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.

Introduction: Objectives: ‘‘Code Blue’ is a standardised hospital emergency system for rapid response to cardiorespiratory arrest. Conventional Code Blue systems (CBS) rely on overhead paging, manual team mobilisation, and paper-based documentation, leading to slower communication, delayed response, and limited quality improvement. In contrast, mobile-based Code Blue systems enable silent, real-time activation, automated documentation, and seamless communication through secure messaging and voice calls. This study aimed to evaluate the efficiency of a basic single mobile voice call-based Code Blue activation at a 200-bedded cardiothoracic centre and assess its effectiveness while analysing factors influencing patient survival.

Design: Retrospective audit of a functioning code-blue system. Setting: 200-bed tertiary care cardiothoracic unit with cardio-thoracic surgical, cardiology and respiratory medicine units supported by laboratory and imaging services. The code blue activation system studied is a cell phone voice-based code-blue system where a simple voice call was made to a designated mobile phone number to activate a code. This cellphone was carried by the code-blue team stationed in a centrally located operation theatre at all times. This ensured trained responders could be rapidly mobilised without relying on centralised announcements, improving response times and minimising delays. Participants: An analysis of all ‘Code Blue’(CB) feedback forms filled up after completing a cell phone-based ‘Code Blue’ call during the study period (Aug 2021 to Dec 2023). Interventions: No interventions were performed. A retrospective analysis of all cellphone-based code blue calls and data from code blue forms was conducted. Measurements Data from the forms recorded, including response times, patient condition, interventions performed, and outcomes, was systematically tabulated and analysed using standard statistical methods to assess the effectiveness of the mobile-based system. Key performance metrics, such as response time, interventions, and survival outcomes, were compared with previously published studies on conventional Code Blue systems (CBS) to determine the system’s efficiency. Main Results: 149 code-blue calls during the study period were analysed, 85% of which originated from acute care areas. The response time of the code-blue team to reach the site along with defibrillators, equipment and medications (2.22±1.43 minutes) was similar to conventional code-blue response times previously reported in the literature from other centres (2.83 ± 1.30 minutes). 26.8% of cases did not require CPR. The most common presenting rhythms were severe bradycardia and asystole (54.3%), while chest compressions (53.6%) and endotracheal intubation (7.3%) were the most frequent pre-arrival interventions noted. Adrenaline was administered in 66.4% of cases, and 17.4% required defibrillation. ROSC was achieved in 18.4% of asystole cases. Poor outcomes were linked to age >60 years and asystole. Despite 57.7% of calls occurring outside working hours, there was no difference in outcomes between working and non-working hours. CPR duration (p<0.001) and adrenaline doses (p<0.001) were significantly higher in patients who did not achieve ROSC.  Conclusion: The cellphone-based voice call-activated Code Blue system demonstrated satisfactory response times. It is a viable alternative to conventional systems in compact hospital settings with a single response team, ensuring efficient emergency activation. In the era of the Internet of Things, with real-time guidance by mobile maps, innovative cell phone-based solutions will be able to cater even for larger widespread patient care areas.

Background: Postoperative nausea and vomiting (PONV) remains a prevalent and distressing complication following ear, nose, and throat (ENT) surgeries. Multiple factors such as anesthetic agents, airway management strategies, patient characteristics, and surgical procedures have been implicated in influencing PONV incidence. This study aimed to evaluate the incidence and identify the potential risk factors associated with PONV in ENT surgeries, with a special focus on anesthetic techniques and airway instrumentation. Materials and Methods: A prospective observational study was conducted on 150 patients undergoing elective ENT surgeries under general anesthesia at a tertiary care hospital. Patients aged 18–65 years with ASA physical status I and II were included. Data were collected on demographics, type of surgery, anesthetic agents used (inhalational vs. total intravenous anesthesia), and airway instrumentation (endotracheal tube vs. laryngeal mask airway). PONV was assessed within the first 24 hours postoperatively using a standard scoring system. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: The overall incidence of PONV was 38.6% (n=58). Female gender (p=0.01), history of motion sickness (p=0.03), use of inhalational anesthesia (p=0.001), and endotracheal intubation (p=0.005) were significantly associated with increased PONV. In multivariate analysis, inhalational anesthesia (OR 2.8, CI 1.4–5.6, p=0.002) and endotracheal tube use (OR 2.2, CI 1.1–4.3, p=0.01) remained independent predictors. Total intravenous anesthesia and use of laryngeal mask airway were associated with lower PONV rates. Conclusion: PONV is a common postoperative complication in ENT surgeries, with significant associations observed with inhalational anesthetics and endotracheal airway instrumentation. Adoption of total intravenous anesthesia and use of laryngeal mask airways may reduce PONV incidence and improve patient comfort in the postoperative period

: Background: Endotracheal intubation is a routine part of delivering general anesthesia. Post operative sore throat is the most common complaint following tracheal intubation. Endotracheal tube cuff design, cuff pressure lubrication and tube size are the important factors that affect the incidence and severity of sore throat. Present study was aimed to compare incidence of sore throat after endotracheal cuff inflation with air (or) lignocaine. Material and Methods: Present study was prospective, comparative study, conducted in 60 Consenting patients undergoing general anaesthesia, will be randomly assigned to one of the following two groups as Group A (n = 30): Endotracheal tube cuff inflated with lignocaine & Group B (n = 30): Endotracheal tube cuff inflated with air. Results: It was noted that ETT Cuff with Lignocaine is effective than ETT Cuff with AIR in reducing the Sore throat. Consenting patients undergoing general anaesthesia were randomly assigned to Group A (n = 30): Endotracheal tube cuff inflated with lignocaine OR Group B (n = 30), Endotracheal tube cuff inflated with air. Conclusion: t is concluded that ETT Cuff with Lignocaine is effective than ETT Cuff with AIR in reducing the Sore throat.

Background: Airway management is essential in perioperative and emergency care. Endotracheal intubation (ETI) remains a gold standard, whereas supraglottic airway devices (SGAs) offer less invasive alternatives. This study compares the hemodynamic response and efficacy of ETI versus SGA insertion in elective surgeries. Methods: A cross-sectional observational study was performed at Parbhani Medical College over 12 months. Two hundred patients (ASA I–II), aged 18–60 years, scheduled for elective surgeries under general anesthesia, were equally allocated to ETI (Group E, n = 100) or SGA (Group S, n = 100). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, pre-insertion, during insertion, immediately post-insertion, and at 1, 3, and 5 minutes post-insertion. Device insertion success rate, time to secure airway, ease of insertion, and complications were documented. Results: Baseline demographics were comparable. During device placement, Group E exhibited significantly higher increases in HR, SBP, DBP, and MAP compared to Group S (p < 0.05). Peak HR rise in Group E was +25 bpm vs. +10 bpm in Group S; peak SBP increase was +35 mmHg vs. +18 mmHg. Group E required longer insertion time (mean 25 ± 5 s) than Group S (15 ± 4 s, p < 0.001). First-attempt success was 95% in Group E and 98% in Group S. Complications (sore throat, minor blood staining) were more common in Group E (15%) than Group S (5%). Conclusions: SGAs offer a favorable hemodynamic profile, quicker placement, and fewer complications compared to ETI in elective surgical patients. SGAs may be preferred in those at risk from hemodynamic fluctuations.

Background: General anaesthesia (GA) with endotracheal intubation is the mainstay of anaesthesia for elective coronary bypass surgeries. The study was aimed to compare a new indigenous TAS (The anaesthesia society) scope with conventional Macintosh laryngoscope in Cormack Lehane grading (CLG) of larynx and ease of intubation along with hemodynamic response. Materials and Methods 120 patients undergoing coronary artery bypass surgery with GA were randomized into two groups and named after A device which was used for both laryngoscope and intubation. In Group TAS, patients were intubated with TAS Scope after initial laryngoscopy with Macintosh. In Group MAC, Intubated with Macintosh after initial laryngoscope /CLG with TAS scope. CLG, Time to intubate, number of attempts, hemodynamic parameters were noted. Results: Patients having Cormack Lehane grading of gr 3 and 4 (11.6%) in MAC group changed gr 1 and 2 when laryngoscopy was performed with TAS scope and none had gr 3 and 4 when TAS scope was performed. Mean time to intubate were 23.73 ±3.48 and 12.50 ±2.50 (p=0.006) seconds in TAS and MAC groups respectively. Conclusion: Indigenous TAS can be used to get better visualization of larynx with improved Cormack Lehane gradings with acceptable hemodynamic changes.

