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Background, Aims and Objectives: Shivering is a common problem in obstetric patients undergoing cesarean section under spinal anaesthesia and its incidence is approximately 30% to 55%. Aim of our study was to compare the efficacy of intravenous Dexmedetomidine, intravenous Tramadol with placebo in prevention of post-spinal anaesthesia shivering in obstetric patients undergoing caesarean section. Secondary objective was to observe any side effects like nausea, vomiting, hypotension, bradycardia and sedation. Materials and methods: This prospective, randomized, and double-blinded study was conducted in the department of Anaesthesia, PGIMS, Rohtak . 126 Healthy pregnant women, 20-40 years of age, without any comorbid conditions requiring caesarean section under spinal anaesthesia were enrolled for the study and randomly allocated into one of the three groups according to computer generated randomisation . Group A (n=41) received 0.5 mcg/kg Dexmedetomidine, Group B (n=43) 0.5 mg/kg Tramadol and Group C (n=42) plain 100 mL normal saline IV infusion after spinal anaesthesia and delivery of baby. Shivering, sedation, blood pressure, heart rate was measured intraoperatively. Result: All data were summarised as mean ± SD for continuous variables, numbers and percentages for categorical variables. There was a significant difference between the various groups in terms of distribution of Incidence of Shivering (χ2 = 48.199, p-value < 0.001) . 9.8% (n=4) of the participants in the Group A, 53.5% (n=23) of the participants in the Group B, and 85.7% (n=36) of the participants in the Group C had shivering. Conclusion: This study showed dexmedetomidine as a better drug for the prevention of shivering after spinal anaesthesia as compared to tramadol as it has a low incidence of shivering, benefits of awake sedation and not associated with nausea and vomiting. [ABSTRACT FROM AUTHOR]

Introduction: The assessment of seal pressure or leak pressure in supraglottic devices has commonly been used to confirm device functionality and for research purposes regarding laryngeal mask airways (LMAs). When used for controlled ventilation, the LMA Protector provides a better oropharyngeal seal pressure. Materials and Methods: In this cross-over study, thirty-five patients of either sex, aged 18 to 70 years, American Society of Anaesthesiology (ASA) class I and II, with a weight range of 50-70 kg, scheduled for elective surgery under general anaesthesia where a supraglottic airway device was indicated, were enrolled. In all 35 patients, the position of the patient's head and neck was changed from neutral to flexion, extension, and right and left lateral rotation. The primary objective of the study was to compare the differences in oropharyngeal leak pressure (OLP) with changes in head and neck positions using the LMA Protector airway device. Results: The mean age of the participants was 42.26 years, and the average weight was 63.34 kg. The LMA Protector was placed in 18 females and 17 males. A Mallampati grade of I was noted in 16 patients, while a grade of II was observed in 19 patients. The OLP achieved in this study was higher, providing adequate ventilation and oxygenation in all positions. The OLP and tidal volume in flexion were higher compared to the seal pressure in the neutral position (31.89 cm H2O, SD 5.080 cm H2O vs. 34.49 cm H2O, SD 4.804 cm H2O, p<0.05). No significant difference in OLP was observed when changing to different head positions, i.e., in extension, right lateral, and left lateral positions. Conclusion: The LMA Protector is an effective device in terms of achieving high oropharyngeal seal pressure. It produced better oropharyngeal seal pressure in the flexion position compared to the neutral position. [ABSTRACT FROM AUTHOR]

The article is devoted to monitoring the condition of the respiratory tract during general anesthesia, which is the most important duty of an anesthesiologist. Despite advances in airway monitoring devices, rigid laryngoscopy and intubation remain preferred methods. Airway treatment during intubation causes a hemodynamic reaction due to stimulation of the upper respiratory tract, which leads to an increase in catecholamine levels, which leads to hypertension, tachycardia and rhythm disturbances. This reaction reaches its maximum immediately after intubation and usually lasts 5-10 minutes. Despite the successful use of both nitroglycerin for intravenous administration and magnesium sulfate for this purpose, there is currently no direct comparison of these two drugs in the literature with respect to attenuation of hemodynamic changes during laryngoscopy and intubation. Therefore, our research is aimed at conducting such a comparative study. The study was a double-blind, prospective, randomized study involving sixty patients aged 18 to 60 years who were scheduled for surgery requiring general anesthesia and endotracheal intubation, with the status of asa I and II.Both intravenous administration of MgSO4 (30 mg/kg) and NTG (1 mcg/kg) were effective in attenuating the pressor reaction caused by laryngoscopy and endotracheal intubation. However, MgSO4 was significantly superior to NTG in reducing heart rate. [ABSTRACT FROM AUTHOR]

