A Comparative Study of Haemodynamic Changes on LMA Insertion with Propofol, Etomidate and Propofol+Etomidate Admixture in Laparoscopic Cholecystectomy

The objective of current study was to compare the efficacy of three different anaesthesia induction approachesi.e. Inj propofol, Inj etomidate and admixture of Inj propofol and Inj etomidate in maintaining hemodynamicstability during induction and following Proseal LMA insertion in laparoscopic cholecystectomy. Patientswere randomly divided in to 3 groups with 90 patients each and received 2.5mg/kg of propofol(P), 0.3mg/kgof etomidate(E) and 1mg/kg of propofol+0.2mg/kg of etomidate which was mixed in a 20ml syringe. We alsostudied side-effects like PONV, myoclonus, pain on Injection, allergic reactions and thrombophlebitis. Wefound that the use of P-E admixture for induction of Proseal LMA provides hemodynamic stability as itprevents hypotension caused by propofol and also hypertension caused by etomidate when used alone. Admixturewas also associated with less incidence of other side effects like PONV, pain on Injection and myoclonus. Weconcluded that combination of propofol and etomidate for induction of anaesthesia for Proseal LMA issignificantly better than either drug used alone

Primary HIV-1 infection--a "window of opportunity" for healthcare providers.

The diagnosis of primary HIV-1 infection (PHI) is often missed and requires a high index of suspicion and a thorough knowledge of laboratory methods. We report the case of a young promiscuous male who presented with fever, rash and neurological symptoms 8 weeks after unprotected sexual exposure. Clinical and laboratory investigations showed the presence of leucopenia and thrombocytopenia with elevated transaminases, and a normal cerebrospinal fluid analysis, while CNS imaging revealed a vasculitis-like involvement of the corpus callosum. Symptoms resolved spontaneously over 3 weeks. Fourth generation ELISA with p24 antigen assay was positive with high HIV-1 RNA load while Western-Blot was negative, thus confirming the diagnosis of PHI. The patient was subsequently started on antiretroviral therapy (ART) and showed undetectable viral load after 8 weeks of therapy. We present the differential diagnoses which need to be entertained as well as the pros and cons of very early ART intervention.

Nevirapine-induced fulminant hepatitis.

Nevirapine induced hepatotoxicity is known but fatality is rare. We report a case of a young individual who developed nevirapine (NVP) induced fatal hepatitis without apparent risk factors or preceding rash. Exacerbation of underlying silent chronic liver dysfunction possibly contributed to the fatal outcome. This case stresses the need for careful evaluation, regular monitoring and prompt omission of drug on suspicion of hepatotoxicity.