Background: Rapid Sequence Intubation (RSI) is a critical procedure in emergency medicine for securing the airway quickly and safely, especially in patients at risk of aspiration. Conscious sedation, involving the administration of sedative agents without complete loss of consciousness, is increasingly utilized to optimize patient cooperation and physiological stability during RSI. This study aims to retrospectively evaluate the role and outcomes of conscious sedation in RSI among emergency department (ED) patients. Materials and Methods: A retrospective analysis was conducted using medical records of 240 patients who underwent RSI in the ED. Patients were divided into two groups: those who received conscious sedation prior to RSI (Group A, n=120) and those who underwent standard RSI with deep sedation (Group B, n=120). Sedative agents included midazolam, fentanyl, and ketamine. Data on intubation success rate, hemodynamic parameters, incidence of complications (e.g., hypotension, desaturation), and time to intubation were collected and analyzed using SPSS v26. Statistical significance was set at p<0.05. Results: First-pass intubation success was higher in Group A (94.2%) compared to Group B (88.3%) (p=0.043). Incidence of post-intubation hypotension was lower in the conscious sedation group (12.5%) than in the deep sedation group (21.7%) (p=0.031). Mean time to successful intubation was 43.7 ± 8.6 seconds in Group A versus 47.9 ± 10.1 seconds in Group B (p=0.022). No significant difference was observed in oxygen desaturation episodes between groups (p=0.41). Conclusion: The use of conscious sedation in RSI appears to improve intubation outcomes and minimize hemodynamic complications in emergency settings. Conscious sedation may serve as a safer alternative to deep sedation in select emergency patients, warranting further prospective trials for validation.

Background: Difficult airway management remains a major contributor to anaesthesia-related complications during elective surgeries. Simple, non-invasive tools like the Modified Mallampati Classification (MPC) and Thyromental Distance (TMD) are commonly used for preoperative airway assessment, but their predictive accuracy varies across populations, warranting local validation against standard grading systems. Objective: To evaluate the predictive accuracy of the Modified Mallampati Classification and Thyromental Distance—individually—for anticipating difficult laryngoscopy and intubation in patients undergoing elective surgery under general anaesthesia. Methodology: This diagnostic study included 300 ASA I–II patients (18–65 years) undergoing elective surgery under general anaesthesia at a tertiary hospital. Preoperative MPC and TMD assessments were compared with intraoperative Modified Cormack-Lehane grades to identify difficult intubations. Sensitivity, specificity, PPV, NPV, and accuracy were analysed using SPSS v20. Results: Among the 300 patients, 20 (6.7%) had difficult laryngoscopy per CL grading. •Modified Mallampati Classification predicted difficult intubation in 20 patients. It demonstrated a sensitivity of 95%, specificity of 99.6%, positive predictive value (PPV) of 95%, negative predictive value (NPV) of 99.6%, and overall accuracy of 99.3%. •Thyromental Distance predicted 18 cases as difficult, with sensitivity of 90%, specificity of 100%, PPV of 100%, NPV of 99.3%, and accuracy of 99.3%. Both assessments were found to be excellent standalone predictors of difficult laryngoscopy, although TMD had a slightly lower sensitivity. Conclusion: The Modified Mallampati Classification and Thyromental Distance are reliable, simple, and cost-effective bedside screening tools for predicting difficult laryngoscopy and intubation. Both demonstrated high diagnostic accuracy in this study, validating their routine use in preoperative airway assessment. However, clinical judgment should complement their application, particularly in high-risk or borderline cases

Introduction: Tracheoesophageal fistula (TEF) repair in neonates presents significant anesthetic challenges due to airway abnormalities, associated cardiac defects, and pulmonary complications. This study retrospectively analyzes anesthetic management, intraoperative difficulties, and outcomes over five years. Methods: A retrospective observational study was conducted on 44 neonates undergoing TEF repair under general anesthesia from April 2013 to April 2018 at seven pediatric superspecialty hospitals. Data on demographics, airway management, intraoperative complications, postoperative morbidity, and mortality were collected and analyzed. Results: The cohort comprised 54.55% males and 45.45% females, with a mean birth weight of 2.42 kg. Difficult intubation occurred in 11.36% of cases, and desaturation during intubation was observed in 18.18%. Postoperative pneumonitis was prevalent (70.45% moderate, 22.73% severe). Mortality rate was 6.82%, primarily in neonates weighing less than 2 kg and with cardiac anomalies. Early surgery (≤3 days) was associated with better outcomes. Statistical analysis revealed birth weight and cardiac anomalies as significant predictors of morbidity and mortality (p < 0.05). Conclusion: Effective anesthetic management and multidisciplinary perioperative care significantly improve survival in neonates undergoing TEF repair. Low birth weight and cardiac anomalies remain key risk factors. Early intervention and NICU support are crucial to reduce morbidity and mortality.

Background: Post-operative sore throat (POST) is a frequent, distressing complication after tracheal intubation, with reported incidence ranging from 21–65%. Magnesium sulphate has anti-inflammatory and membrane-stabilizing properties, and nebulization before induction may reduce mucosal injury and subsequent sore throat. Aim: To evaluate the effect of preoperative magnesium sulphate nebulization on the incidence and severity of POST in adult surgical patients undergoing general anaesthesia with endotracheal intubation. Methods: This is a Prospective and randomized study was conducted in the Department of Anaesthesiology at Tertiary Care Teaching Hospital from please mention the period of study  from January 2023 to June 2024 in 120 ASA I–II adult patients scheduled for elective surgeries under general anaesthesia. Patients were randomized into two groups: Group M (magnesium sulphate 225 mg in 5 mL saline nebulization) and Group C (5 mL saline nebulization) 15 min before induction. Incidence and severity of POST were assessed at 1, 6, 12, and 24 hours post-extubation using a 4-point scale. Results: Percentage of patients with POST at 1 h, 6 h, 12 h, and 24 h after extubation. Group M consistently has fewer patients with POST than Group C at 1, 6, and 12 hours (p-values < 0.05). At 24 h, the difference is not statistically significant. The incidence of POST at 6 hours was significantly lower in Group M compared to Group C (18.3% vs 43.3%, p<0.01). Severity scores were also reduced at all time points. No significant adverse events were observed. Conclusion: Preoperative nebulization with magnesium sulphate effectively reduces the incidence and severity of POST without notable side effects.

Background: Endotracheal intubation is routinely practiced to secure the airway during general anesthesia. Even well-experienced anesthesiologists can encounter challenges during unanticipated difficult intubation that can lead to failed intubation, which may increase morbidity and mortality.  Aim: Analysing various ultrasound parameters for airway assessment during surgery under general anaesthesia. Materials and methods: 200 patients aged between 18 and 70 years belonging to ASA classes I, II, and III scheduled for elective surgery requiring general anesthesia under endotracheal intubation was included in the study. Clinical parameters such as body mass index, neck circumference, modified Mallampati grading, thyromental distance, and ultrasound parameters such as anterior neck soft tissue thickness at the level of the thyrohyoid membrane (ANS-TM) and anterior neck soft tissue thickness at the level of vocal cord (ANS-VC) were obtained preoperatively. After intubation, the CL grading was noted and categorized into two groups: easy (classes 1 and 2) and difficult (classes 3 and 4).  Results: Ultrasound-guided measurements of ANS-TM and ANS-VC are independent predictors of difficult laryngoscopy compared with clinical screening tests. Of the two parameters, we found that ANS-TM has a better diagnostic value for predicting a difficult airway with an area under the ROC curve (AUC) of 92% compared with ANS-VC, which has an AUC of 85%. Of the clinical parameters, the modified Mallampati grading has an AUC of 82%, leading to better diagnostic value in the prediction of a difficult airway. Conclusion: Our study demonstrated that ANS-TM and ANS-VC are independent predictors of a difficult airway. ANS-TM has a better correlation with CL grading. Clinical screening tests should be combined with ultrasound measurements to aid in the better prediction of difficult laryngoscopy.

