Background Orthopedic surgeries lead to moderate to severe postoperative pain, treating which is a challenge to the anesthesiologist. The present prospective, randomized study was carried out to compare the efficacy of postoperative pain relief between patient controlled epidural analgesia (PCEA) and conventional intermittent bolus epidural analgesia (IBEA) \with very low concentration of bupivacaine plus fentanyl in 60 ASA I and ASA II patients for orthopedic lower limb surgeries. Following variables like heart rate, mean arterial pressure, oxygen saturation, visual analogue scale (VAS) score, total analgesic consumption, patient satisfaction (Likert scale) and side effects were assessed for 24 h postoperatively. Results The hemodynamic parameters were comparable in both the groups at various time intervals. There was a significant decrease in VAS score, less analgesic consumption, less rescue analgesia requirement and more patient satisfaction in PCEA group as compared to IBEA group. Conclusions Patient controlled epidural analgesia (PCEA) with a combination of bupivacaine and fentanyl has more efficacy and safety than intermittent bolus epidural analgesia (IBEA) so it should be used more often.

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Background Aberrant airway anatomy in cases of laryngeal carcinomas makes airway management a herculean task for the anesthesiologist. What can further compound the situation is an external compression by thyroid mass. Case presentation We present a case report of successful airway management by awake nasal fiberoptic intubation in a 65-year-old male who was found to have compressive symptoms due to thyroid swelling in addition to supraglottic obstructive mass. Although a detailed airway examination and indirect laryngoscope did assist in planning the procedure, but what lay inside could only be dealt with by having an in-depth orientation of airway anatomy, practical know-how to fiberoptic scope, and swift reflexes to prevent an adverse event. Conclusion From our experience, fiberoptic intubation can only be optimally utilized if emphasis is laid on planning and preparation for the procedure which are key elements in making any difficult airway management successful.

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BACKGROUND Supraglottic airway devices (SAD) like air Q and I-Gel are widely used in place of tracheal intubation for general anaesthesia. The present study was undertaken to compare the insertion conditions of these two supraglottic airway devices and as conduits for endotracheal tube (ETT) insertion in adult patients undergoing elective surgeries. METHODS 100 patients belonging to American Society of Anaesthesiologists (ASA) grade 1 and 2 between 18 to 70 years were randomly divided into 2 groups of 50 each. In group A, Air-Q was used and in group B, I-gel. The following parameters were compared while inserting SAD and endotracheal tube (ETT): number of insertion attempts, insertion time, ease of insertion, intraoperative and postoperative complications. RESULTS Insertion in first attempt was 90 % in air- Q and 72 % in I-gel. The mean time of insertion for air-Q was 7.28  1.46 seconds which  was shorter as compared to I-gel which was 8.46  2.18 seconds (p = 0.002). Air Q was easy to insert in 93 % cases and I-Gel in 52 % cases. ETT insertion through Air-Q was easy when compared to I-Gel .Complications occurred in some patients in both the groups. CONCLUSIONS We concluded that Air-Q has better efficacy than I-gel in terms of insertion conditions and as a conduit for endotracheal intubation.