Curēus
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Background Dexmedetomidine is being used as an adjuvant analgesic, both as intravenous (IV) and intrathecal infusion. The role of perineural (P) dexmedetomidine has evoked attention recently. The aim of this study was to compare the effect of IV dexmedetomidine and P dexmedetomidine as an adjunct to supraclavicular brachial plexus block in upper limb orthopaedic surgery. Methods Patients were randomly divided into two equal groups (n=20). Group I (IV dexmedetomidine) received dexmedetomidine 1 mcg/kg IV as loading dose over 10 minutes, followed by continuous infusion of dexmedetomidine 0.4 mcg/kg/hr IV. ⋯ There was no difference in intraoperative Ramsay sedation scores in both groups, but postoperative Ramsay sedation scores at 9, 12, and 15 hours were better in group I (p<0.05). The average time to rescue analgesia (visual analogue scale >4) was higher in group I (p>0.05). Conclusion IV dexmedetomidine produced early onset of sensory block, longer duration of sensory and motor block, and longer duration of analgesia as compared with P dexmedetomidine as an adjuvant to supraclavicular block with 5 mg/kg lignocaine (2%) and 2 mg/kg bupivacaine (0.5%) in upper limb orthopaedic surgeries.
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Acute respiratory distress syndrome (ARDS) is often associated with severe hypoxemia and a high mortality rate. Prone positioning is a well-established intervention for ARDS. It has been shown to improve oxygenation and prevent ventilator-induced lung injury due to the more uniform distribution of lung stress and strain. ⋯ Although no single variable used during prone positioning reduces mortality rates in ARDS patients, combining several optimal conditions may yield increased survival benefits. Early initiation of extended prone positioning sessions combined with low tidal volumes shows encouraging results in severe ARDS patients. Future research on this subject should focus on further examining these variables in a study enrolling a larger number of subjects in a setting with adequately trained staff familiar with proper prone positioning techniques.