EFFECTS OF INTRATHECAL MIDAZOLAM IN SPINAL ANAESTHESIA: A PROSPECTIVE DOUBLE BLINDED CASE CONTROL STUDY

Background: Increasing the duration of action and maximizing postoperative analgesia has always been a domain of interest in spinal blocks. Many adjuvants have been tried along with local anaesthetic agent to achieve the same. The following study was conducted to compare sensory and motor characteristics with 2mg midazolam in subarachnoid block. Aim: To evaluate the efficacy and analgesic effect of the mixture of 2 mg midazolam and 15 mg (3 ml) hyperbaric bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgery under spinal block. Material and Methods: In this observational prospective case control study 100 patients (ASA class I and II), aged 18 to 55 years, undergoing elective infra-umbilical surgeries under spinal block were randomly divided into Group I- patients were administered 0.5% hyperbaric Bupivacaine (3 ml) + 0.9% Normal saline (0.4 ml) intrathecally and Group 2- patients were administered 0.5% hyperbaric Bupivacaine (3 ml) + 2mg preservative free Midazolam (0.4 ml) intrathecally. The onset and duration of sensory and motor block, hemodynamic variables, and side effects during the surgery and recovery were compared among the groups. Results: 2mg of preservative free midazolam used as an adjuvant to bupivacaine intrathecally reduces onset time of sensory and motor blockade, also time taken to reach T-10. It also increases time taken for two segmental recession and mean duration of analgesia. Conclusion: It can be inferred that Inj. Midazolam 2 mg in combination with Inj. bupivacaine  0.5% hyperbaric can be safely administered  intrathecally for better postoperative analgesia. KEYWORDS: Intrathecal Midazolam; Post-operative Analgesia; Bupivacaine; Spinal Anesthesia

EFFECTS OF INTRATHECAL MIDAZOLAM IN SPINAL ANAESTHESIA: A PROSPECTIVE DOUBLE BLINDED CASE CONTROL STUDY

Background: Increasing the duration of action and maximizing postoperative analgesia has always been a domain of interest in spinal blocks. Many adjuvants have been tried along with local anaesthetic agent to achieve the same. The following study was conducted to compare sensory and motor characteristics with 2mg midazolam in subarachnoid block. Aim: To evaluate the efficacy and analgesic effect of the mixture of 2 mg midazolam and 15 mg (3 ml) hyperbaric bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgery under spinal block. Material and Methods: In this observational prospective case control study 100 patients (ASA class I and II), aged 18 to 55 years, undergoing elective infra-umbilical surgeries under spinal block were randomly divided into Group I- patients were administered 0.5% hyperbaric Bupivacaine (3 ml) + 0.9% Normal saline (0.4 ml) intrathecally and Group 2- patients were administered 0.5% hyperbaric Bupivacaine (3 ml) + 2mg preservative free Midazolam (0.4 ml) intrathecally. The onset and duration of sensory and motor block, hemodynamic variables, and side effects during the surgery and recovery were compared among the groups. Results: 2mg of preservative free midazolam used as an adjuvant to bupivacaine intrathecally reduces onset time of sensory and motor blockade, also time taken to reach T-10. It also increases time taken for two segmental recession and mean duration of analgesia. Conclusion: It can be inferred that Inj. Midazolam 2 mg in combination with Inj. bupivacaine  0.5% hyperbaric can be safely administered  intrathecally for better postoperative analgesia. KEYWORDS: Intrathecal Midazolam; Post-operative Analgesia; Bupivacaine; Spinal Anesthesia

Robust and Agile System against Fault and Anomaly Traffic in Software Defined Networks

The main advantage of software defined networking (SDN) is that it allows intelligent control and management of networking though programmability in real time. It enables efficient utilization of network resources through traffic engineering, and offers potential attack defense methods when abnormalities arise. However, previous studies have only identified individual solutions for respective problems, instead of finding a more global solution in real time that is capable of addressing multiple situations in network status. To cover diverse network conditions, this paper presents a comprehensive reactive system for simultaneously monitoring failures, anomalies, and attacks for high availability and reliability. We design three main modules in the SDN controller for a robust and agile defense (RAD) system against network anomalies: a traffic analyzer, a traffic engineer, and a rule manager. RAD provides reactive flow rule generation to control traffic while detecting network failures, anomalies, high traffic volume (elephant flows), and attacks. The traffic analyzer identifies elephant flows, traffic anomalies, and attacks based on attack signatures and network monitoring. The traffic engineer module measures network utilization and delay in order to determine the best path for multi-dimensional routing and load balancing under any circumstances. Finally, the rule manager generates and installs a flow rule for the selected best path to control traffic. We implement the proposed RAD system based on Floodlight, an open source project for the SDN controller. We evaluate our system using simulation with and without the aforementioned RAD modules. Experimental results show that our approach is both practical and feasible, and can successfully augment an existing SDN controller in terms of agility, robustness, and efficiency, even in the face of link failures, attacks, and elephant flows

Barber's neck manipulation causing bilateral diaphragmatic paralysis and type-2 respiratory failure

This is a case report of an unusual cause of bilateral diaphragmatic palsy. A 54-year-old gentleman, presented to us with exertional dyspnea and chest heaviness for the past 6 months which had increased in the last 6 days. Dyspnea increased on lying down. He was diagnosed as pneumonia on the basis of X-ray and chest CT scan, received treatment for the same and responded to the therapy. However, breathlessness and hypercapnia persisted. He had unexplained hypercapnia for which extensive investigations were carried out. Neurological and cardiac assessments were essentially normal. On revisit clinical examination, he was found to have paradoxical diaphragmatic movement with respiration. Ultrasound of chest detected no diaphragmatic movement. Detailed history elicited that patient was fond of neck massage and neck cracking wherein his barber would bend his neck with jerk to either side after a haircut.After considering all possible etiologies; we concluded that it was a case of diaphragm palsy induced by barber neck manipulation, leading to Type-2 respiratory failure. The fact that the vital clues to the diagnosis were elicited by detailed history and thorough examination reinforces that history and clinical examination for doctors shall remain a very important tool for clinical diagnosis