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Background and Aims: Apnoeic oxygenation during laryngoscopy has been emphasised in recent recommendations for airway management. We aimed to compare the effect of nasal oxygen supplementation on time for pulse oximeter oxygen saturation (SpO2) to fall from 100% to 92% (desaturation safety time), to assess the arterial oxygen partial pressures (PaO2) with and without nasal oxygen supplementation and the time for SpO2 to recover from 92% to 100% after initiation of ventilation. Methods: This is a prospective randomised placebo-controlled trial involving sixty patients, where nasal oxygen supplementation given at 10 L/min during apnoea of laryngoscopy in one group of patients (Group O2) was compared to no oxygen supplementation in other group (Group NoO2). Desaturation safety period and the PaO2 just after intubation were compared. Time for SpO2 to increase to 100% after initiation of ventilation was also assessed. Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. Results: Desaturation safety period at 415.46 ± 97.23 seconds in group O2 versus 378.69 ± 89.31 seconds in group NoO2 (P = 0.213) and PaO2 (P = 0.952) and time to recovery of SpO2 (P = 0.058) were similar in both groups. Rise in arterial carbon dioxide secondary to apnoea was slower in oxygen supplementation group (P = 0.032). Conclusion: Apnoeic oxygen supplementation at 10 L/min flow by nasal prong did not significantly prolong the apnoea desaturation safety periods or the PaO2 in our study. [ABSTRACT FROM AUTHOR]

Background and Aims: Preprocedural ultrasound (US) assisted and real-time US-guided subarachnoid block (SAB) are useful adjuncts for successful SAB. This study compared the feasibility and efficacy of real-time US-guided SAB with preprocedural US-assisted and landmark-based SAB using paramedian approach. Methods: The study enroled 150 American Society of Anesthesiologists I and II patients, aged 20-65 years, scheduled for lower limb orthopaedic surgery under SAB. In group L (n = 50), the patients underwent landmark-guided SAB utilising paramedian approach. In group P (n = 50), preprocedural US-assisted SAB was instituted and in group M (n = 50) real-time US-guided SAB was administered. The number of needle attempts for a successful SAB was the primary outcome. The secondary outcomes included successful SAB in first attempt, time taken to perform SAB and patients' satisfaction. Results: The number of attempts for SAB were (mean ± standard deviation = 1.05 ± 0.35, 1.00 ± 0.28, 1.03 ± 0.26) in groups L, P and M, respectively (P = 0.436). The SAB was successful in the first attempt in 82%, 82% and 80% in groups L, P and M, respectively (P = 0.207). The time taken for the successful SAB was more in group M as compared to groups L and P (groups L and M, P = 0.045 and groups P and M, P = 0.004). The patients' satisfaction score was comparable. Conclusion: Real-time US guidance for spinal anaesthesia resulted in needle attempts comparable to landmark and preprocedural US-assisted SAB in patients with a normal spine. The time required for the completion of the block was more in real-time US-guided SAB. [ABSTRACT FROM AUTHOR]

Background: Ultrasound‑guided caudal block injection is a simple, safe, and effective method of anesthesia/analgesia in pediatric patients. The volume of caudal drug required has always been a matter of debate. Materials and Methods: This present prospective, randomized, double‑blinded study aimed to measure extent of the cranial spread of caudally administered levobupivacaine in Indian children by means of real‑time ultrasonography. Ninety American Society of Anesthesiologists I/II children scheduled for urogenital surgeries were enrolled in this trial. Anesthesia and caudal analgesia were administered in a standardized manner in the patients. The patients received 0.5 ml/kg or 1 ml/kg or 1.25 ml/kg of 0.125% levobupivacaine according to the group allocated. Cranial spread of local anesthetic was noted using ultrasound. Results: There was no difference in the spread when related to age, sex, weight, or body mass index. A significant difference of ultrasound‑assessed cranial spread of the local anesthetic was found between Group 1 (0.5 ml/kg) with both Group 2 (1 ml/kg) (P = 0.001) and with Group 3 (1.125 ml/kg) (P < 0.001) but there is no significant difference between Group 2 and Group 3 (P = 0.451) revealing that spinal level spread is only different between 0.5 ml/kg and 1 ml/kg of local anesthetic. Conclusion: In conclusion, the ultrasound assessment of local anesthetic spread after a caudal block showed that cranial spread of the block is dependent on the volume injected into the caudal space. Since there was no difference between 1 ml/kg and 1.25 ml/kg, to achieve a dermatomal blockade up to thoracic level, we might have to increase the dose beyond 1.25 ml/kg, keeping the toxic dose in mind. [ABSTRACT FROM AUTHOR]

Introduction: Physicians and nurses of emergency department are often the first line of qualified health-care providers attending the patient in person or parent's query over phone reporting immediately following the dental avulsion. Prompt action by them becomes the decisive factor in survival and prognosis of the tooth. Although a few researchers have evaluated knowledge of emergency room physicians, there is scanty of reports concerning nurses who play a climacteric role. Materials and Methods: A 10-item questionnaire regarding clinical situation apropos dental injury and tooth avulsion, inquiring knowledge of physicians and nurses was administered to 150 each of nursing professionals and physicians of the emergency department. Results: With 100% response rate, the data obtained was subjected to statistical analysis. Results showed lack of knowledge and confidence in both groups. About 66.7% (n = 100) nurses and 74.7% (n = 112) considered reimplantation of avulsed tooth. There was overbalanced confusion regarding storage/transport media and handling of avulsed tooth. Conclusion: The findings from the results suggested a definite inadequacy in knowledge, demanding need for appropriate training for delivering treatment with more predictability and better prognosis. [ABSTRACT FROM AUTHOR]

