Objective:Magnesium has been used as an adjuvant by various routes, including intravenous, intrathecal, and epidural in different dosage regimens. The effect of single bolus dose of magnesium as an adjuvant to fentanyl for postoperative analgesia has not been studied. This prospective randomized controlled trial was done to evaluate the efficacy of single bolus administration of magnesium epidurally as an adjuvant to epidural fentanyl for postoperative analgesia in patients undergoing total hip replacement under combined spinal epidural anesthesia.Methods:Sixty patients received combined spinal–epidural anesthesia with 2 mL of 0.5% hyperbaric bupivacaine intrathecally. After the surgery, patients were randomized into Group F [epidural fentanyl (1 μg/kg) in 10 mL saline] and Group FM [epidural magnesium (75 mg) along with fentanyl (1 μg/kg) in 10 mL saline]. Supplementary analgesia was provided by 50 mg intravenous tramadol if Verbal Rating Score (VRS) >4. Patient's first analgesic requirement and duration of analgesia were recorded.Results:The duration of analgesia was significantly longer for Group FM, 340±28.8 min, compared with Group F, 164±17.1 min (P=0.001). The frequency of rescue analgesics required in 24-h postoperative period in Group FM (2.3±0.5) was significantly less than that in Group F (4.3±0.5) (P=0.001). VRS was significantly lower in Group FM up to 4 h in the postoperative period (P=0.001). Bromage scale was statistically insignificant at all points of time.Conclusions:The administration of magnesium (75 mg) as an adjuvant to epidural fentanyl (1 μg/ kg) for postoperative analgesia results in significantly lower VRS with prolonged duration of analgesia as compared with epidural fentanyl (1 μg/kg) alone. Concomitant administration of magnesium also reduces the requirement of breakthrough analgesics with no increased incidence of side effects.

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Coronavirus Disease-2019 Associated Invasive Aspergillosis (CAPA) is a known entity with significant mortality. There is paucity of literature with secondary aspergillosis infection in post-COVID-19 patients. Serum galactomannan is a highly sensitive test for screening patients for Aspergillus antigenemia. We report five post COVID-19 patients with High Resolution Computed Tomography (HRCT) features and associated high risk factors for opportunistic aspergillosis (55 years old male, 46 years old male, 75 years old female, 55 years old female and 27 years old male) like prolonged intensive care stay, acute respiratory distress syndrome, corticosteroid and broad spectrum antibiotic therapy like Meropenem, Colistin and Targocid etc.

Abstract:Anomalous coronary arteries and hypertrophic cardiomyopathy are the leading cause of sudden cardiac death in young individuals with a high rate of autopsy diagnosis. A 38 year old male with fracture left distal end of radius presented with history of occasional palpitations and a single syncopal attack. Transthoracic echocardiography showed non-obstructive hypertrophic cardiomyopathy while CT angiography revealed anomalous inter-arterial right coronary artery. The above findings categorized the patient as extremely high risk for perioperative major cardiac event. The team of perioperative physicians in communication with the patient reached a consensus for closed reduction of the fracture with referral to a cardiothoracic center for malignant right coronary. Diligent pre-anaesthestic evaluation and team based approach helped in diagnosis of this rare life threatening entity while ultrasound guided supraclavicular block proved critical for the patient in having a favorable outcome.

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