Background: Spinal anesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anesthesia. We compared onset and duration of sensory block with intrathecal use of 1% 2-chloroprocaine (30 mg) or 0.5% Hyperbaric Bupivacaine (15 mg) as primary objective. Secondary objectives being onset and duration of motor block, duration of analgesia, time to return of voiding function, hemodynamic parameters and side effects.Methodology: 90 patients of age group 18-60 years, either sex, belonging to ASA physical status I/II undergoing infra-umbilical surgeries were randomly divided into two groups, 1% 2-chloroprocaine Group A (n=45) and 0.5% hyperbaric bupivacaine Group B (n=45). Each group received intrathecally either 30 mg of 2-chloroprocaine or 15 mg of hyperbaric bupivacaine 15 mg. For statistical analysis unpaired-t-test and chi-square test were used.Results: Earlier onset and shorter duration of sensory block were observed in Group A as compared to Group B respectively (p < 0.001). Similarly, onset was earlier and duration of motor block, duration of analgesia and time to return of voiding function were shorter in Group A as compared to Group B respectively (p < 0.001). Hemodynamic parameters (HR, MAP) were comparable in both groups.Conclusion: Intrathecal 1% 2-chloroprocaine 30 mg provides spinal anesthesia of adequate duration for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier voiding with stable hemodynamics as compared to 0.5% hyperbaric bupivacaine 15 mg.Citation: Khare A, Thada B, Yadav D, Mathur V, Singh M. A randomized double blind study to compare 1% 2-chloroprocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia for infra-umbilical surgeries. Anaesth. pain & intensive care 2019;23(2):162-167

BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity. Early diagnosis and specific treatment may improve outcomes. Lack of specific clinical signs or tests make the diagnosis challenging. AIM To assess the efficacy of cerebrospinal fluid (CSF) lactate in diagnosing meningitis in critically ill patients. METHODS A prospective, observational cohort study was carried out in a neuro-medical intensive care unit (ICU) over a 22 mo period. Adult patients, with suspected meningitis admitted in ICU, were serially recruited. Patients who refused consent, those with peripheral sensorineural deficit, or with any contraindication to lumber puncture were excluded. CSF cytology, bio-chemistry, lactates, culture and polymerase chain reaction based meningo-encephalitis panel were evaluated. Patients were divided in two groups based on clinical diagnosis of meningitis. The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests. RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis. The mean values of CSF total leucocyte count (TLC), proteins and lactates were significantly higher in meningitis group. There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel. CSF lactate (> 2.72 mmol/L) showed good accuracy in diagnosing meningitis with an area under the curve of 0.81 (95% confidence interval: 0.69-0.93), sensitivity of 82.6%, and specificity 72.9%. These values were comparable to those of CSF TLC and protein. Twelve patients with bacterial meningitis had significantly higher CSF lactate (8.9 ± 4.7 mmol/L) than those with non-bacterial meningitis (4.2 ± 3.8 mmol/L), P = 0.006. CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients. CSF lactate (> 2.72 mmol/L) showed good accuracy, sensitivity, and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.

Background and aims: Sepsis is not only a leading cause of intensive care unit (ICU) admission but also one of the variables which affect outcomes of cancer patients. We aimed to assess the clinical characteristics, clinical course, mortality and risk factors associated with 30-day mortality in medical oncology patients admitted in a multi-disciplinary medical ICU. Methods: We conducted a retrospective analysis of 435 consecutive cancer patients admitted in medical ICU over a 28 months period. Patients were divided into two groups based on the presence of sepsis at the time of ICU admission. Data regarding baseline patient characteristics, clinical and laboratory data, need for organ support and 30-day mortality were collected. Sepsis patients were further classified as 30-day survivors and non-survivors and risk factors for mortality in these patients were determined. Results: Overall 30-day mortality was 57.8%. It was significantly higher in sepsis group patients (73.9%) as compared to non-sepsis patients (46.6%) ( p < 0.001). Most common reason for ICU admission in non-sepsis group was respiratory distress (51.4%) followed by altered sensorium (28.4%). Presence of metastasis [odds ratio, OR: 3.89 (95% confidence interval, CI: 1.536–9.901)], high lactate [OR: 1.374 (95% CI: 1.024–1.843)] and need of invasive mechanical ventilator (IMV) support [OR: 7.634 (95% CI: 2.519–23.256)] or vasopressor support [OR: 3.268 (95% CI: 1.179–9.090)] were directly associated with 30-day mortality. Conclusion: Critically ill cancer patients admitted with sepsis had high mortality. Presence of metastasis, high lactate and need of IMV or vasopressor support was associated with worse prognosis in cancer patients admitted with sepsis in ICU.

