bilateral nonhomogeneous opacities while X-ray cervical spine did not reveal any bony lesion. Fundoscopy revealed no abnormality. After institution of mechanical ventilation, pulse rate stabilised at 130-140/min, blood pressure varied from 110-130/60-70mm of Hg and SpO 2 ranged from 90-92%.Patient was conscious the next morning and was responding to verbal commands, pulse rate was 140/min and blood pressure 130/80mm of Hg. PEEP was gradually increased to 15cm of H 2 O and FiO 2 was simultaneously decreased to 0.6, maintaining SpO 2 between 91% and 96%. Throughout the day dopamine at the rate of 3-5µg/Kg/min had to be infused intermittently to maintain systolic blood pressure above 90mm of Hg. On the third day of hospitalisation patient's general condition remained same. She was conscious and tolerated endotracheal tube well, pulse rate varied between 120-136/min and blood pressure varied between 85-90/50-70mm of Hg. Bronchial breath sounds were auscultated bilaterally with no adventitious sounds, but chest X-ray did not reveal any improvement over previous radiological findings. Hemogram and all biochemical parameters were within normal limits and tracheal secretions were sent for culture (which did not grow any organism after 48 hours of incubation). Amikacin and ceftazidime were instituted empirically. Dopamine was continued. Attempts to decrease PEEP keeping FiO 2 less than 0.6 failed and ventilatory parameters were left unchanged with SpO 2 varying from 91%-96%. Patient was sedated with morphine 3 mg IV every four hours. On the fourth day of hospitalisation PEEP was reduced to 10 cm of H 2 O and FiO 2 to 0.5. Dopamine was gradually withdrawn and blood pressure during the day ranged between 90-100/60-70 mm of Hg. On the fifth day of hospitalisation, patient was found to be conscious with pulse rate of 88/ minute, blood pressure of 100/60mm of Hg and SpO 2 of 99%. Chest was clinically clear but X-ray chest showed only minimal improvement. Weaning from artificial ventilation was attempted using SIMV mode with decreasing rate of ventilation followed by a spontaneous breathing trial with Ttube for two hours, but patient failed to maintain adequate SpO 2 and hemodynamic stability and ventilatory support was reinstituted with PEEP of 4 cm of H 2 O and FiO 2 of 0.4. On the sixth day of hospitalisation patient was successfully weaned off the ventilator. Post extubation pulse rate was 104/min, blood pressure was 100/67mm of Hg, SpO 2 98% and respiratory
The purpose of this study was to familiarize oneself with an endemic infestation which often masquerades itself as pyoderma to the naïve physician, more so in an imported case or more importantly, an 'exported' health care professional.
Introduction: Supraclavicular brachial plexus block is used for providing pain relief in upper limb surgeries and has many advantages over general anaesthesia. Alpha-2-adrenergic agonists are chosen with local anaesthetics for their sedative, analgesic and antihypertensive properties. Aim: To compare the efficacy of clonidine and dexmedetomidine when added to 0.5% ropivacaine in nerve stimulator guided supraclavicular block when performed for upper limb surgeries. Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesia Mata Chanan Devi Hospital, New Delhi, India (tertiary care center), from September 2015 to September 2016. Total 90 patients were randomly allocated into three groups. Group A {Inj. ropivacaine 0.5% (29 mL)+ normal saline 1 mL to make 30 mL}, group B {Inj. ropivacaine 0.5% (29 mL)+ clonidine 1 μg kg-1 to make 30 mL) and group C {Inj. ropivacaine 0.5% (29 mL)+ dexmedetomidine 1 μg kg-1 to make 30 mL}. Parameters observed included onset of sensory and motor block, total motor duration, postoperative analgesia as primary outcome; and intraoperative haemodynamic parameters and side effects as secondary outcome. Results: All the three groups were found to be similar with demographic profile. Patients in dexmedetomidine group showed faster onset and longer duration of sensory and motor blocks (p-value<0.01). The mean onset of sensory block in minutes was 12.03±2.20, 8.20±1.40, 6.80±1.35 in groups A, B and C, respectively (p-value<0.001). The mean onset of motor block in minutes was 18.47±2.78, 13.37±2.86 and 11.30±2.04 in group A, group B and C, respectively (p-value<0.001). The mean duration of analgesia in group A, B and C was 555.17±65.36, 710.00±73.58 and 902.67±116.65 minutes, respectively (p-value<0.001). The mean duration of motor block in group A, group B and group C were 330.00±51.78, 418.17±38.29 and 516.83±50.33 minutes, respectively (p<0.0001). The duration of postoperative analgesia and total motor duration were significantly prolonged in dexmedetomidine group than group A and B. Conclusion: It can be concluded that both clonidine and dexmedetomidine increases the total motor duration and postoperative analgesia when added to ropivacaine, but dexmedetomidine is a better choice when used in supraclavicular block, without any significant side-effects.
Background: Post-operative pain is a matter of great concern for anaesthesiologists and surgeons. We compared the efficacy of oral Gabapentin and intravenous Paracetamol for postoperative analgesia in patients undergoing laparoscopic surgeries. Methods: After obtaining written informed consent and ethical committee approval, a total of 70 patients undergoing laporoscopic surgeries were randomly allocated into two groups- 35 patients included in Group A were given 600 mg oral Gabapentin 2 hours before the surgery and Group B patients were given 1gm I.V. PCM 30 minutes before the surgery. The NRS scores at 30 min, 2 hours, 6 hours, 8 hours, 12 hours, and 24 hours were recorded. The time at which first rescue analgesic given and Different hemodynamic parameters like heart rate, blood pressure and oxygen saturation were also recorded at different time intervals. Results: NRS scores and MAP was higher in Group B with a significant p-value at 8 and 12 hours. The need of first rescue analgesic required was at 7.79±3.49 hours in Group A. In Group B requirement of first rescue analgesia was at 6.09±2.75 hrs. The total dose of tramadol used was significantly higher in Group B with mean 92.86±36.67 than Group A 64.29±28.62 with statistically significant p-value (p=0.001). Conclusion: Both oral Gabapentin and intravenous Paracetamol are effective modes of postoperative analgesia hence both can be used as preemptive analgesic agents. Oral Gabapentin has a longer duration of action up to 12 hours in the postoperative period while intravenous Paracetamol is effective up to 6 hours postoperatively.
Vocal cord papillomas are rare growths of viral etiology caused by human papillomavirus (HPV). Large polyps are known to obstruct glottic opening and can cause acute airway obstruction. We report a case of 4-year-old male child with progressive hoarseness of voice and stridor posted for excision of vocal cord papillomas. Paediatric age of the patient and the position of the growth obstructing the glottic opening at vocal cords provided an extremely challenging environment for induction of anaesthesia.
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