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Propofol produces anesthesia with rapid recovery. However, it causes pain or discomfort on injection. A number of techniques have been tried for minimizing propofol-induced pain with variable results. We have compared the efficacy of magnesium and lidocaine for the prevention of propofol induced pain.Three hundred ASA I and II adults undergoing elective surgery were randomly assigned into three groups of 100 each. Group I received magnesium sulfate 1 g, Group II received lidocaine 2% (40 mg) and Group III received normal saline, all in a volume of 2 mL and accompanied by venous occlusion for one minute. Induction with propofol 2.5 mg.kg(-1) was accomplished following the release of venous occlusion. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of pretreatment and propofol injection. Results were analyzed by 'Z' test. A P value of0.05 was considered as significant.Pain during i.v. pretreatment with magnesium was 31% as compared to 2% for both the lidocaine and control groups (P0.05). Seventy-six percent of patients in the control group had pain during i.v. propofol as compared to 32% and 42% in the magnesium and the lidocaine groups respectively (P0.05). Lidocaine and magnesium pretreatment were equally effective in attenuating pain during the propofol injection (P0.05).Intravenous magnesium and lidocaine pretreatment are equally effective in attenuating propofol-induced pain. However, magnesium pretreatment itself causes pain. Therefore, there is no justification in the use of magnesium pretreatment for attenuating pain associated with i.v. propofol.

To report the rapid preoperative preparation of a case of thyrotoxicosis due to Graves' disease resistant to medical treatment.A 14-yr-old boy presented with a history of progressive swelling in the neck. Signs and symptoms were compatible with hyperthyroidism. Thyroid function tests revealed: serum T4 296.5 nmol.L(-1), serum T3 6.06 nmol.L(-1) and serum thyroid-stimulating hormone0.15 mIU.L(-1). The diagnosis of thyrotoxicosis due to Graves' disease was made. Therapy was instituted with carbimazole 30 mg.day(-1) and propranolol 80 mg.day(-1), which were gradually increased to carbimazole 80 mg.day(-1) and propranolol 120 mg.day(-1), without response. Preparation was attempted by adding Iopanoic acid 500 mg four times a day and dexamethasone 0.5 mg four times a day in addition to the above drugs for five days. T3 levels declined to 1.8 nmol.L(-1), but the serum T4 remained elevated. Symptoms of hyperthyroidism persisted but with decreased intensity. As the patient could not be made euthyroid, surgery was planned to relieve the symptoms. Anesthesia was uneventful except for intraoperative and postoperative tachycardia, which was managed successfully with esmolol.In life threatening thyrotoxicosis refractory to medical treatment, Iopanoic acid may be used as an adjuvant to antithyroid drugs for rapid preparation of the patient prior to surgery.

One hundred percent O(2) is used routinely for preoxygenation and induction of anesthesia. The higher the O(2) concentration the faster is the development of atelectasis, an important cause of impaired pulmonary gas exchange during general anesthesia (GA). We evaluated the effect of ventilation with 0.4 FiO(2) in air, 0.4 FiO(2) in N(2)O and 100% O(2) following intubation on the development of impaired gas exchange.Twenty-seven patients aged 18-40 yr, undergoing elective laparoscopic cholecystectomy were administered 100% O(2) for preoxygenation (three minutes) and ventilation by mask (two minutes). Following intubation these patients were randomly divided into three groups of nine each and ventilated either with 0.4 FiO(2) in air, 0.4 FiO(2) in N(2)O or 100% O(2). Arterial blood gases were obtained before preoxygenation and 30 min following intubation for PaO(2) analysis. Subsequently PaO(2)/FiO(2) ratios were calculated. Results were analyzed with Student's t test and one-way ANOVA. P value ofor = 0.05 was considered significant.Ventilation of the lungs with O(2) in air (FiO(2) 0.4) significantly improved the PaO(2)/FiO(2) ratio from baseline, while 0.4 FiO(2) in N(2)O or 100% O(2) worsened the ratio (558 +/- 47 vs 472 +/- 28, 365 +/- 34 vs 472 +/- 22 and 351 +/- 23 vs 477 +/- 28 respectively; P0.05).Ventilation of lungs with O(2) in air (FiO(2) 0.4) improves gas exchange in young healthy patients during GA.

