Clinical usefulness of nebulized dexmedetomidine for conscious sedation in daycare flexible bronchoscopy in Southern India

BACKGROUND

Sedative agents used in bronchoscopy require trained personnel to administer and monitor the patient. This increases the procedure cost, duration, and inpatient stay. Inhalational administration of sedative agents can be a practical solution to the issue. Dexmedetomidine in the inhalational form could give results similar to the intravenous form without significant adverse events.

MATERIALS AND METHODS

The study is prospective, randomized, and double-blinded study. Patients needing bronchoscopy were randomized to receive the nebulized form of either dexmedetomidine or saline (0.9%) before bronchoscopy. The study parameters are assessed and recorded before, during, and after bronchoscopy. Data collected are analyzed using the SPSS software.

DISCUSSION

The side effects limit using commonly administered sedation agents in bronchoscopy, such as midazolam, fentanyl, and dexmedetomidine. The nebulized dexmedetomidine is safe with proven efficacy when compared to the placebo. Proceduralist-administered conscious sedation reduces the overall cost and shortens inpatient stays. Attenuation of hemodynamic parameters by dexmedetomidine could be an advantage for the physician in reducing an untoward cardiac event.

CONCLUSION

Dexmedetomidine in the nebulized form improves the comfort of patients during the procedure. It blunts the pressure response during bronchoscopy and could be a safer and cost-effective agent in its nebulized form for conscious sedation in bronchoscopy. The study is approved by the institutional ethics committee (IEC KMC MLR 10-2021-310).

A Silent March- Post Covid Fibrosis in Asymptomatics-A Cause for Concern?

We report a case series of patients presenting with undiagnosed pulmonary fibrosis as a primary manifestation. On evaluation, after excluding other causes, the fibrosis was attributed to asymptomatic or mild COVID illness in the past. This case series serves to highlight the difficulties posed to clinicians while evaluating pulmonary fibrosis in the post-COVID era, more so in mild to asymptomatic COVID-19. The intriguing possibility of fibrosis setting even in mild to asymptomatic COVID is discussed.

COVID-19 Pandemic: Need of the Hour - A Course Correction, Restructuring & Review of our Policies - An Indian Perspective

The world stunned by a pandemic of such cataclysmic scale is reeling under the joint burden of health impact unleashed by the diseases and the strain on the economy. Glaring shortfalls and inconsistencies in strategies to combat the pandemic have surfaced worldwide irrespective of the country’s economic and health care status. The responses have vacillated from mute to drastic. Gaps in health preparedness coupled with administrative tardiness, lack of co-ordination and foresight has heightened the impact of pandemic. Coordinated holistic approach with structured policies in place is the need of the hour. Surveillance and epidemiological models to predict the unpredictable and preempt the backlash will dictate our future successes and failures in this protracted fight against the pandemic. This article attempts to review the present status of health policy on COVID in general and with specific reference to India and their outcome thus far. We also propose a simple and practical framework on which a decisive, well-knit, reliable and acceptable policy can be framed.

Perils with Pirfenidone and "the tuberculosis link"

We report a case of idiopathic pulmonary fibrosis (IPF) treated with pirfenidone who developed tuberculosis (TB) and later had exfoliative dermatitis secondary to an interaction between pirfenidone and rifampicin. This case report highlights the possible risk of developing TB in patients diagnosed with IPF and on antifibrotic therapy like pirfenidone. Furthermore, this case report documents a previously unreported adverse reaction due to the interaction of rifampicin with pirfenidone.

Charcot's Elbow Following Syringomyelia: Revisited

Neuropathic arthropathy of the elbow joint is uncommon with a reported incidence of 3-8%only. The natural history, pathogenesis and management approaches are debatable with an absence of clear guidelines. We report two cases of Charcot's elbow following syringomyelia with ulnar nerve manifestations. One patient required debulkingsynovectomy and ulnar nerve decompression while the other was managed conservatively. The article aims to enrich the limited knowledge of managing Charcot's elbow.