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Context: The cost of anesthetic technique has three main components, i.e., disposable supplies, equipments, and anesthetic drugs. Drug budgets are an easily identifiable area for short-term savings. Aim: To assess and estimate the amount of anesthetic drug wastage in the general surgical operation room. Also, to analyze the financial implications to the hospital due to drug wastage and suggest appropriate steps to prevent or minimize this wastage. Settings and Design: A prospective observational study conducted in the general surgical operation room of a tertiary care hospital. Materials and Methods: Drug wastage was considered as the amount of drug left unutilized in the syringes/vials after completion of a case and any ampoule or vial broken while loading. An estimation of the cost of wasted drug was made. Results: Maximal wastage was associated with adrenaline and lignocaine (100% and 93.63%, respectively). The drugs which accounted for maximum wastage due to not being used after loading into a syringe were adrenaline (95.24%), succinylcholine (92.63%), lignocaine (92.51%), mephentermine (83.80%), and atropine (81.82%). The cost of wasted drugs for the study duration was 46.57% (Rs. 16,044.01) of the total cost of drugs issued/loaded (Rs. 34,449.44). Of this, the cost of wastage of propofol was maximum being 56.27% (Rs. 9028.16) of the total wastage cost, followed by rocuronium 17.80% (Rs. 2856), vecuronium 5.23% (Rs. 840), and neostigmine 4.12% (Rs. 661.50). Conclusions: Drug wastage and the ensuing financial loss can be significant during the anesthetic management of surgical cases. Propofol, rocuronium, vecuronium, and neostigmine are the drugs which contribute maximally to the total wastage cost. Judicious use of these and other drugs and appropriate prudent measures as suggested can effectively decrease this cost.

Background: The positioning (trendelenburg) and pneumoperitoneum during laparoscopic gynecological surgeries may cause cephalad movement of diaphragm and subsequent endobronchial intubation. Patients & Methods: 50 ASA I/II patients posted for laparoscopic ligation were included in the study. Standardized anaesthesia technique was employed in all the patients. The distance of endotracheal tube to carina was measured in supine position, trendelenberg position, 5 min and 25 minutes post pneumoperitoneum and after deflation of pneumo-peritoneum. Results: The mean distance from the tip of the ETT to the carina was 3.41± 1.3 cm, 2.96 ± 1.4, 2.0 ± 1.5 and 1.7 ± 1.6 in supine position, trendelenburg position and 5min and 25 min post pneumoperitoneum. (P

We describe a case of a young woman, operated for perforation peritonitis who was admitted postoperatively in ICU for deranged consciousness level, hypotension and inadequate respiration. She developed symmetrical peripheral gangrene (SPG) supposedly due to multifactorial association of shock, septicemia, DIC and Dopamine.

We measure the stability and folding relaxation rate of phosphoglycerate kinase (PGK) Förster resonance energy transfer (FRET) constructs localized in the nucleus or in the endoplasmic reticulum (ER) of eukaryotic cells. PGK has a more compact native state in the cellular compartments than in aqueous solution. Its native FRET signature is similar to that previously observed in a carbohydrate-crowding matrix, consistent with crowding being responsible for the compact native state of PGK in the cell. PGK folds through multiple states in vitro, but its folding kinetics is more two-state-like in the ER, so the folding mechanism can be modified by intracellular compartments. The nucleus increases PGK stability and folding rate over the cytoplasm and ER, even though the density of crowders in the nucleus is no greater than in the ER or cytoplasm. Nuclear folding kinetics (and to a lesser extent, thermodynamics) vary less from cell to cell than in the cytoplasm or ER, indicating a more homogeneous crowding and chemical environment in the nucleus., (Copyright © 2011 Biophysical Society. Published by Elsevier Inc. All rights reserved.)