ABSTRACT
Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. MethodsThe children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. ResultsGroup B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. ConclusionsAddition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.
ABSTRACT
Development of antimicrobial resistance (AMR) to different generations of common antibiotics by various organisms is rising alarmingly. A nationwide standard antibiotic policy is needed. We wanted to study the resistant organisms, the drug class to which organisms are becoming resistant and identify factors favoring the development of AMR for formulating an effective antibiotic policy. MethodsWe conducted this observational study from January 2018 to May 2019 in a tertiary care hospital in India. Sample (urine, blood from ICU patients) processing, organism identification and antibiotic susceptibility tests were carried out as per the institutional guidelines in the Microbiology Department from where data collection was done. ResultsOut of 500 samples, 145 (29%) showed significant growth of organisms exhibiting resistance to either single or multiple drugs. Acinetobacter spp. was the most common organism isolated with a total of 40 (27.58%), followed by Klebsiella spp. 23 (15.83%), MRSA 20 (13.79%), E. coli 15 (10.34%), Pseudomonas 12 (8.27%), Enterococci 12 (8.27%), and CoNS 7 (4.82%). Among GNB, Klebsiella and E. coli showed minimal resistance to polymyxins, fosfomycin, minocycline and tigecycline. Among Staphylococcus spp. maximum sensitivity was seen to teicoplanin, tobramycin, tigecycline and minocycline. Acinetobacter spp. showed high sensitivity to polymyxins, tobramycin, tetracycline, tigecycline and minocycline. ConclusionsAMR was highly prevalent with hospital acquired organisms, and against commonly used antibiotics. Variation of resistance and sensitivity pattern with time and local microflora necessitates periodic AMR monitoring and rotation of antibiotics is suggested to restrict further emergence of resistance. Focusing on the organisms causing UTI and BSI and their resistance pattern, helps in selecting proper antibiotic therapy and in strengthening general sepsis measures.