Introduction:Postoperative pain is a major cause of fear and anxiety in hospitalized patients and so if patients remain pain-free during this period, they can cooperate with the circumstances well, leading to early recovery. Over the last two decades, there has been considerable revival of interest in the use of regional anesthesia techniques for surgery and pain management. As very few studies have been conducted using ropivacaine with dexmedetomidine and magnesium sulfate (MgSO4) as adjuvants, the present study was undertaken with primary aims to compare the hemodynamic stability, onset and duration of sensory and motor block and with secondary aims of the postoperative analgesic effect of dexmedetomidine and MgSO4 along with ropivacaine.Materials and Methods:After getting the Institutional Ethics Committee approval, this study was conducted on fifty patients of the American Society of Anesthesiologists physical Status I and II aged between 20 and 65 years of either sex and scheduled to undergo infraumbilical surgeries under spinal anesthesia. They were divided into two groups of 25 each. Group D patients received 3 ml of 0.75% isobaric ropivacaine hydrochloride with 10 μg of dexmedetomidine whereas Group M patients received 75 mg of MgSO4 in the place of dexmedetomidine. The quality of surgical analgesia and quality of intraoperative muscle relaxation were assessed and graded.Results:We found out that onset of sensory and motor block was earlier in Group D in comparison to Group M. There was a significant reduction in the time to the first rescue analgesia in group receiving intrathecal dexmedetomidine.Conclusion:It is concluded from our study that ropivacaine plus dexmedetomidine group are better than ropivacaine plus MgSO4 in providing early onset of sensory and motor block as well as in providing postoperative analgesia.

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Death to most people is a major life event. Nothing in this world prepares us to face and manage the perioperative death although the majority of anesthesiologists will be involved in an intraoperative death during the course of their careers. Whether death on the table was expected or occurred when least expected or may be even later, the anesthesiologist is most likely to be affected emotionally, physically in his personal life, and as well as will have an influence on his professional career. Anesthesiologists as perioperative physicians are likely to experience death on the operating table at some time in their careers. In case of perioperative death, meticulous record keeping including time of occurrence of event and methods and medications used during resuscitation, nature of the problem, and all sequence of events should be adopted to breaking bad news with relatives and blame game should be avoided. The anesthesiologist and the relatives of the patient should also be given emotional support to come out of this untoward event. In this article, we have highlighted the various factors and causes leading on to perioperative death and if in case such an event occurs, what are the protocols to be followed, including medicolegal aspects, giving emotional support to the concerned anesthesiologist, dealing with the relatives of the patient sympathetically, etc. We have also enumerated the various precautions to be taken to prevent perioperative mortality in this article.

Background:Combined spinal-epidural analgesia has become the preferred technique for labor analgesia as it combines the benefits of both spinal analgesia and flexibility of epidural catheter. Study was carried out with the primary aim to compare levobupivacaine and ropivacaine with fentanyl in terms of onset and duration of sensory block and to know maternal and fetal outcome.Materials and Methods:In a prospective randomized double-blind study, 60 primipara of the American Society of Anesthesiologists health status Class I and II with singleton pregnancy in active stage of labor were randomly allocated into two groups of 30 each. Group A received 3 mg intrathecal levobupivacaine with 25 μg fentanyl followed by epidural top-ups of 14 ml of levobupivacaine 0.125% with fentanyl 30 μg whereas Group B received 4 mg intrathecal ropivacaine with 25 μg fentanyl followed by epidural top-ups of 14 ml of ropivacaine 0.2% with fentanyl 30 μg. Patients were monitored for sensory and motor block characteristics, hemodynamics, maternal and fetal outcome, side effects, and complications. These characteristics were analyzed using the “Chi-square tests” and “unpaired t-test.”Results:Onset of analgesia was rapid in Group A (4.72 ± 0.54 min) as compared to Group B (5.58 ± 0.49 min). Duration of analgesia was also prolonged in Group A (117.00 ± 11.86 min) as compared to Group B (90.17 ± 8.85 min). Patients remained hemodynamically stable and side effects, and complications were comparable in both groups.Conclusion:Levobupivacaine with fentanyl leads to early onset and prolonged duration of analgesia as compared to ropivacaine with fentanyl during labor analgesia.

Background- Advance prediction of difcult airway provides us ample time for optimal preparation of equipment and participation of experienced anaesthesiologist to handle difcult airway. The present study was designed to evaluate the efcacy of Upper Lip Bite Test (ULBT), Ratio of neck circumference (NC) and thyromental distance (TMD) and Arne Risk Index in predicting difcult airway. Material and methods-This prospective observational study was conducted on 250 patients, aged 18-60 years of ASAgrade I and II scheduled for surgeries under general anaesthesia. Three screening tests i.e. ULBT, NC/TMD and Arne Risk Index were used to predict difcult airway. Number of patients successfully intubated, number of attempts taken for intubation and time taken for intubation was noted. Difcult intubation was calculated using Intubation Difculty Score (IDS). All the three screening tests were compared for their sensitivity, specicity, negative predictive value (NPV) and Positive predictive value (PPV) to predict difcult airway. Result- The incidence of difcult intubation was found to be 6.8%. 233 (95.2%) patients were intubated in rst attempt and 12 (4.8%) patients were intubated in second attempt and there was no failed intubation. Arne Risk Index had high sensitivity (88.23%), high specicity (88.84%), highest NPV (99.04%) and PPV of 36.58%. ULBThas sensitivity of 76.47%, specicity of 88.41%, NPV of 98.09% and PPV of 32.50% and NC/TMD has sensitivity of 47.05%, specicity of 87.98%, PPVof 22.22% and NPVof 95.79% in predicting difcult airway. Conclusion- Arne Risk index, a multivariate clinical risk index had highest sensitivity, specicity, NPVand PPVto predict difcult airway.