The vibrational population relaxation and hydration shell dynamics of the symmetric tricyanomethanide (TCM) anion are investigated in a sodium bis(2-ethylhexyl)sulfosuccinate reverse micelle as a function of the water pool radius. Two-dimensional infrared (IR) spectroscopy in combination with linear absorption and ultrafast IR pump–probe spectroscopy is utilized in this study. Spectroscopic measurements show that the anion has two bands in the 2160–2175 cm–1 region, each with its own spectroscopic signatures. Analysis of the vibrational dynamics shows that the two vibrational bands are consistent with the anion located either at the interface or in the water pool. The sensitivity of the TCM anion to the environment allows us to unequivocally monitor the vibrational and hydration dynamics of the anion in those two different environments. A TCM anion located at the interface does not show any significant variation of the vibrational dynamics with the water pool size. On the contrary, the TCM anion inside th...

Cranial aspergillosis may present as meningitis, cerebral abscess, cerebral infarcts/haemorrhages or extra-axial mass. Extra-axial cranial aspergilloma may mimic meningioma owing to mass-like characteristics and intense contrast enhancement on MRI there by delaying the diagnosis and further worsening the already bad prognosis in these patients. We present a 45-year-old gentleman who presented with signs of raised intracranial hypertension, secondary optic atrophy and a contrast-enhancing mass arising from the planum sphenoidale. Postoperatively, mass was diagnosed as aspergilloma on histopathology and culture. Despite antifungal treatment, patient could not be saved due to large artery infarcts in the immediate postoperative period. We discuss the clinical and MRI features that could help to have sufficient and early suspicion of fungal aetiology in these patients.

To determine the pattern of onset of the intubating dose when given at a monitored target priming block in either phase of the priming drug effect. Sixty consenting ASA I and II patients were premedicated by intramuscular buprenorphine (5 μg·kg−1) 1h before surgery. Neuromuscular junction monitoring was done by stimulating the ulnar nerve at the wrist using Myotest and recording the adductor pollicis response on Myograph-2000. After stabilization of the twitch tension at the titrated supramaximal stimulus (1 Hz), double-burst stimuli (DBS) were given to monitor the priming effect of vecuronium bromide (Vb) (0.015 mg·kg−1). The DBS ratio (DBSr=D 2/D 1) was calculated for the DBS response, repeated at 20s. Depending on the target priming block level (DBSr 0.8, 0.6, or 0.5) and the phase of the priming block to give an intubating dose of Vb (0.8 mg·kg−1) injection, all patients were randomly assigned to six study groups: group 1 (DBSr 0.8), group 3 (DBSr 0.6), and group 5 (DBSr 0.5) during the priming block progression phase (before peakD 1 suppression), and group 2 (DBSr 0.8), group 4 (DBSr 0.6), and group 6 (DBSr 0.5) during the priming block regression phase (after peakD 1 suppression). Anesthesia was induced by thiopental (5–7 mg·kg−1) just before the intubating dose. The effect of the intubating dose on twitch stimuli (1 Hz) was monitored. We observed that in spite of significantly variable priming intervals for identical DBSr in two different phases, the onset time of the intubating dose to 0 response was identical in similar DBSr group patients; i.e., at 0.8 DBSr, 65.0±5.2s (group 1)vs 66.0±8.0s (group 2); at DBSr 0.6, 55.2±3.7s (group 3)vs 55.2±4.9s (group 4); and at DBSr 0.5, 43.5±4.8s (group 5)vs 43.5±4.2s (group 6). At 0 twitch response, the intubating conditions were comparable in patients of the six groups. In conclusion, target controlled priming (DBSr) for administration of the intubating dose appears to be a useful double-vision sign to predict the onset of the effect of the intubating dose precisely.

The study was planned to compare the sensitivity of a twitch neuromuscular monitoring test, the train-of-four (TOF), with a tetanic test, double-burst stimulation (DBS), during a subclinical dose of vecuronium. Twenty consenting. ASA I patients (16 to 65 years of age) of both sexes were studied. The ulnar nerve was stimulated at the wrist through surface electrodes by Myotest-DBS, and the adductor pollicis response was recorded on Myograph-2000. After stabilization of the twitch tension at titrated supramaximal stimuli (1 Hz), patients were randomly allocated into groups. In group 1 (n=10), the TOF test was monitored; in group 2 (n=10), the DBS test was monitoral. All patients received a priming dose of vecuronium (0.015 mg·kg−1); parameters such asT 1 and TOF ratio (TOFr) (T 4/T 1) were noted in group 1, andD 1 and DBS ratio (DBSr) (D 2/D 1) were noted during the vecuronium effect. The DBS test showed a wider range of change (from control 1.00 to 0.62±0.19 forD 1 and to 0.37±0.14 for DBSr) at a faster rate (0.07±0.04 min−1 forD 1 and 0.08±0.02 min−1 for DBSr) during the block progression phase than the TOF test parameters (T 1 and TOFr). The tetanic fade or DBSr showed peak onset later than peak twitch suppression. The rate of recovery of the DBS test was also slower than that of the TOF test after the peak effect. DBS is a more sensitive test than TOF to quantify the subclinical dose effect of vecuronium, and among the studied parameters (T 1, TOFr,D 1 and DBSr), DBSr, measuring tetanic fade, was the most sensitive single parameter.

