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Introduction: Endotracheal tube (ETT) has been associated with various pharyngolaryngeal morbidities (PLMs) following general anesthesia (GA). Laryngeal mask airway (LMA), currently the most commonly used supraglottic airway device, has several advantageous over the ETT but has been associated with varying results of PLM. The aim of our study was to compare the PLM between them and to know whether LMA is a better alternative. Materials and Methods: One hundred and seventy American Society of Anesthesiologists Grades 1 and 2 women scheduled for elective mastectomy were included in the study, 85 each in either group, E Group (intubated with ETT) and L Group (using LMA) on a random basis. All patients received GA with controlled ventilation using a muscle relaxant. PLMs such as hoarseness, pain on phonation, sore throat, and difficulty in swallowing were documented by an interview done postoperatively. Peroperative parameters such as intubation attempts, trauma during airway device insertion, and intraoperative incidents were also analyzed. A sample size of 85 patients in each group was calculated in order to achieve a study power of 0.8 and alpha level was taken as 0.05. Data were analyzed using SPSS version 16 using Chi-square test, Mann–Whitney U-test and Fisher's exact test were used as nonparametric tests. A two-tailed P< 0.05 was considered significant. Results: Patients in E Group had statistically significant increased incidence of a sore throat and voice complaints whereas L Group showed a statistically significant increase of swallowing problems. There was also a significant correlation between traumatic insertion and sore throat, pain on swallowing in the L Group, which could be due to direct trauma. Conclusions: ETT was associated with an increased incidence of voice problems and sore throat whereas LMA had an increased incidence of dysphagia and odynophagia. Use of LMA changes the pharyngolaryngeal profile to a more acceptable one.

Background and Aims: Immunomodulatory consequences of allogeneic blood transfusion may outweigh the advantages of improved oxygen delivery and tissue perfusion, especially in patients with cancer. In colorectal cancer, there is evidence of cancer relapse in patients who received transfusion. This retrospective analysis was undertaken to evaluate the relationship between perioperative blood transfusion and cancer recurrence in patients undergoing oncosurgery. Methods: In this case-control study, we retrospectively analysed the case sheets of 194 patients who had perioperative transfusion and underwent cancer surgery from March to December 2013(Study group, Cases). They were compared with controls matched for cancer site and TNM staging who did not receive perioperative transfusions (Control Group, Controls). We intended to find out if the Study group had any increased risk of cancer relapse compared with the controls. Records from the institute cancer registry were analysed in 2018 to give a follow-up period of 5 years. Continuous variables were analysed using Student's T test and Mann Whitney U test for normally distributed and skewed data respectively. For Categorical data Fisher's exact test and Chi square test were applied. The risk for recurrence was estimated using odds ratio. Results: The recurrence rate in cases and controls was 53.09% and 19.59% respectively and the odds ratio, 4.647 (CI: 2.954, 7.309). In Cases, significant relapse was noted for carcinomas of ovary, colorectal, bladder, larynx, head of pancreas and liver. Conclusion: In surgical oncology patients, ABT is associated with greater rate of recurrence.

This article presents the findings of a cross-cultural research project that explored similarities and differences between palliative care service provision in Kerala, India and South-East Queensland, Australia, to inform a process of mutual learning for service development. Three major points of difference that can inform this process of mutual learning were identified: 1) an understanding of the significance of honesty in information-giving to the patient, 2) recognition of the importance of palliative care specialists providing education to mainstream health professionals, and 3) appreciation of the need for palliative care to be cognizant of the socio-economic impact of dying-especially for families experiencing poverty-by embracing strategies for financial and material support. The findings highlight the effectiveness of a cross-cultural collaboration between health professionals and researchers in South-East Queensland, Australia and Kerala, India.

The message of palliative care in India has become a movement in several parts of India in a short span of time. The past two decades have seen palpable changes in the mindset of health care providers, and policy makers with respect to the urgency in providing palliative care. With a population of over a billion spread over a vast geo-political mosaic, the reach and reliability of palliative care programmes may appear staggering and insurmountable. Nonetheless we have reasons to be proud in that we have overcome several hurdles and is presently in a ′consolidation mode′. It is only a matter of time before the ′aam admi′ has access to good palliative care. Easing narcotic licensing procedures, creation of standard operating procedures for morphine availability and the passing of the ′Palliative Care Policy′ by the Government of Kerala are commendable milestones. We are today having more of ′silver linings′ and less of ′dark clouds′.

