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Background and objectiveMany tests are at hand to predict difficult intubation preoperatively to prevent morbidity and mortality of unanticipated difficult intubation. The present study was conducted to evaluate and compare the efficacy of the modified Mallampati test (MMT) and upper lip bite test (ULBT) to foresee difficult intubation. Materials and methodsAfter obtaining written informed consent, this prospective comparative observational study was conducted on 225 patients scheduled for elective surgery under general endotracheal anesthesia. Preoperative MMT and ULBT were performed. MMT Grade III, IV, and ULBT Grade IV were regarded as predictors of difficult intubation. The laryngoscopic view was graded as per Cormack and Lehane's laryngoscopic grading after induction of anesthesia by an experienced anesthesiologist ignorant of preoperative airway evaluation. Patients with Cormack and Lehane Class III and IV were regarded as difficult intubation. Sensitivity, specificity, and positive and negative predictive values of MMT and ULBT were computed. Agreement between two tests with the Cormack Lehane test was determined by the Kappa coefficient. ResultsIn our research, the occurrence of difficult intubation was found to be 10.2% (23 cases of difficult intubation out of 225 patients). In our analysis, we found the sensitivity (95.5% vs. 95.4%), specificity (54.8% vs 50.0%), positive predictive value (91.6% vs 93.1%), and negative predictive value (39.1% vs 39.1%) were almost comparable between modified Mallampati test and upper lip bite test. Kappa coefficient for the upper lip bite test (0.492) was slightly higher as compared to modified Mallampati scoring (0.454), but both the values are highly statistically significant (p-value <0.001). ConclusionBoth the upper lip bite test and modified Mallampati test are comparable with each other and since the upper lip bite test is easy to perform bedside test we recommend it to be used alone or in collaboration with other tests in assessing difficult airways.

Objectives: The present study was undertaken to assess the effect of dexmedetomidine as a premedicant on dose requirement of induction agents, thiopentone and propofol in patients undergoing various surgeries under general endotracheal anesthesia under the bispectral index (BIS) guidance. Methods:A double-blinded randomized controlled study was conducted during the year 2014-2015 among 120 patients aged 18-55 years with American Society of Anesthesiologists' physical status Score I or II and Mallampati Grades I and II. After obtaining informed consent, all the eligible patients were randomly assigned to one of the four groups each containing 30 patients: Group SP (control group) -saline infusion before induction with propofol, group DP -dexmedetomidine infusion before induction with propofol, group ST (control group) -saline infusion before induction with thiopentone, and group DT -dexmedetomidine infusion before induction with thiopentone. Results:The mean dose of propofol required was 95.0±6.15 mg and 55.0±7.0 mg in group SP and DP, respectively, whereas the requirement of thiopentone was 6.6±0.93 mg/kg in group ST as opposed to 4.8±0.58 mg/kg in group DT. The decrease in the dose requirement in dexmedetomidine groups than the control groups was statistically significant and also dose reduction in dexmedetomidine was more in DP group compared to that in DT group (p<0.001). Conclusion:Dexmedetomidine as a preanesthetic medication significantly decreases intraoperative anesthetic requirement of thiopentone and propofol, and dose requirement is significantly less in case of propofol as compared to thiopentone.

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Background: Anemia is the most common hematological disorder in the world, due to deficiency of micronutrients such as iron, Zn, Se, Cu, folic acid, and vitamins. Iron deficiency impairs immune response and bactericidal activity of macrophages, monocytes, and neutrophils that alters the length and quality of life. Leukocyte count may be altered due to hypoxia and ischemia, which is seen in anemia. A strong association between leukocyte counts and ischemia is seen from the experimental and clinical studies. Aims and Objectives: The present study was aimed to estimate total leukocyte count (TLC) and differential leukocyte count (DLC), neutrophil-to-lymphocyte ratio (N/L ratio), and platelet count in anemia. N/L ratio has emerged as a useful index in ischemic heart disease (IHD). Materials and Methods: A total of 30 patients of nutritional anemia in both the sexes were taken as study group, whose hemoglobin level was <6 g%, and they were compared with 30 healthy subjects of same age group. The parameters studied were TLC, DLC, N/L ratio, and platelet count. Results: TLC is insignificantly higher in anemic subjects. DLC shows, significant rise in absolute neutrophil count (P < 0.005), fall in absolute lymphocyte count significantly (P < 0.005), and rise in eosinophil and basophil count which is not statistically significant. There is not much difference in monocyte count in both groups. Associated poikilocytosis and anisocytosis of red blood cells are present in anemic subjects. N/L ratio is significantly higher in anemics (P < 0.001). Platelet count is decreased significantly in patients of anemia than control subjects (P < 0.001). Conclusions: Thus, our study highlights that, immunity especially cellular immunity, is influenced by nutritional anemia. High N/L ratio in anemia is associated with IHD and severe anemia is also associated with thrombocytopenia.

Background and objectiveThe development of modern anesthetic agents has made it possible to conduct pain-free surgical procedures. The role of the anesthetist in choosing a suitable anesthetic agent to provide a good anesthetic and sedative effect is very important in any surgical procedure. There is always a degree of risk involved as the hemodynamic parameters may be altered. This study aimed to compare the hemodynamic changes and respiratory effects between the use of etomidate and propofol for the induction of general anesthesia (GA) as well as to compare the side effects of both drugs in daycare surgeries. MethodsThe study was a parallel-design, randomized, double-blinded control trial conducted over a period of three years among patients undergoing elective daycare surgeries under GA. The patients were classified into two groups depending on the type of drug received: Group A or the propofol group and Group B or the etomidate group. Randomization was done by computer-generated random number generator software. A total of 174 patients were selected (87 in each group) at a ratio of 1:1. A baseline evaluation of the hemodynamic parameters was done followed by continuous monitoring. ResultsThe age, weight, and gender distribution of the patients in both groups were comparable. Significant hemodynamic changes were observed following induction in Group A. The fall in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) in Group A following induction was found to be statistically significant (p<0.00). The rise in heart rate was almost similar in both groups, with Group A demonstrating a slightly higher rate. There were fewer signs of respiratory depression in Group B. The major side effects observed after induction were myoclonus, which was more prevalent in Group B patients (21.84%), and pain at the injection site, which was observed more frequently in Group A (17.1%). ConclusionBased on our findings, etomidate is a drug with better hemodynamic stability and less pain at the site of injection compared to propofol. Hence, it may be a better induction agent in daycare surgeries.

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