European Journal of Cardiovascular Medicine

Introduction: hemodynamic changes during tracheal intubation it is more challenging in head injury patients.

Background: Suxamethonium, a depolarizing neuromuscular agent, was introduced in 1952 and since then has been used for tracheal intubation. It was favoured for its rapid onset and ultra-short duration of action but has numerous side effects, especially cardiovascular. So agents with low potency and shorter duration of action were developed, and in 1995, Rocuronium was introduced, which is a non-depolarizing agent and has the fastest onset of action

Introduction: Ventilator associated pneumonia is defined as pneumonia occurring more than 48hours after the initiation of endotracheal intubation and the most common nosocomial infection in intensive care unit.VAP is second most common health care associated pneumonia in spite of wide range of preventive measures. Aim: To isolate the bacterial pathogens and their antibiogram of organisms causing VAP. Materials and Methods: Cross sectional descriptive study conducted for a period of 6 months i.e January 2022 - June 2022 in patients admitted in ICUs of King George hospital on ventilator for more than 48 hours. Endotracheal aspirates are collected and transported to department of Microbiology, AMC, Visakhapatnam. Results: From 50 endotracheal samples studied ,15(30%) were culture positive. Among them the most predominant organism is Pseudomonas aeruginosa 5(33.3%) followed by Methicillin resistant Staphylococcus aureus 4 (26.6%), Klebsiella species 3 (20%) and Acinetobacter species 3(20%).Gram negative bacilli were sensitive to Piperacillin – Tazobactam, fluoroquinolones, macrolides, Polymyxin whereas resistant to beta lactams.Gram positive cocci were 100% resistant to Cefoxitin, Oxacillin and sensitive to Linezolid and Vancomycin. Conclusion: Knowledge of incidence of VAP, their causative microbial flora along with their susceptibility pattern help in selection of appropriate antibiotics for therapeutic use and better outcome

Background:  Patients with the chronic obstructive pulmonary disorder (COPD) are at risk of developing postoperative respiratory failure. That is the reason they may require artificial respiration for longer periods than others. However, being on mechanical ventilation for a long time leads to lung damage and infections. Objective: The present study was undertaken to observe the relation between the severity of COPD in patients of spinal surgery and the prevalence of respiratory failure. Materials and Methods: 40 patients with COPD who had undergone spinal surgery were part of the study. The data was collected from the medical records department including the demographics, spirometry results, blood gas analysis, comorbidities, postoperative and other variables. The important outcome is a respiratory failure within one week after the surgery. Results: Data was presented in table 1 and table 2. Table 1 presents the demographic and clinical parameters of the participants. Table 2 presents the risk factors for respiratory failure of the participants. A longer duration of anesthesia was required for the mild COPD patients. Comorbidities were present in all levels of COPD patients. Table 2 presents the risk factors for respiratory failure of the participants. Length of stay was longer in patients with severe COPD. Extubating time, and endotracheal intubation after surgery were more in the severe COPD patients. Pulmonary infection is present in all groups of patients. Conclusion: There is no significant relationship between the severities of COPD with postoperative respiratory failure. However, there is a strong need to conduct a prospective study with more defined parameters to understand better these relations. So that better and more effective treatment strategies can be developed

Purpose: The purpose of the study was to develop a new scoring system for predicting difficult intubation based on the ratio of the patient’s height to thyromental distance, upper lip bite test(ULBT), head and neck movements, modified Mallampati test(MMT), and neck circumference and compare it with Wilson score. Methodology: This prospective observational study was conducted on 300 ASA I, II, and III patients, who underwent elective surgeries under general anesthesia with endotracheal intubation as per inclusion and exclusion criteria. Results: In this study, among the individual parameters, MMT had the highest sensitivity (61%), while head and neck movements had the highest specificity (95.5%). ULBT had the best positive predictive value (42.9%), negative predictive value (94%), and positive likelihood ratio (5.5). Taking the cutoff for the new score as >=2, it predicted 34 out of 36 difficult intubations. Sensitivity was high at 94.4%. But specificity was low (41.7%). Kappa was 0.13. Wilson score with a cutoff of >=2 predicted only 16 difficult intubations out of 36. Sensitivity was low (44.4%), and specificity was 70.8%. Kappa was 0.09. On comparing the two scores, the sensitivity was very high for the new score >=2 compared with the Wilson score and was statistically significant (94.4% vs. 44.4%, p < 0.01). Specificity was less for the new score than the Wilson score and was statistically significant (41.7% vs. 70.8%, p <0.01). Accuracy was poor for the new score compared to the Wilson score and was significant (48% vs 67.7%, p<0.01).  Positive (PPV) and negative (NPV) predictive values were comparable for both. Using a cut off for New score >=3 resulted in higher sensitivity and specificity (88.9% and 82.6%, respectively) and accuracy of 83.3%. The new score with a cut off of >=3 yielded significantly higher sensitivity (88.9% vs. 44.4%, p <0.01), specificity (82.6% vs 70.8%, p <  0.01), and accuracy (83.3% vs. 67.7%, p <0.01) than Wilson score. PPV (41% vs. 17.2%, p <0.01) and NPV (98.2% vs. 90.3%, p <0.01) were also significantly higher for a new score >=3 than Wilson score. Conclusion: The modified Mallampatti test, the upper lip bite test, the ratio of height to thyromental distance, neck circumference, and, head and neck movements failed to meet the criteria for an ideal predictive test, when used as an independent predictor. When these parameters were combined to derive a new score, the predictive accuracy was much better. We had hypothesized that a new score with a cutoff of >=2 would accurately predict difficult intubation. It was inferior to Wilson score in predicting difficult intubation. By increasing the cutoff to >=3, sensitivity and specificity were equally good, and positive and negative predictive values were also high. On comparing it with the Wilson score, the predictive accuracy of the former was better. A combination of predictors is always better than a single predictor in identifying difficult intubation, and the new score with a cutoff score >=3 predicts difficult intubation better than Wilson score

Background:This study aimed to compare the efficacy and safety of ibuprofen gargle with lignocaine gargle given 30 minutes before surgery in preventing postoperative sore throat (POST) after endotracheal intubation for 24 hours postoperatively.Methods: Eighty ASA I–II patients undergoing elective surgery under general anaesthesia were enrolled in this prospective, randomised, observational study. Patients were allocated into 40 subjects each: Group –L and Group - I; Group-L received lignocaine viscous 2 % solution at 5mg/kg, and Group-I received crushed tab Ibuprofen 400mg diluted in 20ml of water.  Patients were asked to gargle for thirty seconds, thirty minutes before shifting to the operation theatre. Results: There was no statistically significant difference in the occurrence or severity of POST between the two groups for up to 24 hours after the surgery.Conclusions: Preoperative gargling with ibuprofen solution effectively reduces the incidence and severity of POST compared to lignocaine gargle.

Background: General anaesthesia is associated with marked cardiovascular changes. Previous studies say that etomidate can be used in patients with limited hemodynamic reserve and propofol can lead to more hemodynamic instabilities. Hence, the present study was undertaken to compare the effects of propofol and etomidate on hemodynamicA changes during induction of general anaesthesia. Method: total 70 patients of ASA grade I & II, aged 18-60 years, weighs 40-80 kg, undergoing surgeries with general anesthesia were included and randomly divided into two equal groups.Induction of anaesthesia was carried out by using 0.3 mg/kg of etomidate in group A patients and 2.0 mg/kg of propofol in group B patients. Hemodynamic parameters such as: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and O2 saturation (SpO2) was measured and recorded at 1,3,5 and 10 minutes after intubation.Results: Both the groups were comparable and found no significant difference regarding demographic profile of patients, (p>0.05).At various time intervals i.e., T0 (before induction), T1 (after 1 min), T2 (after 3 mins), T3 (after 5 mins) and T4 (after 10 mins) the mean values of HR and SpO2 was comparable between two groups, (p>0.05) while the mean values of SBP, DBP and MAP were significantly lower in group B compared to group A, (p<0.05). Conclusion:Etomidate is haemodynamically more stable compared to propofol as the incidence and severity of hypotension are higher with propofol. Etomidate is a better option in patient’s particularly prone to hemodynamic instability at induction.

Background: In a clinical setting assessment of airway needs to be simple and convenient3. There is no single test with absolute accuracy to predict difficult airway2. In our study we assessed airway difficulty in elective surgeries for adults by comparing ULBT and MMS individually as well as in combination to that of Cormack-Lehane grading. Method: The single blinded prospective, comparative and observational study was conducted at SDMCMS& Hospital Dharwad. A total of 150 patients aged 18-60 years of either sex with ASA physical status 1,2&3 who underwent elective surgery under general anaesthesia were included. CL grade 3&4 deemed as difficult laryngoscopy. Diagnostic testing was carried out to compare MMS and ULBT with CL grade in predicting difficult intubation. McNemar test was used to compare difference between diagnostic parameters. P-value less than or equal to 0.05 was considered statistically significant. Results: Demographic data and ASA grades were same for participants. We observed that at 95% Confidence Interval (CI) for ULBT sensitivity (92%), specificity (68%), positive predictive value (93.5%) and negative predictive value (62.96%) was better compared to that of MMS whose sensitivity was 64.8 %, specificity 24%. Also, ULBT had a better accuracy 88% than that of MMS with 58%.  Conclusion: Our study and analysis concluded that the upper lip bite test is good option for predicting difficult intubation than Modified Mallampati Score.

Background: Endotracheal intubation is a common procedure during general anesthesia, often associated with post-operative complications such as sore throat and emergence cough. This study aimed to investigate the efficacy of three intra-cuff solutions—air, normal saline, and 2% lignocaine—in mitigating these complications and their impact on intubation attempts and hemodynamic parameters. Methods: A randomized clinical trial was conducted involving 114 patients undergoing elective surgeries. Participants were divided into three groups based on the intra-cuff solution used. Intubation attempts, post-operative sore throat, emergence cough, and physiological parameters were assessed and statistically analysed. Results: The use of 2% lignocaine significantly reduced the number of intubation attempts (p < 0.001*) compared to air and normal saline. Additionally, lignocaine was associated with a significantly lower incidence of post-operative sore throat (p = 0.011*) and emergence cough (p = 0.010*) compared to the other solutions. However, there were no significant differences in hemodynamic parameters between the groups. Conclusion: This study suggests that 2% lignocaine may be a preferable intra-cuff solution for endotracheal intubation, as it reduces intubation attempts and the incidence of post-operative complications. Further research and clinical trials are needed to validate these findings and refine the selection criteria for intra-cuff solutions.

