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Anatomical differences in the airway in pediatric patients, compared to adults pose many challenges during endotracheal intubation, such as selecting the proper sized endotracheal tube (ETT) during intubation. Our primary objective was to assess how accurate is ultrasound (US) co-relation in comparison to standard age-based formulas in pediatric patients. Meta-analysis was registered in PROSPERO 2020, CRD42020220041. Online literature available in PubMed, Cochrane, and Embase, Goggle scholar was searched from year 2000 till November 30, 2020, using relevant Mesh terms, ('airway US' OR (('airway'/exp OR airway) AND ('US'/exp OR US))) AND ('endotracheal intubation'/exp OR 'endotracheal intubation') AND ('pediatric'/exp OR pediatric)" to Predict endotracheal tube size/placement in pediatric age (neonate till 18 years) by the US. Bibliographic cross-references of selected publications were further manually screened. The full texts of each article were studied, once the abstract was found appropriate independently by two reviewers. A total of 48 papers published between 2010 and 2020 were identified as relevant and read in detail. Average numbers of patients were 86 and total numbers of patients were 1978. Most of the studies included pediatric patients posted for elective surgeries under general anesthesia and excluded emergency procedures, known laryngeal or tracheal pathology, high-risk patients, recent upper respiratory tract infections or allergy to ultrasound gel. A total of 18 independent correlations were analyzed. Final combined

Congenital pulmonary adenomatoid malformation (CPAM) is a rare entity. The authors searched the US National Library of Medicine Database, EMBASE, Google Scholar, PubMed Central for anesthetic management in CPAM. The search was performed using the terms: congenital cystic adenomatoid malformation, congenital pulmonary adenomatoid malformation, CCAM, CPAM, anesthetic management. The prognosis of CPAM depends on timely diagnosis, presence of hydrops, degree of hypoplasia of remaining lung, and the size of the lesion. Symptomatic patients must be treated surgically and lobectomy is considered the gold standard. Anesthetic management of such cases is challenging as it involves thoracotomy or thoracoscopic lobectomy or cystectomy and can lead to sudden hemodynamic Collapse. Early extubation should be considered to avoid iatrogenic ventilator-induced bronchial stump dehiscence resulting from positive pressure ventilation.

Background: There has been considerable interest in mobile and tablet technology in the field of health care. This interest has brought the area of mobile health apps, described as providing health care and health-related services through communications devices, into-sharp focus. This study aimed to assess the status of contemporary apps targeted at chronic pain assessment and management with a particular focus on patient-centered approach, criterion for pain assessment, medication assessment, targeted system, and pain management/guidance. Methodology: We searched for pain apps specific for chronic pain on the App Store for iOS devices and Google Play for Android devices. Each app store was searched using terms related to “pain,” “chronic pain,” “pain scale,” and “pain management.” Various parameters such as the name of the app, availability in operating systems (iOS or Android), download cost, creation dates, date of latest update, language, type of pathology, user rating, number of downloads, reviews, type of target population, the objective of the app and target population were explored. To explore the downloaded apps, an Excel® tool was designed for data extraction. Observations: Two hundred and fifty-four numbers of apps were identified after excluding duplicates. Forty-seven apps were included in the study that had a rating of above 4 in Google play store for further analysis. Eight out of 47 apps only did extensive pain assessment, and pain rating score was available in 14 apps. Most of the apps targeted exercise as a primary modality of management, and provided knowledge about the disease process. Few apps were based on the patients' hospital-based management and very few apps targeted yoga, integrative therapy, and trigger point as the primary modalities of management. 75% of apps targeted general pain, and only 25% were specific to an organ system. Majority of the apps were neither designed nor edited by licensed health-care providers, and there was little direct involvement by health-care professionals. Conclusion: The use of mobile devices can offer many advantages and opportunities for enhancing medical care. At present, due to the lack of evidence supporting their use, caution should be taken in the use of smartphones apps. These applications should also be assessed and regularly analyzed, and integrated with pain assessment and pain management and incorporate various integrative therapies based on available recommendations.

Introduction: Propofol (2,6 di-isopropyl phenol) is a widely used agent for induction of anesthesia, although pain during its injection remains a concern for all anesthesiologists. Pain on intravascular injection of propofol is very incapacitating, and the trouble still remains and has never been eradicated. Materials and Methods: After taking approval from the Institutional Review Board, this randomized controlled study was conducted on patients undergoing elective surgeries under general anesthesia. Two hundred and ten adult patients of either sex aged 28–60 years weighing between 40 and 80 kg were included into three groups: Group L – received 60 mg of preservative-free lignocaine hydrochloride, Group D – received 12 mg of dexamethasone sodium phosphate, and Group T – received 100 mg of tramadol hydrochloride. Venous occlusion was done at the level of mid-fore-arm by inflating a noninvasive blood pressure cuff to a pressure of 60 mmHg. Study drug was then injected over 10 s by consultant who was blinded to the procedure. After 2 min of study drug, venous occlusion was released following which propofol 0.5 mg/kg was injected over 5 s. Spontaneous complaints of pain and behavioral signs which included facial grimace, arm withdrawal, vocal and verbal rating score were recorded by the second anesthesiologist who was unaware of the group allocation. Results: All three drugs reduced the intensity and severity of propofol-induced vascular pain. Incidence of pain in lignocaine, dexamethasone, and tramadol Groups were 15%, 32.8%, and 31.4%, respectively. There was significant pain relief (P = 0.045 and 0.042, respectively) when comparing Group L and D, Group L and T. Pain relief between Group D and T was statistically similar (P = 0.8). The incidence of hand withdrawal was significantly higher in the tramadol group (P < 0.05) as compared to dexamethasone and lignocaine. The incidence of facial grimace was similar in dexamethasone and tramadol group and was higher as compared to that of lidocaine group; however, the incidence was not statistically significant (P = 0.25 between D and L, 0.3 between T and L group). Conclusion: Use of pretreatment with drugs is required to prevent propofol-induced vascular pain. Both tramadol and dexamethasone are equally efficacious in reducing propofol-induced vascular pain, though both are less effective when compared with lignocaine. Dexamethasone has an added advantage of preventing postoperative nausea and vomiting when compared with both lignocaine and tramadol.

