SummaryClassical supraclavicular brachial plexus block was used as the sole anaesthetic technique in 200 children aged between 5 and 12 years undergoing closed reduction of arm fractures. The local anaesthetic used was lidocaine 1.5% with epinephrine. The block was graded as satisfactory if surgical manipulation could be performed without discomfort and unsatisfactory if general anaesthesia had to be given. In 182 children, the procedure was carried out under the block alone, whereas the remaining 18 patients required general anaesthesia. The mean (SD) time required for performing the block was 9.1 (3.7) min and the mean (SD) time to sensory blockade was 8.3 (2.3) min. The mean duration of analgesia was < 3.5 h. There were few complications, with no incidence of pneumothorax in any patient. The acceptability of the block by the children and the parents was 72 and 85%, respectively. The classical supraclavicular brachial plexus block was found to be acceptable, effective and with a good success rate.Keywords Anaesthetic techniques: regional; brachial plexus. Surgery: orthopaedic. Anaesthesia: paediatric. Brachial plexus block is often used to provide anaesthesia for closed reduction of fractures of the upper extremity [1]. Reports confirm that the supraclavicular approach is easy to perform [2] and provides reliable anaesthesia of the upper extremity with excellent muscular relaxation [3, 4]. However, there do not appear to be any reports of the use of classical supraclavicular block [5, 6] in children in the recent past.In our institution, which is situated in the eastern hills of Nepal, we encounter a large number of children with supracondylar fractures of the upper extremity. Most of these children sustain fractures as a result of falling from a height, usually from trees. As they are treated on a day-care basis, we designed a prospective study of the feasibility of using classical supraclavicular brachial plexus block as the sole anaesthetic technique. In this clinical study, we evaluated the acceptability, simplicity, safety and effectiveness of supraclavicular block in young children with upper extremity trauma. MethodsThis prospective study was undertaken in 200 ASA physical status I and II children aged between 5 and 12 years who were scheduled to undergo closed reduction of upper extremity fractures on a day-care basis. Approval of the hospital's ethics committee was obtained as was informed consent from each patient and his or her parents. The procedure was explained in detail to the children and their parents, who were present in the operating theatre during the insertion of the block. All blocks were performed or supervised by the authors. Patients with an open wound or with possible infection at the site of injection, those with associated multiple injuries and those requiring open procedures were not studied. The children were kept fasting for solids for 4 h and for clear liquids for 2 h and were premedicated with oral diazepam 0.2 mg.kg 21 1 h before the procedure. No other sedation was given du...

Management of airway in trauma victim with penetrating cervical/thoracic spine injury has always been a challenge to the anaesthesiologist. Stabilisation of spine during airway manipulation, to prevent any further neural damage, is of obvious concern to the anaesthesiologist. Most anaesthesiologists are not exposed to direct laryngoscopy and intubation in lateral position during their training period. Tracheal intubation in the lateral position may be unavoidable in some circumstances. Difficult airway in an uncooperative patient compounds the problem to secure airway in lateral position. We present a 46-year-old alcoholic, hypertensive, morbidly obese person who suffered a sharp instrument (screwdriver) spinal injury with anticipated difficult intubation; the case was managed successfully.

Pneumoperitoneum causes an increase in ICP. The patient position, either head up or head down as in gynecologic laparoscopic procedures, further worsens ICP. ONSD does not revert back to baseline until 5 minutes after desufflation.

Abstract. Yolk sac tumors are common in children. By virtue of being chemosensitive, they are amenable to cure by chemotherapy alone and radical surgery is often not required. Yolk sac tumors occurring in the vagina are rare and thus may not be recognized early or may be inadvertently subjected to radical surgery. The authors report a case that presented to them after radical surgery with elevated Alpha-fetoprotein level is reported. The management of this case and review of the relevant literature are discussed here.

