Journal of clinical and diagnostic research : JCDR
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Local anaesthetic systemic toxicity (LAST) is one of the most dreadful complications after local anaesthetic (LA) use and it is very difficult to manage. The diagnosis of LAST is purely clinical and its presentation is usually obscured in a sedated or anaesthetized patient. A 25-year-old male patient undergoing laparotomy for acute duodenal perforation under general anaesthesia developed seizures after epidural administration of 0.5% bupivacaine. ⋯ Although, lipid rescue is recommended for LAST, our patient was managed without its use. We, therefore, recommend that utmost care and vigilance should be exercised while using local anesthetics as there is no perfectly accurate method to rule out intravascular administration of LA. Even, if LA is correctly used, LA is detected in plasma due to its systemic absorption from injection site.
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Electrolyte abnormalities are one of the common causes of morbidity and mortality in critically ill patients. The turnaround time for electrolyte reporting should be as low as possible. Electrolytes are measured conventionally in serum obtained from venous blood by electrolyte analyser which takes 20 to 30 min. Point of care analysers are now available where in electrolytes can be measured in arterial blood within 5 min. This study was done to study the agreement of arterial sodium and arterial potassium with venous sodium and venous potassium levels. ⋯ Arterial sodium and arterial potassium can be used instead of venous sodium and venous potassium levels in management of critically ill patients.
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Brachial plexus block is a suitable alternative to general anaesthesia for patient undergoing upper extremity surgery. Ropivacaine the S-enantiomer emerged as a possible replacement of Bupivacaine without undesirable toxic effects. It provides similar duration of sensory analgesia with early recovery of motor block. ⋯ On the basis of present study, conclusions were drawn that onset of action of sensory, motor block was early in Ropivacaine group with faster recovery of motor functions as compared to Bupivacaine group. No adverse effects were noted in either groups. This study suggests that Ropivacaine is a suitable alternative to Bupivacaine for forearm surgeries under Brachial Plexus Block.
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Cardiovascular diseases have become the leading cause of death around the globe and diabetes mellitus (DM) is considered to be a coronary artery disease (CAD) risk equivalent. Ranolazine, an anti anginal drug has been found to reduce Glycated haemoglobin (HbA1c) in diabetes patients with chronic angina. However the effect of another antianginal drug trimetazidine, on glycemic status is not clear. ⋯ In patients with chronic angina and diabetes mellitus Ranolazine 500mg BD and Trimetazidine 35mg BD did not show any effect on HbA1c and fasting blood glucose lebel.