An Observational Study for Evaluation of Supreme LMA in Paediatric Patients.

Background: The need of securing the airway quickly in an easier and safer way, especially in paediatric patients still remains a major concern. Newer and safer alternates to endotracheal intubations are being introduced. LMA supreme is one of such advancement in the field of paediatric anaesthesiology. Easy and quick insertion without any introducer, gastric access and high seal pressure are few advantages claimed by LMA Supreme. Apart from a few studies; the safety and efficacy of its paediatric version is yet to be established in Indian paediatric population. Thus, we have conducted an observational study for evaluation of Supreme LMA in paediatric patients. Observational clinical study. Methods: After obtaining approval from institutional ethical committee and consent from patient’s attendants, 50 patients of ASA grade I and II, weighing 10-20 kg of either sex undergoing general anaesthesia were included. After induction of anaesthesia and muscle relaxation, the LMA Supreme size 2 was inserted. Number of insertion attempts, ease of insertion, time taken for insertion, hemodynamic responses, ease of NGT insertion and incidence of airway trauma were recorded. Results: In 90% of patients, LMA Supreme was inserted in first attempt. In 94% of cases, insertion was easy. Average time required to insert LMA Supreme was 11.66 ± 0.81 seconds. There were no significant hemodynamic changes noted. In 2 % of cases, airway trauma was observed. Conclusion: LMA supreme emerged as a good alternate airway device. It is quick and easy to insert with fast learning curve with least alteration of hemodynamic status in paediatric population.

Levobupivacaína o ropivacaína: un ensayo aleatorio doble ciego controlado con dosis equipotentes en la anestesia espinal / Levobupivacaine or ropivacaine: A randomised double blind controlled trial using equipotent doses in spinal anaesthesia

Introduction: Levobupivacaine and ropivacaine are relatively new local anaesthetics developed in order to address the issue of bupivacaine toxicity Although certain differences do exist between their pharmacological profiles, its clinical relevance at equipotent doses is not evident so far Objective: To compare the efficacy and characteristics of equipotent doses of intrathecal levobupivacaine with ropivacaine Methodology: Sixty ASA grade I/II patients of 18-60 years, either sex posted for lower limb orthopaedic surgery under spinal anaesthesia were randomly given either 15 mg levobupivacaine or 22.5 mg ropivacaine. Sensory and motor block, haemodynamic characteristics, as well as any side effects, were recorded Results: Onset of sensory block to T10 was more rapid in group R than group L, p < 0.0001. The median (range) height achieved in group R was T7 (T5-T10) while in group L was T7 (T4-T10). Time to reach maximum height and time to modified Bromage grade 3 was shorter in group R as compared to group L, p < 0.0001. Levobupivacaine produced significantly longer (290.50 ± 34.67) duration of motor block compared to ropivacaine (222.50 ± 23.00). Duration of analgesia was significantly longer in group L (309.83 ± 36.45) than group R (249.50 ± 22.83). No serious adverse effects were recorded. Conclusion: Levobupivacaine produces significantly longer duration of analgesia than ropivacaine when used in a ratio of 0.6:1. Efficacy, toxicity and haemodynamic profile make ropivacaine suitable agent for surgeries with low threshold for hypotension.

Introducción: La levobupivacaína y la ropivacaína son anestésicos locales relativamente nuevos, desarrollados con el fin de abordar la cuestión de la toxicidad de la bupivacaína. Aunque existen ciertas diferencias entre sus perfiles farmacológicos, su relevancia clínica en dosis equipotentes no es evidente hasta ahora. Objetivo: Comparar la eficacia y las características de las dosis equipotentes de levobupiva-caína por vía intratecal con las de ropivacaína. Metodología: A Sesenta pacientes de grado ASA I/II de 18 a 60 años y de ambos sexos, programados para cirugía ortopédica del miembro inferior bajo anestesia espinal, se les dio al azar o bien 15 mg de levobupivacaína o 22,5 mg de ropivacaína. El bloqueo motor, el bloqueo sensorial, las características hemodinámicas y cualquier otro efecto secundario fueron registrados. Resultados: El inicio del bloqueo sensorial en T10 fue más rápido en el grupo R que en el grupo L, p < 0,0001. El nivel mediano (rango) alcanzado en el grupo R fue T7 (T5-T10), mientras en el grupo L fue T7 (T4-T10). El tiempo para alcanzar el nivel máximo y para alcanzar un grado 3 en la escala de Bromage fue más breve en el grupo R en comparación con el grupo L, p < 0,0001. La levobupivacaína produce una duración significativamente más larga (290.50 ± 34.67) del bloqueo motor que la ropivacaína (222.50 ± 23.00). La duración de la analgesia fue significativamente más larga en el grupo L (309.83 ± 36.45) que en el grupo R. No se registraron efectos adversos graves. Conclusión: La levobupivacaína produce una duración de la analgesia significativamente más larga que la ropivacaína cuando se utiliza en una proporción de 0,6:1. La eficacia, toxicidad y perfil hemodinámico hacen de la ropivacaína un agente adecuado para cirugías con un umbral bajo de hipotensión.

