Savita Saini

Fast ion surface energy loss and straggling in the surface wake fields.

We have measured the stopping powers and straggling of fast, highly ionized atoms passing through thin bilayer targets made up of metals and insulators. We were surprised to find that the energy losses as well as the straggling depend on the ordering of the target and have small but significantly different values on bilayer reversal. We ascribe this newly found difference in energy loss to the surface energy loss field effect due to the differing surface wake fields as the beam exits the target in the two cases. This finding is validated with experiments using several different projectiles, velocities, and bilayer targets. Both partners of the diatomic molecular ions also display similar results. A comparison of the energy loss results with those of previous theoretical predictions for the surface wake potential for fast ions in solids supports the existence of a self-wake.

Decorative hairstyle: cause for difficult endotracheal intubation.

would have been included. Had it been, its effect would have largely offset the effect of Pedersen et al., and the statistical significance of my result would remain P < 0.00005. Somewhat more interesting is Overdyk and Roy’s conjecture that “100% oxygen is an anti-emetic.” However, their proffered empirical support involves three magic tricks. First is the use of a onetailed Fisher’s exact test. This is seldom justified, and cannot be justified when the hypothesis being tested is a novel conjecture about what “appears to be an inconsequential variable at first.” Here’s why. Suppose I offered to sell you a “loaded” penny for one dollar. You want evidence that it really is loaded, so I flip it four times, get four heads, and say, “P = 0.0625-close enough; I’m only asking for a buck.” The trick is that I did not initially say, “This coin is loaded toward heads”-1 just said, “This coin is loaded-and an ordinary penny is as likely to come up four tails as four heads, doubling the probability that you would be buying a plain penny for a dollar. This is why one-tailed tests are frowned upon (6). (I used a two-tailed test in my analysis, even though the conjecture that N,O is untiemetic [the other side of the coin] does not enjoy widespread popularity.) Overdyk and Roy’s second trick is their inclusion of Jensen ‘93 and Taylor ‘93, neither of which report the incidence of emesis. And their third trick is exclusion of Arellano ‘94 and Lim ‘93-especially tricky in light of Overdyk and Roy’s insistence upon “anesthetic regimens differing only by N,O omission” (a criterion that both of these studies satisfy). Doing the proper Fisher’s exact test brings the P value of Overdyk and Roy’s analysis up to 0.1. Excluding Jensen ‘93 and Taylor ‘93 brings it to 0.2. Including Arellano ‘94 and Lim ‘93 brings it to 0.21. Would you buy a purportedly loaded penny because it landed on the same side three times in a row? If so, please send one dollar and a stamped, self-addressed envelope to the address below-I’ve got your coin! Meanwhile, it seems fair to assume that readers who do not send money agree that people who live in glass houses should not throw stones.

Comparative study of anatomical landmark-guided versus ultrasound-guided suprascapular nerve block in chronic shoulder pain

Background: Suprascapular nerve block (SSNB) is an effective method for the treatment of shoulder disorders. The present study was conducted to evaluate and compare the effectiveness of SSNB under ultrasonographic guidance with anatomical landmark-guided (LMG) technique in the treatment of chronic shoulder pain. Materials and Methods: A total of fifty patients with shoulder pain were enrolled in the present prospective randomized study. Patients in Group I (n = 25) received SSNB using the anatomical LMG as technique described by Dangoisse, in whom a total of 6 ml of drug (5 ml of 0.25% bupivacaine and 40 mg methylprednisolone) was injected. Group II patients (n = 25) were given SSNB using the ultrasound guidance with the same amount of drug. Pain was measured using visual analog scale (VAS), range of motion and Shoulder Pain and Disability Index (SPADI) were recorded. Observations were recorded before the block, immediately after the block, and 1 and 4 weeks after the block. Results: There was no statistically significant difference between the VAS score, range of motion and SPADI before the procedure (P > 0.05) in both the groups. Both the groups showed statistically similar improvement of VAS, range of motion and SPADI at 4-week (P > 0.05) follow-up. In Group I, VAS decreased from baseline value of 6.64 ± 1.50–2.04 ± 0.94 at 4 weeks (P < 0.001). In Group II, the VAS decreased from 6.92 ± 1.00 to 1.84 ± 1.03 at 4 weeks (P < 0.01). Conclusion: In our study, both the techniques have produced comparable relief of pain, improvement in shoulder movement, and decreased SPADI 4 weeks after the block.

