Conclusion Dexmedetomidine as an adjuvant to 0.2% ropivacaine in ultrasound guided interscalene blockade is more efficacious than dexamethasone in hastening the onset, prolonging sensory blockade and delaying the time of request for rescue analgesia. Dexmedetomidine produces mild sedation compared to dexamethasone as an adjuvant.

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Introduction: Appropriate size selection of ProSeal laryngeal mask airway (PLMA) is an important prerequisite for successful use of the device. Size of PLMA is often selected based on weight of patients. We aimed to determine whether combined width of patient's index, middle and ring fingers could be used as an alternative to weight-based selection of appropriate size of PLMA. Materials and methods: In this prospective randomized study, 102 patients aged 6 months to 10 years were included. Patients were allocated to one of two groups based on a randomization table and PLMA inserted according to the group allocated. In Group S, PLMA size selected according to weight-based method whereas in Group N, PLMA size was selected based on 3-finger breadth of patients. We recorded insertion parameters, fiberoptic scoring of glottic visualisation, airway manipulations and postoperative complications. Results: In 68 children (66.66%) size of PLMA was same according to both methods. The kappa coefficient was 0.461 concluding moderate agreement between two methods. In the remaining 34 children (33.34%), the disagreement in sizes were with only one size, in whom the patient's weights were borderline values. The PLMA insertion time, ease of insertion, insertion attempts, fiberoptic view of position of device were comparable in both groups. There were no significant complications in the postoperative period. Conclusion: Three finger breadth sizing method can be used as a good alternative to weightbased method for selecting appropriate size of PLMA in children.

Background: Endotracheal intubation may produce haemodynamic fluctuations which may be deleterious in patients with cardiovascular and neurological disorders. This is further worsened in patients with difficult airway. This study was conducted to compare haemodynamic fluctuations produced when intubation was done using Airtraq and fibreoptic bronchoscopy which are used in patients with anticipated difficult airway. Methodology: Prospective randomized study. Eighty patients, ASA PS 1 and 2 undergoing elective surgery were randomized into two groups-Group A and Group F. After routine induction and muscle relaxation, orotracheal intubation was done using Airtraq in Group A and fibreoptic bronchoscope in Group F. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at regular intervals. Duration and number of attempts for intubation were also noted Results: There was no significant difference in the average of variation in HR (p=0.384), SBP (p=0.179), DBP (p=0.746) and MAP (p=0.057) from the baseline between the two groups. Duration of intubation in FOB group (mean value of 56.98 s) was more than Airtraq® video laryngoscope group (mean value of 37.38 s) which was statistically significant. Conclusion: Use of fibreoptic bronchoscope offer no added advantage over Airtraq video laryngoscope in terms of haemodynamic response for intubation in difficult airway situation such as cervical spine injury.

Background and aims: This study is aimed at comparing glottic view and ease of intubation with Macintosh and McCoy TM laryngoscopes in adult patients. Methods: One hundred forty consenting patients undergoing elective surgery requiring orotracheal intubation were randomly assigned to two groups for assessment of glottic view and ease of intubation. Cormack-Lehane (CL) glottic view, ease of intubation, laryngoscopy time and intubation time were recorded. Results: All recruited patients completed the study, with a single attempt for successful intubation. Demographic profile was comparable between groups. Glottic view represented as CL grade (Macintosh laryngoscope-grade 1 among 100 patients, 2a in 26, 2b in 12 and 3a in 2 patients; McCoy TM laryngoscope-grade 1 in 105, 2a in 20, 2b in 13 and 3a in 2 patients), requirement of additional manoeuvres like optimal external laryngeal manipulation (OELM)/use of lever for best glottic view (OELM in 40 patients, lever in 35 patients), ease of intubation (Macintosh laryngoscope-grade 1 in 49 patients, grade 2 in 21 patients; McCoy TM laryngoscope-grade 1 in 53 patients, grade 2 in 17 patients), mean laryngoscopy time (6.02 ± 1.91s with Macintosh and 6.65 ± 2.09s with McCoy TM laryngoscope) and mean intubation time (15.24 ± 3.01s with Macintosh and 16.09 ± 3.42s with McCoy TM laryngoscope) were comparable between laryngoscopes. Conclusion: In adult patients with essentially normal airway, Macintosh and McCoy TM laryngoscopes provide similar glottic view and ease at intubation, with comparable time required for laryngoscopy and intubation when performed by an experienced anaesthesiologist.

A 22 year old male patient with metachromatic leukodystrophy presented in our hospital for multiple teeth extraction under general anaesthesia. Metachromatic leukodystrophy is a rare congenital neurodegenerative disorder which predominantly affect the corticospinal tract. In this case report anaesthetic concerns and our perioperative management are discussed.