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BACKGROUND Spinal anaesthesia is a procedure commonly performed by the anaesthesiologist. Various reasons can lead to a difficulty in performing a lumbar puncture, leading to multiple attempts, thereby increasing chances of complications. Quality of anatomical landmarks is one of the predictors of successful performance of subarachnoid block. MATERIALS AND METHODS 245 patients scheduled for surgery under spinal anaesthesia were enrolled. Interspinous gap and spinous process width were the measured study variables. Patients were classified as either having easy access to subarachnoid space or not, as the outcome variable. Association between these was measured using Chi-square test. RESULTS Confirm that there is obvious association between the ease of access to the subarachnoid space and the interspinous gap and the spinous process width. On further analysis, after dividing the study population based on gender, it was found that the association between the study variables and outcome variable was statistically insignificant in the female population. CONCLUSION Techniques based on surface anatomy of landmarks provide only less than 70% first attempt success rate in performing subarachnoid block. Interspinous gap measured from surface landmarks by palpation correlates consistently with ease of access to subarachnoid space. Imaging confirmation of the palpated measurements for further validation may be considered in future studies.

Mediastinal masses can compress major airways, so patients with this condition should be evaluated carefully before subjecting them to anaesthesia. There have been many reports of hemodynamic and airway collapse induced by general anaesthesia in patients with an anterior mediastinal mass. Bronchial carcinoids which account for 0.5% to 2.5% of all the lung malignancies may have the unusual presentation of an anterior mediastinal mass. Carcinoid tumours pose a great challenge to the anaesthesiologists especially if carcinoid syndrome is present. We report the case of a 30-year-old gentleman who presented to us with persistent cough, diagnosed to have a large anterior mediastinal mass and was posted for debulking of the same. It was suspected to be a bronchial carcinoid intraoperatively and pneumonectomy was done and the histopathological diagnosis confirmed in the postoperative period.

INTRODUCTION: The established methods of interscalene block were based on either proper motor response on paresthesia or nerve stimulation technique. In this study, we compared with nerve stimulator for interscalene blocks using 20ml of 0.75% ropivacaine and 20ml of 0.75% ropivacaine with 50 mcg of fentanyl. The aim of our study is to compare duration of sensory and motor blockade by adding fentanyl. METHODS: A total of 60 patients receiving interscalene block were randomly allocated to Group A who received 20ml 0.75% ropivacaine and Group B who received 20ml 0.75% Ropivacaine with 50 mcg of fentanyl. The onset of sensory and motor blocks, duration of sensory and motor block and time of rescue analgesia were observed. RESULTS: The onset of sensory block in group A (2.5±0.5) and in group B (2.38±0.43) (p=0.3231) and onset of motor block in group A (5.8±3.53) and in group B (5.1±2.8) (p=0.3983) which is not significant. The duration of sensory block in group A (6.4±0.35) and in group B (9.5±1.0) (p