Background:Postoperative pain control after major abdominal surgery is the prime concern of anesthesiologist. Among various methodologies, epidural analgesia is the most preferred technique because of the excellent quality of analgesia with minimum side-effects.Aim:The present study was designated to compare postoperative analgesic efficacy and safety of epidural tramadol as adjuvant to ropivacaine (0.2%) in adult upper abdominal surgery.Settings and Design:Prospective, randomized-controlled, double-blinded trial.Materials and Methods:Ninety patients planned for upper abdominal surgery under general anesthesia were randomized into three equal groups to receive epidural drug via epidural catheter at start of incisional wound closure: Group R to receive ropivacaine (0.2%); Group RT1 to receive tramadol 1 mg/kg with ropivacaine (0.2%); and RT2 to receive tramadol 2 mg/kg with ropivacaine (0.2%). Duration and quality of analgesia (visual analog scale [VAS] score), hemodynamic parameters, and adverse event were recorded and statistically analyzed.Statistical Analysis:One-way analysis of variance test, Fisher's exact test/Chi-square test, whichever appropriate. A P < 0.05 was considered significant.Results:Mean duration of analgesia after epidural bolus drug was significantly higher in Group RT2 (584 ± 58 min) when compared with RT1 (394 ± 46 min) or R Group (283 ± 35 min). VAS score was always lower in RT2 Group in comparison to other group during the study. Hemodynamic parameter remained stable in all three groups.Conclusion:We conclude that tramadol 2 mg/kg with ropivacaine (0.2%) provides more effective and longer-duration analgesia than tramadol 1 mg/kg with ropivacaine (0.2%).

Background Blood gas (BG) analysis is routine today for patient management in intensive care units. Accurate analysis of different parameters in the BG is essential for managing critical patients. Errors in BG analysis can happen at many levels, with one of them being at sampling and heparinization. We compared self-prepared heparinized syringes rinsed with liquid heparin (LH) and the standard commercially available syringes with dry bound heparin (DBH) for arterial BG analysis of postoperative cardiac surgical patients. Methods This prospective observational study was conducted in 100 consecutive adult cardiac surgical patients in the cardiac surgical intensive care unit. Paired samples were collected, analyzed immediately, and statistically compared for pH, partial pressure of arterial oxygen (pO2), partial pressure of arterial carbon dioxide (pCO2), oxyhemoglobin saturation (SaO2), HCO, Na+, K+, Cl–, Ca2+, Mg2+, base excess (BE), hemoglobin (Hb), hematocrit, glucose, and lactate. Paired parameters were compared and agreement was evaluated using Bland–Altman difference plots. The 95% limits of absolute agreement (LOA) were compared with total allowable error (TEa). Results The BG parameters analyzed by two types of heparinized (LH and DBH) syringes were found to be comparable with a negligible mean difference and had an agreement outside the TEa of 8% for pO2, pCO2, and hematocrit, 7% for BE, 6% for Mg2+, 5% for K+, Ca2+, and lactate, 4% for HCOand Na+, 3% for pH, Cl–, Hb, and glucose, and zero for SaO2. The two types of syringes did not show clinically relevant discrepancies among many different parameters as per LOA and TEa limits. Conclusion In this study, we found that the BG parameters—respiratory, metabolic, and electrolytes—were comparable between the two types of syringes used for sampling. Unlike some previous studies, we did not find statistically significant differences among these analytes, which might have been due to appropriate self-preparation of heparin syringes.

Thrombocytopenia and absent radii (TAR) syndrome is a rare genetic disorder characterized by congenital absence of both radii, presence of both the thumbs, and severe thrombocytopenia which resolves spontaneously in childhood. The incidence is 0.5 to 1 per 100,000 live births and this syndrome may be associated with anomalies of other organs like gastrointestinal (milk protein allergy), genitourinary, cerebral, cardiac, renal, and so forth. Involvement of endocrine system is not reported in the literature. We describe a case of TAR syndrome with tetralogy of Fallot and newly diagnosed hypothyroidism.

Dual drainage or double-connection total anomalous pulmonary venous return (TAPVR) is a rare variant in which all four pulmonary veins enter a common venous chamber that then drains into the systemic veins via two or more channels at the supracardiac, cardiac, or infra-cardiac levels. The traditional classification of total anomalous pulmonary venous connection (TAPVC) does not categorize dual drainage separately.We present a case of TAPVR with dual drainage in a 6-year-old child with a rare variety of connection.