Alterations in autonomic activity caused by anaesthesia can be assessed by spectral analysis of heart rate variability (HRV). This study examined the effects of ketamine and midazolam on HRV. Thirty patients of ASA PS 1 were studied. Fifteen were given ketamine (2 mg.kg-1) and 15 received midazolam (0.3 mg.kg-1), iv. The RR intervals of ECG were measured before and after induction of anaesthesia for ten minutes during spontaneous respiration. Power spectral density of the data was computed using fast Fourier transform. The spectral peaks within each measurement were calculated: low frequency area (LF, 0.04-0.15 Hz), high frequency area (HF, 0.15-0.5 Hz), and total power (TP, 0.04-0.5 Hz). Normalized unit power was derived as follows: low frequency area (nuLF): LF/TP x 100%, high frequency area (nuHF): HF/TP x 100%. Both ketamine and midazolam caused reductions in all measurements of HRV power (P < 0.05). However, ketamine increased nuLF from 64 +/- 14% to 75 +/- 13% (P < 0.05) and decreased nuHF from 36 +/- 14% to 25 +/- 13% (P < 0.05), while midazolam decreased nuLF from 66 +/- 15% to 54 +/- 14% (P < 0.05) and increased nuHF from 34 +/- 15% to 46 +/- 14% (P < 0.05). These results documented that both ketamine and midazolam reduced the total power and all frequency components of power in spite of their opposing effects on autonomic nervous activity. However, normalized unit power showed the expected sympathetic activation with ketamine and sympathetic depression with midazolam since ketamine increased nuLF and midazolam decreased nuLF.

Structural changes in nucleic acids in the premelting region (T < melting temperature, Tm) play an important role in the biological activity of DNA at physiological temperature. In the present communication we report the use of an ultrafast molecular rotor as an extrinsic fluorescence sensor to monitor the structural changes in natural DNA at T < Tm, which could not be detected even by circular dichroism spectroscopy. Further, the fluorescence sensor used in the present study is superior than most commonly used DNA stains.

IMPLICATIONS Nasogastric tube placement can cause ulceration and bleeding from the nose, pharynx, esophagus, and stomach. Its accidental placement into the tracheopulmonary system may lead to pneumothorax, hemothorax, or even death. We report a case of its knotting over the epiglottis, leading to life-threatening respiratory distress.

Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I-II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 μg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P

Measurements are made of effective linewidth (ΔHeff) in two samples of MgMn and LiZn ferrites using magneto microwave Kerr effect. The values of ΔHeff are determined at magnetic-fields where the dimensional resonance condition (2 ‖k′+π d = nπ, where k'+ is the real part of propagation constant, d the sample thickness, and n an odd integer) is satisfied. It is found experimentally that the value of ΔHeff strongly depends upon the dimensional resonance parameter n. Mittels Mikrowellen-Magneto-Kerreffekt werden die effektiven Linienbreiten (ΔHeff) zweier Proben von MgMn- and LiZn-Ferriten gemessen. Die Werte von ΔHeff werden bei Magnetfeldern bestimmt, wo die Dimensions-Resonanzbedingung erfullt ist (2 ‖k′+‖ d = nπ, wobei k′+ der Realteil der Aus-breitungskonstante, d die Probendicke und n eine ungerade Zahl ist). Es wird experimentell ge-funden, das der Wert von ΔHeff stark von dem Dimensions-Resonanzparameter n abhangt.

Background Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform attacks with cranial autonomic features (SUNA) are rare primary headache syndromes characterized by spontaneous or triggered attacks of unilateral, brief, multiple, orbitofrontal pain associated with ipsilateral autonomic features. SUNCT is considered as a subset of SUNA. In SUNA, there may be cranial autonomic symptoms other than conjunctival injection and lacrimation, or either of two is present. SUNCT/SUNA can be triggered immediately after or at the decrescendo phase of the ongoing attack without any intervening refractory period. Refractory period is usually present in trigeminal neuralgia. Absent refractory period is thought to reliably differentiate SUNCT/SUNA from trigeminal neuralgia and has been proposed for inclusion into the International Classification of Headache Disorders (ICHD) diagnostic criteria for SUNCT.