Background: Surgical construction of an arteriovenous fistula is preferred for end-stage renal failure patients requiring long-term haemodialysis. Methods: Patients were randomised into two groups: brachial plexus group (n = 30) or local infiltration group (n = 30). In all patients, a radiocephalic arteriovenous fistula was created by an experienced surgeon using a standard surgical technique. In both groups 20 ml of 0.375% ropivacaine was used. Doppler assessment of vessels was performed at fixed time intervals. Results: Primary patency rate was 100% in the brachial plexus block group whereas there was 10% fistula failure rate in the local infiltration group (p-value = 0.237). Diameter of the vessels, peak systolic velocity, mean diastolic velocity, and blood flow at 30 minutes, 48 hours, 2 weeks, and 6 weeks after the fistula creation was significantly greater than the preoperative diameter in all patients (p-value < 0.05). Intergroup comparison revealed that vascular parameters were significantly better in the brachial plexus analgesia group versus local infiltration group at all observation points up to and including six weeks post fistula creation (p-value < 0.05). Conclusion: Brachial plexus anaesthesia significantly dilates the vessel diameter and increases blood flow whereas local infiltration has a negligible effect on vessel diameter and blood flow.

Keeping in mind midline tissue support loss in cleft deformities, we propose routine use of left paraglossal laryngoscopic approach for intubating children with uncorrected BL CL/P anomalies.

In 1961, Sellick popularized the technique of cricoid pressure (CP) to prevent regurgitation of gastric contents during anesthesia induction. In the last two decades, clinicians have begun to question the efficacy of CP and therefore the necessity of this maneuver. Some have suggested abandoning it on the grounds that this maneuver is unreliable in producing midline esophageal compression. Moreover, it has been found that application of CP makes tracheal intubation and mask ventilation difficult and induces relaxation of the lower esophageal sphincter. There have also been reports of regurgitation of gastric contents and aspiration despite CP. Further, its effectiveness has been demonstrated only in cadavers; therefore, its efficacy lacks scientific validation. These concerns with the use of CP in modern anesthesia practice have been briefly reviewed in this article.

Background A few animal studies have shown that IL-6 can serve as an early marker of fat embolism syndrome. The degree to which this is true in human trauma victims is unknown. Questions/purposes In this clinical study, we sought to determine (1) whether elevated serum IL-6 levels at 6, 12, and 24 hours in patients with skeletal trauma were associated with the development of fat embolism syndrome (FES) within 72 hours after injury, and (2) at what time after trauma peak IL-6 levels are observed.Methods Forty-eight patients between 16 and 40 years old who presented to our tertiary trauma center within 6 hours of injury with long bone and/or pelvic fractures were included in this study. Serum IL-6 levels were measured at 6, 12, and 24 hours after injury. The patients were observed clinically and monitored for 72 hours for development of FES symptoms. Gurd's criteria were used to diagnose FES.

Objective: Debridement of burn wounds and skin graft harvesting is associated with increased perioperative bleeding. In this study we evaluated the effectiveness of tranexamic acid in reducing blood transfusion requirements during burn wound debridement/eschar removal and skin graft harvesting in adults with major burn injuries, with the primary outcome being the total amount of intraoperative blood loss. Methods: Fifty adult patients having >20% total body surface area of burn wounds, scheduled for wound debridement/eschar removal ± skin grafting after 10 days of burn injury under general anaesthesia were included. Patients were randomly allocated to receive either injection tranexamic acid 15 mg/kg diluted to 25 ml with isotonic saline over 10 min or an equal volume of only isotonic saline before induction of general anaesthesia. Venous blood gas analysis was done in the beginning and end of surgery, and then at 24 postoperative hours to assess hemoglobin levels of the patients. Blood transfusion was given when hemoglobin levels fell down to or below 7 gm/dl. Intraoperative blood loss was calculated using the Gross formula. Results: Intraoperative blood loss was found to be significantly higher in placebo group compared to tranexamic group, 990 ± 358.9 ml vs 581 ± 333.2 ml (p < 0.00), with more blood and colloid solutions being used to replace the blood loss in placebo group (p < 0.05). Conclusions: Preoperative administration of a single dose of tranexamic acid significantly reduces blood loss during debridement of burn wounds and skin graft harvesting surgeries without increasing the risk of untoward side-effects or complications.