Background: Endotracheal intubation is a common procedure during general anaesthesia, often associated with post-operative complications such as sore throat and emergence cough. This study aimed to investigate the efficacy of three intra-cuff solutions—air, normal saline, and 2% lignocaine—in mitigating these complications and their impact on intubation attempts and hemodynamic parameters. Methods: A randomized clinical trial was conducted involving 114 patients undergoing elective surgeries. Participants were divided into three groups based on the intra-cuff solution used. Intubation attempts, post-operative sore throat, emergence cough, and physiological parameters were assessed and statistically analysed. Results: The use of 2% lignocaine significantly reduced the number of intubation attempts (p < 0.001*) compared to air and normal saline. Additionally, lignocaine was associated with a significantly lower incidence of post-operative sore throat (p = 0.011*) and emergence cough (p = 0.010*) compared to the other solutions. However, there were no significant differences in hemodynamic parameters between the groups. Conclusion: This study suggests that 2% lignocaine may be a preferable intra-cuff solution for endotracheal intubation, as it reduces intubation attempts and the incidence of post-operative complications. Further research and clinical trials are needed to validate these findings and refine the selection criteria for intra-cuff solutions.

Background: Securing airway is a vital skill for anaesthesiologists. Difficulty in securing airway can lead to catastrophic results. The cuffed endotracheal tube is considered as gold standard for providing a safe airway. Laryngoscopy and endotracheal intubation produce reflex sympathoadrenal stimulation. The supraglottic airway device is a novel equipment that fills the gap in airway management between tracheal intubation and use of face mask. I-gel (Intersurgical Ltd., Wokingham, UK) is a relatively new supraglottic airway device with a non-inflatable cuff, made up of soft gel like, transparent thermoplastic elastomer. Aim and objectives: To compare standard, reverse and rotational techniques of i-gel placement in terms of insertion characteristics and success rate. Materials and Methods: A randomized prospective study, was undertaken at Government Dharmapuri Medical College and Hospital, Dharmapuri during the academic year from 2020 to October 2022. Ninety patients (N=90), scheduled for various elective surgical procedures undergoing general anaesthesia belonging to ASA class I and II were included in the study. The participants were divided into 3 groups of 30 participants based on the techniques used for i-gel insertion. Results: There was no statistically significant difference in the age, ASA grading, Mallampatti class between the 3 groups. There was no statistically significant difference in the ease of insertion between the groups. The median attempts for insertion in all three groups was 1 attempt. Chin lift manoeuvre had to be performed in 2 participants in the standard insertion group. The mean time taken for insertion (in seconds) was 20.33 ± 4.05 in standard technique group, 19.47 ± 4.67 in reverse technique group and 19.67 ± 4.26 in rotational technique group and the mean difference was not statistically significant. There was no significant difference in the mean leak pressure across the groups. Maximum number (N=7) complications was seen in standard technique group. There was no significant difference in heart rate measured at 1 min, 3min and 5min across the group. There was significant difference in MAP at 1min (p=0.01), 3min (p=0.001) and 5 min (p=0.062) across the groups with highest mean MAP measured in standard technique group. Conclusion: The three insertion techniques are suitable for routine use in maintaining anaesthesia in spontaneously breathing patients under general anaesthesia with normal airways. By all methods I-Gel appear to be effective in providing a clinically patent airway and have a high rate of insertion success, no hemodynamic changes, and low morbidity.

Context: Our aim was to study the haemodynamic response to endotracheal intubation through Linscope and compare it to the hemodynamic response to intubation with Kingvision video laryngoscope. The Kingvision has demonstrated promise in a number of settings while Linscope video laryngoscope is a newly launched device and no literature is available to the best of our knowledge. Aims: We aimed to compare the Linscope video laryngoscope with Kingvision video laryngoscope for haemodynamic response. Settings and Design: A Randomized Controlled Study. Methods and Material: Seventy patients after approval from Board of Study and ethical clearance divided into 2 groups. In Group A patient were intubated with Linscope videolayngoscope and in Group B patient were intubated with Kingvision videolaryngoscope as per the protocol. Hemodynamic parameters, mean arterial blood pressure and heart rate were recorded before and after induction of anesthesia and every minute up to 5 min after intubation. Results: Patients of Group A recorded a minimal rise in peak mean arterial blood pressure. In comparison patients of Group B recorded a significant sustained rise in mean arterial blood pressure The insertion of endotracheal tube through kingvision video laryngoscope assembly precipitated a rise in mean arterial blood pressure. However,this rise was not statistically significant when compared with baseline value. The increase in heart rate changes were recorded in both the groups, of which immediate post intubation Group B showed significant rise but overall, the rise was not significant. Conclusion: We conclude that intubation through Linscope generates a lower pressor response  to intubation in comparison to intubation using Kingvision video laryngoscope 

Background: Endotracheal intubation can elicit significant hemodynamic responses, necessitating effective management to reduce potential complications. This study compared the efficacy of Fentanyl and Nalbuphine in attenuating these responses. Methods: A total of 100 patients undergoing endotracheal intubation were randomized into two groups, receiving either Fentanyl or Nalbuphine. Heart rate, systolic and diastolic blood pressures, mean arterial pressure, rate pressure product, and oxygen saturation were measured at various time points pre- and post-intubation. Results: Nalbuphine significantly reduced heart rate from 3 minutes post-intubation (p<0.05), and was more effective in lowering systolic and diastolic blood pressures (p as low as 0.0001). Mean arterial pressure was better managed with Nalbuphine, particularly noticeable from 3 minutes onward (p<0.05). Rate pressure product was consistently lower in the Nalbuphine group, starting from 1 minute post-intubation (p<0.05). Oxygen saturation levels remained stable and comparable in both groups. Conclusion: Nalbuphine showed superior efficacy in attenuating the hemodynamic responses to endotracheal intubation compared to Fentanyl. Its significant impact on heart rate and blood pressure control, without compromising respiratory function, suggests it as a preferable alternative in clinical anesthesia practice

BACKGROUNDPostoperative sore throat is one of the most common complications after endotracheal intubation. Both Ketamine and magnesium can block N-methyl-D-aspartic acid (NMDA) receptors and provide central and local analgesia. The study was conducted to compare the effect of magnesium sulfate and ketamine gargle on the incidence and severity of postoperative sore throat. MATERIAL AND METHODS A total of 120 patients’ candidate for surgery were enrolled in the study. Patients in ketamine group (K, n=40) received ketamine gargle (30mg in 30 mL of 25% dextrose in saline), Magnesium group (M, n=40) received magnesium sulfate gargle (1.5mg in 30 mL of 25% dextrose in saline) and Dextrose group (D, n=40) received dextrose gargle (30 mL of 25% dextrose) 15 minutes before the operation. Patient complaint of postoperative sore throat, and its severity measured post operatively were recorded at baseline in recovery room, and then 2, 4, and 24 hours after operation using on a 4-point scale (0-3). RESULTS There were no significant differences between age, sex, body mass index (BMI), the Modified Mallampati class distribution and ASA grade between three groups of patients. Hemodynamics of patients, including blood pressure, mean arterial pressure and pulse rate were not significantly different (P > 0.05). Number of patients with sore throat were significantly lower in magnesium group and ketamine group compared to Dextrose group. Dextrose group had significantly higher incidence of sore throat at 2 hr (P = 0.023) and at 4 hr (P = 0,031) compared to Magnesium group after the operation. No patient had severe sore throat in group M and group K. CONCLUSIONS Magnesium at even a low dose decreases incidence of sore throat and pain severity more effectively when compared to ketamine gargles

Background : In this study, we wanted to compare the haemodynamic responses to endotracheal intubation using Intubating Laryngeal mask airway (ILMA Fastrach ^TM) and  direct laryngoscopy in adult patients with normal airway. Methods: This was a hospital-based study conducted among 60 ASA grade I and II patients undergoing elective lumbar spine surgeries under general anaesthesia. They were grouped into two groups, group I -Laryngoscopy group and group II – ILMA Fastrach ^TM ( group II). Circulatory response to intubation was recorded in both groups  by invasive arterial Blood Pressure(BP) monitoring device placed before induction of anaesthesia. The values were recorded at pre induction, at induction, every minute post induction for 3minutes and at ILMA / laryngoscopy , every 10 second post intubation for 2 minutes followed by every minute for next 3 minutes. The maximum values and maximum increase in BP and HR were recorded in both groups. Results:Intubation through I LMA- Fastrach™ was associated with significantly lower cardiovascular responses compared to direct laryngoscopy and intubation. There was a significant increase in blood pressure and heart rate from baseline in both the groups. The maximum increase was above or equal to preinduction values with laryngoscopy and intubation. The maximum values in I LMA (Fastrach™ ) group were never beyond preinduction values with respect to changes in blood pressure. The maximum increase in blood pressure and heart rate from respective base line values were similar between the two groups. This occurred in spite of longer time required for intubation in I LMA(Fastrach™ )  group in comparison with laryngoscopy group. Conclusion:The intubation done through ILMA(Fastrach™) was associated with lesser haemodynamic response associated with intubation in adult normotensive patients with normal airway. 

Conclusions: USG can be used to predict difficult airway preoperatively by measuring soft tissue thickness at neck and Skin to epiglottis distance at the level of Thyrohyoid membrane on USG is a potential predictor of difficult intubation

Background: Endotracheal intubation has become an integral part of the anaesthetic management and critical care of the patient and has been practised following its description by Rowbatham and Magill in 1921.  Objective: Compare the efficacy of oral clonidine and oral pregabalin premedication 90 min prior to surgery in attenuating the adverse haemodynamic responses to laryngoscopy and tracheal intubation with respect to Systolic blood pressure, Diastolic blood pressure, Mean blood pressure, Rate Pressure Product. Methods: This prospective randomized double blind controlled study was conducted on 100 ASA physical status grade I and II patients of either sex between 18-50 years of age, undergoing elective orthopaedic, spine, otorhinolaryngeal, gynecological and general surgical procedures from October 2012 to May 2014 at SSIMS&RC, Davangere. Results: Haemodynamic variable like SBP, DBP, MAP and RPP were recorded pre-induction, post-induction, immediately after intubation and post-laryngoscopy (1,3,5,10 minutes) vitals were noted. In oral clonidine group there was significant attenuation of RPP in all time period and there was only significant attenuation seen in SBP, DBP and MAP immediately after intubation. In oral pregabalin group there was no significant attenuation of haemodynamic response i,e SBP,DBP, MAP and RPP compared to clonidine.

