Efficacy of Dexmedetomidine Added to Ropivacaine Infilteration on Postoperative Pain following Spine Surgeries: A Randomized Controlled study.

CONTEXT: With modern lifestyle, there has been a steep increase in the number of low back pain patients in clinical practice. Lumbar microdiscectomy is one of the most common surgeries performed for this problem. Postoperative pain management is extremely important aspect of such advanced surgical technique among which wound infiltration is an efficient method. AIMS: The aim of the study was to compare the efficacy of dexmedetomidine added to ropivacaine verses plain ropivacaine following wound infiltration in terms of pain scores, requirement of rescue analgesia, and related adverse effects. SETTINGS AND DESIGN: Randomized, prospective, controlled, double-blind study over a period of 1 year in a tertiary care hospital. MATERIALS AND METHODS: Sixty patients scheduled for lumbar discectomy were randomly allocated into two groups. Group A received wound infiltration with 30 ml 0.2% ropivacaine before wound closure and Group B received wound infiltration with 1ug/kg dexmedetomidine added to 30 ml of 0.2% ropivacaine before wound closure. Data retrieved were demographic data, visual analog scores, postoperative pain scores, rescue analgesia by patient controlled analgesia pump, recovery profile, and adverse effects. STATISTICAL ANALYSIS USED: Data were analyzed using statistical software SPSS version 22. Mann-Whitney test, Kruskal-Wallis test, and Chi-square test were used as applicable. RESULTS: Demographic data were comparable between the groups. Requirement of rescue analgesia was significantly less in Group B where combination of dexmedetomidine and ropivacaine was given. CONCLUSIONS: Dexmedetomidine provided effective postoperative analgesia and reduced fentanyl consumption when administered in wound infiltration with ropivacaine.

Efficacy of premixed versus sequential administration of clonidine as an adjuvant to hyperbaric bupivacaine intrathecally in cesarean section.

BACKGROUND: Density of the drugs injected intrathecally is an important factor that influences spread in the cerebrospinal fluid. Mixing adjuvants with local anesthetics (LA) alters their density and hence their spread compared to when given sequentially in seperate syringes. AIMS: To evaluate the efficacy of intrathecal administration of hyperbaric bupivacaine (HB) and clonidine as a mixture and sequentially in terms of block characteristics, hemodynamics, neonatal outcome, and postoperative pain. SETTING AND DESIGN: Prospective randomized single blind study at a tertiary center from 2010 to 2012. MATERIALS AND METHODS: Ninety full-term parturient scheduled for elective cesarean sections were divided into three groups on the basis of technique of intrathecal drug administration. Group M received mixture of 75 µg clonidine and 10 mg HB 0.5%. Group A received 75 µg clonidine after administration of 10 mg HB 0.5% through separate syringe. Group B received 75 µg clonidine before HB 0.5% (10 mg) through separate syringe. STATISTICAL ANALYSIS USED: Observational descriptive statistics, analysis of variance with Bonferroni multiple comparison post hoc test, and Chi-square test. RESULTS: Time to achieve complete sensory and motor block was less in group A and B in which drugs were given sequentially. Duration of analgesia lasted longer in group B (474.3 ± 20.79 min) and group A (472.50 ± 22.11 min) than in group M (337 ± 18.22 min) with clinically insignificant influence on hemodynamic parameters and sedation. CONCLUSION: Sequential technique reduces time to achieve complete sensory and motor block, delays block regression, and significantly prolongs the duration of analgesia. However, it did not matter much whether clonidine was administered before or after HB.

Recovery profile and emergence delirium following sevoflurane and isoflurane anesthesia in children posted for cleft lip surgery.

UNLABELLED: This prospective, randomized, double control study was carried out in 84 children aged 2-24 months posted for elective cleft lip surgery. METHODS: Patients were randomally divided into 2 groups of 42 patients each. In Group A patients were induced and maintained on sevoflurane while in Group B patients were induced with sevoflurane and maintained on isoflurane. Standardized anesthesia technique was used. Recovery milestones and post operative complications were recorded. RESULTS: Incidence of emergence delirium in sevoflurane group was 11.9% while in isoflurane group is 2.38%. The overall incidence of emergence delirium in the study was 7.14%. There was no significant difference (p > 0.05) in the incidence of emergence delirium between the two groups. There was no effect of duration of exposure of sevoflurane and time taken for achievement of recovery milestones while we observed a positive correlation with isoflurane. In sevoflurane the recovery endpoint first reached was limb movement > spontaneous respiration > spontaneous eye opening. In isoflurane group the recovery end point first reached was spontaneous respiration > limb movement = spontaneous eye opening. CONCLUSION: Our study confirms that the recovery profile of sevoflurane in children less the two years is superior compared to isoflurane.

An observational study on the epidemiological and mycological profile of Candidemia in ICU patients.

BACKGROUND: This study aimed to analyze the epidemiological and mycological profile of candidemia in intensive care unit (ICU) patients attending a tertiary care teaching hospital in the Himalayan region of northern India. MATERIAL/METHODS: A 15-bed medico-surgical ICU and a 5-bed pediatric ICU. Ninety-one consecutively admitted ICU patients were screened for the presence of candidemia by performing blood cultures at periodic intervals. RESULTS: The recovered Candida isolates were speciated and subjected to antifungal susceptibility testing using standard procedures. Forty-one of the recruited patients (45%) were found to be candidemic, with the majority of patients being in the extremes of age (13 neonates and 15 >65 years of age). Four risk factors were found to be significantly associated with the occurrence of candidemia in our patients - a period of hospitalization exceeding 7 days (p=0.0008), previous use of antibiotics (p=0.001), presence of chronic renal failure (p=0.003), and ongoing cancer chemotherapy (p= 0.041). Ninety-six Candida isolates were recovered from the 41 culture-positive patients, with Candida albicans being the commonest isolate recovered (n=75, 78.1%), followed by Candida tropicalis (n=15, 16%), and Candida glabrata (n=6, 6.5%). Fluconazole resistance was observed among 26% of all Candida isolates and 17.3% of C. albicans isolates. CONCLUSIONS: Contrary to the majority of recent reports, species shift towards non-albicans candidemia has not been observed in our center, though the prevalence of azole resistance is alarmingly high even among the C. albicans isolates.