Pain experienced by the patient while the inducing dose being given in the peripheral vein is the most common drawback of this widely used agent. Seen to vary from mild to moderate pain and complained by 2/3rd of the patients around the globe. It is among one of the high-priority outcomes which need changes during general anesthesia. Propofol is supposed to directly irritate the venous tunica intima and release nitric oxide. Propofol itself in emulsion or microemulsion form or opioid adjuvants like fentanyl, alfentanyl, remifentanyl and tramadol are tried with good results. Other agents like ketamine, ketorolac, diclofenac, flurbiprofen and combination of clonidine–ephedrine are also tried but using a larger vein and using it with lignocaine seems to be the best and easiest so far. In this randomized study, we have observed that the pain alleviation was superior in dexmedetomidine (DX) group compared to dexamethasone (DM) group, however, the drop in heart rate was significantly more in DX group, but it was treated only with a single dose of atropine in four patients. Hence dexmedetomidine can be used to attenuate the propofol-induced intravenous pain.

Background and aim: Early detection of complications after intubation is necessary as outcomes can be fatal. In search of an ideal test, we conducted this study under ideal settings to compare the time required and efficacy of airway ultrasonography (USG) vs Capnography with auscultation to confirm correct placement of endotracheal tube after intubation. Methodology: In this prospective, randomized, comparative study, we randomly allocated our sample population of 130 posted for general anesthesia in elective cases in operation theater into two groups and then used capnography with auscultation for group A and USG for group B to confirm tube placement in the trachea. We compared the efficacy and time taken by the two methods of confirmation. p value < 0.05 was considered statistically significant. Results: Tracheal USG confirmation time in group B (2.8 ± 1.9 s) was significantly lower than capnography confirmation time in group A (7.5 ± 2.4 s) (p = 0.03). Time taken to confirm bilaterally equal air entry by auscultation in group A and USG sliding lung sign in group B were comparable. Total time taken for confirmation with USG (16.87 ± 8 s) was faster than auscultation and capnography (24.7 ± 10.6 s) but was not statistically significant (p = 0.43). Both the methods were comparable with respect to efficacy. Conclusion: We conclude that USG is a faster modality for confirmation of correct placement of endotracheal tube compared to capnography and auscultation. Both methods are compared with respect to efficacy.

Aim: Acquisition of basic and advanced airway skills on a mannequin is a well-accepted teaching methodology. To study the impact of video-laryngoscopy-aided identification of airway structures on basic skill acquisition by medical interns for endotracheal intubation (ETI) on a simulator was the aim. Materials and methods: This observational study was conducted in a simulation laboratory. Medical interns were randomized into conventional direct laryngoscopy (DL) and video-laryngoscope aided (VL) groups; they were taught DL and ETI with or without an additional video-laryngoscopy-based session. Participants performed an average of five supervised intubations, subsequent practical exam, and assessed by a blinded observer followed by submission of a structured questionnaire. Results: Eighty interns participated. The mean-time taken to intubate was 48.58 seconds and 48.65 seconds for the DL and VL groups, respectively. success in ETI in the first attempt was 90% (DL) and 87.5% (VL) (p = 0.72). Highest respect toward tissue in the DL group (p = 0.0730) was noted. Conclusion: Addition of video-laryngoscope as a teaching aid in the simulation laboratory did not affect intubation success rate or time. Clinical significance: • Teaching medical and technical skills to students using mannequins is a well-accepted methodology for hands-on experience and attaining proficiency. • Visualization of structures in video-laryngoscopy during endotracheal intubation is assumed to enhance success rate. However, success rate of intubation is independent of the technique used, that is, direct laryngoscopy and video-laryngoscopy. • Tissue respect is superior with direct laryngoscopy.

Aims and objectives: Dexmedetomidine a potent and highly selective α-2 adrenoceptor agonist with sympatholytic, sedative, amnestic and analgesic properties is ideal for monitored anesthesia care (MAC). When used with Ketamine, the bradycardia and hypotension associated with dexmedetomidine may be prevented. Whereas dexmedetomidine may prevent tachycardia, hypertension, salivation, and emergence phenomena of ketamine. There are few references in literature about this drug combination. Hence we studied and compared the effect of intravenous dexmedetomidine infusion with low-dose ketamine infusion on sedation and hemodynamics in ear surgeries under MAC. Materials and methods: ASA 1 and 2 patients scheduled for elective ear surgeries were randomized in groups A and B. Patients in both groups were administered IV dexmedetomidine 0.5 μg/kg as a bolus over 10 minutes followed by the 0.5 μg/kg/hr as maintenance infusion in group A, whereas low-dose IV Ketamine 0.2 mg/kg/hr was added in group B in addition to dexmedetomidine infusion. Local block using 2% lignocaine with adrenaline was performed by the ENT surgeon. Sedation (MOAA/S) hemodynamics, respiratory rate and oxygen saturation were recorded. Patient satisfaction was assessed using Likert scale. Mann-Whitney test was used to compare sedation between the two groups. Hemodynamic variables were analyzed by Student's t-test. The Association of parameters among study group was assessed with the help of Chi-square test. Qualitative data was presented with the help of Frequency and Percentage table. Results: There was a statistically significant difference (p < 0.05) in sedation score between the groups (group A–3, group B–2) from 5 minutes interval onwards. There was significant difference in hemodynamics between the two groups from 5 minutes interval onwards with the values being higher in group B. Patient satisfaction score was better in group B compared to group A. Group A, i.e., only exmedetomidine needed more interventions to maintain sedation and to correct hypotension. Conclusion: Dexmedetomidine with low-dose ketamine infusion provides early onset and adequate sedation, better hemodynamic profile, and patient satisfaction than dexmedetomidine alone for ENT surgeries under MAC. Clinical significance: ‘Synergistic’ combination of dexmedetomidine with low-dose ketamine provides early and better sedation while maintaining hemodynamics as compared to dexmedetomidine infusion alone for ENT surgeries under MAC.

