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Background and Aims: Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. Methods: This randomised controlled trial recruited 106 adult patients (18-65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro-Wilk test, and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. Fisher's exact test was used to assess any non-random associations between the categorical variables. Results: The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. Conclusion: A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA. Keywords: Ambulatory surgery, dexamethasone, emetogenic, general anaesthesia, olanzapine, ondansetron, postoperative nausea and vomiting, propofol, Author(s): Binayak Deb [1]; Kulbhushan Saini (corresponding author) [1]; Suman Arora [1]; Sanjay Kumar [1]; Shiv L. Soni [1]; Manu Saini [2] INTRODUCTION Post-discharge nausea and vomiting (PDNV) refers to [...]

Background Total anomalous pulmonary venous connection (TAPVC) to left superior vena cava (LSVC) is an extremely rare congenital heart disease, and its surgical management is very challenging. Case summary We report one such case of a 5-year-old south Asian male with double outlet right ventricle and unbalanced atrioventricular canal defect, where all the pulmonary veins were found opening into LSVC, which was then opening into the left side of the common atrium. Intraoperatively, the LSVC was transected just below the left internal jugular vein and left subclavian vein junction and left-sided bidirectional Glenn shunt done using 8 mm Dacron tube graft. Pulmonary veins were left draining through the LSVC into the common atrium. Right-sided Glenn shunt was completed as usual. Currently, the patient is year and half post-surgery and is doing well; school going on par with the peer group maintaining a room air saturation of 87%. Discussion Here, we report a successful surgical correction of TAPVC to LSVC in a child with univentricular physiology, however due to the paucity of data and rarity of such cases, optimal surgical management is yet to be defined. [ABSTRACT FROM AUTHOR]

Background: Transurethral resection of bladder tumors (TURBT) surgeries requires post‐resection catheterization for continuous irrigation of the bladder. This indwelling catheter is associated with distressing catheter‐related bladder discomfort (CRBD) and increases postoperative pain and agitation. Objectives: To prove the hypothesis that transurethral 100 mg lidocaine irrigation at the end of TURBT can reduce the frequency of moderate‐to‐severe postoperative CRBD. Methods: 116 patients scheduled for TURBT were screened, 94 were recruited and completed the study. American Society of Anesthesiologists Physical Status I–II adult patients, 20–75 years of age undergoing elective TURBT surgery under general anesthesia were included. Transurethral normal saline with 0.01% lidocaine (100 mg in 1 L NS) was used for irrigation 30 min before the completion of surgery in group L, while only normal saline was used for transurethral irrigation in group N. The main outcomes were frequency of CRBD, pain and patient satisfaction at 0, 1, 2, and 6 h postoperatively. Results: A total of 94 patients were analyzed in the study. The incidence of moderate–severe CRBD was significantly lower in group L as compared to group C at 0, 1, and 2 h (65.9% vs. 31.9%, p = 0.01; 31.9% vs. 10.6%, p = 0.012; 21.3% vs. 2.1%, p = 0.004, respectively). At the 6‐h mark, the incidence of CRBD was lower in group L, although this did not achieve statistical significance (6.38% vs. 2.1%; p = 0.613). Conclusion: Irrigation with 0.01% lidocaine (100 mg) towards the end of TURBT reduces the incidence of moderate–severe CRBD by 52% and increases patient satisfaction. [ABSTRACT FROM AUTHOR]

