Airway management in a patient with a large mass in scapular region: a case report

Airway management is one of the most important routine tasks performed by an anesthesiologist. Adept airway management is an essential skill for an anesthesiologist. Although practice guidelines and algorithms may help in such situations, but vigilance and a timely decision remain all important in such a situation. We encountered a patient with a rapidly enlarging subscapular mass due to which maintenance of supine position on the operating table for laryngoscopy and intubation was almost impossible. We had little options for airway management during general anesthesia in this patient. We present our method of successful management in this case and reiterate the role of different methods of correct positioning and intubation in such circumstances

comparative study of the effect of parentral and oral glutamine on biochemical parameters and on the duration of ICU stay in critically ill patients

To study the comparative effects of parenteral and oral glutamine therapy on biochemical parameters and reduction in the hospital stay of critically ill patients. Randomized controlled trial. 120 critically ill patients aged 16-60 years admitted to Trauma Ventilatory Unit, Trauma centre King George Medical University, Lucknow. The patients were randomly divided into 3 equal groups, 40 in each group: Group A [control group] received no glutamine; Group B received oral glutamine 20 g/d for 5 days and Group C received l-alanyl-l-glutamine dipeptide 0.3 g/kg/d by intravenous infusion for 5 days. Complete blood count was done at regular intervals of 24 hours. Total proteins and serum albumin were recorded at 5 day intervals. Single blinding was done. The total leukocyte counts [TLC] levels in all the three groups increased after the treatment and the observed increase was least evident in Group C [18.7%], followed by Group B [32.5%] and it was the highest in Group A [38.2%]. A similar observation was made for CRP and lymphocyte levels in all of the three groups. However, a significant decrease was found in total protein and albumin levels. The mean duration of hospital stay of Group C was the least followed by Group B and Group A. Parenteral glutamine in a dose of 0.3 g/kg/d was more efficacious than 20 g/d oral glutamine in increasing/decreasing in the biochemical parameters after the therapy. The duration of hospital stay was similar in all the groups after treatment

Japanese encephalitis

We present a case of Japanese encephalopathy, which posed serious problems during diagnosis as well management. Our patient had to be nursed in ICU and mechanically ventilated for a prolonged period [more than 50 days] and was successfully weaned, but with difficulty and with sustained and careful monitoring and flexible planning. A multispecialty approach made all the difference between life and death