Background: The incidence of nausea and vomiting following laparoscopic cholecystectomy is very high. 5-hydroxytryptamine receptor antagonists are drug of choice for prevention of post-operative nausea and vomiting (PONV) because of their good efficacy and very few side effects in comparison to other antiemetics. Aims and Objectives: This study was undertaken to compare the efficacy and safety of intravenous ramosetron 0.3 mg and ondansetron 8 mg for prevention of PONV in patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: One hundred patients between 18 and 70 years of age with American Society of Anesthesiology Grade I and II scheduled for elective laparoscopic cholecystectomy were randomly divided into two groups of 50 patients each. Group A patients were given injection ondansetron 8 mg and Group B patients were given injection ramosetron 0.3 mg approximately 5 min just before the induction of general anesthesia. Results: Difference in Nausea, vomiting/retching, and PONV score assessed at 4, 8, 12, and 24 h interval postoperatively in both groups was found to be statistically insignificant (P>0.05). The severity of nausea was assessed by visual analogue scale at various time intervals and use of rescue antiemetics in both the groups were found statistically insignificant. Incidence of side effects was also comparable in both the groups. Conclusion: Ramosetron and ondansetron are equally effective for prevention of PONV in patients who underwent elective laparoscopic cholecystectomy under general anesthesia when used prophylactically. Both drugs are safe and have low incidence of side effects. [ABSTRACT FROM AUTHOR]

A primary concern for anesthesiologists is the maintenance of oxygenation during general anesthesia. Extending the safe apnea time, which is the time from the onset of apnea until the oxygen saturation concentration reaches 90% or less, increases the margin of safety with tracheal intubation. Preoxygenation before anesthetic induction has been a widely accepted manoeuver to increase oxygen reserves and hence delay the onset of arterial desaturation during apnea. This study aimed to evaluate the efficacy of pressure support ventilation with/without positive end-expiratory pressure (PEEP) for preoxygenation in adult patients. A total of 132 patients, aged 20 to 50 years, scheduled for elective surgery under general anesthesia, requiring endotracheal intubation, were included and randomly divided into three groups (n = 44 per group): spontaneous ventilation (SV), pressure support ventilation without PEEP (PS), and pressure support ventilation with PEEP (PEEP) groups. In the SV group, the patients breathed spontaneously without any support using a face mask; in the PS group, the patients breathed spontaneously with the inspiratory pressure support of 12 cm H2O without PEEP; and in the PEEP group, the patients were subjected to preoxygenation (similar to the PS group) with PEEP at 6 cm H2O. Preoxygenation was terminated when the fraction of expired oxygen reached 90% and the duration was recorded. Time from 90 seconds after administration of rocuronium bromide until oxygen saturation fell to 93% was recorded and taken as safe apnea time. The time taken for preoxygenation (the expired oxygen fraction reaches 90) was significantly shorter in patients of PEEP and PS groups when compared to the SV group. The safe apnea time was significantly longer in patients of PEEP and PS groups compared with the SV group. Application of inspiratory pressure support of 12 cm H2O and PEEP of 6 cm H2O during preoxygenation significantly reduces the preoxygenation time and prolongs the safe apnea time compared with conventional preoxygenation. [ABSTRACT FROM AUTHOR]

Background-Respiratory symptoms are not uncommon in thyroid diseases and can be overlooked and misdiagnosed as acute exacerbation of asthma or COPD. Case report- A 58 years old female presented to emergency department with complaints of fever, shortness of breath from last 3–4 days for which she intubated in emergency department and shifted to ICU. Next day patient was absolutely fine and extubated and was planned to be shifted out surprisingly the same episode was repeated following which patient was intubated again and was found to be absolutely normal after 3–4 h and extubated again. The same episode was repeated next day as well. Eventually she was diagnosed to have cystic thyroid swelling. Immediate aspiration of the cyst done to relieve the symptoms and total thyroidectomy was done subsequently and patient was cured of the symptoms. Conclusion- Acute airway obstruction can occur in asymptomatic goitre patients. The anaesthetic management is crucial for airway till definitive surgery is done. [ABSTRACT FROM AUTHOR]

Hemophilia A is a congenital bleeding disorder with low factor VIII levels in the blood. We report the anesthetic management of a hemophilic patient presenting with trauma in the left forearm. Patient received Factor VIII perioperatively with no excessive blood loss intraoperatively. We stress that adequate preoperative preparation and a planned anesthesia leads to a successful management of hemophilic patients. [ABSTRACT FROM AUTHOR]