Choice of sedative for deep brain stimulation in Parkinson’s disease: Our experience and comparison of two cases

AbstractIntroductionParkinson’s disease (PD) is a severe, debilitating disease of the extra pyramidal central nervous system, which has a significant effect on lifestyle and day to day living of the affected population. Statistically, more of the elderly are now going to present with this disease. Moving ahead from older procedures such as cingulotomy, pallidotomy and thalamotomy which had irreversible side effects, deep brain stimulation (DBS) has emerged as a new, safer and more attractive option for such patients. Anaesthetic concerns for such procedures mainly incorporate principles of awake craniotomy, for which the basic requirement is a cooperative patient. Although Propofol was somewhat of a gold standard for this purpose until a few years back, Dexmedetomidine has emerged as the new drug of choice.CaseWhile conducting two surgeries for DBS over two days, we had an obverse experience with these drugs. We describe the pre-operative assessment and intra-operative management of the two cases and a discussion of the factors which might have contributed to this contradiction.ConclusionThe choice of sedation for DBS in PD should take into consideration factors such as patient cooperation, ‘drug off’ state due to pre-op medication stoppage, GABA versus non-GABA mediated mechanism of drugs, amount of dependence on PD drugs, severity of disease and finally requirement of the testing team. No drug can be singled out to be better and must be chosen based on individual merits of the patient and disease

Exact Security Analysis of ASCON

The Ascon cipher suite, offering both authenticated encryption with associated data (AEAD) and hashing functionality, has recently emerged as the winner of the NIST Lightweight Cryptography (LwC) standardization process. The AEAD schemes within Ascon, namely Ascon-128 and Ascon-128a, have also been previously selected as the preferred lightweight authenticated encryption solutions in the CAESAR competition. In this paper, we present a tight and comprehensive security analysis of the Ascon AEAD schemes within the random permutation model. Existing integrity analyses of Ascon (and any Duplex AEAD scheme in general) commonly include the term $DT/2^c$, where $D$ and $T$ represent data and time complexities respectively, and $c$ denotes the capacity of the underlying sponge. In this paper, we demonstrate that Ascon achieves AE security when $T$ is bounded by $\min\{2^{\kappa}, 2^c\}$ (where $\kappa$ is the key size), and $DT$ is limited to $2^b$ (with $b$ being the size of the underlying permutation, which is 320 for Ascon). Our findings indicate that in accordance with NIST requirements, Ascon allows for a tag size as low as 64 bits while enabling a higher rate of 192 bits, surpassing the recommended rate

ANAESTHETIC MANAGEMENT OF EXTRAHEPATIC PORTAL VENOUS OBSTRUCTION

Extrahepatic portal venous obstruction (EHPVO) is the commonest cause of portal hypertension and variceal bleeding in children. Major concerns are growth retardation, decrease lean body mass and loss of muscle that may lead to postoperative respiratory failure. Upper abdominal surgery with severe pain may compound the problem of pulmonary atelectasis. Poor preoperative nutritional status and anemia may lead to delayed wound healing, delayed ambulation, and respiratory complications. To avoid postoperative respiratory complications and surgical site infection we inserted epidural catheter despite the possibility of intraepidural space bleed due to low platelet counts. The patient had an excellent recovery profile in term of analgesia, decrease postoperative nausea and vomiting due to decrease consumption of opioids, increase sedation-free period, early ambulation and parent’s satisfaction. The intraoperative epidural also provides better abdominal muscle relaxation, wider surgical bloodless field and optimal pressure in anastomosis vessels. Regional techniques are avoided in thrombocytopenia, but risk and benefits must be assessed in each case

The Pre-Conception and Pre-Natal Diagnostic Techniques Act and its implication on advancement of ultrasound in anaesthesiology; time to change mindsets rather than laws

Ultrasonography (USG) has a continuously expanding role in anaesthesiology, critical care and pain management and has enhanced and refined patient care. The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act was established to counter the persistent problem of female foeticide in India. This unique problem which seems to be rooted in our social structure has indirectly impeded the evolution of USG as a widespread tool in medicine in our country. This brief review is aimed at highlighting the expanding role of USG in anaesthesia practice and training, nuances of the PCPNDT act and its implications on the growth and management of ultrasound technology in anaesthesia, in India