Ulinastatin treatment was associated with improved outcomes in patients with severe acute pancreatitis.

Percutaneous tracheostomy (PCT) is emerging as a popular method to secure a definitive airway in ventilated patients in critical care units as an alternative to surgical tracheostomy. It offers several advantages such as ease of performance, small skin incision, less tissue trauma, lower infection rate, bedside conduct as well as optimum utilization of ICU personnel. 1,2 The scope of PCT is increasing with training and experience, with successful management of more and more scenarios which were earlier perceived as contra indications. The present study was taken up with the objectives to evaluate safety of PCT in patients with difficult anatomy, bleeding diathesis and high ventilatory requirement, which are described as relative contra indications. We also intended to assess the complication rate and determine average time required.

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BACKGROUND The sequence of induction of anaesthesia, laryngoscopy and tracheal intubation is associated with marked haemodynamic changes and autonomic reflex activity which may be a cause of concern in many high-risk patients. Objective of this study is to compare the effects of oral Clonidine with Diazepam with respect to anxiolysis, sedation, anaesthetic requirements, heart rate, blood pre ssure, attenuation of sympathetic responses to laryngoscopy and intubation, respiratory rate and undesirable effects. MATERIALS AND METHODS 100 ASA I and II status normotensive patients scheduled for elective surgical procedure were selected randomly and divided into two groups of 50 each. Group I received 3 µgm/kg oral Clonidine and Group II received oral Diazepam 10 mg, 90 minutes before induction of anaesthesia. Anxiolysis, sedation, anti-sialagogue effect, respiratory rate, heart rate, systolic and diastolic pressure were recorded during premedication and 90 minutes after premedication. Also, the HR, systolic, diastolic blood pressures were recorded non-invasively during induction, 1, 3, 5, 10, 15, 30 minutes from the onset of laryngoscopy. Also, the dose of thiopentone injected intravenously till the loss of eyelash reflex was calculated and any undesirable effects were looked for. RESULTS After premedication with oral Clonidine 3 µgm/kg BW, heart rate, diastolic blood pressure, respiratory rate were equally comparable to oral Diazepam, however systolic blood pressure decreased in the Clonidine group and also the dose of Inj. Thiopentone was less in Clonidine group. After intubation, the incidence of tachycardia was significantly greater in the Diazepam group than in Clonidine group. Rise in SBP and DBP were also statistically significant in Diazepam group than in Clonidine group. CONCLUSION Clonidine provides better anxiolysis without any change in the respiratory pattern when compared with Diazepam group. Oral Clonidine 3 µgm/kg provides a consistent, reliable and effective attenuation of pressor response as compared to Diazepam 10 mg.

BACKGROUND Spinal anaesthesia with hyperbaric Bupivacaine Hydrochloride has been popular for surgical procedures. The need to intensify and increase duration of sensory blockade without affecting motor blockade has led to the addition of fentanyl, thus prolonging the duration of post-operative analgesia. Aim of this study is to assess the duration and quality of post-operative pain relief when Hyperbaric Bupivacaine Hydrochloride is combined with fentanyl for sub-arachnoid block and also to study the prolongation of motor and sensory blockade. MATERIALS AND METHODS 75 patients were randomly allocated into the following three groups Group A received SAB with 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric) Group B received SAB with addition of 10g fentanyl to 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric). Group C received SAB with addition of 25g fentanyl to 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric). RESULTS Mean duration of analgesia was increased with addition of fentanyl with 0.5% hyperbaric Bupivacaine intrathecally. Mean duration of analgesia was statistically highly significant in the fentanyl groups. The total dose of analgesics given in the postoperative period was highest in group A which was statistically significant. Times for two segment regression of sensory level were prolonged in group B and group C thus increasing the duration of sensory analgesia. Time to full motor recovery was not delayed in any of the three groups. The haemodynamic changes were similar in all the three groups with minimal changes in pulse rate and systolic blood pressure. CONCLUSION The addition of intrathecal fentanyl to the local anaesthetic injected intrathecally in subarachnoid block prolonged sensory analgesia obtained by the block without hampering recovery from motor block or causing untoward haemodynamic disturbances. Dose of 10 g fentanyl provided all these benefits which were accentuated by increasing the dose to 25g. Hence a dose of 10 g to 25 g as deemed fit is useful for this purpose.