A Comparative Study of Intravenous Dexmedetomidine with Local Infiltration of Ropivacaine in Attenuation of Stress Response to Skull Pin Insertion in Craniotomies.

Objective Skull pin insertion in patients undergoing craniotomies elicits hemodynamic and neuroendocrine stress response that may be deleterious to the patient. Various drugs and techniques have been documented in literature to abate this stress response. Against this background, we aimed to compare the efficacy of intravenous dexmedetomidine and local infiltration of ropivacaine for attenuation of stress response to pin insertion in craniotomies. Methods Eighty-eight adult patients undergoing craniotomy under general anesthesia from March 2019 to April 2020 requiring application of head holder were randomized into two equal groups. After intubation, 0.75 µg kg -1 of dexmedetomidine over 10 minutes through infusion was given in group D, while local infiltration at pin sites was done with 0.5% ropivacaine, 2 mL at each site in group R. Hemodynamic parameters and levels of serum cortisol, prolactin, and blood glucose were measured before and after pin insertion. Unpaired t -test for continuous variables and Mann-Whitney U test was used for nonnormally distributed variables. Results Heart rate was statistically similar between the two groups at all the observed time points. The difference in mean arterial pressure values between the two groups was found to be statistically significant only from 10 to 20 minutes after pin insertion being statistically similar at rest of the time points. Levels of serum glucose, cortisol, and prolactin values 30 minutes after pin insertion were statistically similar between both groups. Conclusion We concluded that both interventions are equally efficacious in attenuation of hemodynamic and stress response to head holder application in patients undergoing craniotomies.

Comparison and evaluation of two different crystalloids - Normal saline and plasmalyte in patients of traumatic brain injury undergoing craniotomy.

BACKGROUND AND AIMS: Fluid therapy is one of the most important components of the management of patients with traumatic brain injury (TBI). The present study was planned to compare plasmalyte and normal saline (NS) in patients who underwent craniotomies for TBI in terms of their effects on acid-base equilibrium, renal functions, and coagulation profile. METHODS: Fifty patients of age 18-45 years of either sex, who underwent emergency craniotomy for TBI, were included in the study. The patients were randomized into two groups. Group P (n = 25) received isotonic balanced crystalloid (plasmalyte) and Group N (n = 25) received NS intraoperatively and postoperatively till 24 h after surgery. RESULTS: The pH was lower in Group N (P < 0.05) at different time points after surgery. Similarly, more patients in Group N had pH <7.3 (P < 0.05); while the rest of the metabolic parameters were comparable in the two groups. Blood urea and serum creatinine were higher in Group N. Coagulation profile was comparable in the two groups. CONCLUSION: Acid-base, electrolyte balance, and renal profile were better in patients receiving plasmalyte as compared to NS. Hence, it can be a wiser choice for fluid management in patients of TBI undergoing craniotomy.

Reconstruction of complete tracheal transection with cardiopulmonary bypass support following bull horn injury in neck during coronavirus disease 19 pandemic lockdown.

A 22-year-old male had complete tracheal transection 2.5 cm above the carina with distal end retracted into the mediastinum. This was accidental bullhorn injury to the trachea in the lower cervical region, which posed arduous challenge of "cannot intubate" situation, necessitating percutaneous femoro-femoral cardiopulmonary bypass for surgical reconstruction, during coronavirus disease 19 (COVID-19) pandemic lockdown.

A comparative study to evaluate ultrasound-guided transversus abdominis plane block versus ilioinguinal iliohypogastric nerve block for post-operative analgesia in adult patients undergoing inguinal hernia repair.

BACKGROUND AND AIMS: Both transversus abdominis plane (TAP) block and combined ilioinguinal-iliohypogastric (IIN/IHN) blocks are used routinely under ultrasound (USG) guidance for postoperative pain relief in patients undergoing inguinal hernia surgery. This study compares USG guided TAP Vs IIN/IHN block for post-operative analgesic efficacy in adults undergoing inguinal hernia surgery. METHODS: Sixty adults aged 18 to 60 with American Society of Anesthesiologsts' grade I or II were included. After general anaesthesia, patients in Group I received USG guided unilateral TAP block using 0.75% ropivacaine 3 mg/kg (maximum 25 mL) and those in Group II received IIN/IHN block using 10 mL 0.75% ropivacaine. Postoperative rescue analgesia was with tramadol (intravenous) IV ± diclofenac IV in the first 4 h followed by oral diclofenac subsequently. Total analgesic consumption in the first 24 h was the primary objective, intraoperative haemodynamics, number of attempts and time required for performing the block as well as the postoperative pain scores were also evaluated. RESULTS: Time to first analgesic request was 319.8 ± 115.2 min in Group I and 408 ± 116.4 min in Group II (P = 0.005). Seven patients (23.33%) in Group I and two (6.67%) in Group II required tramadol in first four hours. No patient in either groups received diclofenac IV. The average dose of tablet diclofenac was 200 ± 35.96 mg in Group I and 172.5 ± 34.96 mg in Group II (P = 0. 004). CONCLUSION: USG guided IIN/IHN block reduces the postoperative analgesic requirement compared to USG guided TAP block.

