Background:Lumbar spine surgeries are associated with severe postoperative pain due to the extensive handling of tissue and bone. Multimodal analgesia is the preferred choice but is associated with systemic side effects. Atomized drugs at the local surgical site may be a more attractive option than the intravenous route. In this study, we compare the atomized form of ketamine and dexmedetomidine at the surgical site for postoperative pain relief in lumbar spine surgeries. Methods:After approval from institutional ethics committee and the Clinical Trial Registry - India, 45 patients of age group between 18 and 60 years, scheduled for lumbar spine surgery under general anesthesia were divided into three equal groups: Group D: Received dexmedetomidine 1 µ/kg, Group K: Received Ketamine 1 mg/kg and Group N: Received 20 ml of normal saline. Drugs were diluted in 20 mL of normal saline and applied over the surgical site at the end of the surgery, before closure, in the form of fine droplets using an atomizer device. Our primary outcome was the postoperative analgesia measured by the Visual Analog Scale. Results:Duration of postoperative analgesia was significantly higher in the ketamine group, 240 min (interquartile range [IQR]: 120-360) than the dexmedetomidine group, 120 min (IQR: 120-240) determined by the Kruskal-Wallis test (P < 0.001). Conclusion:Atomized ketamine and dexmedetomidine at the surgical site during closure in lumbar spine fixation surgery is an attractive choice for postoperative pain relief without any systemic side effects.

BACKGROUND:Tracheostomy tube (TT) change is the common procedure in trauma Intensive Care Unit (ICU) and almost always associated with cough reflex, increase in blood pressure, and heart rate. Dexmedetomidine (DEX) is a selective α2-adrenergic receptor agonist well studied for the prevention of pressor response during laryngoscopy and extubation, but literature on prevention of pressor response during TT change is lacking. AIMS:The aim of this study is to compare two doses (0.5 and 1.0 μg/kg) of DEX for prevention of cough and pressor response during TT change in traumatic brain injury patients. SETTINGS AND DESIGN:Prospective randomized, double-blind trial. MATERIALS AND METHODS:Sixty tracheostomized traumatic brain injury patients in ICU scheduled for TT change were randomized to two equal groups: Group A to receive DEX 0.5 μg/kg and Group B to receive DEX 1.0 μg/kg. Calculated dose of studied drug was given by infusion pump over 10 min after dilution in 50 ml. Hemodynamic parameters, cough reflex, and adverse event were recorded and statistically analyzed. STATISTICAL ANALYSIS:Statistical analysis was done with nonpaired (two tailed, independent) Student's t-test for continuous data. Demographic data were compared using Pearson's χ2 test. P < 0.05 was considered to be statistically significant. RESULTS:Both doses of DEX were able to attenuate the hemodynamic response of tracheal stimulation and cough reflex. Cough reflex was better controlled with 1.0 μg/kg dose but associated with increased incidence of hypotension and bradycardia. CONCLUSIONS:We conclude that 0.5 μg/kg dose provides desired attenuation of hemodynamic response during TT change without any significant adverse events.

Objective: Intraoperative transient chest discomfort/pain is a common problem during lower segment cesarean section (LSCS), incidence ranging from 30-60 %. Only a few drugs are available to treat it due to concerns regarding maternal and fetal safety. Fentanyl is commonly used but has limited or no availability in most of India especially in rural areas. So we planned this study to compare ketamine as alternative to fentanyl to treat this chest discomfort/pain. Methodology: This prospective, randomized, double blind study was carried out on sixty patients aged above 18 years, of American Society of Anesthesiologist (ASA) grade I or II scheduled for elective LSCS under spinal anesthesia, who complained of chest discomfort/pain within 15 min of delivery of baby. The parturients were randomly divided into two groups. Group F to receive inj fentanyl 1 mu g/kg and Group K to receive inj ketamine 0.25 mg/kg intravenously immediately after complaining of chest discomfort/pain. Duration of surgery, time of onset of pain, time required to relieve pain, hemodynamic parameters, adverse event and duration of postoperative analgesia were observed. The drugs were compared by using equivalence test; Two-One-Sided-Test (TOST). Results: There was no difference in demographic profile and baseline parameter in both groups. After drug administration chest discomfort/pain was relieved in both groups effectively in 1.15 +/- 0.83 min vs. 1.23 +/- 0.48 min in Group F and Group K respectively, without any significant adverse event. Conclusion: Low dose ketamine can be used as alternative to fentanyl for transient retrosternal chest discomfort/pain during LSCS.

