Journal of clinical and diagnostic research : JCDR
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Laryngoscopy and tracheal intubation is invariably associated with a reflex sympathetic pressor response resulting in elevated heart rate and blood pressures. This may prove detrimental in high risk patients. Objective of this study is to compare the effects of lignocaine and fentanyl in attenuation of this pressor response to laryngoscopy and tracheal intubation. ⋯ Attenuation of pressor response is seen both with lignocaine and fentanyl. Of the two drugs fentanyl 4mgicrogram i.v. bolus provides a consistent, reliable and effective attenuation as compared to lignocaine 1.5mg/kg iv. bolus.
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Since central neuraxial analgesia cannot provide adequate post operative pain relief when it is used alone in patients who had undergone Total Knee Replacement Surgery (TKR), an alternative analgesic method is usually advised. The alternatives include either systemic analgesics (opioids, Non Steroidal Anti Inflamatory Drugs, [NSAIDs], etc) or peripheral nerve blocks. When complete analgesia is aimed in such patients, combining the sciatic nerve blocks along with the Femoral Nerve Blocks (FNBs) will be beneficial. But performing femoral and sciatic nerve blocks together in patients with regional or general anaesthesia will be too cumbersome and in this direction, the major clinical trials are yet to decide on their feasibility. Thus, in an attempt to keep the analgesia methods very simple and effective, the physicians may decide on doing a single nerve block when an ongoing epidural analgesia infusion is in situ. ⋯ A single injection femoral nerve block provides adequate analgesia for the patients who undergo TKR surgery, when an active epidural is in-situ on the day of the surgery. It keeps the analgesic mode as simple and comfortable and it achieves lower pain scores on the day of the surgery, also with least complications, in patients with an ongoing epidural local anaesthetic infusion.
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Tuberculosis is the commonest of the infections world wide and it can affect almost any part of the body, most commonly the thorax. The spine is affected in 50 % of the cases of skeletal tuberculosis. A tuberculous infection of the spine causes a bony destruction and collapse of the vertebrae, with a gibbus deformity, skip lesions, an intervertebral disc involvement, an epidural abscess, a paravertebral abscess and oedema in the soft tissue planes. Magnetic Resonance Imaging (MRI) is the most valuable investigation in the patients with spinal tuberculosis, as it can clearly demonstrate all of the above findings. ⋯ The MRI scan is highly sensitive in the detection of various pathological processes of Pott's spine and the patterns of occurrence of these findings were analyzed in this study. Since the incidence and prevalence of tuberculosis are dependent on various epidemiologically sensitive parameters, this study can provide a benchmark, against which the results of studies which will be done in the future can be compared.