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Batteries are a popular and important item that are utilized as energy sources in a variety of applications. The rise of electric vehicles in the twenty-first century has increased its importance. A battery's state of charge (SoC) is critical information. It is vital to estimate SoC with a reasonable degree of precision. During charge and discharge cycles, lithium-ion batteries change their internal state. The level of charge of a lithium-ion battery changes throughout the charging cycle and is dependent on the internal structure of the components, which can degrade over time. Battery management systems that depend on charge counting and cell voltage monitoring frequently estimate the status of charge. It's difficult to tell what state the battery components are in physically. This work will focus on different methods of estimating SoC. Basically, this study will cover terminal Voltage method, Open Circuit Voltage Method, Coulomb Counting Method and a dynamic method based on Unscented Kalman Filter (EKF). The study will be based on simulation on MATLAB and it will also cover a practical experiment by charging and discharging a battery multiple time. A comparative study of the advantages and drawbacks of the existing methods will be discussed in this work.

Difficult airway management has till date been the most fearsome and challenging part of any anaesthetic management. Meticulous planning is always done prior to anaesthetic induction of such patients with multiple back up plans and rescue strategy. Significant advancements in terms of clinical protocols, techniques, and devices / gadgets in this field have led to decreased incidence of airway related complications. We hereby present a case series of 3 clinical cases with different airway scenarios; 1) Patient with huge goiter, who was intubated with the help of an indigenously developed fish mouth valve device, 2) a temporomandibular joint ankylosis case, managed with awake fibreoptic guided intubation 3) Patient with post burn contracture of face and neck, in which fibreoptic intubation was performed after partial release of scar under tumescent anaesthesia. Extensive preoperative airway evaluation and preparation to handle any emergency by multiple backup plans always helps in smooth sailing through these difficult clinical scenarios

To evaluate the efficacy of modified sphenopalatine ganglion block (MSPGB) to reduce the severity of post-dural puncture headache (PDPH). Five adult patients of both genders with age >18 years having PDPH intractable to conservative management were given modified sphenopalatine block in the postoperative period, and numeric rating scale (NRS) was recorded at regular intervals till the hospital discharge. MSPGB is a simple, noninvasive technique that provides instantaneous symptomatic relief in PDPH.

Posterior mediastinal masses by their location pose a risk of compression of heart, great vessels and airway. These risks are further exaggerated, with the use of neuromuscular relaxants and lateral positioning during anesthesia. We report a case of a 2.5 months old baby with posterior mediastinal mass causing compression of left bronchus and significant mediastinal shift with respiratory distress as a primary complaint. This posterior mediastinal Mass (PMM) was removed by right lateral thoracotomy without the initial use of neuromuscular blockade till the pleura was opened.

Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24-48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.

Context: Fractures of femur and hip surgeries pose a challenge because of excruciating pain. Fascia iliaca compartment block is an effective and easily learned procedure to decrease postoperative pain score and dosage of opioid. Many adjuvants are combined with local anesthetics to prolong the postoperative analgesia. Aims: The aim was to study duration of postoperative analgesia in terms of Numeric Rating Scale (NRS), number of times rescue analgesic used, any adverse effect, and patient satisfaction score. Settings and Design: Operation theatre of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Materials and Methods: The present study was retrospective study with 203 patients evaluated. Based on the combination of the anesthesia and drugs, study patients were divided into six groups. Pain scores were assessed at 6 hourly intervals for 24 h. Statistical Analysis Used: Kruskal–Wallis H-test used to compare NRS as well as age and duration of anesthesia. Chi-square test/Fisher's exact test used to compare the proportions. Results: Postoperative analgesia was comparable and insignificant (P > 0.05) at 0, 6, 12 h in all six groups. Better postoperative analgesia was observed with dexmedetomidine and dexamethasone as adjuvant at 18 h, dexmedetomidine as adjuvant in comparison to dexamethasone as adjuvant at 24 h. Rescue analgesia in postoperative period was required maximum in plain bupivacaine. Satisfaction levels were good and excellent in dexmedetomidine and dexamethasone as adjuvant. Conclusions: Addition of dexmedetomidine to bupivacaine provides longer duration, good quality postoperative analgesia, reduced requirement for rescue analgesic, lesser postoperative nausea and vomiting, and better satisfaction levels.

