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Aims: The aim of the study was to compare the effect of mannitol (M) and hypertonic saline (HTS) on brain relaxation and electrolyte balance. Settings and Design: Prospective, randomized, double-blind study. Subjects and Methods: A total of 114 patients with American Society of Anesthesiologists status II and III, scheduled to undergo craniotomy for supratentorial brain tumor resection were enrolled. Patients received 5 ml/kg 20% mannitol (n = 56) or 3% HTS (n = 58) at the start of scalp incision. Hemodynamics, fluid balance and electrolytes, were measured at 0, 15, 30, and 60 min and 6 h after infusion. Intensive Care Unit (ICU) stay between the two groups was also recorded. The surgeon assessed brain relaxation on a four-point scale (1 = Relaxed, 2 = Satisfactory, 3 = Firm, 4 = Bulging). Appropriate statistical tests were used for comparison; P < 0.05 was considered significant. Results: Brain relaxation conditions in the HTS group (relaxed/satisfactory/firm/bulging, n = 28/20/5/3) were better than those observed in the M group (relaxed/satisfactory/firm/bulging, n = 17/21/11/9). The levels of serum sodium were higher in the HTS group (P < 0.001). The average urine output was higher in the M group (5.50 ± 0.75 L) than in the HTS group (4.38 ± 0.72 L) (P < 0.005). There was no significant difference in fluid input, ICU stay, and hospital days between the two groups. Conclusion: We concluded that HTS provided better brain relaxation than mannitol during elective supratentorial brain tumor surgery, without affecting ICU and hospital stay. [ABSTRACT FROM AUTHOR]

Background: Trigeminal neuralgia is sudden unilateral severe, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. Pulsed radiofrequency stimulation (PRF) has been recently introduced to alleviate neural, joint pain, and muscle pain. We tried to use PRF for pain relief in trigeminal neuralgia. The primary objective of our study was to observe the effectiveness and safety of pulsed radiofrequency in the patients of trigeminal neuralgia who are refractory to medical management. The secondary objective was to study the effect of pulsed radiofrequency on the duration of pain relief in these patients. Methodolgy: In this observational study, we enrolled all fresh patients with trigeminal neuralgia attending our pain clinic for the first time and those who had not responded to conservative medical treatment or interventional nerve blocks. All the patients were diagnosed on the basis of signs, symptoms and MRI (CISS sequence). Anatomical landmarks of ophthalamic nerve, maxillary nerve, mandibular nerve were identified and nerve stimulation was done by placing the probe in the affected nerve division. Each point was stimulated with the radiofrequency probe kept for 10 minutes, giving a current of 10 to 30 milli-amperes with a set frequency of 2 Hertz. A total of 10 settings were given on alternate days. Assessment of pain relief, improvement, or deterioration was done using Barrow Neurological Institute Pain Intensity Score and Brief Pain Inventory facial scale scoring. Results: There was a significant reduction in pain scores observed on Barrow neurological institute (BNI) and Brief Pain Inventory-(BPI) pain intensity score (p value of <0.05) before and after pulsed radiofrequency (PRF) application. The duration of pain relief after the application of PRF was up to 180 days in 15 patients, 181-300 days in 8 patients and 300 to 600 days in 7 patients. Only 2 patients had a prolonged pain relief lasting for 601-720 days. One patient had developed exposure keratitis after 4 sittings of pulsed radiofrequency application at the supraorbital foramen. Conclusion: PRF offers short term relief in a majority of patients for a period of 18 months to 24 months. However, it was found that the long term effects of PRF may not be seen in patients with TN. PRF may be used as a short term measure for alleviating severe pain of TN till neurolytic blocks or a definitive surgery is carried out. [ABSTRACT FROM AUTHOR]

Background: Fat embolism syndrome (FES) is a clinical problem arising mainly due to fractures particularly of long bones and pelvis. Not much literature is available about FES from the Indian subcontinent. Materials and Methods: Thirty-five patients referred/admitted prospectively over a 3-year period for suspected FES to a north Indian tertiary care center and satisfying the clinical criteria proposed by Gurd and Wilson, and Schonfeld were included in the study. Clinical features, risk factors, complications, response to treatment and any sequelae were recorded. Results: The patients (all male) presented with acute onset breathlessness, 36-120 hours following major bone trauma due to vehicular accidents. Associated features included features of cerebral dysfunction (n = 24, 69%), petechial rash (14%), tachycardia (94%) and fever (46%). Hypoxemia was demonstrable in 80% cases, thrombocytopenia in 91%, anemia in 94% and hypoalbuminemia in 59%. Bilateral alveolar infiltrates were seen on chest radiography in 28 patients and there was evidence of bilateral ground glass appearance in 5 patients on CT. Eleven patients required ventilatory assistance whereas others were treated with supportive management. Three patients expired due to associated sepsis and respiratory failure, whereas others recovered with a mean hospital stay of 9 days. No long term sequelae were observed. Conclusion: FES remains a clinical challenge and is a diagnosis of exclusion based only on clinical grounds because of the absence of any specific laboratory test. A high index of suspicion is required for diagnosis and initiating supportive management in patients with traumatic fractures, especially in those having undergone an invasive orthopedic procedure. [ABSTRACT FROM AUTHOR]

Airway assessment is the most important aspect of anaesthetic practice as a difficult intubation may be unanticipated. A prospective study was done to compare the efficacy of airway parameters to predict difficult intubation. Parameters studied were degree of head extension, thyromental distance, inter incisor gap, grading of prognathism, obesity and modified mallampati classification. 600 Patients with ASA I& ASA II grade were enrolled in the study. All patients were preoperatively assessed for airway parameters. Intra-operatively all patients were classified according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value & negative predictive value. Results obtained showed an incidence of difficult intubation of 3.3 % of patients. Head and neck movements had the highest sensitivity (86.36%); high arched palate had the highest specificity (99.38%). Head and neck movements strongly correlated for patients with difficult intubation. [ABSTRACT FROM AUTHOR]