Comparison of two different doses of hyperbaric bupivacaine for intracavitary radiotherapy in patients with carcinoma cervix ? A randomized control trial

Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double?blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 � 32.4 minutes vs. Group II: 143.2 � 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 � 47.12 minutes versus Group II: 247.00 � 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.

Cotard’s syndrome in the postoperative period following head and neck cancer surgery – A case report

Major head and neck surgery is a known factor for postoperative delirium; however, Cotard’s syndrome (CS) has been rarely reported following head and neck surgery. We report a case of a 51?year?old man who underwent surgery for carcinoma right buccal mucosa and developed agitation and nihilistic delusion after extubation. The patient had a preexisting psychiatric history which is often reported as a risk factor for CS. Of interest, though is that this condition subsided as quickly as it emerged with only supportive counselling and brief pharmacotherapy.

Refractory cancer pain in young child at end?of?life: Can we alleviate the suffering?

Pain is a common and highly distressing symptom in children with advanced malignancies and it is often multifactorial at the end?of?life. The prognosis of cancer pain is reported to be worse in those with mixed pain type, high pain severity, daily opioid use, and poor emotional well?being. We describe a case of 13?year?old boy, known case of metastatic Ewing sarcoma right iliac bone, who presented to our palliative care ward with intractable pain and was finally discharged home for terminal care with high doses of morphine, ketamine, and midazolam infusion through elastomeric pump attached to a peripherally inserted central catheter (PICC line). The suffering of imminently dying children should be reduced, and judicious dose escalation of opioids along with adjuvants is appropriate and often necessary.

Breast cancer pain management - A review of current & novel therapies.

Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO’s three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients.

Irrigation with domestic wastewater: Responses on growth and yield of ladyfinger Abelmoschus esculentus and on soil nutrients.

Domestic wastewater is generated continuously and in large quantities. It can serve as an alternative water nutrient source for irrigation. In the present study Abelmoschus esculentus L. (Ladyfinger) was irrigated using untreated wastewater (T1), treated wastewater (T2) and rainwater (T3) in pot experiments. The effect was seen on nutrient fortication, growth and yield of the plant and the nutrient status of the soil. Additionally the build up of Cr, Cu and Zn from the irrigation water were anlayzed in different parts of the plant biomass and in the soil. The sapling survival rate was found to be 87% in T1 followed by T2 and T3. Root shoot ratio under different treatments was found in the order T3 (0.46) >T2 (0.35) >T1 (0.31). The chlorophyll a, b and carotene content in the leaves (mg g-1) was found to be 6.3, 0.5, 0.9 under T1, 4.8, 0.4, 0.8 under T2 and 3.2, 0.3, 0.5 under T3 respectively and all the three varied in the order T1>T2>T3. The same trend was found in case of total dry matter (g) T1 (6.3) >T2 (3.7) >T3 (2.3) at p<0.05. There was a considerable increase in nutrients in the soil under T1 and T2 as compared to T3 after final harvest. The organic matter (%), NO3 -N and PO4 3- (mg kg-1) content post harvest soil was found to be 3.4, 71, 90 under T1 and 2.9, 52, 63 under T2 respectively. Also, there was an increase in cations Na, K, Ca and Mg in the soil irrigated with T1 and T2 after the final harvest. Thus irrigation with wastewater generally increased soil fertility. Only a small percentage of the heavy metal was bioaccumulated by the plant parts from the irrigation water. There was hardly any metal accumulation in fruits. Bulk of the metal ions remained in the soil.

Role of bioinoculants and organic fertilizers in fodder production and quality of leguminous tree species.

The comparative effect of dual inoculation of native N fixer (Rhizobium) and AM fungi consortia with different organic fertilizers (vermicompost and farm yard manure) on fodder production and quality of two leguminous tree species (Leucaena leucocephala (Lam) de. Wit. and Sesbania sesban (L.) Merr.) in silvopastoral system and their impact on the fodder production of un-inoculated Panicum maximum Jacq. under cut and carry system. After three years of plantation maximum tree survival was in L. leucocephala in all the treatments in comparison to S. sesban while fodder production was more in S. sesban for initial two years and in third year it accelerated in L. leucocephala. Dual inoculation with vermicompost significantly improved fodder production, fodder quality and rhizosphere microflora in L. leucocephala but in S. sesban dual inoculation was at par with single inoculation of N fixer, AM fungi and control (without inoculation). The grass production was higher with L. leucocephala for two years while in third year it was more with S. sesban. The association of Rhizobium with AM fungi in L. leucocephala was better than in S. sesban.

Propofol for pediatric radiotherapy.

OBJECTIVE: Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room. METHODS: This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20-22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted. RESULT: The drug was graded on a scale of 0-10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (+/-SD) of all the measured parameters were calculated and compared between the two groups. CONCLUSION: Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was between 94-95%, was easily treatable with supplementation of oxygen by face mask.