Depth of Anaesthesia(DoA) is one of the advanced anaesthesia monitoring which helps to optimize the quantity of anaethestic drug delivered to a patient during surgery. This reduces the costs and improves patient outcomes. Present study aims to measure Depth of Anaesthesia(DoA) using Wavelet Analysis. Wavelet Entropy(WE) of the EEG signal is extracted as a measure of DoA from the EEG signals collected during the four phases of general anaesthesia called awake, induction, maintenance and recovery. In order to find out the wavelet entropy, EEG signals during anaesthesia were decomposed into its constituent frequency bands, then WE was calculated from the approximation and detail coefficients. Finally extracted WE is compared with BIS index, which is a commercially available DoA monitor.

Safe, effective airway management is the foundation of quality anaesthetic practice. The classic laryngeal mask airway (LMA) is one of the airway equipments, which revolutionised airway management in the anaesthetic history. The popularity of the LMA stems from perceived benefits over other airway devices.[1] Following success and popularity of Classic™ LMA, many different variants of this device have been designed and marketed. There is no survey of supraglottic airway device (SGAD) usage done in India. Considering the widespread usage of the LMA and its variants in India we decided to get the first-hand user details about the practice of SGADs here.

Pain is frequently encountered in outpatient oncology practice and its management often is inadequate. Effective analgesia often could be provided for these patients through simple practices like pain intensity monitoring, documentation and treatment accordingly. A survey was carried out among cancer patients attending outpatient pain clinic to evaluate scale preferences, comparison of different scales as well as proxy reporting by caregiver, health professionals, for pain management. The aim of the study was to determine preferences in Indian population and to compare our study subjects' preferences to those previously reported in other cultures. A total of 99 patients participated in the study. The majority preferred a visual analogue scale (VAS). The visual analogue scale and verbal descriptive scale (VDS) were found to be equally reliable pain rating tools. Proxy reports were found to equally representative of patient's pain. VAS was the preferred pain assessment tool. In the absence of VAS scale, VDS also could be used. Proxy reports could be relied upon for management of pain.

The nasolabial flap is a simple option for the reconstruction of selected oral defects. Though its use in floor-of-mouth reconstruction has been described, other uses in the oral cavity have not been studied extensively. We present a series of 224 oral malignancies where the nasolabial flap was used for reconstruction after surgical excision.

Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

Objective: The Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) is a 7-item self-report scale developed to identify pain which is of predominantly neuropathic origin. The aim of this study was to develop a Malayalam version of the LANSS and to test its validity and reliability in chronic pain patients. Methodology: We enrolled 101 Malayalam-speaking chronic pain patients who visited the Division of Palliative Medicine, Regional Cancer Centre, Thiruvananthapuram, Kerala, India. The translated version of S- LANSS was constructed by standard means. Fifty-one neuropathic pain and fifty nociceptive pain patients were identified by an independent pain physician and were subjected to the new pain scale by a palliative care nurse who was blinded to the diagnosis. The “gold standard diagnosis” is what the physician makes after clinical examination. Its validation, sensitivity, specificity, and positive and negative predictive values were determined. Results: Fifty-one neuropathic pain and fifty nociceptive pain patients were subjected to the Malayalam version of S-LANSS pain scale for validity testing. The agreement by Cohen's Kappa 0.743, Chi-square test P < 0.001, sensitivity 89.58, specificity 84.91, positive predictive value 84.31, negative predictive value 90.00, accuracy by 87.13, and likelihood ratio 5.94. Conclusion: The Malayalam version of S-LANSS pain scale is a validated screening tool for identifying neuropathic pain in chronic pain patients in Malayalam-speaking regions.

SummaryRadiation induces a variety of changes in the airway that can potentially lead to difficult intubation. Osteoradionecrosis (ORN) of the mandible, a severe consequence of radiotherapy for head and neck malignancies can cause a reduction of the ‘mandibular space’ and alteration of the morphometric measurements, viz. thyromental distance, hyomandibular distance, anterior mandibular length and posterior mandibular length, that usually predict difficult intubation. A case of osteoradionecrosis of the mandible presenting for elective surgery under general anaesthesia is presented. The primary intention of this article is to focus awareness amongst anaesthesiologists on the myriad of airway problems to be anticipated in cancer patients who present for surgery after radiotherapy.