Background:Catheter - associated urinary tract infection (CAUTI) remains a critical threat for patients in intensive care unit especially in traumatic brain injury patients with low Glasgow coma score (GCS). Almost all patients in ICU receive antibiotic either prophylactic or therapeutic based on local antibiogram of particular ICU or hospital. For prophylaxis, systemic antibiotics are used. It will be helpful to avoid systemic side effects by introducing antibiotics locally through bladder irrigation. The indwelling urinary catheter is an essential part of modern medical care.Aims and Objectives:The primary objective was to study the effect of Neomycin and Polymyxin sulphate solution for bladder wash on CAUTI in traumatic brain injury patients. The secondary objectives was to study the various organisms causing CAUTI and their antibiotic sensitivity and resistance pattern.Materials and Methods:This was a prospective randomized controlled study performed on 100 patients who met the inclusion criteria at the trauma intensive care unit of Banaras Hindu University between September and February 2016. The patients were randomized into two groups – one was the study group which received Neomycin and Polymyxin Sulphate solution bladder wash, while the other was the control group that received Normal saline bladder wash. Urine samples were collected at certain days and sent for culture and sensitivity.Results:There was significant reduction in the incidence of CAUTI in neomycin/polymyxin test group in comparison to normal saline irrigated control group. Out of 50 patients in test group 8 patients and in control group 26 patients was identified as CAUTI positive and they were statistically significant. In our study pseudomonas aeruginosa (51%) was the commonest isolated pathogen.Conclusions:Neomycin and Polymyxin Sulphate bladder wash was effective in preventing CAUTI. It can thus decrease the antibiotic usage thereby preventing the emergence of antibiotic resistance.

Airway management in patients of faciomaxillary injury is of great concern to the anesthesiologist. Bag and mask ventilation and orotracheal intubation may be difficult with these patients. Recently, a middle aged, obese female presented in the emergency department after sustaining a blast injury, with laceration of the upper chest and left submandibular region. Laceration of the submandibular region was communicating with the intraoral space and the airway was filled with blood. The airway was secured with nasotracheal intubation aided by a lightwand, after failure with the Macintosh laryngoscope. This case report highlights the importance of the lightwand in intubating a patient with a bleeding airway and when the bright light glow of the lightwand gives sufficient direction toward the glottis for successful tracheal intubation.

Background:Caudal block is a reliable regional analgesic technique for pediatric urogenital surgeries. Various adjuvants have been tried to enhance the duration of action of bupivicaine. Though clonidine is extensively used as an adjuvant in caudal anaesthesia, it can have troublesome adverse effects like bradycardia, hypotension and sedation. Lately dexamethasone has become popular as an adjuvant in paediatric caudals due to its safety profile.Aim:The aim of this study was to compare dexamethasone and clonidine coadministered with bupivicaine caudally in paediatric patients undergoing urogenital surgeries in terms of analgesia and adverse effects.Settings and Design:Prospective, double blinded randomised study.Subjects and Method:Sixty American Society of Anesthesiologists physical status I and II children, aged 1-6 years undergoing urogenital surgeries were allocated in 2 groups: Group I: 0.5 mL.kg−1 of 0.25% bupivicaine with dexamethasone 0.1 mg.kg−1 in 1 ml normal saline (NS) Group II: 0.5 mL.kg−1 of 0.25% bupivicaine with clonidine 1 μg.kg−1 diluted in 1 ml normal saline. The parameters studied included duration of analgesia, intraoperative and postoperative hemodynamics, sedation scores and incidence of adverse effects like wound dehiscence, bleeding, vomiting and respiratory depression.Statistical Analysis Used:Statistical analysis was carried out using Stata Version 10. After checking for the normality assumption, t-test for comparing means of two independent samples was used for comparing baseline continuous variables. P values <0.05 were considered significant.Results:Patients in Group II had longer duration of analgesia postoperatively. Patients in this group also had lower heart rate and more sedation scores.Conclusion:Our study shows that caudal dexamethasone is a good alternative to clonidine with more stable hemodynamics and lesser sedation scores in the immediate postoperative period. Both the drugs offer good analgesia postoperatively with the duration of analgesia more in clonidine.

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