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Empagliflozin has a demonstrated cardiovascular benefit. It is co-prescribed as a glucose-lowering medication in patients with type II diabetes mellitus. Herein, we discuss dual-emergency side-effects, Fournier's gangrene (FG) and diabetic ketoacidosis with lower-than-anticipated glucose levels in a patient on Empagliflozin, a sodium-glucose transport protein 2 inhibitor (SGLT-2i). The pathophysiologic mechanism of FG in correlation with SGLT-2i is not yet elucidated. SGLT-2i increase predisposition to genital mycotic and urinary infections, a mechanism favouring FG. A patient with type II diabetes mellitus on SGLT-2i presented with acute necrotic infection of the scrotum and simultaneous diabetic ketoacidosis with lower-than-anticipated glucose levels. This dual emergency was managed with debridement and medical treatment on lines of diabetes ketoacidosis, respectively. A re-look at this group of glucose-lowering medications from bedside towards benchtop research may help to prod into any other mechanistic basis of these life-threatening clinical occurrences.

Background: Knowledge of basic and advanced cardiac life support is of paramount significance amongst health care professionals to attain higher survival rate of patients suffering from sudden cardiac death. Objectives: To determine the awareness and knowledge for performing high quality CPR amongst junior resident doctors in a tertiary care hospital. Methods: In a prospective cross-sectional study, 220 preformed questionnaires were distributed amongst the interns, postgraduate and non-postgraduate junior resident and senior resident doctors, with a response rate of 69% (n-152). Data on the responders awareness of cardipulmonary resuscitation (CPR), core knowledge of basic life supoort (BLS) and advanced cardiac life supoort (ACLS) were collected. Data was subjected to descriptive and inferential statistical analyses using SPSS version 23.0 and was expressed as mean ± standard deviation or in percentage. A p-value ≤ 0.05 was considered as significant level. Results: Among the 152 responders, 31(20%) were interns, 74(49%) were postgraduate course junior residents (PG JR), 7(5%) were non- post-graduate course (Non-PG JR) and 40 (26%) were senior resident (SR) doctors. Only 24% (n-36) of doctors have done previous certified CPR training course. The awareness of resuscitation amongst all doctors was 71% and observed highest amongst the PG JRs 73%. The core knowledge of BLS and ACLS was only 47% and 44% respectively, amongst all doctors. Conclusion: Majority of resident doctors have limited knowledge of basic concept of BLS and ACLS guidelines. A well structured and evidence based format of CPR training should be incorporated in training modules for better outcome.

Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20–30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.

Introduction: Dipeptidyl peptidase-4 are a relatively new class of oral antihyperglycemic agent that enhance insulin secretion by reducing degradation of endogenous glucagon-like peptide 1. Currently, sitagliptin, vildagliptin, saxagliptin, linagliptin and alogliptin are approved in India, USA and Europe for the use in patients with type 2 diabetes. In this study we have tried to assess the safety of saxagliptin used in patients of type 2 DM who were previously on metformin monotherapy. Materials and Methods: A total of 35 patients who were previously on metformin montherapy with uncontrolled diabetes were enrolled. Patients were started with saxagliptin (2.5 mg OD) and were followed up at 1st, 3rd and 6th months for the estimation of Liver Function Test (SGOT, SGPT, Bilirubin direct & indirect), Renal Function Test (BUN and Sr. Creatinine). During the follow up period patients were also assessed for the adverse drug reactions. Results: Male and female patients mean age SD (61.42 yrs 6.99 and 55.93 yrs 5.74 respectively). The mean significant decrease in values from baseline at 24 weeks were seen for SGOT, SGPT, Blood urea nitrogen and serum creatinine. Conclusion: The combination of saxagliptin plus metformin for the treatment of type 2 diabetes offers an oral treatment regimen that is safe and well tolerated. Keywords: Saxagliptin, Uncontrolled type 2DM safety knee arthralgia.

