Background and aimsManagement of difficult airway can be associated with serious morbidity and mortality and it is a basic and serious concern for anesthesiologists. The preoperative airway assessment is done by using conventional clinical predictors. The present study was conducted to find the correlation of various new clinical predictors with the Cormack-Lehane (CL) grade at the laryngoscopic view in patients undergoing general anesthesia with endotracheal intubation.

Sepsis is the most frequent cause of mortality in patients with acute illness worldwide [1]. Delays in the identification of sepsis and its management often result in rapid deterioration to circulatory collapse, multiple organ failure, and eventually death [2]. Therefore, prompt diagnosis of sepsis and rapid initiation of treatment can positively impact patient outcomes and reduce costs [3,4]. Sepsis is defined as a dysregulated immune response to an infectious insult, which results in life-threatening organ dysfunction [5].A positive microbiological culture is an accepted benchmark for distinguishing sepsis from noninfectious conditions. However, bacteria may take a long time to grow, and during this phase, the condition of the patients may promptly decline. To date, no single ideal biomarker for sepsis has been identified [6]. Thus, there is an urgent need for a biomarker that can identify sepsis in an early stage as

Background: Both nasal and oral routes can be used for fiberoptic intubation. Often it leads to hemodynamic disturbances, which may have a significant effect in patients with limited cardiopulmonary reserve as well as with cerebrovascular diseases. Aims: The aim of the study was to evaluate whether there is a clinically relevant difference between the circulatory responses to oral and nasal fiberoptic intubation. Settings and Design: This was a prospective, randomized, and comparative study. Materials and Methods: In this study, a total of 90 patients with the American Society of Anesthesiologist physical status I and II of either sex in the age group of 18–60 years and having anticipated difficult airway (DA) posted for elective surgery under general anesthesia were randomly allocated into two groups. Patients underwent fiberoptic intubation via either oral or nasal route under sevoflurane anesthesia with bispectral index guidance. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), time taken to intubation, and need of maneuver were measured. Statistical Analysis Used: All the analyses were carried out on SPSS 16.0 version (Inc., Chicago, USA). Mean and standard deviation were calculated. The test of analysis between two groups was done by unpaired t -test. Results: Demographic and DA characteristics were similar in both the groups. Significantly ( P < 0.01) lesser alteration in HR, SBP, DBP, and MAP was seen in oral fiberoptic intubation when compared to nasal fiberoptic intubation in the early phase of postintubation. Time taken to intubation was also significantly ( P < 0.01) lesser in the oral route compared to the nasal route. Conclusions: Oral fiberoptic intubation causes less hemodynamic alteration and takes less time in comparison to nasal fiberoptic intubation.

Background:Traditional approach to predicting trauma-related mortality utilizes scores based on anatomical, physiological, or a combination of both types of criteria. However, several factors are reported in literature to predict mortality independent of severity scores. The objectives of the study were to identify predictors of 1 year mortality and determine their magnitude and significance of association in a resource constrained scenario.Materials and Methods:Prospective observational study enrolled 572 patients. Information regarding factors known to affect mortality was recorded. Other factors which may be important in resource constrained settings were also included. This included referral from a peripheral hospital, number of surgeries performed on the patient, and his socioeconomic status (below poverty line (BPL) card). Patients were followed till death or upto a period of 1year. Logistic regression, actuarial survival analysis, and Cox proportionate hazard model were used to identify predictors of 1year mortality. Limited estimate of external validity of the study was obtained using bootstrapping.Results:Age of patient, Injury Severity Score (ISS), abnormal activated partial thromboplastin time (APTT), Glasgow Coma Scale (GCS) score at admission, and systolic blood pressure (BP) at admission were found to significantly predict mortality on logistic regression and Cox proportionate hazard models. Abnormal respiratory rate at admission was found to significantly predict mortality in the logistic regression model, but no such association was seen in Cox proportionate hazard model. Bootstrapping of the logistic regression model and Cox proportionate hazard model provide us with a set of factors common to both the models. These were age, ISS, APTT, and GCS score at admission.Conclusion:Multivariate analysis (logistic and Cox proportionate hazard analysis) and subsequent bootstrapping provide us with a set of factors which may be considered as valid predictors universally. However, since bootstrapping only provides limited estimates of external validity, there is a need to test these factors against the well accepted requirements of external validity namely population, ecological, and temporal validity.

Background: Various drugs are used for premedication to reduce anxiety and to provide hemodynamic stability. The study was designed to investigate the optimum dose of oral clonidine administered preoperatively with regard to its anxiolytic efficacy and its effect on hemodynamics and sedation. We studied the effect of three different doses of oral clonidine on surgeries below umbilicus which were administered intrathecal bupivacaine. Methods: A placebo controlled double blind study was conducted on 120 patients scheduled for surgeries below umbilicus. Group 1 received oral placebo, group 2 received oral clonidine 3 µg kg-1 , group 3 received oral clonidine 4 µg kg-1 and group 4 received oral clonidine 5 µg kg-1 along with 0.5% heavy bupivacaine 0.3 µg kg-1 intrathecally in each group. Outcomes assessed were anxiolysis through VAS, level of sensory block, time to reach highest sensory segment, regression to L1 segment, sedation score, bradycardia and hypotension. Results: There was improved block duration and sedation with the different doses of clonidine. Time for the sensory block to regress to L1 and rescue analgesia was longest in 4 followed by groups 3 and 2. There was significant dose dependent decrease in VAS anxiety score between group 1 and other clonidine groups in intraoperative and post-operative period. However, the episodes of bradycardia and hypotension were highest in 4 group. Conclusion: Preoperative oral clonidine 4 µg kg-1 appears to be the optimum dose for optimization of spinal anaesthesia with bupivacaine as it prolongs the sensory block maximally with minimal side effects.