Background: Instrumental vaginal delivery is a major concern during epidural labour analgesia. In previous studies levobupivacaine 0.1% was associated with increase in instrumental vaginal delivery when compared to 0.1% ropivacaine. Reducing the concentration of levobupivacaine may decrease the incidence of instrumental delivery. Hence, we compared 0.08% levobupivacaine and 0.1% ropivacaine with fentanyl as adjuvant for epidural labour analgesia in terms of mode of delivery. Methods: This prospective randomised controlled trial was conducted on 70 nulliparous parturients with singleton uncomplicated pregnancy. They were randomized into two groups to receive 0.08% levobupivacaine or 0.1% ropivacaine with 2g/ml fentanyl as intermittent epidural boluses. The epidural analgesia was initiated with 12ml of study drug solution in active stage of labour and was maintained by repeated demand boluses whenever the Visual Analogue Scale (VAS) score was > 3. Onset, duration and quality of analgesia, degree of motor blockade was analysed. Primary outcome measure was the mode of delivery. Onset and duration of analgesia and Apgar score of baby were the secondary outcomes. Results: Instrumental vaginal delivery was 6.45% in levobupivacaine(L) and 4.54%in ropivacaine(R) group. However,11.4% and 37.1% parturients underwent caesarean section in group L and group R respectively (p=0.012**). Mean onset of analgesia and duration of analgesia was comparable. More than 80% of parturients had excellent pain relief in both the groups with good baby APGAR score. Conclusion: We conclude that 12ml of intermittent epidural boluses of 0.08% levobupivacaine and 0.1% ropivacaine with 2g/ml fentanyl (equipotent dose) provided equal and effective analgesia during labour with comparable incidence of instrumental vaginal delivery.

Background and Aims: Postoperative psychomotor dysfunction is one of the deciding factors for discharge after daycare surgeries. Sedation for daycare procedures is commonly done using propofol and dexmedetomidine. Hence, we decided to study the recovery characteristics of dexmedetomidine and propofol in patients undergoing short gynaecological day care procedures. Methods:After getting informed consent, 40 patients aged between 18 to 65 years and ASA physical status 1 and 2 undergoing short gynaecological procedures were included for this double-blind prospective randomized controlled trial. All patients were educated about psychomotor tests preoperatively. Patients were randomized into two groups, Group P (propofol) and Group D (dexmedetomidine). Sedation was given using propofol or dexmedetomidine according to the group and titrated to achieve observer's assessment of alertness/sedation (OAA/S) scale 2-3. Recovery characteristics were assessed by modified Aldrete score, time to sit without support, finger tapping test and visual-spatial capacity memory test. Results: Demographic variables, baseline finger tapping test and visual-spatial capacity memory test, duration and type of surgery were comparable. All forty patients tolerated the procedure with no signs of respiratory depression.Time to achieve modified Aldrete score 9-10 was significantly more in Group P compared to Group D (5.6±1.4min vs 4.0±1.4min; P=0.002), while time to sit without support was significantly less in Group P (5.6±1.4min vs 4.0±1.4min; P=0.002). Psychomotor tests during recovery and patient satisfaction score were comparable between the groups. Conclusion:Dexmedetomidine and propofol have been found to have comparable recovery characteristics in daycare short gynaecological surgeries.

Background: Simple manoeuvres such as head elevated laryngoscopy position (HELP) can facilitate a better glottic view. We conducted this prospective randomised clinical trial to compare the glottic view in a HELP with the same patient in supine and 25° backup positions. Methods: A total of 180 patients aged between 18 and 65 years who planned for elective surgery under general anaesthesia with endotracheal intubation using Macintosh laryngoscope were included. Any patient with anticipated airway difficulty, emergency surgeries, or rapid sequence induction was excluded. All patients were randomised into two groups (group B = 90 and group S = 90). In group S, the glottic view was assessed whilst the patients were in the 25° backup HELP position (first position). Then, the patients were repositioned and intubated in the supine HELP (second position) position after reassessing the glottic view. In group B, the glottic view was assessed whilst the patients were in the supine HELP position (first position). Then, the patients were repositioned and intubated in the 25° backup HELP position (second position) after reassessing the glottic view. Percentage of glottis opening score (POGO), Cormack Lehane (CL) grade, laryngoscopy time, intubation time, attempts for intubation, anaesthesiologists comfort, use of ancillary devices/manoeuvres, and ease of intubation were recorded. Results: The mean POGO score was significantly more in 25° backup than supine position (n = 180; 25° backup HELP: 64.78±26.83% vs supine HELP: 46.96±27.71%, P -value <.0001). The CL grade was significantly higher in the supine HELP position than the 25° backup HELP position (n = 180, P -value < .0001). The mean laryngoscopy time was comparable between two positions (n = 180, supine with HELP: 9.38±3.80 seconds, 25° backup with HELP: 9.47±3.80 seconds; P -value: .608). The mean intubation time was significantly shorter ( P = .001) in group B (7.7±2.2 seconds) than group S (9.2±3.6 seconds). Conclusions: This study has shown that the 25° backup HELP position provides improved glottic view in comparison with the supine HELP position.