Aim:This study was designed to evaluate the efficacy of nitroglycerine (NTG), esmolol, and dexmedetomidine (DEX) as hypotensive agents in decreasing intraoperative blood loss by producing controlled hypotension in posterior spine surgeries.Materials and Methods:Sixty patients aged 18–60 years, the American Society of Anesthesiologists physical status Classes I and II of either gender, were randomly assigned into three groups to receive either: NTG (0.01%) at the rate of 3–10 μg.kg-1.min-1 after positioning without a prior loading dose in Group N, esmolol 500 μg.kg-1 loading dose over 1 min before induction of anesthesia followed by 50–300 μg.kg-1.min-1 infusion in Group E, and DEX 1 μg.kg-1 over 10 min before induction followed by 0.2–0.7 μg.kg-1.h-1. infusion in Group D to maintain mean arterial blood pressure (MAP) between 60 and 65 mmHg. The three groups were compared for the achievement of target MAP, intraoperative blood loss, reversibility of hypotensive state, quality of surgical field, emergence time, and postextubation sedation score.Statistical Analysis:Analysis of variance was used for intergroup analysis, and for multiple comparisons, Bonferroni post hoc test was applied. P < 0.05 was considered statistically significant.Results:Patients in Group D and Group E achieved the target MAP with better heart rate control as compared to Group N. The intraoperative blood loss was significantly lesser in Group D (P < 0.001). The time to hypotension reversal and emergence time was prolonged in Group D (P < 0.001). The mean quality of surgical field score was statistically insignificant among the three groups. The mean Ramsay Sedation Scores were significantly higher in Group D compared to Groups N and E at 20th and 40th min postextubation (P < 0.001) with no significant intergroup difference at 60th min postextubation (P = 0.130).Conclusion:Continuous infusion of DEX is an effective and safe method of producing controlled hypotension by achieving the target MAP, minimizing blood loss, and maintaining superior hemodynamics in comparison with NTG and esmolol in posterior spine surgeries.

Background: Acute severe pneumonia is the leading cause of death in children below five years of age. India tops in the list amongst the 15 countries having a high incidence of childhood pneumonia with 43 million episodes of pneumonia annually. Identification of modifiable risk factors of acute severe pneumonia can help in reducing the burden of disease. Methods: A hospital-based case control study was undertaken to determine risk factors associated with acute severe pneumonia in under-five children. A case definition of acute severe pneumonia as given by world health organization (WHO) was used for cases. Healthy children attending Pediatrics outpatient Department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in predesigned proforma. 732 children including 366 cases and 366 controls were enrolled in the study. Results: On stepwise logistic regression analysis it was found that low literacy status of the mother (OR:9.46; 95%CI:7.31-19.0); inappropriate immunization for age (OR:38.04;;cooking fuel other than liquid petroleum gas (OR:3.79; 95%CI: 2.40-6.78); low socioeconomic status (OR: 6.12; 95%CI: 2.42-35.48); overcrowding (OR:1.21; 95%CI: 1.03-2.21) and upper respiratory infection in family (OR:5.08; 95%CI: 3.79-7.67) were the significant contributors to the occurrence of acute severe pneumonia in children under five years. Conclusions: Low literacy status of mother, incomplete immunization status, use of fuel other than LPG, low socioeconomic status, overcrowding, family history of URTI emerged as risk factors for occurrence of acute severe pneumonia in under five children.

Landmark-guided zygomaticotemporal nerve blocks are a well-described modality to manage headaches in the temporal region. We report 3 cases in which ultrasound-guided zygomaticotemporal nerve blocks were performed for severe unilateral temporal headaches that failed to respond to standard treatment in the outpatient pain clinic. All the patients reported substantial and durable pain relief with no complications.

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