider knowledge for MNH was assessed by interviewing providers. Respondents were scored on each question by calculating the number of correct responses provided out of the total possible answers, and standardizing this to a scale of 100. Mixed linear regression was used to determine individual and contextual factors associated with the score.ResultsA total of 3800 interviews with complete data were included in this study. Most respondents were diploma midwives (73%), BSc midwives (11%) and diploma nurses (10%). On average, midwives scored 60 out of 100 on the question regarding the primary aspects of focused antenatal care and elements of a birth plan. Half of the midwives and health officers, and one-third of nurses knew to provide a loading dose of magnesium sulphate. Midwives scored 90% on the steps of active management of third stage of labor. In the mixed linear regression, working in a private for profit facility, health center/clinic, rural area, or in a facility with a protocol on referral/counter referral predicted lower knowledge scores. More positive scores were associated with work environments that had a computer, internet, and protocols on safe abortion care, management of selected obstetric topics, integrated management of pregnancy, childbirth, postnatal, and newborn, care for low birth weight including kangaroo mother care, and treatment of infection in young infants.ConclusionWith regard to most knowledge related questions, health officers and midwives scored similarly. Providers scored substantially better on routine intrapartum and newborn care than on aspects related to care for complications. A substantial proportion of providers indicated that they would never give a loading dose of magnesium sulphate.

Open-labelled randomised controlled trial of 12 hours versus 24 hours modified Pritchard regimen in the management of eclampsia and pre-eclampsia in Ghana (MOPEP Study): study protocol

IntroductionHypertensive disorders of pregnancy continue to be a major contributor to maternal and perinatal morbidity and mortality. Magnesium sulfate therapy is the standard of care for seizure prophylaxis and treatment...

Comparison between Magnesium Sulphate and Ketorolac Intravenous Infusion on Characteristics of Spinal Anesthesia

AbstractBackground: Spinal anesthesia is used widely for many procedures, many adjuvants had been used to prolong duration of sensory and motor block and improve post-operative pain.Aim of Study: The aim of this study is to compare the effect of magnesium sulphate and ketorolac intravenous infusion on sensory and motor blockage, hemodynamic pa-rameters, duration of analgesia and side effects during spinal anesthesia.Patients and Methods: Patients were classified randomly into three groups (30 patients each) Group M (Magnesium sulphate Group), Group K (Ketorolac Group), Group C (Con-trol Group). Group M patients received a loading dose of magnesium sulphate 40mg/kg IV over 10min followed by 15mg/kg/h IV infusion, Group K patients received a loading dose of ketorolac (0.4mg/kg) (IV) over 10min followed by 0.8mg/kg/h IV infusion. Group C received 50ml of saline (IV) over 10min followed by saline infusion. After ensuring free flow of cerebrospinal fluid, 3mL of bupivacaine (0.5%) injected Pulse rate, electrocardiography, non-invasive blood pressure and SpO2 monitored continuously. Measurements: Demographic data (age, weight, BMI, ASA physical status). Hemodynamic (HR, MAP, SpO2) before giving study drugs, 10min after giving study drugs and after reaching the maximal level of spinal anesthesia and then every 30min till end of surgery. Onset of sensory blockade has been assessed by pinprick method. Onset of motor blockade has been assessed by modified Bromage Scale. Level of sensory and motor blockade has been checked at 3, 5, 10 and 15min after spinal anesthesia and then every 20min throughout the surgery. Time to achieve complete regression from sensory and motor blockade has been noted. All the durations were calculated considering the time of spinal injection as zero time. Post-operatively analgesia has been assessed by the Visual Analog Scale (VAS). The time at which analgesia was first received and total analgesic requirement in 24h was recorded. Patients observed for any adverse effects such as nausea, hypotension.Results: There were insignificant changes between the three groups in HR and MAP but there was significant decrease in HR and MAP in each group at 10min, maximal level and 30min in comparison with base line. There were insignificant changes in onset and duration of sensory and motor block in the three studied groups.The total dose of analgesic consumption (pethidine (mg)) showed significant decrease in Group M in comparison with Group K & Group C with insignificant change between Group K & Group C.The time of first rescue analgesia showed significant increase in Group M in comparison with Group K & Group C and insignificant changes in Group K in comparison with Group C.Conclusion: Addition of intravenous magnesium sulphate with spinal anaesthesia provides significant decrease in post-operative analgesic requirements and prolongs the time of the first rescue analgesia as compared to intravenous ketorolac with spinal anaesthesia.

