Yogesh Singh

Background: Preoperative emotional distress in children should be addressed properly for better anesthetic experience. The present study was a Prospective randomized double-blind study to evaluate comparative efficacy of three different doses of intranasal dexmedetomidine for premedication in children. Materials and Methods:  Sixty children were then randomly allocated to one of the three groups of 20 each by a computer generated table. The drug was administered 45 minutes prior to induction of anesthesia intra-nasally. Following intra-nasal drug administration, anxiety was assessed at 0 minutes -baseline, 30 minutes, 45 minutes and at parental separation in the preoperative area just before shifting in operation theater using the mYPAS (modified Yale Preoperative Anxiety Scale). At induction, induction compliance was assessed using the induction compliance checklist and heamodynamic response to definitive airway was assessed. Results: It was observed that intranasal dexmedetomidine in lower doses of 0.5 and 1µg/kg was effective in reducing anxiety from baseline values but was not sufficient for providing anxiolysis at the most stressful time - at parental separation and shifting to OR (Operating room). The dosage of 1.5µg/kg was found to be the most effective dose for allaying preoperative anxiety without any adverse effect. However, this dose was insufficient for optimizing induction as it is mainly anxiolytic and higher doses having additional sedative action may be required to make the child more compliant for induction of anesthesia. Conclusions: Based on our findings, we recommend that intranasal dexmedetomidine in the dose of 1.5µg/kg can be used for allaying preoperative anxiety, without any adverse events. Key Points Summary: • Question: To evaluate and compare the efficacy of three different doses of intranasal dexmedetomidine for premedication in children for preoperative anxiety using the mYPAS scale. • Findings: Dose of 1.5µg/kg can be used for allaying preoperative anxiety, without any adverse events. • Meaning: Optimum dose of intranasal dexmeditomedine which is efficient to allay preoperative anxiety in children. Keywords: Intranasal dexmedetomidine, Premedication.

Background: Laparoscopic cholecystectomy is usually conducted under general anaesthesia(GA) which has its own limitations and may be associated with certain complications. This single-arm prospective interventional study was done to assess the safety and efficacy of thoracic segmental spinal anaesthesia(TSSA) as a sole anaesthetic procedure in patients undergoing laparoscopic cholecystectomy. Materials and Methods: TSSA was administered to 50 patients of the American Society of Anaesthesiologists physical status 1, 2, 3, who were scheduled for elective laparoscopic cholecystectomy (1.5 ml of 0.75% ropivacaine with dexmedetomidine 6 µg as an adjuvant was injected in one of the intervertebral spaces between T7- T12). The primary objective of the study was to evaluate the efficacy and safety of TSSA to provide complete surgical anaesthesia in terms of the total number of cases converted to GA. The data was analysed using SciPy(version 1.3.1), a statistical analysis package, in Python programming language (version 3.7.4). Results: Our study revealed that TSSA provided complete surgical anaesthesia in 48 patients and in two patients there was a failure to achieve adequate sensory block and GA had to be administered. The median time for full sensory regression was 90 min and the median time for complete motor regression was 60 min. No major intraop or postop adverse event was noted. Conclusion: TSSA offers safe and satisfying operating conditions for elective laparoscopic cholecystectomy. This technique practised with caution can provide a useful alternative to GA, especially in conditions where GA may have limitations.   Keywords: Anaesthesia, Segmental, Spinal, Thoracic, Laparoscopic, Cholecystectomy.

Dietary intake has a significant impact on the physical well-being of an individual. Plants that are a natural source of bioactive compounds like polyphenols are known to have proven health benefits. An important finding has been the role of phytochemicals in improving cytological functioning resulting in enhancing cellular longevity and organismal lifespan. Sirtuins are a class of proteins that delay cellular aging and increase the life expectancy of the organism by regulating cellular activities. In silico and in vitro studies have elucidated the compounds that act as potential sirtuin activators. This has led to several molecular and biochemical studies confirming the anti-aging effect of polyphenol compounds found in plants to be related to sirtuin activation.