Background and Aims: The Air-Q blocker (Cook gas LLC, Mercury Medical, Clearwater, FL, USA) is a relatively new supraglottic airway device (SAD) with capability to serve as a conduit for intubation. As there is limited data on Air-Q blocker, the present study was performed to compare the efficacy of Air-Q blocker and Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. Methods: A total of 90 American Society of Anesthesiologists (ASA) physical status I and II patients were randomly allocated to Air-Q blocker or PLMA group. Oropharyngeal leak pressure (OLP), insertion success, insertion time, ease of orogastric tube (OGT) insertion, fibreoptic visualisation of the glottis, haemodynamic and ventilation parameters, and complications at emergence and postoperatively were investigated. Results: OLPs were higher in PLMA group as compared to Air-Q blocker group (P = 0.002). Still, the OLP (27.5 ± 5.8 cm H2O) was clinically effective in Air-Q blocker group. The mean time for successful insertion was significantly shorter for Air-Q blocker than PLMA (P = 0.019). The number of attempts to insert both the devices was comparable (P ≥ 0.05). Air-Q blocker provided a significantly better fibreoptic score than PLMA (P = 0.038). The two groups were comparable in terms of ease of OGT insertion, haemodynamics and ventilation parameters, and complications at emergence and postoperatively. Conclusions: Air-Q blocker provides a clinically effective OLP though PLMA provides a slightly better sealing function in patients undergoing laparoscopic and non-laparoscopic surgeries under general anaesthesia requiring neuromuscular blockade. Air-Q blocker has shorter insertion time and a better fibreoptic view of glottis as compared to PLMA.

Introduction and Aims: Prognostic indices are infrequently practiced in surgical intensive care units (SICU) of Indian tertiary care hospitals to assess the overall outcomes. Simplified Acute Physiology Score 3 (SAPS 3) prognostic system is now practiced globally and comprises easily measurable parameters on admission of patient in intensive care unit (ICU).The objective of the present study was to evaluate SAPS 3 index as a predictor of mortality in postoperative critically ill surgical patients admitted to ICU in a northern Indian setup. Materials and Methods: This prospective observational study was performed in the ICU of a tertiary hospital in northern India. SAPS 3 global model was applied to measure the predicted ICU mortality. Standardized mortality ratio (SMR) was computed by comparing the observed and predicted mortality rates. To predict ICU mortality the discrimination and calibration properties of the SAPS 3 index were analysed. Data were prospectively collected at the time of admission of surgical patients in ICU. Estimated mortality rates were measured by SAPS 3 scores. Discrimination was estimated by area under receiver operating characteristic (AUROC) curves. Calibration was interpreted by Hosmer-Lemeshow goodness-of-fit C-statistic test to appraise the agreement between observed and expected number of survivors and non- survivors in alliance to the probability of death. In this analysis, P > 0.05 denotes good test adjustment. Results: A total of 55 postoperative patients were included over 3 months period. The observed ICU mortality was 17.1%. Standardised mortality ratio (SMR) was 1.07. The SAPS 3 score of 42 showed sensitivity and specificity of 83.3% and 45.8% respectively. SAPS 3 global index had fair discrimination with an area under the receiver operating characteristic curve (AUROC) of 0.743 (CI 0.55-0.93). Patient calibration by Hosmer-Lemeshow test displayed good adjustment (P -0.388 and X2 -6.32). Conclusion: This group of postoperat

Objective The Gnana Laryngeal Airway (GLA) device, a novel supraglottic airway device, is similar to the LMA-Classic in basic design, but with an additional suction port on the convex portion of the laryngeal mask to remove the saliva. We evaluated the GLA device in terms of ease and time to insertion, the number of attempts, oropharyngeal leak pressure (OLP), correct placement, and complications in adult patients undergoing elective surgical procedures. Methods After general anaesthesia, the GLA device was inserted in ASA Class I–II consecutive patients aged 18–60 years, who were scheduled for elective surgeries lasting

Introduction: Type 2 diabetes affects millions of people worldwide and significantly contributes to morbidity and mortality of those affected by it. Current guidelines recommend individualized treatment regimens following first line metformin therapy. Saxagliptin, a dipeptidyl-peptidase 4 inhibitor, provides a secondary mechanism of action to decrease hyperglycemia when used in combination with metformin. In this study we have tried to assess the efficacy of saxagliptin in patients of type 2 DM. Materials and Methods: A total of 35 patients were enrolled who were on metformin monotherapy and with uncontrolled diabetes. Patients were given saxagliptin 2.5 mg once a day. Patients were followed up at 1st, 3rd and 6th month and HbA1c, FPG and 2h-PG estimation was done during the follow up period. Results: The mean age SD in male and female patients was 61.42 yrs 6.99 and 55.93 yrs 5.74 respectively. The mean change in value from baseline at 24 weeks was 10.7%, 16.48% and 21.63% for HbA1c, FPG and 2h-PG respectively and 20% of patient had achieved HbA1c Conclusion: Saxagliptin has shown an improvement in glycemic index (HbA1c, FPG, 2h-PG) during 6 months of treatment in patients of type 2 DM. Keywords: Saxagliptin, Uncontrolled type 2DM, Efficacy.

