No abstract

Background: Regional anesthesia avoids airway instrumentation, preserves conscious level and provide rapid recovery with significant postoperative analgesia. There has always been a search for adjuvants to the regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects. The search for the ideal additive still continues, and therefore in this study, we investigated the effects of addition of dexamethasone versus clonidine to levobupivacaine for supraclavicular brachial plexus block. The primary outcome of this study was the onset and duration of sensory block, motor block, and the secondary outcome was postoperative analgesia. Aims and Objectives: The aim of the study was to compare the effect of dexamethasone and clonidine on onset and duration of anesthesia, when used as an adjuvant to levobupivacaine in supraclavicular brachial plexus block. 7. Materials and Methods: In this prospective, double-blind, randomized controlled trial, 60 patients with American Society of Anaesthesiologists physical status I/II scheduled to undergo upper limb surgeries below shoulder were enrolled. The patients were randomly divided into two groups: Group I (n=30): 20 mL of 0.5% isobaric levobupivacaine with 2 mL of dexamethasone. Group II (n=30): 20 mL of 0.5% isobaric levobupivacaine and 30 mcg clonidine (diluted in normal saline, making volume of 2 mL). Results: Clonidine when added to levobupivacaine provide early onset of sensory and motor block but less duration of analgesia and motor blockade as compared to dexamethasone. Conclusion: Dexamethasone should be preferred as compared to clonidine as an adjuvant whenever longer duration of post-operative analgesia is required.

Objectives:To compare the intubating conditions of dexmedetomidine alone versus fentanyl -midazolam combination during AFOI Methodology: Group-I patients (n=30) received dexmedetomidine 1µg/kg bolus infusion over 10 minutes, followed by infusion of 0.1 µg/kg/hr titrated to 0.7 µg/kg/hr whereas Group-II patients (n=30) received i.v fentanyl 2µg/kg bolus followed by midazolam infusion of 0.02-0.1mg/kg/hr until they were adequately sedated i.e. Ramsay Sedation Score (RSS) of 3 .Intraoperatively Total Comfort Score, 5 point FOI score was noted and Questionnaire assessment was done 24 hours after surgery. Results: During preoxygenation, the mean TCS was not statistically signicant different between the two groups but during FOS and during intubation, the mean TCS was lower in group-1than group-2and the difference between the two groups was statistically signicant.(p<0.05). Signicant differences in the patient's reaction to tube were found during FOS and after intubation between the two groups with lower reaction in dexmedetomidine group(p≤0.05). During follow-up assessment 24 hours after the surgical procedure, the dexmedetomidine group patients judged their sedation more positively and were having less pain and discomfort during the procedure than fentanyl plus midazolam patients. Conclusion: The use of dexmedetomidine at 1mcg/kg bolus over 10 minutes, with maintenance rates of 0.1-0.7 μg/kg/hr offer better tolerance, preservation of a patent airway and spontaneous ventilation, while maintaining hemodynamic stability during AFOI.

A 22 year old pregnant woman was hospitalised with fever, cough, myalgia and dyspnoea at 12 weeks of gestation. Worsening respiratory distress and lack of improvement in peripheral oxygen saturation mandated the need for mechanical ventilation and ICU admission. A nasopharyngeal swab proved positive for severe acute respiratory syndrome coronavirus 2 by reverse transcription-PCR. In view of poor P/F ratios patient was ventilated intermittently in prone position for approximately 14-16 hours/day. With this strategy, patient was ventilated for 5 days and successfully extubated. Regular foetal assessments revealed that the fetus was unharmed by the intervention. Thus, we recommend timely prone ventilation in pregnant patients with severe covid 19 infection for better outcomes

Background: The hemodynamic changes during awake fibreoptic intubation (AFOI) are attributed to patient’s anxiety, poor topicalization of the airway, excessive sedation, lack of expertise, pain, prolonged time to intubation, stimulation of oropharyngeal structures, and jaw thrust to aid intubation. In this study, we compared hemodynamic changes of dexmedetomidine (DEX) with midazolam (MDZ) and fentanyl during AFOI. Aims and Objectives: The objective of the study is to compare the hemodynamic changes in DEX alone versus fentanyl- MDZ combination during AFOI. Materials and Methods: Group-I patients (n=30) received DEX 1 μg/kg bolus infusion over 10 min, followed by infusion of 0.1 μg/kg/h titrated to 0.7 μg/kg/h whereas Group-II patients (n=30) received iv fentanyl 2 μg/kg bolus followed by MDZ infusion of 0.02–0.1 mg/kg/h until they were adequately sedated, i.e. Ramsay Sedation Score (RSS) of 3. Hemodynamics including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation (SpO2) were recorded when patient is sedated, i.e. at RSS-3, every min of fibrescopy till 5 min and at intubation and every 3rd min post-intubation till 30 min. Results: Measurements of the HRs in the two groups showed significant differences between the two groups at RSS-3, during FOS and post-intubation with the DEX group showing lower mean HRs compared with the MDZ and fentanyl group. SBP and DBP showed a fall in both the groups as compared with the baseline at RSS-3, during FOS and post-intubation; however, no significant differences were noted between the two groups. The mean SpO2values show significant difference between the two groups. (P<0.05) at RSS-3, FOS, post intubation upto 18 min (P<0.05). Conclusion: The use of DEX at 1 mcg/kg bolus slowly over 10 min, with maintenance rates of 0.1–0.7 μg/kg/h, is safe and beneficial for patients undergoing AFOI. Thus, DEX acts like an ideal drug for AFOI. It provides excellent intubating conditions without significant hemodynamic perturbations and risk of hypoxia.