Anupama M K

Background : Brachial plexus blockade via supraclavicular approach for upper limb surgery can significantly reduce pain, decreases the need for post operative analgesics, decreases the incidence of nausea and vomiting, increases patient satisfaction and allows for faster discharge from hospital when compared with general anesthesia. Aim is to study the use of an adjuvant Dexamethasone with local anesthetic bupivacaine and lignocaine with adrenaline for the onset of sensory block, onset of motor block and the duration. Materials and Methods: This is a prospective, comparative and observational study of 60 patients who were divided randomly into two groups with each 30 patients: GROUP C received 15 ml of bupivacaine 0.5%, 15ml of 2% lignocaine with adrenaline and 2ml of normal saline to a total volume of 32ml. GROUP D received 15 ml of bupivacaine 0.5%, 15ml of 2% lignocaine with adrenaline and 2ml of Dexamethasone to a total volume of 32ml. Statistical Analysis : Cross tabs, Independent Samples t test, Repeated Measure ANOVA were used. SPSS for windows (version 17.0) was employed for data analysis. Results : Demographic parameters like age, weight, height, BMI were comparable between the two groups with p value >0.05 We observed that, onset of both sensory and motor block was earlier in group D and duration of sensory block and motor block was more in group D. Also, there was less requirement of rescue analgesics in group D. Conclusion: Dexamethasone added to the routine local anesthetic bupivacaine and 2% lignocaine and adrenaline is an effecient and safe choice for rapid onset and increases the duration of oth sensory and motor block in brachial plexus block. Keywords: Brachial plexus, Supralavicular approach, Dexamethasone

Introduction: There has been a dramatic increase in the use of computed tomography (CT) scan to diagnose conditions and to monitor treatment in the pediatric setting. Infants and children require sedation during procedure to maintain a motionless state to ensure high quality imaging. The target sedation depth required depends on imaging procedure and individual patient characteristics. CT scans with modern multislice scanners do rapid image acquisition and procedure may require minimal sedation. But some children need to be asleep to tolerate the study scan. Procedures may be rescheduled and repeated if the movement is excessive which leads to additional radiation burden which leads to increasing the cost of the procedure and patient stress. Careful planning of sedation is important in such scenarios.1 Many drug regimens have been recommended to achieve satisfactory sedation for such painless procedure. Most of these medications can be administered through various routes and selecting the drug varies on the procedure, level of pain, optimum depth of sedation required and the patient’s condition.2 Midazolam has been widely used as a sedative in children for a long time.3 This study compares the effect of intravenous and oral Midazolam in paediatric age group with respect to degree of sedation levels achieved, and the need for a rescue dose for non CNS Computed Tomography scans. Materials and Methods: In this prospective study, oral Midazolam verses IV Midazolam was studied for sedation in paediatric patients of 2 to 6 years of age for non CNS CT scan. 0.5mg/kg of oral Midazolam and 0.01mg/kg of IV Midazolam was used. 1mg/kg Propofol used as the rescue drug and 0.5mg/kg subsequently till the desired sedation score was achieved. 70 patients were divided into 2 groups of 35in each group. 1: Group A received oral 0.5 mg/kg body weight Midazolam 20 minutes prior to the scan (a maximum dose of 10 mg); 2: Group B received IV 0.01mg/kg body weight Midazolam 5 minutes prior to scan. Statistical Analysis: Calculation of sample size using the Open Epi software considering ? error 5% and β error 20% was 66 (Kelsey). The statistical analysis done by SPSS-20, unpaired ‘t’ test and Chi-Square test. Results: In oral midazolam group: At the end of 20 minutes 54% achieved the desired sedation score. At the beginning of scan i.e. at 25 minutes from the drug administration, 60% achieved desired sedation score. 40% required the rescue drug. There was no incidence of haemodynamic or respiratory disturbances after giving the rescue drug. In IV Midazolam group: At the end of 5 minutes (sedation end point) 8.5% achieved required sedation level. At the beginning of scan i.e 5 minutes later 11.4% of the study population achieved sedation level. 88.6% required the rescue drug with multiple subsequent doses. There was no incidence of haemodynamic or respiratory disturbances after giving the rescue drug. Conclusion: 1: As compared to IV route, Midazolam by oral route in the dose of 0.5mg/kg was effective in achieving desired sedation level with slower onset time but lesser incidence of rescue drug requirement; 2: The recovery with oral Midazolam was comparatively of longer duration than with IV Midazolam; 3: The incidence of haemodynamic and respiratory disturbances such as desaturation was not observed in either the groups. Keywords: Paediatric sedation, Midazolam, Computed tomography (CT) scan.

