Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery: A randomized, double-blind study.

OBJECTIVES: The purpose of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in postcardiac surgery patients. SETTINGS AND DESIGN: A prospective, randomized, double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass. INTERVENTIONS: Sixty-four patients who underwent elective cardiac surgery under general anesthesia were shifted to intensive care unit (ICU) and randomly divided into two groups. Group A (n = 32) received a 12 h infusion of normal saline and group B (n = 32) received a 12 h infusion of dexmedetomidine 0.4 µg/kg/h. Postoperative pain was managed with bolus intravenous fentanyl. Total fentanyl consumption, hemodynamic monitoring, Visual Analogue Scale (VAS) pain ratings, Ramsay Sedation Scale were charted every 6(th) hourly for 24 h postoperatively and followed-up till recovery from ICU. Student's t-test, Chi-square/Fisher's exact test has been used to find the significance of study parameters between the groups. RESULTS: Dexmedetomidine treated patients had significantly less VAS score at each level (P < 0.001). Total fentanyl consumption in dexmedetomidine group was 128.13 ± 35.78 µg versus 201.56 ± 36.99 µg in saline group (P < 0.001). A statistically significant but clinically unimportant sedation was noted at 6 and 12 h (P < 0.001, and P = 0.046 respectively). Incidence of delirium was less in dexmedetomidine group (P = 0.086+). Hemodynamic parameters were statistically insignificant. CONCLUSIONS: Dexmedetomidine infusion even without loading dose provides safe, effective adjunct analgesia, reduces narcotic consumption, and showed a reduced trend of delirium incidence without undesirable hemodynamic effects in the cardiac surgery patients.

Perioperative management of patient with Bombay blood group undergoing mitral valve replacement.

Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets. Autologous blood transfusion was carried out. The mitral valve was replaced with a prosthetic valve successfully. After weaning off from cardiopulmonary bypass, heparinisation was corrected with protamine. Post-operatively, the patient received autologous red blood cells. The patient recovered after 1-day of inotropic support with adrenaline and milrinone, and diuretics and was discharged on the 5(th) post-operative day.

1-[Bis(4-fluoro-phen-yl)meth-yl]-4-[(2Z)-3-phenyl-prop-2-en-1-yl]piperazine-1,4-diium dichloride hemihydrate.

The asymmetric unit of the title monohydrated salt, 2C26H28F2N2 (2+)·4Cl(-.)H2O, consists of a 1-[bis-(4-fluoro-phen-yl)meth-yl]-4-[(2Z)-3-phenyl-prop-2-en-1-yl]piperazine-1,4-diium cation with a diprotonated piperizine ring in close proximity to two chloride anions and a single water mol-ecule that lies on a twofold rotation axis. In the cation, the piperazine ring adopts a slightly distorted chair conformation. The dihedral angles between the phenyl ring and the 4-fluoro-phenyl rings are 89.3 (9) and 35.0 (5)°. The two fluoro-phenyl rings are inclined at 65.0 (5)° to one another. In the crystal, N-H⋯Cl hydrogen bonds and weak C-H⋯Cl inter-molecular inter-actions link the mol-ecules into chains along [010]. In addition, weak C-H⋯O inter-actions between the piperizine and prop-2-en-1-yl groups with the water mol-ecule, along with weak C-H⋯Cl inter-actions between the prop-2en-1-yl and methyl groups with the chloride ions, weak C-H⋯F inter-actions between the two fluoro-phenyl groups and weak O-H⋯Cl inter-actions between the water mol-ecule and chloride ions form a three-dimensional supra-molecular network.

(Z)-1-Di-phenyl-methyl-4-(3-phenyl-prop-2-en-yl)piperazine.

In the title compound, C26H28N2, the piperazine group adopts a chair conformation with the exocyclic N-C bonds in equatorial orientations. The dihedral angle between the geminal benzene rings is 80.46 (12)° and the C=C-C-N torsion angle is 145.9 (2)°. In the crystal, weak C-H⋯π inter-actions link the mol-ecules into [100] chains.

Evaluation of efficacy of different gingival displacement materials on gingival sulcus width.

AIM: The purpose of the present in vivo study was to measure the efficacy of different gingival displacement materials in achieving gingival tissue displacement and to compare the efficacy of Expasyl displacement paste (Pierre Rolland, France) and gingival displacement cord for gingival displacement. MATERIALS AND METHODS: Sixteen subjects were included in the study. Premolars were prepared to receive full veneer crown, gingival displacement was carried using gingival retraction cord and gingival displacement paste. Impression of the gingival sulcus was made. Sulcus width after displacement was measured under magnification. RESULTS: The mean displacement value of sulcus width was 0.21 ± 0.01 mm for the gingival retraction cord and 0.26 ± 0.02 mm for the gingival displacement paste. 'F' test was used for statistical analysis. Difference among the two test agents was statistically significant (p < 0.01). CONCLUSION: Gingival displacement paste showed better response in achieving horizontal displacement of the gingival sulcus than gingival retraction cord. CLINICAL SIGNIFICANCE: Gingival displacement helps in recording the unprepared tooth surface adjacent to the finish line in the impression being made, thereby helping a better marginal adaptation and emergence profile in the extracoronal restoration.

An in vitro comparison of resistance to second and third order archwire activations of three different varieties of esthetic brackets.

BACKGROUND: When ceramic brackets were introduced as an esthetic alternative to the stainless steel brackets, it was a step ahead in the use of esthetic appliances for orthodontic treatment. Although ceramic brackets had overcome the drawbacks of the initial polycarbonate brackets such as staining and bracket slot distortion, they posed an altogether different problem. This was on account of the physical properties of the ceramic material, namely brittleness. PURPOSE OF THE STUDY: The purpose of this study is to investigate the physical properties of three different varieties of esthetic brackets, i.e., "MXI" ceramic bracket, "Spirit MB" bracket (Ormco), a composite bracket with metal slot reinforcement and the third one fiber bracket, with silicious copolymer, Natura (Leone Co.). AIMS AND OBJECTIVE OF THE STUDY: The objective of this study is to compare the torsional resistance of the brackets and resistance of brackets to second order archwire activations. CONCLUSION: The strength of the selected brackets was more than sufficient to withstand orthodontic load without any fracture or deformation.

Anomalous fascicle of triceps brachii muscle and its clinical importance in relation to radial nerve entrapment.

We present a case of unreported morphological variant of the triceps brachii muscle which was observed while dissecting a cadaveric upper limb at the department of human anatomy. It was noted that an anomalous fascicle present between the lateral and long heads of the triceps. The fascicle was passing just superficial to the spiral groove and was crossing the radial nerve and profunda brachii artery. After the literature search, it was found that the present variation has not been previously reported. The clinical implication of this anomalous fascicle in relation to radial nerve entrapment and non-traumatic radial nerve palsy are discussed.