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Background: This study seeks to evaluate the accuracy and reliability of bronchoscopy in confirming the correct positioning of double-lumen endotracheal tubes (DLTs) in patients undergoing thoracic surgery. Accurate DLT placement is crucial for lung isolation. This research employs bronchoscopy as a diagnostic tool to validate DLT positioning and assess its effectiveness in clinical practice. Methods: Our study included 30 adult patients undergoing thoracic surgery, which required the use of left-sided double-lumen endobronchial tubes. Anesthesia was induced with propofol, fentanyl, and midazolam as per body weight. Neuromuscular blockade was achieved with vecuronium and patients were ventilated with oxygen for 3mins. The adequate size of the left-sided double-lumen endobronchial tube (Portex sizes 35, 37, 39, and 41) was introduced. Confirmation of DLT placement was assessed initially by auscultation of the desired side of the lung by isolating it, capnography, and movement of the chest wall. Also, moisture during exhalation in the transparent proximal limb of DLT and on the catheter mount was noted. Results: Among 30 patients studied 9 were females and 21 were males. Surgery performed included 10 Lobectomy, 2 Pneumonectomies, 1 Tumor excision, 14 Decortication (in Tubercular Cases), 1 Diaphragmatic Plication, 1 hydatid Cyst Excision, 1 Fungal Ball Removal. Among all the above patients Right Thoracotomy was performed in 19 patients and 11 had left thoracotomy. In all the patients studied left left-sided double-lumen tubes (DLT) (Sizes-35, 37, 39, 41 fr) were used. Of the sample studied (30 Patients), 9 were female and 21 were males. Out of 30 cases studied desired lung isolation was achieved in 26 cases on clinical evaluation (auscultation and chest expansion), in 4 cases DLT was not giving satisfactory results on clinical evaluation and DLT was repositioned properly using the bronchoscope. Conclusion: Bronchoscopy emerged as an invaluable tool in our study, enabling visualization of key anatomical landmarks and identification of complications such as bronchial cuff herniation and deep tube placement. Prompt intervention under direct vision allowed for the correction of these issues, ensuring proper tube placement and minimizing the risk of complications such as inadequate lung isolation or airway trauma. [ABSTRACT FROM AUTHOR]

Selective Harmonic Elimination PWM (SHEPWM) is a classical method of voltage control of the inverter while eliminating the undesirable lower order harmonics for low-frequency applications. Multivariable non-linear equations often result in SHE modulation scheme. In this work, a Most Valuable Player Algorithm (MVPA) has been applied to solve the non-linear SHE equations for the elimination of lower order harmonics in a cascaded H bridge multilevel inverter. The MVPA algorithm shows better convergence characteristics and wider modulation control compared to some popular meta-heuristic optimization methods. Optimized switching angles have been obtained for 5, 7 and 9 level inverters for different modulation index (MI) from 0.05 to 1. The Total Harmonic Distortion (THD) for the output voltage was found to be smoother compared to the powerful Differential Evolution (DE) algorithm for modulation index greater than 0.6. And for modulation index greater than 0.8, MVPA scores better than DE in terms of THD. Experimentally, the performance of MVPA has also been validated for 1-phase 5, 7 and 9 level cascaded H-bridge inverter and 5th, 5th and 7th, 5th, 7th, and 11th harmonic was eliminated respectively. [ABSTRACT FROM AUTHOR]

Injury to the sciatic nerve from dorsogluteal intramuscular (IM) injection is not an uncommon iatrogenic cause. This case report discusses the successful management of a child with sciatic nerve injury due to an IM injection in the left gluteal region. The child experienced severe pain that was not responding to pharmacological therapy and was limiting physiotherapy, which forms an important step in the management of patients with peripheral nerve injuries. The case report outlines the use of a posterior tibial nerve block, which provided immediate relief of pain sensations in the sole of the foot, allowing the child to walk and eventually improving sleep and appetite. The report suggests that distal nerve blocks may be an effective treatment option for patients with severe neuropathic symptoms resulting from peripheral nerve injury. [ABSTRACT FROM AUTHOR]

Amorphous poly(ethylene terephthalate) (PET)/nanotalc nanohybrids have been prepared through solution casting route. The fine dispersion of nanotalc clay in the polymer matrix has been examined through transmission electron microscopy (TEM). The intercalation and interaction of nanoclay have further been confirmed using X‐ray diffraction, ultraviolet, and Fourier transform infrared techniques. The thermal stability has been tested via thermogravimetric analysis and nanohybrids have been found thermally stable. The glass‐transition temperature has been further confirmed through DTA and differential scanning calorimetry analysis which has been increased in the presence of nanotalc arising from greater interaction. The nanohybrids have been tested for their mechanical performances and have been found to have improved mechanical responses for nanotalc‐filled nanohybrids. The modulus has been increased whereas toughness has been compromised meagerly. The modulus values have been theoretically predicted using various micromechanical models. The microhardness of the nanohybrids has been examined through Vicker hardness test. The theoretical prediction of the hardness values has been done using different micromechanical models. The structural development upon uniaxial stretching of the samples has been studied using small‐angle X‐ray scattering and wide‐angle ray diffraction. The stretched samples have found to have short‐range ordering as well as increased blob size and better coherency in the presence of nanotalc. The aspect ratio has been increased upon stretching. The inclusion of nanotalc has induced high barrier for gas permeation as compared to pure PET. The oxygen transmission rate has been found to decrease up to 64% for 8 wt % of filler concentration. The prediction of the permeability data has been done using different models considering different aspect ratios. The permeability values have been predicted very closely and nanohybrids have been found suitable for practical applications such as packaging. © 2020 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2019, 137, 48607. [ABSTRACT FROM AUTHOR]

