Background and Aims:Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia. The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine and fentanyl group during AFOI.Material and Methods:This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for elective laparotomies who were randomly allocated into two groups: Group A received dexmedetomidine 1 mcg/kg and Group B received fentanyl 2 mcg/kg over 10 min. Patients in both groups received glycopyrrolate 0.2 mg intravenous, nebulization with 2% lidocaine 4 ml over 20 min and 10% lidocaine spray before undergoing AFOI. Adequacy of intubation condition was evaluated by cough score and post-intubation score. Incidence of desaturation, hemodynamic changes and sedation using Ramsay sedation scale (RSS) were noted and compared between two groups.Results:Cough Score (1-4), post-intubation Score (1-3) and RSS (1-6) were significantly favorable (P < 0.0001) along with minimum hemodynamic responses to intubation (P < 0.05) and less oxygen desaturation (P < 0.0001) in Group A than Group B.Conclusion:Dexmedetomidine is more effective than fentanyl in producing better intubation conditions, sedation along with hemodynamic stability and less desaturation during AFOI.

A 17-year-old girl was posted for spinal surgery for traumatic spinal injury. The patient was a well-controlled epileptic with history of seizure since 8 years of her age. She was induced with thiopentone sodium and muscle relaxant atracurium was administered. Minutes after that, she had an episode of ventricular tachycardia, this converted to ventricular fibrillation despite of institution of cardiopulmonary resuscitation (CPR). CPR was continued for a prolonged period of 45 minutes and after 45 minutes, QRS complexes appeared and later sinus rhythm restored. Next 24 hours, she was kept on mechanical ventilation. Within 24 hours, Glasgow Coma Scale (GCS) improved and patient was conscious and extubated. We suggest that the neuromuscular blocking drug contributed to an anaphylactic reaction which might be the cause of cardiac arrest and highlight the importance of prolonged resuscitation and successful outcome in this scenario.

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BACKGROUND The haemodynamic surge in laparoscopic surgery following carbon dioxide insufflations can be attenuated by various drugs. Dexmedetomidine, a selective-alpha-agonist depresses central sympathetic outflow producing sedation, decreased analgesic requirement, is approved by USFDA for mechanically ventilated patients in ICU for a period of <24 hours. One of its "off label" uses is attenuation of Hemodynamic changes in laparoscopic surgery. Parenteral magnesium sulphate has been used as an antiarrhythmic and antiseizure drug in preeclampsia. It also has analgesic action on NMDA receptor, inhibits catecholamine release from peripheral nociceptors and attenuates vasopressor mediated vasoconstriction. A study was conducted to assess and compare the effects of these drugs. We wanted to study the relative efficacy of infusions of dexmedetomidine & magnesium sulphate on attenuation of hemodynamic responses in laparoscopic surgery under general anaesthesia. METHODS A prospective, double blind, randomized, comparative study was conducted on a total of 105 patients in a tertiary care teaching hospital. The three groups (n=35) were: Control (Group-C), Dexmedetomidine (Group-D), and Magnesium sulphate (Group-M). RESULTS Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure were significantly lower with Dexmedetomidine group than Magnesium sulphate group at all intervals (p<0.05) The MgSo4 group however showed significantly (p<0.05) better haemodynamic control at 30 minutes compared to the control group. CONCLUSIONS Intravenous infusion with Dexmedetomidine for laparoscopic surgery under general anaesthesia is more effective than Magnesium sulphate in attenuating the cardiovascular effects of pneumoperitoneum.

BACKGROUND Sepsis and septic shock are major causes of mortality in the intensive care units worldwide. The scoring systems are very useful to predict risk of mortality and evaluating outcome in critically ill patients. In this study, we aimed to research the effectiveness of SAPS II and APACHE IV scoring systems in the evaluation of prognosis in severe sepsis and septic shock patients hospitalized in ICU. MATERIALS AND METHODS A prospective observational study was conducted on 50 consecutive patients of severe sepsis and septic shock admitted to ICU between April 2016 to April 2017. Predicted mortality was calculated using online calculator. Standardised mortality rate (SMR) was calculated with 95% confidence intervals. Calibration was assessed using Hosmer-Lemeshow test, statistic and Cohen's kappa statistic. Discrimination was assessed using receiver operating characteristic curves. RESULTS The actual mortality rate in this study was 52%. Predicted mortality rate of APACHE IV and SAPS II were 39.21% (SMR 1.32) and 45.85% (SMR 1.13) respectively. The Cohen's kappa for APACHE IV and SAPS II were 0.369 and 0.426 respectively. Hosmer-Lemeshow goodness of fit statistic indicates good logistic regression model fit for both APACHE IV and SAPS II scoring system (p value > 0.05). AUROC of APACHE IV and SAPS II were 0.748 and 0.760 respectively. CONCLUSION SAPS II had a closer prediction and better discriminative ability than APACHE IV.