Several additives have been combined with local anaesthetics for intravenous regional anaesthesia to improve block quality, analgesia and to decrease tourniquet pain. Magnesium sulphate is one potential additive. This prospective, randomised, double-blinded study was conducted in 30 ASA physical status I or II patients undergoing upper limb surgery under tourniquet. In group L, patients received intravenous regional anaesthesia with lignocaine alone (9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Patients in group M received intravenous regional anaesthesia with lignocaine plus magnesium sulphate (6 ml of 25% magnesium sulphate plus 9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Assessment was by observing the response to injection of drug; sensory and motor block and tourniquet pain. The mean time of onset of sensory block was 12.40 and 3.47 minutes in groups L and M respectively (P <0.001). The average times of onset of motor block in groups L and M were 17 and six minutes respectively (P <0.001). Of the patients in group M, 66.7% reported moderate to severe pain while the drug was being injected, compared to 20% in group L (P=0.011). There was a statistically significant difference in visual analogue scale for tourniquet pain at 10 and 30 minutes after tourniquet inflation (lower in group M). These findings indicate that magnesium sulphate added as an adjuvant to lignocaine hastens the onset of sensory and motor block and decreases tourniquet pain. However, there is increased incidence of transient pain on injection if magnesium sulphate is added.

Objective The Truview Evo2TM laryngoscope blade is designed to improve glottic view. This study was designed to evaluate the effect of cricoid pressure (CP) on laryngeal view and the ease of orotracheal intubation with the Truview Evo2 laryngoscope. Methods In this randomized controlled trial, 50 patients (American Society of Anesthesiologists physical status I-II, aged 18 to 60 yr) scheduled for elective surgery were enrolled. After induction of anesthesia and muscle paralysis, laryngoscopy was performed using the Truview Evo2 TM laryngoscope with the patient's head in the neutral position. In Group 1, the percentage of glottic opening (POGO) score was evaluated first without CP, then with CP, and CP was applied for intubation. In Group 2, the POGO score was evaluated first with CP, then without CP, and no CP was applied for intubation. Time to intubation and number of attempts required for intubation were also recorded. Results In 50 patients, the mean (standard deviation) POGO view obtained with the application of CP was 93% (10%) compared with 81% (19%) in patients without CP (P \ 0.01). Times to intubation were similar in the two groups: 14.2 (6.6) sec vs 14.0 (9.3) sec in Groups 1 and 2, respectively (P = 0.924). Sixteen percent of patients in Group 1 required a second attempt at tracheal intubation, while only 4% of patients in Group 2 required a second attempt (P = 0.162). Conclusion When using the Truview Evo2TM laryngoscope with the patient's head in the neutral position, application of CP improves the glottic view. This approach is not associated with increased difficulty in intubation.

The Proseal Laryngeal Mask Airway (PLMA) is routinely inserted by the digital and introducer tool techniques but a newer Gum Elastic Bougie (GEB) guided insertion technique has been described.The aims and objectives were to compare the ease of PLMA insertion and fibreoptic view of PLMA after placement using GEB and conventional techniques.Ninety-six ASA I or II patients of either gender, aged 18 to 60 years, scheduled for elective surgery under general anaesthesia in the supine position were included in this study. Following induction of anaesthesia, a PLMA was inserted using a GEB, introducer tool or digital technique in Groups G, I and D respectively (n=32). Correct placement of the PLMA was confirmed by using clinical tests along with fibreoptic assessment. Ease of PLMA insertion was assessed by the number of attempts, time taken and number of patients requiring lateral approach for insertion. The fibreoptic view of PLMA placement through the airway tube was graded on a scale from 4 (best view) to 1 (worst view).GEB-guided PLMA insertion was more successful both after the first attempt (G 100%, I 69%, D 72%, P <0.01) and after two attempts (G 100%, I 78%, D 84%, P <0.05). Time taken for successful placement was significantly shorter in the GEB-guided group after two attempts (G 22±2 seconds, I 31.9±18.8 seconds, D 29.5±18.6 seconds, P <0.05). The fibreoptic view through the airway tube was significantly better in the GEB-guided group (P <0.01). Incidence of trauma was significantly less in the GEB-guided group (P <0.05).

Background and Aims:We compared the laryngoscopy position attained by a 7-cm-high pillow (Sniffing position-SP) with that attained by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using variable height inflatable pillow.Material and Methods:This prospective-randomised-cross-over study included 50 patients in each group. Group-AM-S: A 7 cm uncompressible pillow was used for attaining first laryngoscopy position, followed by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using an inflatable pillow for attaining second laryngoscopy position followed by intubation. Group-SP: Horizontal alignment of external auditory meatus-sternal notch (AM-S) line-was done using an inflatable pillow for attaining first laryngoscopy position, followed by using 7 cm uncompressible pillow for second laryngoscopy position followed by intubation. The CL-grade, Intubation Difficulty Score (IDS) and time to intubation were compared in both positions. The head raise (in cm) required for attaining AM-S alignment was noted.Results:CL-grade-I was obtained in significantly larger number of patients with AM-S alignment position than with 7 cm head raise (P = 0.004). CL-grade-III was obtained in significantly lesser number of patients with AM-S alignment (P = 0.002). Mean IDS with AM-S alignment (1.18 ± 1.69) was significantly less than with 7cm head raise (2 ± 1.59; P = 0.007) and time to intubation with AM-S alignment (17.33 ± 4.52 s) was significantly less than that with 7cm head raise (18.94 ± 4.64 s; P = 0.041). The mean head rise required to achieve AM-S line alignment was 4.920 ± 1.460 cm.Conclusion:External Auditory Meatus-Sternal notch (AM-S) line alignment provides better laryngeal view, better intubating conditions and requires lesser time to intubate as compared to a conventional 7-cm-head raise. The size of pillow used for head raise should be individualised.