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Objectives: This study aimed to evaluate the relative efficacy of intravenously administered clonidine and tramadol for control of intraoperative shivering following spinal anaesthesia. Materials and Methods: A prospective, randomized, clinical controlled study was conducted on 60 ASA grade-I &II patients of either sex, aged 18-40 years, scheduled for elective lower abdominal and lower limb surgeries, under spinal anaesthesia. Patients who developed post spinal intraoperative shivering of grades 3 or 4, lasting for minimum period of 2minutes were included in the study, and randomly allocated to one of the two groups, group C (n=30), received Inj. clonidine 50µg i.v., and group T (n=30), received Inj. tramadol 50mg i.v. when shivering was observed. Time taken for control of shivering, response rate, recurrence rate, and side effects were observed. Results: The response rate was significantly higher in tramadol group than clonidine group at 1min, 2mins, and 3mins and 5mins intervals and comparable in both groups at 15 mins. The average time taken for disappearance of shivering was higher in clonidine group i.e. 5.76 ± 0.88mins as against 3.16 ± 0.84mins in tramadol group (P=0.038). Patients with incomplete response and recurrence were more in clonidine group. Side effects like hypotension, bradycardia, sedation and dry mouth were observed in clonidine group patients, and nausea and vomiting in tramadol group, but were controllable. Conclusion: Tramadol is better as compared to clonidine for control of intraoperative shivering under spinal anaesthesia due to rapid onset, higher response rate, lesser recurrence, lesser sedation and lesser hemodynamic alterations.

Background and Aims: Video laryngoscopy has been shown to improvise Cormack–Lehane grading and rate of successful tracheal intubation and is now incorporated in most of the difficult airway guidelines. Since there is scarce literature regarding the use of channeled blade of King Vision video laryngoscope (KVVL) in anticipated difficult intubation, we planned to undertake this randomized control trial to assess the performance of channeled blade of KVVL and Macintosh laryngoscope in patients with anticipated difficult intubation. Design and Setting: This prospective randomized study was conducted in a tertiary care hospital. Materials and Methods: Patients fulfilling the inclusion criteria were randomly assigned equally to the KVVL group or Macintosh group. The primary outcome of the study was intubation success in the first attempt and number of attempts required for intubation, and the secondary outcomes were Cormack–Lehane grading and time required to intubate in both the groups. Results: The first-pass success of intubation was 88.6% in the KVVL group and 76.5% in the Macintosh group ( P = 0.035). The second attempt of intubation was required in 11.4% and 20.6% of patients in the KVVL and Macintosh groups, respectively. Cormack Lehane Grade I was achieved in 100% of patients of the KVVL group as compared to 29.4% of patients in the Macintosh group. Moreover, the difference was statistically significant ( P = 0.035). The mean duration of intubation was prolonged in the KVVL group as compared to the Macintosh group, and the difference was statistically significant ( P = 0.04). Conclusion: The channeled blade of KVVL had a higher first-pass success rate and required fewer attempts to intubate when used in patients with anticipated difficult intubation. Further, the KVVL was found to be significantly better than the Macintosh laryngoscope in terms of Cormack–Lehane grading, but the time taken to intubate the trachea was more in the KVVL group.

BACKGROUND Spinal anaesthesia is the most popular and elegant approach for obstetric patients undergoing caesarean section due to its several advantages. Hypotension resulting from sympathectomy due to subarachnoid block can have detrimental effects on the foetus as well as the mother, so needs to be prevented and treated adequately. Vasopressors for the treatment of hypotension have a well-established role as vasodilatation is the primary cause of the reduction in arterial blood pressure. The primary objective of the study was to compare mephentermine and phenylephrine with respect to their clinical efficacy in maintaining arterial blood pressure during spinal anaesthesia in caesarean section and the secondary objective was to determine any untoward effects of the study drugs on the mother and foetus. METHODS This prospective, randomized, comparative, double-blind study was conducted among  90 pregnant women of ASA-I physical status having singleton pregnancies in the age group of 18-30 years undergoing elective as well as emergency caesarean section and were randomly allocated in to two groups. Group M (n=45), received 6 mg of mephenterine as an intravenous bolus (volume made up to 1 ml) and Group P (n=45), received 100 g of phenylephrine as intravenous bolus (volume made up to 1 ml) whenever hypotension occurred after spinal anaesthesia. A comparison of the mean values among the two groups was done using a student t-test. To compare more than two variables, ANOVA test was used. The p-values of less than 0.05 were considered statistically significant. RESULTS The systolic blood pressure, diastolic blood pressure and mean arterial pressure remained significantly high (P < 0.05) in the phenylephrine group as compared to the mephentermine group. The phenylephrine group also showed a significant fall (P < 0.05) in heart rate as compared to the mephentermine group. CONCLUSIONS Both the drugs were effective in treating the hypotension caused by spinal anaesthesia without any adverse effects on the mother as well as on neonatal outcome but phenylephrine had a quicker onset, better maintenance of blood pressure and can be preferred in patients in whom tachycardia is undesirable.