Conclusions: Both Clonidine and oral pregabalin effectively attenuates the haemodynamic response to laryngoscopy and intubation of trachea. Of the two, oral clonidine is effective in attenuation compared to oral pregabalin

Background: This study was conducted to compare the efficacy of ketamine and ondansetron, two of the commonly used drugs, on blood pressure among patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: This was a prospective randomized double-blind study conducted among 56 patients coming for elective laparoscopic cholecystectomy under general anesthesia at UPUMS Saifai, Etawah, from November 2018 to April 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Study assessed preoperative patient conditions and randomly allocated 56 patients into two groups for comparative anesthesia techniques. Group A (n = 28) received Inj. Ketamine10 mg diluted upto 5 ml in normal saline, while Group B received Inj. Ondansetron 4 mg diluted upto 5 ml in normal saline before induction. All patients were premedicated and induced with standard drugs. Vital signs were recorded just after giving the study drug, at the time of induction, immediately after intubation and every minute after intubation upto 10 minutes.  Monitored closely, and any deviations from baseline were noted,and hypotension managed through fluid resuscitation and rescue drugs if necessary. Heart rate changes were also recorded. The study aimed to evaluate the effects of Ketamine versus Ondansetron on hemodynamic stability during anesthesia induction, employing rigorous monitoring and treatment protocols for any adverse events. Results: In comparison of SBP (Systolic Blood Pressure) at baseline and different follow-up intervals between two study groups, just after giving away the trial drug, mean systolic blood pressure was 135.82±12.14 mmHg in group A (ketamine) as compared to 122.82±11.16 mmHg in group B (ondansetron), thus showing a statistically significant difference between two groups (p<0.001). Immediately after intubation, mean systolic blood pressure was 132.86±14.78 mmHg in group A (ketamine) as compared to 125.75±10.78 mmHg in group B (ondansetron). Statistically, the difference between the two groups was significant (p = 0.045). At all the follow-up intervals, mean values were higher in group A (ketamine) as compared to group B (ondansetron) and the difference was also significant statistically at 3 min and 10 min post-intubation intervals (p<0.05). Conclusion: Post-induction anesthesia hypotension incidence was higher in ondansetron as compared to that in ketamine group; however, the difference was not significant statistically. It seemed that pressor responses following intubation superseded the hypotensive effect of induction anesthesia

Introduction:  Rigid laryngoscopy and tracheal intubation continue to be the gold standards of airway care in contemporary anesthesia practice. It was discovered more than 50 years ago that airway manipulation affected blood pressure and heart rate. Aim: The aim of the study is to compare the effect of magnesium sulphate and lignocaine in attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation. Materials and method: It was a randomized prospective study. 120 patients were divided into two equal groups. Group A received intravenous 50% magnesium sulphate 30 mg/kg and Group B received intravenous 2% lignocaine 1.5mg/kg, 10 mins prior to induction of GA. Result: Statistically significant differences (p<0.05) between magnesium sulphate and lignocaine were found in HR, SBP, DBP at 10 min after study drug was given, at induction, at intubation and onwards till 10 mins after intubation. No significant adverse effects were noted with both drugs. Conclusion: Compared to intravenous 2% lignocaine 1.5 mg/kg bolus over 1 minute, 10 minutes before to induction, intravenous 50% magnesium sulphate 30 mg/kg diluted to 20 ml infusion over 3 minutes 10 minutes prior to induction more effectively attenuates the hemodynamic response.

Objectives: The aim of this study is to compare the Ease of intubation and changes in hemodynamic parameters during endotracheal intubation using McIntosh & Hugemed laryngoscope in a patients who are ASA grade I and II.. Methods: A total of 70 patients who are ASA grade I and II belonging to the age group 18 to 60 years posted for elective surgeries under general anesthesia in Government Medical College, Thrissur were studied. 35 of them were intubated using McIntosh laryngoscope while the rest were intubated using Hugemed video laryngoscope. The time taken to perform endotracheal intubation and changes in hemodynamic parameters during the initial five minutes following intubation were recorded and compared between the 2 groups. Results: The 2 groups were similar with respect to demographic data and airway examination. The duration of laryngoscopy and intubation was significantly longer in group B (Hugemed laryngoscopy) when compared to group A patients with p value = 0.000. However, haemodynamic changes did not show any significant differences between the groups. Conclusion: The study found that, as compared to traditional laryngoscope (McIntosh), Hugemed video laryngoscopy did not provide any benefits for patient hemodynamic response to laryngoscopy and intubation, but the time required for intubation was significantly longer in the video laryngoscope group.

Background And Justifications: Pre-anesthetic checkup is a necessary tool to take the detailed history of the patient, conduct physical examination and investigations which is used to evaluate the peri-operative risk informing priorly about the surgical anesthetic complications and risk factors As aging causes decline in the progressive function of the organ system, it is important to detect the underlying diseases, dental loss,head and neck joint changes ,so it is very important to plan for the level of difficulty in the endotracheal intubation,as the delay in endotracheal intubation can causes fatal consequences. The current study is carried out to determine the causes of difficult endotracheal intubation in the patients of different age groups and to assess the airway. Objectives: The objective of the study is to assess the airway and difficulty of endotracheal intubation during pre-anaesthetic checkup in different age groups. Results: The total of 60 patients included in the study,29(43.30%) were male and 31(51.66%) were female.To assess predictive factor for endotracheal intubation according to the three age groups.Patients basic demographic profiles assessed according to the Wilson’s scoring of airway assessment was investigated.In this study 56 (93.33%) patients experienced easy intubation, 3(5%)patients were experienced moderate difficulty and 1(1.66%) patient experienced difficult tracheal intubation(P=0.21192) Conclusion: The study’s findings shows that the age is not a factor for difficult endotracheal intubation and its predictive factors are varying by different age groups..

Laparoscopic surgery involves creating a pneumoperitoneum with insufflation of CO2 into the abdomen to visualise during the surgery. Insufflation with CO2 has advantages such as reduced risk of venous air embolism however few disadvantages like sudden tachycardia and hypertension and hypercarbia.  This study aimed at measuring the ETCO2 (End Tidal CO2) after intubation, after insufflation and 10 mins after pneumoperitoneum to analyse the rise of PaCo2 due to pneumoperitoneum with CO2 during laparoscopic surgeries.  This study included 113 patients between 18-65 years of age, both sexes with ASA 1 & 2 posted for laparoscopic surgeries. Patients with History of Cardiovascular disorders, neurological disorders and pregnant patients were excluded from the study.  After the start of the anaesthesia after intubation, the initial ETCO2 was noted and followed by wich the measurements were noted immediately after pneumoperitoneum and 10 mins after the pneumoperitoneum. Result was found that there was an immediate increase in ETCO2 value after pneumoperitoneum when compared to before and after 10 mins of pneumoperitoneum. This may be attributed to the absorption of co2 as a result of higher CO2 tension gradient between the pneumoperitoneum and the blood perfusing the peritoneum.

Abstract Background: Postoperative sore throat (POST) is a common complication following general anesthesia with endotracheal intubation. This study compared the efficacy of ketamine, magnesium sulfate, and lignocaine gargles in preventing POST. Methods: In this randomized, double-blind, placebo-controlled study, 120 patients undergoing surgery under general anesthesia with endotracheal intubation were allocated to four groups: ketamine gargle, magnesium sulfate gargle, lignocaine gargle, and control. The incidence and severity of POST were assessed at 0, 2, 4, 8, 12, and 24 hours postoperatively. Patient satisfaction and willingness to undergo the same intervention in future surgeries were also recorded. Results: The incidence of POST was significantly lower in the magnesium sulfate group compared to the ketamine, lignocaine, and control groups at 0 hours (3.3% vs. 10%, 13.3%, and 26.7%, respectively; p=0.049), 2 hours (6.7% vs. 16.7%, 20%, and 40%, respectively; p=0.011), and 4 hours (3.3% vs. 13.3%, 16.7%, and 33.3%, respectively; p=0.015). The severity of POST was also significantly lower in the magnesium sulfate group at 0, 2, and 4 hours postoperatively (p<0.05). Patient satisfaction and willingness to undergo the same intervention were highest in the magnesium sulfate group (96.7% and 93.3%, respectively; p<0.05). The side effect profiles were comparable among the groups. Conclusion: Magnesium sulfate gargle is superior to ketamine and lignocaine gargles in reducing the incidence and severity of POST in the early postoperative period, with higher patient satisfaction and willingness to undergo the same intervention in future surgeries.

Background: Direct laryngoscopy and tracheal intubation is associated with a rise in the hemodynamic responses as well as intraocular pressure.¹ Pediatric airway is different from adult and the complications associated with laryngoscopy and intubation is higher. The use of supraglottic airway devices to maintain airway have been very effective in reducing the pressor response associated with tracheal intubation.^2,3 I-gel is a second generation supraglottic airway device made of a soft gel-like thermoplastic elastomer with a non-inflatable cuff. I-gel has got a channel for gastric suction catheter placement and its design is compatible with the anatomical structures so that it causes minimal pharyngeal tissue compression.⁴. Methods: The study was a prospective randomized controll trial. It was a comparative study with 60 pediatric patients of age group 2-12 yrs, undergoing strabismus surgery. The study duration was six months. Inclusion criterias were ASA physical status I/ II, Age group 2- 12yrs, both males and females were included in the study. Exclusion criteria were Patients with difficult airway, Patients with a history of allergy to multiple drugs, Cases of intubation following failure of I-gel insertion, patients with history of raised ICP. Patients were randomized into groups A and B of 30 each by a sealed envelope method. Group A patient’s airway was managed by I-gel supraglottic device and group B by tracheal intubation. The variables assessed were Intraocular pressure (IOP) of both eyes, Heart rate, Systolic blood pressure (Non-invasive blood pressure), Mean arterial pressure (Non-invasive blood pressure), Breath holding on extubation. The instrument used fo the study was Perkins applanation tonometer for measuring IOP. Results: The demographics of the two groups were age comparable. The mean age of group A was 5.77±2.69 and group B was 6.30±2.67 (p = 0.443) and mean weight was 21.47±9.87 in group A and 22.53±8.68 in group B (p = 0.658). Two groups were also gender matched with 17(56.7%) males & 13(43.3%) females in group A and 12(40%) males & 18(60%) females in group B. The baseline haemodynamic parameters were comparable between the groups.  Baseline heart rate (HR) in group A was 83.30±12.96 and in group B was 83.83±8.74 (p = 0.852). HR increased in both groups immediately following airway intervention and was found to be higher at 5 minutes after intervention. The HR immediately after airway intervention was 94.50±12.66 in group A and 101.33±14.07 in group B which was statistically not significant (p=0.053). The HR at 5minutes following intervention in group A was 87.23±14.89 and in group B 89.23±13.40 (p = 0.587).. Conclusion: I-gel is a safe and effective airway management device which provides better haemodynamic stability and stable intra ocular pressure in general anaesthesia for pediatric strabismus surgeries