Nasal endoscopy is a valuable adjunct to the localization of the sphenopalatine ganglion. Twenty-two patients with advanced malignancies of the head and neck region whose pain was not adequately controlled with conventional medications, including oral morphine, were given nasal endoscopically guided neurolytic sphenopalatine ganglion block with six per cent phenol after a prognostic block with local anaesthetic solution. Seventeen patients had good immediate relief. One had partial relief and four had inadequate relief. On follow-up for one month, the patients had significantly lower pain intensity and the pain was more manageable with oral medication. The vicious cycle of pain was broken. This block is relatively safe and can be usefully performed as an out-patient procedure.

BACKGROUND: The pressure half time (PHT) method is unreliable for measurement of mitral valve area (MVA) immediately after valvotomy. The proximal isovelocity surface area (PISA) method has been used to derive mitral valve area in patients with mitral stenosis. The aim of our study was to compare PISA method and PHT method in patients undergoing percutaneous balloon mitral valvotomy (BMV). METHODS: The PISA was recorded from the apex and MVA was calculated using continuity equation by the formula 2pir(2) Vr/Vm, where 2pir(2) is the hemispheric isovelocity area, Vr is the velocity at the radial distance "r" from the orifice, and Vm is the peak velocity. A plain angle correction factor (theta)/180 was used to correct the inlet angle subtended by leaflet tunnel as a result of leaflet doming. RESULTS: MVA calculated using PISA method (r = 0.5217, P < 0.0001, SE = 0.016) and PHT (r = 0.6652, P < 0.0001, SE = 0.017) correlated well with 2D method in patients with mitral stenosis before BMV. After BMV, MVA by PISA method correlated well with 2D planimetry (r = 0.5803, P < 0.0001, SE = 0.053) but PHT showed poor correlation (r = 0.1334, P = 0.199, SE = 0.036). The variability of measurement of MVA was most marked with PHT method in the post-BMV period. CONCLUSION: The PISA method correlates well with 2D planimetry in patients with mitral stenosis before and after BMV and is superior to the PHT method in the post-BMV period where the latter may be unreliable.

Twenty-one eases of laryngectomy/laryngopharyngectomy that required primary reconstruction with P. M. M. C flaps at the Division of Surgical Oncology, Regional Cancer Centre, Triyandrum were studied retrospectively from July 1995 to December 2090 and compared with the in cases where primary closure of the neopharynx was done.Four of the 21 cases developed post operative pharyngocutaneous fistulae PCF(I9%) which healed Complefely within an average period of I week compared to 4 PCFs (40%) after primary closure. (n=10), where the average healing time was 12.5 days, with I recurrence. The average duration of Onset of fistula was relatively earlier in cases that required primary closure (II days) compared to those cases where P. M. M. C flap was used for reconstruction (12.5 days). All complications were Wound related and managed conservatively.

Thoracic minimally invasive procedures may produce certain life threatening complications perioperatively. Vigilent monitoring, prompt diagnosis and timely intervention are very important to reduce morbidity and mortality in such surgeries.

Fatigue is a common symptom of advanced cancer limiting one's activity and affecting the quality of life. It is a multidimensional symptom complex with subjective and objective components. Hence, its definition and assessment seems arbitrary, incomplete, and elusive. Components of fatigue often merge with other 'disease states' as anemia, depression and so on, compounding difficulty to assess it separately. Fatigue has a high prevalence rate, and lasts longer in chronic diseases like cancer. Its association with treatment modalities like chemotherapy, radiotherapy alongside the primary disease process makes it seemingly ubiquitous in many cases. Systemic manifestation of cancer causes excess demand on body resources on cell repair, uncontrolled growth with metabolite accumulation causing fatigue. Co-morbid conditions of organic and psychological nature causes fatigue. There are many assessment tools for fatigue with different uses and objectives, simple and reproducible tools like Brief Fatigue Inventory, Edmonton Symptom assessment scale seem feasible in everyday practice. Management of fatigue is not straightforward and rewarding. Although treatment of cause appears to be an attractive option, it is not possible in all cases. Therapeutic agents targeting cytokine load is in early stages of study and available results are not favorable. Specific measures aimed at pain relief, prevention/treatment of sepsis, management of depression, avoidance of drugs causing fatigue, restoring the metabolic profile are important. Methyl phenidate, megestrol, and modafinil are some drugs with promising effect to treat fatigue, though confirmatory studies are yet to be established. Non-pharmacological methods are also helpful. Forewarning patients on upcoming fatigue, active regular exercise, and stress management are some of them. Fatigue being a multidimensional entity, single mode of therapy is insufficient. Combined modality tailored to individual patient need and understanding may be the right way to battle this ill-understood symptom. This review article examines the etiopathogenesis and management strategies of fatigue in cancer.