Subclavian artery aneurysm is usually operated under general anesthesia (GA), but in specific situations, it can also be conducted under regional anesthesia (RA) such as cervical epidural anesthesia (CEA). A 48-year-old male presented with chief complaint of progressive swelling in the right side of the neck for the past 3 months following trauma. He was diagnosed as subclavian artery aneurysm, and surgical intervention was advised. He had previous history of angina 4 months back for which tablet aspirin 75 mg and tablet clopidogrel 75 mg once daily was prescribed. Cardiological evaluation revealed of an ejection fraction of around 30% with mild left ventricular hypokinesia and grade 2 diastolic dysfunction. Due to the poor cardiac functional status of the patient, RA with CEA was planned. The risk with GA in cases with a history of myocardial ischemia is more than RA, hence, it is better to use CEA which is equally efficacious in such high-risk cases.

Blowout fractures are a common occurrence in traumatic brain injury patients. In pediatric age group, orbital floor fracture is a common occurrence. We report a case of 2-year-old male admitted to trauma center, with penetrating injury to the left eye by the clutch of motorbike which fell on the child. Noncontrast computed tomography scan revealed fracture of the roof of left orbit with left frontal contusion sparing the left eyeball. There was also the continuous leak of brain matter from the left eye which suggested tear of dura mater. Urgent left frontal craniotomy was done with the evacuation of contusion, reconstruction of orbital roof, and duroplasty under general anesthesia.

Despite the decrease in the incidence of goiter throughout the world, there are still cases reported having large thyroid masses presenting for surgery. These cases impose difficulty for definite airway management while providing anaesthesia to these patients. Recent advances in airway management and its widespread availability such as fibreoptic bronchoscope has decreased the rate of various complications.

These cases represented significant challenges in the areas of intensive care, obstetrics, and ethics.A previously healthy 30-year-old elderly primigravidae, G1P0, presented at 28 weeks’ gestation with road traffic accident. The patient was transferred by ambulance to our institution for management. On admission, the patient was afebrile with stable vital signs. The patient suffered mild head injury with GCS (Glasgow coma scale) of 13/15 with one episode of vomiting on the way to hospital.

BACKGROUND:To augment the subarachnoid block utility, the efficacy of newer molecules as an adjuvant is investigated constantly. Considering the favorable profile of dexmedetomidine, it could have a potential role as an adjuvant to ropivacaine.AIM:We evaluated the efficacy of two different doses of dexmedetomidine as an adjuvant to isobaric ropivacaine, intrathecally.METHODS:Ninety patients scheduled for lower abdominal surgery under spinal anesthesia were randomized into three groups to receive 2.5 ml of isobaric ropivacaine (0.75%, 7.5 mg/ml) added to 5 µg (10 µg/ml) or 10 µg (20 µg/ml) of dexmedetomidine or 0.5 ml of normal saline in group A, B or C, respectively. Block characteristics were compared as a primary outcome.STATISTICAL ANALYSIS:One-way analysis of variance test, Fisher's exact test/Chi-square test, whichever appropriate. A P < 0.05 was considered significant.RESULTS:Time to achieve desired block was least in group B and maximum in group C. The sensory-motor blockade remained significantly prolonged in group B compared to other groups. Hemodynamic parameters remained stable in all three groups.CONCLUSION:Among the investigated doses, dexmedetomidine augments the efficacy of intrathecal ropivacaine in a dose-dependent manner, without any untoward side effects.