In patients with critical tracheal stenosis, particularly involving the lower part of trachea, a highly experienced team of anesthesiologists to tackle the difficulties of securing and maintaining the ventilation, cardiac surgeon who can swiftly establish cardiopulmonary bypass, an experienced surgeon for tracheal reconstruction are a prerequisite for managing these highly complex cases. The present paper describes three patients suffering from severe tracheal narrowing wherein spontaneous bag-mask ventilation was used for establishing cardiopulmonary bypass via mid-sternotomy as a rare life-saving procedure for urgent tracheal reconstructive surgery. A highly experienced team of anesthesiologists to tackle the difficulties of securing and maintaining the ventilation, cardiac surgeon who can swiftly establish CPB, and an experienced surgeon for tracheal reconstruction are a prerequisite for managing these highly complex cases. The present paper describes three patients suffering from severe tracheal narrowing wherein spontaneous bag-mask ventilation was used for establishing CPB via mid-sternotomy as a rare life-saving procedure for urgent tracheal reconstructive surgery. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine is commonly used as an additive in supraclavicular brachial plexus block (SBPB). Due to its adverse effects such as bradycardia and hypotension, finding the appropriate dose of dexmedetomidine is the question. Aims: We aimed to compare two commonly used doses of dexmedetomidine (1 μg/kg and 2 μg/kg) added to levobupivacaine in ultrasound-guided SBPB in terms of its effect on duration of analgesia, hemodynamics, and associated adverse effects. Settings and Design: This randomized, double-blinded prospective study was conducted over a period of 1.5 years in our tertiary care hospital. Materials and Methods: Clearance from the Institutional Ethical Committee and Clinical Trial Registry of India was taken. Ninety patients' physical status American Society of Anesthesiologists Classes I and II undergoing upper limb surgeries under SBPB were included in this study. Patients in Group I received 1 μg/kg dexmedetomidine, whereas patients in Group II received 2 μg/kg dexmedetomidine added to 20 cc levobupivacaine. The primary outcome measure was the duration of analgesia after administering the block. Secondary outcomes included effect on hemodynamics, duration of blockade, and adverse effects. Statistical Analysis: Statistical analysis was carried out using Stata Version 10. Unpaired t-test and Chi-square test were used. Results: The duration of analgesia and sensory and motor blockade were similar in both the groups. The heart rate (HR) and mean arterial pressure were statistically lower in Group II. The incidence of bradycardia and hypotension was more in Group II. Conclusions: Increasing the dose of dexmedetomidine does not prolong the duration of analgesia, but it is associated with lower HR and blood pressure. Incidence of hypotension and bradycardia is also more. Hence, a lower dose of 1 μg/kg dexmedetomidine added to 0.5% levobupivacaine is a good balance between safety and efficacy. [ABSTRACT FROM AUTHOR]

Background and Aim: The sonographic assessment of airway in the preoperative period has encouraging results in predicting difficult laryngoscopy. Materials and Methods: The prospective, observational study was conducted on 120 patients scheduled for elective surgery requiring general anesthesia and tracheal intubation. The depth of the pre‑epiglottic space (Pre‑E), the distance from the epiglottis to the midpoint of the distance between the vocal cords (E‑VC) was measured sonographically. Similarly, hyomental distance ratio (HMDR) was sonographically measured with head in neutral and extended positions. The primary outcome was the efficacy of Pre E/E‑VC, HMDR for predicting difficult laryngoscopy (Cormack–Lehane [CL] Grade 3, 4). The secondary outcome was to correlate these parameters to CL grading. Results: Difficult intubation was observed in 12.5% of patients. The mean ± standard deviation (SD) of Pre E/E‑VC ratio was 1.33±0.335, 1.62±0.264 and 1.87±.243, 2.22±.29 for CL Grade 1, 2, 3, and 4, respectively (P = 0.00). The mean ± SD of HMDR was 1.11±.35, 1.12±.29, and 1.07±.39, 1.04 ± 0.01 for CL Grade 1, 2, 3, and 4, respectively (P = 0.00). Pre E/E‑VC ratio of more than 1.77 cm had 82% sensitivity, specificity 80%, whereas HMDR less than 1.085 had sensitivity 75% and specificity 85.3%, in predicting difficult laryngoscopy (P = 0.00). Conclusion: The sonographic measurement of the Pre E/E‑VC ratio is a better predictor of CL grading as compared to HMDR. The noninvasive prediction of CL grading can be precisely done by Pre‑E/E‑VC ratio (range: 0–1.425 corresponds to CL Grade 1; 1.425–1.77 ≈ CL Grade 2; 1.77–1.865 ≈ CL Grade 3, more than 1.865 corresponds to CL Grade 4). [ABSTRACT FROM AUTHOR]