Background: Patient age, preoperative anxiety, dental requirement, risks associated with pharmaceutical management, safety, parental expectations, and cost influence the choice of pharmacological behavior management.Thus, this randomized controlled clinical study aimed to compare the effectiveness and acceptance of intranasal dexmedetomidine and midazolam for sedation in children aged 5–8 years using a mucosal atomizer device (MAD). Methods: A total of 48 participants with Frankl’s II behavior were randomly divided into two groups: Group I received intranasal midazolam (0.25 mg/kg), and Group II received intranasal dexmedetomidine (1.5 μg/kg).The primary outcomes assessed were drug acceptance, onset and effectiveness of sedation, and pre-and post-treatment anxiety levels. Secondary measures were also evaluated pre- and post-treatment. Results: Intranasal dexmedetomidine demonstrated significantly better drug acceptance (P < 0.001). Midazolam had a faster onset but was less effective than dexmedetomidine (P < 0.001). Additionally, dexmedetomidine exhibited better anxiolytic properties than midazolam (P < 0.001). Conclusion Dexmedetomidine was better accepted by children aged 5–8 years, was more effective, and had superior anxiolytic properties compared with midazolam.

Background: Patient age, preoperative anxiety, dental requirement, risks associated with pharmaceutical management, safety, parental expectations, and cost influence the choice of pharmacological behavior management.Thus, this randomized controlled clinical study aimed to compare the effectiveness and acceptance of intranasal dexmedetomidine and midazolam for sedation in children aged 5–8 years using a mucosal atomizer device (MAD). Methods: A total of 48 participants with Frankl’s II behavior were randomly divided into two groups: Group I received intranasal midazolam (0.25 mg/kg), and Group II received intranasal dexmedetomidine (1.5 μg/kg).The primary outcomes assessed were drug acceptance, onset and effectiveness of sedation, and pre-and post-treatment anxiety levels. Secondary measures were also evaluated pre- and post-treatment. Results: Intranasal dexmedetomidine demonstrated significantly better drug acceptance (P < 0.001). Midazolam had a faster onset but was less effective than dexmedetomidine (P < 0.001). Additionally, dexmedetomidine exhibited better anxiolytic properties than midazolam (P < 0.001). Conclusion Dexmedetomidine was better accepted by children aged 5–8 years, was more effective, and had superior anxiolytic properties compared with midazolam.

Background: Patient age, preoperative anxiety, dental requirement, risks associated with pharmaceutical management, safety, parental expectations, and cost influence the choice of pharmacological behavior management.Thus, this randomized controlled clinical study aimed to compare the effectiveness and acceptance of intranasal dexmedetomidine and midazolam for sedation in children aged 5–8 years using a mucosal atomizer device (MAD). Methods: A total of 48 participants with Frankl’s II behavior were randomly divided into two groups: Group I received intranasal midazolam (0.25 mg/kg), and Group II received intranasal dexmedetomidine (1.5 μg/kg).The primary outcomes assessed were drug acceptance, onset and effectiveness of sedation, and pre-and post-treatment anxiety levels. Secondary measures were also evaluated pre- and post-treatment. Results: Intranasal dexmedetomidine demonstrated significantly better drug acceptance (P < 0.001). Midazolam had a faster onset but was less effective than dexmedetomidine (P < 0.001). Additionally, dexmedetomidine exhibited better anxiolytic properties than midazolam (P < 0.001). Conclusion Dexmedetomidine was better accepted by children aged 5–8 years, was more effective, and had superior anxiolytic properties compared with midazolam.