The Effect of Loading Dose of Magnesium Sulfate on Uterine, Umbilical, and Fetal Middle Cerebral Arteries Doppler, Biophysical Profile, CTG, Maternal Vital Signs in Women With Severe Preeclampsia

The Effect of Loading Dose of Magnesium Sulfate on Uterine, Umbilical, and Fetal Middle Cerebral Arteries Doppler, Biophysical Profile, CTG, Maternal Vital Signs in Women With Severe Preeclampsia

Quality of care in early detection and management of pre-eclampsia/eclampsia in health facilities in Afghanistan

BackgroundAfghanistan faces a high burden of maternal and neonatal morbidity and mortality. Hypertensive disorders of pregnancy, including pre-eclampsia and eclampsia (PE/E), are among the most common causes of maternal and neonatal complications. Hypertensive disorders of pregnancy can lead to fatal complications for both the mother and fetus. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment assessed quality of early detection and management of PE/E in health facilities and skilled birth attendants’ (SBAs) perceptions of their working environment.MethodsAll accessible public health facilities with an average of at least five births per day (n = 77), a nationally representative sample of public health facilities with less than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Methods included a facility inventory and record review, interviews with SBAs, and direct clinical observation of antenatal care (ANC), intrapartum care and immediate postnatal care (PNC), as well as severe PE/E case management.ResultsMost facilities had supplies and medicines for early detection and management of PE/E.At public health facilities, 357 of 414 (86.2%) clients observed during ANC consultations had their blood pressure checked and 159 (38.4%) were asked if they had experienced symptoms of PE/E. Only 553 of 734 (72.6%) SBAs interviewed were able to correctly identify severe pre-eclampsia described in a case scenario. Of 29 PE/E cases observed, 17 women (59%) received the correct loading dose of magnesium sulfate (MgSO4) and 12 women (41%) received the correct maintenance dose of MgSO4.At private health facilities, 39 of 45 ANC clients had their blood pressure checked and 9 of 45 (20%) were asked about symptoms of PE/E. Fifty-four of 64(84.4%) SBAs in private facilities correctly identified severe pre-eclampsia described in a case scenario.ConclusionNotable gaps in SBAs’ knowledge and clinical practices in detection and management of PE/E in various health facilities increase the risk of maternal and perinatal mortality. Continuing education of health care providers and increased investment in focused quality improvement initiatives will be critical to improve the quality of health care services in Afghanistan.

Management of Women with Severe Preeclampsia by Different Regimens of Magnesium Sulfate

Background: Preeclampsia is serious syndrome that can affect human pregnancy causing serious complications. Preeclampsia is pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. Objective: The aim of our study was to assess the comparative effects of three regimens for the administration of the magnesium sulfate when used for the care of women with severe preeclampsia to determine the effective dose of magnesium sulfate in controlling cases with severe preeclampsia and prevention of eclampsia and to determine whether only loading dose of magnesium sulfate is effective in prevention of eclampsia or not. Patients and methods: The study included 240 pregnant women presenting to the casualty unit diagnosed as cases of severe preeclampsia in the Obstetrics and Gynecology Department, Al-Azhar University Hospital and EL Mahalla General Hospital. A randomized controlled study that compared three regimens for administration of MgSO4 used for these cases. Results: There was no significant difference between occurrence of eclampsia in the three groups after either administration of loading dose of MgSO4 only or administration of loading dose with maintenance dose for 12 hours or maintenance dose for 24 hours in the studied patients. Conclusion: Magnesium sulfate proved to cause many hemodynamic changes as it has vasodilator effect on maternal and fetal blood vessels. Magnesium sulfate should be given to all patients with severe preeclampsia.