Thoracic Epidural- An Alternate to General Anaesthesia for Sick Laparotomy.

Choices of anaesthetic technique in patients with perforation peritonitis requiring emergency laparotomy vary drastically on the basis of anaesthetist preference and patient’s condition. We report a case of a geriatric male, with restricted mouth opening due to ludwig’s angina and renal derangement, posted for emergency laparotomy for gastric perforation. Thoracic epidural block was used as a sole anaesthetic technique because of above mentioned airway difficulty, instruments limitation in emergency setup and associated co- morbidity. Surgery was conducted successfully.

Spinal Anaesthesia or General Anaesthesia: Which is better in Premature Neonates: A Case Report.

General anaesthesia in premature neonates is associated with various complications. Spinal anaesthesia can be better choice in premature babies in surgeries below umbilicus. Spinal anaesthesia provides all components of balance anaesthesia with minimum cardiorespiratory disturbance and post-operative nausea vomiting, early ambulation and rapid return of appetite. We report a case of one day old premature new-born who was given successful spinal anaesthesia and was operated with good outcome.

Pulmonary alveolar proteinosis a rare disease.

Pulmonary alveolar proteinosis is a rare lung disease in which abnormal accumulation of surfactant occurs with in the alveoli, interfering with gas exchange. PAP can occur in a primary form or secondarily in the settings of malignancy , pulmonary infection, or environmental exposure to dusts or chemicals. Rare familial forms have also been recognized suggesting a genetic component . we are going to present a rare case of pulmonary alveolar proteinosis.

Gunthers with haemolytic anaemia extremly rare: A case report.

Congenital erythropoietic porphyria (CEP), also called Gunthers is the rarest of the porphyrias, with a prevalence estimated at 1 in 1,000,000 or less. Only approximately 200 cases of CEP have been reported till now worldwide. CEP affects males and females equally, and occurs in all ethnic groups. Clinically it is a subacute to chronic type of porphyria, defect is expressed in infancy and clinical features such as extreme cutaneous photosensitivity, blistering, scarring, hyper and hypo pigmentation of photo exposed parts. Haemolytic anaemia with splenomegaly and retarded growth may also be present. Due to its rarity we are presenting Congenital erythropoietic porphyria with haemolytic anaemia.

Remmiting seronegative symmetrical synovitis with pitting edema (RS3PE) a rare Disease.

Remitting Seronegative Symmetrical Synovitis with Pitting Edema is a rare clinical entity described as an acute onset polyarthritis with edema affecting geriatric population particularly males. The etiopathogenesis of disease is still elusive but clinical, radiological and immunological characteristics separate it from the more common disease like Rheumatoid arthritis and Polymyalgia rheumatica. Disease has an excellent prognosis with low dose steroids and patients undergo long-term remission even after withdrawal of drugs. We hereby describe a case of 90 year old female presented to us with polyarthritis and pitting edema of hands that we diagnosed as RS3PE.

Role of serum HsCRP as prognostic markers in septicemia in elderly population.

Background: Presence of elevated serum HsCRP is strongly associated with morbidity and mortality in diverse populations with sepsis and is a potentially useful biomarker to risk stratify patients with severe sepsis. Aims & Objective: We aimed to study whether the serum HsCRP level at presentation in elderly patients with sepsis correlate with stage of sepsis and ultimate outcome. Material and Methods: In a single centre prospective, observational study conducted in geriatric ward of tertiary care centre, 200 elderly patients (age>60 yrs) with sepsis were included. The primary outcome was 14 days in hospital mortality. Risk factor variable was venous serum HsCRP (mg/l) at presentation. Results: Mortality at 14 days in elderly patients with sepsis was 20%. Mean serum HsCRP in survivor group was 33.42 ± 21.56 while 57.28 ± 25.31 in mortality group (p value <0.001). The mean serum HsCRP level in survivor and non survivors was 32.49 ± 21.45 and 48.05 ± 16.40 in sepsis, 33.61 ± 25.45 and 67.71 ± 21.49 in severe sepsis, 46.62 ± 10.55 and 73.82 ± 32.87 in MODS while 49.0 ± 26.72 and 101.5 ± 9.19 in septic shock group. Conclusion: We conclude that initial high serum HsCRP level was associated with increased mortality independent of etiology of sepsis, it also correlate well with severity of sepsis and serum HsCRP level were high in those with septic shock.