Introduction: Laparoscopic cholecystectomy is one of the most commom surgeries done under general anaesthesia. Second generation supraglottic airways are used more frequently due to ease of insertion, less haemodynamic changes and good oropharyngeal pressures nowadays. Aim: To compare efficacy and safety of Baska mask, Ambu AuraGain and LMA Supreme in airway management of laparoscopic cholecystectomy Methodology: A randomized controlled, open label study was done on 150 patients of either sex, of age 20 to 70 years undergoing elective laparoscopic cholecystectomy under general anaesthesia. The patients were randomized in to one of the three groups, Group I (Baska mask), Group II (Ambu AuraGain) Group III (LMA Supreme) and airway secured. Time required for successful insertion, correct insertion of device ,OLP and leak fraction and ease of gastric tube placement noted. Postoperative morbidity, laryngopharyngeal morbidity and haemodynamic stability also noted. Results: Time required for successful insertion was least for AAG: median 7.8 sec, Baska mask :8.15sec, LMA Supreme (9.45 sec). Oropharyngeal leak pressure (OLP) significantly highest in Baska mask group (32.39 ± 1.65) than AAG group (28.33 ±1.17) and LMA Supreme (25.91 ±1.44) cm of H2O.Ease of insertionof gastric tube, incidence of postoperative complications, laryngopharyngeal morbidity and haemodynamic changes were same. Conclusion: All SADs were comparable and efficient in maintaining the hemodynamic stability. Higher first attempt success rate, less time required for adequate insertion and ventilation, ease of insertion, and gastric drainage, less intubation response of Baska mask, AAG and LMA Supreme make them an ideal choice for airway management of patients undergoing laparoscopic cholecystecomy.

Our study comparing two groups for elective surgery requiring anesthesia showed that a better view of the larynx was obtained in the McCoy group with respect to Cormack and Lehane grade compared to the Macintosh group and a significant HR of 3 and 2 minutes after laryngoscopy was increased in the McCoy group. . The hemodynamic response to laryngoscopy in the Macintosh group was characterized by an increase in HR, SBP, DBP and MAP compared to the McCoy group. Better visibility the hemodynamic response to laryngoscopy is less compared to the Macintosh blade.

Introduction: Endotracheal intubation is essential for airway management during anaesthesia. Conventional laryngoscopy can cause significant hemodynamic responses, like increased heart rate and blood pressure, which may be harmful to high-risk patients. Fibreoptic intubation offers a potential alternative by reducing airway trauma and hemodynamic instability. Objectives: The primary objective of the study was to compare hemodynamic responses and intubation times between conventional laryngoscopy and fibreoptic intubation. The secondary objective was to assess post-procedural complications associated with each method. Methods: This randomized controlled trial involved 200 ASA grade I and II patients aged 18-45 undergoing elective surgery. Patients were divided into two groups: Group A (Conventional laryngoscope [Romsons Scientific & Surgical Pvt. Ltd., Agra, Uttar Pradesh, India], n=100) and Group B (Fiberoptic bronchoscope [Karl Storz GmbH & Co. KG, Tuttlingen, Germany], n=100). Measurements included intubation time, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) at baseline, post-induction, and five minutes after intubation. Post-procedural complications (sore throat, soft tissue trauma, dental injury) were assessed over 24 hours. Statistical analysis used SPSS v23, with p<0.05 deemed significant. Results: Group B showed significantly lower hemodynamic responses compared to Group A. One minute after intubation, the average HR in Group A was 95.74 bpm, while in Group B it was 80.99 bpm (p < 0.05). Similarly, SBP was higher in Group A (135.52 mmHg) compared to Group B (114.57 mmHg) (p < 0.05). Intubation time was longer for Group B (30.83 seconds) than for Group A (24.69 seconds) (p < 0.01). Postoperative complications were lower in Group B, with 3 patients (3%) reporting a sore throat, compared to 11 patients (11%) in Group A (p = 0.024). Additionally, there were no cases of soft tissue trauma in Group B, whereas 11 patients (11%) in Group A experienced this complication (p < 0.01). Conclusion: Fiberoptic intubation offers better hemodynamic stability and fewer postoperative complications, although it requires more time for intubation. It is a safer option for airway management, particularly in patients prone to hemodynamic changes or airway injuries.

Introduction: Effective airway management in anesthesia relies on the optimal choice of laryngoscope blade, which can impact both the visibility during intubation and the patient's cardiovascular response, especially in elective surgeries where minimizing physiological stress is crucial. Objectives: This study aimed to evaluate the differences in laryngoscopic views and cardiovascular responses elicited by the use of Macintosh, Mc Coy, and Miller blades in adults undergoing elective orthopedic surgeries under general anesthesia. Methods: A total of 120 adult patients scheduled for elective orthopedic procedures under general anesthesia were included in this comparative retrospective study. Patients were grouped based on the laryngoscope blade used: Macintosh, Mc Coy, or Miller. The quality of the laryngoscopic view was assessed using the Cormack-Lehane grading system, and cardiovascular responses (changes in blood pressure and heart rate) were monitored and recorded during intubation. Results: The Mc Coy blade was found to provide the best laryngoscopic view, with 47.5% of cases achieving an excellent view, compared to 30% for Macintosh and 32.5% for Miller. In terms of cardiovascular response, the Miller blade was associated with the highest incidence of significant increases in blood pressure (40%), whereas the Mc Coy blade showed the lowest (10%). Statistical analyses confirmed significant differences across the blade types in both the quality of laryngoscopic views and the magnitude of cardiovascular responses (p < 0.05). Conclusion: The study underscores the importance of blade selection in optimizing laryngoscopic outcomes and minimizing cardiovascular risks. The Mc Coy blade may offer a favorable balance, providing superior visibility with less hemodynamic disturbance, suggesting its potential benefits in patients at risk of cardiovascular complications.

Objective: To evaluate the effectiveness of transthoracic echocardiography as a hemodynamic monitoring tool during induction of anesthesia and endotracheal intubation Design:  Prospective, single center, observational study Setting: Medical college teaching hospital Participants: Sixteen patients undergoing elective coronary artery bypass surgery Interventions: Patients were monitored with Transthoracic echocardiography and pulmonary artery catheter  Measurements and Main results: Baseline pre induction Transthoracic echocardiography was done to calculate fractional Shortening, fractional Area Change. Cardiac output and systemic vascular resistance were calculated by left ventricular outflow and mitral inflow Doppler. At the same time baseline pulmonary artery catheter measurements, cardiac output and calculated systemic vascular resistance were recorded. Measurements of Transthoracic echocardiography and pulmonary artery catheter were repeated during post induction and one minute after endotracheal intubation. Percent difference between baseline and post induction (Group A data) and percent difference between post induction and post intubation (Group B data) of all parameters were calculated. From group A and group B data estimated percent change in cardiac output and systemic vascular resistance correlated between two techniques. It also predicts the change in contractility during induction and endotracheal intubation. The change in cardiac output as estimated by the mitral inflow doppler and the left ventricular outflow doppler correlated well. Conclusion: Transthoracic echocardiography can be used as a replacement for pulmonary artery catheter to predict change in blood pressure, afterload and cardiac output during induction of anaesthesia in a non-invasive manner

Aim and Objective: To compare the Glottic view using Cormack Lehane grading in Sniffing Position (by Fixed Pillow) and Modified Ramped Position (by Customized Pillow) and to compare the number of attempts taken for endotracheal intubation in both groups Methodology: A cross-sectional study was conducted in the Department of Anaesthesiology at Government Medical College, Idukki, over six months to evaluate the effect of head and neck positioning on ease of intubation. The study included two groups: Group A (sniffing position: by Fixed Pillow) and Group B (Modified Ramped Position: by Customized Pillow), comprising ASA class 1, 2, and 3 patients aged above 18 years undergoing elective surgery under general anesthesia. Exclusion criteria included pregnancy, BMI >35, unstable cervical spine, or contraindications to conventional laryngoscopy or study drugs. Sample size was calculated 36 patients per group. Ethical approvals were obtained, and informed consent was secured. Result: The study included 72 participants (mean age: 41.08 ± 13.00 years), with 55.6% females and 44.4% males. BMI distribution showed 52.8% normal weight, 31.9% overweight, 6.9% obese, and 8.3% underweight, with a mean BMI of 24.20 ± 4.00 kg/m². ASA Class 1 comprised 73.6% of participants, followed by Class 2 (25.0%) and Class 3 (1.4%). Participants were evenly divided between Group A (sniffing position) and Group B (Modified Ramped Position). The Cormack-Lehane (CL) grade distribution was significantly better in Group B (p = 0.012), with higher proportions of Grade 1 and 2A, indicating superior airway visualization. Group B also required significantly less airway assistance (p = 0.032), with fewer cases needing bougie or BURP maneuvers and a higher proportion of successful intubations without assistance. Conclusion: Overall, the Customised Pillow (CP) group showed better airway visualisation, easier intubation, and required less assistance compared to the Fixed Pillow (FP) group. Significant differences were observed in MMPC scores, CL grades, and the use of assistance tools, with CP consistently showing superior outcomes. These findings confirm that Customised Pillow positioning provides a clinical advantage in airway management.