Background and Aims: Accurate endotracheal tube (ETT) size selection in pediatric patients is crucial for safe airway management. Traditional formula-based predictions often fail in anatomically diverse children. This study aimed to evaluate and correlate age-based, height-based, and ultrasound-guided subglottic diameter estimation methods with actual ETT size used. Methods: A prospective observational study was conducted on 150 children aged 1–10 years undergoing elective surgery requiring intubation. ETT size was estimated using Cole’s formula, a height-based equation, and ultrasonographic subglottic diameter. The clinically appropriate ETT was confirmed via minimal leak technique. Correlation coefficients and prediction accuracies were analyzed. Results: Ultrasound demonstrated the highest correlation with actual ETT size (r = 0.91), followed by height-based (r = 0.84) and age-based (r = 0.76) formulas. Correct prediction rates were 90.7% for ultrasound, 74.0% for height-based, and 63.3% for age-based methods (p < 0.001). Conclusion: Ultrasound-guided subglottic diameter measurement is the most reliable and accurate method for selecting ETT size in children, outperforming conventional predictive formulas.

Introduction: Anticipating difficult laryngoscopy is a cornerstone of safe anesthetic practice. Although multiple bedside tests exist, their predictive accuracy remains variable. Aim: To evaluate the association between preoperative difficult airway predictors and Cormack-Lehane grades in surgical patients undergoing general anesthesia. Methods: A cross-sectional study was conducted on 160 adult patients undergoing elective surgery under general anesthesia with endotracheal intubation. Preoperative airway assessments included Mallampati classification, thyromental distance (TMD), sternomental distance (SMD), inter-incisor gap (IID), upper lip bite test (ULBT), neck mobility, BMI, short neck, and receding mandible. Direct laryngoscopy was performed after induction, and the glottic view was graded using the Cormack-Lehane classification. Association between predictors and difficult laryngoscopy (CL grade III/IV) was analyzed using chi-square tests, logistic regression, and diagnostic accuracy indices. Results: The overall prevalence of difficult laryngoscopy was 19.4%. Significant predictors included Mallampati III/IV (OR 3.01, p=0.0066), TMD <6.5 cm (OR 2.85, p=0.0098), IID <3.5 cm (OR 3.57, p=0.0042), ULBT class III (OR 3.12, p=0.0077), and limited neck extension (OR 2.75, p=0.0202). On multivariable analysis, Mallampati, TMD, IID, ULBT, and neck extension remained independent predictors. The risk of difficult laryngoscopy increased with multiple predictors, rising from 9.0% (0-1 predictors) to 40.0% (≥4 predictors) (p-trend = 0.0017). Conclusion: Difficult laryngoscopy was encountered in nearly one-fifth of patients. Mallampati, inter-incisor gap, thyromental distance, upper lip bite test, and neck extension were the strongest independent predictors. A composite airway assessment approach is superior to reliance on a single test in identifying patients at risk.

Background: Intraoperative awareness under general anaesthesia, though rare, can lead to severe psychological consequences. This study compares the efficacy of propofol and dexmedetomidine in preventing intraoperative awareness in patients undergoing open cholecystectomy. Objectives: To evaluate and compare the incidence of intraoperative awareness and explicit recall using propofol versus dexmedetomidine infusions during open cholecystectomy surgeries under general anaesthesia, and to assess their effects on intraoperative hemodynamic parameters. Methods: A prospective, randomized, single-blind study was conducted on 60 ASA I & II patients aged 18–65 years undergoing open cholecystectomy in a resource-limited setting. Patients were randomized into two groups (n=30): Group P received propofol (2 mg/kg induction, 0.25 mg/kg/hr infusion), and Group D received dexmedetomidine (1 mcg/kg bolus over 10 minutes, followed by 0.5 mcg/kg/hr infusion). Hemodynamic parameters and intraoperative awareness were assessed using the Brice Questionnaire 24 hours post-extubation. Results: Intraoperative awareness was reported in three patients (two definite, one possible) in the propofol group and none in the dexmedetomidine group. Hemodynamic parameters (MAP, HR) were more stable in the dexmedetomidine group at key surgical milestones. Mild bradycardia occurred in three patients in Group D. Statistical analysis showed a significant difference in awareness incidence (p = 0.04) and MAP changes during intubation and incision (p < 0.005). Conclusion: Both dexmedetomidine and propofol reduce intraoperative awareness, but dexmedetomidine demonstrated superior effectiveness and hemodynamic stability. In resource-limited settings where BIS monitors are not available, tools like the Brice Questionnaire offer a viable and accessible method for assessing awareness.

Introduction: Critically ill patients on mechanical ventilation experience catabolic stress and inflammation, predisposing them to malnutrition. Malnutrition worsens outcomes by prolonging ICU stay, increasing infection risk, and elevating mortality. The Nutritional Risk in Critically Ill (NUTRIC) score was designed specifically for ICU patients to identify those most likely to benefit from early nutrition therapy. This study evaluated nutritional risk using the NUTRIC score and its correlation with outcomes, with interleukin-6 (IL-6) assessed as a marker of systemic inflammation. Methods: An observational cross-sectional study was conducted in the ICU of Dr. D.Y. Patil Medical College, Kolhapur, over 18 months. Adults (≥18 years) requiring invasive mechanical ventilation were enrolled within 24 hours of intubation. Patients with burns, malignancy, AIDS, neuromuscular disorders, or readmissions were excluded. Demographic and clinical data, comorbidities, APACHE II and SOFA scores were collected. Serum IL-6 was measured by ELISA. NUTRIC scores (0–10) were calculated; scores ≥6 indicated high risk. Outcomes included ICU stay, ventilator days, time to weaning, and mortality. Correlations were analyzed statistically. Results: The cohort (mean age 59.5±16.1 years, male predominance) showed moderate-to-severe illness (APACHE II 26.46±8.0, SOFA 9.46±3.96). Mean IL-6 was 89.12±35.77 pg/mL, and mean NUTRIC score 5.06±1.87, with nearly half at high risk. Hypertension (46.9%) and neurological disorders (43.8%) were the most frequent comorbidities. Average ICU stay was 15.4 days, with 8.9 ventilator days and 8.0 days to weaning. High NUTRIC scores correlated positively with mortality (r=0.389, p<0.001) and IL-6 (r=0.319, p<0.001). Survivors were mainly low risk (88.6%), while more than half of non-survivors were high risk (p=0.001). High risk correlated negatively with ICU stay and ventilator duration due to early mortality. Sepsis and renal disease showed the strongest associations with high nutritional risk and elevated IL-6. Conclusion: The NUTRIC score is a simple and effective tool for identifying nutritional risk in ventilated ICU patients. High scores predicted increased mortality, greater inflammatory burden, and comorbidity impact. Early recognition of nutritionally vulnerable patients supports timely intervention and better utilization of ICU resources. Incorporating the NUTRIC score alongside illness severity indices can improve prognostication and guide personalized care.

