BackgroundThe importance of decreasing bleeding in spine surgery is not only important to maintain the patient's hemodynamic balance but also allow a better view of the surgical field.ObjectivesThe current study aimed to compare dexmedetomidine and Esmolol™ as agents to induce hypotension in lumbar spine surgeries.Patients and MethodsA total of 50 patients aged 20 to 65 years belonging to the American society of anaesthesiologist (ASA) class I - II scheduled for decompression and fixation of the lumbar spine were included and divided into two groups namely, Group I, who received Esmolol and group II, who received dexmedetomidine, intravenously. The patients were compared for intraoperative hemodynamic parameters, estimated blood loss, operation time, intraoperative analgesic (fentanyl) consumption, and total fall in haemoglobin (Hb) during the perioperative period.ResultsThe study results showed that dexmedetomidine had lower (100.8 µg) fentanyl and sevoflurane consumption (1.2%), and less blood loss (278 mL) in comparison to the Esmolol group.ConclusionsBoth dexmedetomidine and Esmolol can be used as agents to control hypotension in patients undergoing lumbar spine decompression and fixation surgery; the dexmedetomidine group, however, was associated with better intraoperative hemodynamic stability and reduced intraoperative analgesic and volatile anaesthetic requirement.
Background: Addition of adjuvants to local anaesthetic in supraclavicular brachial plexus block helps in improving duration of block and analgesia. We compare clonidine and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block.Method: A total of 75 patients aged from 20 to 60 years belonging to ASA I-II scheduled for upper limb surgery were included and divided into three groups-Group I received 0.5% ropivacaine plus normal saline, Group II received 0.5% ropivacaine plus clonidine and Group III received 0.5% ropivacaine plus dexmedetomidine. The patients were compared for onset as well as duration of sensory and motor blockade, duration of analgesia and haemodynamic side effects. Results:The mean duration of sensory and motor block as well as analgesia was found to be more (statistically highly significant p<0.001) in group III (dexmedetomidine group) having a much longer duration of sensory and motor block as well as analgesia compared to group I (plain ropivacaine) and group II (clonidine group). Conclusion:Therefore, in present study it was found that addition of clonidine and dexmedetomidine to 0.5% ropivacaine are effective in supraclavicular brachial plexus block. However, dexmedetomidine is a better alternative to clonidine as adjuvant for 0.5% ropivacaine in to obtain early onset and prolong the duration of sensory and motor block and postoperative analgesia.
Background: Supracondylar fracture of the humerus is one of the commonly encountered injuries in paediatric age group accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures, classically occurring as a result of fall on an outstretched hand. Regional anesthesia may represent one of the best solutions for intraoperative and postoperative paediatric pain management however, due to lack of proficiency and the increased risk of complications in children and difficulty in obtaining cooperation compared to adults, it is not the method of choice for most of the anesthesiologists in children. Methods: A total of 50 paediatric patients were included who were to undergo CRPP and divided into two groups Group I- General anaesthesia alone (n = 25), Group II- General anaesthesia with USG guided supraclavicular brachial plexus block studied for the intraoperative opioid consumption as well as postoperative analgesia quality, duration and Opioid consumption. Results: Demographic data were similar in both groups (I and II). Time to first dose of analgesia after surgery in the group I was 54.8±5.4 min and 746.6±40.2 min (p<0.001). The incidence of PONV was 24% (group I) and 16% (GroupII). Duration of analgesia was significantly higher (746.6±40.2 min) and mean pain scores lower in first 24 hour. The fentanyl consumption was higher intraoperatively and rescue analgesic doses were more in group I. Conclusion: USG guided brachial plexus block is an excellent and effective means for analgesia in CRPP for supracondylar fracture with lower intraoperative Opioid consumption and better postoperative analgesia , lower pain scores and Opioid consumption in first 24 hour post operative period.
Background: The purpose of this study is to evaluate the causes of failure of dacryocystorhinostomy by computed dacryocystography (CT-DCG).Methods: CT-DCG was done in 38 patients of failed DCR of either sex in the age group of 16-60 years, the radiologist blinded to the clinical status of the patient evaluated position and size of bony ostium, soft tissue scarring, bony regrowth, secondary stenosis of canaliculi, synechiae between the ostium and nasal septum and anatomic variations in nasal cavity, turbinates or nasal septum.Results: The most common causes of failure in our study were inappropriate size of osteotomy window in 34 patients (84.47%), inappropriate location of osteotomy window in 31 patients (81.57%), fibrous tissue scarring at osteotomy window in 22 patients (57.89%), the other causes were bilateral concha bullosa in 2 patients, ethmoidal sinusitis in 2 patients, common canalicular block in 1 patient, faulty passage into ethmoidal sinus in 1 patient and no osteotomy window seen in patient.Conclusions: CT-DCG is a valuable imaging tool to evaluate DCR failure before re-operation. In our study CT-DCG showed that small size of osteotomy window, inappropriate position of osteotomy window and fibrous tissue scarring at osteotomy window were frequently seen causative factors of DCR failure.
Placement of CVC can lead to complications such as, malposition of the catheter and complications relating to perforation and/or injury of nearby blood vessels and structures. We present a case report is about malposition of central venous catheter (CVC) from right internal jugular vein (IJV) into right subclavian and axillary vein. It is advisable to check free venous outflow in all the ports of CVC, central venous waveform should obtained with transducer in place and following placement of CVC catheter, chest radiograph should be completed to confirm the position.
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