Fat embolism syndrome (FES) is a rare but a serious clinical catastrophe occurring after traumatic injury to long bones. Cerebral involvement in the absence of pulmonary or dermatological manifestation on initial presentation may delay the diagnosis of cerebral fat embolism (CFE). We discuss a case series of CFE which posed a challenge in diagnosis. The clinical presentations of these patients did not satisfy the commonly used clinical criteria for aiding the diagnosis of FES. Early MRI brain (DWI and T2 weighted sequences) in patients with neurological symptoms after trauma even in the absence of pulmonary and dermatological findings should be the goal.
Background: Proper position of the head and the neck is important for optimizing laryngoscopic view and for ease of endotracheal intubation.We compared two different positions, sniffing position and simple head extension during direct laryngoscopy on the basis of laryngoscopic view, intubation difficulty and sympathetic response. Methodology: One hundred twenty patients of age group 20-50 years, scheduled for elective surgeries under general anaesthesia were divided into two equal groups in a randomized fashion. In group A (n = 60), sniffing position during laryngoscopy and intubation; and in group B(n =60),simple head extension position during laryngoscopy and intubation. Laryngoscopy view, ease of intubation and hemodynamic parameters were recorded. Results: Demographic data and the different parameters for assessment of difficult airway were similar in both groups. Glottic visualization grade was superior in group A and intubation difficulty score were higher in Group B (P < 0.05), Hemodynamic parameters at different time intervals were comparable. Conclusion: Sniffing position during laryngoscopy was found to be superior to simple head extention position in respect of better glottis visualization and ease of intubation though no difference in sympathetic response to intubation was found.
Incidence of acute kidney injury (AKI) in adult trauma patients is 18% with 70% requiring renal replacement therapy. It is a challenge to treat AKI with coagulopathy since there are no defined transfusion triggers for these patients. We report a case wherein a polytrauma patient developed AKI for which he/she was dialysed and subsequently had an intracerebral bleed. There is a need to develop guidelines to transfusion triggers in AKI patients keeping vigilance on fluid overload, hyperkalemia and uraemia-induced platelet dysfunction.
Background: Fiber optic intubation has become an integral part in management of anticipated difficult airways. Various anesthetic drugs have been used to assist awake fiber optic intubation (AFOI) for producing conscious sedation to provide a calm, cooperative, and responsive patient without respiratory depression for successful awake fibre optic intubation.
Aims and Objectives: The aim of the present study was to compare the efficacy of dexmedetomidine and magnesium sulfate during awake fiber optic orotracheal intubation in patients scheduled for cervical spine surgeries.
Materials and Methods: A randomized, prospective, and comparative study design was conducted in 60 patients in JAH group of hospitals. All patients were randomly divided into two groups: Group A (n=30) patients received dexmedetomidine (1 μg/kg) and Group B (n=30) patients received magnesium sulfate (40 mg/kg) in 100 ml normal saline over 10 min. The fiber optic orotracheal intubation was performed and primary outcome was level of sedation assessed using Ramsay sedation score. Other parameters of study included cough score and intubation score to compare intubating conditions. The secondary outcomes of study included variations in hemodynamic parameters heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and SPO2 during drug infusion at 2-min interval, immediately after intubation and every 10 min after intubation till 30 min.
Results: Group A (Dexmedetomidine) had better sedation score, cough score, and intubation score with stable hemodynamic variables than Group B (Magnesium Sulphate) with statistically significant results.
Conclusion: Patients receiving dexmedetomidine had better sedation providing more optimum conditions for AFOI with stable hemodynamic parameters and lesser adverse effects during the procedure than magnesium sulfate.
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