Background: Accurate confirmation of endotracheal tube (ETT) placement is vital during anaesthesia and emergency airway management. Conventional auscultation has limited sensitivity, whereas point-of-care ultrasound (POCUS) has emerged as a promising alternative. Objective: To compare the diagnostic accuracy of POCUS and auscultation in confirming ETT placement. Methods: Ninety ASA I–II patients undergoing elective surgery under general anaesthesia were randomised into three groups (trachea, right main bronchus, left main bronchus). Independent blinded anaesthesiologists performed intubation, fibreoptic confirmation, auscultation, and ultrasound examinations. Diagnostic indices were calculated against fibreoptic bronchoscopy (gold standard). Results: Auscultation achieved sensitivity 68.8%, specificity 87.8%, and accuracy 84.7%. POCUS demonstrated sensitivity 92.5%, specificity 95.3%, and accuracy 94.7%. Haemodynamics and oxygen saturation remained stable, while EtCO₂ and airway pressures increased significantly with endobronchial intubations. Conclusion: POCUS is more accurate than auscultation for confirming ETT placement. It is a rapid, reliable, and non-invasive bedside tool with potential to complement or replace auscultation in clinical practice.

Introduction: Difficult visualization of the glottis during laryngoscopy can hinder successful endotracheal intubation. External laryngeal manoeuvres such as burp (backward-upward-rightward pressure), jaw thrust, and cricoid pressure are commonly used to enhance glottic view. However, limited comparative studies exist evaluating the effectiveness of these techniques during video laryngoscopy. Methods This comparative study was conducted over 6 months at the Department of Anaesthesiology and Critical Care, ACSR Medical College and Government General Hospital. A total of 120 adult patients (ASA grade I and II) undergoing elective surgery under general anaesthesia were randomized into four groups: Group I (standard technique), Group II (cricoid pressure), Group III (jaw thrust), and Group IV (BURP manoeuvre). Preoperative airway parameters were recorded, and each patient underwent video laryngoscopy using all three manoeuvres in random order, followed by tracheal intubation with the assigned technique. Glottic visualisation was graded using the modified Cormack-Lehane scale. Time to successful intubation was also measured. Results BURP manoeuvre (Group IV) significantly improved glottic visualisation compared to the standard technique and other manoeuvres. Group III (jaw thrust) also showed improved laryngeal view but was slightly less effective than BURP. Cricoid pressure showed minimal improvement and, in some cases, worsened the view. The BURP manoeuvre was associated with a higher incidence of Grade 1 views and the shortest mean intubation time. Conclusion Among the three manoeuvres studied, the BURP manoeuvre was the most effective in improving glottic visualisation and reducing intubation time during video laryngoscopy. The BURP manoeuvre should be considered as the first-line technique for managing anticipated difficult airways.

Introduction: Laryngoscopy and tracheal intubation elicit sympathetic responses that may cause deleterious cardiovascular effects, particularly in high-risk patients. Various pharmacological agents are used to blunt this response. This study compares intravenous magnesium sulphate and clonidine in attenuating hemodynamic changes during laryngoscopy and intubation. Materials and Methods: Eighty ASA I–II patients aged 18–60 years undergoing elective open abdominal surgeries were randomized into two groups. Group M (n=40) received 30 mg/kg magnesium sulphate IV, and Group C (n=40) received 2 µg/kg clonidine IV, both diluted in 100 ml normal saline and infused over 10 minutes before induction. Hemodynamic parameters (HR, SBP, DBP, MAP) were recorded at baseline, post-infusion, post-induction, immediately after intubation, and up to 10 minutes after intubation. Results: Both groups showed significant reductions in HR, SBP, DBP, and MAP from baseline. Maximum reduction in SBP, DBP, and MAP occurred at 10 minutes post-intubation, greater in the magnesium group (p<0.05). Attenuation of HR response was comparable between groups. Conclusion: Both magnesium sulphate and clonidine effectively attenuated pressor responses to laryngoscopy and intubation. Magnesium sulphate demonstrated superior attenuation of blood pressure rise, while clonidine produced stable heart rate control.

Background: Laparoscopic surgeries continue to evolve day by day to reduce trauma to the patient, morbidity, mortality and hospital stay; with consequent reduction in health care costs. Objective: To study the efficacy of dexmedetomidine for attenuation of hemodynamic responses in patients undergoing laparoscopic surgeries. Methods: This study was carried out in the Department of Anesthesiology,  at Gulbarga Institute Of Medical Sciences  Kalaburagi. Result: Sex, age, weight and ASA physical grading were comparable in both the groups. Dexmedetomidine maintained cardiovascular stability during laryngoscopy and laparoscopy. There was a significant rise in the heart rate and systolic, diastolic & mean arterial blood pressures in the patients of group S; in comparison to group D, during laryngoscopy and intubation, throughout the period of pneumoperitoneum, after extubation and 30 minutes postoperatively. Conclusion: Hence dexmedetomidine can be safely used to attenuate the hemodynamic responses during laparoscopic surgeries with the added advantage of it being an adjuvant to general anaesthesia.

Background: Laparoscopic cholecystectomy requires secure airway management due to pneumoperitoneum and altered respiratory mechanics. Endotracheal intubation is standard, but supraglottic devices such as I-gel may offer advantages. Aims: To compare the efficacy and safety of I-gel versus endotracheal tube (ETT) in elective laparoscopic cholecystectomy. Settings and Design: Prospective, randomized study at a tertiary-care hospital on 64 ASA I–II patients aged 18–60 years. [I-gel (n=32) or ETT (n=32)]. Outcomes included insertion ease and time, hemodynamic responses, ventilatory parameters (end-tidal CO₂, peak airway pressure), and postoperative complications. Data were analysed using SPSS v22; p<0.05 was considered significant. Results: Baseline demographics were comparable. I-gel insertion was easier (p=0.043) and faster (14.8 ± 9.5 s vs. 22.8 ± 11.4 s; p<0.001). Hemodynamic stability was greater with I-gel, with significantly lower heart rates at several perioperative points (p<0.05). Peak airway pressures and end-tidal CO₂ were lower with I-gel both after insertion and 20 minutes post-pneumoperitoneum (p<0.05). Oxygenation remained adequate in both groups. Postoperative sore throat and airway trauma occurred more frequently in the ETT group.  Conclusion: I-gel is an effective and safe alternative to ETT for airway management in low-risk patients undergoing laparoscopic cholecystectomy. It offers benefits of faster insertion, better hemodynamic stability, and fewer airway-related complications

Background: Laryngoscopy and endotracheal intubation during general anaesthesia (GA) is associated with hemodynamic stress response. Fentanyl and dexmedetomidine helps attenuate this response. This study was conducted with an aim to compare these two drugs in effectively attenuating the hemodynamic parameters of stress response.  Method: A prospective study was conducted at the Department of Anaesthesiology for a duration of one year. Patients aged between 18-60 years admitted for surgery under GA were enrolled for the study. The patients were randomly separated into two groups. Before starting the procedure, baseline heart rate (HR), mean arterial blood pressure (MAP), systolic and diastolic BP, (SBP, DBP) and SpO₂ were recorded. Patients in group I received 1 µg/kg dexmedetomidine IV. Group II received 2 µg/kg Fentanyl IV. Vital signs were recorded again after 5 mins. Intubation was completed within 30 seconds of laryngoscopy in first attempt. HR, MAP, SBP, DBP and rate pressure product (RPP) were measured immediately after intubation followed by at 2, 3, 5, 7, and 10 minutes. P<0.05 was considered significant. Results: Total 58 patients were enrolled in the study. There was a significant reduction in HR in group I at all time points compared to group II. Patients in both groups had reduced SBP and DBP after drug infusion, the difference between the groups was highly significant statistically. Group II consistently showed significantly higher MAP compared to group I. Group II consistently exhibited significantly higher RPP values compared to group I. After extubation, patients in group I were significantly more tranquil and co-operative compared to group II.  Conclusion: Dexmedetomidine more effectively suppressed the hemodynamic stress response to laryngoscopy and intubation compared to fentanyl.