BACKGROUND End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). METHODS The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. RESULTS The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p

Background: Ultrasound is evolving as a probable tool in airway assessment. The upper airway is a superficial structure and has sonographically identifiable structures which makes it ideal for evaluation with the ultrasound. Aims: The aim of this study was to evaluate the role of skin to hyoid and skin to thyrohyoid membrane distance in prediction of difficult laryngoscopy. Settings and Design: This is a prospective observational study included 150 patients aged 18–60 years of American Society of Anesthesiologists Physical Status I and II scheduled to undergo surgery under general anesthesia requiring laryngoscopy and endotracheal intubation. Materials and Methods: The modified Mallampati score, mouth opening, mentohyoid distance, thyromental distance were noted. Skin to hyoid bone distance and skin to thyrohyoid membrane distance were measured by ultrasound. Patients were clubbed retrospectively into easy and difficult laryngoscopy groups on the basis of Cormack Lehane grading, and the characteristics of both groups were compared. Statistical Analysis: Statistical Package for the Social Sciences, Version 23 was used for statistical analysis. Independent samples t-test was used to compare the means between difficult and easy laryngoscopy patients. Diagnostic accuracy of the significant (P < 0.05) variables between difficult and easy laryngoscopy patients was calculated using receiver operating characteristics curve in terms of their area under curve. Appropriate cutoff values (with corresponding sensitivity, specificity, and overall accuracy) were also identified. Results: Out of 150 patients, 13 (8.7%) were identified as difficult laryngoscopy whereas 137 patients (91.3%) were identified as easy laryngoscopy. The demographics of both groups were comparable. Mentohyoid distance, skin to hyoid bone distance, and skin to thyrohyoid distance were statistically different between easy and difficult laryngoscopy patients, with lower mentohyoid distance and higher skin to hyoid bone distance and skin to thyrohyoid distance in difficult laryngoscopy patients. Diagnostic accuracy of the mentohyoid distance (70.3%) was slightly superior to skin to hyoid bone distance (67.1%) and skin to thyrohyoid distance (68.1%). Conclusion: Ultrasound measurements of skin to hyoid bone and skin to thyrohyoid membrane distance fail to eclipse clinical parameters in accurately predicting a difficult laryngoscopy.

Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24–48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.

Background and Aim: Airway management is a lifesaving skill which all health-care workers should possess. Currently, most of the resuscitation councils recommend supraglottic airway devices as the technique of choice for airway management during cardiopulmonary resuscitation by health-care providers without expertise in tracheal intubation. This is because of its high first-pass success rate and easy to acquire and retain skill even by novices. Materials and Methods: The present study was planned to compare the efficacy of two commonly available supraglottic airway devices, classic LMA (cLMA) and I-gel in securing airway in adult manikin by inexperienced persons (58 paramedics and 46 medical students), after a brief training. Our primary aim was to determine the first attempt success rate, and other parameters studied were the time and ease of insertion, overall success rate, and preference for device. Results: The first-attempt success rate of I-gel was higher in both groups of participants (74% in students and 69% in paramedicals) compared to that of cLMA (70% in l students and 53% in paramedics) although the overall success was the same. Majority of participants could secure airway quickly and easily by I-gel than by cLMA. More than 90% of participants preferred I-gel over cLMA. Conclusion: This study shows that inexperienced persons could learn to place the I-Gel and cLMA successfully in the manikin after a brief training in manikin. The first-attempt success rate and insertion of I-gel was easier and faster than that of cLMA by both groups of participants and most participants preferred I-gel due to ease of handling.

Background: Quadratus lumborum block (QLB) has provided adequate analgesia and lowered postoperative opioid requirement in comparison to controls for some urological surgeries. Aims: The aim of this study was to assess the efficacy of postprocedure ultrasound-guided QLB in comparison to port-site infiltrations with local anesthetics (as control) in lowering postoperative pain after laparoscopic pyeloplasty. Settings and Design: This was a prospective, single-blinded, randomized controlled trial. Materials and Methods: Fifty-three adults undergoing laparoscopic pyeloplasty were randomly allocated to either anterior QLB group (n = 27) or port-site infiltration Group P (n = 26) with 20 mL of 0.5% ropivacaine. The primary outcomes were static and dynamic pain on the Visual Analog Scale (VAS) of 0–100 at the 30th min, 2nd, 6th, 12th, and 24th hour after surgery. The secondary outcomes were number of patients requiring rescue analgesics and having postoperative nausea or vomiting (PONV) in 24 hours after surgery. Statistical Analysis: Intergroup comparison of VAS was done with Student's t-test. Categorical data were analyzed using the Chi-square test. Results: The static VAS scores were found to be significantly lower in QLB group at the 2nd, 6th, and 12th hour, and the dynamic VAS was lower at all time points after the 30th min in the QLB group. The number of patients requiring rescue analgesics were significantly lower in the QLB group (13 as compared to 21 in Group P; P = 0.015). The incidence of PONV was comparable. No other side effects were seen. Conclusion: Ultrasound-guided anterior QLB is more effective in comparison to traditional technique of port-site local anesthetic infiltration for providing analgesia after laparoscopic pyeloplasty.

