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Background: Supraglottic airway devices play a crucial role in managing the airway during various surgical procedures conducted under general anesthesia. In this study, we evaluated the impact of different head and neck positions (extension, flexion, neutral, and right rotation) on ventilation while using I-gel, Ambu AuraGain, and Baska masks in anesthetized paralyzed patients. Methodology: A total of 114 patients were randomly allocated into Group I (n=38) using I-Gel, Group II (n=38) using Ambu AuraGain, and Group III (n=38) using Baska Mask. Clinical performance in terms of OLP (Oropharyngeal Leak Pressure) and anatomical position of the device was evaluated after insertion under general anaesthesia. Ventilation parameters including peak airway pressure, EtCO2 (End-tidal Carbon Dioxide), expiratory tidal volume and ventilation score were assessed at different head and neck positions using three supraglottic airway devices. Results : Maximum OLP was observed in Group II and minimum OLP was observed in Group I. In all three devices, OLP was maximum in the flexion position and minimum in the extension position. The Median Brimacombe score was 3 in all three groups at all head and neck positions except at maximum extension in Group I. Although peak airway pressure in Group II is significantly higher than the other two groups, ventilation is not impacted as evidenced by comparable ventilation score, EtCO2 and expiratory tidal volume in all patients of three groups at different head and neck positions. Conclusion : To conclude, Ambu Auragain has better anatomical seal at all head and neck positions as compared to I-gel and Baska Mask. However, despite differences in OLP, the ventilatory performances of the three devices were not significantly affected. Keywords: Ambu Auragain, Baska Mask, I-Gel, Supraglottic Airway Device, Head And Neck Position, Oropharyngeal Leak Pressure

Background: Postoperative pain prolongs hospital stay after laparoscopic cholecystectomy and remains a major challenge during the postoperative period. Effective pain control encourages early ambulation, which significantly reduces postoperative complications. In recent years, multimodal analgesia has been recommended with fewer adverse effects and more effective analgesia. The primary objective of this study was to compare the efficacy of analgesia between Transversus Abdominis Plane Block (TAP) Block and intraperitoneal instillation of bupivacaine by comparing the meantime of the first dose of rescue analgesia in either group and the total supplementary analgesia required. Methods: This retrospective observational study was conducted on 150 patients who underwent laparoscopic cholecystectomy Group 1 comprised of patients who had received Intraperitoneal Bupivacaine for analgesia and Group 2 received TAP Block for pain relief. Results: Time of the first dose of analgesia after surgery was observed earlier in Group 1 as compared to Group 2 (Time – hours: 9.2 ± 2 vs. 12.3 ± 1.6; p = 0.0001. The Total dose of analgesic was higher in the Intra Peritoneal Bupivacaine Group as compared to the TAP group. Conclusion: AP block provided for a better quality of analgesia as assessed by the reduced requirement of intravenous supplementary analgesia which was less in patients who were given TAP Block as compared to local instillation of Bupivacaine. Keywords: Cholecystectomy, Bupivacaine, Transversus abdominis plane block

Objectives: This article describes the on ground challenges faced by the medical care team deployed for transferring critically ill patients by air from remote locations of the high altitude and hilly terrain to definitive health care facility. Methods: All intubated critical patients requiring definitive and super specialty medical care, transferred by air from high altitude hilly terrain to tertiary care hospital during Jan 2016 to Dec year 2020, analyzed in this retrospective study. Results: The total duration of flight was between 40 – 150 min and average being 83 min. Twenty four patients were transferred by fixed wing aircraft and rest 76 by helicopters. All patient were given sedation in form of injection fentanyl 1mcg/kg in dividing doses and boluses of propofol 10 mg intravenously during transfer. The most common change noticed was fall in oxygen saturation with incidence almost 100% of the patients. The mean fall in saturation was 17.29%. Four patients required injection atropine for bradycardia which resulted with decrease of Saturation of peripheral oxygen (SpO2). Conclusion: Transferring a critically ill patient by road to distant medical centers is often not an option because of losing the golden hour of the medical care. Here comes the importance of aeromedical evacuation for a timely transfer for early medical attention. But shifting the critical patients through aerial mode requires planning and poses a variety of challenges. Keywords: Air­evacuation, High altitude, Air ambulance

Intussusception is one of the common causes of acute abdomen in paediatric age bracket with ileocolic type being the most prevalent. This happens when a proximal segment of bowel (intussusceptum) telescopes into the lumen of the adjacent distal segment (intussuscepiens). Here we report six cases of intussusception in which five were in paediatric age group and one was adult. All children were admitted, resuscitated well, USG abdomen was done to confirm the diagnosis, written and informed consent for surgery and anaesthesia, was taken from parents. However, all were managed successfully by hydrostatic saline reduction under sedation. Only one child had recurrence after one year who was again treated conservatively. Adult case was managed by means of laparotomy by excision of benign polyp being the pathological lead point. We present this case series to analyse the spectrum of presentation, diagnostic and therapeutic options available with review of literature. Since primary care providers and family physicians are first responders, this case series would help them for differential diagnosis and prompt referrals for further management.