With the increase in life expectancy, nowadays we commonly come across with patients with many comorbidities, which make them high risk for general anesthesia. In these patients, regional anesthesia becomes a preferred choice because of its better safety profile and lesser risk of morbidity and mortality. We describe management of a patient with interstitial lung disease for wide local excision of tongue lesion with neck dissection under regional anesthesia.

Conn's syndrome is caused due to increased secretion of aldosterone from the adrenal glands. It could be because of an adrenal adenoma or adrenal hyperplasia. Excessive aldosterone levels lead to water retention, hypertension, and hypokalemia. We hereby report a case of a 37-year-old female who presented to the emergency department with quadriparesis and malignant hypertension. On investigating, she was found to have hypokalemia, metabolic alkalosis, rhabdomyolysis, raised aldosterone levels, and a right adrenal adenoma in the CT abdomen. Hypokalemia was treated and she was started on tablet spironolactone. She underwent laparoscopic adrenalectomy under general anesthesia. Her perioperative course was uneventful. Anesthesia management of a case of Conn's syndrome presents various challenges for the anesthesiologist. Good coordination between anesthesiologists, endocrinologists, and surgeons is required for the successful management of such a case.

Careful preoperative evaluation and planning is essential to prevent airway-related morbidity and mortality during induction of anesthesia. According to previous studies, predictors of difficult airway include Mallampati III, limitation of jaw protrusion, male sex, presence of teeth, limited neck extension, and reduced thyromental distance. There are no clear-cut guidelines regarding application of difficult airway predictors in patient having painful mouth opening. In this case report, we have described our experience of pre-emptive analgesia to increase the accuracy of airway assessment in patient having painful mouth opening.

Several techniques of infraclavicular brachial plexus nerve block (ICB) have been described in literature: stressing on various surface landmarks, site of needle insertion, and needle direction. Classical infraclavicular approach was the first one to be described followed by the retroclavicular and costoclavicular approach. Here we describe a novel technique of ICB is proximal out-plane retroclavicular approach. Proximal out-plane retroclavicular is simple and handy, in our experience. It also offer advantages over distal in-plane retroclavicular approach as it targets proximally clustered cords rather than individual cord.

Background: Intravenous leiomyomatosis (IVL) is an uncommon entity characterized by the growth of benign, smooth muscle tumors within the venous system. Intracardiac extension of this tumor is rare, and very few cases have been reported in the literature. Case description: We describe a case of IVL with intracardiac extension in a 55-year-old woman, who presented with severe dyspnea, ascites, and lower limb edema. Two-dimensional transthoracic echocardiography and computed tomography showed that the pelvic mass infiltrated the inferior vena cava via the iliac vessels and was extending to the right ventricle and pulmonary artery. The patient underwent a one-stage multidisciplinary thoracoabdominal operation with cardiopulmonary-bypass and deep hypothermic circulatory arrest. Conclusion: Due to the rarity of the present pathology, awareness is widely scarce and diagnosis is often deferred. A correct timely diagnosis, reasonable perioperative plan, and radical excision guarantees favorable outcomes.

The technological innovations in all the sectors of medical specialty have improved not only clinical practice but also administrative work to a great extent. Along with clinical practice, modern technology has replaced traditional techniques of record-keeping and storing piles of paperwork. An anesthesia information management system (AIMS) is an electronic record system that allows the collection, storage, and presentation of patient data during the perioperative course. Anesthesia information management systems (AIMS) have implemented the smooth transition from simple, automated intraoperative record-keeping in a selected few institutions to widely adopted, modern and sophisticated hardware and software solutions that are integrated into a hospital's electronic health record system which contributes to the documentation of patient's entire perioperative experience. The availability of AIMS helps to proliferate and allows sharing of the data across multi-institutional collaborations. Visual analytics and advanced analytics techniques such as machine learning may be applied to AIMS data, to offer even more benefits. Our hospital is a tertiary care, Joint Commission International (JCI) reaccredited hospital, with technological advancement in storing health records in various hospital locations such as operation theaters, wards, Intensive Care Units (ICUs), administrative work, and billing systems.