The effect of perioperative dexmedetomidine on postoperative bowel function recovery in adult patients receiving general anesthesia.

BACKGROUND: Dexmedetomidine has opioid sparing actions but its effect on bowel recovery is controversial. Primary aim of this review was to evaluate the effect of perioperative dexmedetomidine on postoperative bowel recovery. Secondary aim was to evaluate the effect of dexmedetomidine on hospital discharge. EVIDENCE ACQUISITION: Randomized controlled trials in English language reporting any or all of the following parameters of bowel recovery; time to first bowel sounds, first flatus, first feces, or time to oral diet were included. EVIDENCE SYNTHESIS: Twelve hundred and thirty-five patients from 13 studies were analyzed. There were insufficient studies evaluating bowel sounds. Perioperative dexmedetomidine usage significantly reduced the time to first flatus [MD -5.61 h (95% CI: -8.61 to -2.60); P=0.0003; I2=95%], first feces [MD -12.70 h (95% CI: -19.11 to -6.29); P=0.0001; I2=76%] and the composite outcome of bowel recovery (flatus, feces, oral diet) [MD -7.44 h (95% CI: -10.31 to -4.57); P<0.00001; I2=96%]. No difference was seen in the time to oral diet [MD -6.29 h (95% CI: -13.48 to 0.91); P=0.09; I2=88%] or hospital discharge [MD -0.47 days (95% CI: -1.27 to 0.33); P=0.25; I2=86%]. CONCLUSIONS: Perioperative dexmedetomidine usage significantly shortens the time to first flatus, feces and composite bowel recovery but does not result in a shorter time to oral diet or earlier hospital discharge in adult patients receiving general anesthesia. Strength of evidence is however very low for the effect of dexmedetomidine on bowel recovery.

Severe Oleander Poisoning Presenting with Hyperkalaemia and Unusual Electrocardiographic Changes.

BACKGROUND: Hyperkalaemia in oleander (Nerium oleander) poisoning has been associated with a poor prognosis. Different electrocardiographic (ECG) presentations are possible because of vagotonia and hyperkalaemia. METHODS/RESULTS: We report a series of three cases of oleander poisoning in which ECG showed unusual hyperkalaemia features, such as bradyarrhythmia, sinoatrial block, atrioventricular block and junctional rhythm. CONCLUSIONS: If arterial blood gas analysis or laboratory values indicate hyperkalaemia in oleander poisoning, the hyperkalaemia should be treated immediately, even if the ECG does not show typical hyperkalaemia features. LEARNING POINTS: Hyperkalaemia in oleander poisoning is associated with a poor prognosis.Hyperkalaemia should be treated aggressively in oleander poisoning even if the ECG does not show typical features, as mimics other conditions on ECG.

The effect of 'THE MOTOR VEHICLES (AMENDMENT) ACT, 2019' on the clinico-epidemiological profile of road traffic accident patients presenting to a tertiary care trauma centre in Bhubaneswar.

CONTEXT: Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1st 2019 that permits heavy penalties for traffic rule offenders. AIMS: To find out the early impact of "THE MOTOR VEHICLES (AMENDMENT) ACT, 2019". SETTINGS AND DESIGN: A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department. METHODS AND MATERIALS: Patients studied in two groups - One Pre MVA group (n = 371) and one Post MVA group (n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded. STATISTICAL ANALYSIS USED: Statistical analysis was done by R version 3.6.1. RESULTS: There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly (P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier (P = 0.016). CONCLUSIONS: The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity.

Air embolism through open hub of external jugular vein intravenous cannula.

INTRODUCTION: Venous air embolism is a catastrophic complication that can result in sudden cardiac arrest and death. Massive air embolism has been reported with central venous catheter through the internal jugular and subclavian veins. Though external jugular vein is a potential site of an air embolism to cardiac chambers and subsequently to vital organs such as brain, heart and lungs but has not been reported yet in literature. CASE PRESENTATION: We are reporting a case of sudden pulmonary air embolism in a patient through the open hub of an intravenous cannula, vigilant monitoring and timely action saved the patient from a catastrophic outcome. CONCLUSION: We recommend vigilant monitoring and adequate precaution in patients with external jugular venous cannulation in the operation theater, intensive care unit or wards to prevent iatrogenic complications.