Evaluation of the Intubating Laryngeal Mask Airway (ILMA) as an intubation conduit in patients with a cervical collar simulating fixed cervical spine

Background: Cervical spine immobilisation with a semi-rigid cervical collar imposes difficulty in tracheal intubation. There is increasing use of the Intubating Laryngeal Mask Airway (LMA- FastrachTM) for intubation in patients with difficult airways. The present study was conducted to assess its potential role for tracheal intubation in simulated fixed cervical spine patients. Method: After obtaining approval from the ethics committee and patients’ consent, this observational study was performed on 35 adult patients of either sex of ASA physical status I and II scheduled to undergo surgery under general anaesthesia requiring tracheal intubation. A two-piece semi-rigid cervical collar of appropriate size was positioned around the neck of patients. A standard anaesthesia protocol comprising glycopyrrolate, propofol and vecuronium was used for induction of anaesthesia. ILMA placement and blind tracheal intubation through this was attempted by using dedicated silicone tube provided with the ILMA set. Success rate, number of attempts required, time taken, difficulties encountered and any complication that occurred were noted. Anaesthesia was maintained with isoflurane in oxygen and nitrous oxide, pethidine and vecuronium. Following completion of surgery, neuromuscular blockade was reversed with glycopyrrolate and neostigmine. Results: The overall success rate was 85.7% and the success rate for ILMA placement at first attempt was 57.1%. Tracheal intubation was successful at first attempt in 70.5% of patients. The time taken for ILMA placement and tracheal intubation through this was 31.76 ± 9.74 and 34.04 ± 12.68 seconds respectively. Decreased mouth opening due to presence of the collar led to difficulty in ILMA placement. Conclusions: Blind tracheal intubation through ILMA is a possible option for airway management in patients with a semi-rigid cervical collar.

Ultrasonographic measurement of optic nerve sheath diameter: A point of care test helps in prognostication of Intensive Care Unit patients

Early identification of elevated intracranial pressure (ICP) is critical to ensuring timely and appropriate management to improve patient outcome. Measurement of the optic nerve sheath diameter by ultrasound is a well studied modality for noninvasive assessment of ICP. Recent studies have shown it to correlate with invasively measured ICP. We utilized this technique in our ICU and found it to be of great help in guiding patient management and predicting the prognosis. A case series of four patients is reported illustrating its utility in ICU patients.

Dexmedetomidine: A Saviour in a Child with Hand Schuller Christian Diseasefor MRI

Hand Schuller Christian disease (HSC) primarily affects infants and children. Its classical presentation includes triad of exophthalmos, diabetes insipid us, and calvariallytic lesions. Systemic involvement may include hepatomegaly, lymphadenopathy, dermatological, gastrointestinal tract, renal, pulmonary and CNS involvement. CNS involvement includes convulsions, increased intracranial pressure, focal neurological deficits, mental retardation, hearing disturbance, and tremors. We encountered a 4 year old female child with HSC disease who was posted for elective MRI scan under anaesthesia. Patient’s history, physical examination, and lab reports revealed multitude of problems enumerated in case report. Such patients when posted for anaesthesia pose a major challenge in view of multiple organ involvement. Polydipsia made difficult to keep the patient fasting and giving general anaesthesia as per standard protocol became risky. The loose teeth with bleeding gums and protruded mandible would have compounded the mask ventilation, LMA placement or laryngoscopy and intubation, manifolds. We managed this case successfully with intravenous sedation with inj. dexmedetomidine at 1 μg/kg/min over 10 min and then maintenance infusion at 0.1 μg/kg/min. Spontaneous ventilation was supplemented with oxygen (FiO2 0.60). MRI scanning was completed in 45 minutes comfortably. Hence, dexmeditomidine offers advantage in such patients if anaesthesia has to be given in remote locations like MRI suite.