328. Policy and system bottlenecks influencing the management of pre-eclampsia in five countries

Introduction While training and mentoring programs have focused on primary healthcare (PHC) level providers to identify, stabilize and refer women with pre-eclampsia, policy and procurement bottlenecks are barriers to provision of care. Objective To describe health system factors that affect timely management of preeclampsia at all levels in Bangladesh, Ethiopia, Kenya, Nigeria and Pakistan. Methods Qualitative data were collected through in-depth interviews with policy makers and health managers across five countries on the knowledge of existing policies and procurement plans. Assessment of data used NVivo (Version 10) to derive codes for themes. Results Most countries have maternal health policies and guidelines covering management and treatment of pre-eclampsia however it is less clear within the different health system levels on specific task shifting to PHC level. Bangladesh, Ethiopia and Nigeria have task-shifting policies allowing PHC providers to administer a loading dose of magnesium sulphate (MgSO4) and referral, but is less clear on prescription of anti-hypertensives to control blood pressure. MgSO4 is on each country’s essential medicines list, however, procurement of MgSO4 (and other MH drugs) continues to be haphazard. The commodity is either not budgeted for, or the budget line is not being implemented, due to over-reliance on donor procurement or poor forecasting, tracking and accountability (Kenya, Pakistan). Widespread practice of patients and their families expected to procure drugs themselves continues; many stakeholders are concerned about quality of these drugs. Discussion Procurement of essential maternal health drugs and commodities for effective management of HDPs, have not been prioritized across all countries. Even tertiary hospitals fail to procure essential drugs and keep at point of use. Challenges remain in formalizing task shifting policies to manage pre-eclampsia effectively across the health system. Recommendations include lobbying ministries of finance and health to collaborate and prioritise maternal health care.

287. Contextualizing care for women with pre-eclampsia and eclampsia in Ethiopia: Exploring policy and implementation environments

Background Effective management of pre-eclampsia and eclampsia (PE/E) depends how policy environments relate to health service delivery interfaces. Less known is how these contextual factors intersect with the lived experience of care provision and use. Objective To explore the policy and health systems environment around PE/E to improve care provision and use in Ethiopia. Methods Institutional ethnography was used to assess viewpoints across multiple primary data sources (n = 95) and a desk review of peer-reviewed publications and maternal health-related textual guidelines and policies (n = 43). In-depth interviews were conducted with women who experienced pre-eclampsia (n = 17), health extension workers (n = 17), health workers (nurses/midwives/doctors) (n = 22), and policymakers and stakeholders at kebele, woreda, zonal, regional and national levels (n = 21). Sixteen focus group discussions engaged men and women of reproductive age in select areas. Results Despite a progressive maternal health policy environment around task shifting and expanding service access, including to PE/E care, there remains ambiguity of provider roles in PE/E diagnosis and management. No document delineates cadres to administer the loading dose of magnesium sulphate (MgSO4) or antihypertensive drugs nor details pre-referral care and referral processes sufficiently. All respondents describe the visibility of guidelines and protocols in facilities influence care provision. Downstream effects of professional practice norms, supervisory structures, and provider abilities manifest in the lack of confidence among providers at all levels of the health system to administer MgSO4. Supply chain bottlenecks limit the use of essential PE/E drugs and commodities at health centers and health posts, curtailing providers’ ability to manage and refer women in a timely way. Conclusions A health system’s ability to effectively manage pre-eclampsia and eclampsia depends on various contextual factors, including an amenable policy environment, supportive health worker practice norms, and supply chain functioning. Factor confluence has implications for quality of care and outcomes experienced by women with PE/E.

108. Difference in difference analysis of task-shifting with community health extension workers to manage hypertensive disorders in pregnancy in Nigeria

Introduction In Nigeria, though the task-shifting policy recognizes community health extension workers (CHEWs) to administer a loading dose of magnesium sulphate in severe pre-eclampsia/eclampsia prior to referral, it is silent on whether CHEWs should administer anti-hypertensive drugs for the associated hypertension. Objective This study tests the feasibility and acceptability of CHEWs managing hypertension in HDPs at Primary Care level. Methods A cross-sectional survey (baseline n = 72 and endline n = 73) carried out in 40 selected facilities, stratified into intervention and comparison arms (n = 20/ study arm). CHEWs in intervention arm received training, job aids and mentoring on how to identify and manage HDPs with alpha methyldopa and were monitored for one year. The comparison received no training. Structured interviews using pre-tested questionnaires were conducted before and after the intervention. A difference-in-difference (DID) analysis was conducted using SPSS version 20. Results There was significant increase in CHEWs’ ability to define hypertension correctly (DID = 33.3%, p = 0.009), describe how to manage blood pressure (DID = 13.8%, p = 0.000) and grade the hypertension as mild, moderate or severe (DID = 60%, p = 0.000). CHEWs in the intervention arm were more likely to know when to introduce and stop anti-hypertensives (DID = 69.3%, p = 0.000; DID = 48.9%, p = 0.000, respectively), and were more likely to classify HDPs into chronic hypertension (DID = 35%, p = 0.024), gestational hypertension (DID = 18.2%, p = 0.054), pre-eclampsia (DID = 10.2%, p = 0.073), severe pre-eclampsia (DID = 39.6%, p = 0.000) and eclampsia (DID = 20.1%, p = 0.804). CHEWs in the intervention arm were more likely to prescribe an antihypertensive (DID = 42.2%, p = -0.095) and mostly prescribed (DID = 20.6%, p = 0.03) methyldopa compared to their counterparts in the comparison arm. Antihypertensives were mainly procured through the open market. Incidence of anti-hypertensives stock-outs were frequent. Discussion CHEWs gained and retained knowledge and skills in the diagnosis and management of HDPs-associated hypertension. If this is combined with regular availability of commodities, care for women with HDPs at PHC level could improve remarkably.

