Background and Aims: Breast surgery is associated with moderate-to-severe postoperative pain, nausea, and vomiting. For this, neuraxial anesthesia might be a better alternative to general anesthesia (GA), providing superior analgesia, with higher patient satisfaction and lesser incidence of nausea vomiting. This randomized-controlled open-label trial was done to compare segmental spinal and GA for breast cancer surgery. Material and Methods: The present study enrolled 56 female patients scheduled to undergo breast cancer surgery. They were randomly divided into two groups, group G (received standard GA) and group TS (received segmental thoracic spinal anesthesia with 0.5% isobaric levobupi vacaine at T5–T6 inter spaces). The primary objective of this study was patient satisfaction with the anesthetic technique, while secondary objectives were hemodynamic changes, perioperative complications, time of first rescue analgesic, total opioid consumption in first 24 h, and surgeon satisfaction score. Data were expressed as mean (SD) or number (%) as indicated and were compared using Chi-square, Fisher’s exact, or Student’s ttest as appropriate. Results: Patient in group TS had significantly higher satisfaction score median 5 (IQR 1) compared to patients in group G median 4 (IQR 3.5) (P = 0.0001). Nausea and vomiting were significantly higher in group G compared to group TS (P = 0.01). Mean time to rescue analgesia was 33.21 ± 7.48 min in group G as compared to 338.57 ± 40.70 in group TS and opioid consumption was also significantly lower in group TS (70.00 ± 27.38) as compared to group G (366.07 ± 59.40). There was no significant difference in hemodynamic parameters (except significantly lower heart rate at 15 min in group TS (P = 0.001) and surgeon satisfaction score between groups. Quality of postoperative analgesia was better in group TS. Conclusion: Segmental thoracic spinal anesthesia technique provides better satisfaction with superior postoperative analgesia and fewer complications in patients undergoing breast cancer surgery compared to GA.

Context:Laryngoscopy and endotracheal intubation lead to strong sympathetic response which may precipitate arrhythmias, myocardial ischemia and cerebrovascular accidents in patients with preexisting cardiovascular disease.Aims:This study was aimed to compare the effect of dexmedetomidine and esmolol on hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective surgery under general anesthesia.Settings and Design:This was a prospective, randomized controlled double-blinded study.Materials and Methods:A total of ninety patients were selected and randomized into three groups of thirty patients each: Group C received infusion of 20 mL 0.9% normal saline (NS) over 10 min, Group D received infusion of dexmedetomidine 1 μg/kg diluted in 20 mL NS over 10 min, and Group E received infusion of esmolol 1.5 mg/kg diluted in 20 mL NS over 10 min. Three minutes after the completion of infusion, patients were induced with general anesthesia. Baseline parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and rate pressure product (RPP) were recorded before administration of study drugs and at 1, 3, 5, 7, and 10 min after intubation.Statistical Analysis Used:One-way ANOVA was used for comparison among the groups and unpaired t-test was used for comparison within the groups along with Tukey's test for post test analysis.Results:Mean HR, SBP, DBP, MAP, and RPP values remained significantly lower in Group D than that of Group C and Group E at all time intervals up to 10 min after intubation.Conclusions:Both dexmedetomidine and esmolol suppressed the hemodynamic response to intubation when compared to control group, but dexmedetomidine is more effective than esmolol in maintaining hemodynamic stability following laryngoscopy and intubation.

Background and Aims: This study was designed to compare the efficacy of Macintosh laryngoscope-guided insertion of I-gel™ with the conventional blind insertion technique. Methods: A total of 156 adult patients scheduled to undergo elective surgery under general anaesthesia were included. All participants were randomly divided into two groups; I-gel™ was inserted with conventional blind and Macintosh laryngoscopic-guided technique in group A and B respectively. The primary objective of the study was to determine the incidence of optimal positioning in both the groups based on fibreoptic bronchoscope score of the glottic view. Oropharyngeal leak pressure, haemodynamic parameters and insertion characteristics were also compared. Categorical data were presented as ratio or percentage, continuous data were presented as mean ± standard deviation or median (95% confidence interval). The strength of association between insertion technique and the anatomical fit of the device was calculated by relative risk ratio. Results: Fibreoptic scores were significantly better in laryngoscope-guided insertion group when compared to the blind insertion group ( P < 0.0001). The incidence of malposition was 3.85% in the laryngoscopic insertion group and 39.4% in the blind insertion ( P < 0.0001). Oropharyngeal leak pressure was higher in laryngoscope-guided insertion group than in blind insertion group (26.89 ± 3.37 cm H 2 O versus 24.42 ± 3.00 cm H 2 O; P < 0.0001). Other insertion characteristics except time taken to insert the device were comparable in both groups. Conclusion: When compared to the standard blind insertion technique, laryngoscope-guided insertion of I-gel™ results in better alignment with the laryngeal inlet providing a proper anatomical fit and better airway seal pressure.