Comparative study of anatomical landmark-guided versus ultrasound-guided suprascapular nerve block in chronic shoulder pain.

BACKGROUND: Suprascapular nerve block (SSNB) is an effective method for the treatment of shoulder disorders. The present study was conducted to evaluate and compare the effectiveness of SSNB under ultrasonographic guidance with anatomical landmark-guided (LMG) technique in the treatment of chronic shoulder pain. MATERIALS AND METHODS: A total of fifty patients with shoulder pain were enrolled in the present prospective randomized study. Patients in Group I (n = 25) received SSNB using the anatomical LMG as technique described by Dangoisse, in whom a total of 6 ml of drug (5 ml of 0.25% bupivacaine and 40 mg methylprednisolone) was injected. Group II patients (n = 25) were given SSNB using the ultrasound guidance with the same amount of drug. Pain was measured using visual analog scale (VAS), range of motion and Shoulder Pain and Disability Index (SPADI) were recorded. Observations were recorded before the block, immediately after the block, and 1 and 4 weeks after the block. RESULTS: There was no statistically significant difference between the VAS score, range of motion and SPADI before the procedure (P > 0.05) in both the groups. Both the groups showed statistically similar improvement of VAS, range of motion and SPADI at 4-week (P > 0.05) follow-up. In Group I, VAS decreased from baseline value of 6.64 ± 1.50-2.04 ± 0.94 at 4 weeks (P < 0.001). In Group II, the VAS decreased from 6.92 ± 1.00 to 1.84 ± 1.03 at 4 weeks (P < 0.01). CONCLUSION: In our study, both the techniques have produced comparable relief of pain, improvement in shoulder movement, and decreased SPADI 4 weeks after the block.

Evaluation of efficacy of dexmedetomidine versus propofol for sedation in children undergoing magnetic resonance imaging.

BACKGROUND: A deep level of sedation is required for magnetic resonance imaging (MRI) in children to ensure optimum image quality. The present study was conducted to evaluate the efficacy and safety of dexmedetomidine versus propofol for sedation in children undergoing MRI. MATERIALS AND METHODS: A total of sixty children aged 2-10 years, having physical status 1 or 2 according to the American Society of Anesthesiologists, undergoing MRI were included in the study. Group D: (n = 30) received injection dexmedetomidine 2 µg/kg for 10 min followed by continuous infusion of 1.0 µg/kg/h. Group P (n = 30) received injection propofol 1 mg/kg bolus followed by continuous infusion of 100 µg/kg/min. RESULTS: The mean time for onset of sedation in Group D was much longer than in Group P (P = 0.000). Mean duration of sedation was comparable in the two groups. The number of patients requiring increased infusion of study drug was significantly higher in Group D (30%) as compared to Group P (16.7%) (P < 0.05). The average recovery time in Group D was much longer than in Group P (P < 0.001). CONCLUSION: Propofol had an advantage of providing rapid onset of sedation and quicker recovery time. Dexmedetomidine resulted in a better preservation of respiratory rate and oxygen saturation, so it may be more suitable in children who are prone to respiratory depression. Hence, both the drugs could achieve required sedation in children posted for MRI.

Trapezius squeeze test as an indicator for depth of anesthesia for laryngeal mask airway insertion in children.

BACKGROUND: Clinical tests, such as loss of verbal contact, eyelash reflex, corneal reflex, and jaw relaxation, are used to assess the depth of anesthesia. "Trapezius squeeze test" (TST) is one such clinical test. It is a simple test to perform in which 1-2 inches of trapezius muscle is held and squeezed in full thickness and response is evaluated in the form of toe/body movement. MATERIALS AND METHODS: One hundred pediatric patients between 3 and 5 years of age, scheduled to undergo elective surgery, were included in this study. We evaluated negative TST as an indicator for optimal anesthesia depth for laryngeal mask airway (LMA) insertion in anesthetized spontaneously breathing children. Anesthesia was induced using 4% sevoflurane in oxygen. As the child lost the verbal contact or loss of body movement, TST was performed. Test was repeated every 15 s till it became negative. When the TST became negative, a well lubricated, appropriate-size LMA was inserted. RESULTS: Mean time for TST to become negative in our study was 271.80 ± 55.8 s and ease of insertion was excellent in 91 patients and acceptable in 9 patients. LMA was successfully inserted in first attempt in 96% patients. CONCLUSIONS: Negative TST is a reliable indicator for placement of LMA in spontaneously breathing children. Excellent conditions for LMA placement are present in majority of the patients without any untoward effects at this point of time.

Reversible white matter abnormalities in a patient with migraine.

A 35-year-old female with migraine without aura, presented with sudden onset of visual aura along with loss of vision on the left side. Following this she had nausea, vomiting and headache. Magnetic Resonance Imaging (MRI) performed at this stage revealed ill-defined lesions hyperintense on Flair images, located in the right temporal and right occipital region. Diffusion weighted images, MR angiogram, T1-weighted and T2-weighted images were normal. She got relief with symptomatic treatment. Twenty days after this attack of migrainous aura she had a similar episode. An MRI scan was performed again. It revealed similar lesions only in the right occipital lobe. Follow-up MRI performed seven weeks later was normal.