A study on mean anion gap over 6 hours after admission as a predictor of pediatric mortality in pediatric intensive care unit

Background:The aims of the study was to correlate change in anion gap at 0 and 6 hours of admission with mortality in pediatric intensive care unit (PICU).Methods:Fifty children up to 12 years of age, admitted in PICU were included in the study. Blood gas anion gap levels were taken at 0 and 6 hours of admission and change in anion gap was calculated. Final outcome was recorded.Results:Out of 50 patients enrolled in the study, 18 (36%) patients died and 32 (64%) survived. Mortality was higher in group with increased anion gap after 6 hours of admission as compared to survived. Change in anion gap was higher in expired patient as compared to survivors.Conclusions:Mortality was higher in group with increased anion gap after 6 hours of admission

Dexamethasone As Adjuvant To Intratheacal Bupivacaine

Spinal Analgesia is most preferred technique of regional analgesia for surgeries below umbilical region. The most commonly used drug is Bupivacaine heavy for the procedures lasting for 90 to 120 minutes. Sometimes procedures last longer requiring supplementation of anaesthesia or sedation. Various additives have been tried for prolongation of analgesia duration like Epinepherine, clonidine and opiods. Opiods can prove risky in elderly patients. Corticosteroids have shown positive effect on quality of sensory blocks and post operative analgesia on peripheral nerves. The purpose of this study was to evaluate the effect of Dexamethasone as adjuvant to intrathecal Bupivacaine, on onset time and duration of spinal analgesia. Material and Method: Sixty patients between 18 to 65 years of age belonging to ASA group I and II were studied. Patients were divided into two groups of 30 patients each. Study group received intrathecal 15 mg (3 ml) of 0.5% hyperbaric Bupivacaine heavy and 8 mg (2.0ml) of preservative free Dexamethasone(Total 5.0 ml solution) and control group received intrathecal 15 mg (3 ml) of 0.5% hyperbaric Bupivacaine heavy with 2.0 ml normal saline (Total 5.0 ml solution). Highest level of sensory block was noted and marked. It was evaluated every 5 minutes till 4 sensory segment level regression from highest level. Onset time and duration of sensory block were noted. Patients were monitored in post operative period for any symptoms. Conclusion: Addition of Dexamethasone with Bupivacaine has shown prolongation of duration of sensory block and decreased the requirement of analgesics in postoperative management