Background: Hypertensive disorders of pregnancy, particularly preeclampsia, eclampsia remain one of the leading causes of maternal morbidity and mortality worldwide. We studied the association between the risk factors, interventions required, diagnosis and outcome in these patients admitted to the Intensive Care Unit (ICU). Materials and Methods: We conducted a prospective, observational study after the Institutional Scientific and Ethics committee approval. The Institutional record was taken to identify 70 women with Pregnancy Induced Hypertension (PIH) admitted to ICU after meeting the inclusion and exclusion criteria. Socio-demographic details, indication and timing of ICU admission were noted. On ICU admission; baseline vitals, detailed history, duration of complications, therapeutic interventions, laboratory parameters and imaging were compiled. Maternal outcome was assessed in terms of interventions needed, complications encountered and mortality or discharge and follow up was done up to 6 weeks postpartum. Fetal outcome was assessed in terms of live births or Intrauterine fetal death (IUFD), Apgar score, term/preterm and followed up to 7 postnatal days. Result: It was observed that out of 70 women enrolled in our study, 48 women were diagnosed with preeclampsia, 54 belonged to the age group of 21-30 years, 61 were unregistered for antenatal checkup, 46 had term gestation, 52 were nulliparous and 64 underwent Lower segment caesarean section (LSCS). 60 of them had postpartum ICU admission, all of them had significant rise in blood pressure. Most common interventions were transfusion of blood products (n=30) and mechanical ventilation (n=6). HELLP syndrome was the most common complication (n=7). Maternal mortality was seen in 6 women. 35 neonates had low birth weight, 6 had intra uterine growth retardation (IUGR), 19 were preterm and Apgar score was significant at 5 minutes. Conclusion: From our observations, it can be concluded that majority of the women were diagnosed with preeclampsia, were relatively of younger age group, nulliparous with no antenatal checkup, underwent LSCS and were admitted postpartum to ICU. Transfusion of blood products was the most common intervention & HELLP syndrome was most common complication. Maternal mortality was higher in women with preeclampsia although overall mortality was low. The incidence of low birth weight, IUGR and preterm neonates was more in eclamptic women. Neonatal mortality was more in preeclamptic women.   Keywords: Pregnancy, Hypertension, ICU, Maternal and fetal outcome.

Introduction: There are no studies comparing Supreme laryngeal mask airway (LMA), I gel and Baska mask in Indian population. A comparison of the clinical performance of Supreme LMA, I gel and Baska mask was undertaken in this randomized controlled study. Materials and Methods: The present research was undertaken in 75 patients aged 18 to 60 years who underwent elective surgery for less than 3-hour duration under general anaesthesia. The patients were randomly divided into three groups; Supreme LMA, I gel, and Baska mask. The oropharyngeal leak pressure (OLP) after 30 minutes to loss of spontaneous respiration was the primary objective, whereas the secondary objectives were attempts required for insertion of LMA, ease of gastric tube insertion, time required for gastric tube insertion and post-operative morbidity. Results: The mean OLP of Baska mask group was (28.2 cm HO) as compared to Supreme LMA (25.3 cm HO) and I-gel (24.1 cm HO) groups (p-value = 0.0001). The mean gastric tube insertion time of Baska mask group was (20.7 s) as compared to Supreme LMA (6.7 s) and I-gel (9.6 s) groups (p-value = 0.0001). The three groups were comparable with regards to the number of attempts required, ease of gastric tube insertion and post-operative morbidity. Conclusion: A higher OLP was observed in Baska mass group as compared to Supreme LMA and I-gel. The three devices were similar in terms of attempts required for insertion, ease of gastric tube insertion and post-operative morbidity.   Keywords: Supreme laryngeal mask airway, Baska mask, I- gel, Oropharyngeal leak pressure, Gastric tube insertion.

Aims and Objectives: Aim of this study was to know the prevalence of Coagulase Negative Staphylococci (CoNS) in Blood Stream Infection (BSI) among patients attending a Superspeciality hospital in North India. Objective of this study was to compare incidence of CoNS in ICU and ward patients suffering from BSI and their antimicrobial susceptibility pattern. Materials and Methods: This retrospective hospital based study was conducted in the Microbiology Department, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow for a period of two years (January, 2017 -December, 2018). Blood samples from a total of 6498 patients from Out-Patient, In-Patient and Intensive care unit departments were subjected to aerobic and anaerobic bacterial culture. Culture positive broth was subcultured on Blood Agar and MacConkey Agar to isolate pathogens in pure culture. Pure cultured isolates were tested for antimicrobial susceptibility pattern by Kirby Bauer Disk Diffusion method as per CLSI 2018.