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  Citation statistics : Table of Contents
   2015| May-August  | Volume 9 | Issue 2  
    Online since September 11, 2015

 
 
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ORIGINAL ARTICLES
Is this the time to introduce ketamine in acute respiratory distress syndrome? A pilot study
Radwa A Elhefny, Mohamed Elsonbaty, Sherif Nassib, Mohamed Mansour
May-August 2015, 9(2):23-28
DOI:10.4103/1687-9090.165160  
Introduction Acute respiratory distress syndrome is regarded to be an acute, diffuse inflammation of the lung that leads to an increase in the permeability of the pulmonary vascular tissue. The relations between ARDS classes and the permeability of the pulmonary microvasculature as well as the water content of the pulmonary extravasculature remains to be clarified. The anti-inflammatory and the antioxidant properties of ketamine were observed in acute lung injury; ketamine promotes the attenuation of the expression of mediators of inflammation. The aim of the work The aim of this study was to test whether ketamine treatment by the inhaled route or the infusion route could be an efficient method of treatment for ARDS. Participants and methods Mechanically ventilated critically ill adult trauma patients admitted to the ICU with developing ARDS were eligible to participate in this study. Group A was treated by ketamine inhalation, group B was treated with ketamine infusion, and group C was treated by pulse steroid therapy. The serum interleukin-6 level was analyzed. Results Concerning group A (ketamine inhalation) and group B (ketamine infusion), there were significant correlations in both the groups starting from day 2 till day 5 of treatment with regard to the tidal volume and positive end-expiratory pressure and from day 3 of treatment with regard to the blood pressure and FiO 2 .
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Anesthetic management of ruptured ectopic pregnancy in immune thrombocytopenic purpura patient: a case report
Babita Ambush, Bhupendra Singh, Sakshi Maheshwari, Rakesh Karnawat
May-August 2015, 9(2):29-31
DOI:10.4103/1687-9090.165161  
Bleeding in patients with low platelet counts is an important anesthetic challenge. We report a case of a 22-year-old woman who presented with a ruptured extrauterine pregnancy. The patient was a known case of immune thrombocytopenic purpura and she was on treatment with steroids. Her Hb was 6 g/dl and platelet count was 5000/ml. The postoperative period was uneventful and the patient was discharged 8 days after surgery. Here, we discuss the management and outcome of this rare presentation performed successfully under general anesthesia without the use of intravenous immunoglobulin that is an important agent for preoperative management of a planned surgical procedure for immune thrombocytopenic purpura patient to increase platelet count. The duration of surgery was 1 h. Hemostasis was achieved in this period as well.
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A study to evaluate the effects of intranasal dexmedetomidine as a premedicant in paediatric patients undergoing cardiac surgeries
Jayanthraj Rajalakshmi, Kempanna S Lokesh Kumar
May-August 2015, 9(2):17-22
DOI:10.4103/1687-9090.165159  
Background Premedication is defined as the administration of drugs before anaesthesia to allay apprehension, produce sedation and facilitate the administration of anaesthesia to the patient. The current study is a prospective randomized double-blinded trail conducted to evaluate the effects of intranasal dexmedetomidine over placebo (0.9% saline) as a premedicant in paediatric cardiac surgeries. Patients and methods A total of 60 children of ASA physical status I and II, between the ages of 2 and 8 years undergoing various cardiac surgeries were assigned randomly into two groups. In group D, patients received intranasal dexmedetomidine (2 μg/kg), and in group P, patients received intranasal saline. At intervals of 10, 20, 30 and 45 min after intranasal administration of the study drug, parameters such as heart rate, blood pressure, respiratory rate and SpO 2 (oxygen saturation) were monitored. At 45 min, sedation, the ease of separation and intravenous cannula acceptance were evaluated. Results Statistically significant reductions in heart rate and blood pressure were observed from 30 min onwards in group D (P < 0.05) when compared with the placebo group. In the study, the sedation score in group D was 3.23 ± 0.568 when compared with 1.13 ± 0.345 in the placebo group (P = 0.0001). The ease of parental separation was 2.63 ± 0.614 in group D compared with 1.1 ± 0.305 in the saline group (P = 0.0001). The intravenous cannula acceptance score in group D was 2.1 ± 0.547 when compared with 1.06 ± 0.253 in group P (P = 0.0001). Conclusion Intranasal dexmedetomidine (2 μg/kg) provided better sedation, parental separation and intravenous cannula acceptance than placebo in children undergoing cardiac surgeries.
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