Amarjeet Kumar

Radial artery spasm treatment by radial, median, or musculocutaneous nerve block? A potential therapeutic dilemma

To the Editor, We read with great interest the recent article by Bhakta et al. describing two cases of radial artery spasm relieved by block of the radial nerve. In that study, 5 mL of 0.5 % levobupivacaine was injected, under ultrasound guidance, 5 cm distal to the elbow crease just lateral to the radial artery where pulsatile arterial movement was visible. It was presumed that the block was affected by inhibiting the sympathetic postganglionic axons innervating the radial artery. The preganglionic sympathetic innervation of the upper limb is derived from cell bodies located predominantly in upper-mid thoracic spinal segments (T2-T6). Their axons emerge from the ventral roots, course through the sympathetic chain, and synapse onto postganglionic cells located in the stellate ganglion. The postganglionic fibres, in turn, project to the arm via the brachial plexus. Anatomical studies in human cadavers indicate that the radial artery receives its sympathetic innervation from the radial, median, and musculocutaneous nerves. Moreover, the radial artery may receive variable innervation from these nerves in its proximal, middle, and distal portions. Functionally, the contributions of the median and radial nerves to the sympathetic innervation of the radial artery have been inferred by the demonstration in patients of increases in radial artery blood flow after blocking the median or radial nerves, with no effect following block of the musculocutaneous nerve. In another study on human patients, an increase in hand temperature was observed following block of the ulnar or median nerves but no effect was observed after block of the radial or musculocutaneous nerves. These observations suggest that more than one nerve may carry sympathetic fibres innervating the radial artery and, in some cases, radial artery spasm may require block of a variable combination the radial, musculocutaneous, and median nerves for maximally effective treatment.

Comparative Assessment of Physicochemical and Biological Quality Characters of Vermicompost from Different Biomass Substrates

In an estimate, the annual total crop residues generated by the world population is projected around 3.8 billion tonnes (Lal, 2005). Around 3 thousand million tonnes of wastes annually produced in India, out of which more than 60% are decomposable (Chauhan et al., 2010). These large quantities of plant residues may serve as potential sources of plant nutrients (Suthar, 2007). These wastes may be recycled by making manure, compost as well as vermicompost which are the best options for its management (Bhat et al., 2013). Animal wastes also require a route for recycling into valuable end product rather being desecrate and discharge in the environment. Composting by using earthworm which offers the rapid recovery of valuable resources from biodegradable plant and animal wastes to humus-like vermicompost at a very short period of time (Pramanik et al., 2007). A large International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 7 Number 01 (2018) Journal homepage: http://www.ijcmas.com

Dual oxygen therapy in patient on bilevel positive airway pressure prevented invasive mechanical ventilation

During noninvasive bilevel positive airway pressure (BiPAP) ventilation it is found that several times patients are unable to maintain oxygen saturation and develop breathing difficulty despite its high setting and high oxygen flow, further management requires invasive positive pressure mechanical ventilation. Increasing oxygen concentration inside the BiPAP mask using nasal cannula with addition of another flow meter not only increase oxygen saturation but also make the patient more comfortable and prevent intubation and its complications. This dual oxygen therapy is particularly useful in patients where non invasive ventilation is required and avoiding the need invasive mechanical ventilation. High-flow nasal cannula oxygen therapy has many advantages over traditional oxygen delivery systems. Here, we are going to report two cases of patients on BiPAP in which invasive positive pressure ventilation was prevented using dual oxygen therapy using nasal cannula with flow meter and BiPAP mask with addition another flow meter in a single sitting.

A comparison of dexamethasone and clonidine as an adjuvant for caudal blocks in pediatric urogenital surgeries

Background: Caudal block is a reliable regional analgesic technique for pediatric urogenital surgeries. Various adjuvants have been tried to enhance the duration of action of bupivicaine. Though clonidine is extensively used as an adjuvant in caudal anaesthesia, it can have troublesome adverse effects like bradycardia, hypotension and sedation. Lately dexamethasone has become popular as an adjuvant in paediatric caudals due to its safety profile. Aim: The aim of this study was to compare dexamethasone and clonidine coadministered with bupivicaine caudally in paediatric patients undergoing urogenital surgeries in terms of analgesia and adverse effects. Settings and Design: Prospective, double blinded randomised study. Subjects and Method: Sixty American Society of Anesthesiologists physical status I and II children, aged 1-6 years undergoing urogenital surgeries were allocated in 2 groups: Group I: 0.5 mL.kg−1 of 0.25% bupivicaine with dexamethasone 0.1 mg.kg−1 in 1 ml normal saline (NS) Group II: 0.5 mL.kg−1 of 0.25% bupivicaine with clonidine 1 μg.kg−1 diluted in 1 ml normal saline. The parameters studied included duration of analgesia, intraoperative and postoperative hemodynamics, sedation scores and incidence of adverse effects like wound dehiscence, bleeding, vomiting and respiratory depression. Statistical Analysis Used: Statistical analysis was carried out using Stata Version 10. After checking for the normality assumption, t-test for comparing means of two independent samples was used for comparing baseline continuous variables. P values <0.05 were considered significant. Results: Patients in Group II had longer duration of analgesia postoperatively. Patients in this group also had lower heart rate and more sedation scores. Conclusion: Our study shows that caudal dexamethasone is a good alternative to clonidine with more stable hemodynamics and lesser sedation scores in the immediate postoperative period. Both the drugs offer good analgesia postoperatively with the duration of analgesia more in clonidine.