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Objective: To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults., Methods: In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge)., Results: We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 - 1.05; p = 0.11). No secondary outcome showed a statistically significant difference., Conclusion: Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.

Background: Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60-80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron-dexamethasone and ondansetron-dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery., Methods: Sixty-four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron-dexamethasone and ondansetron-dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded., Results: Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2-6hours only (p=0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0-24hours postoperatively) was 37.5% in group O and 9.4% in group P (p=0.016). Absolute risk reduction with palonosetron-dexamethasone was 28%, the relative risk reduction was 75%, and the number-needed-to-treat was 4. The patient's satisfaction score was higher in group P than group O (p=0.016). The frequency of rescue medication was more common in group O than in group P patients (p=0.026)., Conclusion: The combination of palonosetron-dexamethasone is superior to ondansetron-dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries., (Copyright © 2020. Publicado por Elsevier Editora Ltda.)

Background: Intra-articular injections of platelet-rich plasma to treat symptoms of knee osteoarthritis have been successfully used in young patients. However in most of these studies the control and test knees were present in different patients thus incorporating a large amount of bias in the results. Therefore, the present study was designed in which patients with bilateral osteoarthritis knee were included and platelet-rich plasma was administered in one knee and normal saline in another knee of same patient., Methods: 20 patients aged 30-65 years with bilateral osteoarthritis knees (ASA class I and II) of either gender were included in the study. Patients were randomized to receive platelet-rich plasma and normal saline in one of the two knees. The primary outcome was VAS and WOMAC score at 6months after procedure. The secondary outcome included changes in joint stiffness, physical function, any adverse effects noted during the course of study., Results: The baseline VAS score in platelet-rich plasma knee was 8.4 ± 0.88 which improved significantly to 4.85 ± 2.48 (p < 0.001) at 6months as compared to normal saline knee (p = 0.017). The WOMAC pain score also improved from baseline (14.5 ± 1.3) to over 6month 7.00 ± 4.24 (p < 0.001) in platelet-rich plasma knee while in the normal saline knee, no significant change occurred from baseline to six months (10.2 ± 1.2 to 10.05 ± 1.23). There was also significant decrease in stiffness and improvement of physical activity in the platelet-rich plasma knee as compared to normal saline knee., Conclusion: The present study showed significant decrease in pain and stiffness and improvement of physical functions of knee joint with intra-articular platelet-rich plasma injection as compared to normal saline., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Prone position is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible because of anisocoria. Anisocoria partially improved but persisted till follow up., (Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: Efficacy of preoxygenation depends upon inspired oxygen concentration, its flow rate, breathing system configuration and patient characteristics. We hypothesized that in actual clinical scenario, where breathing circuit is not primed with 100% oxygen, patients may need more time to achieve EtO 2 ≥90%, and this duration may be different among various breathing systems. We thus studied the efficacy of preoxygenation using unprimed Mapleson A, Bain's and Circle system with tidal volume breathing at oxygen flow rates of 5L.min -1 and 10L.min -1 ., Methods: Patients were randomly allocated into one of the six groups, wherein they were preoxygenated using either Mapleson A, Bain's or Circle system at O 2 flow rate of either 5L.min -1 or 10L.min -1 . The primary outcome measure of our study was the time taken to achieve EtO 2 ≥90% at 5 and 10L.min -1 flow rates., Results: At oxygen flow rate of 5L.min -1 , time to reach EtO 2 ≥90% was significantly longer with Bain's system (3.7±0.67min) than Mapleson A and Circle system (2.9±0.6, 3.3±0.97min, respectively). However at oxygen flow rate of 10L.min -1 this time was significantly shorter and comparable among all the three breathing systems (2.33±0.38min with Mapleson, 2.59±0.50min with Bain's and 2.60±0.47min with Circle system)., Conclusions: With spontaneous normal tidal volume breathing at oxygen flow rate of 5L.min -1 , Mapleson A can optimally preoxygenate patients within 3min while Bain's and Circle system require more time. However at O 2 flow rate of 10L.min -1 all the three breathing systems are capable of optimally preoxygenating the patients in less than 3min., (Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Objectives: Sternotomy for cardiac surgeries causes significant postoperative pain and when not properly managed may cause significant morbidity. As neuropathic pain is a significant component here, gabapentin and pregabalin may be effective in these patients and may reduce postoperative opioid consumption. The purpose of this systematic review was to find out efficacy of gabapentin and pregabalin in acute postoperative pain after cardiac surgery., Methods: Published prospective human randomized clinical trials, which compared preoperative and/or postoperative gabapentin/pregabalin with placebo or no treatment for postoperative pain management after cardiac surgery has been included in this review., Results: Four RCTs each for gabapentin and pregabalin have been included in this systematic review. Three gabapentin and two pregabalin studies reported decrease in opioid consumption in cardiac surgical patients while one gabapentin and two pregabalin studies did not. Three RCTs each for gabapentin and pregabalin reported lower pain scores both during activity and rest. The drugs are not associated with any significant complications., Conclusion: Despite lower pain scores in the postoperative period, there is insufficient evidence to recommend routine use of gabapentin and pregabalin to reduce opioid consumption in the cardiac surgical patients., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)