Background and Aims:Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy is not much investigated. The objective was to assess the dose dependent effect of dexmedetomidine (3 mcg vs 5 mcg) as an adjunct to isobaric ropivacaine in spinal anesthesia.Materials and Methods:Forty selected female patients were randomized to receive intrathecal 0.5% isobaric ropivacaine (15 mg) with dexmedetomidine 3 mcg (Group D3) or 5 mcg (Group D5) in spinal anesthesia for abdominal hysterectomy. Block characteristics, hemodynamic changes, postoperative analgesia, and adverse effects were compared.Results:Both groups were comparable regarding sensory-motor block characteristics and postoperative analgesia (P > 0.05). Four (10%) patients of Group D5 and 5 (12.5%) of Group D3 could not achieve desired T6 sensory level and Bromage score of 3(complete motor block) hence were converted to general anesthesia at the outset. Nine (22.5%) patients each in both groups required ketamine supplementation (0.5 mg/kg) for intraoperative pain at the time of uterine manipulation. Incidence of hypotension was comparable (55.56% in Group D5 and 37.14% in Group D3, P = 0.11), but this occurred significantly earlier in Group D5, P < 0.001. Sedation was also significantly more in Group D5 as compared with Group D3, P < 0.01.Conclusion:We conclude that spinal anesthesia with isobaric ropivacaine (15 mg) with dexmedetomidine (3 mcg or 5 mcg) did not show much promise for abdominal hysterectomy as one third cases required analgesic supplementation. Both doses of dexmedetomidine produced a similar effect on block characteristic and postoperative analgesia; however, a dose of 5 mcg dose was associated with more hypotension and sedation.
Background: Cardiovascular diseases (CVD) and its complications are on an increased trend in the younger age group. In this study we aimed to identify the different risk factor profile and coronary angiographic characteristics of young adults presenting with coronary artery disease.Methods: We conducted this retrospective observational study at SCB MC and H and Ashwini Hospital, Cuttack, Odisha, India over a period of one year from June 2016 to June 2017 on 170 patients who undergone coronary angiogram. Inclusion criteria being patients admitted for STEMI, NSTEMI, or UA, age <40 years and those who underwent coronary angiography. All patients who underwent coronary angiography for surgical fitness e.g., patients of rheumatic heart disease and congenital heart disease were excluded from the study.Results: Among the 150 cases included in the study, 85.3%were males and 14.7% were females. Maximum number of cases i.e. 71.3% were in the age group 36-40 yr, while 23.3% were between 31-35 and 5.4% were between 25-30 age group. Among 150 cases with critical CAD, SVD was most prevalent seen in 68.7% cases, followed by DVD in 22.6% and TVD in 8.7% cases.Conclusions: Incidence of critical CAD in young adults is quite high. Young patients with CAD are mainly males, and SVD is more common. Comparative analysis of young patients with STEMI and NTEMI/ UA revealed that SVD was predominantly involved in STEMI group, whereas TVD was predominant in NSTEMI/UA group.
Background: Though variations of the Circle of Willis (CW) is quite common. not much CT angiographic study has been done to identify the anatomic anomalies. Variations of anterior cerebral artery, one of the small terminal branch of internal carotid artery, can be an incidental finding during routine radiological investigation or can be presented with aneurysm formation, ischemic or hemorrhagic manifestation. Methods: We have conducted a prospective study with retrospective analysis on all CT angiograms of the circle of Willis in 350 cases presented with symptoms of TIA or ischemic cerebral stroke using 128 slice MDCT. Results: We found Classical type of CW in 285 cases (81.42%) and variation in anterior cerebral circulation in 65 patients (18.57%). Among the variations we observed hypoplasia of A1 segment in 37 cases (10.5%), aplasia of A1 segment in 24 cases (6.8%), triple A2 segment in one case (0.2%), azygous artery in one case (0.2%) and fenestration in 2 cases (0.5%).Among 37 cases of hypoplasia of A1 segment 21(6%) cases have right sided hypoplasia and 16(4.5%) cases have left sided hypoplasia. Among 24 cases of aplasia of A1 segment 16 (4.5%) have right sided aplasia and 8 (2.2%) have left sided aplasia. Azygous variant of ACA was seen in one (0.2%) case & Fenestrations observed in 2 (0.5%) cases. Conclusions: Most of our results are in accordance with previous studies.
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