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Background and Aims: Arthroscopic orthopaedic surgery may lead to significant postoperative pain. Interscalene block (ISB) is associated with undesirable effects like phrenic nerve palsy. Shoulder block (ShB) is a relatively recent diaphragm sparing alternative for analgesia in these cases. Methods: This prospective randomised trial was conducted in 70 adult patients posted for arthroscopic Bankart repair surgery. Patients were randomly assigned into two groups: interscalene block [Group ISB (n = 35): 0.5% bupivacaine 10 ml] or shoulder block [Group ShB (n = 35): 0.5% bupivacaine (suprascapular block 10 ml and axillary block 10 ml)] using ultrasound and nerve stimulator. The primary aim of our study was to compare the ISB with ShB for visual analogue score (VAS) in recovery area (zero hour). Time for block performance, VAS, time to first rescue analgesia, total analgesic requirement, patient satisfaction and complications were recorded. Results: VAS was significantly higher in ShB group at 2 and 4 h (P = 0.001 and 0.000) while it was significantly higher in ISB group at 12 h (P = 0.013). The time to first analgesic request was significantly prolonged in ISB group as compared to ShB group (8.22 h vs. 4.69 h; P = 0.002) but total analgesic requirement and patient satisfaction at 24 h were similar. Complications like dyspnoea, ptosis and motor weakness were seen only with ISB group. Conclusion: Both ShB and ISB blocks have similar efficacy in terms of postoperative pain scores, cumulative analgesic requirements and patient satisfaction. However, considering the various undesirable effects associated with ISB, like phrenic nerve blockade, prolonged upper limb weakness and the occurrence of rebound pain, shoulder block may be preferred for arthroscopic shoulder surgeries.

Airway emergencies are among the life-threatening events that are encountered in the operating room, emergency department or intensive care unit. They are important causes of preventable morbidity and mortality where time is the essence. It can be extremely challenging to rapidly assess the airway for early diagnosis and perform appropriate interventions simultaneously. Outcome depends on the implementation of an optimal strategy to establish a patent airway. Equally important is the overall stabilisation of the patient and management of the primary clinical condition as appropriate. Key components of management include early recognition of threatened airway, appropriate and timely airway intervention, and maintaining oxygenation. In this review, we describe aetiology, evaluation and management of airway emergencies.

Stone Man syndrome or fibrodysplasia ossificans progressiva (FOP) is an extremely rare (1 in 2 million) genetic disorder characterised by ectopic ossification of the skeletal and connective tissues leading to progressive fusion of axial and appendicular skeleton. Surgery and anaesthesia-induced trauma can lead to disease flare-up if due precautions are not taken and disable the patient further. However, rarity of the disease may lead to its common misdiagnosis and anaesthesiologist may be caught unaware. There is relative paucity of literature regarding anaesthetic management of children with FOP. Videolaryngoscopes (VLs) provide a non-line-of-sight view and require less anterior force to visualise the glottis, may provide an alternative to fibreoptic intubation for airway management in such cases. Use of VL has only been reported once in an adult with FOP for nasotracheal intubation. We describe the successful anaesthetic management of an 11-year-old child with FOP and anticipated difficult airway.

The goal of preoperative risk assessment is to identify and modify the procedure and patient factors that significantly increase the risk for complications. Preanaesthesia clinics (PACs) have been developed to improve the preoperative experience of the patients by coordinating surgical, anaesthesia, nursing and laboratory care. These clinics can also help in developing practice guidelines, and decreasing the number of consultations, laboratory tests and surgical cancellations. Though these clinics are present in most of our hospitals, a major effort is needed to upgrade these setups so as to maximise the benefits. This review gives a brief account of organisation and functioning of PACs.

Hypothermia is a common occurrence under anaesthesia and may prolong the duration of action of neuromus-cular blockade . By limiting fall in temperature, an infusion of amino acid enriched solution may speed the recovery from neuromuscular blockade. We studied 60 ASA Grade - I/II patients of aged between 20 to 60 years scheduled for elective surgery under general anaesthesia. The patients were randomly divided into four groups to receive amino acid infusion with vecuronium bromide AV, normal saline with vecuronium bromide(CV), amino acid with atracurium besylate(A-At) and normal saline with atracurium besylate(C-At). Although there was a significantly lesser decrease in the core temperature from the baseline in all the patients receiving amino acid infusion (p< 0.05), it significantly reduced the time to 25% recovery from the time of injection of vecuronium only. (60.59 ± 11.39 in CV vs 51 ± 14.72 min in AV) (P < 0.05), and not for atracurium.

The foundations of quality patient care are laid during training, but awareness of recent developments in medical knowledge is prerequisite to maintain a high level of quality care. Conferences and workshops are held as a part of continuing medical education (CME) under various banners in all specialties worldwide. This audit was carried out among the residents (JR and SR) working in various hospitals in Northern India. A questionnaire (14 questions) was designed to assess the attitude of resident doctors in the specialty of anaesthesiology towards conferences and workshops. Two hundred and fifty residents (110 senior and 150 junior residents) partici-pated in the audit and the information thus collected was analyzed. The audit revealed that all the residents were attending CME programmes whenever possible and major rea-sons cited for attending were to update knowledge (52% SRs and 63% PGs), make a presentation, to meet friends and socialize. The duration of workshop found to be most optimum was 2-3 days (70% residents). Almost all the residents (98% SRs and 96% PGs) were in favor of making a presentation during a conference in order to increase their confidence level, acquire knowledge and improve the resume. The majority preferred an oral presentation (87% SRs and 84% PGs) to a poster presentation as it enhanced their confidence and it was easier to prepare and carry out the material. The audit revealed that most of the residents suggested the making of some form of presentation compulsory during conferences every year (42% SRs and 29% PGs), with financial aid (20% SRs and 25% PGs) and special leaves (25% SRs and 28% PGs) to encourage active participation among the residents.