Thesis (M Med (Anaesthesiology)) -- University of Limpopo, 2013. / Purpose: The purpose of this study was to determine whether etomidate should be the induction agent of choice for Rapid Sequence Intubation in the Emergency department due to its haemodynamic stability. Objective: To measure the haemodynamic effects of etomidate post- induction in patients undergoing Rapid sequence intubation. Methods: This was a prospective, randomized, observational and unblinded study. The study was conducted at DR GEORGE MUKHARI HOSPITAL theatre unit on 45 patients between the ages of 11 and 65 years of age who fall under the American Society of Anaesthesiology classification (ASA) IE – IIIE. Each patient had an established intravenous line, was pre-oxygenated and then received etomidate (0.2 mg – 0.3 mg/kg). Cricoid pressure was applied immediately following loss of consciousness. Suxamethonium 1.5 mg/kg or Rocuronium 1.2 mg/kg was administered and this was followed by endotracheal intubation 60 seconds later. Data collected included amongst others vital signs:- Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Pressure which were measured pre-induction, immediately post-intubation, 2.5 minutes, 5 minutes and 7.5 minutes later by a non invasive automated blood pressure monitor. Statistical Analysis: Descriptive statistical analysis was applied using the SPSS (Statistical Programme for Social Sciences) to demonstrate the demographics and ASA classifications of the patients in the study. Mean standard deviations were calculated for both males and 10 females in the study. Changes in vital signs immediately post-intubation were graphically demonstrated. The changes in vital signs (HR, SBP, DBP and MAP) were calculated and differences in such changes over-time were expressed as p-value. Significant differences in changes of the vital signs were noted if p ≤ 0.05. Results: The blood pressure increased immediately following intubation due to laryngoscopy and intubation. As anaesthesia progressed (i.e. 2.5 minutes, 5 minutes and 7.5 minutes later) the blood pressure gradually declined to levels lower than pre-induction values but at acceptable levels. Conclusion: Etomidate is an effective anaesthetic induction agent as it is haemody-namically stable and thus should be used in an Emergency department

Background: The aims of this randomised, double blind, placebo controlled trial were to compare vaginal PGE2 gel with oral misoprostol in the induction of labour at term. Methods: Women randomised to the oral misoprostol group received 20mcg oral misoprostol solution at two hourly intervals and placebo vaginal gel, and those in the vaginal prostaglandin group received vaginal PGE2 gel at six hourly intervals and oral placebo solution. The primary outcome measures were vaginal birth not achieved in 24 hours, uterine hyperstimulation with associated fetal heart rate changes, and caesarean section. Women were asked about their preferences for care, and a cost comparison was performed for the two methods of induction of labour. A nested randomised trial compared health outcomes for the woman and her infant related to morning or evening admission for commencing induction of labour. Results: A total of 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal PGE2 group. There were no differences between women in the oral misoprostol group and women in the vaginal PGE2 group, for the outcomes vaginal birth not achieved in 24 hours (Misoprostol 168/365 (46.0%) versus PGE2 155/376 (41.2%); RR 1.12 95% CI 0.95-1.32; p=0.134), caesarean section (Misoprostol 83/365 (22.7%) versus PGE2 100/376 (26.6%); RR 0.82 95% CI 0.64- 1.06; p=0.127), or uterine hyperstimulation with fetal heart rate changes (Misoprostol 3/365 (0.8%) versus PGE2 6/376 1.6%); RR 0.55 95% CI 0.14-2.21; p=0.401). Women in the misoprostol group were more likely to indicate that they 'liked everything' associated with their labour and birth experience compared with women in the vaginal PGE2 group (Misoprostol 126/362 (34.8%) versus PGE2 103/373 (27.6%); RR 1.26; 95% CI 1.02-1.57; p=0.036). There were no differences in the primary outcomes when considering morning or evening admission to commence induction. The use of misoprostol was associated with a saving of $110.83 per woman induced. Conclusions: The use of oral misoprostol in induction of labour does not lead to poorer health outcomes for women or their infants, women express greater satisfaction with their labour and birth experience, and with misoprostol induction there is a cost saving to the institution. / Thesis (Ph.D.)--Department of Obstetrics and Gynaecology, 2005.

Ingestion of extracts prepared from various medicinal plants to induce or augment labour is common amongst Black South African women during the late stages of pregnancy. This applies particularly to the rural areas where modern health care facilities are often lacking. Many of these plants have not been investigated scientifically and one needs to substantiate claims of quality, safety and efficacy. Furthermore, it is believed that the consumption of these plant extracts can result in foetal meconium staining at delivery. An investigation into the uterotonic properties of three plants viz. Ekebergia capensis Sparrm. Clivia miniata (Lindl.) Regel. and Grewia occidentalis L. were carried out using guinea pig uterine smooth muscle in vitro. Supercritical fluid extraction was performed with water modified supercritical carbon dioxide to extract the uterotonic components. An attempt was also made to couple supercritical fluid extraction directly on-line to the bioassay so that on line screening of crude plant extracts could be performed within short periods of time. The effects of supercritical CO2 decompression on temperature and pH of the muscle bathing solution were considered since these factors affect muscle contractility. The direct effects of excess CO2 on intracellular mechanisms were eliminated by constructing a CO2 reduction interface together with passage of carbogen which aided in the rapid displacement of excess CO2, As samples of these extracts were found to induce muscle contraction, supercritical fluid fractionation (SFF) was performed by sequentially increasing the fluid density. Extracted fractions were obtained by sequentially increasing the pressure at constant temperature and modifier concentration in an attempt to identify the active fractions. Extractions were performed at 200 atm, 300 atm and 400 atm respectively. Subsequent testing of these fractions enabled the detection of active and inactive fractions as well as a fraction that had a spasmolytic effect on uterine muscle. The 400 atm extracts of E. capensis and C. miniata displayed maximum activity while only the 300 atm extract of G. occidentalis induced uterine muscle contraction. Subsequent analysis of the sequentially extracted fractions, by high performance liquid chromatography and micellar electrokinetic capillary chromatography revealed that certain compounds present in the fractions that stimulated muscle contraction, were sensitive to the extraction pressure hence making it possible to determine the compounds that were likely to be active. Column chromatography followed by various spectroscopic techniques were performed in an attempt to isolate and elucidate the structures of the compounds that were present in the plant extracts. The extract of Ekebergia capensis yielded five known compounds (B-sitosterol, oleanonic acid, 3-epioleanolic acid, 2,3,22,23-tetrahydroxy-2,6,1 0, 15,19 ,23-hexamethyl-6, 10, 14, 18- tetracosatetrene and 7-hydroxy-6-methoxy coumarin. The extract of Clivia miniata yieded linoleic acid and 5-hydroxymethyl-2-furancarboxaldehyde while the extract of Grewia occidentalis yielded 3-(4-hydroxy-3-methoxyphenyl)-2-propenal, a novel compound 2,2' ,6,6'-tetramethoxy-4'-al-4-(w-oxo-E-propenyl)-biphenyl and oleanonic acid. The pure compounds were further evaluated pharmacologically to identify the active components and assess the physiological mode of action by the use of various receptor blockers. Oleanonic acid, 3-epioleanolic acid, linoleic acid and 5- hydroxymethyl-2-furancarboxaldehyde and 3-(4-hydroxy-3-methoxyphenyl)-2-propenal were found to induce an agonistic muscle response. All these compounds were observed to mediate their effects through the cholinergic receptors. The results obtained in this study supports the claim of these plants possessing uterotonic properties. / Thesis (Ph.D.)-University of Natal, Durban, 1997.