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Background: Dexmedetomidine, an alpha-2 agonist, has been used for attenuation of hemodynamic response to laryngoscopy, but not through the nebulized route. The aims of this study were to evaluate the effect of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy-intubation, intraoperative anesthetic-analgesic requirements and recovery outcomes. Methods: 120 ASA I & II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were enrolled and randomized to receive nebulized dexmedetomidine (1 µg/kg in 3-4 ml of 0.9% saline) or 0.9% saline (3-4 ml), 30 minutes before anesthesia induction. Heart rate and non-invasive systolic blood pressures were studied for 10 minutes following laryngoscopy. Results: After laryngoscopy, linear mixed effect modelling showed significantly lower trend of increase in heart rate in the dexmedetomidine group versus saline (P = 0.01). However, there was no difference in the systolic blood pressure changes between the two groups (P= 0.90). Induction dose of propofol (P < 0.001), intraoperative fentanyl consumption (P = 0.007) and isoflurane requirements (P = 0.01) were significantly lower in the dexmedetomidine group. There was no difference in the 2-hr postoperative nausea and vomiting (PONV) (P = 0.61) or sore-throat (P = 0.74). Conclusions: Nebulized dexmedetomidine 1 µg/kg attenuated the increase in heart rate but not systolic blood pressures following laryngoscopy; and reduced the intraoperative anesthetic and analgesic consumption. There was no effect on early PONV, sore-throat or increase in incidence of adverse effects. Nebulized dexmedetomidine may represent a favorable alternative to the intravenous route in short duration surgeries.

Background and objectivesUltrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks and transverse abdominis plane (TAP) blocks are widely used for postoperative analgesia in children undergoing inguinal hernia repair (IHR). Quadratus lumborum block (QLB) provides analgesia for both upper and lower abdominal surgery. Very few randomized controlled trials in children have assessed the efficacy of QLB in IHR. Thus, this study was designed to find the comparative effectiveness of QLB versus TAP and II/IH blocks in children undergoing open IHR.Materials and methodsSixty children scheduled for open IHR were randomly allocated in groups of 20 to receive either ultrasound-guided TAP block with 0.4 mL/kg of 0.25% ropivacaine, II/IH nerve block with 0.2 mL/kg of 0.25% ropivacaine, or QLB with 0.4 mL/kg of 0.25% ropivacaine. Anesthesia was standardized for all patients, and an experienced anesthesiologist performed the blocks after anesthesia induction.Primary outcomeTime to first analgesia.Secondary outcomesPostoperative pain scores, intraoperative and postoperative opioid consumption, cumulative paracetamol usage, block performance time, and block-related complications.ResultsThe median time to first analgesia was 360 (120), 480 (240), and 720 (240) min in the TAP block, II/IH block, and QLB groups, respectively; and was significantly longer in the QLB versus TAP (p<0.001) and II/IH (p<0.001) groups. The time to first analgesia was not significantly different between the TAP and II/IH groups (p=0.596). The mean postoperative tramadol consumption was 11 (12.7), 4 (7.16), and 3 (8) mg in the TAP, II/IH, and QLB groups, respectively (p=0.023); and it was lowest in the QLB group. No significant differences were found between the groups for other secondary outcomes.ConclusionsQLB provides a prolonged period of analgesia and leads to decreased opioid consumption compared with TAP blocks and II/IH nerve blocks in children undergoing open IHR.Trial registration numberCTRI/2019/09/021377.

Until now, known as the demure cousin of dengue virus (DENV) inhabiting Africa, Zika virus (ZIKV) has reinvented itself to cause explosive epidemics captivating the Western hemisphere. The outbreak causing potential for ZIKV was realized when it made its way from Africa to Yap Island Micronesia in 2007, and in French Polynesia in 2013. From there, it moved on to Brazil in 2015. Now ZIKV has infected people in more than 33 countries in Central and South America and the Caribbean. Moreover the epidemiological and subsequent virological association with microcephaly cases in Brazil has prompted the World Health Organization to declare a public health emergency of International Concern. ZIKV shares not only its vector Aedes aegypti with dengue and chikungunya but also the geographic distribution and clinical features, which makes the laboratory confirmation mandatory for definitive diagnosis. The serological cross-reactivity with other Flavivirus, particularly with DENV makes laboratory confirmation challenging and will place additional burden on health systems to establish molecular diagnostic facilities. The evidence of additional nonvector modes of transmission, such as perinatal, sexual as well as transfusion has made preventative strategies more difficult. As ZIKV disease continues to mystify us with several unanswered questions, it calls for coordinated effort of global scientific community to address the ever growing arboviral threat to mankind.

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