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lower incidence of head movements.

Caudal analgesia was a widely practiced regional anesthesia technique in pediatric population. Transversus abdominus plane block (TAP) block has recently emerged as a promising analgesic method in pediatric lower abdominal surgeries.

This study aimed to compare the analgesic efficacy of ultrasound-guided TAP block and caudal block.

This study was conducted in the department of anesthesiology of a tertiary care teaching hospital.

This was a prospective, single-blinded, randomized controlled study.

Sixty-two children of American Society of Anesthesiologists Class I and II undergoing inguinal hernia repair received TAP block at a dose of 0.5 ml.kg

of 0.25% bupivacaine (Group A) or caudal block at a dose of 1 ml.kg

of 0.25% bupivacaine (Group B) after randomization. The children were analyzed by comparing the post operative pain scores and duration of analgesia. Statistical analysis was done with IBM SPSS software 23 version. Unpaired sample

-test and Mann-Whitney U-test were used to compare the means of continuous variables. Fisher’s exact test/Chi-square test was used to find the association between categorical variables.

Both groups were comparable in terms of age, gender, weight, and surgery duration. Duration of analgesia was longer in TAP block group compared to that of caudal analgesia (12.93 ± 2.91 h vs. 6.52 ± 1.67

< 0.001). The postoperative pain scores were comparable up to 6 h and at 24 h. Pain scores at 12 h and 18 h were significantly higher in caudal analgesia group compared to that of TAP block group.

Children who received TAP block had prolonged duration of analgesia and lower pain scores compared to those who received caudal analgesia.

Children who received TAP block had prolonged duration of analgesia and lower pain scores compared to those who received caudal analgesia.

Supplementation of Vitamin-D in Vitamin-D deficient patients may reduce morbidity and mortality in critically ill patients in ICU.

The aim of this study is to investigate serum level of Vitamin-D in critically ill patients and supplementation of vitamin-D in deficient patients and finally to compare clinical outcomes between two groups.

Randomized, prospective and comparative study.

In this study, serum vitamin-D level was investigated in recruited patients and vitamin-D deficient patients were randomly allocated into two groups viz; group-1, group-2. Vitamin-D (sachet CALCIROL 60,000 IU) supplementation was done once a week and twice a week in in group-1 and group-2 respectively, clinical outcomes between two groups were compared in terms of length of ICU stay, need for inotropic support, need for mechanical ventilation and 28 days ICU mortality.

Mean and standard deviation were calculated. Test of analysis between two groups was done by

-test and then

value was calculated.

No significant difference was found between two groups whether vitamin D supplementation done once or twice weekly (

= 0.24) in terms of length of ICU stay. Patients of group-2 required significantly less inotropic support as compared to group-1 (

= 0.037). There was no significant difference found in duration of mechanical ventilation (

= 0.138) and 28 days ICU mortality (

= 0.284).

From the above results we concluded that vitamin D supplementation in high dosages may be started in all critically ill patients, who are deficient in serum vitamin D level to get better clinical outcomes.

From the above results we concluded that vitamin D supplementation in high dosages may be started in all critically ill patients, who are deficient in serum vitamin D level to get better clinical outcomes.

Surgeries in prone position expose a patient to multitude of complications including laryngeal edema which may be related to the volume of fluid administered. Administering larger volumes of fluid intraoperatively may contribute to significant tissue edema, leading many anesthesiologists to practice a restrictive fluid infusion strategy. Although previous studies have compared fluid infusion strategies, changes in airway dimensions leading to airway edema have not been extensively investigated. Here, we compared two fluid infusion regimens in patients undergoing spine surgery in the prone position, and assessed their association with airway edema by means of the cuff leak test (CLT).

The aim of this study was to test the hypothesis whether a larger volume of crystalloid administration in spine surgeries performed in prone position would result in greater chances of airway edema, than would a restricted infusion policy, utilizing the CLT.

After ethical committee approval, thirty patients, aged 21-60 yearund between the duration of anesthesia and development of airway edema in our study group.

Because surgeries in the prone position are at risk of airway edema, restrictive fluid regimen strategy should be preferred over the liberal one as there are more chances of reduction in laryngeal lumen dimensions with permissive fluid infusions.

Because surgeries in the prone position are at risk of airway edema, restrictive fluid regimen strategy should be preferred over the liberal one as there are more chances of reduction in laryngeal lumen dimensions with permissive fluid infusions.

The objectives of the study were to compare the insertion facility, the effect on hemodynamic parameters, and effective ventilation using I-gel versus Air-Q supraglottic airway devices (SADs) for pediatric patients undergoing short-duration surgical procedures.

One hundred and fifty children aged 3-10 years were randomly divided into two equal groups Group I received I-gel and Group Q received Air-Q SAD. All patients were anesthetized by sevoflurane inhalation using a face mask without neuromuscular blockade. Study outcomes included SAD insertion success rate (SR), insertion time, anatomic alignment of the SAD to the larynx as judged using fiberoptic bronchoscope (FOB) inserted through the SAD, and tidal volume leak, and incidence of postoperative complications.

Total and first attempt SRs were 97.3% and 85.3% for I-gel and 94.7% and 82.7% respectively, for Air-Q with nonsignificant differences. However, I-gel insertion time (12.3 ± 3.6 s.) was significantly (

= 0.034) shorter than Air-Q (13.7 ± 4.2 sequired a shorter insertion time and provided a high SR which is satisfactory for trainees and during an emergency. I-gel SAD allowed minimization of tidal volume leak and gastric inflation and is associated with infrequent complications.