A 31-year-old female with bilateral neck swelling causing tracheal narrowing and deviation of trachea to the left side was posted for total thyroidectomy. Long standing thyroid swellings with or without associated airway compromise are a challenge for anaesthesiologists to secure the airway. Because of the thyroid swelling, there may be deviation of trachea and/or compression of the trachea. Here we present a case of long-standing goitre with tracheal deviation and compression of trachea at the level of 2nd tracheal ring. Securing the airway in such cases poses a great challenge requiring meticulous planning and skillful experience. Careful preoperative evaluation and preparation in the form of clinical and radiological assessment is essential in formulating a plan of anaesthesia. Though static assessment is always important and helps in deciding the plan of management, conventional parameters may not be true in all cases such as in ours. Dynamic assessment may help the anaesthesiologist in deciding airway management in such cases.

Background: Laparoscopic common bile duct (CBD) exploration (LCBDE) allows cholecystectomy and the removal of CBD stones to be performed during the same sitting, thereby decreasing hospital stay. CBD exploration through choledochotomy can be closed primarily with an absorbable suture material but can lead to biliary leakage postoperatively. In this study, we tried to find a solution to further lower the incidence of bile leakage using fibrin glue to reinforce the sutures put on choledochotomy suture line. Patients and Methods: This study was conducted at a tertiary care teaching hospital in New Delhi, India. Twenty patients with CBD stones documented on magnetic resonance cholangiopancreatography with CBD diameter of 9 mm or more were included in this study. Patients were randomized into two groups, namely – Group “A” in which choledochotomy was closed with polyglactin 4-0 suture and suture line reinforced with fibrin glue and Group “B” in which choledochotomy was closed with polyglactin 4-0 suture alone. Both the groups were evaluated and compared on clinical parameters such as operative time, drain content, drain output, number of days drain was required, blood loss and transfusion requirements, length of postoperative hospital stay, and conversion to open surgery. Results: The operative time for Group A ranged from 60 to 210 min (mean: 131.50 min) and Group B ranged from 65 to 300 min (mean: 140 min). In Group A, there was no case of bile leak but there was bile leak in 2 cases in Group B, minimum 0 and maximum 900 ml with a mean of 97 ml and P= 0.147 with no statistically significant difference in bile leak in test and control groups. The minimum and maximum serous drainage in Group A was nil and 80 ml (mean: 11 ml) and in Group B was nil and 270 ml (mean: 72.50 ml).P value came as 0.028 which was statistically significant. Thus, serous leakage in Group A was significantly less than in Group B. The drains in Group A were removed from 2 to 4 days (mean: 3 days) while in Group B from 2 to 9 days (mean: 3.9 days). The patients in Group A stayed in hospital postoperatively from 3 to 8 days (mean: 5.30) while in Group B, it ranged from 3 to 10 days with a mean of 5 days. Conclusion: Fibrin glue application on CBD decreases bile leakage but in statistically insignificant manner. Fibrin glue application on CBD can significantly decrease postoperative serous drainage after LCBDE. Fibrin glue application on CBD is safe and easy technique without any significant adverse effects and can help less experienced surgeons performing LCBDE.

Pulmonary hypertension is defined as persistent rise in mean pulmonary artery pressure of 25 mmHg or more with pulmonary occlusion pressure

Introduction: Talon cusp is an uncommon odontogenic anomaly which most frequently affects maxillary permanent incisors. Its presence causes the problem in esthetics, prevention of caries, and occlusal accommodation for the patient and problems in the diagnosis and clinical management for the dentist. Case Report: This article reports a case of talon cusp on the palatal surface of the permanent maxillary central incisor. Discussion: Since, the presence of talon cusp usually demands that definitive treatment be instituted; it represents a problem of clinical significance. The dentist should be able to diagnose it as the maxillary incisor is also the principal site for supernumerary tooth.

Odontomas are the most common non-cystic odontogenic lesions representing 70% of all odontogenic tumors. Often small and asymptomatic, they are detected on routine radiographs. Occasionally they become large and produce expansion of bone with consequent facial asymmetry. We report a case of such a lesion causing expansion of the mandible in an otherwise asymptomatic patient.