Purpose Tracheal extubation remains a critical step in anesthetic management and is supposedly associated with coughing, bucking, laryngospasm, and agitation. Physicians should make all possible efforts to allow optimal smooth extubation and attenuate the airway and circulatory responses. Several drugs have been discovered to attenuate the aforementioned reflexes. The popularity of magnesium sulfate (MgSO₄) can be attributed to its sedative, analgesic, and antihypertensive properties. We aimed to study the effect of MgSO₄ on the smooth accomplishment of tracheal extubation. Patients and methods We selected 60 patients, aged 18–65 years. All patients had undergone a standardized anesthetic technique. They were randomized to either the MgSO₄ group (group M, 30 patients) or placebo group (control group C, 30 patients). We recorded and analyzed the smoothness of tracheal extubation, sedation score, hemodynamics, visual analog scale pain score, the time of extubation, the duration of surgery, the amount of fentanyl consumption, and postoperative morphine consumption. Results The aforementioned two groups were homogenized to obtain their demographic information. There were no clinically significant differences between the groups, based on the average arterial pressure, heart rate, or oxygen saturation. However, the smoothness of extubation score was lower in the MgSO₄ group (median=1, interquartile range: 1, 2) than in the control group (median=3, interquartile range: 2, 3) (P<0.001). However, the Ramsey sedation score was higher and the visual analog scale was lower in the MgSO₄ group compared with the control group. The MgSO₄ group revealed lower intraoperative fentanyl consumption than the control group. Moreover, the MgSO₄ group displayed lower postoperative morphine use. Conclusion The MgSO₄ group was associated with smooth extubation conditions, concomitant with less coughing, bucking, and laryngospasm than the control group.

Background The recent coronavirus disease 2019 (COVID-19) pandemic has taken a great toll on the already strained healthcare services. In this study, we aim to evaluate the effect of the COVID-19 pandemic on hospitalization rates for cardiac emergencies in our high-flow tertiary center. Patients and methods A retrospective nonrandomized descriptive study was conducted on urgent and emergency cardiovascular hospitalization rates from October 2019 to September 2020, which were compared with the data from the same time of the previous year. Results The total number of patients with acute mechanical valve thrombosis significantly decreased from 11 patients in the year before the pandemic to only one in April 2020 (P<0.001). Acute type A aortic dissection patient numbers decreased significantly from 16 to eight patients (P<0.05). Lastly, both urgent and emergency thoracic procedures decreased significantly during the COVID-19 year, which was evident from April to July 2020 (P<0.001). Conclusions Critical healthcare conditions should not be overshadowed by newly emerging pandemics. Future developed healthcare strategies should accommodate the increasing numbers of patients and ensure a reliable ‘safe zone’ for patients to avoid nosocomial infections.

Context Majority of studies have compared the clinical efficacy of levobupivacaine or ropivacaine with bupivacaine. Therefore, new and safer anesthetic agents ropivacaine and levobupivacaine have been introduced and are commonly used nowadays. Aims To assess and compare the effect of levobupivacaine versus ropivacaine with fentanyl as an adjuvant in thoracic epidural analgesia for post-thoracotomy pain relief. Settings and design The study was conducted in the Department of Anesthesia, Cardiothoracic and Vascular OT. Study design Hospital-based randomized, double-blind interventional study. Patients and methods After obtaining the Institutional Ethics Committee approval and written informed consent, 60 patients aged between 18 and 60 years of either sex, with American Society of Anesthesiologist status II/III, with weight more than 45 and less than 65 kg and height between 152 and 182 cm, scheduled to undergo surgeries with thoracotomy were enrolled for the study. The patients were randomized to receive injection levobupivacaine (0.2%) or ropivacaine (0.2%) 6 ml in 20 ml normal saline with injection fentanyl 20 μg bolus in the epidural space followed by injection levobupivacaine 0.1% or ropivacaine 0.1% with fentanyl 2 μg /ml at a rate of 0.1 ml/kg/h thoracic epidural infusion till 24 h postoperatively. Statistical analysis used Independent t test and analysis of variance test were used to compare the continuous variable and χ² test was used for categorical variables. Results The demographic and preoperative hemodynamic and respiratory parameters were comparable in both the groups. The postoperative hemodynamic variables, respiratory parameters, and pain scores were also comparable in both the groups. In visual analog scale score, statistically significant difference was observed at 20, 24, and 28 h. Patients receiving levobupivacaine required rescue analgesia later (31.78±15.22 h) than patients receiving ropivacaine (23.16±13.67 h) and were extubated earlier with lesser duration of ICU and hospital stay. Conclusions We concluded that the duration of analgesia was longer with levobupivacaine with fentanyl as compared with ropivacaine with fentanyl as need for first rescue analgesia was later in the levobupivacaine group. In the levobupivacaine group patients were extubated earlier and had a lesser stay in ICU and hospital.