Pediatric fiberoptic intubation: Another challenge… another approach!!

• Combined NPA–FOB technique: Involves administration of oxygen and general anesthesia through an (intact) NPA in one nostril and the FOB can be introduced orally or from the opposite nasal passage. • Combined endoscopy mask–FOB: Endoscopy mask has a single port for administration of oxygen and anesthetic gases and another port with an insertion diaphragm wide enough to allow passage of ETT and FOB. • Intubation with FOB through the laryngeal mask airway, intubating laryngeal mask, and air-Q.

Comparison of ProSeal laryngeal mask airway placement techniques using digital, introducer tool and gum elastic bougie in anaesthetized paralyzed patients

Background: Conventionally laryngeal mask airway (LMA) is placed in the oral cavity using fingers without the need for laryngoscope. ProSeal laryngeal mask airway (PLMA) placement is relatively difficult owing to its bulky design and sometimes require alternative techniques. We compared three techniques (digital, introducer-tool, gum-elastic bougie) for its placement. Methods: One hundred fifty patients of ASA class I & II of either sex, undergoing surgery under general anaesthesia were randomly allocated to one of the three groups. Standard anaesthesia protocol comprising of glycopyrrolate, thiopentone, vecuronium and halothane in oxygen plus nitrous oxide was used. Insertion attempts, success rate and time taken were noted after confirmation of proper placement. Efficacy of airway seal, oropharyngeal leak pressure (OLP) , ease of gastric tube insertion, trauma to oropharyngeal structures, postoperative airway morbidity were noted. Haemodynamic monitoring was done throughout the procedure. Results: First attempt success rate as well as overall success rate was high in gum elastic bougie group. Although in this group insertion time was slightly longer. Airway seal was also better in this group as shown by high OLP. Airway trauma was comparable in all the three groups. Conclusions: Gum elastic bougie guided PLMA insertion is a good alternative if traditional methods of its placement fail.

A unique method of intubating an unusual neck injury with knife-in-situ

Abstract A young male, aged 32 years, was brought to the emergency operation theatre, with a household knife-in-situ, in the neck. A detailed history revealed psychiatric illness to be the cause of this self inflicted injury. His vitals were found to be stable and he had no respiratory embarrassment and was conversing comfortably. Intubating him with a knife-in-situ was a great challenge. A simple technique using two endotracheal tubes was used which helped in securing the airway avoiding any further injury with the knife-in-situ.

Pseudoaneurysm following Fracture shaft of femur – A plea for concern

1 Dr. Geeta Ahlawat, 2 Dr. Savita Saini , 3 Dr. Kirti Kshetrapal, 4 Dr. Mangal Singh Ahlawat, 5 Dr. sushila Taxak, 6 Dr. Rajmala Jaiswal 1 Associate Professor Deptt. Of Anaesthesiology and Critical care,Pt. BDS PGIMS ROHTAK 2 Senior Professor Deptt. Of Anaesthesiology and Critical care,Pt. BDS PGIMS ROHTA 3 Associate professor Deptt. Of Anaesthesiology and Critical care,Pt. BDS PGIMS ROHTAK. 4 Senior Resident Deptt. Of Anaesthesiology and Critical care,Pt. BDS PGIMS ROHTAK. 5 Professor Deptt. Of Anaesthesiology and Critical care,Pt. BDS PGIMS ROHTAK. 6 Associate professor Deptt. Of Anaesthesiology and Critical care,Pt. BDS PGIMS ROHTAK.