Efficacy of intravenous dexmedetomidine-lignocaine infusion compared to morphine for intraoperative haemodynamic stability in modified radical mastectomy: A randomised controlled trial.

Background and Aims: In recent times, non-opioid analgesic-based anaesthesia has been gaining popularity as it can achieve the goals of hypnosis, amnesia, and haemodynamic stability while avoiding opioid side effects. Our study compares the efficacy of opioid-free anaesthesia and opioid-based general anaesthesia regarding intraoperative haemodynamic stability, anaesthetic requirements, awareness, and recovery profile. Methods: After receiving ethical approval and registering the trial, we conducted this randomised, single-blinded study on American Society of Anesthesiologists (ASA) physical status I and II patients who were aged 18-65 and were scheduled for modified radical mastectomy under general anaesthesia. Patients were randomised into two groups of 60 each. Group DL received IV dexmedetomidine 1 µg/kg loading over 10 min, 10 min before induction and 0.5 µg/kg/h infusion after that along with IV lignocaine 1.5 mg/kg at bolus followed by 1.5 mg/kg/h infusion. Group MN received IV morphine 0.15 mg/kg. Standard monitoring and general anaesthesia protocol were followed. Intraoperative haemodynamics, anaesthetic requirement, extubation time, and recovery profile were monitored. Data were analysed using Stata version 14 software, and statistical tests (Chi-squared test for qualitative variables, unpaired t-test and Mann-Whitney U test for quantitative variables) were performed. Results: Both groups had comparable haemodynamic stability (P > 0.05). Group DL had a significantly lower propofol requirement for induction and maintenance (P < 0.001). Ramsay sedation score (P = 0.002) and extubation time (P = 0.029) were significantly higher in Group MN. The recovery profile was favourable in Group DL, with there being lower postoperative complications. Conclusion: Dexmedetomidine and lignocaine IV infusion demonstrated stable intraoperative haemodynamic stability, lower anaesthetic requirement, and better recovery profile than morphine without significant complications.

Outcomes of Infants with Prenatally Diagnosed Congenital Heart Disease Delivered in a Tertiary-care Pediatric Cardiac Facility.

OBJECTIVE: To report short-term outcomes of infants with prenatally diagnosed Congenital Heart Disease (CHD) delivered in a tertiary-care cardiac facility. DESIGN: Retrospective study. SETTING: Tertiary-care referral hospital. PARTICIPANTS: Children with prenatally diagnosed CHDs who underwent delivery at study centre during the period January 2008 - December 2013 were included. Outcomes tracked from hospital records and direct follow-up. RESULTS: Of the 552 fetuses diagnosed to have CHD, 121 (22%) were delivered at the study centre. Fetuses undergoing a planned delivery were diagnosed in late gestation (mean gestational age 31.5 ± 5.1 wk). 74 fetuses (61.2%) had simple CHD and rest were complex. 96 (79.3%) neonates received cardiac care; 30 (24.8%) required surgery while 5 received catheter-based interventions. 11 patients underwent surgery on follow-up. Neonatal survival in cardiac care group was 93.8%; on follow-up (12.5 ± 13.1 mo); 83 (86.4%) of these infants were alive. All infants undergoing neonatal surgery or catheter-based interventions survived. 25 patients (20.6%) received comfort care (Complex CHD, associated co-morbidities); 14 (56%) survived neonatal period and 6 (24%) were alive on follow-up. CONCLUSIONS: Infants with prenatal diagnosis of CHD and planned delivery in a cardiac facility had satisfactory immediate outcomes, expecially in those receiving specialized post-natal cardiac care.

Correlation of EEG, CT, and MRI Brain with Neurological Outcome at 12 Months in Term Newborns with Hypoxic Ischemic Encephalopathy.

OBJECTIVE: To correlate electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI) brain with neurological outcome at 12 months in term neonates with hypoxic ischemic encephalopathy. DESIGN: Prospective observational study. SETTING: Neonatal intensive care unit (NICU) in a tertiary care teaching hospital. MATERIALS AND METHODS: The study was conducted between June 2010 and November 2011. Consecutive term neonates with perinatal asphyxia and hypoxic ischemic encephalopathy were the subjects. All babies were managed as per standard protocol. EEG was done as soon as the baby was stable and CT brain within 7 days. MRI was done at 3 months. Neurodevelpmental assessment was done at 12 months. RESULTS: Of the 31 babies, four died and one was lost to follow-up. Neurodevelopmental at 12 months of age was normal in 15 babies. EEG was normal in six babies and all of them had a normal neurodevelopment. Thirteen of the 14 babies with burst suppression pattern were abnormal (P<0.001). CT brain was normal in 14 and all of them had normal neurodevelopment (P<0.001), while 11 of the 12 with cerebral edema had abnormal outcome (P<0.001). Of the 16 babies with normal MRI, 14 were normal, while all six babies with abnormal signals in the cortex and thalamus had abnormal outcome (P=0.002). CONCLUSIONS: A normal EEG and CT brain in a term newborn with hypoxic ischemic encephalopathy (HIE) is associated with good neurological outcome. Burst suppression pattern in EEG, bleeds, or hypodensities in the CT and involvement of basal ganglia/thalamus in the MRI are predictors of abnormal outcome.