Disseminated intravascular coagulation (DIC) is seen in <5% of patients with severe Plasmodium falciparum malaria and is more common in cerebral malaria. Here, we report the diagnosis and management of a case of severe P. falciparum malaria with DIC.

BACKGROUNDPostoperative nausea and vomiting is the most common and unpleasant event following laparoscopic cholecystectomy often involving multifactorial pathways and receptors. Combination prophylaxis acting through different mechanisms has been shown to be superior to the use of a single agent in prevention of PONV. We designed this study to find out and compare the efficacy of preoperative palonosetron and palonosetron with dexamethasone for the prevention of Postoperative Nausea and Vomiting (PONV) following elective laparoscopic cholecystectomy under general anaesthesia.

Introduction: For the best maternal and foetal outcome during caesarean section under spinal anaesthesia, maintaining Systolic Blood Pressure (SBP) at 100% of the baseline is necessary. Mephentermine and Phenylephrine are both sympathomimetic drugs used for timely correction of maternal hypotension. Aim: To compare the effect of intravenous bolus administration of mephentermine and phenylephrine for prevention and management of maternal hypotension and to evaluate the foetal outcome. Materials and Methods: In this randomised double-blinded controlled trial, a total of 150 American Society of Anaesthesiologist (ASA) II scheduled for elective Lower Segment Caeserean Section (LSCS) were randomly allocated into three groups to receive the study drugs: group A received mephentermine 6 mg in 2 mL Normal Saline (NS), group B received phenylephrine 100 mcg in 2 mL NS, and group C received 2 mL NS immediately following subarachnoid block. Whenever hypotension occurred (Systolic Blood Pressure (SBP) <90 mm Hg) rescue boluses were given. Maternal haemodynamic parameters, umbilical cord blood gases, and complications were recorded from the time of sub-arachnoid block till the end of surgery. Results: There was no significant difference in the maternal haemodynamics and neonatal outcome among the three groups. It was observed that phenylephrine had quick peak effect, higher foetal umbilical pH and better neonatal outcome though statistically insignificant. Incidence of significant bradycardia (16%) and absence of intraoperative nausea and vomiting were also reported among group B. None of the neonate had APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score <7 and the umbilical pH was comparable in all the three groups (p >0.05). The time of first rescue vasopressor and the total volume of requirement was earlier and higher in group C with the mean timing of 5.87±4.37 min and mean volume of 2.68±1.58 mL respectively. Conclusion: There is a significant improvement of arterial blood pressures and better neonatal outcome observed when phenylephrine (100 mcg) and mephentermine (6 mg) are given as a prophylactic intravenous (i.v.) bolus dose immediately after subarachnoid block; especially in the initial time period between skin incision and delivery of the baby. When given as a prophylactic i.v. bolus, it had the advantage of lesser total dose requirement of the vasopressor used and better haemodynamic maintenance till the delivery of the baby

mg). The incidence of nausea, and vomiting, severity of nausea and need of rescue antiemetic were studied for the first 24 hours postoperatively at 0-6 hours and 6-24 hours and 0-24 hours.Results: The incidence of nausea, PONV, rescue antiemetic were reduced in the RD group during 0-6 hours post operative periods while the incidence of vomiting was significantly reduced in RD group during 0-6 hours post operative (P = 0.003). The severity of nausea which measured by VRS was also significantly lesser in the RD group (P = 0.00). There were no clinically significant adverse effects during the study which required intervention. Following the study, patients were reported to have experienced satisfactory postoperative period. Conclusions: Perioperative prophylaxis of ramosetron with dexamethasone combination given before the induction of anaesthesia is more effective regimen than ramosetron alone in preventing the incidence of PONV after elective laparoscopic cholecystectomy under general anaesthesia.

Introduction: Propofol contributes largely in the rapid evolution of day care surgery due to its superior recovery characteristics. However, it is associated with dose-dependent systemic arterial hypotension which increases morbidity and mortality. Bispectral index or BIS is an Electroencephalographic (EEG) derived parameter used to assess the depth of anaesthesia. Titrating drugs to a specific BIS value during general anaesthesia allows to adjust the dose of anaesthetic needed by the patient thereby, reducing the dose related side-effects. Aim: To determine whether the dose of propofol guided BIS values causes less arterial hypotension than the commonly used sleep dose method. Materials and Methods: The present study was a randomised control trail conducted on 92 patients of American Society of Anesthesiologists (ASA) I and II physical status, aged 18-60 years, of both genders, scheduled for elective surgeries under general anaesthesia and were randomly divided into group A and B (46 in each). For induction of anaesthesia, Group A received propofol till the BIS values reached 50±1 for 30 seconds, while Group B received sleep dose of propofol without BIS monitoring. Haemodynamic effects Heart Rate (HR), Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP) and Mean Arterial Pressure (MAP) were recorded at baseline, during induction and at 1, 5, 10 and 15 minutes after intubation. Total propofol consumption and secondarily, level of sedation after extubation using Ramsay Sedation Scale were also measured in both the groups. Results: The total dose requirement of propofol was reduced significantly in group A compared to group B (p<0.005). Blood pressure decreased from the baseline in both the groups following induction with propofol but was insignificant. HR increased by 2.2% in group A while it decreased by 8.5% in group B but was insignificant (p>0.005). On arrival to Post Anesthesia Care Unit (PACU), group A were more co-operative, oriented patients compared to group B (67.4% vs 32.6% respectively). Conclusion: BIS monitoring significantly reduces the consumption of propofol for induction of anaesthesia while the incidence of hypotension was similar in both the groups. Lower sedation level with comparatively better extubation score with the use of BIS helps in fast tracking.