ProSealTM Laryngeal Mask Airway (PLMA) for children had been introduced in 2004, by Dr. Archie Brain. It has, in addition to Classic Laryngeal Mask Airway (CLMA), a drainage tube for providing a bypass channel for gastric contents to prevent regurgitation and pulmonary aspiration. A randomized prospective study was performed comprising of 60 ASA – I/II patients, between the age groups of 3 and 10 years, of either sex. All the patients were premedicated with oral Midazolam and Glycopyrollate. General anaesthesia with caudal epidural analgesia was given in all the cases. Inhalation with 8% Sevoflurane was used as a sole induction agent in all the patients. They were randomly divided into two groups. PLMA was inserted in patients of Group P and Endotracheal Tube (ETT) in patients of Group I. In all cases, after PLMA / ETT insertion; caudal epidural analgesia was given and general anaesthesia (GA) using Sevoflurane was provided for maintenance of anaesthesia. Muscle relaxant was not used in our study. We studied parameters such as number of attempts, ease of insertion and conditions during insertion, haemodynamic parameters, changes in SpO2, EtCO2, gastric insufflation, regurgitation, pulmonary aspiration, postoperative airway complications and so on. We found that insertion of PLMA as well as ETT was performed in the first attempt in all the patients. Ease of insertion and conditions during insertion were comparable in both the groups. Changes in SpO2 and EtCO2 were comparable. However, highly significant changes in haemodynamic parameters were observed in the ETT group. Complications such as sore throat (13.33% cases), coughing (40% cases), vomiting (3.33% cases) and hypoxia (3.33% cases) were observed in the ETT group. No gastric insufflation or regurgitation was noted in our study. Thus, we concluded that PLMA could be used as an effective and safe airway device in children compared to ETT undergoing general anaesthesia.

Introduction: Addition of adjuvants like Dexmedetomidine and Fentanyl to hyperbaric Bupivacaine has been proposed to improve the quality of spinal anaesthesia. Aims and Objectives: The aim of current study was to compare the effects of adding Dexmedetomidine, Fentanyl and saline to low dose hyperbaric Bupivacaine (1 ml, 0.5%) on the properties of unilateral spinal anaesthesia. Methods and Materials: 120 patients divided into three groups. The spinal anaesthetic agent in each of the three groups was 1 mL bupivacaine 0.5% (5 mg). In groups BD, BF and BS, 5mcg of Dexmedetomidine, 25mg of Fentanyl and 0.5 mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the assessment of pain during 24 h after surgery were noted. Results: Duration of motor and sensory block were significantly longer in the BF and BD groups than the BS group. Mean total number of rescue analgesic required were less in group BD and BF compared to group BS. Conclusions: Addition of Dexmedetomidine and Fentanyl to low dose Bupivacaine in unilateral spinal anaesthesia increase the duration of the motor, sensory block and post op analgesia.

: I-Gel and Ambu Aura Gain are two novel second generation supra-glottic airway devices available for airway management and can be used safely and effectively in paediatric patients under controlled ventilation with adequate airway seal. The aim of our study was to compare efficacy of I-Gel and Ambu Aura Gain in providing safe and adequate airway seal in paediatric patients under controlled ventilation. A prospective, randomized, single blind clinical study was carried out on total 60 paediatric patients with ASA grade I & II, 3-10 years age, undergoing surgery under general anaesthesia. The patients were randomly assigned into Group I (I-Gel) (n=30) and Group-A (Ambu Aura Gain) (n=30) using randomizer software. I-Gel was inserted using “finger technique” and Ambu Aura Gain with simple insertion technique. We assessed effective airway insertion time, time required for insertion of the device, ease and number of attempts for airway and gastric tube insertion, oropharyngeal leak pressure, haemodynamic parameters and complications. Statistical analysis was done using the MedCalc software, student’s paired t- test, unpaired t-test and chi-square test. Effective airway insertion time (p=0.1671), ease and numer of airway insertion attempts were comparable amongst both groups. Oropharyngeal leak pressure was significantly higher in group I (22.366±1.4735 of H2O) than in group A (20.8±1.01 cm of H2O), p value = 0.0001. Airway seal of Ambu Aura Gain is lesser compared to I-Gel. I-Gel can be used with better safety and efficacy for controlled ventilation in paediatric patients. I-Gel provides higher oropharyngeal seal pressure, which gives higher safety against risk of aspiration and air leak than Ambu Aura Gain, yet oropharyngeal seal pressure of Ambu Aura Gain is adequate that it allows its use during controlled ventilation under general anaesthesia. Hence, both devices can be used alternatively.

Introduction:The Proseal Laryngeal Mask Airway (PLMA) and I-gel are two novel supraglottic devices available for airway management and can be used safely in paediatric patients. The primary aim of our study was to compare the efficacy of PLMA and I-gel in providing adequate airway seal in paediatric patients under controlled ventilation. Materials and Methods: A prospective, randomized, single blind clinical study was carried out during October 2014 to September 2015. A total of 64 ASA PS grade I and II paediatric patients (Aged 3-9 years) undergoing elective general surgery were included. Patients with upper respiratory tract infection and difficult intubation were excluded. The patients were randomly assigned into two groups PLMA Group and I-gel Group using randomizer software. We assessed airway insertion time, ease of insertion and number of attempts for airway control and gastric tube placement, oropharyngeal seal pressure, hemodynamic parameters and complications. Results: The oropharyngeal seal pressure was significantly higher (p=0.0025) in group PLMA (29.1±3.7cm of H2O) than in group I-gel (26.3±3.5 cm of H2O). Hemodynamic parameters, success rate and postoperative complications were comparable among both the groups. Conclusion: Both, PLMA and I-gel can be used safely and effectively for airway management in paediatric patients under controlled ventilation.

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