A rapid cycle method for local adaptation of an obstetric emergencies training program.

To describe the adaptation of an obstetric emergencies training program to align with local clinical practice. A feasibility study was conducted to investigate the potential implementation of the PRactical Obstetric Multi-Professional Training (PROMPT) program at eight urban tertiary hospitals in the Philippines. Multi-professional teams attended a 2-day course on September 23 and 24, 2015, that comprised a demonstration PROMPT course (day 1) and a Train-the-Trainers session (day 2). During a facilitated adaptation session, each team reviewed the PROMPT algorithms for eclampsia, severe pre-eclampsia, postpartum hemorrhage and sepsis. The teams marked steps concordant with local practice and identified differences with local practice. Suggested amendments were reviewed by the PROMPT project team, using clinical guidelines to support any adaptations. The PROMPT algorithm for initial management of eclampsia was used as an exemplar. Five of the nine management steps were concordant with local practice: support; airway; breathing; circulation; and control seizures. Amendments were successfully implemented for the following steps: call for help; magnesium sulfate loading dose; and magnesium sulfate maintenance dose. Rapid and efficient adaptation of PROMPT training materials for use in the Philippines was possible using a facilitated and focused approach, utilizing the expertise of a representative mix of local healthcare professionals and evidence-based guidelines.

Dexmedetomidine-ketamine versus magnesium sulfate-ketamine for sedating children undergoing bronchoscopic fiberoptic intubation

Background and aims Meticulous airway management, with the support of satisfactory sedation while keeping up a patent airway and guaranteeing ventilation, is an integral part for conscious sedation for bronchoscopic fiberoptic intubation in pediatric patients. This randomized double-blinded, prospective, comparative, clinical study aimed to compare the effects of dexmedetomidine-ketamine versus magnesium sulfate-ketamine for sedating children experiencing bronchoscopic fiberoptic intubation. The primary outcome was intubation scores as assessed by (a) vocal cord movement, (b) coughing, and (c) limb movement. Secondary outcomes were intubation time and patient tolerance using fiberoptic intubation comfort score. Patients and methods A total of 60 patients having American Society of Anesthesiologist grade I aged between 7 and 14 years undergoing elective minor infraumbilical surgeries were included in the study. Patients were randomly allocated to one of two groups: group DK patients (n=30) received intravenous loading dose of dexmedetomidine (2 µg/kg) in 20 min, and then were maintained by 0.5 µg/kg/h infusion until successful placement of the tube in the trachea, and intravenous ketamine (0.5 mg/kg/h) after finishing the loading dose, and just before fiberoptic intubation, and group MK patients (n=30) received intravenous loading dose of magnesium sulfate (40 mg/kg) in 20 min, and then were maintained by 10 mg/kg/h until successful placement of the tube in the trachea, and ketamine (0.5 mg/kg) after finishing the loading dose, and just before fiberoptic intubation. Continuous data were summarized as mean±SD, whereas discrete (categorical) in percentage. The groups were compared by independent Student’s ‘t’ test. The discrete (categorical) variables were compared by χ2-test. Results Intubation scores were better in group DK than group MK for vocal cord movement (P=0.009) and limb movement (P=0.0016), but there was no statistically significant difference in coughing (P=0.89). Time required for intubation was significantly less in group DK, as compared with the group MK (76.4±13.25 and 89.83±20.069 s, P=0.043). There was better fiberoptic intubation comfort score in group DK (P=0.0032). All patients were successfully intubated through fiberoptic bronchoscope in both groups. There were no significant hemodynamic changes between the two groups. Conclusion Intravenous dexmedetomidine/ketamine improved awaken bronchoscopic fiberoptic intubation in children with better intubation scores, intubation tolerance, and less intubation time when compared with magnesium sulfate-ketamine.

Use of loading dose of magnesium sulphate versus standard regime for prophylaxis of severe Pre-Eclampsia- A comparative study

Use of loading dose of magnesium sulphate versus standard regime for prophylaxis of severe Pre-Eclampsia- A comparative study