Background:Mixing of various adjuvants has been tried with local anesthetics in an attempt to prolong anesthesia from peripheral nerve blocks but have met with inconclusive success. More recent studies indicate that 8 mg dexamethasone added to perineural local anesthetic injections augment the duration of peripheral nerve block analgesia.Aims:Evaluating the hypothesis that adding dexamethasone to ropivacaine significantly prolongs the duration of analgesia in supraclavicular brachial plexus block compared with ropivacaine alone.Patients and Methods:It was a randomized, prospective, and double-blind clinical trial. Eighty patients of ASA I and II of either sex, aged 16-60 years, undergoing elective upper limb surgeries were equally divided into two groups and given supraclavicular nerve block. Group R patients (n = 40) received 30 ml of 0.5% ropivacaine with distilled water (2 ml)-control group whereas Group D patients (n = 40) received 30 ml of 0.5% ropivacaine with 8 mg dexamethasone (2 ml)-study group. The primary outcome was measured as duration of analgesia that was defined as the interval between the onset of sensory block and the first request for analgesia by the patient. The secondary outcome included maximum visual analogue scale (VAS), total analgesia consumption, surgeon satisfaction, and side effects.Results:Group R patients required first rescue analgesia earlier (557 ± 58.99 min) than those of Group D patients (1179.4 ± 108.60 min), which was found statistically significant in Group D (P < 0.000). The total dose of rescue analgesia was higher in Group R as compared to Group D, which was statistically significant (P < 0.00).Conclusion:Addition of dexamethasone (8 mg) to ropivacaine in supraclavicular brachial plexus approach significantly and safely prolongs motor blockade and postoperative analgesia (sensory) that lasted much longer than that produced by local anesthetic alone.

Background:Monitored anesthesia care (MAC) combines intravenous sedation along with local anesthetic infiltration or nerve block. Several drugs have been used for MAC, but all are associated with complications. Dexmedetomidine is a selective α2-adrenoceptor agonist with both sedative and analgesic properties and is devoid of respiratory depressant effects. Its short elimination half-life makes it an attractive agent for sedation during MAC.Aim:Comparative evaluation of dexmedetomidine and midazolam for MAC.Methods:In this prospective, randomized, double-blind study, 50 American Society of Anesthesiologist I and II patients undergoing a surgical or diagnostic procedure of <1 h requiring MAC were enrolled. Dexmedetomidine-ketamine (Group “KD”) patients (n = 25) received intravenous (I.V.) dexmedetomidine 1 mcg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine. Midazolam-ketamine patients (n = 25) received I.V. midazolam 0.05 mg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine to get a targeted level of sedation (≤4 using Observer's Assessment of Alertness/Sedation Scale score). Inadequate sedation (e.g., 15% increase in mean arterial blood pressure or heart rate, decrease in degree of calmness, increase in respiratory rate, physical movement) was treated by a ketamine bolus of 0.5 mg/kg as a rescue analgesia.Statistical Analysis:The statistical tests used in the study are unpaired Student's t-test for continuous variables and Chi-square test for categorical variables. Mann–Whitney test was used to assess the patient and surgeon satisfaction. Data were expressed as mean ± standard deviation. Value of P < 0.05 is considered significant and P < 0.0001 as highly significant.Results:Clinically desired sedation and analgesia was achieved earlier and better with dexmedetomidine. Patients and surgeons satisfaction were significantly higher with dexmedetomidine. The requirement of additional sedation and analgesia was less in dexmedetomidine (KD) group.Conclusion:During MAC dexmedetomidine provides better sedation and analgesia than midazolam.

Tuberculosis is a rare cause of liver abscess even in countries where the tuberculosis is prevalent, liver may be involved as a part of miliary tuberculosis or as local tuberculosis. We present a case of tuberculous liver abscess in patient with smear positive pulmonary tuberculosis and right pleural effusion. A positive BACTEC culture and Polymerase chain reaction (PCR) for Acid Fast Bacilli (AFB) in the pus aspirated from abscess confirmed the diagnosis of tuberculous liver abscess.

Endotracheal tube is an airway catheter inserted in the trachea to assure patency of the upper airway. ETT cuff seals the trachea to facilitating positive-pressure ventilation and to prevent aspiration. The cuff pressure of an endotracheal tube depends on various patient-related factors like obesity, old age, environmental circumstances and therapeutic interventions. Physiological changes in laparoscopic surgery under general anesthesia, due to pneumoperitoneum and change in patient position can affect ETT cuff pressure. These changes in ETT cuff pressure can lead to significant peri-operative adverse outcome. Aims and Objectives: To evaluate the changes in ETT cuff pressure between open and laparoscopic cholecystectomy under general anesthesia. Materials and Methods: 80 ASA grade I/II patients, aged 20-50 years, undergoing laparoscopic or open cholecystectomy, under GA were included in this prospective observational study. Patients were divided in two equal sized groups (N=40) for laparoscopic and open cholecystectomy. ETT cuff pressures were recorded with ETT manometer, at 5 min intervals until extubation. Patients were followed 6 hourly, for 24 hours to record any postoperative complications. Results: The changes in hemodynamic parameters were more in laparoscopic surgery than open surgery. Abdominal insufflation in laparoscopic surgery causes significant increase in cuff pressure due to altered thoracic compliance. Change in position, during laparoscopic surgery, also affects endotracheal tube cuff pressure. Conclusion:The pneumo-peritoneum and positional changes during laparoscopic surgery cause significant increase in endotracheal tube cuff pressure and thus associated with an increased incidence of postoperative complications.

No abstract