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Background and Aims: Postoperative sore throat (POST) can be as high as 42% in supraglottic devices. LMA® Protector™ is a novel second-generation laryngeal mask airway (LMA) with Cuff Pilot™ technology that allows continuous cuff pressure monitoring. Elevated cuff pressure is a risk factor for POST in supraglottic devices, so we conducted this study to determine whether continuous cuff pressure monitoring can alleviate POST. Methods: This randomised double-blinded clinical trial compared the incidence of sore throat between LMA® Protector™ and LMA® ProSeal™ and was conducted in 118 patients scheduled for elective short surgical procedures. They were randomised to either LMA® Protector™ (Group PT) or LMA® ProSeal™ (Group P). The airway was secured with either of the two devices. The primary outcome was the incidence of sore throat at 1, 6, and 24 hours postoperatively and compared using the Chi-square test along with other parameters like first attempt success rate and blood staining of the device. The time taken for insertion and oropharyngeal seal pressure were compared using an independent t-test. Results: The incidence of POST was low with Group PT (12%) compared to Group P (28.8%) (P = 0.005). The mean oropharyngeal seal pressure was significantly higher in Group PT than in Group P [33.72 (3.07) versus 27.72 (3.88) cm of H2O], P < 0.005. The first attempt success rate was 81.2% and 100% in LMA® Protector™ versus LMA® ProSeal™. Conclusion: LMA® Protector™ had a reduced incidence of POST compared to LMA ProSeal. However, a longer insertion time and difficult placement may be a concern.

Background and Aims: Retrograde transillumination technique has been found helpful for performing direct and video laryngoscopy by better identification of glottis. The usefulness of this technique during flexible videoscopy by novices has not been evaluated. So, we aimed to compare the retrograde transillumination and conventional technique of flexible videoscopy by novices. The primary outcomes were the time required to visualise the glottis from the point of insertion of the scope into the nostril (T1) and the time needed to see tracheal rings after glottis visualisation (T2). The secondary outcomes were incidence of desaturation with peripheral oxygen saturation (SpO2)

Background and Aims: Shivering is common after spinal anesthesia in patients undergoing cesarean section. Various drugs have been used for its prevention. The primary aim of this study was to assess the efficacy of adding a small dose of fentanyl intrathecally (12.5 μg) in reducing the occurrence of intraoperative shivering and hypothermia and note any significant side effects in this subset of patients. Material and Methods: In this randomized controlled trial, 148 patients undergoing cesarean section under spinal anesthesia were included. In 74 patients, spinal anesthesia was administered with 1.8 mL of hyperbaric bupivacaine (0.5%), and the remaining 74 patients received 12.5 μg of intrathecal fentanyl with 1.8 mL of hyperbaric bupivacaine. Both were compared to find the incidence of shivering and change in nasopharyngeal and peripheral temperature along with the temperature at the onset of shivering and the grade of shivering. Results: The incidence of shivering was 9.46% in the intrathecal bupivacaine plus fentanyl group, which was significantly less than the group with intrathecal bupivacaine alone (41.89%). The nasopharyngeal and peripheral temperature showed a decreasing trend in both groups but were greater in the plain bupivacaine group. Conclusion: The addition of 12.5 μg of intrathecal fentanyl to bupivacaine in parturient undergoing cesarean section under spinal anesthesia significantly reduces the occurrence and intensity of shivering without its adverse effects such as nausea, vomiting, and pruritus, etc.

Background and Aims: Successful intubation with video laryngoscopes necessitates good hand-eye coordination and the use of intubation adjuncts like bougie and stylet. We proposed this study to find whether using Frova introducer with C-MAC video laryngoscope will reduce the intubation time in trainee anesthesiologists. Material and Methods: We enrolled 140 adults without any difficult airway predictors. They were randomly assigned to undergo C-MAC video laryngoscope guided intubation by anesthesia residents using tracheal tube preloaded over Frova introducer (n = 70) or without Frova introducer (n = 70). Primary outcome was the intubation time. Secondary outcomes were the number of redirections of tracheal tube or Frova introducer toward glottis, need for external laryngeal maneuvers (ELMs), first attempt intubation success rate, and ease of intubation. Results: The median actual intubation time (IQR) in Frova and non-Frova group, respectively, were 25.46 (28.11–19.80) and 19.96 (26.59–15.52) s (P = 0.001). The number of redirections of TT or Frova introducer toward glottis, first attempt success rate, and ease of intubation were comparable. The need for ELMs [n (%)] was 15 (21.4) and 26 (37.1) in Frova and non-Frova group, respectively (P = 0.04). Conclusion: Frova introducer guided endotracheal intubation with C-MAC videolaryngoscope in patients with normal airways had a marginally prolonged intubation time with a significant reduction in the need of external laryngeal manoeuvres but with a comparable number of redirections and attempts. Further research is needed to generalize these findings to patients with difficult airways.

Induction of general anesthesia in patients with mediastinal mass can lead to life threatening respiratory and cardiovascular complications during induction, maintenance and emergence. The inability of pediatric patient to cooperate for local anesthesia further complicates the management of such cases. Here we report the management of a child with anterior mediastinal mass causing airway compression and massive pericardial effusion posted for right pleuropericardial window.

Anaesthetic management of tracheal resection and reconstruction in patients with difficult tracheal pathologies, poses unique challenges—such as pre-operative assessment and preparation, the induction of general anaesthesia, airway sharing with surgeons during the intra-operative period while performing resection and reconstruction, emergence from general anaesthesia, and post-operative care. While there are no guidelines on choosing the ideal airway technique for the intra-operative period, we describe a simple-yet-effective airway modality, viz. spontaneous ventilation, as a key airway technique during the crucial open airway phase during tracheal reconstruction.