Introduction: Diabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. This study is an attempt to show an improvement in lipid profile (TC, TG, LDL and HDL) in patients of type 2 diabetes mellitus who were previously on metformin monotherapy with uncontrolled diabetes. Material and method: A total of 30 patients were enrolled who were on metformin monotherapy and with uncontrolled diabetes. Patients were given metformin 500 mg twice a day and saxagliptin 2.5 mg once a day. Patients were followed up at 1st, 3rd and 6th month and lipid profile (TC, TG, LDL and HDL) estimation was done during the follow up period. Results: The mean age ± SD in male and female patients was 61.42 yrs ± 6.99 and 55.93 yrs ± 5.74 respectively. The mean change in value from baseline at 24 weeks was TC = 9.66%, TG = 9.40%, LDL = 14.87%, HDL = 5.63%. A highly significant difference has been seen at 0 v/s 1, 0 v/s 3 and 0 v/s 6 months in TC, TG, LDL and HDL values. Conclusion: Saxagliptin has shown an improvement in lipid profile (TC, TG, LDL, HDL) during 6 months of treatment in patients of type 2 DM. Keywords: Saxagliptin, Uncontrolled type 2DM, Metformin, Lipid profile.

Pandemic of coronavirus disease 2019 (COVID-19) has generated immense viral exposure risk among frontline health care providers (HCPs), especially due to aerosol-generating events and procedures. This further increased the risk of serious mental health disorders amongst them. Hitherto, there is lack of any specific safety protocol specially during the pre- and post-exposure period for HCPs, who provide direct clinical care to patients suffering from COVID-19. We propose a four-phase checklist approach, which may help them in mental preparedness as well as organizing themselves prior and following virus exposure in clinical postings and may enhance the safety standards. The checklist comprises simple steps and may work as a documented track record of precautionary and preventive measures which must be followed by HCWs working in dedicated COVID-19 hospitals.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are the second line of therapy in diabetes mellitus type 2. They are frequently coprescribed with other noninsulin glucose-lowering medications. Diabetic ketoacidosis (DKA) with lower-than-anticipated glucose levels is an important SGLT2i-related adverse effect in postoperative patients. This case highlights the need for increased postoperative surveillance of patients on this group of medications. Ketonuria was managed with short-acting insulin infusion with dextrose-containing intravenous fluid, as a part of the ongoing intensive care treatment to which the patient responded well. Awareness of DKA with lower-than-anticipated glucose levels is an important clinical challenge, an entity that can be confused in the setting of major and complex surgeries. The frequency of this arcane and underreported diagnosis in the perioperative setting is unknown. How to cite this article: Vadi S, Lad V, Kapoor D. Perioperative Implication of Sodium-glucose Cotransporter-2 Inhibitor in a Patient Following Major Surgery. Indian J Crit Care Med 2021;25(8):958–959.

Background: The aim of the study was to compare the ease the intubation using GlideScope video laryngoscope and Macintosh laryngoscope in adult patients undergoing elective surgery under general anesthesia. Materials and Methods: A total of 200 American Society of Anesthesiologists I–II patients of either sex, in the age group of 18–60 years were included in the study. Patients were randomly allocated to two groups. We assessed ease of intubation depending on time to tracheal intubation, number of attempts, glottic view (Cormack–Lehane grade [CL grade] and percentage of glottis opening [POGO]) and intubation difficulty score (IDS), hemodynamic variables and any intra- and post-operative adverse events. Results: The rate of successful endotracheal intubation (ETI) in both groups was 100% in the first attempt. The time required for successful ETI was 24.89 ± 5.574 in Group G and 20.68 ± 3.637 in Group M (P < 0.001) found to be statistically significant. There was significant improvement in glottic view with GlideScope (as assessed by POGO score 66.71 ± 29.929 and 94.40 ± 10.476 in group G and 75.85 ± 26.969 and 74.20 ± 29.514 Group M and CL grading [P < 0.001]). A comparison of mean IDS between two groups revealed intubation was easier with the use of GlideScope. The hemodynamic response to intubation was significantly lesser with the use of GlideScope when compared with Macintosh laryngoscope. The incidence of adverse events, though minor like superficial lip or tongue bleed, was similar in two groups. Conclusions: GlideScope offers superiority over Macintosh laryngoscope in terms of laryngeal views and the difficulty encountered at ETI in an unselected population.

