Penetrating injury brain is common after accidental falls, sharp projectile injury, suicidal attempts etc. We present an unusual case of accidental penetrating nail injury brain in a 19 year old male patient presenting for emergency craniotomy. This case report highlights the difficulties faced in the anesthetic management of patients presenting with penetrating injury brain.

Aim:The objective of this study was to assess and compare the analgesic duration of local infiltration of bupivacaine plus magnesium sulfate and ropivacaine plus magnesium sulfate for postoperative analgesia in patients undergoing lumbar laminectomy.Study Design:A randomized, prospective, double-blinded single hospital, comparative study.Methods:Sixty adult patients of the American Society of Anesthesiologists physical Status I and II were randomly allocated into two Groups BM and RM, comprising 30 and 31 patients. Postlumbar laminectomy, the study drug was locally infiltrated into the paravertebral muscles on either side before skin closure. Group BM was given 20 ml of 0.25% bupivacaine combined with 500 mg of magnesium sulfate (constituted with normal saline [NS]), and Group RM was given 20 ml of 0.25% ropivacaine combined with 500 mg of magnesium sulfate (constituted with NS). Postoperative visual analog scale pain score was assessed hourly for the first 24 h postoperatively. Duration of postoperative analgesia, rescue analgesia consumption and side effects were also recorded.Statistical Analysis:Comparison of data between the groups was done with SPSS 21.0© using independent t-test, Chi-square test, and Mann–Whitney U-test accordingly. P<0.05 was considered statistically significant.Results:Time to first analgesic consumption was significantly longer in Group BM (7.3 ± 0.46 h) compared to Group RM (6.6 ± 0.69 h) (P < 0.05). The consumption of nalbuphine rescue analgesic was significantly higher in Group RM (15.33 ± 5.07 mg) compared to Group BM (12 ± 4.07 mg) (P < 0.05).Conclusion:Wound infiltration with bupivacaine and magnesium sulfate compared to ropivacaine and magnesium sulfate provided longer duration of postoperative analgesia and significantly reduced postoperative opioid consumption in patients undergoing lumbar laminectomy.

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The clinical factors affecting a patient's condition monitored over time could be useful not only to decide on an intervention that may increase the patients' possibilities of survival but also to predict the treatment outcome. Therefore, this study evaluates the clinical factors as predictors of mortality among severe sepsis patients admitted in the intensive care unit (ICU) of a tertiary care center. Method We did a prospective study on over 50 life-threatening infective cases with different causes admitted in the ICU. Clinical and biochemical parameters like temperature, heart rate, blood pressure, bicarbonate levels, blood lactate levels, and pH were monitored at admission, after 24 hours, and after 72 hours. The statistical analysis was done using Microsoft Excel (Microsoft Corporation, Redmond, WA) and the Statistical Package for the Social Studies (SPSS) version 22 (IBM Corp., Armonk, NY). We have obtained ethical clearance from the ethics committee (human) of Assam Medical College and Hospital, Dibrugarh. Before the collection of the data, we also took informed consent from the participants. Results The mean age of non-survivors was 44.35±11.64 years and that of survivors was 36.60±9.28 years, and the difference was statistically significant (p-value <0.003). An analysis of values of the various vital signs indicated substantial differences in the mean at different time intervals among survivors and non-survivors (p-value <0.05). Among non-survivors, mean temperature, pulse, and rate of respiration were observed to increase over time while blood pressure and oxygen saturation levels were significantly decreasing. Compared to survivors, the mean lactate levels of non-survivors at different time intervals were statistically significant (p-value <0.05). It is also observed that the pH of non-survivors was lower than survivors, and the mean pH value significantly different at different time intervals among the two groups (p-value <0.05). Conclusion The temperature, pulse, rate of respiration, blood pressure, and oxygen saturation levels are essential determinants of patient mortality in those suffering from a severe infection, besides serial lactate levels, bicarbonate levels, and pH levels.

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