BACKGROUND Hepatobiliary system diseases are a common pathology encountered in clinical practice. Ultrasound, Computed Tomography (CT), and Endoscopic Retrograde Cholangiopancreatography (ERCP) and Magnetic Resonance Cholangiopancreatography (MRCP) are the commonly used imaging modalities to evaluate the same. MRCP provides high resolution projection images of the biliary tree and pancreatic duct without being invasive. We wanted to evaluate MRCP appearance of various hepatobiliary lesions and identify the aetiology of benign and malignant strictures. METHODS This is a descriptive study. The study group consisted of 108 patients diagnosed or suspected of having hepatobiliary lesions referred for MRI. RESULTS Malignant stricture of the bile duct was the most common pathology in this study comprising 35 patients followed by benign strictures comprising 27 patients. A total of 30 patients of choledochal cyst was seen, the most common being type 1 Choledochal cyst. 18 patients of choledocholithiasis were seen. A total of 27 patients of benign stricture were seen. Iatrogenic injury was the most common cause of the bile duct stricture followed by stricture associated with chronic pancreatitis in 2 patients. There were 35 patients of malignant stricture in this study. Most common cause of malignant stricture was cholangiocarcinoma. MRCP examination in patients of hepaticojejunostomy with operative site stricture showed stricture at the site of anastomoses. In these patients ERCP was not possible due to unfavourable anatomy. MRCP shows ductal dilatation proximal to stricture in patients of hilar cholangiocarcinoma which was not possible on ERCP in these two patients due to tight stricture. MRCP examined bile duct in physiological state without the problem of the overestimation of the size of the bile ducts. CONCLUSIONS MRCP does not involve ionising radiation, contrast media and is totally non-invasive. Malignant stricture comprises commonest disease, followed by benign stricture of bile duct and choledochal cysts. MRCP is of advantage when distal CBD calculi are obscured by gas on USG. Iatrogenic injury is the most common cause of the benign bile duct stricture.

Purpose: To assess the HRCT findings of symptomatic COVID-19 patients with positive reverse transcriptase polymerase chain reaction (RT-PCR).Methods:This was a prospective observational study comprising 100 consecutive reverse transcriptase polymerase chain reaction (RT-PCR) positive patients who underwent CT chest. Distribution, extent and type of abnormal lung findings were observed. Results:Among the total study cohort of 100 patients,64 (64 %) were males and 36 (36 %) were females with mean age of 42.1± 15.6 years. We observed lung parenchymalabnormalities in 55(55 %) cases whereas 45 (45 %) RT-PCR positive cases had a normal chest CT.Only 11 % of the patients were dyspneic, 6 % had desaturation, 9 % had increased respiratory rate and 15 % had comorbidities.Among the patients with abnormal CT findings bilateral 44/55 (80 %), multilobar 49/55 (89 %) lung involvement with a predominant peripheral and posterior distribution was commonly observed.With regards to the type ofopacity,ground glass opacity (GGO) was the dominant abnormality found in all 55 (100 %) cases.Pure GGO was observed in 16 (29.1%), GGO with septal thickening was seen in 28 (50.9 %) and GGO mixed with consolidation was noted in 11(20 %).Conclusion:In this study population predominantly with mild symptoms and few comorbidities,45% ofRT-PCR positive patients had a normal chest CT; whereas the remaining 55% patients showed typical findings ofpredominant GGOs with a bilateral distribution and peripheral predominance