Background: Introduction: Airway procedures involving direct manipulation can trigger powerful reflexes that cause significant cardiovascular changes, particularly dangerous for patients with pre-existing cardiac, hypertensive, or neurological conditions due to the risk of myocardial ischemia, heart failure, or elevated intracranial pressure. For optimal patient outcomes, laryngoscopy should provide clear glottic visualization, enable precise endotracheal tube placement, minimize physical trauma, and reduce procedure duration - objectives that research shows are increasingly achievable through video laryngoscopy technology, which has demonstrated superior visualization and higher success rates compared to conventional methods. Aim And Objectives: To compare the total time taken for endotracheal intubation (in seconds) in adult patients and the hemodynamic stability during and after insertion of endotracheal tube in adult patient. Materials and Methods: After taking the institutional approval for the study, age 18-60 year, posted for elective surgeries undergoing general anaesthesia were equally divided into 2 groups, 30 patients each after taking written informed consent from patient in their own vernacular language. Group M (n=30) - Conventional Macintosh laryngoscope group. Group G(n=30) – McGrath MAC video laryngoscope group. Results: Patients in all two groups were comparable with Intubation criteria, mean pulse rate, SBP, DBP, mean ABP by using unpaired t-test. The mean difference was found statistically significant with P<0.05. No major complication were reported in patients of any of the group. Conclusion: This study it is concluded that Mcgrath MAC Video laryngoscope provides easier intubation and provide better hemodynamic as compared with Macintosh laryngoscope. And total duration of intubation is less with Mcgrath MAC Video laryngoscope than with Macintosh laryngoscope.

Background: The most common laryngo-tracheal complaints following general anesthesia with tracheal intubation in the postoperative period are sore throat and hoarseness, with an incidence ranging from 24% to 90%, which may hamper the quality of recovery postoperatively. This study was designed to assess whether intraoperative monitoring of endotracheal tube cuff pressure can help reduce the incidence of sore throat and hoarseness. Aims & Objective: Main aim of our study is to compare the quality of recovery in post operative patients and hemodynamic stability, smooth extubation, less post operative airway related complication and better patient satisfaction in whom endotracheal cuff pressure is been measured and monitored intra operatively  v/s not measured. Materials & Methods: 60 patients scheduled for elective procedures under general anesthesia with orotracheal intubation were recruited through simple random sampling and divided into two groups of 30 each: Group A and Group B. All patients received general anesthesia following a standard protocol. In Group A, cuff pressure monitoring was performed, whereas Group B served as the control group with no such monitoring. The incidence and severity of sore throat and hoarseness were recorded for both groups. Result:  100 patients were analyzed for the outcomes without any dropouts. The basic parameters like age, sex, BMI, and duration of surgery were found to be statistically insignificant among the two groups. The incidence of sore throat and its severity along with that of hoarseness of voice were found to be statistically insignificant, but with an evident better outcome in Group A. Conclusion:  We conclude that intraoperative monitoring of cuff pressure using a cuff pressure monitor significantly reduced the incidence as well as the severity of sore throat and incidence of hoarseness of voice in patients undergoing orotracheal intubation, but came out to be statistically not significant with evident improvement in quality of recovery post operatively.

Aims: Study tracheal intubation practices and adverse events in trauma victims on arrival at trauma center. Materials and methods: The study was conducted in trauma triage of a tertiary care hospital in patients age > 18 years, of either gender, requiring definitive airway control with endotracheal intubation in patients of life-threatening injury requiring immediate emergency care. 267 intubations done in trauma center were studied. Results: Most common group is 11-20 years. Mean age of patients was 35.21 ± 12.43 years, majority were male (78.7 %), had history of RTA (76 %). Common injuries observed were head injury (45.3 %), blunt trauma chest (23.6 %), penetrating injury (12 %). Successful intubations were majority in 1st attempt (71.5%), followed by in 2nd attempt (22.8 %) and 11 cases were difficult intubations (3 attempts) (4.1 %). Failed intubation were 9 (1.5 %).  Desaturation was the most commonly reported complication occurring in 39 (14.6%) patients, followed by esophageal intubation at 12 (4.5%). Other complications were equipment failure 7(2.6%), bradycardia 5(1.9%), and dental trauma. Cardiac arrest was reported in 2 (0.7%) patients. Conclusions: The trauma triage is a high-volume area for frequent tracheal intubations which is manned by nonanaesthesia speciality teams. A number of factors related to the patient, staff, availability of airway equipment and unfavourable surroundings impact airway management and may explain the high incidence of airway complications, such as airway injuries in these trauma victims.

AIM: To find a suitable general anaesthetic induction agent that can have optimal condition for endotracheal intubation and haemodynamic stability.  METHIOD: This was a Randomized double blinded controlled trial conducted at Department of Anaesthesia & Intensive Care, for the period of 24 months. However, this study was restricted only to the elective lower limb orthopaedic surgeries. Total number of patients seen at our Institute during the study period was 60 with 30 patients in each group. RESULTS: This study includes 60 healthy individuals of ASA grade I and II. In this study, study population is divided into 2 groups – Group P and Group E. Group P – study population received inj. Propofol 1%, (2 mg/Kg body weight) Group E – study population received inj. Etomidate (0.3 mg/Kg body weight) All observational parameters were noted by an independent observer blinded at the time of induction, during laryngoscopy, at 1 minute, 3-minute, 5 minute and 10 minutes. In this randomised controlled trial, etomidate was found to be a better induction agent for general anaesthesia with more proportion of patients with excellent and good ease of insertion, less incidence of pain on injection, less incidence of apnoea with better SpO2 level, and better haemodynamic stability as compared to propofol. There were less cases of nausea or vomiting, hypotension and tachycardia in etomidate group whereas incidence of myoclonus and bradycardia were slightly more. Thus, etomidate should be preferred over propofol as the induction agent of choice in patients with co-existing cardiac illness in whom maintaining stable hemodynamic parameters is very important during induction for a favourable outcome.  CONCLUSION: In this randomised controlled trial, etomidate was found to be a better induction agent for general anaesthesia with more proportion of patients with excellent and good ease of insertion, less incidence of pain on injection, less incidence of apnoea with better SpO2 level, and better haemodynamic stability as compared to propofol. There was less cases of nausea or vomiting, hypotension and tachycardia in etomidate group whereas incidence of myoclonus and bradycardia were slightly more. Thus, etomidate should be preferred over propofol as the induction agent of choice in patients with co-existing cardiac illness in whom maintaining stable hemodynamic parameters is very important during induction for a favourable outcome.

Background: Direct laryngoscopy and tracheal intubation can result in severe effects such as tachycardia, hypertension, cardiac ischaemia, and cerebral haemorrhage.Clonidine is an α-2 adrenergic receptor agonist that exerts a central sympatholytic action. Clonidine premedication mitigates the haemodynamic stress reactions associated with direct laryngoscopy and tracheal intubation. Pregabalin, a gabapentinoid, seems to exert an inhibitory effect on neuronal excitability.

Aim: The purpose of this study was to compare the effect of oral pregabalin 150 mg & oral clonidine 0.2 mg given 90 minutes before surgery, on haemodynamic stress response resulting from laryngoscopy and endotracheal intubation. Materials and Method:The present study was a prospectiveobservational randomizedcomparativestudy performed conducted for a period of one year in a tertiary care centre. The study comprised 60 patients classified as ASA I and II, scheduled for diverse elective operations under general anaesthesia. The participants were randomised into two groups, A and B, each consisting of 30 patients: the Pregabalin group (Group A) and the Clonidine group (Group B). Group A received premedication with 150 mg of capsaicin pregabalin, whereas Group B was administered 0.2 mg of clonidine. Subsequently, the haemodynamic parameters including heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and mean arterial pressure(MAP) were compared between the two groups during induction, laryngoscopy, and intubation.Result wasanalysed using SPSS 20.0 version and the association was tested using t test. A p value less than 0.05 was considered statistically significant.  Results:  Administration of oral clonidine 0.2 mg 90 minutes before to surgery mitigated sympathetic stimulation and catecholamine responses during laryngoscopy and tracheal intubation. Our investigation revealed that the increase in HR, SBP, DBP, and MAP after laryngoscopy and endotracheal intubation was considerably lower in the Clonidine group compared to the Pregabalin group. The Clonidine group exhibited superior haemodynamic stability throughout surgery compared to the pregabalin group. Conclusion: When compared to oral pregabalin, oral clonidine substantially reduces the sympathetic responses that occur during laryngoscopy and endotracheal intubation, while simultaneously preserving the stability of the cardiovascular system during surgery.

Background: Microlaryngeal surgery is a stressful short surgical procedure for diagnosis and treatment of airway disorders, which produces an intense cardiovascular stimulation during suspension laryngoscopy. The study compared propofol and etomidate as hypnotics in microlaryngeal surgery combined with jet ventilation. They observed more stable anaesthesia and better recovery with propofol group than etomidate group. The study compared propofol and methohexital for total intravenous anaesthesia in microlaryngeal surgery. They observed cardiovascular stability with propofol than methohexitone in microlaryngeal surgery. Another study shown that sevoflurane and remifentanil effectively maintained cardiovascular stability than sevoflurane and alfentanil in patients undergoing microlaryngeal surgery. MATERIAL AND METHODS: This is a prospective study conducted in patients undergoing microlaryngeal surgery in the department of anesthesiology at Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga. A total of 60 adult daycare patients belonging to the American Society of Anaesthesiologist grade I or II were included in the study. Patients were divided into two groups named as propofol group (group P) and sevoflurane group (group s) of 30 each by computer randomization tables. Patients aged 18 to 60 years of ASA grade I and II posted for microlaryngeal surgery under general anaesthesia were included in the study.  RESULTS:Heart rate before and after premedication in Sevoflurane group and Propofol group was nearly equal. There was decrease in heart rate following induction with both propofol (71.63 ± 6.49) which is statistically significant than sevoflurane (76± 2.99). There is good control of Heart rate after intubation in Sevoflurane group when compared to Propofol group. Which was statistically significant (p<0.001). There is decrease in Mean arterial pressure at 3min , 5min ,15 min , 20 min and 25 min time intervals in Sevoflurane group which is statically significant ( P < 0.05) when compared to Propofol group except at 10 min and 30 min where the mean arterial pressure in Propofol group similar to the sevoflurane group. CONCLUSION: Sevoflurane is a better agent compared to propofol, for micro laryngeal surgeries due to stable hemodynamic properties and faster recovery. Post-operative nausea and vomiting is less in patients receiving Propofol than Sevoflurane.

