changing world of local anesthetics

With the renewed interest in multimodal postoperative analgesia and the rapidly evolving medical specialty of interventional pain management, the concerns about the toxicity and the undesirable short duration of local anesthetic agents has lead the researchers to explore different options. These include modification of drug molecule with the discovery of new molecules, e.g. levobupivacaine, as well as drug molecule binding with liposomes. Various studies are being carried out to document comparative biophysical parameters of these drugs. This editorial compliments a similar research study by Narayanappa AB, et al, being published in this issue

Best practice eye care models.

Since the launching of Global Initiative, VISION 2020 “the Right to Sight” many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

Comparative study of oral erythromycin-ranitidine combination and metoclopramide-ranitidine combination in reducing residual gastric fluid volume and acidity in elective surgery

Prokinetic agents and H-2 receptor antagonists are commonly used to decrease the volume and increase the pH of the gastric fluid. This study was conducted to compare the effect of oral erythromycin-ranitidine combination and metoclopramide-ranitidine combination in reducing gastric fluid volume and acidity in patients undergoing elective surgery. 80 patients were divided into two groups by convenient sampling technique after meeting inclusion criteria; Group A was given oral erythromycin 250 mg-ranitidine 150 mg while group B was given oral metoclopramide 10 mg-ranitidine 150 mg two hours before surgery. Gastric fluid was aspirated with orogastric tube after induction. Volume and pH of the gastric fluid were determined. Data analysis of our study showed statistically significant reduction in mean gastric fluid aspirate volume in group A [3.4ml+2.3 vs. 7.2m1+3.1]. [P-value = 0.001 and T-value = 6.24]. There was no statistically significant difference between the two groups as far as increase in gastric pH was concerned [6.5+1.6 vs. 6.2+1.3]. [T-value = 0.925 / Two tailed P-value = 0.36]. In both the groups' gastric pH was increased from the average normal value [0.3-2.9]. Combination of erythromycin-ranitidine is more effective than metoclopramide-ranitidine in reducing the gastric aspirate fluid volume and thus in prevention of acid aspiration syndrome