A well-secured endotracheal tube (ETT) is essential for safe anesthesia. The ETT has to be fixed with the adhesive plasters or with tie along with adhesive plasters appropriately. It is specially required in patients having beard, in intensive care unit (ICU) patients or in oral surgeries. If re-adjustment of the ETT is necessary, we should be cautious while removal of the plasters and tie, as there may be damage to the cuff inflation system. This can be a rare cause of ETT cuff leak, thus making maintenance of adequate ventilation difficult and requiring re-intubation. In a difficult airway scenario, it can be extremely challenging to re-intubate again. We report an incidence where the ETT cuff tubing was severed while attempting to re-adjust and re-fix the ETT and the patient required re-intubation. Retrospectively, we thought of and describe a safe, reliable and novel technique to prevent cuff deflation of the severed inflation tube. The technique can also be used to monitor cuff pressure in such scenarios.

Background and Aims:Bag mask ventilation (BMV) allows for oxygenation and ventilation of patients until a definitive airway is secured and when definitive airway is difficult/impossible. This study hypothesised that the EO (thumb and index finger form a O shape around the mask) technique of mask holding provides better mask seal with the novices compared to the classic EC clamp technique (thumb and index finger form a C shape around the mask).Methods:Sixty patients participated in this double blinded, prospective, crossover study. The patients were randomly allocated to either EC or EO group. After adequate anaesthesia and neuromuscular blockade, a novice (experience of less than five attempts at BMV) held the mask with preferred hand with the allotted technique, while the ventilator provided five breaths at set pressure control of 15 cm H2O with one second each for inspiration and expiration. After recording the exhaled tidal volume (primary objective) for each breath for five consecutive breaths, the study was repeated with the other technique. Secondary outcome variables were minute ventilation, audible mask and epigastric leak.Results:The tidal volume and minute ventilation were significantly better with EO technique compared with the EC technique (P = 0.001, a tidal volume difference of 46 mL and P = 0.001, a minute volume difference of 0.51 L).Conclusion:The EO technique provides better mask seal (superior tidal volumes) than the conventional EC technique during single-handed mask holding performed by novices in the absence of other factors contributing to difficulty in mask ventilation.

Neurotransmitters in the spinal cord attenuate or amplify the pain signals from the periphery. Substance P, calcitonin and gene related peptides amplify while endogenous opioids, norepinephrine, serotonin, GABA and glycine attenuate the pain signal. Nociceptive impulse reaches the thalamus by second order neurons in the spinothalamic, spinoreticular and spinomesencephalic tracts. This study included 60 children, of both genders, coming for various elective infra-umbilical surgical procedures such as herniotomy, circumcision, orchidopexy, urethroplasty etc. After obtaining clearance from the hospital ethical committee a written informed consent was obtained from parents before commencing the study. The baseline oxygen saturation (SpO2) was 98.67 ± 1.24% in group B. In group D, the baseline oxygen saturation (SpO2) was 98.17 ± 1.51%. There was no significant difference between the groups. At 5, 15 and 30 minutes SpO2 values were 99 ± 0.74%, 98.1% ± 0.89 and 97.9% ± 1.24 respectively in group B and 98.23% ± 1.4, 98.67% ± 1.18 and 98.6% ± 1.04 24 respectively in group D. The differences were statistically significant but clinically insignificant.

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