BACKGROUND: Laryngeal Mask Airway (LMA) is a supraglottic airway device, requiring optimal conditions for insertion to minimize the hemodynamic perturbation associated with LMA insertion. The aim of our study is to compare Dexmedetomidine-Propofol (Dp) and Fentanyl-Propofol (Fp) for conditions of LMA insertion in short surgeries under general anesthesia. AIMS AND OBJECTIVES: To compare efficacy of Dexmedetomidine-Propofol and Fentanyl-Propofol for LMA insertion in terms of 1) Ease of insertion, 2) The Hemodynamic responses to LMA insertion. MATERIALS AND METHODS: Ours was a double blinded randomized comparative study having 30 patients in each group, Dp and Fp, where patients received 1µg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of LMA insertion parameters (Jaw relaxation, Coughing or movement during insertion, number of attempts required) and hemodynamic parameters (Mean heart rate, mean Systolic BP, mean Diastolic BP, Respiratory rate, SPO2) were monitored at following time intervals: Baseline, Pre-med, Pre LMA, Post LMA (at insertion), 1 min, 2 mins, 3 mins, 5 mins, 7 mins, 10 mins. Statistical analysis: Statistical analysis was done by using descriptive and inferential statistics using Chi square test, Wilcoxon signed rank test and Mann Whitney U test. The software used in the analysis was SPSS 17.0 version and Graph Pad Prism 5.0 and p< 0.05 is considered as level of significance. RESULTS: Jaw relaxation was statistically better, with less incidence of coughing in dexmedetomidine group. Hemodynamic parameters remained stable in Dexmedetomidine group whereas in fentanyl group a rise in HR and SBP was seen Post LMA insertion which stabilized quickly. Numbers of attempts of LMA insertion were comparable, with SPO2 and ETCO2 values within normal limits. CONCLUSION: Dexmedetomidine gives better insertion conditions and better attenuation of pressor response to LMA insertion compared to fentanyl in the given doses.
Deltamethrin is a newer class of insecticide used on crops, pets, and livestock, in home pest control, and malaria vector control belonging to the synthetic pyrethroid group, which is being promoted in the place of organophosphate compounds due to the harmful and persistent effects of the latter. Unfortunately, as its usage increased, so has the number of poisoning cases associated with deltamethrin. Fortunately, the mortality in deltamethrin poisoning cases is low. However, deltamethrin poisoning causes signs and symptoms similar to the clinical features of organophosphate poisoning. This case report is of a 20-year-old man who consumed an unknown substance in a suicidal attempt and presented with clinical signs of organophosphate toxicity. Later the compound was identified as deltamethrin. This case report adds to the medical literature on deltamethrin poisoning. It showed that apart from the similarity in their clinical features in toxicity, deltamethrin can even give a positive result on atropine challenge tests like organophosphate and that the fasciculations induced by deltamethrin may be temporary. This case report will also benefit the clinician in unknown compound poisoning cases as it shows that the clinician can suspect deltamethrin toxicity alongside organophosphate toxicity in the differential diagnosis when the atropine challenge test gives a positive result.
Organophosphate compounds such as Malathion, parathion, dimethoate, chlorpyrifos, tabun etc. Block the acetylcholinesterase enzyme, due to which acetylcholine levels increases. Organophosphate poisoning can occur after dermal, respiratory or oral exposure to organophosphate compounds.Respiratory symptoms are presented frequently in cases of organophosphate poisoning. Salivation, rhinorrhea along with bronchorrhea and bronchospasm are the muscarinic effects contributing to hypoxemia and increase in respiratory rate. Nicotinic effect causes muscular fragility and paralysis which may lead to respiratory failure. In wellens syndrome, the ECG reveals biphasic T waves or deep inverted T waves in leads V2-V3, indicating LAD stenosis, whereas Pseudo-Wellens have a Wellens ECG pattern but normal coronary architecture. In this case a 29-year-old male patient was brought from outside hospital with alleged history binge alcohol consumption and was found in unconscious state in his farm 2 days back.
Stroke is a regularly encountered emergency by emergency physicians, categorized based on the culprit artery and diagnosed based on non-contrast computerized tomography (CT) brain, which is supported by clinical examination that can be treated intravenously by thrombolytic agents or mechanical thrombectomy.Here we present one such case, which was brought to the emergency room with symptoms of posterior circulation stroke within 8 hours and underwent mechanical thrombectomy.
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