Dexmedetomidine as an Adjunct to Propofol in Patients Undergoing Elective Endoscopic Retrograde Cholangio-Pancreaticography - A Double-blind Randomized Controlled Study.

Background: Propofol is the drug of choice for procedural sedation. The addition of α2 agonist dexmedetomidine may improve the safety profile of the procedure by providing stable hemodynamics, better sedation quality, and decreasing the side effects of each drug during elective endoscopic retrograde cholangio-pancreaticography (ERCP). Materials and Methods: Eighty patients aged between 18 and 60 years were distributed randomly into two groups. The dexmedetomidine + propofol group (group DP) received an injection of dexmedetomidine at the dose of 1 mcg/kg in 100 mLsaline, and the propofol group (group P) received plain 100 mL normal saline over 10 min. Subsequently, both groups received a bolus dose of injection propofol 1 mg/kg as sedation, and a modified observer's assessment of alertness/sedation score (MOASS) score was assessed, followed by infusion at the rate of 50 mcg/kg/min during the procedure. A rescue bolus dose (20 mg) of propofol was administered when the patient showed signs of inadequate sedation or analgesia in both groups. Cardiovascular and respiratory parameters were recorded every 10 min throughout the procedure. Post-procedure modified Aldrete score was evaluated for 30 min, and the endoscopist's score was noted at the end of the procedure. Results: There was a significant difference (P = 0.001) in the additional number of rescue doses of propofol administered in group DP (3.47 ± 0.77) as compared to group P (8.78 ± 1.11). The total dose of propofol was lower in group DP (316.59 ± 43.29 mg) than in group P (443 ± 41.1 mg) with P value = 0.001. Statistically significant differences in the hemodynamic values were observed in group DP during infusion (P value < 0.05) of dexmedetomidine and throughout the procedure (P < 0.05) when compared with group P. Endoscopists graded the satisfaction score as very high (3.477 ± 0.77) in group DP. Conclusion: The addition of dexmedetomidine to propofol during ERCP provided better and safer sedation.

New Visionary in Upper Airway Surgeries-THRIVE, a Tubeless Ventilation.

THRIVE stands for Transnasal Humidified Rapid Insufflation Ventilatory Exchange. Usage of THRIVE technique is common in emergency settings and of late its usage in upper airway surgeries is gaining popularity. (1) To determine the operative time, total anaesthesia time, safety and efficacy of THRIVE in patients undergoing upper airway surgeries for varied pathologies. (2) To assess the surgeon's satisfaction and patients post-operative comfort. An observational study was from May 2019 to Oct 2020. Study was conducted through a detailed proforma which consists of patient demographic details, physical status, co-morbidities and various domains to assess the safety and efficacy of THRIVE. A total of 32 patients were divided into four groups depending on the type of surgery. We had 18 patients in microlaryngeal excision, six in direct laryngoscopy and biopsy, four in tracheostomy and four in balloon dilatation for subglottic stenosis groups. The mean operation time was 16 ± 2 min in the first three groups and 29 ± 0.8 in the fourth group. All the patients underwent successful surgeries without any episodes of desaturation, without complications and with good surgical satisfaction. THRIVE with appropriate safety precautions can be tried in patients undergoing various upper airway surgeries of short duration. All the patients in our study maintained stable vital parameters throughout the surgery. Initial results with the use of THRIVE as per our study and other studies are definitely encouraging to use THRIVE in upper airway surgeries with varied pathologies.

Enhanced photocatalytic and electrochemical performance of TiO2-Fe2O3 nanocomposite: Its applications in dye decolorization and as supercapacitors.

This work reveals a green combustion route for the synthesis of TiO2, Fe2O3 and TiO2-Fe2O3 nanocomposites as photocatalysts for decolorization of Titan Yellow (TY) and Methyl Orange (MO) dyes at room temperature in aqueous solution concentration of 20 ppm under UV-light irradiation. We observed that the TiO2-Fe2O3 nanocomposite shows superior photocatalytic activity for TY dye compared to pure TiO2 and Fe2O3. Rate constant (k) values of TiO2, Fe2O3 and TiO2-Fe2O3 for TY and MO are 0.0194, 0.0159, 0.04396 and 0.00931, 0.00772 0.0119 kmin-1 respectively. The surface area and pore volume of TiO2-Fe2O3 nanocomposite were found to be 71.56 m2/g and 0.076 cm3/g, respectively as revealed by BET studies. From the Barrett-Joyner-Halenda (BJH) plot, the mean pore diameter of TiO2-Fe2O3 nanoparticles was found to be 2.43 nm. Further, the TiO2-Fe2O3 nanocomposite showed good electrochemical behavior as an electrode material for supercapacitors when compared to pure TiO2 and Fe2O3 nanoparticles resulted in stable electrochemical performance with nearly 100% coulombic efficiency at a scan rate of 10 mV/s for 1000 cycles. Interestingly, the novelty of this work is that the designed supercapacitors showed stable electrochemical performance even at 1000th cycle, which might be useful for rechargeable supercapacitor applications. The electrochemical properties of the nanocomposites were compared by the data obtained by cyclic voltammograms, charge-discharge tests and electrochemical impedance spectroscopic studies. These results demonstrated that the TiO2-Fe2O3 nanocomposite showed stable performance compared to TiO2 and Fe2O3 nanoparticles at current density of 5 Ag-1.