Background: Head and neck positioning is critical for optimizing laryngeal exposure and facilitating safe, efficient endotracheal intubation. The sniffing position (SP) has been the conventional standard, yet recent investigations highlight that modest modifications to head elevation may significantly influence glottic visualization. This study evaluates three head elevations—0 cm (no pillow), 3 cm, and 6 cm—assessing their effects on Cormack–Lehane (CL) grade, Percentage of Glottic Opening (POGO), and Intubation Difficulty Scale (IDS). Methods: In this prospective randomized analytical study conducted between May 2023 and November 2024, 159 adult patients (ASA I–II) undergoing elective surgery were evaluated. Each patient underwent laryngoscopic assessment in all three positions; the best glottic view was chosen for intubation. CL grade and POGO scores were recorded for each position (n=159 per position). IDS and intubation-related outcomes were analyzed in patient groups where a given pillow height provided the best view and was used for intubation (n=21 for 0 cm, n=110 for 3 cm, n=28 for 6 cm). Statistical significance was set at p<0.05. Results: The 3 cm pillow position provided superior glottic visualization—CL grades 1–2 were observed in 94.3% of 3 cm assessments compared to 56.6% (0 cm) and 48.4% (6 cm) (p<0.001). POGO distribution favored 3 cm: high POGO (100%) observed in 47.2% vs. 12.6% (0 cm) and 11.9% (6 cm) (p<0.001). IDS outcomes in intubation groups showed easier intubation at 3 cm (67.3% classified as 'easy') compared to 0 cm (57.1%) and 6 cm (57.1%) (p<0.001). Mucosal trauma and postoperative complications were also lowest in the 3 cm intubation cohort. Conclusion: Moderate head elevation (3 cm) optimizes airway alignment, enhances laryngeal exposure, reduces intubation difficulty, and lowers mucosal injury—supporting its routine consideration as a refined modification of the sniffing position in elective cases

Background: Head and neck positioning is critical for optimizing laryngeal exposure and facilitating safe, efficient endotracheal intubation. The sniffing position (SP) has been the conventional standard, yet recent investigations highlight that modest modifications to head elevation may significantly influence glottic visualization. This study evaluates three head elevations—0 cm (no pillow), 3 cm, and 6 cm—assessing their effects on Cormack–Lehane (CL) grade, Percentage of Glottic Opening (POGO), and Intubation Difficulty Scale (IDS). Methods: In this prospective randomized analytical study conducted between May 2023 and November 2024, 159 adult patients (ASA I–II) undergoing elective surgery were evaluated. Each patient underwent laryngoscopic assessment in all three positions; the best glottic view was chosen for intubation. CL grade and POGO scores were recorded for each position (n=159 per position). IDS and intubation-related outcomes were analyzed in patient groups where a given pillow height provided the best view and was used for intubation (n=21 for 0 cm, n=110 for 3 cm, n=28 for 6 cm). Statistical significance was set at p<0.05. Results: The 3 cm pillow position provided superior glottic visualization—CL grades 1–2 were observed in 94.3% of 3 cm assessments compared to 56.6% (0 cm) and 48.4% (6 cm) (p<0.001). POGO distribution favored 3 cm: high POGO (100%) observed in 47.2% vs. 12.6% (0 cm) and 11.9% (6 cm) (p<0.001). IDS outcomes in intubation groups showed easier intubation at 3 cm (67.3% classified as 'easy') compared to 0 cm (57.1%) and 6 cm (57.1%) (p<0.001). Mucosal trauma and postoperative complications were also lowest in the 3 cm intubation cohort. Conclusion: Moderate head elevation (3 cm) optimizes airway alignment, enhances laryngeal exposure, reduces intubation difficulty, and lowers mucosal injury—supporting its routine consideration as a refined modification of the sniffing position in elective cases

Introduction: Supraglottic airway device has replaced endotracheal intubation for elective surgeries requiring GA. Insertion of SADs requires adequate depth of anaesthesia in spontaneously breathing patient and Propofol with adjuvants was commonly used to facilitate its insertion. With this background, this study was conducted to compare ease of insertion by addition of either dexmedetomidine or butorphanol added to propofol for insertion of newer generation SAD - Baska mask in short elective surgeries done under general anaesthesia. Aim & Objectives: To compare Butorphanol and Dexmedetomidine as adjuvants to Propofol on the insertion conditions of Baska Mask for short surgical procedures. To assess the ease of insertion & the incidence of complications such as cough, laryngospasm during insertion. Material and Methods: Around 88 adult patients belonged to ASA I or II of either sex, scheduled for elective surgery under general anaesthesia were allocated randomly either to receive dexmedetomidine 0.5µ/kg IV (Group A) or butorphanol 20µ/kg IV (Group B). All patients were uniformly pre-medicated, induced and Baska mask was inserted as per standard protocol. Ease of insertion score was determined by Modified scheme of Lund & Stovner grading & time taken for insertion was noted. Intra operative monitoring of HR, systemic arterial pressures, SpO2 & EtCO2 were recorded at baseline, after induction, 1,3,5,10 and 15 mins after insertion of Baska mask. Results: There were no statistically significant differences in the demographic characteristics and duration of insertion of Baska mask (P > 0.05). The efficacy of successful insertion was statistically significant with respect to various ease of insertion characteristics & number of attempts required to insert Baska mask in Butorphanol group as compared to Dexmedetomidine Group (P < 0.05). Conclusion: The Study conclude that addition of Butorphanol to Propofol as adjuvant compared to Dexmedetomidine reduces the dose of propofol required and provides superior insertion conditions and good jaw relaxation for ease of insertion of Baska mask. The first pass success rate was greater in Butorphanol group than Dexmedetomidine group. We recommend Butorphanol at 20µ/kg as an adjuvant to propofol for Bask mask insertion without hemodynamic compromise when compared to Dexmedetomidine at 0.5µ/kg.

Background: Respiratory failure has to be managed effectively to reduce mortality. Availability of a clinical parameter-based score to predict the need for invasive ventilation is needed to take appropriate decision. Objective of this study were, to predict NIV failure in patients with hypoxemic respiratory failure and to identify the outcomes in high-risk NIV failure patients who underwent intubation at different time points. Materials and methods: An observational study was done at Khaja Banda Nawaz Teaching and Genera hospital Kalaburagi, among patients with acute hypoxemic respiratory failure (AHRF). The study included 42 patients with AHRF. Non invasive ventilation was initiated for all the patients and the clinical parameters such as heart rate, acidosis, consciousness, oxygenation and respiratory rate were noted, which were used to calculate the HACOR score. The predictive ability of this score in identifying the patients in need of intubation. Results: The mean age of the patients with AHRF was 57.2 years and majority were male (61.9%). The NIV failure rate was 42.9%. No significant difference was noticed in the mean age between patients in whom NIV was successful and failed. The mean duration of hospitalization was significantly high among patients those who required intubation than those who were managed effectively with NIV. The HACOR score was significantly high among patients in whom NIV has failed than patients in whom it was successful (7.67 vs 5.13). The sensitivity and specificity at cutpoint of 4 was 94.4% and 95.8% respectively.  Conclusion: HACOR can be used as an effective tool in predicting NIV failure among patients with AHRF. 

: Background: Effective airway management is critical in pediatric anesthesia due to unique anatomical and physiological characteristics. Supraglottic airway devices, such as the i-gel and ProSeal Laryngeal Mask Airway (PLMA), offer minimally invasive alternatives to endotracheal intubation, reducing airway trauma and hemodynamic responses. This study aimed to compare the clinical performance of i-gel and PLMA in pediatric patients under general anesthesia with controlled ventilation. Methods: A prospective, randomized study was conducted with 100 pediatric patients (ASA I-II, aged 1–12 years) scheduled for elective short-duration surgeries under general anesthesia. Patients were randomized into two groups: i-gel (Group I, n=50) and PLMA (Group P, n=50). Key outcomes included hemodynamic parameters (heart rate, blood pressure), ease of insertion, oropharyngeal seal pressure, ventilation parameters (peak airway pressure, end-tidal CO₂), and postoperative complications (sore throat, laryngospasm, and blood-stained devices). Data were analyzed using standard statistical methods, and a p-value < 0.05 was considered significant. Results: Hemodynamic responses were comparable between the groups, with no clinically significant changes. The mean insertion time was 23.97 ± 4.46 seconds for i-gel and 24.52 ± 8.10 seconds for PLMA, with both devices achieving a first-attempt success rate of 92%. The oropharyngeal seal pressure was slightly higher for i-gel (20.34 ± 4.71 cmH₂O) compared to PLMA (19.04 ± 4.61 cmH₂O), but this difference was not statistically significant. Both devices maintained effective ventilation, with peak airway pressures of 14.8 ± 2.3 cmH₂O for i-gel and 15.2 ± 2.1 cmH₂O for PLMA. The incidence of postoperative sore throat was lower with i-gel (12%) compared to PLMA (16%), with no cases of laryngospasm or blood-stained devices in either group.