Background: The Mallampati test is used to evaluate the airway to predict difficult laryngoscopy and intubation. The sitting position is the standard for this test, but it has limited practical utility due to its low sensitivity and moderate specificity in predicting difficult intubation and laryngoscopy. The supine position, on the other hand, may improve its efficacy.This test, as a standard, when conducted with a patient in a sitting position, exhibits limited practicality due to its relatively low sensitivity and specificity in predicting difficult tracheal intubation (DTI). It is hypothesized that MMT, when performed with a patient lying supine, may improve its efficacy as a predictor of DTI, this prospective observational study was conducted involving 100 adult patients requiring general endotracheal anaesthesia. During pre-anaesthetic evaluation, MMT was performed in the sitting position as a standard (sitting MMT). Subsequently, independent observers recorded the MMT in the supine position (supine MMT) before administering general anaesthesia. The sitting and supine MMT were correlated with Cormack and Lehane grades using the Chi‑ square test. Diagnostic performance metrics, including the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive values (PPV) and negative predictive values, were employed to assess the predictive capabilities of MMT in both positions and found as resultant both MMT in the sitting and supine positions demonstrated strong predictive capabilities for DTI, with areas under the ROC, respectively. While sitting in the MMT position exhibited higher sensitivity, supine MMT demonstrated a superior PPV. After completion of the study, we concluded, MMT, when conducted with a patient in a supine position emerges as an alternative and are liable predictor for predicting DTI.  

Introduction: Pediatric patients, because of their anatomical differences in airway compared to adult poses many challenges during endotracheal intubation. One such challenge is, in selecting the proper sized endotracheal tube for intubation. Use of inappropriate size of ETT can cause significant morbidity and mortality. To avoid excessive airway instrumentation, repeated laryngoscopies and minimizing risk of trauma, the preanesthetic assessment of tracheal diameter is important to select appropriate ETT size estimation. Visualization of pediatric airway with the help of USG can enable anaesthesiologist to better predict ETT size. Hence, we undertook this study to assess the accuracy of USG guided tracheal diameter measurement in predicting ETT size in pediatric patients and its comparison with that determined by age based formula. Methods: After institutional ethical committee clearance, a total of 50 pediatric patients of either sex aged between 2 and 6 years were included in this prospective observational study, who underwent elective surgery under general anaesthesia. Laryngoscopy and endotracheal intubation were done with predetermined sized ETT estimated by USG. ETT size was considered optimal when the cuff leak test was negative. The comparison was done between the size of ETT calculated by USG guided subglottic diameter, age related formula for accuracy of prediction for proper ETT size after cuff leak test. Result: Agreement between actual ETT inserted and ETT estimation by age-based formula and ultrasonography was calculated by using kappa statistics. Agreement between actual ETT inserted and ETT measured by age based formula was weak (52.18%) and kappa value was 0.394 but agreement between actual ETT inserted and ETT measured by USG is strong ( 88% ) and the kappa value is 0.853. Conclusion: Determination of endotracheal tube size by ultrasound is a good predictor of proper sized endotracheal tube in pediatric age group when compared with age based formula.

Background: Postoperative sore throat (POST) is a common complication following endotracheal intubation under general anesthesia. Both ketamine and magnesium sulfate are NMDA receptor antagonists with potential analgesic properties, making them viable options for reducing POST. Objective: This study aimed to compare the efficacy of ketamine and magnesium sulfate gargles in preventing POST in patients undergoing general anesthesia with endotracheal intubation. Methods: A total of 90 patients (ASA grade I and II, aged 18-60 years) were randomly assigned to two groups: Group A (ketamine gargle) and Group B (magnesium sulfate gargle). The intervention was administered 5 minutes before induction, and patients were assessed for POST at 0, 4, 8, 12, and 24 hours post-operation using a four-point scale. Statistical analysis was performed using the Chi-square test, and p-values <0.05 were considered significant. Results: Incidence and severity of POST were significantly lower in the magnesium sulfate group at all time points. At 0 hours, 62.2% of patients in Group B reported mild sore throat (Grade 1) compared to 15.6% in Group A. At 24 hours, 100% of patients in Group B had no sore throat (Grade 0), compared to 84.4% in Group A. The differences were statistically significant (p < 0.001). Conclusion: Magnesium sulfate gargle is more effective than ketamine gargle in reducing the incidence and severity of postoperative sore throat after endotracheal intubation.

Aim: We performed a prospective, double-blind, randomized control trial with 60 ASA I and II patients (18–65 years old) undergoing elective laparoscopic procedures. Comparing the hemodynamic effects of intravenous magnesium Sulphate (30mg/kg) with Clonidine (1.0µg/kg) at Kurnool Medical College. Methodology: Two groups of thirty patients each were randomly allocated to them. Group M received Magnesium and Group C received Clonidine in 50 millilitres of normal saline. The test solutions were given before to pneumoperitoneum and after intubation. Heart rate, blood pressure at both systolic and diastolic levels, mean arterial pressure, oxygen saturation, side effects, and degree of sedation (as determined by the Modified Ramsay Sedation Score) were among the parameters that were noted. One-Way ANOVA was used to evaluate nominal data, and the Chi- Square test was used to analyse categorical data. A p-value of less than 0.05was considered statistically significant. Results: In the present study, the two groups' heart rates, blood pressures, and oxygen saturation levels did not significantly differ, according to the results. In contrast to the magnesium group, the Clonidine group experienced noticeably less sedation. Among the side effects, the Clonidine group experienced a 7% incidence of bradycardia. The study found that magnesium (30 mg/kg) and Clonidine (1.0 µg/kg) both worked equally well to control the hemodynamic response throughout laparoscopic procedures, with Clonidine producing less sedation following extubation. Conclusion: The study concluded that, reducing the hemodynamic stress responses during laparoscopic procedures, intravenous Clonidine administration 1.0 µg/kg before pneumoperitoneum is just as beneficial as intravenous magnesium sulphate administration 30mg/kg before pneumoperitoneum. Additionally, Clonidine causes less sedation following extubation than magnesium.

Background: Post-operative sore throat (POST) and hoarseness of voice are very common complaints from patients undergoing endotracheal intubation, the incidence of which has been estimated to be approximately 14.4% to 50%. Budesonide is an ICS commonly used to reduce all these complications. It is a corticosteroid with potent glucocorticoid and weak mineralocorticoid activities. Metered dose delivery of budesonide is considered as simple, less time consuming with high patient acceptability. On the other hand, the main advantage of nebulization with budesonide is that it is deposited directly into the respiratory tract and thus higher drug concentrations can be achieved with fewer adverse effects than when the systemic route is used. Methods: The present study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak in a prospective, comparative, randomised and unblinded manner after obtaining approval from the institutional ethical committee and patients’ written, informed consent. The study included 80 patients of either sex of age 18-60 years, belonging to American Society of Anesthesiologists (ASA) physical status of I-II with Mallampatti score of 1-2, undergoing surgeries under general anaesthesia. Results: The incidence of post-operative sore throat and hoarseness of voice grades were found significantly higher in the Group A (92% and 37.5%) than in Group B (85% and 22.5%) at 2 hours after extubation of the patients. There were significantly higher grades of POST and hoarseness of voice in Group A than in Group B. The incidence of POST and hoarseness of voice grades were found to be significantly higher in Group A than in Group B (55%, 27.5% versus 27.5%, 15%) at 6 hours post-extubation. Higher grades of all categories were seen in group A. At 24 hours post-extubation, the incidence and grades of POST and hoarseness were found higher in Group A than in Group B (10%,22.5% versus 0%,15%). Conclusion : We concluded from our study that Budesonide is a very safe inhalational corticosteroid that can be used frequently during general anaesthesia using endotracheal tube. It has been found to reduce the incidence and grades of post-operative sore throat, cough and hoarseness of voice in the patients following extubation thereby, enhancing the overall satisfaction of the patients in the post-operative period.

Background post-operative sore throat (POST) and hoarseness of voice are very common complaints from patients undergoing endotracheal intubation, the incidence of which has been estimated to be approximately 14.4% to 50%.  Budesonide is an inhaled corticosteroid (ICS), commonly used to reduce all these complications. It is a corticosteroid with potent glucocorticoid and weak mineralocorticoid activities. Metered dose delivery of budesonide is considered simple and less time-consuming but with high patient acceptability. It would obviate the need of additional equipments like nebulisers or atomisers and reduce the assistance of nursing staff. Side-effects like fluid retention, delayed wound healing and glucose intolerance are comparatively less as compared to intravenous corticosteroids.² Methods: The present study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak in a prospective, randomised and unblinded manner after obtaining approval from the institutional ethical committee and patients’ written, informed consent. The study included 100 patients of either sex of age 18-60 years, belonging to American Society of Anesthesiologists Physical Status (ASA PS) of I and II with Mallampatti Grades (MPG) of 1 and 2, undergoing surgeries under general anaesthesia. Patients were randomly allotted to one of the two groups equally, labelled A and B, 50 patients each irrespective of gender, using random number table as follows: Results: The incidence of post-operative sore throat, cough and hoarseness of voice grades were found significantly higher in the Group B than in Group A at 2 hours after extubation of the patients (74%, 56% and 40% versus 22%, 18% and 28%). There were significantly higher grades of POST, cough and hoarseness of voice in Group B than in Group A. The incidence of POST and hoarseness of voice grades were found to be significantly higher in Group B than in Group A (27%, 38% versus 12%, 16%) at 6 hours post-extubation. Though the incidence of cough was higher in Group b than in Group A, it was not statistically significant. Higher grades of all three categories were seen in Group B. In Group B higher incidence of POST, cough and hoarseness of voice were seen as compared to Group A (28%, 28%, 18% versus 10%, 8%, 4%) at 12 hours post-extubation. There were higher grades of POST, cough and hoarseness of voice in Group B. Conclusion: we concluded from our study that Budesonide is a very safe inhalational corticosteroid that can be used frequently during general anaesthesia using endotracheal tube. It has been found to reduce the incidence and grades of post-operative sore throat, cough and hoarseness of voice in the patients following extubation thereby, enhancing the overall satisfaction of the patients in the post-operative period.

