Background and Aims:Eclampsia is a common hypertensive disorder of pregnancy and treatment often includes termination of pregnancy with elective postoperative mechanical ventilation. The present study was aimed to compare midazolam, propofol, and dexmedetomidine for sedation and antihypertensive requirements of such patients admitted to Intensive Care Unit (ICU) after termination of pregnancy.Material and Methods:A total of ninety eclamptic patients administered general anesthesia for the termination of pregnancy through cesarean section and who also required postoperative ventilation were taken up for the study and were randomly allocated into three groups. All patients received MgSO4 (loading dose, 4 g intravenous) following first seizure episode followed by a continuous infusion for next 24 h. Midazolam group (GrM) received 0.05 mg/kg loading dose of midazolam, followed by infusion of 0.05–0.3 mg/kg/h, propofol group (GrP) received 1 mg/kg loading dose of propofol followed by infusion of 2–8 mg/kg/h, and dexmedetomidine group (GrD) received dexmedetomidine loading dose at 1 mcg/kg followed by infusion of 0.2–1.2 mcg/kg/h. Postoperatively, patients were assessed for hemodynamic stability, requirement of antihypertensive and analgesics, duration of sedation and stop sedation-discharge, and total time spent in the ICU.Results:Mean heart rate and mean arterial pressure recorded at different time intervals were lowest in GrD. Nearly 70% (n = 21) patients in the GrM required antihypertensive, 50% (n = 15) in GrP, and 36.6% (n = 11) in the GrD (P < 0.05). Duration of stop sedation-discharge from ICU was least in GrD. A number of patients demanding additional analgesics was also least in GrD.Conclusion:Sedation with dexmedetomidine produced better hemodynamic stability in eclamptic patients, and there was a significant reduction in requirement of additional analgesics (P = 0.035) and antihypertensive (P = 0.004). Total duration of ICU stay was also less in this group of patients.

Background: Treatment resistant depression can be a life-threatening condition as it leads to an increase of suicide attempts by two to three folds. It has been estimated that nearly 1 million people die due to suicide every year, and more than two-third of these cases occur when the person is undergoing a major depressive episode. Ketamine is an NMDA receptor antagonist, an anesthetic agent that is short acting and has recently been used as an antidepressant and anti-suicidal agent. It has been seen that a single intravenous infusion of ketamine at a lower dose. i.e., subanesthetic dose of 0.5 mg/kg over a period of 40 minutes produces antidepressant effect which lasts for about a week and various studies have proved that repeated infusions of ketamine can prolong the duration of the antidepressant response. Methods: It was an observational/descriptive study done in the ketamine clinic/ECT suite of institute of mental health and neurosciences Kashmir (an associate hospital of government medical college Srinagar) which runs once a week. In this study, patients satisfying the criteria of TRD and depressive patients with active suicidal ideations, visiting the ketamine clinic who had given a valid informed consent for ketamine infusion enrolled and observed for ketamine efficacy by using specific scales. The study done over a period of 18 months from January 2020 till July 2021. Results: The response rate of ketamine in our study for treatment resistant depression was 70.27%. The response rate of ketamine for suicidality in our study was 63.16%. Our study showed a rapid onset of action for ketamine, two hours after ketamine infusion. Conclusions: A significant fraction of patients suffering from major depressive disorder do not respond to antidepressants and have a poor psychosocial functioning and an increased risk of suicide attempts making their condition life threatening. These patients therefore require special attention to address their underlying condition as well as suicidality to improve their outcome. In this context we studied the role of intravenous ketamine infusion in these patients in improving the psychosocial outcome as well as preventing the suicidal ideation.

Labour is a physiological process which is associated with most severe pain. Goal of labour analgesia should be to ensure painless labour without any side effect. Various methods have been used to alleviate pain during labour but the only consistently effective method is lumbar epidural analgesia. Since higher doses of local anaesthetics cause undesirable effects like motor block and hemodynamic changes, adjuvants like opioids are used. The present study evaluates the clinical effectiveness of continuous lumbar epidural for vaginal delivery using 0.0625% bupivacaine with 2.5 mcg/ml of fentanyl. Materials and Method: 91 patients admitted to Lalladed hospital govt medical college Srinagar for vaginal delivery and who were in active labour were given first loading dose of 10ml 0.25% plain bupivacaine via epidural catheter followed by continuous epidural infusion of 0.0625% bupivacaine with 2.5 mcg/ml fentanyl @ 12ml/hr. the parturients were assessed for onset and duration of analgesia, hemodynamics, sensory block, mode of delivery, and APGAR(neonatal outcome). Results: Onset of analgesia was significantly faster(10 min). The duration of analgesia was also longer. There were no significant hemodynamic changes. No motor block was seen. 1 min and 5 min APGAR scores were comparable. Conclusion: It was concluded that epidural labour analgesia with low dose bupivacaine (0.0625%) with fentanyl (2.5mcg/ml) given through continuous infusion technique provides good pain relief to the parturient in labour with increased maternal satisfaction without significant maternal or fetal side effects.

Background: Traumatic brain injury (TBI) is a leading cause of mortality, morbidity, disability, and socioeconomic losses in the Indian subcontinent. For policy making, there is a lack of reliable and larger data regarding traumatic brain injuries in our setting. Aim: In our study an attempt was made to analyze and assess the clinical characteristics of patients with traumatic brain injuries admitted in Surgical Intensive Care Unit of SMHS hospital Srinagar. Materials and Methods: In this observational study, 89 patients of TBI admitted in SICU during study period were enrolled, after obtaining ethical clearance from institutional ethical clearancecommittee. All the study patients were followed up in SICU on daily basis. All thedata required for study was recorded from the patient’s clinical notes as per studyprotocol. Outcome of patients was assessed in terms of survival at discharge from SICU. Results: Majority of the TBI patients requiring ICU admission had Severe TBI (64%). Allthe patients required CT Brain on arrival to hospital and brain contusions (65.2%) were the most common findings on CT brain. Check CT brain was required in53.9% of patients. There was need for neurosurgical intervention in 49.4% ofpatients and 21.3% required blood transfusions.