Background and Aims:Dexmedetomidine (Dex), a highly selective α2-adrenoreceptor agonist, is used for sedation management in various clinical settings and shows anaesthetic-sparing effect. Our aim was to study the effects of Dex on requirements of propofol, ketamine, and intraoperative haemodynamic variations during burns debridement and dressing changes, and compare its effectiveness and safety with combination of ketamine and propofol.Methods:Sixty adult patients posted for elective debridement and dressing were included in the study. Thirty patients received Dex (intramuscular)(IM) 1 μg/kg, 1 h before shifting to the operation theatre while the other thirty did not. Anaesthesia was induced with propofol and ketamine followed by adjusted infusion to achieve a Ramsay Sedation Scale score (RSS) of six in all patients. Intraoperatively haemodynamic parameters were recorded at regular intervals of 5, 15, 30, 45, and 60 min. The mean data between the groups were compared by unpaired t test and medians by Mann-Whitney U test. Within group analysis was performed by using repeated measures ANOVA. P < 0.05 was considered significant.Results:The dose requirement of ketamine and propofol in Dex group was significantly lower when compared to control group (100.5 ± 17.58 mg vs. 231.5 ± 60.39 mg (P < 0.0001) and 127.7 ± 15.47 mg vs. 254 ± 59.22 mg (P < 0.0001) respectively). Additionally, recovery time was lower in the Dex group as compared to the control group, 9.57 ± 1.50 min vs. 11.53 ± 2.56 min (P = 0.0006). Haemodynamic variations were also significantly lower in the Dex group as compared to the control group.Conclusion:Dexmedetomidine (1 μg/kg IM) reduced the requirement of propofol and ketamine, with more stable intraoperative haemodynamics.

Background:Spinal anesthesia is used commonly intraoperatively. However, local anesthetics are associated with relatively short duration of action. A number of adjuvants have been used to prolong the postoperative analgesia.Objectives:To compare efficacy of dexmedetomidine and fentanyl when given intrathecally as an adjuvant to 2.5 ml of 0.75% isobaric ropivacaine.Materials and Methods:Sixty selected patients were randomized to receive 2.5 ml of 0.75% isobaric ropivacaine with dexmedetomidine 5 mcg (Group RD) or 20 mcg of fentanyl (Group RF) intrathecally for lower limb surgeries, block characteristics, hemodynamic changes, and adverse effects were compared.Results:Efficacy of both the drugs when given intrathecally was studied. Mean time needed for sensory blockade at T10 was 156.4667 ± 33.78 s in Group RD and 185.2000 ± 35.17 s in Group RF. The results are clinically and statistically significant (P - 0.002). The mean of total duration of sensory block in Group RD was 194.400 min while it was 139.9000 min in Group RF which was clinically and statistically significant (P - 0.0001). Time taken for onset of motor block was almost same in both groups. The mean of total duration of motor block in Group RD was 136.7333 min while it was 94.8667 min in Group RF which was clinically and statistically significant (P - 0.000).Conclusion:Dexmedetomidine at a dose of 5 μg added to 2.5 ml of ropivacaine provided earlier sensory blockade, prolonged duration of sensory and motor blockade for patients under intrathecal anesthesia for lower limb surgeries with no sedation.