Conclusion: Both i-gel and PLMA are effective and safe for pediatric airway management under controlled ventilation. While both devices demonstrated comparable performance, i-gel showed slight advantages in ease of insertion, faster placement times, and reduced postoperative complications. These findings suggest that i-gel may be a preferred choice in scenarios where simplicity and reduced morbidity are prioritized.

Background: Supraglottic airway devices (SADs) are critical in airway management, especially in scenarios where tracheal intubation is challenging or impossible. The Fastrach™-laryngeal mask airway (FT-LMA) and Ambu Aura-i are two prominent SADs designed to facilitate both ventilation and tracheal intubation. The FT-LMA, while effective, has limitations such as its rigid airway tube and non-availability for pediatric use. The Ambu Aura-i, with its preformed curvature and availability in various sizes, offers a modern alternative with reported success in difficult airway management. This study aims to comparatively evaluate these two devices in anticipated difficult airway management in adults. Aim: To compare the effectiveness of Fastrach™ LMA and Ambu Aura-i in tracheal intubation in adults with anticipated difficult airway management. Materials and Methods: This randomized, interventional, two-group, comparative prospective clinical study involved 50 adult patients undergoing scheduled surgeries requiring tracheal intubation under general anesthesia. Patients, aged 18 to 60 years, with ASA physical status I or II, were randomly assigned to two groups: Group A (Fastrach™ LMA) and Group B (Ambu Aura-i). Data on success rates, number of attempts, duration of successful attempts, and adverse events were recorded. Hemodynamic parameters were monitored throughout the procedure. Results: Both groups showed comparable baseline characteristics including age, gender distribution, ASA grade, and physical parameters. There was no significant difference in heart rate, systolic and diastolic blood pressure, mean arterial pressure, or oxygen saturation between the groups. However, Group A (Fastrach™ LMA) required significantly shorter tracheal tube insertion time (16.1±2.0 sec vs. 19.1±1.9 sec; p<0.05) and fewer attempts for successful intubation compared to Group B (Ambu Aura-i). The incidence of blood on SAD and sore throat was higher in Group B but not statistically significant. Conclusion: The Fastrach™ LMA demonstrated marginally superior performance over the Ambu Aura-i in terms of shorter tracheal tube insertion times and fewer attempts required for successful intubation. Both devices are effective in managing difficult airways, but the Fastrach™ LMA offers advantages in ease and efficiency, making it a potentially more effective option for critical scenarios requiring rapid and reliable tracheal intubation.

Background: Laryngoscopy and tracheal intubation trigger a sympathetic surge that produces short-lived tachycardia and hypertension, which can precipitate myocardial ischemia in patients with hypertension and coronary artery disease (CAD). Objectives: To quantify peri-intubation hemodynamic changes and describe electrocardiographic (ECG) alterations in adults with hypertension and/or CAD undergoing elective surgery under general anesthesia. Methods: This prospective observational study enrolled eighty adult patients classified as ASA physical status II–III, all of whom had established hypertension and/or coronary artery disease (CAD). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and ECG (lead II and V5) were recorded at baseline, during laryngoscopy, immediately after intubation, and at 3 and 5 minutes after intubation. Maximum percentage change from baseline was calculated and the proportion with >20% rise was documented. Results: Mean age was 56.8 ± 9.4 years; 65% were male; 47.5% had hypertension alone and 30% had both hypertension and CAD. HR increased from 76.4 ± 8.9 to 98.8 ± 11.6 beats/min immediately after intubation; SBP rose from 138.6 ± 12.8 to 170.8 ± 18.2 mmHg, with gradual decline by 5 minutes. More than half had >20% rise in HR (57.5%) and SBP (52.5%). Transient ECG changes occurred in 22.5%; ST-segment depression was seen in 7.5% and no patient developed sustained arrhythmia or required intervention. Conclusion: Adults with hypertension and/or CAD demonstrated a pronounced but transient pressor response to laryngoscopy and intubation, with infrequent, self-limited ECG changes. Close monitoring and proactive attenuation strategies during airway instrumentation are essential in high-risk patients

Background: Laryngoscopy, tracheal intubation, and pneumoperitoneum during laparoscopic surgery provoke significant sympathetic stimulation, resulting in tachycardia and hypertension. Pharmacological attenuation of this hemodynamic stress response is essential to improve perioperative stability. This study compared dexmedetomidine and fentanyl for their effectiveness in controlling hemodynamic responses during these critical periods. Material and methods: This prospective, randomized, double-blind study included 100 adult patients of ASA physical status I and II undergoing elective laparoscopic surgery under general anaesthesia. Patients were randomly allocated into two groups (n = 50 each). Group D received dexmedetomidine (1 µg/kg loading dose followed by 0.2 µg/kg/h infusion), while Group F received fentanyl in an equivalent dosing regimen. Heart rate, systolic, diastolic, and mean arterial blood pressure, and oxygen saturation were recorded at baseline, during airway manipulation, throughout pneumoperitoneum, at extubation, and during the postoperative period up to 6 hours. Demographic variables were also compared. Results: Baseline demographic characteristics and initial hemodynamic parameters were comparable between the two groups. Dexmedetomidine produced a significantly greater attenuation of heart rate and blood pressure responses following the loading dose, during laryngoscopy and intubation, throughout pneumoperitoneum, and at extubation compared with fentanyl. The differences were most pronounced during periods of maximal surgical stress. Hemodynamic parameters gradually returned toward baseline values in both groups during late postoperative monitoring, with no significant intergroup differences at 3 and 6 hours. Oxygen saturation remained stable and comparable between the groups at all time points. Conclusion: Dexmedetomidine provides superior control of hemodynamic stress responses compared with fentanyl during laparoscopic surgery, without compromising oxygenation. Its use contributes to improved perioperative hemodynamic stability during airway manipulation and pneumoperitoneum

Introduction: Airway management is the cornerstone of resuscitation and is one of the defining skills for an Emergency Physician. Most patients who require emergency intubation on arrival to the ED pose great challenges as they are not pre-evaluated. Most of the research done on the basic apneic oxygenation techniques in India is in controlled environments and studies in the Emergency Department and pre-hospital settings are scant Aims & Objectives: To compare the effectiveness of nasopharyngeal oxygenation versus conventional method during the apneic phase of endotracheal intubation and to compare the incidence and extent of de-oxygenation during the apneic period between both techniques and to compare the complications encountered between the two groups. Methodology: This was a Single blinded Randomized control study conducted in the department of Emergency Medicine among 76 patients on whom rapid sequence intubation is performed. Study is initiated after the approval from ethical committee. Statistical analysis was performed by using the software SPSS 22.0 version. Descriptive statistics were reported as mean ± standard deviation. p value of <0.05 was considered as statistically significant Results: In apneic oxygenation Group A, majority of subjects were in the age group <30 years (23.68%) and in conventional method Group B, majority of subjects were in the age group <30 years (28.95%). In Group A, 84.21% had Grade 1, 7.89% had Grade 2A, 5.26% had Grade 2B and 2.63% had Grade 3. In Group B, 92.11% had Grade 1, 5.26% had Grade 2A, 2.63% had Grade 2B and 0% had Grade 3. There was no significant difference in Cormack Lehane Grade between two groups. Conclusion: On comparing the effectiveness of apneic oxygenation versus conventional method during the apneic phase of endotracheal intubation, the mean SpO2 at apneic period was 95.92 ± 4.01% in conventional group (group A) and 97.11 ± 3.25% in apneic oxygenation group (group B). The incidence and extent of deoxygenation during the apneic period in Group A was 21.1% (8/38) and in Group B it was 13.2% (5/38) to an SpO2 of <93%.

