Background:GlideScope (GS) is a video laryngoscope that allows a real-time view of the glottis and endotracheal intubation. It provides a better view of the larynx without the need for alignment of the airway axes.Aim:This prospective randomized comparative study is designed to compare the intubation time, hemodynamic response, and complications associated with intubation using a GS or Macintosh laryngoscope (ML) in adult subjects undergoing elective surgical procedures.Materials and Methods:Sixty American Society of Anesthesiologists physical status 1–2 patients were included in this prospective randomized comparative study. Patients were randomized to be intubated using either a GS or an ML. The primary outcome measure was the intubation time. The secondary outcome measures were the hemodynamic response to intubation and the incidence of mucosal injury.Statistical Analysis:Mean and standard deviation were calculated for different parameters under the study. The observed results were analyzed using Student's t-test for quantitative data and Z-test of proportions. P<0.05 was considered statistically significant.Results:Intubation time was longer in GS group (45.7033 ± 11.649 s) as compared to ML (27.773 ± 5.122 s) P< 0.0001 with 95% confidence interval (95% CI) −13.2794 to −22.5806. GS provided better Cormack and Lehane laryngoscopic view (P = 0.0016 for grade 1 view) with 95% CI −0.1389 to −0.5951. GS group exhibited more laryngoscopic response than ML group with more increase in blood pressure and heart rate, but the difference was not statistically significant. More cases of mucosal trauma were documented in GS group.Conclusion:Use of GS to facilitate intubation led to better glottic view but took a longer time to achieve endotracheal intubation. GS was associated with more hemodynamic response to intubation and mucosal injury in comparison with an ML.

A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was posted for an emergency laparotomy for hollow viscus perforation. His history was not suggestive of any systemic disorders. An echocardiography revealed left ventricular dysfunction with an ejection fraction of 47% without any valvular or chamber abnormality. Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed. Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge. Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.

Tetany a syndrome of sharp flexion of the wrist and ankle joints (carpopedal spasm), muscle twitching, cramps and convulsions, sometimes with an attack of stridor, is due to hyperexcitability of nerves and muscles caused by decreased extracellular ionized calcium. Hyperventilation secondary to anxiety can result in tetany. We report a case of hyperventilation induced tetany 2 h following spinal anesthesia for inguinal hernia repair.

Background:Pain experienced following laparotomy is largely due to abdominal wall incision. Effective mitigation of this pain is vital to improve patient satisfaction and for early ambulation. We evaluated the efficacy of transversus abdominis plane (TAP) block for postoperative analgesia, as a component of multimodal analgesia.Materials and Methods:Sixty adult ASA physical status I to III patients undergoing emergency laparotomy under general anesthesia were recruited for this double-blind, randomized, controlled trial. The TAP block was performed before skin incision, using the double pop technique in the midaxillary line, at the level of the umbilicus with a 22 gauge blunt needle. The patients were randomly assigned to receive either 25 ml of 0.25% bupivacaine or normal saline (NS), bilaterally. Tramadol was used for postoperative analgesia via a patient-controlled analgesia pump (PCA) along with an intramuscular (IM) injection of diclofenac sodium, 12-hourly. Each patient was assessed in the Post Anesthesia Care Unit (PACU) immediately after shifting and every two hours thereafter, for 24 hours, for pain, nausea, sedation scores, and pruritus. The two-hourly and total tramadol consumption, over 24 hours, was assessed.Results:The mean total pain scores were significantly less in the TAP block group (48.07 ± 6.76) when compared to the control group (62.63 ± 6.66). The total tramadol consumption was decreased by 36% in the TAP block group (281.33 ± 69.66 mg) compared to the control group (439 ± 68.59 mg). Tramadol consumption measured every two hours was also less up to 18 hours postoperatively, after which, there was an increase in pain scores and tramadol consumption in the TAP block group. There was no statistically significant difference between the two groups in terms of nausea, vomiting, sedation or pruritis.Conclusion:TAP block is an effective component of the multimodal analgesia regimen for reducing postoperative pain and opioid requirement after emergency laparotomy.

Background:Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and duration of action of equipotent doses (3ED95) of R and V.Materials and Methods:The study was carried out in 60 adult American Society of Anesthesiologists physical status 1–2 patients of age 20–60 years. The patients were divided into two groups of 30 each and received either 0.9 mg/kg of R (Group R) or 0.168 mg/kg of V (Group V) to facilitate endotracheal intubation. Neuromuscular blockade was assessed at corrugator supercilii and adductor pollicis muscles to evaluate onset time and duration of neuromuscular block, respectively.Results:The mean onset time was significantly rapid in Group R as compared to Group V (P -0.011). Overall intubating conditions were excellent in 100% of patients in Group R as compared to 70% in Group V. The mean duration of action did not show a significant variation between the groups.Conclusion:At equipotent doses, R provides clinically acceptable intubation conditions much earlier than V without significant variation in clinical duration of action.