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.

Morquio-Brailsford syndrome is a type of mucopolysaccharidoses. It is a rare disease with features of short stature, atlantoaxial instability with risk of cord damage, odontoid hypoplasia, pectus carinatum, spine deformities, hepatomegaly, and restrictive lung disease. Neck movements during intubation are associated with the risk of quadriparesis due to cervical instability. This, along with the distortion of the airway anatomy due to deposition of mucopolysaccharides makes airway management arduous. We present our experience in management of difficult airway in a 3-year-old girl with Morquio-Brailsford syndrome posted for magnetic resonance imaging and computerized tomography scan of a suspected unstable cervical spine. As utmost sagacity during intubation is required, the child was intubated inside operation theatre in the presence of experienced anesthesiologists and then shifted to the peripheral location. Intubation was done with an endotracheal tube railroaded over a pediatric fibreoptic bronchoscope passed through the lumen of a classic laryngeal mask airway, keeping head in neutral position.

Background and Aims:The Airtraq™ video laryngoscope facilitates tracheal intubations in patients with difficult airway or cervical spine immobilization. However, curved reinforced tracheal tube and straight reinforced tracheal tubes are useful where neck of the patient is likely to be moved or flexed or if patient is in prone position, wherein nonreinforced endotracheal tube (ETT) might get kinked and/or compressed. We compared intubation success rate of curved and straight reinforced tracheal tubes with polyvinyl chloride (PVC) tracheal tube using Airtaq™ laryngoscope in paralyzed and anesthetized patients.Material and Methods:Totally, 120 patients underwent random allocation to one of the three groups using computer-generated randomization table. Patients were intubated with appropriate size and type of ETT using Airtraq™ after obtaining optimal glottis view. Experienced anesthesiologist performed endotracheal intubation and unblinded observer noted down success and ease of intubation.Results:Patients intubated with PVC tube (100%) had higher rates of successful intubation and shorter intubation time (4 s), in comparison to intubation with curved reinforced (92.5%) and straight reinforced tubes (SRTs) (85%) using Airtraq™ laryngoscope (AL). However, there was no statistical difference in the incidence of airway trauma among all the three groups.Conclusions:PVC tracheal tube is significantly superior to both curved and SRTs for intubation using AL.

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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.