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Introduction:FESS (Functional Endoscopic Sinus Surgery) is done via endoscope and the area is highly vascular thus it becomes important to minimize bleeding. Hence we require hypotensive anesthesia. Various drugs have been used for the purpose: nitroglycerine (NTG), sodium nitroprusside(SNP),propofol,beta blockers, calcium channel blockers, higher concentrations of inhalational anesthetics etc. Since all these drugs have certain limitations there was a search for safer and more effective drug .Dexmedetomidine, a newer alphaadrenoceptor agonist,fulfills this requirement since it is short acting, has no residual effects, produces sedation and analgesia and reduces mean arterial pressure thereby reducing intraoperative blood loss. Aims: To study the efficacy of dexmedetomidine in providing hypotensive anaesthesia so as to minimize bleeding during endoscopic sinus surgery in a randomized double blind control study. Method:40 patients of ASA grade I/II, aged18-55yrs,scheduled for endoscopic sinus surgery, were randomly allocated into two groups of twenty each by sealed envelope method. Group C: received Normal saline as loading dose of 1mcg/kg intravenously followed by maintenance infusion of 0.6mcg/kg intravenously, Group D: received dexmedetomidine in similar doses. The loading dose was given slowly over 15 minutes. The surgery was started after the loading dose was over. Both the anaesthetist conducting the study and the patient were blinded to the study drug. The amount of blood loss, doses of intravenous& inhalation agents and side effects were studied. Results:The patient characteristics did not differ in bothcontrol(C) and study (D) groups (Table1). Blood losses were lower in group D as compared to group C (p = 0.03).Total dose of fentanyl (p< 0.001),propofol(p <0.001)and isoflurane (p =0.04)were lower in group D as compared to group C. The VAS scores in the immediate postoperative periods were also lower in the group D (p =0.03).The only side effect noted was bradycardia (2patients)which however reverted with discontinuation of the drug.Atropine was not required. Conclusions:Dexmedetomidine is a safe &effective adjuvant for hypotensive anaesthesia to decrease bleeding and thus provide bloodless field during FESS surgery. It also decreases the dose requirements of propofol,fentanyl and isoflurane. It is also an effective analgesic agent.

The landscape of fungal endocarditis (FE) has constantly been evolving in the last few decades. Despite the advancement in diagnostic methods and the introduction of newer antifungals, mortality remains high in FE. This systematic review aimed to evaluate the epidemiology, clinical features, diagnostic and therapeutic interventions in patients with FE. We also aim to examine the aforementioned factors as a determinant of mortality in FE. A literature search was performed in PubMed, Google Scholar and Scopus, and all patients ≥18 years with proven fungal endocarditis were included. A total of 220 articles (250 patients) were included in the final analysis. Candida was the commonest aetiology (49.6%), followed by Aspergillus (30%) and Scedosporium species (3.2%). The proportion of prosthetic valve endocarditis (PVE) and intravenous drug users was 35.2% and 16%, respectively. The overall mortality rate was 40%. On multivariate analysis, Aspergillus endocarditis (HR 3.7, 95% CI 1.4‐9.7; p = .009) and immunocompromised state (HR 2.8, 95% CI 1.24‐6.3; p = .013) were independently associated with mortality. Patients treated with surgery along antifungals had better survival (HR 0.20, 95% CI 0.09‐0.42; p < .001) compared to those treated with antifungals alone. Recurrence of FE was reported in 10.4% of patients. In conclusion, FE carries significant mortality, particularly in immunodeficient and Aspergillus endocarditis. We advocate the use of surgery combined with antifungals to improve clinical outcomes.

BackgroundIt has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic.MethodsThis was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown.Results25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block.ConclusionThe COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.