Introduction: Managing airway safely is a vital part of delivering anaesthesia. Unexpected difficulties during laryngoscopy can lead to serious complications. Clinical tools like Modified Mallampati Scale are often unreliable. In recent years, use of ultrasound to measure anterior neck soft tissue structures has promised as more accurate to assess airway before surgery. Aims and Objectives: This study was conducted to understand how measurements taken using ultrasound before surgery relate to the view seen during laryngoscopy in adult cancer patients and aimed to compare how well ultrasound findings predict airway difficulty compared to traditional clinical tests. Materials and Methods: This was a prospective observational study on 123 adult patients with cancer who underwent elective surgeries under general anaesthesia. Preoperative examination for clinical methods such as Modified Mallampati classification, neck size and mouth opening; ultrasound-based measurements that included distance from the skin to epiglottis, skin to hyoid, width of tongue, cross-sectional areas of tongue and floor of mouth, mentohyoid distance and thickness of geniohyoid muscle. Laryngoscopic view was graded using Cormack-Lehane system. The accuracy of each parameter in predicting difficult laryngoscopy was analysed using statistical methods. Results: Among all measurements, distance from the skin to the epiglottis proved to be the most reliable predictor with excellent accuracy. Measurements of skin to hyoid bone, tongue width and the cross-sectional area of the tongue also showed good predictive value. However, Modified Mallampati classification was less reliable. Patients who experienced difficulty had higher body mass index took longer to intubate and required more attempts. Conclusion: Ultrasound measurements, particularly skin to epiglottis and skin to hyoid distances were more accurate in predicting difficult laryngoscopy than standard clinical tests. Adding ultrasound to routine airway assessments may help identify those at higher risk and allow for better preparation especially in those undergoing surgery for cancer.

Background: Laryngoscopy and endotracheal intubation is accompanied by intense sympathomimetic stimulation resulting in increase in Heart Rate (HR) and arterial Blood Pressure (BP). This response is transient and less significant in healthy individuals. But in patients with reduced myocardial reserve / hypertension / cerebro-vascular insufficiency / raised intracranial or intraocular pressure this response is very hazardous and may predispose to pulmonary edema / myocardial infarction / cerebro-vascular accident / dysrhythmias Objective: To compare the efficacy of Dexmedetomidine in reducing the hemodynamic stress response in two different doses (0.6 mcg/Kg and 1 mcg/Kg body weight) which was given prior to laryngoscopy and endotracheal intubation. Methods: 80 ASA 1& 2 patients between the age group of 18-60 years included in this study will be randomly divided into two groups. Group A patients:  Received 0.6 mcg/kg Dexmedetomidine diluted in 100 ml normal saline 10 minutes prior to induction over 10 minutes. Group B- patients:  Received 1 mcg/kg Dexmedetomidine diluted in 100ml normal saline 10 minutes prior to induction over 10 minutes.  After premedication, anesthesia was induced with inj. Thiopentone sodium till the abolition of the eyelash reflex. After checking the adequacy of the mask ventilation, inj. Succinylcholine 1.5 mg/kg was given for intubation. Laryngoscopy and intubation were done with Macintosh blade laryngoscope after one minute. HR, SBP, DBP, MAP and SpO2 were recorded at various interval.  Result: In both groups, HR, SBP, DBP & MAP reduced significantly. During intubation, 1- and 3-minutes following intubation there was minimal rise in blood pressure compare to value at the time of induction in Group A but in group B there was marked fall continuously.  Conclusion: Both doses of Dexmedetomidine (0.6mcg/kg & 1 mcg/kg) attenuated the stress response of laryngoscopy and intubation effectively. The reduction in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was more in 1 mcg/kg group. Hence dexmedetomidine at a dose of 0.6mcg/kg itself is adequate to control the stress response of laryngoscopy and intubation.

Background: Laryngoscopy and intubation induce significant physiological stress responses, including hemodynamic fluctuations such as increases in heart rate (HR) and blood pressure. These responses are particularly concerning in patients undergoing laparoscopic surgeries, where hemodynamic stability is crucial. Various pharmacological strategies have been employed to mitigate these responses, with intranasal dexmedetomidine and lignocaine being among the most widely studied.Objective: This study aimed to compare the effects of intranasal dexmedetomidine alone versus a combination of intranasal dexmedetomidine and lignocaine spray in attenuating the stress response to laryngoscopy and intubation in patients undergoing elective laparoscopic surgery. Methods: A prospective, randomized study was conducted with 120 adult patients (age 18–60 years) of ASA physical status I and II, scheduled for elective laparoscopic surgery. Patients were randomly allocated into two groups: Group D (n = 60), which received intranasal dexmedetomidine 1 mcg/kg, and Group DL (n = 60), which received intranasal dexmedetomidine 1 mcg/kg combined with 10% lignocaine spray (1.5 mg/kg). Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were recorded at baseline, pre-induction, immediately after intubation, and at 1, 3, 5, and 10 minutes post-intubation. Results: Both groups demonstrated a significant reduction in the hemodynamic response compared to baseline values. However, Group DL exhibited significantly more effective attenuation of HR, SBP, DBP, and MAP compared to Group D, particularly in the immediate post-intubation period (p < 0.05). The differences between the two groups were statistically significant at several time points post-intubation, with Group DL showing lower HR and BP values overall. There were no significant differences in oxygen saturation (SpO₂) between the groups, and both groups maintained stable levels throughout the perioperative period. Conclusion: The combination of intranasal dexmedetomidine and lignocaine spray is more effective in attenuating the hemodynamic response to laryngoscopy and intubation than intranasal dexmedetomidine alone. This combination approach provides a simple, non-invasive, and reliable strategy to enhance perioperative hemodynamic stability, particularly in laparoscopic surgeries.

Background: The induction of anaesthesia, laryngoscopy, tracheal intubation and surgical stimulation evoke cardiovascular responses leading to alteration in heart rate, cardiac rhythm and blood pressure. The response starts in 5 seconds, peaks within 1-2 minutes and returns to baseline in 5 minutes. The goal is to compare the effectiveness of Esmolol and Magnesium Sulphate for attenuation of haemodynamic stress response to laryngoscopy and intubation. Materials and Methods: After approval from the ASRAMS Institutional Ethics Committee, the procedure was clearly explained to patients and informed written consent was obtained. The study was conducted during the period, April 2024- March 2025 at ASRAM General and Super-Specialty Hospital, Eluru, Andhra Pradesh. 90 patients of age group 15 to 60 yrs of ASA physical status I and II who underwent elective ENT surgery under general anesthesia were selected and randomly allocated into 3 groups. Baseline heart rate and blood pressure was measured. They were premedicated with Inj. Glycopyrrolate 0.2mg and Inj. Midazolam 0.04mg/kg intramuscular 45 minutes before surgery. Patients were then shifted into the theatre. Inj. Fentanyl 2µg/kg was given 5 minutes before intubation to all patients. They were induced with Inj. Propofol 2mg/kg and Vecuronium 0.1mg/kg. Group M received Inj. Magnesium Sulphate 50mg/kg in 100ml of normal saline infusion over 10 minutes before induction. Group P received 15ml of normal saline 5 minutes before induction. Group E received Esmolol 1.5mg/kg in 15ml normal saline over 15-20 seconds one minute after vecuronium and intubation was done after 2 minutes.  Group P received 15ml of normal saline 5 minutes before induction. The heart rate, systolic and diastolic blood pressure and mean arterial pressure were recorded baseline, after premedication, one min after test drug, after induction, immediately after intubation, thereafter 1, 3 and 5 minutes following intubation. Laryngoscopy duration was noted. Results: 1) Group E showed maximum attenuation of heart rate and blood pressure. 2) Group M also showed significant attenuation of blood pressure response but produced tachycardia on infusion of the drug. Heart rate response was not statistically significant compared to group E. 3) All patients recovered well.  4) Incidence of side effects was not significant between the groups. Conclusion: From this study, it is concluded that hemodynamic changes to laryngoscopy and intubation can be attenuated by giving intravenous Esmolol 1.5mg/kg. Esmolol is effective in blunting the response followed by Magnesium Sulphate which blunts the hypertensive response but produces tachycardia during infusion of the drug. Placebo was ineffective in blunting hemodynamic stress response to laryngoscopy and intubation..

Background: This study was done to assess the ability of neck circumference to thyromental distance ratio (NC/TM distance ratio) for predicting difficult intubation among obese patients coming for surgery under general anaesthesia. It enabled us to compare NC/TM distance ratio to routinely used Mallampati score and neck circumference as reliable tests for predicting difficult intubation. This study also identified incidence of difficult intubation among obese individuals Materials and Methods: After approval from the ASRAMS Institutional Ethics Committee, the procedure was clearly explained to patients and informed written consent was obtained. The study was conducted during the period, April 2024- March 2025 at ASRAM General and Super-Specialty Hospital, Eluru, Andhra Pradesh. Validated Intubation difficulty score (IDS score) for each obese patient was assessed intra operatively by the anesthetist who performed intubation. The entire study population were divided into easy and difficult intubation groups based on the IDS score. IDS score greater than or equal to five was considered as difficult intubation. NC/TM distance ratio greater than or equal to five was correlated with IDS score greater than or equal to five. The study assessed the statistical significance of NC/TM distance ratio and difficult intubation by univariate and multivariate logistic regression analysis and its comparison with Mallampati score and neck circumference with respect to sensitivity / specificity/ positive predictive value and negative predictive value. The study also calculated the incidence of difficult intubation among obese patients Results: Binary univariate logistic regression analysis of predictors of difficult intubation showed age greater than sixty, increased neck circumference, decreased thyromental distance, modified Mallampati test, NC/TMD ratio ≥ 5 as statistically significant variables that were associated with a difficult intubation (p ≤ 0.05). Binary multivariate logistic regression analysis showed only neck circumference (p=0.030 [odd ratio 2.519(1.094 5.802)] and NC/TMD ratio (p <0.001 [odd ratio 23.680(10.638-52.713)] independently predicted difficult intubation. However, NC/TMD ratio had higher specificity / PPV and larger AUC on an ROC curve compared to neck circumference. The incidence of difficult intubation among obese patients was 20.8 % Conclusion: Among obese patients, NC/TMD ratio can be considered as a better preoperative predictor of difficult intubation and incidence of difficult intubation among them was as high as 20.8 percent.

