a b s t r a c tTransfusion and resuscitation practices in trauma have undergone a sea change over the past decade. New understanding of transfusion physiology and experiences in military trauma over the last decade has identified key factors taken as challenges in trauma. The most important challenge remains acute traumatic coagulopathy (ATC) which sets in early after a trauma and spirals the patient into shock and continued bleeding. World wide trauma is the leading cause of mortality. More than 6 million deaths occur due to trauma out of which 20% are due to uncontrollable bleeding. Out of the hospital admissions in trauma 20% develop coagulopathy. Mortality is three to four times higher in a patient with coagulopathy and thus prevention and correction of coagulopathy is the central goal of the management of hemorrhagic shock in trauma. Damage control resuscitation (DCR), a strategy combining the techniques of permissive hypotension, hemostatic resuscitation and damage control surgery has been widely adopted as the preferred method of resuscitation in patients with haemorrhagic shock. The over-riding goals of DCR are to mitigate metabolic acidosis, hypothermia and coagulopathy, This article looks at the importance of acute traumatic coagulopathy, its etiology, diagnosis, effects and resuscitation strategies to prevent it and to see the background behind this shift.ª 2014, Armed Forces Medical Services (AFMS). All rights reserved.

Background and Aims:Obstructive sleep apnoea (OSA) is largely undiagnosed in surgical population. Airway-related complication account for 35% of anaesthesia-related deaths and OSA patients have higher occurrence of difficult intubation (DIT). The aim of the study is to estimate the occurrence and compare utility of OSA screening parameters in predicting difficult mask ventilation (DMV) and DIT in patients with undiagnosed OSA.Methods:A prospective observational study was conducted in a tertiary care centre in patients undergoing elective surgery. STOP-BANG questionnaire was administered preoperatively along with collection of demographic data and airway assessment. Population was divided in to OSA and non-OSA groups based on STOP-BANG score >3. Occurrence of DMV, laryngoscopy (DL), and DIT were compared between both groups using DMV score, Cormack–Lehane grading, and intubation difficulty scale score, respectively.Results:A total of 54 patients in OSA and 46 patients in non-OSA group were studied. A total of 49 cases of DMV, 14 cases of DIT, and 25 cases of DL were encountered. In the OSA group, there was 77.7% DMV, 22.2% DIT, and 33.3% DL. History of snoring had the highest sensitivity and negative predictive value while history of apnea, body mass index >35, sleep apnoea clinical score had the highest specificity in determining occurrence of difficult airway. Multivariate logistic regression analysis demonstrated STOP-BANG score as the single most important predictor of DMV (odds ratio 3.15, 95% confidence interval, 2.06–4.8).Conclusion:Positive screening test for OSA is associated with difficult airway management.

Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain management interferes with early discharge of patient. Administration of opioid for pain relief is a concern because of its side effects. To avoid this problem, we planned our study to find out the best alternative of opioid in patients undergoing laparoscopic cholecystectomy. Methods: 68 patients were enrolled for this study in a stipulated time of 1 year in a tertiary level hospital. A questionnaire was responded by patients and a chart was maintained for pain score in visual analogue scale (VAS) and for side effects. We used paracetamol and diclofenac as post operative analgesic in two different groups and data was recorded in Excel panel and was analyzed by standard statistical test by software MINITAB 1513 with a significant p-value of <0.05. Results: We have found the significant outcome (p-values are 0.0005 at 0 hrs, 0.003 at 2 hrs, 0.001 at 6 hrs, 0.0005 at 12 hrs) in VAS pain score in between the two groups at different intervals. Patients who were administered paracetamol had shown better outcome with less requirement of rescue analgesia and side effects. Conclusion: Administration of intravenous paracetamol in the intra operative period 30 minutes prior to the completion of surgery followed by administration of 1g paracetamol every 8 hourly in the post-operative period gives better quality of analgesia.