Introduction: Labour analgesia is being preferred by the parturient women these days due to increased awareness, comfortness and low threshold to perceive pain. The effects of epidural and parenteral analgesia on duration and mode of deliveries have been studied since last few decades. Aim was to study the effects of epidural labour analgesia on the duration of labour, mode of delivery, fetal outcome and patient satisfaction and comfortness. This was a prospective, comparative and observational study. Material and Methods: One hundred parturient women with full term single live gestation with vertex presentation with spontaneous onset of labour, meeting the inclusion criteria were divided into two groups. Group C: Parturient women who opted out of labour analgesia were taken as controls. Group E: Parturient women who opted for labour analgesia were taken as cases. Statistical Analysis: Independent- Samples t test, Cross tabs and Repeated Measure ANOVA were used. SPSS for windows (version 17.0) was employed for data analysis. p Results: Demographic parameters like age, weight, height, BMI were comparable between the two groups E and group C (p>0.05) The gestational age between the groups C and E were comparable as p >0.05 No significant difference in Bishops score between Group E and Group C (p>0.05) There was no difference stastistically in terms of mode of delivery (Normal delivery, Instrumental delivery, Caesarean delivery) between the groups. Instrumental delivery was seen more in group E. No change in normal or ceasarean deliveries. Shortening of active phase was seen in group E (P nd hour). Prolonged second stage of labour was seen in group E (P=0.001) which is statistically significant. Decreased pain score in group E with p value of 0.006 which is highly significant statistically. There was improvement of APGAR at 1 minute in group E with significant p value. No significant difference between the groups for APGAR score at 5 minute. No significant difference between the groups in terms of requirement of NICU admission. Conclusion: Many safe techniques are available for parturient women to bypass the painful labour process and enjoy the birth of the baby. Labour analgesia is one of the most commonly used method in developed countries. Due to lack of awareness and false perception of ending up in caesserian sections, labour analgesia has not gained much popularity in India. Our study aims to study the incidence of casserian sections, instrumental deliveries and the effects of labour analgesia in newborns. Epidural is a regional technique which is safe as to reduce the labour pain and to experience the joy of motherhood, without pain. The prs and cons of labour analgesia should be explained to al labour women and to be given an option of opting it to enjoy the process of painless labour. Keywords: Epidural, Labour analgesia, Fetomaternal outcome, Instrumental deliveries, Parturient women caesarean section, Bishop’s score, APGAR score, NICU.

Introduction: Laryngoscopy and endotracheal intubation during induction of general anaesthesia are extremely strong nociceptive stimuli, which often lead to unintended stimulating of the sympathetic nervous system manifested by increased arterial pressure and tachycardia.1 The present study aimed to assess usefulness of neuromuscular monitoring with peripheral nerve stimulator in reducing the haemodynamic response to laryngoscopy and tracheal intubation using vecuronium. Material and Methods: This study included 100 cases classified randomly into two group (Each n= 50). Group I (C) (n=50): control group: Laryngoscopy and tracheal intubation done at the end of 3 minutes after administration of 0.1mg/kg body weight of intravenous iv vecuronium. Group II (N) n=50: Neuromuscular monitoring done after giving 0.1mg/kg body weight of intravenous vecuronium using TOF with supramaximal stimuli of current intensity 50 mA at right ulnar nerve, and the response of the thumb is monitored every 10 seconds, once all the responses for TOF are lost, the time noted and laryngoscopy and endotracheal intubation were performed. Statistical Analysis: Independent- Samples t test, Cross tabs and Repeated Measure ANOVA were used. SPSS for windows (version 17.0) was employed for data analysis. p Results: Group-N (study group) showed statistically significant decreased haemodynamic response to laryngoscopy and intubation after iv Vecuronium, when compared to Group-C (control group). Conclusion: Neuromuscular monitoring by using PNS at AP is useful to have good intubation condition and to reduce the haemodynamic response to laryngoscopy and intubation. Keywords: Peripheral nerve stimulator, Train of four, Adductor pollicis muscle, Vecuronium, Intubation, Haemodynamic response.

Purpose: To detect dry eye and to associate it with rheumatoid factor and severity of disease in rheumatoid arthritis. Materials and Methods: Cross-sectional explorative study & study period December 2013 to October 2015. Fifty nine eyes of 30 patients diagnosed as rheumatoid arthritis age > 18 years were included. Status of rheumatoid factor, severity of disease calculated with DAS28-ESR were noted and TBUT, Fluorescein staining and Schirmer’s Test were done. Results: Out of 59 eyes 42.4% had TBUT 5mm (mean 18.7 ± 6.8 mm). 42.4% were diagnosed with dry eye. Out of 51 eyes with positive rheumatoid factor 24 had dry eye but 1 out of 8 eyes with negative rheumatoid factor had dry eye (p=0.066). Mean severity score of disease based on DAS28-ESR was 2.9 in dry eye and 4.1 in patients without dry eye. Conclusion: Dry eye in rheumatoid Arthritis can be detected by simple tests and there is no statistically significant association between rheumatoid factor and dry eye. Dry eye is independent of severity of disease. Keywords: Dry eye, Rhematoid arthritis.