Background: Dexmedetomidine an α2 agonist reduces heart rate and blood pressure due to sympatholytic activity. The aim of this study was to evaluate the effect of dexmedetomidine on haemodynamic response during endotracheal extubation in patients undergoing craniotomies for intracranial space occupying lesion (ICSOL).Methods: Sixty patients of ASA grade I and II, age 18-50 years scheduled for craniotomy for nonvascular ICSOL were selected after randomization into 2 groups with 30 patients in each group. Group D and C received an IV infusion of dexmedetomidine 0.5 mg/kg and normal saline 100 ml respectively over 10 min at the time of skin closure in a double-blind manner. Heart rate, systolic and diastolic blood pressure were recorded just before drug administration, 3 and 5 minutes after drug administration, during extubation and at 3, 5, 10 and 15 minutes after extubation. Respiratory rate and oxygen saturation were analyzed at 3, 5, 10 and15 minutes after extubation. Any laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension and bradycardia was noted.Results: Heart rate, systolic and diastolic blood pressure increased during emergence time in both groups (p<0.05) but this increase was more significant in control group than group D. SBP and heart rate were significantly lower in group D from 3 minutes after drug administration to 15 minutes after extubation. DBP was lower in group D during extubation till 15 minutes after extubation (p<0.01). No significant differences were observed in the respect of adverse events between the groups.Conclusions: Intravenous dexmedetomidine 0.5 mg/kg before extubation is attenuates haemodynamic response during endotracheal extubation in craniotomies.

Introduction: Femoral fractures are among the most common fractures of long bones. The management of pediatric femur fractures depends basically on the age group of the child although the age of bone and size of the child also determines the treatment choice. The choice of management may also be determined by surgical experience and local trends in practice. Study aimed to assess the results of treatment of paediatric femoral diaphyseal fractures with titanium elastic nails. Material and methods: The study was performed Medical institute. A total of 22 patients with closed shaft femur fractures and age ranging between 5-16 years scheduled to undergo treatment with titanium elastic nails were selected for the study. Children with open fractures, outside this age group with concomitant head injury, bilateral femur fracture or associated fracture of either limb whose fixation was done after 7 days were excluded from the study. No control group was used. They were treated by retrograde TENS fixation using two nails of equal diameter for each fracture. Pre-operative evaluation includes full length radiograph of the fractured femur both antero-posterior (A-P) and lateral views. Results: In the present study, 22 patients with closed shaft femur fractures were treated with titanium elastic nails. The mean age of the patient was 13.23 years. We observed that in regards to fracture location, proximal fracture was seen in 5 patients, midshaft fracture in 14 patients and distal fracture in 3 patients. However, in regards to pattern of location, transverse fracture was seen in 6 patients, oblique fracture in 8 patients, spiral fracture in 5 patients and comminuted fracture in 3 patients. Conclusion: From this study we can conclude that Intramedullary nailing of the pediatric femoral diaphyseal fractures using titanium elastic nail is an effective surgical modality, with advantages of minimal incisional scar, minimal soft tissue damage, with early union time and excellent union rates, and without affecting shoulder and elbow function.

Introduction: There are various methods of management of fractures in both bones of forearm in children. Historically, closed reduction and plaster cast application has been the gold standard in management of these fractures, however there are increased chances of re-displacement, particularly in older children. Aim of the study was to assess clinical outcomes of flexible intramedullary nailing in adolescent patients with forearm fractures. Material and methods: The study was performed in the Department of Orthopedics of the Medical institute. A total of 18 patients with age ranging between 10-16 years of age with a both-bone forearm fracture that was planned to treat with IM nailing were selected for the study. The subjects were evaluated of their preoperative and follow-up anteroposterior (AP) and lateral radiographic views of forearm Radiographic measurements were obtained using a pencil and goniometer and it included angulation of the fracture site, percentage translation of the distal fragment, and location of the ulnar fracture in relation to the radius. Results: There were 18 patients included in the study. The mean age of the patients was 12.34 years. The number of male patients was 11 and number of female patients was 7. We observed that the union of fractured bones at 3 months was seen in 50% patients; whereas, bony union at 6 months was seen in 72.3% patients. Loss of forearm rotation was seen in 22.22% patients. The complications seen were in 3 and 2 patients, that were both major and minor respectively. Conclusion: We conclude that Intramedullary nailing of forearm fractures in adolescent patients is an equally very efficacious treatment as compared to plate and screw fixation.