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Background and objectives: To perform comparative investigation of intra-operative Fentanyl dose administered between the study group and the control group of the population selected for study. To distinguish the intra-operative dose requirement of Fentanyl administered between the study group and the control group. Evaluation of the degree of post operative pain in the study and the control group. Estimation of the rescue analgesic required in Post Operative Care Unit in the study group and the control group. To report the peri operative adverse events in the study and the control group. To approximate the time required for extubation in the study group and the control group. Methods: A Prospective comparative randomized study was conducted after obtaining Institutional Ethical Committee approval with no EC/NIMS/2736/2021 and Informed Consent of the patients was conducted in Department of Anaesthesia at Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India from December 2020 - November 2021 which included females of 18-60 years age undergoing mastectomy Surgery under General Anaesthesia. Results:The study statistically evaluated impression of intra operative fentanyl dose guided by hemodynamic and SPI parameters. Correlation of different fentanyl doses to the parameters like age, BMI, cardiological health, Spectral entropy, intraoperative and post operative events and symptoms, mean extubation time was estimated during mastectomy. Conclusion: The study derives inference from mastectomy performed under general anaesthesia that SPI guided group will distinguish by better hemodynamic stability which will probably result into lower intraoperative fentanyl requirement. Also, apositive postoperative analgesic property andlesser chance of postoperative nausea and vomiting reported when compared with study conducted using conventional hemodynamic guidance. [ABSTRACT FROM AUTHOR]

Difficulty in airway management is a major cause of morbidity and mortality in anesthetic practice. The ability to identify patients at risk of difficult tracheal intubation is important especially in patients with apparently normal airways. The importance of preoperative prediction of a difficult airway is obvious, as 85% of all mistakes regarding airway management result in permanent cerebral damage and up to 30% of all anaesthetic deaths can be attributed to the management of difficult airways. In patients with limited cervical extension, the intubation will turn out to be even more difficult as we cannot make the neck extension in these scenarios, visualization of glottis will be very difficult and it will ultimately result in complications. Thorough preoperative assessment is essential to identify the patients at risk of difficult intubation so that proper management can be planned beforehand. As there is no preoperative assessment criteria or tool to predict the difficulty in these limited cervical extension patients, the purpose of the present study was to evaluate the accuracy of the Neck circumference to Inter incisor gap ratio in predicting the difficulty of laryngoscopy in limited cervical extension patients. [ABSTRACT FROM AUTHOR]