BACKGROUND AND OBJECTIVES: Magnesium has been used as an adjuvant by various routes, including intravenous, intrathecal and epidural in different dosage regimens. This is a prospective, randomized, controlled study designed to assess the efficacy of single bolus administration of Magnesium epidurally as an adjuvant to epidural fentanyl for postoperative analgesia in patients undergoing orthopedic hip surgeries under combined spinal epidural anesthesia. MATERIALS and METHODS: 50 Patients of ASA grade I and II aged 35 to 50 years of either gender undergoing orthopedic hip surgeries enrolled in study received combined spinal epidural anesthesia with 3 ml of 0.5% hyperbaric bupivacaine intrathecally. After surgery patients were randomized into Group F (epidural fentanyl 50µg in 10ml saline) and Group FM (epidural magnesium 75 mg along with fentanyl 50µg in 10 ml saline). Rescue analgesic is provided by intravenous tramadol if VAS score >4. Patient's first analgesic requirement time and duration of analgesia were recorded. RESULT: The duration of analgesia was significantly longer for Group FM compared to Group F. The frequency of rescue analgesics required in 24 hr postoperative period in Group FM was significantly less than that in Group F. CONCLUSION: The administration of magnesium as an adjuvant to epidural fentanyl for postoperative analgesia results in significantly lower VAS with prolonged duration of analgesia as compared to epidural fentanyl alone.

BACKGROUND: Xeroderma Pigmentosum (XP) is a rare autosomal recessive disorder characterized by hypersensitivity of the skin to UV radiation. These patients show a failure to repair UV induced DNA lesions caused by Nucleotide Excision Repair mechanism. They develop neoplasms at an early age and require repeated surgeries. METHODOLOGY: We report an 18 year old female patient with XP who presented with squamous cell carcinoma over parotidectomy site and was scheduled for wide excision and skin grafting. During Pre anesthetic checkup, difficult air way was anticipated and so all the available airway gadgets were kept ready. General anesthesia with propofol was planned. OBSERVATION: After adequate preparation, counseling regarding anesthetic plan of action and high risk consent, propofol given followed by succinylcholine. Patient had severe restriction of mouth opening when compared to preoperative period probably due to masseter spasm after succinylcholine. Placing an I-Gel by an experienced anesthesiologist helped in the successful management of this case. CONCLUSION: Newer supraglottic devices like I-Gel may be considered as a safer alternative in such difficult situations.

INTRODUCTION: Magnetic Resonance Imaging (MRI) causes a great amount of anxiety to both parents and child. Fear of unpleasant procedures and separation from parents may result in lasting and untoward psychological consequences in children. So sedation and anxiolysis is required for children undergoing even for minor diagnostic procedures. OBJECTIVES: The objectives of our study was to compare safety, onset of sedation, degree of sedation produced by intranasal and sublingual administration of midazolam for premedication in children of 4-10 years undergoing MRI. MATERIALS AND METHODS: In this prospective randomized double blind study, the intranasal and sublingual administration of midazolam in pediatric patients who were to undergo MRI was evaluated in 60 children who were aged between 4-10 years with ASA physical status I and II by using a newer midazolam spray. The patients were divided into two groups of 30 patients each and they received Midazolam 0.3 mg/kg. Either intranasally or sublingually in a randomized manner. The heart rate, oxygen saturation (SPO2), respiratory rate and the degree of sedation before and at 3 minutes intervals, recovery score, MRI image quality were recorded and compared. RESULTS: The respiratory rate, heart rate and the oxygen saturation was found from the baseline in both the groups (p >0.05). A sedation score of >3 (approx.) was achieved in both the groups within 10 minutes of drug administration. The recovery score did not differ significantly between the two groups (p >0.05). CONCLUSION: Both the intranasal and sublingual administration of Midazolam as sedative is safe and equally effective in pediatric patients.