Context:Clinical assessment of severity of illness is an essential component of medical practice to predict the outcome of critically ill-patient. Acute Physiology and Chronic Health Evaluation (APACHE) model is one of the widely used scoring systems.Aims:This study was designed to evaluate the Performance of APACHE II and IV scoring systems in our Intensive Care Unit (ICU).Settings and Design:A prospective study in 6 bedded ICU, including 76 patients all above 15 years.Subjects and Methods:APACHE II and APACHE IV scores were calculated based on the worst values in the first 24 h of admission. All enrolled patients were followed, and outcome was recorded as survivors or nonsurvivors.Statistical Analysis Used:SPSS version 17.Results:The mean APACHE score was significantly higher among nonsurvivors than survivors (P < 0.005). Discrimination for APACHE II and APACHE IV was fair with area under receiver operating characteristic curve of 0.73 and 0.79 respectively. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV was 85. Above cut-off point, mortality was higher for both models (P < 0.005). Hosmer–Lemeshow Chi-square coefficient test showed better calibration for APACHE II than APACHE IV. A positive correlation was seen between the models with Spearman's correlation coefficient of 0.748 (P < 0.01).Conclusions:Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in our study. There was good correlation between the two models observed in our study.

Pheochromocytoma, a tumour arising from adrenal medulla or other ganglia of sympathetic nervous system is notorious for secreting catecholamines. This form of the tumour is a major challenge to anaesthesia team as acute changes in blood pressure and heart rate usually occurs due to the release of catecholamines from the tumour site before tumour resection and cessation of the same after resection leading to hemodynamic instability intraoperatively. Better hemodynamic stability is desired during this form of tumour resection as acute fluctuations in blood pressure may lead to severe intracranial or cardiovascular events. Dexmedetomidine and magnesium sulphate were used as anaesthetic adjuncts to achieve good hemodynamic stability in a 35 years old female who presented with the history of headaches, palpitation and sweating on and off since last 2 years. The use of these agents allowed us to obtain an acceptable level of hemodynamic stability along with the help of other agents such as inotropes, vasopressors, vasodilators and antihypertensive agents. Dexmedetomidine and magnesium sulphate were used before resection of the tumour in our case and stopped thereafter. These agents may be an excellent option as anaesthetic adjuncts to obtain greater hemodynamic stability during resection of pheochromocytoma.

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Spontaneous cervical cerebrospinal fluid leak is a rare entity and occurs because of tear in cervical dural layer. Management has been conservative in the past but here we present this case that was managed successfully with cervical epidural blood patch. A 36-year-old man presented to neurology outpatient clinic with headache in occipito-frontal region and dizziness for 15 days and managed with various modalities without benefit. The severity of headache increased in standing and sitting position but relieved in supine position. There was no history of trauma, fever, photophobia, neck pain, tinnitus, weakness of other parts. Clinical examinations including neurological examinations were normal. So, magnetic resonance imaging of head and neck was obtained which showed dural leak in C3-C4 region. Adequate hydration, caffeine and oral medications were prescribed without benefit and then after 5 days, Anesthesiology department was consulted and was planned for cervical epidural blood patch. Under aseptic precaution in left lateral position with full neck flexion, 18g Tuohy needle was inserted in C5-C6 epidural space by loss of resistance technique to air, and 15 ml of the autologous blood was injected. Then patient was kept in supine position for 24 hours and neurological status was monitored frequently. Over the next two days, patient became asymptomatic and was discharged. The patient was regularly followed up weekly for six weeks and then monthly for six months and had no reoccurrence of symptoms or other findings.