What is known and objective Linezolid, a member of the oxazolidinone class of antibacterial drugs, is approved by the US Food and Drug Administration (FDA) for the treatment of vancomycin-resistant Enterococcus faecium infections, nosocomial and community-acquired pneumonia, as a part of anti tubercular regimen and complicated and uncomplicated skin and soft tissue infections, including diabetic foot infections. Linezolid has potential adverse effects like bone marrow suppression, peripheral neuropathy and hyponatremia. One of the extremely rare reported adverse effects of the drug is hypoglycaemia. We present a case of Linezolid toxicity presenting as resistant hypoglycemia, bone marrow suppression and severe hyponatremia all together in a single patient. Case description We present a case of an 82 years old gentleman with no known chronic co-morbidities. He was started on Linezolid 600 mg twice a day for 10 days by a local doctor possibly for some minor infection post hip surgery. He was in respiratory distress on arrival. Blood sugars showed severe hypoglycemia of 36 mg/dL (2.0 mmol/L). He was admitted in intensive care unit and started on injectable antibiotics and 5% dextrose infusion and sugars were strictly monitored. His blood tests revealed severe hyponatremia with sodium level of 119 mEq/L and haemoglobin (Hb) of 8.8 gm/dL, leucocytes of 6500/µL, platelets of 82 000/µL. The infection markers were normal throughout. The platelet count went progressively down from 82 000/µL on admission to 20 000/µL 2 days later; before it started rising back. Similarly there was drop in Hemoglobin and white cell counts. He required vasopressors to maintain mean arterial pressures. The blood sugar levels stabilized after the same. However patient had suffered acute lung injury secondary to aspiration and became NIV dependent and eventually passed away. What is new and conclusion Our case was unique in a way that our patient had adverse effects of linezolid like myelosuppression as well as the rare side effects of hypoglycemia at the same time. This combination of adverse events has never been described in the past to our knowledge. All the adverse effects responded to antibiotic de-challenge in our case. We had ruled out the possibility of other causes of Hypoglycemia such as sepsis, insulinoma, alcohol excess, malnutrition or hypoadrenalism. We searched the PubMed database and found four case reports out of which two were diabetics and other two were non diabetics. Out of 15 cases described by Vishwanathan et al only three cases were non diabetics. Our patient was non diabetic as well. Therefore our case is only the sixth reported case of hypoglycemia in non diabetic receiving Linezolid to our knowledge.

Context: Aluminum phosphide (ALP) is a highly toxic agricultural fumigant pesticide commonly implicated in poisoning. Aim: The aim of the study was to study the profile of patients presenting with ALP poisoning in Dr. RPGMC Kangra, Tanda, Himachal Pradesh. Settings and Design: This was a retrospective study conducted in the Department of Medicine at Dr. RPGMC Kangra, Tanda, Himachal Pradesh, from August 2011 to January 2014. Material and Methods: Case record forms of 117 patients were reviewed and analyzed. Data were collected for sociodemographic and clinical parameters. Outcome of patients was recorded as expired and improved. All the patients were managed symptomatically. Statistical Analysis: Statistical analysis was performed using SPSS version 15. P < 0.05 was considered statistically significant. Results: Out of the total 117 patients included in the study, 61 (52.1%) were males and 56 (47.1%) were females. Mean age ± standard deviation of presentation was 30.9 ± 12.2 years. About 70% of the patients were from rural background. Out of the total 117 patients, 68 (58.1%) patients had expired and 49 (41.9%) had improved. Most of the patients in the expired group consumed ALP in tablet form (54.7% of the total). Nearly 57% of the patients had leukocytosis at presentation and