Background: Unforeseen painful laryngoscopy and intubation are still relevant challenges in the anaesthetic practice and bring significant morbidity to the airways. It is crucial that proper airway examination during the pre-operation phase is conducted instead of the prevention of hypoxic complications. WWW - The Modified Mallampati classification (MMC) is a bedside examination instrument, it is used when the difficult larynx look is to be pre-empted, and it is conventionally performed with patients seated. However, its appropriateness in the supine position, which is the most appropriate in certain operating/emergency setting, is contentious as well. This was to be achieved through researching the impact of Mallampati grade in upright anatomical position and supine position to forecast tricky laryngoscopy and intubation. Methods: The proposed study was a cross-sectional study that was carried out through the prospective analysis of 30 adult ASA I2 patients (18 years old onwards) who were to receive elective surgical operations under general anaesthesia. Mallampati evaluation in upright and supreme positions was performed on all of the participants before induction. It was an airway examination conducted by a seasoned anaesthesiologist who was conservative with regard to laryngoscopy. The standard of reference was Cormack Lehane grade that was established as the direct laryngoscopy. Modern-day difficult laryngoscopy was considered that of Cormack -Lehane grade III and IV. Both of the positions were bargained towards the gaining of the diagnostic indices of sensitivity, specificity, positive and negative predictive (PPV, NPV) and accuracy. Statistical measure was represented in SPSS v22 where Chi-square and Student t tests were taken as the developed measures. Results: Problematic laryngoscopy found in 3 ( 10% ) patients; among them, only external laryngeal positioning allowed them to be intubated. The supine position (26.6) compared to the upright position (20) showed Mallampati class III-IV more often. The supine test had superior specificity (92.6) and PPV (60) to predict a challenging laryngoscopy and the upright had a modest higher sensitivity (66.7) and NPV (96):. Concordance rates between Mallampati class and the view of laryngoscopy were greater in the supine position (κ = 0.42) as compared to the upright (κ = 0.33) position. Conclusion: The upright position used in Mallampati assessment has limitations as it may not be practical in supine position since it has both similar sensitivity and high in predicting challenging laryngoscopy. Supine examination can therefore prove useful on patients who cannot tolerate the sitting position.

Background: Direct laryngoscopy and endotracheal intubation provoke a sympathetic stress response resulting in tachycardia, hypertension, and increased myocardial oxygen demand. Attenuation of these adverse hemodynamic responses is essential to reduce perioperative cardiovascular complications. Objectives: To compare the incidence of adverse hemodynamic events and efficacy of intravenous labetalol, esmolol, and lignocaine in attenuating the cardiovascular response to laryngoscopy and endotracheal intubation in adult patients. Materials and Methods: This prospective, randomized, double-blinded comparative study was conducted on 75 adult patients aged 20–60 years, belonging to ASA physical status I and II, undergoing elective surgeries under general anesthesia. Patients were randomly allocated into three equal groups (n = 25 each): Group LG received lignocaine 1 mg/kg, Group ES received esmolol 0.5 mg/kg, and Group LB received labetalol 0.25 mg/kg intravenously, 2 minutes prior to laryngoscopy. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product were recorded at baseline, before intubation, and at 1, 3, 5, 7, and 10 minutes post-intubation. Incidence of adverse hemodynamic events was noted. Data were analyzed using ANOVA and post-hoc Tukey test. Results: Baseline demographic variables and hemodynamic parameters were comparable among the groups (p > 0.05). All groups showed a significant rise in hemodynamic parameters at laryngoscopy and intubation. However, the increase was significantly lower in the labetalol group, followed by the esmolol group, compared to the lignocaine group (p < 0.001). Labetalol provided superior control of heart rate, systolic blood pressure, mean arterial pressure, and rate pressure product during laryngoscopy and early post-intubation period. The incidence of adverse hemodynamic events was highest in the lignocaine group and lowest in the labetalol group. No serious adverse effects were observed. Conclusion: Intravenous labetalol is more effective than esmolol and lignocaine in attenuating adverse hemodynamic responses to laryngoscopy and endotracheal intubation, with a favorable safety profile. Labetalol may be considered the preferred agent for achieving hemodynamic stability during airway manipulation in adult patients.

Background: Optimisation of glottic visualisation is a key determinant of successful endotracheal intubation. Although videolaryngoscopy improves laryngeal exposure, external airway manoeuvres such as jaw thrust and backward–upward–rightward pressure (BURP) are frequently employed to further enhance the glottic view. Evidence comparing these manoeuvres during McGrath videolaryngoscopy remains limited. Materials and Methods: This prospective, randomised study employed a mixed design, with within-subject repeated-measures assessment of glottic visualisation under conventional, jaw thrust, and BURP manoeuvres using the McGrath videolaryngoscope, and parallel-group comparison of intubation characteristics. A total of 135 adult patients (ASA physical status I–II) undergoing elective surgery under general anaesthesia were randomised into three groups. MCL grade, POGO score, laryngoscopy time, intubation time, and ease of insertion were analysed. Results: Within-subject analysis demonstrated that both jaw thrust and BURP manoeuvres significantly improved glottic visualisation compared with the conventional technique, as reflected by improved MCL grades and higher POGO scores (p < 0.0001). No significant difference in glottic visualisation was observed between the two manoeuvres. Mean intubation time was significantly shorter in Group J (13.49 ± 1.63 s) and Group B (12.22 ± 1.24 s) compared with Group C (24.36 ± 3.73 s) (p < 0.0001). Ease of insertion was significantly better in Groups J and B than in Group C (p = 0.003). Laryngoscopy time, haemodynamic responses, and airway trauma were comparable among the groups. Conclusion: Jaw thrust and BURP manoeuvres significantly enhance glottic visualisation and improve intubation characteristics during McGrath videolaryngoscopy in adult patients with anticipated normal airways undergoing elective surgery, with comparable effectiveness and safety.

Background: Laparoscopic surgeries performed under general anaesthesia are associated with significant hemodynamic fluctuations due to carbon dioxide pneumoperitoneum along with sympathetic stimulation during laryngoscopy and endotracheal intubation. Attenuation of these responses is essential for perioperative cardiovascular stability. Dexmedetomidine, an α2-adrenergic agonist, has sympatholytic, analgesic, and sedative properties. This study evaluated its efficacy in attenuating perioperative hemodynamic responses during laparoscopic surgeries. Aim: This study aimed to evaluate the efficacy and safety of dexmedetomidine in attenuating perioperative hemodynamic changes during laparoscopic surgery under general anaesthesia. Methods: This prospective, randomised, double-blind controlled study was conducted in 90 ASA physical status I–II patients aged 18–50 years undergoing elective laparoscopic surgery. Patients were randomised into two groups: Group D received dexmedetomidine (loading dose 1 µg•kg⁻¹ over 10 min followed by 0.5 µg•kg⁻¹•h⁻¹ infusion till end of surgery and Group C received normal saline in the same dose. Standardised balanced general anaesthesia was administered to all patients. Hemodynamic parameters were recorded at predefined perioperative time points. Postoperative pain was assessed using the Visual Analogue Scale and sedation was evaluated using the Ramsay Sedation Scale. Results: Demographic variables and baseline hemodynamic parameters were comparable between the groups. Dexmedetomidine significantly attenuated increase in heart rate, systolic blood pressure and diastolic blood pressure associated with intubation, pneumoperitoneum, and extubation compared to the control group (P < 0.05). Postoperative pain scores were significantly lower in the dexmedetomidine group at all measured intervals (P < 0.05). Although immediate postoperative sedation was higher with dexmedetomidine, recovery was smooth without prolonged sedation or respiratory compromise. Conclusion: Dexmedetomidine as an adjuvant in general anaesthesia for laparoscopic surgeries provided stable haemodynamic profile in the perioperative period and effectively attenuates laryngoscopy and intubation responses, provides superior postoperative analgesia and ensures a favourable sedation profile during laparoscopic surgery. It is a safe and effective adjuvant to general anaesthesia for maintaining perioperative cardiovascular stability.

