Comparison of Cardiopulmonary Parameters with and without Midazolam Premedication during Propofol Sedation in Regional Anaesthesia

Regional anaesthesia is a commonly used technique in orthopedic procedures. Sedation during regional anaesthesia reduces patients anxiety, increases patient comfort with improvement in operating conditions during surgery. The present study compared the cardiopulmonary parameters amongst subjects during regional anaesthesia with propofol sedation with or without midazolam premedication and effect of midazolam premedication on propofol requirement. Methods: A total of forty, ASA grade I- III patients aged 25 to 65 years who were scheduled for total hip or knee replacement surgery under combined spinal epidural were included in this study. Patients in group I (n= 20) were started on propofol infusion alone for sedation after giving regional anaesthesia and group II (n=20) patients were given Inj Midazolam 2 mg im 30 min before arrival in OT given regional anesthesia and then started on propofol infusion. This was followed by monitoring of blood pressure, pulse rate and oxygen saturation. All the data thus obtained was arranged in a tabulated form and analysed using SPSS software. Mean of all values was recorded. Results: In group I, the pulse rate preoperatively was 83.4±10.6 and in Group II it was 79.1±11.1. At 15 mins, the pulse rate in Group I and Group II was 64.4±10.0 and 85.9±12.9 respectively. In group I, the oxygen saturation preoperatively was 98.6±0.66 and in Group II it was 98.8±0.65. At 15 mins, the oxygen saturation in Group I and Group II was 99.7±0.45 and 99.6±0.47 respectively. At 60 mins, the blood pressure in Group I and Group II was 96.4±5.9 and 94.2±3.8 respectively. Conclusion: There was no significant difference in the hemodynamic parameters amongst both the groups. Therefore, midazolam can be safely used with propofol. The dose of propofol needed for sedation is also reduced.

Candida tropicalis: insight into the characteristics and outcome of adult patients admitted in medical and surgical intensive care units

Background: Non albicans species are emerging increasingly as significant ICU pathogens.  The increasing incidence of C. tropicalis infections is a significant problem because of its ability to develop rapid resistance to fluconazole.Methods: The study was designed to isolate, evaluate the risk factors and outcome of C. tropicalis infection from intensive care units. Identification was done by the biochemical methods. A total of 89 patients culture positive for C. tropicalis were selected for retrospective analysis over a period of one year. We collected various data about risk factors and outcome from the medical records.Results: A total of 89 patients culture positive for Candida tropicalis were analysed. Majority of these culture isolates were obtained from their blood (59.55%) followed by urine samples (31.46%). The indwelling devices (93.2%) remained a highest risk followed by prolonged administration of antibiotic therapy (92.1%) and admission in ICU for more than a week (88.8%). Overall mortality rate was 31.5%. Mortality was higher in patients with longer total length of stay in hospital (89.3%; p 1.000), indwelling devices (85.7%; p 0.5663) and in whom the antimicrobial therapy was administered for prolonged duration (82.1%; p 0.7581), although these factors remained statistically insignificant. 92.1% of isolates were sensitive to amphotericin B and showed 52.8%; 9.0% sensitivity to itraconazole and fluconazole respectively.Conclusions: C. tropicalis is now classified as the third or fourth NAC species being commonly isolated from clinical samples and associated with persistent systemic infections leading to a longer stay in the hospital. Several virulence factors seem to be responsible for high dissemination and mortality.

Pattern of Ocular Morbidity among Children Referred Through a National Screening Program in a Tertiary Hospital in Northern India.

Background: The Rashtriya Bal Swasthya Karyakram (India) is directed towards achieving universal health coverage among children by early detection of diseases. Under the scheme, children are screened at the level of schools and community and are thereafter referred to tertiary centre. The purpose of study was to identify common causes of ocular morbidity in children screened and referred through this national screening program. Methods: Retrospective analysis of records of all children who presented to our centre with ocular problems over a period of one year (2015) was undertaken. Clinical diagnosis was recorded on a seven point scale based on major anatomical involvement. An analysis of causes of visual impairment was undertaken with a special emphasis on avoidable and treatable causes. Results: A total of 851 subjects presented with ocular problems (mean age 9.5±4.9 years); of them 819 were classified into seven major clinical groups and subgroups. Most common clinical group was that of strabismus (59.9%), followed by refractive errors (16.9%), lids related disorders (6.2%), orbit and adnexal developmental defects (4.6%), lenticular (3.3%), corneal and conjunctival (3.2%) and retinal disorders (2.1%). A total of 49.7% cases had avoidable or treatable causes of visual impairment. Conclusion: A national program with capacity to screen and ensure appropriate referral facilities resulted in intervention in many cases with avoidable and treatable causes of visual impairment. A varied pattern of ocular morbidity was found among the referred cases; our study could provide a platform for a target oriented approach towards planning and implementation of such screening programs.