Effect of bilateral infraorbital nerve block on intraoperative anesthetic requirements, hemodynamics, glycemic levels, and extubation in infants undergoing cheiloplasty under general anesthesia

Background@#Inappropriate use of intravenous and inhaled anesthetics may be dangerous in infants undergoing facial cleft surgeries. This study primarily aimed to compare the effect of infraorbital nerve block on sevoflurane requirement in infants undergoing cheiloplasty. Intraoperative opioid consumption, hemodynamics, blood glucose levels, extubation time, and delirium were also compared. @*Methods@#This prospective, randomized, double-blinded study was conducted in 34 infants undergoing cheiloplasty under general anesthesia. After induction, group A received bilateral infraorbital nerve block with 0.5 mL of 0.5% bupivacaine and group B 0.5 mL saline. An increase in heart rate or blood pressure > 20% was managed by increasing sevoflurane by 2–2.5%, followed by fentanyl 0.5 µg/kg bolus. The chi-square test and independent-sample t-test were used where applicable. @*Results@#Demographics, duration of surgery, and intravenous fluids used were comparable between the groups.Compared to group A, patients in group B had significantly higher consumption of fentanyl (14.2 ± 4.4 µg vs. 22.1 ± 6.2 µg) and sevoflurane (14.2 ± 4.8 mL vs. 26.8 ± 15.6 mL). Intraoperative hemodynamic parameters were significantly lower in group A, the number of times increases in hemodynamic parameters occurred, and fentanyl supplemental bolus was required remained significantly lower in group A than in group B. Intraoperative glycemic levels remained higher in group B, and the extubation time was significantly shorter in group A than in group B (4.40 ± 1.60 min vs. 9.2 ± 2.18 min). Group A had a lesser occurrence of postoperative delirium. @*Conclusion@#Supplemental infraorbital block in infants undergoing cheiloplasty under general anesthesia resulted in significantly decreased anesthetic requirements and optimal hemodynamic and glycemic levels with faster extubation and lesser delirium.

Management of Mandibular Body Fracture in an Eighteen-Month Old Child - A Case Report

@#With the advancement of the transportation system and improvement in road conditions, the number of high-velocity accidents has also increased. Almost all of these reported cases involve individuals who had travelled in vehicles without adhering to personal protection standards and with rash driving. Injuries to the facial region can be profoundly disturbing and particularly in children. Parents find it very distressing to see their child in pain with a disfigured or injured face. It is difficult to manage such crying & sometimes uncontrollable children. The most commonlyinjuredfacialbonesareNasal,Zygomaticandthe Mandible. The incidence of facial bone fracture in children is uncommon, and we present a case report of an18-month old child with a history of road traffic accident and swelling on the right side of the face. Intraoral examination shows limited mouth opening with submucosal ecchymosis in the right buccal mucosa and based on clinical and computed tomographic scan working diagnosis of fracture in the right body of the mandible was arrived. The child was treated with the circum-mandibular wiring to stabilize the mandibular fracture under general anaesthesia. After three weeks the splint was removed. The injury healed without complications in the post-operativeperiod.

Acute kidney injury in the tropics

Acute kidney injury [AKI] is one of the most challenging problems faced by clinicians in the tropics owing to its fast-changing burden. AKI in the tropics is strikingly different from that in the developed world in terms of etiology and presentation. In addition, there is a stark contrast between well-developed and poor areas in the tropics. The true epidemiological picture of AKI in the tropics is not well understood due to the late presentation of patients to tertiary centers. Infections remain the major culprit in most cases of AKI, with high mortality rates in the tropics. Human immunodeficiency virus-related AKI, related to nephrotoxicity due to antiretroviral therapy, is on the rise. Acute tubular necrosis and thrombotic micro-angiopathy are the most common mechanisms of AKI. A notable problem in the tropics is the scarcity of resources in health centers to support patients who require critical care due to AKI. This article reviews the unique and contrasting nature of AKI in the tropics and describes its management in each situation