REFERENCES1. Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med 2003;349:2527-39. 2. Shah PL, Hansell D, Lawson PR, et al. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis.

Background:To use laparoscope as an easily available and easy to use alternative option to videolaryngoscope.Aims:The aim of the study was to assess the improvement in the glottic view using a conventional direct laryngoscope (DL) assisted by a laparoscope with its endovision system along with the time taken for tracheal intubation.Settings and Design:A prospective, double blind, randomized, controlled study was conducted in a tertiary care centre.Methods:Sixty patients with American Society of Anesthesiologists (ASA) physical status I and II requiring general anaesthesia and tracheal intubation for elective surgery were included in the study. The patients were anaesthetized, paralysed, DL was performed and Cormack and Lehane grade (C and L) noted, followed by the introduction of the laparoscope alongside the flange of the Macintosh laryngoscope and a further C and L grading done as seen on monitor. Demographic data, ASA physical status, airway assessment, mouth opening, modified Mallampatti class, jaw protrusion, thyromental and sternomental distances, optimal external laryngeal manipulation, time taken for intubation, pulse oximetry, blood on; tracheal tube, lip, dentition or mucosal trauma, sore throat, hoarseness of voice, excessive secretions and regurgitation were recorded.Statistical Analysis:Statistical analysis was done using statistics package for social sciences software (17.0 version). A P-value less than 0.05 was considered statistically significant.Results:Eighty-three percent of the patients showed improvement in glottic view after laparoscopic assistance. Eighty-one and 85% of the patients with C and L grade II and III respectively on DL had an improved glottic view with this technique. The mean time to intubate was 37 seconds.Conclusions:Laparoscopic assistance provided a better glottic view than DL in most patients (83%). It has a potential advantage over standard DL in difficult intubation.

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Pregnancy itself is a stressful period for women which gets further compounded by the presence of mitral stenosis (MS). The interaction between the hyperdynamic cardiovascular changes of pregnancy, i.e. increased cardiac output, increased heart rate and increased oxygen consumption and the narrowed mitral valve are to be understood to avoid the complications occurring during labour and delivery. Pulmonary hypertension (PH) is rarely seen in pregnancy but can result in high maternal mortality secondary to increased risk of congestive heart failure, arrhythmia and sudden cardiac arrest. In this report, we discuss the management of a case of severe MS compounded with PH requiring caesarean section. Case reportA 25-year-old, 38 +4 weeks gestation G 1 P 0 with known rheumatic heart disease and severe MS was scheduled for elective caesarean section (CS) in view of intrauterine growth restriction and severe oligohydramnios. Her first trimester was uneventful. In second trimester, she developed fever and breathlessness for which she presented to the obstetric department and was managed conservatively with antipyretics and analgesics and was discharged home in stable condition. No cardiology opinion was taken at the time. She again developed cough and breathlessness in third trimester. A complete cardiological evaluation was done. Her echocardiography revealed severe MS with severe PH. Balloon mitral c u r r e n t m e d i c i n e r e s e a r c h a n d p r a c t i c e x x x ( 2 0 1 5 ) x x x -x x x Available online xxx Keywords: Anaesthesia Parturient Mitral stenosis Caesarean section Invasive blood pressure monitoring a b s t r a c tMitral stenosis is the most common valvular heart disease seen during pregnancy. Conception is discouraged because of increased morbidity and mortality in cases where pulmonary hypertension develops during the course of mitral stenosis. We present the anaesthetic management of a 25-year-old 38 +4 weeks parturient with severe mitral valve stenosis and pulmonary hypertension. We preferred invasive blood pressure monitoring to observe early haemodynamic changes and arterial blood gas analysis, so that necessary interventions could be taken at the earliest.Please cite this article in press as: Gupta AK, et al. Anaesthetic management of a parturient with severe mitral stenosis and pulmonary hypertension for caesarean section, Curr Med Res Pract. (2015), http://dx.

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Introduction:The focus on enhanced recovery after surgery (ERAS) and opioid-free anesthesia has renewed interest in use of lignocaine. We evaluated postoperative pain relief following intravenous (IV) lignocaine administration in patients undergoing laparoscopic intraperitoneal onlay mesh repair (IPOM).Methods: Seventy patients were randomized into two groups. Group L patients were administered IV lignocaine infusion (1.5 mg/kg) at induction of anesthesia followed by infusion (1.5 mg/kg/h), until 1 hour in the postanesthesia care unit (PACU). Group P patients received equal volumes of normal saline IV infusion. We recorded hemodynamics, perioperative analgesic consumption, postoperative visual analog scores (VAS), incidence of postoperative nausea and vomiting (PONV), bowel function, patient satisfaction and length of hospital stay (LOS). Results: The hemodynamics in both groups were maintained. Group L had lower VAS scores as compared to Group P (P < .05). Intraoperative fentanyl consumption in Group L was significantly less than Group P (P = .029). Group L patients scored lower on the Likert scale in comparison to the patients of Group P at 0 hour (P = .013). Recovery of bowel function as assessed by time to pass first flatus was significantly shortened by IV lignocaine (P = .001). The perioperative administration of IV lignocaine resulted in decreased postoperative analgesic requirement and greater patient satisfaction scores. Conclusions: Perioperative IV lignocaine infusion provided good pain relief, hemodynamic stability and decreased perioperative analgesic consumption. PONV incidence decreased along with an early return of bowel function, reduced LOS and improved patient satisfaction in patients undergoing laparoscopic IPOM surgery.

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