Background: Postoperative sore throat is one of the most undesirable postoperative complaints after general anaesthesia. To assess the incidence and severity of postoperative sore throat at 1 hour, 6 hours and 24 hours post-surgery. To assess coughing, hoarseness of voice and dysphonia if any at 1 hour,6 hours and 24 hours post-surgery. Materials And Methods: Patients were randomized into two groups using sealed envelope technique. Group A – Intra-cuff Tramadol 2mg/Kg, Group B – Intra-cuff Air. Results:  All the demographic data was comparable between the two groups and there is no statistically significant difference between the two groups. There was a highly statistically significant difference between the groups pertaining to cough,  19 patients (39.6%) in the air group had cough immediate extubation lasting for less than 15 seconds whereas none of the patients in the tramadol group had cough immediate post extubation. Only 3 patients (6.3%) out of 48 in the tramadol group had minimal sore throat in the 1st hour whereas 35 patients (72.9%) had minimal sore throat and 9 patients (18.8%) had moderate sore throat in the air group. Conclusion: We conclude that intracuff tramadol used in doses of 2mg/kg significantly reduces postoperative sore throat in the 1st hour and 6 hours post-surgery. It is also found to significantly reduce the cough immediate post extubation providing smoother emergence as well as postoperative cough and hoarseness

Background: Spontaneous Breathing Trials (SBTs) are pivotal in assessing readiness for extubation during weaning from mechanical ventilation. The ideal weaning strategy remains debatable and often varies based on individual patient conditions. This study aimed to compare the effectiveness of high-flow oxygen and T-piece ventilation in patients primarily intubated for respiratory distress or low Glasgow Coma Scale (GCS). Materials and Methods This was a randomized prospective, double-blinded controlled trial conducted between July 2023 and January 2025 among patients aged above 18 years with respiratory distress admitted in the ICU of BLDE(DU) SBMPMCH, Vijayapura. A total of 110 patients requiring mechanical ventilation for over 12 hours and meeting standard weaning criteria were randomly assigned to undergo SBT using either high-flow oxygen or T-piece ventilation (55 patients in each group). SBT was conducted for 30–60 minutes. In the high-flow group, FiO₂ was 0.4 with a flow of 60 L/min; in the T-piece group, FiO₂ ranged from 0.21 to 1.00. Parameters such as arterial blood gas, heart rate, oxygen saturation, and mean arterial pressure were recorded. Results High-flow oxygen patients had a significantly shorter ICU stay (5.49 days) compared to the T-piece group (7.29 days) (p = 0.019). Post-extubation, a significant rise in PaO₂ (141.11 to 193.60 mmHg, p = 0.001) and PaCO₂ (35.12 to 38.54 mmHg, p = 0.035) was observed in the high-flow group, indicating improved oxygenation and ventilation adjustment. T-piece patients showed no significant post-extubation change. Dyspnea was the leading intubation cause in the high-flow group, while low GCS dominated the T-piece group (p = 0.000). No major adverse events or deaths were reported during the assessment period. Conclusion High-flow oxygen therapy is an improved alternative to conventional T-piece ventilation in reducing ICU stay and enhancing post-extubation oxygenation, particularly in patients with respiratory distress.

Background: Postoperative sore throat (POST) is a frequent complication of endotracheal intubation, impacting patient comfort. Nebulized ketamine, clonidine, and dexmedetomidine show promise in prevention. Methods: PubMed, EMBASE, and Cochrane Library were searched for RCTs comparing nebulized ketamine, clonidine, dexmedetomidine, or combinations against placebo or active controls in adults undergoing general anaesthesia with intubation. Primary outcomes were POST incidence and severity at 1, 2, 6, 12, and 24 hours. Secondary outcomes included adverse effects. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Bayesian network meta-analysis ranked interventions.  Results: Twenty RCTs (n=2,346) were included. Dexmedetomidine reduced POST incidence at 2 hours (RR 0.52, 95% CI 0.41–0.66) and 6 hours (RR 0.44, 95% CI 0.32–0.60). Ketamine reduced POST at 24 hours (RR 0.45, 95% CI 0.37–0.54). Ketamine + clonidine outperformed ketamine alone (RR 0.16, 95% CI 0.07–0.36 at 24 hours). Dexmedetomidine ranked highest for early prevention. Adverse effects were minimal.  Conclusion: Dexmedetomidine is optimal for early POST prevention, while ketamine + clonidine offer sustained benefits.

Background: Laparoscopic cholecystectomy demands effective airway management due to the physiological changes caused by pneumoperitoneum. While endotracheal intubation (ETT) is the gold standard, the I-gel a second-generation supraglottic airway device, offers a potentially less invasive alternative. Since its introduction has become common modality of airway management in short duration surgeries. It does not only provide adequate ventilation, oxygenation and delivery of anesthetic agents but also lowers risk of respiratory adverse events. Objectives: To determine the efficacy of I-gel compared to ETT in terms of ease of insertion, hemodynamic changes as well as ventilation efficacy in adults undergoing elective laparoscopic cholecystectomy under general anesthesia. Methods: A hospital based observational study was conducted under Department of Anesthesiology, Assam Medical College, Dibrugarh for 2 months. Sixty ASA I-II patients aged 20-60 years scheduled for elective laparoscopic cholecystectomy were randomized into two groups: Group A (I-gel) and Group B (ETT). The insertion time, number of attempts, ease of insertion, hemodynamic parameters, and End-tidal CO₂ (EtCO₂) were compared between the two groups. Statistical significance was determined using appropriate tests. Results: Mean insertion time was significantly shorter in I-Gel (11.73±1.62 sec) than ETT (16.50±1.07 sec, p<0.0001). Ease of insertion was significantly better with I-gel (96.6% vs. 80%, p=0.0444). I-gel was also associated with higher first attempt success rate (96.67% vs 86.67%). Hemodynamic responses (HR and MAP) at 1minute post-insertion were significantly higher in the ETT group (p=0.011 and 0.02). EtCO₂ values were comparable between both groups. Conclusion: I-gel offers faster, easier insertion with less hemodynamic changes than ETT. We conclude that I-Gel can be a suitable alternative in short-duration laparoscopic surgeries in healthy adults.

Introduction: Endotracheal intubation using direct laryngoscopy is the gold standard for establishing an airway and it is a fundamental skill for acute care practitioners. The advancement in digital technology has led to a number of video laryngoscopes (VLs) being developed for clinical use. The objective of our study was to compare the laryngoscopic view, to compare the time taken for intubation, to compare the hemodynamic parameters, to compare POGO score and also to compare Cormack Lehane grading between direct laryngoscope and video laryngoscope. Material and Methods: The present Hospital based prospective randomized single blinded study was carried out at Department of Anaesthesiology at our tertiary care center involving patients indicated for laryngoscopy. Group DL: 30 patients intubated with conventional Laryngoscope and Group VL: 30 patients intubated with Video Laryngoscope. Results: We included total 60 subjects in our study. Group DL included 30 and Group VL included 30 cases. Mean POGO score of the cases from Group DL and Group VL was 80±24.91 and 90±20.34. This difference in the mean POGO score was statistically non- significant (p>0.05). Mean ET insertion time of the cases from Group DL and Group VL was 16.30±2.23 and 18±2.03 seconds. This difference in the mean ET insertion time was statistically significant (p>0.05). Heart rate between two groups. It was observed that mean heart rate in Group VL was significantly less as compared to Group DL after intubation 0,5,10,15,30 minutes as well as up to post operatively 30 minutes. SBP, DBP, MAP and SPO2 were comparable in both the groups with no significant difference. Conclusion: Video laryngoscope is a superior device than the conventional direct laryngoscope (Macintosh). It can be used as a teaching tool for novice intubators and offers approach to tracheal intubation.

Introduction: Awake fibreoptic intubation (AFOI) is a preferred method for managing anticipated difficult airways, particularly in patients with anatomical or physiological challenges. Sedation plays a critical role in ensuring patient comfort and procedural success, without compromising respiratory or cardiovascular stability. While midazolam-fentanyl is a commonly used sedative combination, dexmedetomidine has gained interest due to its sedative and sympatholytic properties with minimal respiratory depression. Aims and Objectives: This study aimed to compare dexmedetomidine versus midazolam-fentanyl for (1) hemodynamic stability, (2) sedation level, and (3) ease and comfort of intubation during AFOI. Materials and Methods: In this prospective, double-blinded, randomized study, 60 ASA I–II patients undergoing elective head and neck surgery were divided into two groups: Group D (dexmedetomidine 1 µg/kg loading + 0.7 µg/kg/hr infusion) and Group FM (fentanyl 2 µg/kg + midazolam 40 µg/kg over 10 minutes). Ramsay Sedation Scores, intubation time, COMFORT scale, and hemodynamic parameters were recorded and compared. Statistical analysis was conducted using t-tests and chi-square tests. Results: Group D had significantly better hemodynamic stability (p<0.001), shorter intubation time (15.4 vs. 20.6 seconds, p<0.001), and lower COMFORT scores indicating greater patient comfort (10.0 vs. 15.87, p<0.001). Sedation levels were also deeper in Group D (Ramsay score 2.87 vs. 1.70, p<0.001). Complication rates were similar across groups. Conclusion: Dexmedetomidine offers superior sedation, enhanced comfort, and better hemodynamic control compared to fentanyl-midazolam during AFOI, supporting its use as the preferred sedative agent in anticipated difficult airway management.

Background: A key aspect of general anesthesia, laryngoscopy and endotracheal intubation, commonly induces significant hemodynamic responses including elevated blood pressure and heart rate.  Effective management of these responses is essential particularly in patients with pre-existing cardiovascular risks. Aim: This study aimed to compare how effectively and safely Esmolol and Dexmedetomidine reduce the hemodynamic responses (changes in heart rate and blood pressure) caused by laryngoscopy and intubation. Methods: This study involved 100 patients, randomly assigned to 2 groups, each receiving one of the esmolol and dexmedetomidine agents were assessed and their impact on hemodynamic parameters, specifically heart rate (HR), systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP). These measurements were taken at baseline, during laryngoscopy, and then at 1, 3, 5, 7, and 10 minutes.  Adverse events including bradycardia, hypotension, nausea, respiratory depression, and drowsiness were evaluated. Results Both agents effectively reduced hemodynamic responses, with varying efficacy and side effect profiles. Dexmedetomidine provided the most stable hemodynamic control with minimal side effects. HR at T1 was 77.6 ± 8.2 bpm, significantly lower compared to 82.0 ± 8.8bpm HR in esmolol group during laryngoscopy (p<0.05). Esmolol significantly reduced HR (82.0 ± 8.8 bpm at T1) but had a higher incidence of bradycardia. Hemodynamic parameters were lower in dexmedetomidine group compared to esmolol group. Conclusion: Dexmedetomidine proved to be the most effective drug for managing hemodynamic responses while causing the fewest side effects, making it a preferred option in clinical settings. We recommend further research in larger and more diverse patient groups to confirm these results.