Background and Objectives:Supraglottic airway devices (SADs) have revolutionized the pediatric anesthetic practice and got a key role in difficult airway (DA) management. Several modifications of SADs design had come up to improve their safety.Aim:The aim of this survey was to determine the current usage of SADs in pediatric anesthetic practice, their availability, and to know any difficulties noted in practice.Methods:It was a questionnaire survey among the anesthesiologists who attended the National Pediatric Anesthesia Conference-2016. The questionnaire assessed the current practice preferences of SADs in routine pediatric cases and DA management, availability of various devices, and any difficulties noted in their usage.Results:First-generation SADs were widely available (97%), and 64% of respondents preferred to use it for pediatric short cases. 64% felt the use of SADs free their hands from holding the facemask and 58% found better airway maintenance with it. Intraoperative displacement (55%) was the common problem reported and only 11% felt aspiration as a problem. Most of the respondents (73%) accepted its use as rescue device in airway emergency, and 84% felt the need of further randomized controlled studies on safety of SADs in children. The majority were not confident to use SADs in neonates.Interpretation and Conclusions:The key role of SADs in DA management was well accepted, and aspiration was not a major problem with the use of SADs. Although many newer versions of SADs are available, classic laryngeal mask remains the preferred SAD for the current practitioner. Further, RCTs to ensure the safety of SADs in children are warranted.

Background and Objectives:Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for.Methods:It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval. The total amount of all drugs wasted at the end of a surgical day from each major OR was audited for five nonconsecutive weeks. Drug wasted includes the drugs leftover in the syringes unutilized and opened vials/ampoules. The total cost of the wasted drugs and average daily loss were estimated.Results:The drugs wasted in large quantities included propofol, thiopentone sodium, vecuronium, mephentermine, lignocaine, midazolam, atropine, succinylcholine, and atracurium in that order. The total cost of the wasted drugs during the study period was Rs. 59,631.49, and the average daily loss was Rs. 1987.67. The average daily cost of wasted drug was maximum for vecuronium (Rs. 699.93) followed by propofol (Rs. 662.26).Interpretation and Conclusions:Financial implications of anesthetic drug wastage can be significant. Propofol and vecuronium contributed maximum to the financial burden. Suggestions for preventive measures to minimize the wastage include education of staff and residents about the cost of drugs, emphasizing on the judicial use of costly drugs.

Aims: Hemodynamic changes caused by laryngoscopy, endotrachial intubation and creation of pneumoperitonium in laparoscopic surgeries is deleterious to patients. This study was done to compare nalbuphine an agonist antagonist opioid with fentanyl, a gold standard opioid, when used in patients undergoing laparoscopic appendectomy under general anesthesia. Materials and Methods: This study included 60 ASA I patients who underwent elective appendectomy were randomised to receive either nalbuphine 0.1mg/kg or fentanyl 2µg/kg as analgesics 5 minutes prior to intubation. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at baseline and at every 2 minutes post intubation till the end of surgery. The time of laparoscopic port insertion and creation of pneumoperitonium was noted. Independent student't' test and chi square test was used to analyse continuous variables and categorical variables respectively. Results: The changes in heart rate were comparable between both groups at all time points of observation. Nalbuphine and fentanyl group showed an increase in heart rate of 3.81% and 6.03% respectively. Mean arterial pressure was comparable at all time points of observation except at the time of insertion of second port wherein fentanyl group showed 12.70% increase as compared to 4.54% fall from baseline in nalbuphine group. Side effects were comparable between both groups except sedation which was significantly more in nalbuphine group and pruritus more in fentanyl group. Conclusion: Nalbuphine due to its availability without license is an effective alternative to fentanyl in laparoscopic surgeries.

Background:Hypobaric spinal anesthesia is advantageous for unilateral lower extremity fractures as it obviates pain of lying on fractured limb for performing subarachnoid block.Aims:This study compares block characteristics and complications of three different baricities of constant dose intrathecal hypobaric levobupivacaine to determine an optimum baricity.Settings and Design:One-twenty American Society of Anesthesiologists Physical Status 1 and 2 patients aged 18–65 years undergoing unilateral lower limb surgeries were divided into three equal groups for this prospective cohort study.Materials and Methods:To 2 mL intrathecal 0.5% isobaric levobupivacaine (10 mg), 0.4 mL, 0.6 mL, and 0.8 mL of distilled water were added in Groups A, B, and C, respectively. Baricities of Groups A, B, and C are 0.999294, 0.998945, and 0.998806, respectively. Development of sensory and motor block was assessed by the pinprick method and Bromage scale, respectively. The total duration of analgesia and complications were noted.Statistical Analysis Used:Mean, standard error, one-way ANOVA, and Bonferroni were used to analyze quantitative variables; proportions and Chi-square tests for qualitative variables.Results:Demographic parameters, motor block of operated limb, and complications were comparable. Group C had the fastest onset of sensory block (10.10 min) and maximum duration of analgesia (478.97 min; P < 0.001); but high sensory levels in 48.7%. Group B had T10 sensory level in 92.5%; onset comparable to Group C (P = 0.248), and reasonable duration of analgesia (332.50 min). Group A had inadequate sensory levels, slow onset, and early regression.Conclusions:Group B (baricity - 0.998945) has better block characteristics among three groups compared.