Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation.

INTRODUCTION: Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. In individuals with systemic hypertension, coronary artery disease, cerebrovascular disease and intracranial aneurysm, the effect of this transient sympathetic response can evoke life threatening conditions like pulmonary oedema, cardiac failure and cerebrovascular haemorrhage. METHODS: Patients were randomly divided into two groups, 30 in each group. Group I received 50 mg of esmolol and group II received lignocaine 2 mg/kg. Haemodynamic parameters like pulse, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured before induction of anaesthesia, immediately after intubation then at intervals of one minute, three minutes, five minutes, seven minutes and 10 minutes. RESULTS: There was no significant difference in demographic or base line vital signs between two groups (Table 1). The mean systolic blood pressure (SBP) increased on laryngoscopy and tracheal intubation by 15 mmHg in the group I whereas in group II it was 17.4 mmHg. There was a significant rise in diastolic blood pressure (DBP) in both the groups, but the rise was lesser in group II than in group I. CONCLUSION: Both esmolol and lignocaine were not effective in attenuating hemodynamic stress response to laryngoscopy and tracheal intubation; however esmolol was superior to lignocaine in blunting the stress response.

Retrospective study on early outcome of acute burn injuries treated at Nepal Cleft and Burn Centre of Public Health Concern Trust-Nepal.

BACKGROUND: Nepal Cleft & Burn Center, Kirtipur Hospital, Kathmandu has been providing the acute burn care since 2013 with 10 ICU beds, 32 general beds and two operating rooms. This study analyses the demographics of and early outcome in the acute burn patients. METHODS: This is a descriptive retrospective study of the clinical data of acute burn patients admitted from January 1 to December 31, 2014. RESULTS: There were 78 patients from 3 months to 88 years of age with a median age of 29 years. Forty six (58.9%) were females and 32 (41.1%) were males. Most of the injuries (n=57; 73%) occurred inside the house. Flame burn was the commonest mode of injury (n= 48, 61.6%). Only eleven (14.1%) patients arrived on the same day of the injury. The time elapsed was from 1 to 67 days with a median of 5 days. Only two (2.5%) patients had poured water for more than 20 minutes. Range of total body surface area (TBSA) involved was 1% to 70% with a median of 12%. Range of hospital stay was 1 to 105 days with a median of 17 days. Sixty (76.9%) patients underwent 102 surgical operations. Twenty six (33.3%) patients needed blood transfusion. A total of 15 (19.2%) patients died. None survived a burn injury of more than 40% TBSA. CONCLUSIONS: Treatment of acute burn is very challenging with high mortality rate. A lot of effort is needed to change the present standard of care. Awareness programs on First Aid treatment of burn injuries together with the preventive programs focused on high risk population such as females and children in a large scale needs to be organized as soon as possible.