Background and aims: Ambu Aura-i was compared with Fastrach™ (FT)-laryngeal mask airway (LMA) as a conduit for tracheal intubation. Material and Methods: A hundred consenting patients were randomly allocated into two groups of 50 patients each in a prospective randomized study. Standard anesthesia technique was used for all patients and FT-LMA or Ambu Aura-i was selected. After insertion of airway device, the cuff was inflated and ventilation was attempted. Once satisfactory ventilation was achieved, with or without maneuvers, a fiberoptic scoring for glottis view was noted. A polyvinylchloride (PVC) tracheal tube of appropriate size was inserted through the airway device as per procedure. If no resistance was felt while advancing the tracheal tube, it was fully inserted into the device and tracheal tube cuff was inflated. The device was removed and tracheal tube was left in situ. If the first attempt failed during tracheal tube insertion, the recommended maneuvers were used. A maximum of three attempts were allowed for intubation. First attempt for tracheal intubation attempt was a blind, second attempt was made with maneuver. If second attempt of intubation was unsuccessful, fiberoptic-guided intubation was performed as a third attempt. When tracheal intubation was unsuccessful, it was performed by direct laryngoscopy and considered as failed intubation. Rest of the anesthesia management was as per the discretion of attending anesthesiologists. The success rate of device insertion, fiberoptic score of glottis view, tracheal intubation via FT-LMA or Aura-i and time were recorded. Results: Both FT-LMA and Aura-i were successfully placed within two attempts. The success rate of blind intubation was 92% in FT-LMA and 76% in Aura-i (P < 0.01). Time taken for tracheal intubation at first attempt was lesser in group FT-LMA and Aura-i, respectively (P < 0.01). Fiberoptic-guided intubation success rate was higher with Aura-i than with FT-LMA. Conclusions: FT-LMA had a higher success rate in facilitating blind tracheal intubation compared with Ambu Aura-i.

Introduction: Genital mycotic infections are common among patients with poorly controlled diabetes. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) induced pharmacological glycosuria increases the risk of these infections (2–3 fold) among patients with type 2 diabetes (T2D). The data about incidence of these infections in Indian setting is unclear. Aim: To study the prevalence of genital mycotic infections caused by SGLT2i among Indian patients with T2D. Materials and Methods: We collected data of 205 patients with T2D on SGLT2i for more than 1-month duration. Patients with symptoms and/or signs suggestive of genital mycotic infections and who had positive response to antifungal treatment were considered to have infection. Data were collected for a period of 2 months from July to August 2017. Results: Among 205 patients, mean age was 52.4 ± 8.7 years and percentage of females was 52.2%. Among SGLT2i, empagliflozin, canagliflozin and dapagliflozin were prescribed to 50.7%, 30.2% and 19.1% patients, respectively. The mean duration of treatment with SGLT2i was 7.6 ± 5.9 months. At least, one episode of genital mycotic infection occurred in 53 (25.9%) patients and 25 (12.2%) had second episode. Incidence of these infections was marginally higher in females than males with no statistically significant difference (P = ns). There was no significant correlation between age, sex, duration of disease, duration of treatment, glycaemic control, type and dose of SGLT2i used with the incidence of genital mycotic infections (P = ns). The patients who had knowledge of side effects of the drug and observed precautions had significantly lesser incidence of infections (P < 0.001). Majority of the infections were mild in nature and responded well to treatment. Conclusion: There is a very high risk of genital mycotic among Indian patients with T2D on SGLT2i. All patients should be educated about the risk of genital mycotic infections when on SGLT2i and precautions needed to minimise the risk.

Background Diabetes mellitus (DM) causes serious deterioration in general quality of life (QoL) mainly affecting the health-related quality of life (HRQOL). Routine assessment of QoL improves communication with the patient, helps to predict treatment response, and supports clinical decision-making. QoL can predict an individual's capacity to manage the disease and maintain long-term health and wellbeing. Aims To find out the QoL and its socio-demographic, anthropometric, and clinical determinants among DM patients attending health institutions from sub-Himalayan region, catering rural population. Settings and design This cross-sectional study was conducted in two hospitals mostly catering rural population from 2014 to 2018. Purposive sampling technique was used. Materials and methods Socio-demographic, anthropometric, and clinical data of DM patients (N = 300) were collected. They were administeredHindi translation of QoL Instrument for Indian Diabetes Patients (QOLID) and Patient Health Questionnaire-9 (PHQ-9). All statistical analyses were carried out using Statistical Package for Social Sciences (SSPS) (Version 17.0, USA). Results About 10% had very poor, 13% poor, 11% average, 16% good, and 50% very good QoL on QOLID. General health (GH) and treatment satisfaction (TS) were the most affected domains. Fatigue was the most common symptom (79%) reported in QOLID. Age more than 55 years, rural background, and PHQ-9 score of more than 7 were predictors of poorer QoL. Conclusion There is a need for a holistic and collaborative care of DM patients, to maintain a good HRQoL. Screening of depression, fatigue, and regular assessment of QoL should be emphasized.

