Gabapentin for refractory idiopathic trigeminal neuralgia.

Trigeminal neuralgia is sudden, usually unilateral, severe, stabbing, brief recurrent pain in the distribution area of one or more of the branches of trigeminal nerve. Various pharmacological agents including carbamazepine, oxcarbazepine, phenytoin, lamotrigine, baclofen and clonazepam have been tried with variable success rate. Here a case of idiopathic trigeminal neuralgia is presented. The patient presented in the emergency room with severe pain in the distribution area of maxillary branch of trigeminal nerve, resistant to conventional pharmacotherapy, managed successfully with gabapentin without untoward side-effects.

Self-extubation in intensive care and re-intubation predictors: a retrospective study.

To find out the incidence of self-extubation in intensive care, to evaluate the factors responsible for it and to identify the predictors of need for re-intubation, a retrospective analysis was conducted among 350 patients who were admitted to the intensive care unit over a two-year period and required ventilatory therapy for more than 48 hours. In all patients who self-extubated, the demographic data, ventilatory parameters before self-extubation (mode of ventilation, inspired oxygen concentration, positive end-expiratory pressure), partial pressure of oxygen in arterial blood and inspired oxygen fraction ration (PaO2/FiO2), and the event of re-intubation were noted. These values were compared among patients who were re-intubated and those who were not. Twelve patients out of 350 self-extubated. Of these 12 patients, 7 required re-intubation while 5 did not. Of these 7 patients, 3 died within 48 hours of the episode of self-extubation and one patient's death was directly attributable to self-extubation. Of the remaining 4 patients, 3 died within a span of 7 days. Re-intubation after self-extubation should not be considered mandatory. Patients who required re-intubation had lower PaO2/FiO2 than patients who did not.