Background and Aims:i-gel®, a recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA Fastrach® frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel® and LMA Fastrach® was evaluated. The complications if any were also studied.Methods:A total of 100 patients undergoing elective surgery under general anaesthesia were randomised in two groups comprising of 50 patients each to tracheal intubation using either i-gel (I group) or LMA Fastrach (F group). After induction of anaesthesia SAD was inserted and on achieving adequate ventilation with the device, blind tracheal intubation was attempted through the SAD. Success at first-attempt and overall tracheal intubation success rates were evaluated, and tracheal intubation time was measured. Data were analysed using IBM SPSS Statistics 20.0 software (Statistical Package for Social Sciences by International Business Machines Corporation). P < 0.05 was considered as statistically significant.Results:There was no difference in the incidence of adequate ventilation with either of the SAD. The success rate of tracheal intubation in first attempt was 66% in Group I and 74% in Group F, while overall success rate of tracheal intubation was 82% in Group I when compared to 96% in Group F. Time taken for successful tracheal intubation through LMA Fastrach was lesser (20.96 s) when compared to i-gel (24.04 s). Complication rates were statistically similar in both the groups.Conclusion:i-gel® is a better device for rescue ventilation due to its quick insertion but an inferior intubating device in comparison to LMA Fastrach®.

Introduction:FESS (Functional Endoscopic Sinus Surgery) is done via endoscope and the area is highly vascular thus it becomes important to minimize bleeding. Hence we require hypotensive anesthesia. Various drugs have been used for the purpose: nitroglycerine (NTG), sodium nitroprusside(SNP),propofol,beta blockers, calcium channel blockers, higher concentrations of inhalational anesthetics etc. Since all these drugs have certain limitations there was a search for safer and more effective drug .Dexmedetomidine, a newer alphaadrenoceptor agonist,fulfills this requirement since it is short acting, has no residual effects, produces sedation and analgesia and reduces mean arterial pressure thereby reducing intraoperative blood loss. Aims: To study the efficacy of dexmedetomidine in providing hypotensive anaesthesia so as to minimize bleeding during endoscopic sinus surgery in a randomized double blind control study. Method:40 patients of ASA grade I/II, aged18-55yrs,scheduled for endoscopic sinus surgery, were randomly allocated into two groups of twenty each by sealed envelope method. Group C: received Normal saline as loading dose of 1mcg/kg intravenously followed by maintenance infusion of 0.6mcg/kg intravenously, Group D: received dexmedetomidine in similar doses. The loading dose was given slowly over 15 minutes. The surgery was started after the loading dose was over. Both the anaesthetist conducting the study and the patient were blinded to the study drug. The amount of blood loss, doses of intravenous& inhalation agents and side effects were studied. Results:The patient characteristics did not differ in bothcontrol(C) and study (D) groups (Table1). Blood losses were lower in group D as compared to group C (p = 0.03).Total dose of fentanyl (p< 0.001),propofol(p <0.001)and isoflurane (p =0.04)were lower in group D as compared to group C. The VAS scores in the immediate postoperative periods were also lower in the group D (p =0.03).The only side effect noted was bradycardia (2patients)which however reverted with discontinuation of the drug.Atropine was not required. Conclusions:Dexmedetomidine is a safe &effective adjuvant for hypotensive anaesthesia to decrease bleeding and thus provide bloodless field during FESS surgery. It also decreases the dose requirements of propofol,fentanyl and isoflurane. It is also an effective analgesic agent.

Background and Aims:Laryngoscopy and endotracheal intubation are considered as potent stimuli which lead to an increase in heart rate and blood pressure. Melatonin (N-acetyl-5-methoxytryptamine) has been studied for pre-operative anxiolysis and sedation in Intensive Care Unit. We made a hypothesis that melatonin can provide haemodynamic stability during laryngoscopy and intubation when given 120 min before the procedure.Methods:Sixty American Society of Anesthesiologists physical status Grade I and II patients of either gender, 20–45 years old, 40–65 kg body weight, scheduled to undergo elective surgical procedures under general anaesthesia were assigned into two equal groups - Group C (control) and Group M (melatonin). They received oral placebo or melatonin tablets 6 mg, respectively, 120 min before surgery. The haemodynamic parameters were recorded preoperatively, during laryngoscopy and endotracheal intubation and thereafter at 1, 3, 5 and 10 min. Unpaired t-test was used for between-group comparison of ratio and interval scale data. For within-group comparison of ratio and interval scale data, repeated-measures ANOVA and post hoc Bonferroni t-tests were used.Results:It was observed that in the control group, there was a significant increase in heart rate and blood pressure at laryngoscopy and intubation and persisted till 10 min post-intubation. In melatonin group, there was an insignificant increase in heart rate at the time of laryngoscopy and intubation which however settled within 1 min post-intubation.Conclusion:Melatonin is an effective drug for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation.

Background and Aims:Effective post-operative analgesia after caesarean section (CS) is important because it facilitates early amelioration, ambulation and expedites breastfeeding. Quadratus lumborum (QL) block is an interfascial block providing effective visceral and somatic analgesia. We conducted this study to compare the analgesic efficacy of QL block and transversus abdominis plane (TAP) block after CS.Methods:In this single hospital-based, prospective double-blind study, 60 patients scheduled for an elective CS between December 2018 and January 2019 were randomised to receive ultrasound-guided TAP block (n = 30) or QL block (n = 30) bilaterally with 0.2% ropivacaine postoperatively. The primary objective was to measure the time for rescue analgesic requirement and secondary objectives included the total number of analgesic dose required over a period of 72 hours and severity of post-operative pain assessment via visual analogue scale (VAS) score at rest and with movement. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students' t-test.Results:Time for rescue analgesic requirement was higher in the QL group than the TAP group (mean ± SD: 68.77 ± 1.74 h vs. 13.3 ± 1.21 h) (P < 0.001). The QL group had significantly less analgesic demand (P < 0.001) at 2, 4, 6, 12, 24, 36, 48 and 72 h post-CS. The VAS at rest and movement was significantly reduced in the QL group at all times.Conclusion:The QL block provided prolonged and effective analgesia in comparison to TAP block up to 72 hours post-CS.