Background: Succinylcholine  chloride  introduced in 1951 was a synthetic depolarising  muscle relaxant.  Succinylcholine with its adverse effects like hyperkalemia, raised intracranial, intraocular, intragastric pressures. Though  many NDMR drugs were introduced, Rocuronium bromide introduced in 1994 became first competitor for succinylcholine.  Rocuronium bromide when given in three times the ED95 doses is said to produce excellent to good  intubating  conditions in 60 seconds and devoid of adverse effects that are seen with succinylcholine.  Materials and Methods: This prospective, randomized study was conducted at the Department of Anaesthesia, Government Medical College and Hospital, Ongole after obtaining institutional ethical  committee approval. A total of 60 adult patients (aged 18–60 years) undergoing  elective surgeries under general anaesthesia were randomly assigned to either the Rocuronium bromide group (Group R, n = 30) or the Succinylcholine group (Group S, n = 30).The onset of neuromuscular blockade was assessed using a single twitch stimulation of 0.1Hz every 10sec after administration of either of the neuromuscular blocking agents.Jaw relaxation, vocal cord movement and Cormack Lehane grading were assessed at the time of intubation. Hemodynamic response to intubation was assessed by recording the preinduction,  and postintubation HR,SBP,DBP and MAP. Results: Incidence of Jaw relaxation was comparable between the two without statistical significance. Absence of vocal cord movements was comparable between the two groups without any statistical significance(Group R and Group S moving  P=0.21), (not moving Group R and Group S P=0.23). Cormack Lehane grading, no statistical significant difference between two groups. There is statistically significant difference in the onset of action of neuromuscular blockade between the two groups, with faster onset action in group S with P value 0.00001. Conclusion: Present study showed Succinylcholine showed an early onset muscle relaxation than Rocuronium. No difference in jaw relaxation and vocal cord movement at the intubation in two groups. There was no difference in hemodynamic response to intubation between the two drugs expect for more increase in pulse rate with rocuronium group.

Direct laryngoscopy done for intubation is associated with hemodynamic responses like tachycardia and increased blood pressure. Background: In order to avoid undesirable outcomes during laryngoscopy and intubation, hemodynamic response must be attenuated. Dexmedetomidine is an excellent drug used to manage the pressor response. Various routes of administration have been documented with paucity of studies on the nebulized dexmedetomidine. Aim: The purpose of this research was to compare the hemodynamic responses to intubation with intravenous and nebulized dexmedetomidine Materials and Methods: Among 98 patients ranging in age from 18 to 60 years old and classified as ASA-I or II, a prospective comparison research was carried out. They were split into two groups: one that received dexmedetomidine by nebulization (N = 49) and another that received it intravenously (N = 49). SBP, DBP, MAP, and HR were measured before induction (at baseline and 10 minutes) and after induction (1st, 3rd, 5th, 7th, and 10th minutes). The agent was given 15 minutes before to induction. Intubation time was also recorded.  Results. No statistically significant differences in hemodynamic indicators were seen between the groups up to the third minute. Results showed that the nebulized group's diastolic blood pressure (BP) and HR remained significantly elevated until the tenth minute. The duration of intubation was similar. Conclusion: The results show that all hemodynamic parameters are dramatically reduced after 3 minutes of intubation and laryngoscopy when nebulized dexmedetomidine is administered. However, post 3 minutes, nebulized dexmedetomidine could successfully attenuate only SBP and MAP and failed to attenuate DBP and HR.

Introduction: Confirming a secure airway before induction of general anaesthesia is critical to prevent life threatening situations such as “can't intubate, can't ventilate,” particularly in patients with difficult airways. Awake fiberoptic bronchoscope-assisted nasotracheal intubation (FOI) is recommended for such cases. Effective airway anaesthesia requires thorough knowledge of airway anatomy and innervation, achieved through topical and regional techniques. Topical anaesthesia methods include sprays and nebulizers, while nerve blocks, though more challenging, provide superior anaesthesia when performed by experienced anaesthesiologists. Materials and Methods: A single blinded randomized controlled trial was performed with 50 adult patients (>18 years) undertaking elective surgeries under general anaesthesia requiring FOI. Randomization done on 50 patients with 1:1 allocation using block randomization with unequal block size into nerve block (N) group and topicalization (T) group. Standard pre-, intra-, and post-operative care was provided to both groups. Continuous variables were compared using an independent t- test, with p<0.05 considered statistically significant. Results: The groups were clinically alike terms of gender, age, comorbidity (DM, hypertension, and hypothyroidism), INR status, heart rate, MAP, SpO2, and respiratory rate (p>0.05). The variance in MAP between the two clusters was high by 8 mm HG at 12 minutes and 10 mm HG at 15 minutes. The mean respiratory rate at 15 minutes was meaningfully different (Mean difference 4 min) between the two groups. The cough and GAG score was relatively high (score 3) in the T group than the N group. The intubation score, comfort score, ease of intubation was better in the N group, and the variance was statistically significant. While 16 patients (64%) in the group N took 6 minutes or less for intubation, only 7 (28%) patients took 6 minutes or less for intubation in the T group (p=0.04). No adverse events were reported. Conclusion: This study emphasizes that both topicalization and airway nerve blocks are safe and effective for awake FOI. However, airway nerve blocks provide superior patient comfort, ease of intubation, duration for intubation, and control of cough and gag reflexes, along with a more stable hemodynamics.

Introduction - Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. A variety of anaesthetic techniques and drugs have been studied and are available to control the hemodynamic response to laryngoscopy and intubation. The present study is performed to compare the hemodynamic changes for lignocaine administered in two forms  that is Mckenzie technique and nebulization in patients  requiring general anesthesia with endotracheal intubation. OBJECTIVES -To compare the haemodynamic changes to direct laryngoscopy after administering nebulized lignocaine (4%) and   Mckenzie technique with (4%) lignocaine in patients scheduled for elective  surgical procedures. MATERIAL AND METHODS - After obtaining written informed consent ,120 patients were randomly allocated to one of the two groups. GROUP A – will  receive   4% lignocaine (4ml)  spray using Mckenzie technique 15 mins before direct laryngoscopy.GROUP B- will   receive   4 ml of 4% lignocaine(4ml) nebulization  15 mins before direct laryngoscopy. Hemodynamic changes(Heart rate ,Mean arterial pressure,ECG) will be monitered and documented at   1min,2min,5min,10min,15min,30min,60min,120min after intubation and  0min,1min,5min,10 min post extubation .Post extubation cough and sore throat  will  be documented. RESULTS -The study demonstrated that Group A (McKenzie technique) exhibited significantly better control over heart rate and blood pressure compared to Group B (4% lignocaine nebulization)  . Specifically, Group A showed a lower heart rate at 1, 5, 10, 15, 30, 60, and 120 minutes post-intubation, with p-values less than 0.05 at each time point, indicating statistically significant differences. Furthermore, SBP and DBP were considerably lower in Group A at multiple time points, indicating a greater dampening of the hemodynamic stress response to intubation in this group. CONCLUSION - The McKenzie technique demonstrated superior efficacy in maintaining haemodynamic stability throughout both intubation and extubation phases. Group A, employing the McKenzie technique, consistently exhibited lower, (SBP) systolic and diastolic blood pressures, mean arterial pressures & heart rates compared to Group B, which received nebulized lignocaine. These differences were statistically significant, underscoring the McKenzie technique's ability to mitigate perioperative stress responses effectively.