Background and Aims: Continuous wound infiltration of local anaesthetics provide postoperative analgesia by peripheral nociceptors blockade. The placement of wound infiltration catheter in the optimal anatomical plane of surgical wound may play a significant role in reducing postoperative pain depends on the surgical procedure. We hypothesised that preperitoneal infusion of local anaesthetics will reduce the postoperative opioid consumption as compared to subcutaneous infusion following cesarean section. Methods: This was a randomised, double-blinded clinical trial. Fifty-two pregnant women who underwent lower segment caesarean section by Pfannensteil incision, under spinal anaesthesia, were randomised to group 'subcutaneous' and group 'preperitoneal'. A wound infiltration catheter was placed in the subcutaneous or preperitoneal plane, depending on their randomisation at the end of the surgery. Bupivacaine of 0.25% at 5 mL/h was infused for the next 48 h. Pain was assessed using numerical rating scale at 1, 2, 3, 4, 5, 6, 12, 24, 36 and 48 h after surgery. Cumulative postoperative consumption and adverse effects of morphine and complications of the procedure were looked for. Results: Cumulative 48-h morphine consumption showed no statistical significance between the preperitoneal group (15.96 ± 7.69 mg) and subcutaneous group (21.26 ± 11.03 mg); P = 0.058. Pain score was comparable. Independent T-test and Mann–Whitney test were the statistical tests used for continuous and categorical data, respectively. Conclusion: Postoperative cumulative morphine consumption and pain scores are comparable when bupivacaine is infused continuously through wound infiltration catheter either in the preperitoneal or subcutaneous layer following Caesarean delivery.

Background and Aims: The LMA ProSeal® is considered a prototype among the second-generation supraglottic airway devices (SAD). The Ambu AuraGain™ is a relatively new, single use, second-generation SAD with a preformed shape. We conducted this study with the aim of comparing the difference in clinical performance between Ambu AuraGain™ and LMA ProSeal® in children receiving controlled ventilation. Methods: Ninety-four children, aged between 6 months to 12 years, weighing 5 to 30 kg, belonging to American Society of Anesthesiologists Physical Status I and II, undergoing elective surgical procedures, were randomized into two groups. The primary end-point was oropharyngeal seal pressure, and the secondary parameters were the number of attempts, time of insertion, ease of placement of the device and gastric tube, and fiberoptic visualization of the laryngeal aperture. Results: The mean oropharyngeal seal pressure with Ambu AuraGain™ was significantly higher than LMA ProSeal® (23.3 ± 4.6 cmH2O vs 20.6 ± 4.8 cmH2O, P = 0.007, respectively). The ease and success rate for device placement, fiberoptic visualization of the larynx, and complications were comparable. However, the time for insertion in Ambu AuraGain™ group was shorter when compared to LMA ProSeal® group, median (IQR [range]); 12 (10–15) s vs 20 (18–23) s (P < 0.001), respectively. The gastric drain was significantly easier to insert in Ambu AuraGain™ compared to LMA® ProSeal (P = 0.01). Conclusion: Our study suggests that Ambu AuraGain™ could be a useful disposable alternative to LMA ProSeal® for securing airway in children.

Background and Aims: Perineural and intravenous dexmedetomidine as a local anaesthetic adjunct has not been compared previously in fascia iliaca compartment block (FICB). The aim of this study was to compare the efficacy and side effect profile of dexmedetomidine as an adjunct to bupivacaine in single dose FICB for femur surgeries in two different routes i.e., perineural and intravenous route. Methods: Eighty American Society of Anesthesiologists physical status 1, 2 or 3 patients posted for femur surgeries were randomised to receive ultrasound guided FICB. Intravenous group(ID) received 40 mL of 0.25% bupivacaine with 2 mL of 0.9% saline for FICB along with 1 μg/kg dexmedetomidine intravenous infusion over 30 min as loading dose followed by 0.5 μg/kg/h as maintenance dose till the end of surgery. Perineural group (LD) received 40 mL of 0.25% bupivacaine with 2 mL of 1 μg/kg dexmedetomidine for FICB. M ean duration of postoperative analgesia and 24 h postoperative morphine consumption as primary and secondary outcome respectively, has been compared. Results: The duration of postoperative analgesia was 8 h 36 min ± 1 h 36 min and 10 h 42 min ± 1 h 36 min for the ID and LD groups, respectively (P = 0.001). A 24 h postoperative morphine consumption in Group ID was 19.7 ± 1.9 mg compared to 17.5 ± 2.2 mg in LD groups (P = 0.001). Conclusion: Perineural dexmedetomidine effectively prolongs the USG guided FICB analgesic duration and reduces the 24 h postoperative morphine consumption when compared to intravenous dexmedetomidine as a local anaesthetic adjuvant for femur surgeries.

Anesthetic management of a child with hemifacial microstomia and frontonasal encephalocele can be challenging due to factors such as a difficult airway, associated systemic conditions, young age, and prolonged operating time. Hereby, we outline the intraoperative management of a 3-year-old child undergoing repair of multiple defects requiring multidisciplinary involvement of neurosurgery, plastic surgery, and anesthesia team. In our case, a size 0 mask and hyper-angulated D-blade video laryngoscopy were used to prevent sac compression and facilitate intubation. Blood conservation strategies included tranexamic acid, precise fluid management, and maintenance of normothermia. Extubation was carefully planned, considering blood loss and airway edema, and performed when the child was fully awake, ensuring a stable postoperative period and successful recovery. This report emphasizes the importance of meticulous preoperative assessment, readiness for a challenging airway, efficient management of intraoperative blood loss, and the value of teamwork.