The mortality of a woman during pregnancy, childbirth, and within 42 days after giving birth has an immediate detrimental effect on both her family and community, Annually, it is estimated that over 770 women in the United States die due to pregnancy or complications associated to pregnancy.  Maternal mortality is a significant medical issue that places a strain on the global healthcare system and necessitates meticulous investigation to identify its underlying causes. This prospective study was carried out to examine the various factors that influence maternal mortality among pregnant women in the Diyala Governorate. Assuming that the elements that govern maternal mortality include age, cause of death, residency, and number of children, these factors were involved in this study. A cross-sectional study was conducted among 75 pregnant women in Diyala Governorate to assess these characteristics. The aim was to determine the link between maternal mortality and parameters such as age, causes of death, residency, and parity among women. Study results revealed that the predominant number of fatalities among women took place within the age range of 21 to 30, with the subsequent highest occurrence observed among women aged 31 to 40,Cardiovascular disease was the primary determinant of these deaths, representing 43% of all mortality causes, Uterine hemorrhage was the second most common cause of mortality, responsible for 29% of all deaths, The survey also found that women residing in rural areas had a significantly greater mortality rate, accounting for 53%, compared to their urban counterparts; in addition, the survey revealed that 76% of the female population consisted of multigravida women, indicating that they had experienced numerous pregnancies, in contrast to primigravida women who were pregnant for the first time. study's findings posit that cardiovascular disease is the leading cause of death for women overall, particularly among younger women (those aged 21–30), rural women, and women who have already given birth many times.

We report a case of transient hoarseness of voice secondary to inadvertent recurrent laryngeal nerve blockade while performing carotid endarterectomy under superficial and intermediate cervical plexus block anesthesia. Though we could not pinpoint the exact cause of recurrent laryngeal nerve block in this case, but have postulated few possible causes for this nerve block. This case highlights that inadvertent recurrent laryngeal nerve block can happen even when ultrasound guided superficial and intermediate cervical plexus block are used in clinical practice.

Background: Today, both general and regional anesthesia (spinal, epidural and combined spinal-epidural) techniques are applied to the patients who will be applying cesarean section. Both anesthesia techniques used in the cesarean section have their own advantages and disadvantages. In our study, we aimed to compare the maternal and neonatal effects of spinal anesthesia and general anesthesia using remifentanil. Materials and Methods: Sixty-six pregnant women with ASA I-II physical status were included in the study. Patients were randomly divided into two groups general anesthesia and spinal anesthesia. A computer-generated randomization program using a random block size was used. The age, height, weight and gestational week of each patient were recorded in the operation room. Systolic Arterial Pressure (SAP), Diastolic Arterial Pressure (DAP), Mean Arterial Pressure (MAP), Peripheral Oxygen Saturation (SPO2) and Heart Rate (HR) were measured and the values were recorded as baseline values. The 1st and 5th min. Activity-Pulse-Grimace-Appearance-Respiration (APGAR) values of the newborns were evaluated by the same pediatrician. Umbilical artery blood gas, 2nd-hour and 24th-hour Neurologic and Adaptive Capacity Scoring System (NACS) values of all newborns were recorded. Anesthesia since newborn hatching, uterine incision-infant hatching, duration of anesthesia and neonatal resuscitation (mask ventilation or intubation) were recorded in both groups. Postoperatively the first time the newborn can receive their mother's breast as effectively as the absorption time was recorded. Results: SAB values were higher in the general anesthesia group and there was a statistically significant difference between the groups (p-value = 0.00 *). In the same way, after the patients undergoing spinal/intubation, 5th, 10th and 15th min. Mean Arterial Pressure (MAP) and Diastolic Arterial Pressure (DAB) values were higher in the general anesthesia group and there was a statistically significant difference between the groups (p-value = 0.00*). Conclusion: We think that general anesthesia performed with remifentanil and thiopental used in the elective cesarean section may be applied as an alternative to spinal anesthesia in terms of mother and newborn health.

Background: Cardiovascular emergencies present a significant threat to human life, necessitating proficient medical responses. In the challenging terrain of Himachal Pradesh, where local healthcare expertise is crucial, assessing the Advanced Cardiovascular Life Support (ACLS) proficiency of medical officers becomes imperative. This study explores the nuanced landscape of ACLS knowledge, recognizing the unique geographical and demographic challenges impacting emergency cardiovascular care delivery. Material and Methods: A cross-sectional survey involving 100 medical officers with a minimum of 12 months of experience in Himachal Pradesh was conducted between July 2023 and October 2023. Utilizing a convenience and snowball sampling technique, a Google form questionnaire assessed ACLS knowledge through 20 structured questions. Data analysis employed Epi Info V7 Software, focusing on frequencies and percentages. The study's validity was ensured by expert input and ethical considerations prioritized participant confidentiality. Results: The study revealed a spectrum of ACLS knowledge among medical officers. Of the participants, 24 demonstrated very good knowledge, 32 exhibited good knowledge, 29 had fair knowledge and 15 showed poor knowledge. Specific knowledge gaps were identified, including the management of stable bradycardia rhythm and the calculation of appropriate defibrillation energy levels. Notably, 58 participants recognized the importance of regular ACLS retraining, reflecting awareness of evolving guidelines. Conclusion: This study emphasizes both strengths and gaps in ACLS proficiency among medical officers in Himachal Pradesh. The findings underscore the need for targeted interventions and continuous training to enhance emergency cardiovascular care. Tailored ACLS training programs, considering the unique characteristics of Himachal Pradesh, are imperative for improved patient outcomes.

