Comparison of two different doses of dexmedetomidine added to ropivacaine in patients posted for upper limb surgery under supraclavicular brachial plexus block

Objective: To compare the effect of adding two different doses of dexmedetomidine to ropivacaine, on onset and duration of analgesia for supraclavicular brachial plexus block in patients scheduled for upper limb orthopedic surgery

Methodology: This prospective randomized double blind comparative study was conducted at our institution. After ethical committee approval and informed patient consents, 50 patients of ASA I, II and aged 21-60 years, who were scheduled for elective upper limb surgery and were enrolled in the study and randomly divided into two equal groups. They received either 30 ml of 0.75% ropivacaine plus dexmedetomidine [1 micro g/kg] diluted with normal saline up to 5 ml [total volume = 35 ml] in Group 1 or 30 ml of 0.75% ropivacaine plus dexmedetomidine [2 micro g/kg] diluted with normal saline up to 5 ml [total volume = 35 ml] in Group 2. The onset and duration of sensory and motor block, duration of analgesia, hemodynamic parameters, sedation score, VAS and side effects were recorded

Results: Onset time of sensory and motor block were earlier in Group 2 than in Group 1 [p < 0.001]. Duration of sensory and motor block and duration of analgesia were longer in Group 2 than in Group 1 [p < 0.001]. There was no significant difference in the incidence of hypotension and bradycardia between both the groups [p > 0.05]. There was a statistically significant reduction in number of rescue analgesic doses and total dose consumption in 24 hours in Group 2 than in Group 1. Quantitative data are represented as arithmetic mean and standard deviation and analyzed using Student's t test or ANOVA as per need. Qualitative data are represented as number [proportion or percentage] and analyzed using Chi square test. The levels of significance and alpha-error were kept 95% and 5% respectively for all statistical analyses. P values < 0.05 were considered significant

Cardiac arrest after simultaneous release of bilateral tourniquets in lower limb orthopaedic surgery: a case report

Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity [bilateral fracture tibia]. Bilateral mid-thigh tourniquets [Esmarch bandage] were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation [CPCR] was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time [<2 hours] and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided

Comparison of clonidine versus midazolam in monitored anesthesia care during ENT surgery: a prospective, double blind, randomized clinical study

Monitored anaesthesia care [MAC] typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs which is a common practice during various ENT surgical procedures. To compare the effectiveness and safety profile of clonidine against midazolam as an intravenously administered agent for MAC. Settings and design: Randomized, double blind, prospective study. Sixty patients undergoing ENT surgery under MAC were divided into two groups of 30 patients each. The patients in Group C received clonidine 2 mcg/kg IV and in Group M received midazolam 20 mcg/kg IV over 10 min. Ramsay sedation score, requirement of intraoperative rescue sedation [propofol] and analgesic [diclofenac infusion], postoperative visual analogue score and analgesic requirement [tramadol], adverse effects, recovery profile [Aldrete Score] and satisfaction scores of patients and surgeon were recorded. Data were analysed by chi-square, student t test and analysis of variance using Epi info 6 with p value <0.05 as significant. Mean Ramsay sedation score [RSS] was significantly more in Group M [2.50 +/- 0.73] as compared to Group C [1.80 +/- 0.85], p = 0.001. Intraoperative rescue sedation with propofol infusion [if RSS<3] was required by significantly higher number of patients in Group C [n=19, 63.4%] than in Group M [n=6, 20%], P=0.001. Intraoperative rescue analgesic requirement was significantly more in Group M [n =21, 70%] as compared to Group C [n=11, 36.6%], p=0.009. Intraoperative bleeding score was significantly less in Group C [1.93 +/- 0.80] than in group M [2.43 +/- 0.73], P=0.014. Postoperative VAS score was also significantly less in Group C than in Group M [2.28 +/- 1.9 vs. 3.28 +/- 1.81, P=0.041]. Both patients and surgeon were more satisfied in Group C than in Group M [p=0.010 and 0.019 respectively]. All patients had Aldrete score of 10 at the end of surgery in both groups. We conclude that clonidine along with rescue sedation using propofol infusion can be a better alternative to midazolam in MAC since it provides a calm patient with better intraoperative and postoperative analgesia, and a bloodless surgical field leading to increased satisfaction of both patient and surgeon

Acute massive pulmonary edema and myocardial infarction after intranasal infiltration of adrenaline during septorhinoplasty

We present a case report of 13 years old male child undergoing septorhinoplasty under general anesthesia, who developed acute massive pulmonary edema following intranasal infiltration of 330 micrograms of inj. adrenaline by the ENT surgeon. Echocardiography showed local wall hypokinesia with ejection fraction [EF] reduced to 20% and raised troponin-T levels [10 times of normal] suggesting it was adrenaline induced acute myocardial infarction and subsequent cardiogenic pulmonary edema. The surgery was postponed and the patient was successfully treated in ICU with positive pressure ventilation, frusemide and ionotropic support. His EF returned to 50% at 5hr and to 70% at 10 hr; and he was extubated after 14 hours and discharged after 5 days

Medical ablation of endobronchial mucormycosis with Amphotericin-B.

A 56 years male diabetic patient presented with recurrent left upper lobe pneumonia. Fiberoptic bronchoscopy revealed extraluminal compression of left main bronchus with an endobronchial mass obstructing the left upper lobe orifice. The lesion resembled bronchial adenoma. However histological examination revealed mucormycosis. Timely diagnosis followed by medical intervention with intravenous Amphotericin B, coupled with proper management of diabetes, ablated the tumor. Relevant literature on the subject is reviewed.