Role of Ultrasound-Guided Hemidiaphragm Sparing Brachial Plexus Block in the Morbidly Obese Patient

Patients with Grade III obesity pose unique challenges to the treating anesthesiologists. The challenges range from difficulty in intravenous cannulation to airway management. Regional anesthesia is advantageous over general anesthesia as it avoids airway manipulation, prevents reduction in functional residual capacity, and provides good postoperative analgesia. Regional anesthesia has its pitfalls like identifying the landmarks accurately and hemi diaphragmatic palsy following brachial plexus block. Hemi diaphragmatic palsy is poorly tolerated in grade III obese patients leading to increased peri-operative morbidity which undermines the advantages of regional over general anesthesia. Ultrasound-guided costoclavicular brachial plexus block(CCBPB) has the benefit of reduced hemi diaphragmatic palsy, avoiding pleural injury, and wider distribution of sensory blockade. Costoclavicular block has been administered to obese patients in the past with great success. We are reporting a successful case of ultrasound-guided costoclavicular brachial plexus block performed in an obese patient with a BMI of 51.56Kg/m2

Splanchnic Nerve Block as a Bridge Therapy in Painful Chronic Pancreatitis During COVID 19 Pandemic: A Case Report

Agonizing and debilitating pain is what most patients with chronic pancreatitis endure. Chronic pain often leads to depression and poor quality of life. Surgical decompression can result in permanent pain relief by reducing intraductal hypertension. Elective surgical procedures had to be postponed during the times of the Covid-19 pandemic as the resources including oxygen supplies, workforce, and ventilators were dedicated to the service of Covid-19 patients. We present a case of 20 year-old-male suffering from severe abdominal pain due to chronic pancreatitis refractory to analgesic medications. In view of the refractory pain and inability to proceed with surgery due to the pandemic, we subjected him to undergo splanchnic nerve block (SNB) with local anesthetic and steroid.  SNB provided adequate analgesia and enabled the patient to tide over the crisis. To our knowledge, no case has been reported using a combination of local anesthetic and steroid in SNB for a patient with chronic pancreatitis

A comparative study of three different anaesthetic techniques in unilateral elective hip surgeries (combined lumbosacral plexus block, spinal and epidural) – A prospective randomized single blinded study

Background:&nbsp; To&nbsp; compare the Adequacy of combined lumbosacral plexus block over subarachnoid block and epidural in terms of motor blockade and sensory blockade, surgeon and patient satisfaction and time for first rescue analgesia for unilateral elective&nbsp; hip surgeries.Materials and methods:A single centred randomized, single blinded study, conducted between May2017 to October 2018, on 60 patients undergoing elective unilateral hip surgeries with 20 patients in each group (group I -combined lumbar and sacral plexus block, Group II - Epidural &amp; Group III- Subarachnoid block). Patients belonging to American society of anaesthesiologists, physical status 1 &amp; 2, aged between 18 – 60 years were enrolled for the study and distributed randomly into one of the three groups. Adequacy of block in terms of motor and sensory blockade, patient and surgeon satisfaction and time for first analgesia were noted.Results:Among 60 patients, block was adequate in group III, compared to group II and group I. The total duration of analgesia was significantly higher in group I (338.5 ± 44.51), compared to group II (135.5 ± 11.45) and GROUP III (141.0 ±17.44). The total doses of analgesic required in the first 24 hours were low in group I, when compared to group II and group III.Conclusion:Combined lumbosacral plexus block, is a good and safe alternative to neuraxial block for patients undergoing unilateral hip surgeries, with good patient and surgeon satisfaction and prolonged postoperative pain relief.</p

Randomized comparison between dexmedetomidine and midazolam for prevention of emergence agitation after nasal surgeries

Background: Emergence agitation (EA) in nasal surgeries is seen in around 22% of patients, which can go to dangerous levels. Dexmedetomidine is effective in prevention of EA in such patients. Midazolam given as premedication fails to prevent EA due to its short half-life. In this study, we compared efficacy of dexmedetomidine and midazolam by intravenous infusion for prevention of EA in adult nasal surgeries. Materials and Methods: Seventy patients belonging to American society of anesthesiologist Status I and II, between 18 and 60 years of age posted for elective nasal surgeries were randomly divided into two groups. Group D received intravenous dexmedetomidine 0.5 mcg/kg over 15 min followed by 0.1 mcg/kg/h. Group M received intravenous midazolam 0.02 mg/kg over 15 min followed by 0.02 mg/kg/h. EA scores, emergence times, and hemodynamic parameters were monitored and compared between the groups. Statistical analysis was done by independent t-test, Mann–Whitney U-test, and Chi-square test as applicable. Results: Incidence of EA was comparable between the groups (P = 0.23). Two patients in midazolam group developed dangerous agitation while none in dexmedetomidine group. Patients in midazolam group (12.4%) were agitated even in postoperative period, which was not seen with dexmedetomidine group. Hypotension and bradycardia were seen more in dexmedetomidine group. Conclusion: Efficacy of midazolam when given as an intravenous infusion is comparable to dexmedetomidine in prevention of EA in nasal surgeries

ILC Reference Design Report Volume 1 - Executive Summary

The International Linear Collider (ILC) is a 200-500 GeV center-of-mass high-luminosity linear electron-positron collider, based on 1.3 GHz superconducting radio-frequency (SCRF) accelerating cavities. The ILC has a total footprint of about 31 km and is designed for a peak luminosity of 2x10^34 cm^-2s^-1. This report is the Executive Summary (Volume I) of the four volume Reference Design Report. It gives an overview of the physics at the ILC, the accelerator design and value estimate, the detector concepts, and the next steps towards project realization.The International Linear Collider (ILC) is a 200-500 GeV center-of-mass high-luminosity linear electron-positron collider, based on 1.3 GHz superconducting radio-frequency (SCRF) accelerating cavities. The ILC has a total footprint of about 31 km and is designed for a peak luminosity of 2x10^34 cm^-2s^-1. This report is the Executive Summary (Volume I) of the four volume Reference Design Report. It gives an overview of the physics at the ILC, the accelerator design and value estimate, the detector concepts, and the next steps towards project realization

ILC Reference Design Report Volume 4 - Detectors

This report, Volume IV of the International Linear Collider Reference Design Report, describes the detectors which will record and measure the charged and neutral particles produced in the ILC's high energy e+e- collisions. The physics of the ILC, and the environment of the machine-detector interface, pose new challenges for detector design. Several conceptual designs for the detector promise the needed performance, and ongoing detector R&D is addressing the outstanding technological issues. Two such detectors, operating in push-pull mode, perfectly instrument the ILC interaction region, and access the full potential of ILC physics.This report, Volume IV of the International Linear Collider Reference Design Report, describes the detectors which will record and measure the charged and neutral particles produced in the ILC's high energy e+e- collisions. The physics of the ILC, and the environment of the machine-detector interface, pose new challenges for detector design. Several conceptual designs for the detector promise the needed performance, and ongoing detector R&D is addressing the outstanding technological issues. Two such detectors, operating in push-pull mode, perfectly instrument the ILC interaction region, and access the full potential of ILC physics