AIMS:Brachial plexus nerve blocks have analgesic and opioid sparing benefits for upper extremity surgery. Single-injection techniques are limited by duration of local anaesthetic agents, however Continuous block techniques can be used for prolonged anaesthesia and analgesia but it presents management challenges. The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset,duration and postoperative analgesia following upper limb surgeries. METHODS AND MATERIAL: A prospective, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. Sixty patients were randomly divided into two groups, Group B and BD.Group B received 30 ml of 0.375% bupivacaine with 2 ml normal saline while Group BD received 30 ml of 0.375% bupivacain with 2ml(8mg) dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post operative analgesia and intra and postoperative complications. RESULTS: There was a significant increase in duration of motor and sensory block and analgesia in Group BD as compared to Group B patients(P < 0.0001). No significant side effects were noted. CONCLUSIONS: The addition of 8 mg of dexamethasone to bupivacaine in supraclavicular brachial plexus block prolongs the duration of motor and sensory block and extends the analgesia period.KEYWORDS: Anaesthesia adjuvants; Dexamethasone; Brachial plexus block. INTRODUCTION:Brachial plexus block is a suitable alternative to general anesthesia for elbow, forearm and hand surgery. (1) Local anaesthetics alone does not provide analgesia for more than 4-8 hours Prolonging the duration of sensory and motor blockade of regional anaesthetic techniques is often desirable to provide intra operative anesthesia and analgesia in the post operative period without any systemic side effects. Several adjuncts have been studied to potentiate efficacy of brachial plexus block including opioids, midazolam, neostigmine, bicarbonate,hyaluronidase and α2 agonists. (2,3,4) Perineural injection of steroids is reported to influence post operative analgesia.They relieve pain by reducing inflammation and blocking transmission of nociceptive C-fibres and by suppressing ectopic neural discharge. Some studies have demonstrated the analgesic effect of local spinal and systemic corticosteroids in combination with bupivacaine. (5,6,7) The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset,duration and postoperative analgesia following upper limb surgeries.

Background: Chronic Suppurative Otitis Media is a disease of multiple aetiology and is well known for its persistence and recurrence in spite of treatment. Changes in the microbiological profile following the advent of sophisticated synthetic antibiotics and unscrupulous usage of antibiotics increase the relevance of reappraisal of the modern day organisms in CSOM and their in vitro antibiotic sensitivity pattern. Aim: To identify bacteriological profile in our geographical area in CSOM both in TTD and AAD types, their latest sensitivity trends to antibiotics. Materials & Methods: 100 Patients with more than 3 months history of ear discharge selected over a period of 18 months. All patients are enquired about the history then subjected to ENT examination. From the discharging ear, pus taken with two sterile swabs and sent for direct smear and aerobic culture and sensitivity. Results: Gram negative organisms are predominant than gram positive. Pseudomonas is the most common organism found followed by Staph. aureus. Sensitivity in gram negative bacteria were mainly to Ciprofloxacin, Gentamycin and Amikacin. The gram positive organisms were highly sensitive to Amoxycillin/Clavulanic acid, Amikacin, Gentamycin, Ciprofloxacin and Tetracycline. Conclusion: Bacterial profile in discharging ears keep changing, latest bacteriological profile with antibiotic sensitivities needed to be obtained from time to time so as to treat the patient more efficiently.

Background: Postoperative nausea and vomiting (PONV) is common complication after general anesthesia and surgery. This randomized double-blind study was designed to compare the effects of acupressure wrist bands and palonosetron for the prevention of post-operative nausea and vomiting (PONV) in laparoscopic cholecystectomy under general anaesthesia.Methods: Sixty ASA I and II patients undergoing elective laparoscopic surgeries under general anaesthesia were divided into two groups. In Group A patients, acupressure wrist bands were applied on p6 point on both hands half an hour before induction. Group P patients received inj. palonosetron 0.075 m.g. i.v. just before induction. Anaesthesia technique was standardized. Post-operatively patients were monitored for nausea, retching or vomiting upto 24 hours. If patients vomited more than once, they were given inj. Metoclopramide 10mg as rescue antiemetic. Efficacy of drugs was compared using Chi square test. ‘p’ value of <0.05 is considered significant.Results: The incidence of PONV and requirement of rescue antiemetic were lower in palonosetron group than acupressure wrist band group.Conclusions: Palonosetron is more effective than acupressure wrist band for prophylaxis of post- operative nausea and vomiting in the patients undergoing laparoscopic cholecystectomy under general anaesthesia, but acupressure wrist band can also be used as an alternative non-pharmacological method.

Survival after nylon rope suicidal hanging is a rare occurance. We describe here a patient who attempted suicide by nylon rope hanging and developed post obstructive pulmonary edema was managed successfully. Patient recovered completely with ventilatory support in next 60 hours without any neurological deficit.This case highlights an unusual complication of hanging and its recovery. KEYWORDS: Post obstructive pulmonary edema,cerebral edema, Nylon rope attempted suicidal hanging. KEYMESSAGES: Patient was lucky enough to be rescued and brought to the hospital early, even after nylon rope attempted suicidal hanging. Such cases need to be managed aggressively as there are chances of their complete recovery INTRODUCTION:Depression is increasing at an alarming rate globally. (1,2,3) Hanging is one of the oldest and common mode of suicide in the young adults. Death takes about 8-10 minutes in such cases. (4) The mortality and morbidity change dramatically if such patients are rescued early and managed aggressively, even in small ICUs. Here we report a case who presented in severe pulmonary and cerebral edema after attempted suicidal nylon rope hanging.

Background: Failure/delayed effect of spinal anesthesia were noted in several patients with past history of scorpion sting during routine practice. Scorpion venom is known to delay the activation of sodium neuronal channels. Local anesthetic agents also act through the sodium channels. Therefore this study was conducted to test the association of scorpion sting with failure/resistance to effect of spinal anesthesia. Methods: 40 patients in the age range of 18-80 years were divided into two equal groups. Group 1 with past history of one or multiple scorpion stings and group 2 with no such history. The anaesthetic management was identical i.e. subarachnoid block with 3.5 ml. 0.5% Bupivacaine heavy. The onset of sensory and motor block was noted. Peaks of sensory and motor blocks were also observed. Sensory block was assessed by pin prick method and motor block by Bromage scale. After waiting for 20 min, general anesthesia was administered if the block was inadequate. Results: The time of onset of sensory and motor block as well as the time for the peak of sensory and motor blocks was significantly prolonged in scorpion sting group. 5 patients had failed sensory and motor block. All the patients in control group had adequate subarachnoid block. Conclusion: There is a direct association between previous scorpion sting and development of resistance to the effect of spinal anesthesia.