Deviceassociated infections (DAIs) increase the morbidity and mortality in the intensive care unit (ICU). Studies from the neurosurgical ICU in developing countries are sparse.

The aim of this study was to assess the incidence of device-associated healthcare associated infections, pathogens isolated, antibiotic resistance, and mortality in neurosurgical ICU.

A retrospective study was conducted in the neurosurgical ICU of a tertiary care center.

This study was done by analyzing data of patients admitted in a neurosurgical ICU with one or more devices during the period from January 2011 to July 2017.

Quantitative variables were expressed as mean and standard deviation; qualitative variables were expressed as frequency and percentage.

During this period, 6788 patients with devices were admitted in the ICU, and 316 patients developed DAI. Two hundred and forty-eight patients had catheter-associated urinary tract infection (CAUTI), 78 had ventilator-associated pneumonia (VAP), and 53 had central line-a CLABSI. With the implementation of insertion bundles and adherence to aseptic precautions, the DAI rate had come down.

Despite the latest advances in breast surgery, the procedure is frequently associated with postoperative pain, nausea, and vomiting, which leads not only to increased patient’s suffering but also to a prolongation of hospital stays and related costs. Thoracic paravertebral block (TPVB) has been successfully used to provide analgesia for multiple thoracic and abdominal procedures in both children and adults.

Forty patients were allocated for this observational, comparative study and divided into two groups of 20 each, namely thoracic paravertebral group (Group P) study group and general anesthesia (GA) group (Group G), control group, and observations made for duration of procedure, visual analog score, rescue analgesia, surgeon and patient’s satisfaction, postoperative complications, and duration of postanesthesia care unit (PACU) stay in both the groups.

We found that there was a statistically significant difference in duration of procedure, more time was taken in performing TPVB. Pain was better controlled in Group P and requirement of rescue analgesia was higher in Group G patients, postoperative complications such as shivering, nausea, vomiting, and duration of PACU stay were more in patients receiving GA.

Hence, we conclude that ultrasound-guided TPVB appears to be safe, reliable, and effective technique for breast surgeries with several advantages over GA in terms of long-lasting pain relief, fewer complications, and shorter hospital stay.

Hence, we conclude that ultrasound-guided TPVB appears to be safe, reliable, and effective technique for breast surgeries with several advantages over GA in terms of long-lasting pain relief, fewer complications, and shorter hospital stay.

Resuscitation of critically ill patients requires an accurate assessment of the patient’s intravascular volume status. Passive leg raise cause auto transfusion of fluid to the thoracic cavity.

This study aims to assess and compare the efficacy of superior vena cava (SVC) and inferior vena cava (IVC) diameter changes in response to passive leg raise (PLR) in predicting fluid responsiveness in mechanically ventilated hemodynamically unstable critically ill patients.

We enrolled 30 patients. Predictive indices were obtained by transesophageal and transthoracic echocardiography and were calculated as follows (Dmax – Dmin)/Dmax for collapsibility index of SVC (cSVC) and (Dmax – Dmin)/Dmin for distensibility index of IVC (dIVC), where Dmax and Dmin are the maximal and minimal diameters of SVC and IVC. HTH-01-015 solubility dmso Measurements were performed at baseline and 1 min after PLR. Patients were divided into responders (increase in cardiac index (CI) ≥10%) and nonresponders (NR) (increase in CI <10% or no increase in CI).

Among those included, 24 (80%) patients were R and six were NR. There was significant rise in mean arterial pressure, decrease in heart rate, and decrease in mean cSVC from baseline to 1 min after PLR among responders. The best threshold values for discriminating R from NR was 35% for cSVC, with sensitivity and specificity of being 100%, and 25% for dIVC, with 54% sensitivity and 86.7% specificity. The areas under the receiver operating characteristic curves for cSVC and dIVC regarding the assessment of fluid responsiveness were 1.00 and 0.66, respectively.

cSVC had better sensitivity and specificity than dIVC in predicting fluid responsiveness.

cSVC had better sensitivity and specificity than dIVC in predicting fluid responsiveness.

The diagnosis of ventilator-associated pneumonia (VAP) remains a challenge, with clinicians mainly relying on clinical, radiological, and bacteriologic strategies to manage patients with VAP.

To compare the results of non-bronchoscopic and bronchoscopic techniques of distal airway sampling for the diagnosis of VAP.

This was a single-center prospective diagnostic accuracy study done in the 14-bedded intensive care unit of a tertiary care referral hospital.

Patients aged ≥18 years, on mechanical ventilation for ≥48 h, and with clinical suspicion of VAP (fever, leukocytosis, and increased tracheal secretions) either on admission or during their stay were included. Every patient underwent both procedures for sample collection, first non-bronchoscopic protected bronchoalveolar lavage (NP-BAL) and then bronchoscopic BAL (B-BAL). Clinical Pulmonary Infection Score (CPIS) was calculated for each patient and the collected samples were evaluated in laboratory using standard microbiological techniques.

The sensitivity, specificity, positive predictive value, and negative predictive value of NP-BAL and B-BAL for the diagnosis of VAP were calculated taking CPIS score of >6 as index test for the diagnosis of VAP.