Introduction: Preoperative anxiety may cause hemodynamic problems in the intraoperative period, increased analgesic need, and lower postoperative satisfaction of the patients. Melatonin has anxiolytic, sedative and potential analgesic effects when used as premedication before surgery. After institutional ethical committee clearance and patient Materials and methods: s informed written consent, 100 ASA 1 and 2 patients aged between 18 to 65 years posted for laparoscopic surgeries under GA were randomized into M and P groups with 50 in each. All patients received either 6mg oral melatonin dissolved in 3ml distilled water in melatonin group or 3ml distilled water in placebo group one hour before surgery. APAIS anxiety scale was measured before and one hour after premedication. Post operatively RSS scale for sedation and NRS scale for pain were measured at 30 min, 60 min, 90min, 120min in post anaesthetic care unit. The time of rst rescue analgesia was noted. APAIS anxiety Results: scores determined prior to administration of medications showed non-signicant differences between the groups (11.9 SD 1.3 in melatonin group, 11.8 SD 1.6 in placebo/control group). APAIS anxiety scores determined at one hour after receiving the study medication were decreased more signicantly in melatonin group than in control group with p value of 0.0005 (3.5 SD 1.1 in melatonin group, 7.5 SD 1.2 in placebo/control group). Postoperatively RSS scores showed better sedation in Melatonin group than in Placebo group. Pain scores were less in melatonin group than in placebo group. The time for rst request of rescue analgesia was delayed in melatonin group than in placebo. Preoperative oral Conclusion: melatonin 6mg reduces preoperative anxiety, postoperative pain and analgesia requirement.
Blunt trauma to the abdomen can cause damage to vital organs like spleen, liver, kidney and intestines and is associated with high morbidity. Hereby we are presenting a case of Grade 5 Renal Injury(shattered kidney) following blunt injury abdomen. A 21 year old male presented to our Emergency Room with history of RTA. He revealed history of severe abdominal pain. He presented with severe tachycardia (HR−140⁄minute),blood pressure and saturation were normal and GCS was 15⁄15. His CECT abdomen revealed shattered left kidney with subcapsular and perinephric collection with renal vascular injury. His hemoglobin was found to be 5.7g/dl, rest of the blood investigations were within normal limits. He was shifted to OT immediately and was proceeded with open nephrectomy. Post induction he devoloped severe hypotension and was started on iv crystalloids and colloids and minimal Nor adrenaline support. Intraoperatively 4 units of PRBC and 3 units of FFP were transfused. Around 1 litre of blood, bladder clots and a concealed hematoma in messentry were evacuated. Post transfusion ABG revealed metabolic acidosis. He was shifted to ICU with the ET Tube. He made an uneventful recovery in ICU and was extubated.Physiologically, hemodynamic compensatory mechanisms maintain vital organ perfusion till about 30% TBV loss, beyond which there is a risk of critical hypoperfusion. Massive blood loss is best managed by following the massive transfusion protocol (MTP).
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