No abstract

Background and Aims:Dexamethasone has a powerful anti-inflammatory action with significant analgesic benefits. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous (IV) and caudal route on post-operative analgesia in paediatric inguinal herniotomy patients.Methods:One hundred and five paediatric patients undergoing inguinal herniotomy were included and divided into three groups. Each patient received a single caudal dose of ropivacaine 0.15%, 1.5 mL/kg combined with either corresponding volume of normal saline (Group 1) or caudal dexamethasone 0.1 mg/kg (Group 2) or IV dexamethasone 0.5 mg/kg (Group 3). Baseline, intra- and post-operative haemodynamic parameters, pain scores, time to rescue analgesia, total analgesic consumption and adverse effects were evaluated for 24 h after surgery. Unpaired Student's t-test and analysis of variance were applied for quantitative data and Chi-square test for qualitative data. Time to first analgesic administration was analysed by Kaplan–Meier survival analysis and log-rank test.Results:Duration of analgesia was significantly longer (P < 0.001), and total consumption of analgesics was significantly lower (P < 0.001) in Group II and III compared to Group I. The incidence of nausea and vomiting was higher in Group I (31.4%) compared to Group II and III (8.6%).Conclusions:Addition of dexamethasone both caudally or intravenously as an adjuvant to caudal 0.15% ropivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia with the significant advantage of caudal over IV route.

Background: Supraglottic airway devices (SADs) are very useful airway adjunct in managing anticipated and unanticipated difficult airway and can be used as a ventilating aid and as a conduit for tracheal intubation. The new versions of SADs like i-gel and intubating laryngeal mask airway (ILMA), have advantage of hands-free airway maintenance without the need for tracheal intubation, they can be placed easily without direct visualization of the larynx, ensure predictable ventilation and can be used as conduit for tracheal intubation. Objective: To compare ease and success of placement of both SADs and ease and success of endotracheal (ET) intubation through both SADs. Method: Eighty patients of both sexes, aged between 18-60 years and belonging to ASA grade I and II undergoing surgical procedure under general anaesthesia (GA) were randomly divided into two group (i-gel and ILMA) of equal number. Following induction the allocated device was inserted and after confirming adequate ventilation, blind ET intubation was attempted through the device. First attempt and overall success rate of SAD insertion and ET intubation through SAD; time taken for SAD insertion and ET intubation through SAD; hemodynamic changes and postoperative complications were recorded and compared between groups. Result: Demographic profile, success rate of SAD insertion, haemodynamic changes and adverse effects were similar between groups (p>0.05).Overall time needed for successful SAD insertion was significantly shorter in group i-gel (22.52±5.64 sec) than group ILMA (31.15±5.52 sec) (p value <0.0001). Overall success rate of blind ET intubation was higher in group i-gel (75%) in comparison to group ILMA (65%). I-gel required significantly less time to achieve successful ET intubation than ILMA (26.30±11.35 sec vs. 33.53±13.13 sec)(p<0.0001). Conclusion: Both the SADs were proved to be useful alternative to conventional laryngoscope for ET intubation, although i-gel required lesser time and had better success rate of ET intubation as compared to ILMA.