Background: Laparoscopic cholecystectomy (LC) is associated with moderate-to-severe pain in immediate postoperative period. Some patients even suffer from prolonged pain long after surgery. Aims: The aim of present study is to determine the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) in patients undergoing LC, time to ambulation after surgery, and incidence of prolonged pain up to 6 months later. Settings and Design: This was a double-blinded prospective randomized controlled trial. Materials and Methods: Eighty-five adults posted for elective LC were randomized to receive bilateral ESPB at T7 level with either 20 mL of 0.375% ropivacaine or 20 mL normal saline. Postoperative static and dynamic pain score as per the visual analog scale (VAS), intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted. Statistical Analysis: Independent t-test and Mann–Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data. Results: Static and dynamic VAS scores were significantly lower in ESPB group (P < 0.05). Intraoperative fentanyl requirement (165 ± 30.72 – ESPB, 180.95 ± 29.12 – controls, P = 0.020) and number of patients requiring diclofenac (28/42 – ESPB, 37/42 – controls, P = 0.019) were lower, while number of patients ambulating by 4 hours (20/42 – ESPB, 9/42 – control, P = 0.012) were higher in ESPB group. Patients suffering from pain at 1 week (22/42 – ESPB and 34/42 – control, P = 0.005) and 1 month (9/42 – ESPB and 13/42 – control, P = 0.207) were lower in ESPB group. Conclusion: ESPB provides effective analgesia and early ambulation after LC. The benefit extends to 1 week thereafter.

Extracorporeal carbon dioxide removal (ECCO2R) is a valid alternative to consider in hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) patients to avoid invasive ventilation when noninvasive ventilation fails. Here we report a similar case, after obtaining informed consent, where a patient suffering from severe hypercapnic respiratory failure due to COPD, was selected for ECCO2R and improved remarkably.

Background: The purpose of the study was to evaluate the efficacy of two new laryngoscopes by experienced anaesthesiologists. Airtraq and Truview EVO2 were compared with gold standard Macintosh laryngoscope for endotracheal intubation of elective surgical patients with normal airway distribution. Methods: In prospective, randomised and controlled manner 150 patients of either sex above 18 yrs, presenting for elective surgery were randomly allocated in three equal groups. Endotracheal intubation was done using either Macintosh (group ML), Airtraq (group AQ) or Trueview (groupTL) laryngoscope. Laryngoscopic view of glottis (Cormac and Lehane grade), time taken for intubation , subjective assessment for ease of intubation, intubation difficulty scale (IDS) score as well as attempts for successful intubation, success rate and soft tissue injury during laryngoscopy and intubation were compared. Results: All the patients intubated with Airtraq and Trueview had Cormack and Lehane grade I or II and none had grade III in comparison with 42 (84%) having grade I or II and 8(16%) having grade III (p

Background and Objectives: Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation. Study Design: Prospective, randomized, controlled open-label study. Materials and Methods: A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C ( n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D ( n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups. Results: Target sedation was achieved in 86% observations in Group D and 62% in Group C ( P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D ( P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine. Conclusion: Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.

Background and objective: Providing a spinal block with preferential distribution to operative side is a useful technique. This study aimed to determine the incidence and suitability of unilateral spinal block, hypotension and recovery profile by 7.5 mg of 0.5% hyperbaric bupivacaine alone or with fentanyl/clonidine for knee or below knee orthopaedic surgery of moderate duration. Methods: 120 patients undergoing orthopaedic surgery of lower limb received 7.5 mg of 0.5% hyperbaric bupivacaine intrathecally with 25 μg of fentanyl (Group BF), 25i€ Regularg of clonidine (Group BC) or 0.5 ml of saline (Group BS). Block characteristics, unilaterality, haemodynamic changes and recovery profile was noted. Results: Unilateral block was seen in more than 70% of patients in all the groups (p=0.057). Time of regression of sensory block to L2 level (133 ± 18, 187 ± 19, 182 ± 18 mins respectively in groups BS, BF and BC) and time of first postoperative analgesia (245 ± 27, 324 ± 24, 318 ± 22 mins respectively in groups BS, BF,BC, p

Central venous catheterization is associated with its share of complications. Most of these complications can be avoided and treated by appropriate patient selection, careful insertion technique and vigilance following catheter insertion. We report a patient presenting with unilateral hydrothorax due malposition of central venous catheter in lung parenchyma. Prompt recognition of complication and its treatment remedied the situation.