Objective: Administration of warm intravenous (IV) fluid infusion and use of forced air warmers is the most easy and physiologically viable method for maintaining normothermia during surgery and postsurgical periods This study was conducted to assess the effect of combination of active warming (AW) methods namely warm IV fluid infusion and forced air warming versus forced air warming only (WA) on maternal temperature during elective C-delivery under spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for elective c-section were grouped into those who received both warmed IV fluid infusion and forced air warmer (Combination of active warming WI= 50) and those who received only forced air warmer (WA = 50). Core body temperature and shivering incidence were recorded using a tympanic thermometer from prespinal till the end of surgery every 10 min and in postanesthesia care unit (PACU) at 0, 15, and 30 min. Results: Core temperature showed statistically significant difference in 15, 35, 45, and 55 min between air warmer and warm infusion groups and in PACU at 0, 15, and 30 min, it was statistically significant ( P = 0.000) among WI group (mean temperature = 36.79°C) when compared to WA group (mean temperature = 35.96°C). There was a lower incidence of shivering in WI compared to WA group, which is statistically significant. Conclusion: Combination of warm Intravenous fluid infusion and Forced air warming is better than forced air warming alone. In maintaining near normal maternal core body temperature during elective cesarean section following spinal anesthesia. Combined warming method also reduces shivering incidence.

A 7-year-old girl presented to the emergency room (ER) with alleged history of aspiration of a toy magnet. The challenge was to safely extract the foreign body. A bronchoscopic approach with forceps, or Dormia basket, or Fogarty catheter, was considered, but these approaches had disadvantages, such as slipping or impaction of the object, and oxygen desaturation. Applying principles of removal of intraocular metallic objects in ophthalmologic surgery using magnetism, the object was removed with the help of another larger surface magnet. The location of the foreign body was confirmed by bronchoscopy. A Fogarty catheter was introduced distal to the object, under bronchoscopic guidance. A strong surface magnet was then placed on the surface of the chest and under C-arm guidance, the object was moved from the bronchus to the trachea. Once at the vocal cords, the Fogarty catheter was inflated to prevent it from slipping back and the magnet was extracted using forceps.

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Background: Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways. Objectives: We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed. Methods: An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways. They were divided into video laryngoscopy (Group V) and direct laryngoscopy (Group D). The primary outcome measures included time taken for intubation, number of attempts required, Cormack-Lehane glottic view, use of optimization maneuvers, the requirement of tube repositioning, and hemodynamic parameters before and after intubation. Results: The time taken for intubation was longer in the video laryngoscopy group ( group D, 24.28 sec vs. group V, 27.65 seconds (P = 0.01). The Cormack-Lehane glottic view was grade 1 in all the patients in the video laryngoscopy group, while only 35 children showed grade 1 in the direct laryngoscopy group. (P < 0.001). We observed a significant increase in both heart rate and mean arterial pressure in the video laryngoscopy group at 1, 3, 5, and 10 min after intubation ((P < 0.001, P < 0.05). Conclusions: The time taken for intubation was more in group V, but the glottic view was much better, and the requirement for external maneuvers was also less. Pressure response to intubation was more in group V compared to group D.

IntroductIonDexmedetomidine is a highly selective α-2 adrenoceptor agonist commonly used in anesthesia practice. Dexmedetomidine produces sedation, hypnosis, analgesia, anxiolysis, and sympatholysis with minimal respiratory depression. [1] The central effects are due to the activation of α-2A receptors in locus coeruleus, and cardiovascular effects are due to a dose-dependent decrease in the central sympathetic outflow. The transient hypertensive response is seen initially due to its effects on α-2B receptors present in the vascular smooth muscle until there is a decrease in the central sympathetic outflow. [2] Dexmedetomidine has been shown to reduce perioperative oxygen consumption and blunt the sympathetic response to laryngoscopy and surgical stimuli, resulting in improved cardiac outcomes. [3,4] Dexmedetomidine infusions postoperatively have been shown to reduce plasma catecholamine levels and lesser hemodynamic fluctuations. [5] Dexmedetomidine has also been shown to reduce anesthetic and analgesic requirements. [6,7] The above-stated properties make dexmedetomidine an ideal preanesthetic agent. A study demonstrated that single preanesthetic dose of dexmedetomidine decreased the thiopental dose requirement without any serious hemodynamic changes. [7] Objective: To find out the dose of propofol consumption for induction and also the variation in hemodynamics following single-dose dexmedetomidine premedication. Methods: A total of 60 American Society of Anesthesiologists Class 1 and 2 patients aged between 18 and 80 years, posted for elective surgeries were randomized into two groups: Group C -premedication with 2 mcg/kg fentanyl and Group D -premedication with 1 mcg/kg dexmedetomidine + 2 mcg/kg fentanyl. Both groups were preloaded with 10 ml/kg crystalloid solution. The parameters measured were propofol requirements, heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), cardiac output (CO), and stroke volume variation (SVV). Results: Propofol requirements were 26.6% lesser in Group D (P < 0.001). In Group C, HR was significantly low at baseline (P = 0.008), induction (P = 0.006), and at intubation (P = 0.001) in Group D. Cardiovascular parameters such as MAP (P = 0.007), CI (P = 0.038), and CO (P = 0.021) were significantly lower in Group D compared to Group C only at baseline. There were no differences at any other point during the study. SVV was noted to be significantly lower (P = 0.018) in Group D only at intubation. Conclusion: Dexmedetomidine decreases the requirements of propofol for induction and also attenuates the hemodynamic response to intubation. Cardiovascular parameters such as MAP, CI, and CO were significantly lower in Group D only at baseline. Hemodynamic stability is mainly attributed to adequate preloading and less propofol requirement in the dexmedetomidine group.

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Background & objective: We studied the safety and effectiveness of combination of dexmedetomidine and fentanyl for chronic sub-dural hematoma (CSDH) evacuation. Main objectives of the study was to register the effects on the combination on the cardio-respiratory and analgesic outcome. Methodology: 56 patients with CSDH were divided into two group. Patients of Group A received dexmedetomidine 1 µg/kg over a period of 10 min with fentanyl 1 µg/kg, followed by an infusion of dexmedetomidine 0.3 µg/kg/min. Group B received fentanyl 1 µg/kg and midazolam 0.03 mg/kg IV. Sedation scores, hemodynamic changes and serial arterial blood gas (ABG) measurements were compared between the two groups. Results: Heart rate and diastolic blood pressure were significantly lower in Group A compared to Group B throughout the observation period after premedication. Systolic blood pressure readings was significantly lower in Group A compared to Group B from 10 min onwards till the end. ABG analysis showed that Group A had significantly lower PCO2 levels during and at the end of surgery and significantly higher PO2 at the end of procedure. Conclusion: The use of dexmedetomidine is associated with significantly higher PO2 at the end of the surgical procedure. It results in lower heart rate, systolic and diastolic blood pressures and PCO2 levels during and at the end of the subdural hematoma evacuation, but the fall remains within the physiological range.