Background and Aims: Caudal analgesia is a good, reliable, and easy method to provide intraoperative and postoperative analgesia for infra-umbilical surgeries in children. Many additives are being used in combination with local anesthetics in caudal block to prolong the postoperative analgesia (clonidine, midazolam, ketamine, fentanyl, and dexmedetomidine). The purpose of this study was to compare the intraoperative hemodynamics, postoperative analgesia, postoperative rescue analgesic requirement, postoperative sedation and side-effects of clonidine and midazolam used as adjuvants to bupivacaine for caudal analgesia. Material and Methods: Following approval from Institutional Ethical Research Committee, 75 American Society of Anesthesiologists I and II patients aged between 1 and 7 years undergoing various elective infra-umbilical surgical procedures were included in this study. The patients were randomly allocated into three groups of 25 patients each. Group B received 1 ml/kg 0.25% bupivacaine in normal saline, Group BC received 1 ml/kg 0.25% bupivacaine + 1 µg/kg clonidine in normal saline, and Group BM received 1ml/kg 0.25% bupivacaine + 30 µg/kg midazolam in normal saline. The various parameters studied were intraoperative hemodynamic changes, duration of postoperative analgesia, postoperative sedation, postoperative analgesic requirement, and incidence of side-effects. Results: All the groups were similar with respect to patient and block characteristics. The hemodynamic parameters before and after administering caudal analgesia were also comparable. The mean duration of analgesia was 724.80 ± 60.29 min in Group BC, 605.40 ± 82.37 min in Group BM and 295.00 ± 41.78 min in Group B. Thus, the duration of analgesia was significantly prolonged in Group BC compared to Groups BM and B. The FLACC pain score was higher in Group B at the end of 4th, 8th and 12th h compared with Group BC and Group BM. Furthermore at the end of 12th h, pain scores were significantly higher in Group BM compared to Group BC. Only 1 child in Group BC received three rescue medications compared to 15 (60%) children in Group B and 7 (28%) children in Group BM. None of the groups were treated for bradycardia or hypotension and no significant sedation was noted. Conclusion: This study showed that the addition of both clonidine (1 µg/kg) and midazolam (30 µg/kg) with bupivacaine administered caudally significantly increase the duration of postoperative analgesia with minimal side-effects in children. The use of clonidine as an additive to bupivacaine in caudal epidural is a superior choice to midazolam as it reduces the demand of postoperative rescue analgesics significantly. [ABSTRACT FROM AUTHOR]

A 26 year-old primigravida at 30 weeks of pregnancy presented with frequent seizures, headache and vomiting. On examination she had a right sided hemiparesis. Magnetic Resonance Imaging (MRI) findings were suggestive of infective aetiology with possibility of tuberculoma. Emergency surgery was decided in view of rapid deterioration in patient's neurological state and uncontrollable headache and vomiting. Anaesthetic management was tailored for both pregnancy and an intracranial space occupying lesion. Foetal heart rate (FHR) was monitored prior to operation and throughout the surgery and periodically for 24 hours postoperatively. An obstetrician was requested to remain as standby for FHR assessment and for an urgent caesarean section if required in case of foetal distress. The major concerns for the anaesthesiologist are maternal and foetal monitoring and utero-placental drug transfer. [ABSTRACT FROM AUTHOR]

A 7-year-old girl had presented with right cheek swelling noted 3 months earlier. It was slowly progressive. Swelling was well defined, non-tender, smooth, firm in consistency and measured 4x4 cm. Intraoral examination revealed no missing teeth. Permanent teeth - central incisors (upper and lower), primary lateral incisor, canine and first and second molar were present. X-ray paranasal sinuses showed well-defined unilocular radiolucency with a thin sclerotic border enclosing permanent first molar, premolar and canine on the right side and first molar on the left side. The cyst was removed by enucleation procedure. Mucoperiosteal flap was elevated, and paper thin bone overlying the cyst was removed. The cyst was enclosing the permanent canine, premolar and molar teeth. Histopathological report was consistent with the dentigerous cyst. After 1-year follow-up, the patient has no obvious swelling over the cheek. [ABSTRACT FROM AUTHOR]