Objective:To study the utility of Fournier's Gangrene Severity Index (FGSI) with mortality predictive value in our tertiary institutes in North India.Materials and Methods:A retrospective study of 95 cases of Fournier's Gangrene (FG), admitted from 2009 to 2011, was carried out. We analysed clinical and laboratory findings, various prognostic factors, surgical treatments and their outcomes in FG patients. FGSI was used as individual variable to estimate the severity of FG; the effects of these factors on mortality were also evaluated.Results:The overall mean age was 46.5 ± 15.6 (range 24-82) years. Anorectal and urological regions were the main sites of the infection. The most common site of infection origin was scrotum in 81.3% in group A and 41.2% in group B. One or more predisposing factors such as diabetes mellitus (DM; 55%) malignancies (4.6%), chronic renal failure (4.5%) and previous surgery (9.2%) were detected. We observed mortality in 26.5% cases (17/65). The FGSI calculated averaged 5.95 ± 365 in group A and 9.44 ± 2.56 in group B, at the time of admission (P > 0.05).Conclusion:In FG, an early diagnosis and early surgical debridement are essential. The FGSI seems to be an excellent tool for the outcome prediction.

Background:Postoperative shivering (PAS) is a common problem following general and spinal anesthesia and may lead to multiple complications. This placebo-controlled, randomized study was performed to evaluate the efficacy of Ondansetron and butorphanol premedication reduces shivering after general and spinal anaesthesia.Aims:The aim of this study to highlight the efficacy of Butorphenol and ondosteron in controlling postoperative shivering.Materials and Methods:This clinical trial included 180 patients scheduled for elective general surgery, E.N.T., Ophthamological operations, randomly divided to six groups. Three groups in which General Anaesthesia was used i.e. Group 1-ondansetron 8 mg intravenously(IV).Group 2 butorphanol 2 mg IV and Group 3 – saline 4 ml IV. And three groups where spinal Anaesthesia was used i.e. Group 4-Ondosteron 8 mg IV, Group 5 butorphanol 2 mg IV and Group 6 – saline 4 ml IV 3-5 minutes before anaesthesia. Patients were observed in terms of vital signs, side effects and shivering.Settings and Design:The type of the study was double blind randomized trial.Statistical Analysis Used:Statistical Package for Social Sciences version 13.0 statistical analysis software.Results:Postoperative shivering was observed in 15.5%, 22.2% and 60% in general anaesthesia groups I II and III respectively. The reduction of core and dermal temperature during the anaesthesia and recovery, changes in systolic and diastolic blood pressure and heart rate were similar in all three groups (i.e. Group I,II,III). In spinal anaesthesia groups, PAS occurred 10%, 13.3% and 43.3% in group IV, V, VI respectively. The reduction of core temperature is similar in all three groups of spinal anaesthesia. But heart rate and mean arterial pressure increase were significant in control saline group in post operative recovery time. No complication seen in any of the six groups.Conclusion:This study suggested that use of Butorphanol and Ondansteron both are effective in reducing the incidence of PAS after general and spinal anaesthesia.

Background: Magnesium sulphate is used during anaesthesia for its antihypertensive/ antiarrhythmic properties and attenuating the response to endotrachial intubation and as an anticonvulsant for women with eclampsia. At the motor nerve terminal, MgSO4 inhibits acetylcholine release. Thus, it enhances the effect of neuromuscular blocking agents. Aims & Objectives:To determine the effect of magnesium sulphate pre-treatment on the onset, duration and recovery of nondepolarizing muscle relaxant and to quantify the haemodynamic effects of administration of MgSO4 on the arterial blood pressure. Materials and Methods: One year old prospective, randomized, double blinded, controlled clinical study was conducted on randomly selected 45 patients of either sex, aged between 18-55 years, of grade I or II of American Society of Anaesthesiologists, undergoing elective surgery at a Medical College of eastern Uttar Pradesh. Patients were divided into three groups according to the doses of MgSO4 used for pre-treatment. Statistical evaluation was done by using student's 't' test for paired data. Results: The Mean Arterial Blood Pressure response to laryngoscopy, tracheal intubation, was almost abolished in Group A (p<0.05) followed by Group B (p<0.05) and maximum pressure response occurred in Group C where MgSO4 was not used (p<0.05). The speed of onset of neuromuscular block was accelerated by pre-treatment with MgSO4 before non-depolarizing muscle relaxants. The mean onset time was 144.3 ± 12.08 seconds (p<0.001) in Group A, 192.66 ± 19.81 second (p<0.001) in Group B and 286.33 ± 34.20 seconds in Group C. The clinical duration was prolonged in MgSO4 group as compared with control group. Mean value was 52.4 ± 8.97 minutes (p<0.001), 44.86 ± 6.59 minutes (p<0.01), and 34.2±8.05 minutes respectively in Group A, B and C. Pre-treatment with MgSO4 before non-depolarizing muscle relaxant, accelerated speed of onset of neuromuscular block, necessary for intubation of trachea. MgSO4, in the presence of non-depolarizing muscle relaxant, intensified and prolonged the neuromuscular blockade and recovery. Conclusion: Monitoring of neuromuscular function and reduction in dose of vecuronium are required when using these two drugs in combination.Cite this article as: Singh S, Malviya D, Rai S, Yadav B, Kumar S, Sharma A. Pre-treatment with Magnesium sulphate before non-depolarizing muscle relaxants: Effect on speed on onset, induction and recovery. Int

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Background Endoscopic retrograde cholangio-pancreatography (ERCP) is an invasive procedure and hence is distressing for awake patients, requiring adequate level of sedation and analgesia. Recent advancements have encouraged use of monitored anesthesia care (MAC), that allows the patient to tolerate unpleasant procedures while maintaining cardio-respiratory function. The main aim is to compare the effect of dexmedetomidine and propofol on the hemodynamics during ERCP, quality of sedation, recovery profile, and any side effects. A total of 100 patients were randomized by a computer-generated random number table into two groups of 30 patients each. The group P received continuous propofol infusion at a rate of 25-75 mcg/kg/min to achieve a Ramsay sedation scale (RSS) of 3-4 before starting the procedure. Group D received dexmedetomidine at loading dose of 1 μg/kg i.v. over 10 min followed by 0.5 μg/kg/h infusion until RSS reached 3-4. Results The present study shows significant decrease in heart rate in group D (65.27 ± 4. 3 vs.77.27 ± 9.3) with more stable blood pressure values throughout than group P. There were episodes of transient desaturation in few patients in group P while no patient showed any signs of respiratory depression or desaturation in group D. The time to achieve Ramsay sedation score (RSS) 3-4 is significantly more in group D (11.4 ± 1.37 vs. 7.93 ± 1.32) with increased tendency to use rescue drug but shows better and early recovery. Conclusion Dexmedetomidine is a better substitute to propofol for patients undergoing ERCP; however, use of adjunct may be necessary to decrease the need for rescue drug.