Context:Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI.Aim:This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI.Methodology:This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1–2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired t-test were used for statistical analysis.Results:Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB.Conclusion:Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.

A 30-year-old male jewellery factory worker accidentally ingested silver potassium cyanide and was brought to the emergency department in a state of shock and profound metabolic acidosis. This patient was managed hypothetically with use of injection thiopentone sodium intravenously until the antidote was received. Cyanide is a highly cytotoxic poison and it rapidly reacts with the trivalent iron of cytochrome oxidase thus paralysing the aerobic respiration. The result is severe lactic acidosis, profound shock, and its fatal outcome. The patient dies of cardio-respiratory arrest secondary to dysfunction of the medullary centres. It is rapidly absorbed, symptoms begin few seconds after exposure and death usually occurs in <30 min. The average lethal dose for potassium cyanide is about 250 mg. We used repeated doses of thiopentone sodium till the antidote kit was finally in our hands, hypothesising that it contains thiol group similar to the antidote thiosulphate. Moreover, it is an anticonvulsant. We were successful in our attempts and the patient survived though the specific antidotes could be administered after about an hour.

Background:The data comparing the efcacy of intrathecal fentanyl with intrathecal dexmedetomidine is studies very less in literature. In our study, we decided to compare 10 μg of dexmedetomidine and 25 μg of fentanyl as adjuvant to 0.5% hyperbaric bupivacaine in patients undergoing infraumblical surgeries. The studyMethods: was conducted in two groups of patients. Hospital based prospective, randomized, double blind, interventional study. Hyperbaric with injection of hyperbaric Bupivacaine 0.5% 2.5ml (12.5mg) + Fentanyl 0.5ml (25μg) of total volume of 3ml in 50 subjects and Hyperbaric Bupivacaine 0.5% 2.5ml(12.5mg)+ Dexmedetomidine 0.5ml(10μg) of total volume of 3ml in 50 subjects. : We conclude that both fentanyl 25

The present study was conducted in Department of Anaesthesia, Sardar Patel Medical College and PBM Hospital, Bikaner, with the aim of comparative evaluation of subclavian vein catheterization by supraclavicular and infraclavicular approach. There are three common routes of central venous catheterization i.e. subclavian, internal jugular and the femoral. Hence in our study we have done a comparative evaluation of supraclavicular and infraclavicular approach for SCV catheterization with primary objective of successful catheterization of SCV using anatomical landmark technique and secondary objective of first attempt success rate, time taken for cannulation and also record the incidence of complications related to either approach. In our study, 60 patients enrolled were randomly divided into two groups of 30 patients each. In Group A Infraclavicular SCV catheterization and in Group B Supraclavicular catheterisation was performed using anatomical landmark approach. Successful catheterization, first attempt success rate, time taken for venous access and catheterization, catheter malfunction or any other complication were recorded. In group A (IC) Maximum 63.33% were inserted in single attempt whereas minimum 10% required 3 or more attempts while in group B (IC) maximum 93.33% were inserted in single attempt whereas minimum 3.33% needed 3 or more attempts, and the difference was found statistically significant. Overall successful catheterization was 90% in Group A and 96% in Group B while 93 % when combined for both groups. Mean time taken for insertion was observed more (6.67 ± 1.44 min.) in group A whereas less (4.47 ± 1.01min.) in group B, and the difference was found statistically highly significant. We conclude that SC approach of SCV catheterization is better as comparable to IC approach in terms of landmarks accessibility, success rate, time taken and rate of complications.