Background:Fentanyl-induced cough is not always benign and brief and can be remarkably troublesome, spasmodic, and explosive. Dextromethorphan, an opioid derivative with an antitussive action, may be effective in reducing the fentanyl-induced cough. Dextromethorphan, a N-methyl D aspartate receptor antagonist, may have some effect on diminishing the stress response to surgery. This study was undertaken to determine whether preoperative dextromethorphan could effectively attenuate its incidence, severity, and effect on postoperative stress hormone levels.Materials and Methods:Three hundred and twenty patients of American society of anesthesiologists I-II, aged 18–60 years, undergoing elective laparoscopic cholecystectomy or appendicectomy were randomly allocated into two groups (Group C, control; Group D, dextromethorphan) consisting of 160 patients each. Patients in Group D received dextromethorphan 40 mg orally and in Group C received placebo tablets 60 minutes before induction of anesthesia. The incidence of cough was recorded for 1 minute after fentanyl injection and graded as none (0), mild (1–2), moderate (3–5), and severe (>5 cough). Blood samples were collected for estimation of stress hormone levels before surgery and again at 1 hour and 24 hours postoperatively and compared. The appearance of adverse reactions was recorded.Results:The incidence of reflex fentanyl cough was lower in dextromethorphan group (3.9%) in comparison to placebo (59.8%). Five patients developed mild and one moderate cough in the dextromethorphan group. In the control group, 31 patients developed mild, 29 moderate, and 32 severe cough. The stress hormones were significantly higher at 1 hour and 24 hours postoperatively in both groups in comparison to its preoperative values. However, at 1 hour postoperatively, adrenocorticotropic hormone, epinephrine, and growth hormone values were significantly low in the dextromethorphan group (61.5 ± 21.1 pg/ ml, 142.1 ± 11.2 pg/ml, and 3.8 ± 0.7 ng/ml) relative to the control group (73.4 ± 21.9 pg/ml, 158.9 ± 17.9 pg/ml, and 4.2 ± 1.3 ng/ml), but changes became insignificant at 24 hours postoperatively.Conclusion:Preoperative oral dextromethorphan 40 mg decreased the incidence and severity of fentanyl induced cough and reduced the rise in stress hormones at 1 hour postoperatively.

No abstract

No abstract

Last year in the month of August and September there had been an increased incidence of Japanese Encephalitis being reported all over West Bengal, India. Keeping this public and medical interest in the backdrop, the authors are reporting a 28 years old female patient admitted to the medical ward with acute onset flaccid paralysis of both lower limbs, diplopia, nasal intonation of voice, difficulty in swallowing and features suggesting facial nerve palsy.The intensivist was called for management of gradually worsening respiratory failure and the patient was put on mechanical ventilator after being shifted to Intensive Therapy Unit. On neurological examination, power of lower limb was diminished with sixth and seventh cranial nerve palsy. The patient was diagnosed to have Japanese Encephalitis infection by a four-fold rise in virus-specific antibody detected in paired acute and convalescent sera by enzyme-linked immunosorbent assay. In nerve conduction velocity test she had bilateral symmetrical demyelinating sensory>>motor polyradiculoneuropathy suggestive of Sural nerve sparing acute inflammatory demyelinating polyneuropathy. Cerebrospinal fluid study revealed albumino-cytological dissociation. She was off the ventilator after 3 days of full course of plasmapheresis and she gradually regained her motor power with physiotherapy and nursing care.Japanese Encephalitis patients are mainly admitted with feature of central nervous system insults and have poor prognosis. Syndromic association of Japanese Encephalitis with sixth/seventh cranial nerve palsy having Guillain-Barré Syndrome without any features of meningo-encephalitis is a rare phenomenon and there are very few case reports in literature regarding this topic. This case report highlights the successful management of such rare experience.

No abstract