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August Bier's first report of spinal anesthesia in August 1898 impressively described the development of a postedural puncture headache (PDPH) (1). When asked for complications of spinal anesthesia today, patients often respond with PDPH. PDPH is defined as a constant headoache that worsens in the sitting or upright position folglowing lumbar puncture (LP). Its incidence after spinal anesthesia in obstetric anesthesia is 1% to 6% (2) and 30% to 50% after a diagnostic LP (3) and can reach 80% after inadvertent LP during epidural obstetric anesthesia (4). Many theories exist regarding the pathophysiology of PDPH, but it appears to be related to the loss of cerebropspinal fluid into the epidural space with a decrease in cerebrospinal fluid pressure and downward movement of the brain and traction on the dura (5). Spontaneous recovery within 5 days occurs in most cases, but PDPH can last up to many months, like the case report of Barlbosa et al. demonstrated (6). During this time, patients suffer and rehabilitation is restricted. Pharmacological therapy is seldom a complete success (5), but an epidural blood patch can resolve the issue in many cases (7).Due to the frequency of occurrence and the resulting physical limitations of patients, every effort should be made to learn about the risk factors of PDPH and how to avoid it. Nonmodifiable risk factors include gender, age, pregnancy, previous history of PDPH or chronic headache, and low body mass index (BMI). However, of modifiable risk factors, such as needle shape, bevel orientation, number of LP attempts, and prelumbar puncture positioning (8, 9), the most relevant appears to be needle size the smaller the size, the lower the PDPH incidence.Nevertheless, the approach may be considerable. Median, paramedian, and Taylor´s approaches have been advocated as the primary method in different settings, whereas the median approach may be easier for trainees, because the primary orientation seems straightforward. If cerebrospinal fluid cannot be detected, many choose the paramedian approach as a second strategy. With reagard to the angled paramedian approach as the primary method, Mossafa et al. show that there is no difference in the incidence of PDPH compared with the median apcproach. In their study, the number of attempts to puncbture is restricted to only one. This may not reflect clinical reality but may be part of the reason for these interesting results, demonstrating this kind of approach is not a risk factor for PDPH.

Introduction: This study was done to estimate the nucleated red blood cell count (NRBCs) in normal and asphyxiated babies and find their correlation with severity of birth asphyxia. Materials and Methods: About 50 normal newborns as control and 50 newborns with perinatal asphyxia as cases were considered. At birth 2 mL of venous blood was collected in both cases and control groups. nRBC count per 100 white blood cells (WBC) was done at admission. Clinical assessments in terms of neurologic status at birth, 24 hours after birth and every day thereafter till discharge/death was done. Cord blood nRBC/100 WBC was correlated with stages of HIE during hospital stay. Neonates were monitored for adverse outcome such as tone abnormalities, feeding difficulty, refractory seizures and death. Controls were followed up in the same manner. Results: Among 50 cases, 24 had no hypoxic ischaemic encephalopathy (HIE),17 had stage 1 HIE, 6 had stage 2 and 3 newborns had stage 3 HIE. The mean APGAR score in cases was 5.34 ± 1.19 whereas for the control group it was 8.12 ± 0.77 with p value of 0.001 which is statistically significant. The mean nRBC in newborns with APGAR score of 3, 4,5, 6 were 35.5, 19.9, 20.6 and 12 respectively. The low APGAR scores showed high nRBCs. Mean nRBCs for HIE stage 1, 2, 3 was 19.1, 31.0, and 54.3 respectively. High nRBC count correlated with increasing severity of birth asphyxia. Conclusion: nRBC count is an easy, simple and a reliable test to assess the severity of birth asphyxia in resource poor settings.

Introduction: High morbidity and mortality in DF/DHF is due to multiorgan involvement. Hepatic involvement can present with varied manifestations ranging from hepatomegaly to fulminant hepatic failure. Incidence of hepatic dysfunction is more in Dengue shock syndrome and Dengue hemorrhagic fever. Ultrasound can be used as a prognostic indicator and also used as means of monitoring for plasma leakage. Objectives: To study the clinical presentation, hepatic abnormalities and the ultrasonographic findings in dengue fever, dengue haemorrhagic fever and dengue shock syndrome and to correlate these findings with the severity of dengue fever. Materials and Methods: 100 hospitalized patients of Dengue fever were classified as DF/DHF/DSS as per their clinical manifestations. Lab investigations namely SGOT, SGPT, PT, APTT and INR were monitored. Ultrasonography of the abdomen and thorax were done. Hepatic enzymes, coagulation workup and ultrasonographic parameters in DF/DHF/DSS were compared in the study. Conclusion: Severe dengue can pose challenges to the treating physician. Hence early identification of deterioration in the clinical status can be reasonably assessed by using hepatic and ultrasound parameters which will help in the management of dengue illness and thus reducing the mortality and morbidity.