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  • ISSN: 2333-6641
    Volume 6, Issue 1
    Review Article
    Suraci N*, Garcia P, and Poliwoda S
    When thinking of patient infection in the operating room setting, the anesthesiologist is not the first vector that comes to mind. However; several studies have demonstrated a connection between infection and the anesthetic clinician. Many of the infections induced by the clinician are due to cross contamination, inadequate hand hygiene, and infrequent cleaning of the anesthesia machine and equipment. In order to bring attention to the problem of anesthesiologist-mediated infection, we review the current literature as well as contemporary recommendations and interventions to identify preventable infections that can occur from the anesthesiologist and their work place in the operating room. This review is to provide better awareness of this growing problem and provide a better outlet for improved patient care.
    Spurthi* and Bindu George
    Background: Postoperative analgesia is a sine qua non in current clinical practice. So we are in need for an adjuvant that can prolong the action of local anaesthetics after single- injection blocks. Dexmedetomidine and clonidine are two commonly used adjuvants. This study was undertaken to assess which among them proved to be a superior analgesic adjuvant in lower doses.
    Materials and methods: After ethical committee approval study was conducted on 60 patients, aged 18-55 years, posted for upper limb surgery under USG guided supraclavicular brachial plexus block at St.John's Hospital, Bangalore. The study was conducted from January 2015-January 2016- Prospective randomised double blind study. Preoperative baseline values of heart rate, blood pressure and oxygen saturation was recorded. Brachial plexus block by supraclavicular approach was carried out under USG guidance using strict aseptic precautions. Patients were assigned randomly to one of the two groups using computer generated tables:-
    Group C- Clonidine 0.5 μg /kg added to 25ml of 0.375% bupivacaine.
    Group D - Dexmedetomidine 0.5 μg /kg and 25ml of 0.375% bupivacaine.
    The onset of sensory block and motor block, the duration of analgesia, duration of motor block and sedation scores were assessed. Complications were also noted.
    Results: In our study, the mean onset of sensory block was 11.6 +/-3.4 minutes in group C, 14.4 +/-4.5 minutes in group D. The mean onset of motor block was 17.6 +/-4.9 in group C, 20.6+/-5.9 in group D. The duration of sensory block in Group C was 9.7+/-1.6 hours, 13.3+/-1.9 hours in Group D. Duration of motor blockade (hrs) was 9.1+/-1.7 in Group C, 12.1+/-2.0 in Group D. Duration of sensory and motor blockade was longer in Dexmedetomidine group than Clonidine group. First rescue was required at 10.5 ± 1.7 hrs in Clonidine group and at 15 ± 2.2 hrs in Dexmedetomidine group. None of the subjects in Clonidine group had side effects; were as 10% of subjects in Dexmedetomidine group had side effects.
    Conclusions: Dexmedetomidine proves to be better adjuvant compared to clonidine as it notably prolongs analgesia and is also lesser complications at lower doses.
    Case Report
    Urvashi Tandon* and Deepak Dwivedi
    This inhalational agent has been in use since 1844 [1]. Of late there have been numerous debates on whether Nitrous Oxide should be used at all in the clinical practice of Anaesthesia. As it appears to be gradually phasing out of anaesthetic practice, here is a quick review on the properties of this gas, its clinical advantages and disadvantages.
    Teng-Fei Ma*
    Research utilizes a cyclical process of steps in order to conduct a study to prove or disprove a hypothesis or answer a specific question [1-2].
    Research Article
    Ajay Singh Thapa*, Binod Bhattarai, and Binita Dhakal
    Total intravenous anesthesia is a technique involving infusion and maintenance of anesthetic state with intravenous drugs alone. Propofol has three important characteristics of ideal TIVA agent, i.e. rapid induction, rapid metabolism and rapid recovery. In view of these advantages we studied the characteristics of propofol in total intravenous anesthesia for craniotomy.
    Aim: To study induction and recovery characteristics of propofol during craniotomy
    Methods: A total of 60 patients aged 18-60 years belonging to ASA I and II physical status with GCS more than 13 were included in the study. Exclusion criteria was GCS less than 13, ASA more than II, hemodynamic instability and other associated injuries. All patients were induced with propofol (2mg/kg) and maintained with 50 μg/kg/min infusion of propofol. Anesthesia was supplemented with fentanyl 2 mcg/kg and intubation facilitated with vecuronium 0.1 mg/kg. Based on hemodynamic signs, dose of propofol was adjusted in intraoperative period. Muscle relaxation was maintained with vecuronium 0.001mg/kg/min and analgesia with fentanyl 1 mcg/kg/hour intraoperatively. During skin closure, infusions were discontinued and neuromuscular blockade reversed at the end of surgery.
    Result: Propofol enabled smooth and rapid induction in all patients with mean induction time of 17.32 ± 2.43 seconds. During maintenance, propofol provided adequate depth of anesthesia in 53 (88.33%) of the patients, as assessed by hemodynamic changes. Recovery was good with short response time of 11.78 ± 2.99 minutes and orientation time of 21.86 ± 6.68 minutes.
    Interpretation and conclusion: Propofol based total intravenous anesthesia provides rapid induction and smooth recovery in most of the head injury patients.
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