A prepregnancy weight of more than 40 kg, BMI of more than 19.8 and hemoglobin of at least 7 g% or more favor good obstetric outcome.

Context:The cost of anesthetic technique has three main components, i.e., disposable supplies, equipments, and anesthetic drugs. Drug budgets are an easily identifiable area for short-term savings.Aim:To assess and estimate the amount of anesthetic drug wastage in the general surgical operation room. Also, to analyze the financial implications to the hospital due to drug wastage and suggest appropriate steps to prevent or minimize this wastage.Settings and Design:A prospective observational study conducted in the general surgical operation room of a tertiary care hospital.Materials and Methods:Drug wastage was considered as the amount of drug left unutilized in the syringes/vials after completion of a case and any ampoule or vial broken while loading. An estimation of the cost of wasted drug was made.Results:Maximal wastage was associated with adrenaline and lignocaine (100% and 93.63%, respectively). The drugs which accounted for maximum wastage due to not being used after loading into a syringe were adrenaline (95.24%), succinylcholine (92.63%), lignocaine (92.51%), mephentermine (83.80%), and atropine (81.82%). The cost of wasted drugs for the study duration was 46.57% (Rs. 16,044.01) of the total cost of drugs issued/loaded (Rs. 34,449.44). Of this, the cost of wastage of propofol was maximum being 56.27% (Rs. 9028.16) of the total wastage cost, followed by rocuronium 17.80% (Rs. 2856), vecuronium 5.23% (Rs. 840), and neostigmine 4.12% (Rs. 661.50).Conclusions:Drug wastage and the ensuing financial loss can be significant during the anesthetic management of surgical cases. Propofol, rocuronium, vecuronium, and neostigmine are the drugs which contribute maximally to the total wastage cost. Judicious use of these and other drugs and appropriate prudent measures as suggested can effectively decrease this cost.

Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy.

Context:We hypothesized that reduced oropharyngolaryngeal stimulation with video laryngoscopes would attenuate hemodynamic response to laryngoscopy and intubation.Aim:Comparison of hemodynamic response to laryngoscopy and intubation with video laryngoscopes and Macintosh (MC) laryngoscope.Setting and Design:Superspecialty tertiary care public hospital; prospective, randomized control study.Methods:Sixty adult patients undergoing elective coronary artery bypass grafting (CABG) were randomly allocated to three groups of 20 each: MC, McGrath (MG), and Truview (TV). Hemodynamic parameters were serially recorded before and after intubation. Laryngoscopic grade, laryngoscopy, and tracheal intubation time, ST segment changes, and intra-/post-operative complications were also recorded and compared between groups.Statistical Analysis:SPSS version 17 was used, and appropriate tests applied. P < 0.05 was considered significant.Results:Heart rate and diastolic arterial pressure increased at 0 and 1 min of intubation in all the three groups (P < 0.05) while mean arterial pressure increased at 0 min in the MG and TV groups and at 1 min in all three groups (P < 0.05). A significant increase in systolic arterial pressure was only observed in TV group at 1 min (P < 0.05). These hemodynamic parameters returned to baseline by 3 min of intubation in all the groups. The intergroup comparisons of all hemodynamic parameters were not significant at any time of observation. Highest intubation difficulty score was observed with MC (2.16 ± 1.86) as compared with MG (0.55 ± 0.88) and TV (0.42 ± 0.83) groups (P = 0.003 and P = 0.001, respectively). However, duration of laryngoscopy and intubation was significantly less in MC (36.68 ± 16.15 s) as compared with MG (75.25 ± 30.94 s) and TV (60.47 ± 27.45 s) groups (P = 0.000 and 0.003, respectively).Conclusions:Video laryngoscopes did not demonstrate any advantage in terms of hemodynamic response in patients with normal airway undergoing CABG.

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The lidocaine-ketamine combination is most effective for decreasing the pain on propofol injection.

Ni-Cr-Mo steels are widely used in machine part members, gears and shafts. Steels with higher carbon content (~1%) are used for heavy machine parts and bearings. Abrasive wear resistance is often a very important requirement for these high carbon steels, apart from sliding wear properties. In the present study, En31 steel was subjected to varying heat treatments to generate different microstructures. An attempt has been made to correlate the two body abrasive wear resistance with the bulk hardness and microstructures. The microstructures were studied through a combination of scanning electron microscopy (SEM), energy dispersive spectrometer attached to SEM (i.e. SEM-EDS) and X-ray diffraction (XRD). The bulk hardness decreased with increase in tempering temperature from 423 K to 848 K. The precipitation of Cr7C3 after 598 K tempering did not cause an appreciable increase in the hardness. At higher tempering temperatures (848 K), the martensite decomposed to give ferrite and cementite. The abrasive wear tests were carried out on hardened and tempered specimens. The abrasive wear mass loss increased with increase in the tempering temperature. Hardness had a direct correlation with the two body abrasive wear behaviour in En31 steel -increase in hardness increased the abrasive wear resistance. The important material removal mechanism were micro cutting and micro ploughing, the relative contribution of each to total wear loss was influenced by abrasive wear test conditions.

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