Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: a randomized study

The present study was designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. One hundred American Society of Anesthesiologists [ASA] physical status I/II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 50 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 1 microg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 microg/kg/h till the end of surgery, whereas patients in group C received an equivalent quantity of normal saline. The time taken for regression of motor blockade to modified Bromage scale 0 was significantly prolonged in group D [220.7 +/- 16.5 min] compared to group C [131 +/- 10.5 min] [P < 0.001]. The level of sensory block was higher in group D [T 6.88 +/- 1.1] than group C [T 7.66 +/- 0.8] [P < 0.001]. The duration for two-dermatomal regression of sensory blockade [137.4 +/- 10.9 min vs. 102.8 +/- 14.8 min] and the duration of sensory block [269.8 +/- 20.7 min vs. 169.2 +/- 12.1 min] were significantly prolonged in group D compared to group C [P < 0.001]. Intraoperative Ramsay sedation scores were higher in group D [4.4 +/- 0.7] compared to group C [2 +/- 0.1] [P < 0.001]. Higher proportion of patients in group D had bradycardia [33% vs. 4%] [P < 0.001], as compared to group C. The 24-h mean analgesic requirement was less and the time to first request for postoperative analgesic was prolonged in group D than in group C [P < 0.001]. Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia.

Exostosis: A donor site for autograft.

This article reports the utilization of exostosis as a source of autogenous bone for the treatment of osseous defects. A patient presented with an exostosis on the mandibular lingual region on the right side of the jaw. Exostosis was surgically removed using a chisel and mallet. The autograft thus obtained was used to treat a shallow osseous crater between 46 and 47. New bone formation was noticed at the grafted site 6 months after grafting. Bone formed in the grafted areas showed comparable clinical features to those of native bone.

Efficacy of a 3-day artesunate-mefloquine combination in the treatment of uncomplicated falciparum malaria in Kanchanaburi province of Thailand

Background: In Kanchanaburi province located on the Thai-Myanmar border, Plasmodium falciparum parasites have developed significant resistance to commonly-used anti-malarials. For use against falciparum malaria, 2-day artesunate-mefloquine combination (MAS2) has recently been replaced by a 3-day artesunate-mefloquine combination (MAS3) that is an artemisinin-based combination therapy regimen recommended by the WHO. Objective: Investigate the efficacy and safety of MAS3 in the treatment of uncomplicated falciparum malaria in patients of Kanchaburi province. Methods: The study was conducted at Bongtee sub-district, Sai Yok district, Kanchanaburi province between June and November 2009. Fifty-one uncomplicated falciparum malaria patients were enrolled. Inclusion, exclusion and study method followed the WHO protocol for assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Patients received a MAS3 and were followed for 42 days. Results: All patients clinically recovered, but four patients were again parasitaemic on day 21, (1 patient) 28 (2 patients) and 42 (1 patient), respectively. Molecular analyses suggested that all recurrences were caused by recrudescence. There were no severe adverse events, but complaints of headache, gastrointestinal upset, nausea, and vomiting. Delay in parasite clearance was found. Proportion of parasite clearance on day 1, 2, 3 and 7 were 17.7%, 62.7%, 80.4%, and 100%, respectively. Conclusion: MAS3 is comparable to MAS2, and meet the WHO efficacy criteria for use against falciparum malaria, but the effect on parasite clearance was inferior to that of MAS2. Close monitoring evaluation is required.

Carcinoid of ampulla of Vater.

Carcinoid tumors of ampulla are rare clinical entities. They form 0.35% of all the gastrointestinal carcinoids. So far, only 109 cases have been reported in the literature, mostly as individual case reports. Since the metastatic potential and the tumor size have no correlation, unlike in duodenal carcinoids, pancreatoduodenectomy is considered the treatment of choice. Here we present a case of carcinoid of ampulla presenting to our department.