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Background and Aims: Preoperative laboratory testing is done to detect abnormalities in the body not detected by clinical examination. Often a battery of tests is advocated as a routine for patients scheduled for low or intermediate risk surgery. This prospective observational study was aimed to assess agreement of the current practice of preoperative laboratory investigations with the National Institute of Clinical Excellence (NICE) guidelines, and the impact of investigations on patient care and costs. Material and Methods: The study was conducted at a tertiary referral center on 385 patients aged 18-70 years of either gender, posted for elective general surgical, gynaecological or otolaryngological surgery. Sixteen investigations were examined: hemogram, blood urea, serum creatinine, serum electrolytes, coagulation profile, urinalysis, thyroid function tests, electrocardiogram, echocardiogram, chest x-ray, pulmonary function tests, blood sugar, glycosylated hemoglobin, liver function tests, treadmill test and coronary angiogram. The history and physical examination were reviewed to examine for indication for these laboratory investigations. These were compared with NICE guidelines. Impact of these investigations on anesthetic decision-making was noted. Results: There was almost no agreement of the current practice with the NICE guidelines. The total cost of all tests obtained was Rs 5,48,755. Total additional cost of unindicated tests was Rs 5,10,730 (93%). Average amount spent on additional investigations per patient was Rs 1326.57. Conclusion: Most investigations are overprescribed and have minimal agreement with NICE guidelines. None of the tests had any impact on clinical care. Nearly a million rupees is incurred per year in one referral hospital alone, when NICE guidelines are not followed.

Background and Aims: Coughing and sore throat postoperatively are common clinical problems during general anesthesia which can be avoided by various methods including topicalization of airway with local anesthetics, endotracheal tube cuff (ETT) inflation with local anesthetics, use of intravenous drugs such as dexamethasone, maintaining ETT cuff pressure, intubation by an experienced anethesiologist, etc. The aims of the study were to compare postextubation coughing response, mean number of cuff deflations required intraoperatively, and postoperative airway morbidity in terms of sore throat (2 h and 18–24 h), hoarseness of voice, and dysphagia following inflation of ETT cuff with air, anesthetic gas mixture, saline, and 2% lignocaine during general anesthesia. Material and Methods: One hundred and four patients were randomized into 1 of 4 groups depending on whether air, anesthetic gas mixture, saline, or 2% lignocaine was used to inflate the cuff of ETT using computer-generated randomization table. Results: There was no significant difference in the postextubation cough response among the four groups. The mean number of times the ETT cuff was deflated was significantly in favor of liquid media comapred to gaseous media (P < 0.001). The incidence of sore throat at 2 h and at 18–24 h, hoarseness of voice, and dysphagia were comparable in all groups. Conclusion: ETT cuff inflation with air, anesthetic gas mixture, 2% lignocaine, and saline are comparable in terms of incidence of postextubation cough and postoperative airway morbidity symptoms such as sore throat, hoarseness of voice, and dysphagia.

Background and Aims: Laryngeal mask airway (LMA) CTrach™ and Airtraq® videolaryngoscopes are useful for endotracheal intubation in patients with limited cervical spine movements and other predicted difficult airways. We aimed to compare LMA CTrach™ and Airtraq® videolaryngoscopes as conduits for endotracheal intubation in patients with simulated limitation of cervical spine movements by manual in-line stabilization (MILS). Material and Methods: This was a prospective, randomized study including 50 patients undergoing elective surgeries under general anesthesia. Patients were assigned to undergo intubation using Airtraq® (n = 25) or LMA CTrach™ (n = 25) by an experienced anesthesiologist, while MILS was provided. Laryngoscopy and intubation were compared in terms of time taken to obtain optimal laryngeal view, successful intubation, total time, percentage of glottis opening (POGO) score, maneuvers required for optimal laryngeal view and alignment of endotracheal tube, and number of attempts and complications. An integrated score was calculated to classify the attempt as good, restricted, or poor. Results: Time taken to obtain optimal laryngeal view, successful intubation, and total time in both groups were comparable. POGO score >50% was seen in 25 and 21 patients in Groups A and C. Seventy-six percent and ninety-six percent in Groups A and C, respectively, had a good integrated score; 6% and 1% had restricted score; none had a poor score; and the difference between them was statistically significant (P = 0.042). Conclusions: LMA CTrach™ and Airtraq® are similar with respect to time taken for obtaining optimal laryngeal view, successful intubation, and total time when used for intubation in patients with simulated limitation of cervical spine movements.