Background: Early prediction of severity of acute pancreatitis (AP) is important for management of AP patients with escalation of care and aggressive therapy which can reduce complications. Bedside index of severity in AP (BISAP) score is helpful in early diagnosis of severe AP. D-dimer, a biomarker of secondary fibrinolysis may be helpful in predicting the severity of pancreatitis. Aims and Objectives: The objective of this study was to evaluate the two scoring systems - the BISAP score and D-dimer in early prediction (within 24 h) on the severity of AP and to analyze how D-dimer correlates with BISAP score. Materials and Methods: Seventy-five patients, aged 18–70 years, suffering from AP due to any cause were included for this prospective, observational study. Within 24 h of admission D-dimer was estimated and BISAP score was calculated. The severity was assessed based on D-dimer level and BISAP scoring systems within 24 h of hospital admission and data were tabulated for analysis. The D-dimer level >2.5 mg/L was considered to be suggestive of severe pancreatitis. The BISAP score >2 in first 24 h was defined as predictive of severe pancreatitis. Spearman rank correlation was used for an analysis of the association between two set of data (BISAP scores and d-dimer levels) and thus to measure the strength and direction of the relationship between the two variables. Results: In the present study, 37.3% of the patients had D-dimer ≤2.5 mg/L and 62.7% had D-dimer>2.5 mg/L’ on calculating the Pearson’s correlation on the ranked values of the data (BISAP scores and D-dimer levels), the correlation coefficient (Spearman’s Rho, designated as “rs”) was found to be 0.406 which indicates about moderate positive correlation. Conclusion: D-dimer testing can be used as an alternative test to predict the severity of AP. It shows a moderate correlation with BISAP scoring.

Background: Although various adjuvants have been added to local anesthetic agents to potentiate its effect, dexmedetomidine is a relatively new drug with only a fewer studies. Aims and Objectives: The present study has been conducted to compare the efficacy of intrathecal hyperbaric bupivacaine alone with dexmedetomidine of two different doses as adjuvants in spinal anesthesia for the lower abdominal surgery. Materials and Methods: This was a double-blinded, randomized, and controlled trial. Total 120 patients of American Society of Anesthesiologists physical status I and II, 70 male and 50 female, aged between 20 and 60 years, were randomized into three groups receiving 15 mg 0.5% hyperbaric bupivacaine with normal saline, 4 μg (microgram) dexmedetomidine, and 2 μg dexmedetomidine, respectively, administered intrathecally. Results: There was significant difference among all three groups with regard to the onset of sensory block and time to reach the highest level of sensory block. Time to reach T10 dermatome, time to reach Bromage 3 motor block, the mean regression time to S1 dermatome level, the mean regression time to reach Bromage 0, and time to first requirement of rescue analgesia – all these variables showed significance when 4 μg dexmedetomidine additive group was compared with 2 μg dexmedetomidine additive group and bupivacaine alone group. Conclusion: In our double-blinded, randomized, and controlled trial, 4 μg intrathecal dexmedetomidine coadministered with 0.5% hyperbaric bupivacaine showed superior efficacy. Further, larger trials are needed to confirm our findings.

Background: Direct laryngoscopy and endotracheal intubation elicit hemodynamic pressor responses which may be hazardous in high risk patients. Fentanyl, a low cost synthetic opioid, when used judiciously, may be a good option to attenuate this stress response. Aims and Objectives: The present study has been conducted to compare the efficacy of three different doses of intravenous fentanyl in attenuation of hemodynamic pressor response to laryngoscopy and endotracheal intubation in elective surgery under general anesthesia. Materials and Methods: It was a double-blinded randomized controlled trial. A total of 90 patients of American Society of Anesthesiologists physical status I and II, 55 male and 35 female, aged between 20 and 55 years, were randomized into three groups receiving 2, 3, and 4 μg/kg of injection fentanyl, respectively, administered intravenously 5 min before direct laryngoscopy and endotracheal intubation. Results: There were significant differences in hemodynamic variables among all three groups at 1, 3, 5, and 10 min after endotracheal intubation. Just after endotracheal intubation; heart rate, mean arterial pressure, and diastolic arterial pressure – all these variables showed significance between 3 μg/kg and 4 μg/kg groups only. Incidence of nausea/vomiting showed statistical significance between 2 μg/kg and 4 μg/kg groups only. Conclusion: In our double-blinded randomized controlled trial, 4 μg/kg of injection fentanyl administered 5 min before laryngoscopy and intubation, has showed superior efficacy in suppressing hemodynamic stress responses associated with it. Further, larger trials are needed to confirm our findings.