The virus SARS-CoV2 and the disease spectrum caused by it have led to a widespread impact on the medical and economic status of all nations of the world. This led to an expedited mission to introduce a vaccine which could attempt to neutralize the pandemic to some extent. Many vaccines have been introduced with an acceptable safety profile, producing only mild adverse effects of soreness at injection site, malaise, fever, diarrhoea, myalgia and uncommonly allergic/anaphylactic reactions and possibility of getting infected with SARS-CoV2. Some isolated reports have also emerged of serious thromboembolic phenomena and neurological complications such as Guillain-Barré Syndrome (GBS). A similar incident was noticed at our institute, where a 71 year old male recipient of COVID-19 vaccine at an immunization centre, presented to us with features of GBS. We hereby report this case, not establishing a direct link between the two, but to raise awareness regarding the ongoing mass immunization world-wide.

Background: Total knee replacement (TKR) is associated with intense post-operative pain. Providing both optimal analgesia and early mobilization are vital for the patient. We hypothesized the adductor-canal-block, being a pure sensory block, provides a longer ambulation distance by patient when compared with femoral nerve block as the latter causes both sensory and motor block. Method: Patients aged 30-80 years scheduled for TKR were included in this randomized controlled trial. The patients were divided into two groups, one received a continuous adductor-canal-block(n=25)and other group received continuous femoral nerve block(n=25) via a catheter with continuous infusion of 0.2% Ropivacaine at the rate of 5-10 ml/hour. During the next 24 hours VAS and MMT score were calculated at different intervals. 10 metre ambulation distance covered by patients was measured after 24hr of surgery. Result: 50 patients were analysed using student t test. The Visual Analogue Scale and Manual Muscle Testing score were noted during 24-hour period post-op. There was a significant difference among the VAS scores in the two groups at 2 hours post-op period only. The MMT was significantly different at 2 instances – 6 and 12-hours post-op. The ambulation distance post-24-hours surgery showed no significant difference between the two groups. Conclusion: Based on our study it can be concluded that either ACB or FNB can be administered to the patients as both blocks are almost equally effective in terms of ambulation distance after 24 hrs of surgery and pain relief in post-operative period. Keywords: Total knee replacement, Adductor canal block, Femoral nerve block, Ambulation distance, VAS and MMT.

The year 2020 saw the rise of an influenza-like illness from SARS-nCoV2 (Severe Acute Respiratory Illness by novel Coronavirus 2), which causes myriad of symptoms in patients, ranging from mild upper respiratory symptoms to severe ARDS (Acute Respiratory Distress Syndrome). It is, however, known to cause high morbidity and mortality in patients with underlying comorbidities like diabetes, hypertension, kidney disease, obesity and malignancies. Amongst these, the subset with haematological malignancies has an especially poor prognosis possibly as a result of immune suppression, due to underlying bone marrow depression as well as effects of chemotherapeutic agents. These patients need frequent visits and admissions to the hospital for treatment, thus exposing them to the risk of acquiring the infection. Also, a high index of suspicion, with low threshold for testing is needed in view of possible atypical presentation and symptoms. These patients may also warrant an early ICU admission, as they tend to develop severe disease with ARDS more frequently, with an overall poor prognosis and high mortality rate. We hereby present a series of six patients with underlying haematological malignancies who were admitted in our ICU with a serious COVID-19 illness and a grave outcome.

Patients with nasal polyposis frequently have associated bronchial asthma and hypersensitivity to NSAIDs. When the three conditions co-exist, it is referred to as the Samter’s triad. Patients with Samter’s triad are an important subset of those with aspirin-exacerbated respiratory disease (AERD). We present a case of a young female patient undergoing endoscopic sinus surgery for nasal polyps, who although did not show any other features of AERD, went on to develop florid anaphylaxis to diclofenac administration intra-operatively. After adequate resuscitation and intensive care stay, the patient made a complete recovery. NSAIDs must be avoided in patients with nasal polyps, despite showing no other features of this syndrome. Other analgesic agents that can be used include IV paracetamol and opioids like tramadol.

Objective Perioperative shivering is a very common complication. Despite the vast array of knowledge regarding perioperative shivering and its after-effects, its prophylaxis is often overlooked. The study aims to compare the efficacy and safety of low-dose ketamine, ondansetron, and pethidine in the prevention of perioperative shivering in patients undergoing total knee replacement surgery under the subarachnoid block. Methods In this randomized controlled study, 203 patients aged 18-75 were included and allocated to one of the 4 groups; normal saline (group S), ondansetron 4 mg (group O), ketamine 0.25 mg kg −1 (group K), and pethidine 0.25 mg kg −1 (group P). Side effects, namely hypotension, nausea and vomiting, sedation, hallucinations, and respiratory depression were recorded. Results Perioperative shivering was present in 22 (44%), 8 (16%), 4 (7.84%), and 4 (7.69%) patients respectively in group S, O, K, and P, which was statistically significant when compared to group S with group K and P ( P < .01). No difference in the incidence of hypothermia was observed across the groups ( P < .17). A significantly lower incidence of hypotension was observed in group K. In group K, 5.9% of the patients were scored as being under severe sedation, according to the modified Wilson sedation scale. There was no incidence of hallucination or respiratory depression observed in any of the groups. Conclusions Patients undergoing total knee replacement surgeries are highly predisposed to the development of hypothermia. Temperature monitoring is thus imperative for all patients. Prophylactic administration of low-dose ketamine or ondansetron or low-dose pethidine produces a significant anti-shivering effect without any significant side effects. However, low-dose ketamine has the advantages of a lower incidence of hypotension, nausea, and vomiting than pethidine.