Background: Anesthesia is a critical component of modern medical care, ensuring patient comfort and safety during surgical procedures. Despite its significance, public awareness and concerns regarding anesthesia remain underexplored, particularly in the distinct context of District Kinnaur, Himachal Pradesh. This study aims to assess the awareness and concerns surrounding anesthesia in this unique geographical and sociocultural setting. Material and Methods: A cross-sectional survey was conducted in District Kinnaur, Himachal Pradesh, targeting adults aged 18 and above. A sample size of 400 participants was determined using a 95% confidence level and a 5% non-response rate. A Google Form questionnaire, comprising socio-demographic and anesthesia-related knowledge questions, was pre-tested and distributed through online platforms. Validity was ensured by expert review. Data were analyzed using Epi Info V7, and ethical considerations were prioritized. Results: Among the 400 respondents (57.5% male, 42.5% female), 65.5% demonstrated very good or good knowledge regarding anesthesia. While 83.75% understood the role of anesthesia in medical procedures, knowledge gaps were observed, emphasizing the need for targeted education. Over 64% expressed concerns about complications, highlighting the importance of addressing fears associated with anesthesia. Communication improvements were desired by 71.5% of participants. Conclusion: Residents of District Kinnaur exhibit commendable awareness of anesthesia; however, specific knowledge gaps and concerns necessitate targeted interventions. Tailored educational programs and enhanced communication strategies, as supported by previous Indian studies, are crucial to addressing these challenges and fostering a more informed and confident patient population.

Background: Cardiovascular emergencies pose a significant global health challenge, necessitating prompt interventions for improved patient outcomes. Basic Cardiovascular Life Support (BCLS) is a critical skill set, especially for frontline responders such as medical officers. This study evaluates the BCLS knowledge among medical officers in Himachal Pradesh, India, considering the state's diverse healthcare settings and infrastructure nuances. Materials and Methods: A cross-sectional survey was conducted in the state of Himachal Pradesh between July and October 2023. The study included 100 medical officers with over 12 months of experience. A Google Form questionnaire assessed socio-demographic information and BCLS knowledge. The questionnaire comprised 20 structured questions, scored on a scale and responses were analyzed using Epi Info V7 Software. Validity was ensured by expert review. Ethical considerations were prioritized, maintaining participant confidentiality and anonymity. Results: The study revealed commendable BCLS knowledge among medical officers, with 31 participants demonstrating very good knowledge, 39 good knowledge, 18 fair knowledge and 12 poor knowledge. Specific knowledge gaps were identified, notably in areas such as AED use, age-specific BCLS approaches and managing choking in adult victims. Factors influencing BCLS proficiency included years of experience and prior training. The findings echo global trends and align with similar studies, emphasizing the need for targeted training interventions. Conclusion: This study contributes valuable insights into BCLS knowledge among medical officers in Himachal Pradesh. While demonstrating commendable proficiency, the identified knowledge gaps underscore the importance of tailored training initiatives to enhance preparedness for diverse emergency scenarios. The findings resonate with global research, emphasizing the need for continuous education and training to maintain and improve BCLS proficiency among healthcare professionals.

Introduction: Clinical assessment of tissue oxygen delivery is a challenging task for anesthesiologists. Anemia indicates a decrease in the oxygen-carrying capacity of blood, which poses a significant risk for oxygen Delivery Insufficiency (DO₂) and cellular hypoxemia and it can be used to assess tissue hypoxia. Blood transfusion is commonly used to correct anemia promptly and efficiently, but in certain circumstances, clinicians may be unable to perform blood transfusion, necessitating the use of alternative therapeutic approaches by anesthesiologists. Case Report: A 20-year-old female presented with anemia, with a hemoglobin (Hb) level of 6.0 g/dL. The patient's clinical and hemodynamic conditions were stable within normal limits and blood transfusion was planned. However, the Comb test results were incompatible, representing an absolute contraindication to transfusion. The patient exhibited clinical changes indicating tissue hypoxia when the Hb level dropped to 2.0 g/dL. The doctor decided to maximize DO₂ and reduce oxygen consumption (VO₂) to achieve a balance in oxygen requirements. The patient received steroid therapy due to suspected Autoimmune Hemolytic Anemia (AIHA). On the eighth day, the patient showed clinical improvement, stable hemodynamics and an increase in Hb level. Conclusion: Clinical evaluation related to tissue oxygenation distribution is crucial in patients with AIHA.

Background: Epidural anaesthesia is commonly used for pain management during labor and delivery. While it provides effective pain relief, it is essential to evaluate its impact on intrapartum, postpartum and neonatal complications. This prospective interventional study aimed to assess these outcomes and contribute to evidence-based decision-making in obstetric anaesthesia. Materials and Methods: The study was conducted at the Department of Obstetrics and Gynaecology in collaboration with the Department of Anaesthesiology at Dr. RPGMC Kangra at Tanda. Primigravida women in the early active phase of labor were included if they met specific criteria. The study had a sample size of 60 participants, divided into two groups: Group 1 (epidural group) and Group 2 (non-epidural group). Data on demographic characteristics, intrapartum complications, postpartum complications and neonatal complications were collected and analyzed using appropriate statistical methods. Results: The mean age, booking status, residence, education status and socioeconomic status were comparable between the two groups. In terms of intrapartum complications, there was no significant difference between Group 1 and Group 2. Similarly, there was no significant difference in postpartum complications between the two groups. Neonatal complications, including Apgar scores at 5 minutes and NICU admissions, showed no significant differences between the groups.

Conclusion: The study did not find a significant association between epidural anaesthesia and increased intrapartum, postpartum, or neonatal complications. These findings suggest the safety and effectiveness of epidural anaesthesia for pain management during labour and delivery.