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Year : 2013  |  Volume : 57  |  Issue : 1  |  Page : 103-104  

Author's reply

Department of Anaesthesiology and Critical Care, M S Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India

Date of Web Publication14-Mar-2013

Correspondence Address:
C A Tejesh
Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore - 560 054, Karnataka
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Sandhya K, Shivanna S, Tejesh C A, Rathna N. Author's reply. Indian J Anaesth 2013;57:103-4

How to cite this URL:
Sandhya K, Shivanna S, Tejesh C A, Rathna N. Author's reply. Indian J Anaesth [serial online] 2013 [cited 2021 Aug 3];57:103-4. Available from: https://www.ijaweb.org/text.asp?2013/57/1/103/108599


We thank the authors for their comments on our article in this issue of the IJA. [1] Infective endocarditis prophylaxis was not administered in this patient, as it is no more recommended as per the latest AHA guidelines for prevention of infective endocarditis. The guidelines clearly state in the conclusion and we quote 'Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure'. [2] Though [Table 3] in the guidelines mentions uncorrected cyanotic heart disease as the highest risk of adverse outcome from endocarditis, absence of an established genitourinary infection made prophylaxis unnecessary. [2] We did use invasive arterial monitoring during the drainage of the vulval haematoma. Epidural analgesia for the drainage of haematoma was achieved with 10 mL of 0.125% bupivacaine and 50 mcg of fentanyl, which was given in small aliquots of 2-3 mL at a time. We do agree with the authors that phenylephrine is the vasopressor of choice, if hypotension results due to epidural analgesia, which was available and kept ready. Our patient did not require any vasopressor as epidural analgesia was achieved in a graded manner. Paradoxical air embolism [3] and fall in SVR, following oxytocin bolus [4] are valid concerns in patients with right to left shunts. Our institutional protocol mandates us to give oxytocin only as a slow infusion and never as bolus in all our patients. Giving all these details was not considered necessary, within the purview of the case report.

   References Top

1.Sandhya K, Shivanna S, Tejesh CA, Rathna N. Labour analgesia and anaesthetic management of a primigravida with uncorrected pentalogy of Fallot. Indian J Anaesth 2012;56:186-8.  Back to cited text no. 1
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2.Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736-54.  Back to cited text no. 2
3.Solanki SL, Jain A, Singh A, Sharma A. Low-dose sequential combined-spinal epidural anesthesia for cesarean section in patient with uncorrected tetralogy of Fallot. Saudi J Anaesth 2011;5:320-2.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Thomas JS, Koh SH, Cooper GM. Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing caesarean section. Br J Anaesth 2007;98:116-9.  Back to cited text no. 4


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