Congenital complete heart block (CCHB) has an incidence of one in 20,000 live births and carries a 20% risk of mortality. The hemodynamic instability due to bradycardia and asystole due to the increasing metabolic demands can be avoided by appropriate antenatal planning, timely delivery and initiation of medical treatment and early pacemaker insertion. In this report, we discuss the anaesthetic challenges of permanent epicardial pacemaker insertion with good outcomes in a 32-week gestational age 1380 grams neonate within a few hours of birth. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of the study is to evaluate the safety and efficacy of adjunctive use of mitomycin-C (MMC) using two different concentrations 0.2 mg/ml and 0.4 mg/ml for lacrimal duct probing to treat the nasolacrimal duct obstruction (NLDO) in adults. SUBJECTS AND METHODS: Prospective, an interventional comparative randomized pilot study of lacrimal duct probing conducted in the two study groups 0.02% MMC group (n = 30) and 0.04% MMC group (n = 30) in confirmed primary acquired NLDO of <1-year duration. Patency of lacrimal duct probing confirmed by syringing was compared at 1, 3, and 6-month follow-up in the two study groups, and corresponding subjective improvement of watering was appraised according to Kraft and Crawford grading. RESULTS: Patency of lacrimal duct probing in 0.02% MMC versus 0.04% MMC group was 66.66%/73.33% (P = 0.71) at 1 month, 46.66%/66.66% (P = 0.09) at 3 months and 46.66%/66.66% (P = 0.03) at 6-month follow-up, respectively. Subjective improvement of watering (no watering and mild watering) observed in 0.02% MMC versus 0.04% MMC group was 46.66%/73.33% (P = 0.03), at 1 month, 66.66%/83.33% (P = 0.13) at 3 months and 56.66%/73.33% (P = 0.17) at 6-month follow-up. CONCLUSION: Adult lacrimal duct probing with 0.04% MMC was associated with significant higher objective success rate than adult lacrimal duct probing with 0.02% MMC, without added concurrently side effects. [ABSTRACT FROM AUTHOR]

Ventricular septal defects (VSD) are the most common congenital cardiac defect. Patients with large VSDs present early due to an increase in the volume load on the left ventricle and pressure load on the right ventricle. Few of them present late even without surgical intervention, due to partial restriction of perimembranous (PM) VSD, either by the septal leaflet of the tricuspid valve or by aortic valve cusp prolapse into the VSD. The authors observed a novel structure (ie, subaortic membrane in this case) restricting the large PM VSD in a 15-year-old child. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic is an emerging, rapidly evolving public health emergency where a nation's health-care system can face a marked surge in demand for intensive care unit (ICU) beds and organ support. In regions with insufficient medical resources, it may further aggravate the existing shortage, limiting an ICU's ability to provide the normal standard of care. It can present ethically or legally demanding questions about how to prioritize the allocation of life-saving medical resources. In developing countries like India, still many hospitals are challenged by competing priorities and remain underprepared. In the wake of COVID-19 pandemic, to guide the intensive care disaster planners in regions with low resources and to ensure ICU readiness, this review shares our experience and strategies for preparing ICU with existing and alternative resources, focusing on space, equipment, and health-care workers' safety and training. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the efficacy of orally administered midazolam, clonidine and dexmedetomidine with regard to preoperative sedation, effect on parental separation, acceptance of face mask and recovery profile in children. Methodology: This was a prospective, randomized, double blind clinical trial, conducted in a tertiary care hospital, in which 80 children in the age group of 1-4 years were included. The study population was divided into three groups and each group was premedicated with one of the three oral premedicants. Patients in Group-M received 0.5 mg/kg of oral midazolam 30 min before the surgery, Group-C received 4 μg/kg of oral clonidine 90 min before the surgery and Group-D received 4 μg/kg of oral dexmedetomidine 60 min before the surgery mixed in honey. In the waiting area sedation score, parental separation score, mask acceptance at induction were measured on 4 point scales. In the PACU, children were monitored for NIBP, ECG, SpO2 and Steward Recovery Score every 15 min for 2 hours. Nausea, vomiting, shivering or other complications if any and time taken to achieve Steward Score of 6 was noted. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows). Results: All the three groups had comparable sedation. Parental separation was easy for children in Group-M (96.6%) and Group-D (93.6%) while it was significantly low in Group-C (63.5%) (p=0.001). Significantly higher number (96.6%) of children in Group-M showed satisfactory mask acceptance in comparison to Group-C (45.8%) and Group-D (25.9%) (p<0.001). Recovery from anaesthesia was significantly faster in Group-M when compared with Group-C and Group-D (p<0.001). Conclusion: Despite effective preoperative sedation (>90%) with the two alpha-2-agonists, clonidine and dexmedetomidine, parental separation and mask induction was not satisfactory as compared to midazolam. [ABSTRACT FROM AUTHOR]