Human diversity plays a crucial role in the contemporary themes of social justice. A positive recognition of disability has become a part of the inescapable human diversity that enriches our experience. Every civilized society therefore, must provide for adequate physical and financial resources for the education and rehabilitation of the disabled so that they can enjoy a life of freedom, self respect and take active part in social life. The present study is an attempt to understand the current scenario of the available services for the disabled in the state of Jammu & Kashmir.

The single-use LMA Supreme (Teleflex, Inc., Wayne, PA, USA) and the LMA ProSeal (Teleflex, Inc., Wayne, PA, USA) laryngeal mask airway (LMA) have similar characteristics. To date, studies have not achieved a consensus regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme and LMA ProSeal, and there is little information on their efficacy in laparoscopic cholecystectomy. This study compared the safety and efficacy of the LMA Supreme and LMA ProSeal devices in patients undergoing laparoscopic cholecystectomy.Eighty-four eligible consenting patients were randomly allocated to the LMA Supreme group or the LMA ProSeal group. Both groups received the standard anesthesia technique. The Supreme or ProSeal LMA was inserted, the cuff was inflated to 60 cmH2O, and the LMA position was confirmed. Anesthesia was maintained using propofol and 50% oxygen in air. A gastric tube was inserted through the drain tube of the LMA to deflate the stomach, and the first attempt success rate and insertion time were recorded. During surgery, the intra-abdominal pressure was maintained at 12 mmHg. The fiberoptic view of the larynx was determined by passing a flexible fiberoptic bronchoscope. The OLPs, success rate, insertion time, hemodynamic and respiratory parameters, and complications were recorded at different time points.The mean OLP was significantly lower in the LMA Supreme group than in the LMA ProSeal group (24.9 ± 5.3 cmH2O vs. 28.4 ± 5.8 cmH2O; p 0.01). The first attempt success rate and ease of insertion grading for LMA were higher in the Supreme group. The insertion time was lower in the Supreme group than in the ProSeal group (p 0.01). The fiberoptic view was better with the ProSeal LMA. The hemodynamic and ventilatory parameters and postoperative sore throat were comparable in both groups.The LMA ProSeal has a higher OLP than the LMA Supreme. The success rate of first attempt insertion and ease of insertion were better for the LMA Supreme group and the insertion time was lower in the LMA Supreme group. The Supreme and ProSeal LMAs were both effective for positive pressure ventilation in laparoscopic cholecystectomy.

Dexmedetomidine, an α2 agonist, has been evaluated for its hypnotic, analgesic, and anxiolytic properties in the intraoperative period and critical care setting. However, data on the effect of dexmedetomidine on attenuation of pressor response to direct laryngoscopy and tracheal intubation are limited. We studied the effect of a single preinduction intravenous dose of dexmedetomidine of 0.5 μg/kg on hemodynamic responses to tracheal intubation, and dose requirements of anesthetics for induction and their adverse effects.Eighty adult patients scheduled for elective surgery under general anesthesia requiring tracheal intubation were included. Patients were randomized into two groups: dexmedetomidine and placebo (n = 40 each). The study drug was administered intravenously over a period of 10 minutes prior to induction. Direct laryngoscopy and endotracheal intubation were performed. Hemodynamic parameters, the total dose of propofol, and adverse effects were recorded during induction and postintubation periods for 15 minutes.The maximum percentage increase in the heart rate after intubation was 19.6% less in the dexmedetomidine group than that in the placebo group (12.96% vs. 32.57%). The maximum percentage increases in systolic blood pressure, diastolic blood pressure, and mean blood pressure after intubation were significantly lower in the dexmedetomidine group than in the placebo group (12.38% vs. 45.63%, 19.36% vs. 60.36%, and 15.34% vs. 50.33%, respectively). There was a significant reduction of the mean total dose of propofol required for induction, 1.04 mg/kg in the dexmedetomidine group versus 2.01 mg/kg in the placebo group (p 0.001). No serious side effects or adverse reactions were observed in either group.Administration of a single preinduction intravenous dose of dexmedetomidine of 0.5 μg/kg resulted in significant attenuation of the rise in the heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure, until 5 minutes postintubation. It significantly reduced the dose requirements of propofol for induction and caused minimal side effects.