Background: Dynamic parameters used for predicting fluid responsiveness require special equipment and are minimally invasive. Therefore, recent interest in the use of carotid artery ultrasound parameters, such as carotid corrected flow time (FTc) and peak velocity variation (ΔVpeak) has grown. Therefore, we performed this systematic review and meta-analysis to assess the ability of carotid FTc and/or ΔVpeak to accurately predict fluid responsiveness. Methods: We searched the PubMed and Embase databases for articles evaluating the diagnostic accuracy of carotid FTc or ΔVpeak for predicting fluid responsiveness. Two independent authors performed the search and selected studies published until May 2022. The studies were assessed for the inclusion and exclusion criteria using Rayyan (Rayyan Systems Inc., 2022). Results: Ten studies (n=438) that fulfilled the inclusion criteria were selected. Studies were divided into those assessing carotid FTc and those assessing carotid ΔVpeak. Five studies (six datasets) assessed FTc. The pooled sensitivity and specificity of carotid FTc were 0.76 and 0.88, respectively. The summary receiver operating characteristic (SROC) curve for carotid FTc had an area under the curve (AUC) of 0.9092, with a Q value of 0.8412. Seven studies calculated carotid ΔVpeak. The pooled sensitivity and specificity for ΔVpeak were 0.83 and 0.81, respectively. The SROC curve had an AUC of 0.8941 and a Q value of 0.8250. Conclusions Our meta-analysis showed that both carotid FTc and ΔVpeak are useful for predicting fluid responsiveness in anesthesia and critical care settings with good specificity and sensitivity.

Postmenopausal ovarian masses are not uncommon. Most of them are malignant due to inflammation and adhesion with the surrounding structures; these masses are fixed and torsion is not a usual phenomenon. We present a 73-year-old postmenopausal woman, parity five and five living issues with an acute abdomen. The examination revealed a 28–30-week size abdominal pelvic mass, which was confirmed to be ovarian in origin, with characteristics that indicated torsion on ultrasound Doppler. She underwent an emergency laparotomy with a total abdominal hysterectomy and bilateral salpingo-ophrectomy. Histopathology confirmed the diagnosis of serous cystadenoma. Ovarian torsion is a crucial differential diagnosis in postmenopausal adnexal masses presenting with acute abdomen. A high index of suspicion is required to diagnose and promptly manage women to improve the outcome.

Background: Awake fiberoptic intubation (AFOI) is the procedure of choice for securing the airway in patients with a difficult airway when undergoing surgeries under general anesthesia. An ideal drug would not only provide conscious sedation but also maintain spontaneous ventilation, smooth intubation conditions, and stable hemodynamics. We compared the effects of dexmedetomidine alone and dexmedetomidine in combination with fentanyl at a dose lower than the standard dose for achieving conscious sedation during AFOI in difficult airway patients undergoing oral cancer and dental surgeries. Methods: We included 68 adult patients undergoing AFOI. The patients were randomized in two groups, wherein Group D received intravenous dexmedetomidine 1 µg/kg and Group DF received dexmedetomidine 0.5 µg/kg and fentanyl 1 µg/kg. The outcomes measured were airway obstruction score, intubation scores, fiberoptic intubation comfort score, sedation score, and hemodynamic variables. Results: Low-dose dexmedetomidine with fentanyl showed similar results as those with the standard dose of dexmedetomidine in terms of airway obstruction, vocal cord movement, degree of cough, degree of limb movements, and intubation comfort. However, the sedation achieved and incidence of hypotension and bradycardia were higher in Group D than in Group DF. Conclusions A low dose of dexmedetomidine–fentanyl provides satisfactory intubation conditions as those with a standard dose of dexmedetomidine in AFOI, thereby avoiding bradycardia, hypotension, and sedation.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill and has exposed the lack of preparedness of most nations’ health care sys-tems. Even in usual times, palliative care has not received its fair share of recognition as an important component of patient care; instead, the emphasis is often placed on aggressive patient management. Now, with the entire medical community and decision-making committees focussed on intensive patient care, end-of-life care has taken a backseat. Methods: This article is a brief communication. Results: COVID 19 infection has been shown to lead to greater mortality and morbidity in patients with pre-existing illnesses such as hypertension, diabetes, renal failure, and cancer. Patients typically in need of end-of-life care, such as those with late-stage cancer or heart failure, are therefore at a higher risk of both contracting COVID-19 and suffering a more severe disease course. The strict nationwide lockdowns being imposed in most countries have deterred patients from seeking medical attention or hospice care. Every day new research is coming to light regarding COVID 19. This has helped significantly in creating awareness and limiting the spread of disease. However, misinformation is also rampant, leading to discrimination and mistreatment of infected patients. Conclusion This pandemic has been a terrifying ordeal for all and has exposed our entire population physically, psychologically, emotionally, and financially to unimaginable stresses. In the present scenario, EOL care is as much a necessity as intensive care and should be given at least a fraction of its importance.