This randomised, double-blind study was designed to compare the duration of analgesia and adverse effects following intrathecal administration of dexmedetomidine or clonidine, both with bupivacaine, in trauma patients. Ninety adult trauma patients of American Society of Anesthesiologists physical status I—II, scheduled for lower limb surgery under subarachnoid block, were randomly allocated to one of three groups. All groups received hyperbaric bupivacaine 0.5% 3 ml, to which was added saline 0.5 ml (Group B): clonidine 50 μg (Group C) or dexmedetomidine 5 μg (Group D). The onset and duration of sensory and motor blockade, severity of postoperative pain, time to first rescue analgesia and total analgesic requirement for 24 hours were noted. There was no significant difference in the onset time of the block but the duration of sensory and motor blockade was prolonged in Groups C and D, compared with Group B. The time to analgesia was significantly prolonged in Group D (824±244 minutes) compared with Group C (678±178 minutes; P=0.01), the latter being longer than Group B (406±119 minutes; P=0.0001). Postoperative pain scores were lower in Groups C and D compared with Group B. The requirement for rescue analgesia during the first 24 postoperative hours was significantly less in Groups C and D as compared to Group B (P=0.0001), but comparable between Group C and D (P=0.203). In conclusion, dexmedetomidine 5 μg added to intrathecal bupivacaine 15 mg produces longer postoperative analgesia than clonidine 50 μg among trauma patients undergoing lower limb surgery.

Diabetes mellitus is the most common medical condition and with increased awareness of heath and related issues, several patients are getting diagnosed with diabetes. The poor control of sugar and long-standing status of disease affects the autonomic system of body. The autonomic nervous system innervates cardiovascular, gastrointestinal, and genitourinary system, thus affecting important functions of the body. The cardiovascular system involvement can manifest as mild arrhythmias to sudden death. Our search for this review included PubMed, Google Search and End Note X6 version and the key words used for the search were autonomic neuropathy, diabetes, anesthesia, tests and implications. This review aims to highlight the dysfunction of autonomic system due to diabetes and its clinical presentations. The various modalities to diagnose the involvement of different systems are mentioned. An estimated 25% of diabetic patients will require surgery. It has been already established that mortality rates in diabetic patients are higher than in nondiabetic patients. Hence, complete workup is needed prior to any surgery. Diabetic autonomic neuropathy and its implications may sometimes be disastrous and further increase the incidence of in hospital morbidity and mortality. Overall, complete knowledge of diabetes and its varied effects with anaesthetic implications and careful perioperative management is the key guiding factor for a successful outcome.

We have derived simple formulae to predict mentohyoid, thyromental and sternomental distances relevant to airway based on height and age of children.

A one-year-old child operated on for arachnoid cyst in right frontoparietotemporal region had sudden bradycardia followed by cardiac arrest leading to death after connecting negative pressure to the subgaleal drain during craniotomy closure. The surgical procedure was uneventful. It is a common practice to place epidural or subgaleal drains connected to a vacuum system towards the end of craniotomy to prevent accumulation of intracranial and extracranial blood. The phenomenon of bradycardia with hypotension is known to occur following negative pressure application to the epidural, epicranial, or subgaleal space after craniotomy closure. However cardiac arrest as a complication of negative pressure suction drain in neurosurgical patients is not described in the literature.

Objective: Oral cancer patients have a potentially difficult airway, but if managed properly during the perioperative period, morbidity and mortality can be reduced or avoided. Methods:The medical records of 156 patients who were operated for oral cancers were reviewed for airway management during the perioperative period. Results:The surgical procedures ranged from excisions, wide local excisions with split skin graftings, hemiglossectomies and radical neck nodes dissections to pectoralis major myocutaneous or free fibular flaps. Intubation was assessed as difficult in 14.7% of patients because of tumour-or radiation fibrosis-related trismus, restricted neck mobility and prior similar surgeries. Twenty patients had undergone surgery for oral cancer previously and were scheduled for flap reconstruction. Nasotracheal intubation was a preferred route, and 62.8% of patients could be intubated nasotracheally after neuromuscular blockade. Tracheostomy (elective or existing) was utilised for airway control in 19.2% cases. Patients who had undergone prior radiotherapy were more likely to be tracheostomised. McCoy laryngoscopes (13.4%), gum elastic bougies (23.6%), Airtraq devices (0.006%) and fibreoptic bronchoscopes (FOBs) (0.03%) were the additional airway techniques employed. In total, 64 patients (50.7%) could be extubated immediately after surgery. Conclusion:Proper preoperative evaluation and planning help manage difficult airways effectively with minimal need of advanced airway gadgets. Gum elastic bougies and Magill forceps are very useful in airway management and decrease the need of elective tracheostomy in oral cancer patients. Keywords: Oral cancer, surgery, airway managementAmaç: Ağız kanseri hastaları potansiyel olarak zor bir havayoluna sahiptirler. Ancak, ameliyat süresince doğru bir şekilde yönetilirse, morbidite ve mortalite düşürülebilir veya önlenebilir.Yöntemler: Ağız kanseri nedeniyle ameliyat edilen 156 hastanın tıbbi kayıtları perioperatif dönemde havayolu yönetimi açısından incelendi. Bulgular:Cerrahi işlemler eksizyon, parsiyel kalınlıkta deri greftleri, hemiglossektomiler, radikal boyun nodu diseksiyonlarından pektoralis majör miyokutan veya serbest fibular fleplere değişiklik göstermiştir. Entübasyon hastaların %14,7'sinde, tümör veya radyasyon fibrozisiyle ilgili trismus, sınırlı boyun hareketliliği ve daha önceden yapılmış ameliyatlardan dolayı zor olarak değerlendirildi. Yirmi hasta daha önce ağız kanseri nedeniyle ameliyat edilmişti ve flep rekonstrüksiyonu planlandı. Nazotrakeal entübasyon tercih edilen bir yöntemdi ve hastaların %62,8'i nöromusküler blokaj sonrasında nazotrakeal olarak entübe edilebildi. Vakaların %19,2'sinde havayolu kontrolü için trakeotomi (elektif ya da mevcut) kullanıldı. Daha önce radyoterapi alan hastalarda trakeotomi ameliyatı olma olasılığı daha yüksek olarak bulundu. McCoy laringoskoplar (%13,4), gum elastik bujiler (%23,6), Airtraq cihazlar (%0,006) ve fiberoptik bronkoskoplar (FOBs) (%0,03) kullanılan diğer havayolu teknikleriydi. Toplamda 64 hasta (%50,7) ...