A Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvant to Spinal Bupivacaine in Lower Abdominal and Lower Limb Surgeries- A Double Blind Randomised Study.

Spinal anaesthesia is a popular regional anaesthetic technique. Hyperbaric bupivacaine is the most common intrathecally used local anaesthetic. Use of intrathecal adjuncts with local anaesthetic helps to prolong the duration of analgesia and decreases the local anaesthetic dosage. We compared dexmedetomidine and fentanyl as adjuncts to intrathecal hyperbaric bupivacaine.METHODSA randomised double blind control study was conducted on 120 patients posted for elective lower abdominal and lower limb surgery under spinal anaesthesia in a tertiary care hospital. Group A received 2.5 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of 0.9% saline into the sub-arachnoid space. Group B received 2.5 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of dexmedetomidine (5 µg) into sub-arachnoid space. Group C received 2.5 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of fentanyl (25 µg).RESULTSThere was a statistically significant drop in HR as early as 25 minutes in the dexmedetomidine group compared to saline group (p=0.033); and at 30 minutes in fentanyl group compared to saline group (p=0.015). Significant drop in SBP was seen at 30 minutes after the centrineuraxial blockade in the dexmedetomidine group compared to saline group (p=0.012) and remained so till 180 minutes after the blockade.CONCLUSIONSThe combination of 0.5% hyperbaric bupivacaine with dexmedetomidine (5 µg) is better compared to 0.5% hyperbaric bupivacaine with fentanyl (25 µg) or 0.5% hyperbaric bupivacaine alone in providing analgesia, as the combination offers a convenient, simple, inexpensive, effective and safe means of good post-operative analgesia for lower abdominal & lower limb surgery.

Refractory hypokalemia while weaning off bypass

Hypokalemia is defined as serum potassium level less than 3.5 mEq/L. When the serum level of potassium is less than 3 mEq/L, intravenous potassium supplementation is warranted. A 23 yr old adult female with complaints of dyspnoea (NYHA II) since 6 yrs, dyspnoea (NYHA III) and paroxysmal nocturnal dyspnoea on and off since 2 months, diagnosed with severe mitral stenosis, was posted for mitral valve replacement. After the release of ACC, ECG revealed sine wave pattern, Transesophageal echocardiographic examination revealed global hypokinesia and ABG showed potassium of 2.3 mEq/L. Hypokalemia in cardiac patients can occur due to the effect of poor oral intake, increased renal loss by the secondary hyperaldosteronism in congestive heart failure, loss due to use of digoxin and diuretics like thiazide diuretics, loop diuretics etc. Hypokalemia should be avoided while weaning off cardiopulmonary support as it can lead to atrial and ventricular arrhythmias. Potassium ion is very important for the normal contractility of the heart. Hypokalemia if refractory to intravenous potassium supplementation, concomitant magnesium deficiency should be suspected and treated.

Unknown left atrial appendage mass! real-time three-dimensional transesophageal echocardiography helps in identification

Left Atrial Appendage (LAA) is the most contractile part of Left atrium. It is also the most frequent place for thrombus formation that may lead to disastrous consequences. Complete trasoesophageal echocardiography examination always includes assessing LAA but sometimes unusually placed pectinate muscle, which is a normal structure may give baffling shadow that can only be interpreted correctly by Real time 3D echocardiography.