Dexmedetomidine decreases the requirement of ketamine and propofol during burns debridement and dressings.

BACKGROUND AND AIMS: Dexmedetomidine (Dex), a highly selective α2-adrenoreceptor agonist, is used for sedation management in various clinical settings and shows anaesthetic-sparing effect. Our aim was to study the effects of Dex on requirements of propofol, ketamine, and intraoperative haemodynamic variations during burns debridement and dressing changes, and compare its effectiveness and safety with combination of ketamine and propofol. METHODS: Sixty adult patients posted for elective debridement and dressing were included in the study. Thirty patients received Dex (intramuscular)(IM) 1 µg/kg, 1 h before shifting to the operation theatre while the other thirty did not. Anaesthesia was induced with propofol and ketamine followed by adjusted infusion to achieve a Ramsay Sedation Scale score (RSS) of six in all patients. Intraoperatively haemodynamic parameters were recorded at regular intervals of 5, 15, 30, 45, and 60 min. The mean data between the groups were compared by unpaired t test and medians by Mann-Whitney U test. Within group analysis was performed by using repeated measures ANOVA. P < 0.05 was considered significant. RESULTS: The dose requirement of ketamine and propofol in Dex group was significantly lower when compared to control group (100.5 ± 17.58 mg vs. 231.5 ± 60.39 mg (P < 0.0001) and 127.7 ± 15.47 mg vs. 254 ± 59.22 mg (P < 0.0001) respectively). Additionally, recovery time was lower in the Dex group as compared to the control group, 9.57 ± 1.50 min vs. 11.53 ± 2.56 min (P = 0.0006). Haemodynamic variations were also significantly lower in the Dex group as compared to the control group. CONCLUSION: Dexmedetomidine (1 µg/kg IM) reduced the requirement of propofol and ketamine, with more stable intraoperative haemodynamics.

Parenteral nutrition: Revisited.

The prevalence of malnutrition among critically ill patients, especially those with a protracted clinical course, has remained largely unchanged over the last two decades. The metabolic response to stress, injury, surgery, or inflammation cannot be accurately predicted and these metabolic alterations may change during the course of illness. Both underfeeding and overfeeding are common in intensive care units (ICU), resulting in large energy and other nutritional imbalances. Systematic research and clinical trials on various aspects of nutritional support in the ICU are limited and make it challenging to compile evidence-based practice guidelines.