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: Desflurane had increased anaesthetic armamentarium for maintenance of general anesthesia in neurosurgical cases. Few studies have compared isoflurane and desflurane for patients undergoing elective supratentorial craniotomy. Aims: The aim of this study is to compare emergence characteristics, intraoperative haemodynamic and intraoperative brain relaxation between isoflurane and desflurane in patients undergoing craniotomy for supratentorial lesions. Settings and Design: Prospective randomized and comparative study. Subjects and Methods: In this study, patients were randomly allocated in two groups. Groups I and D received Isoflurane and desflurane in MAC (0.8-1.2) during maintenance of general anesthesia after endotracheal intubation till skin closure. Emergence time, Extubation time, perioperative hypertension and intraoperative brain relaxation was compared between 2 groups across different time period. Statistical Analysis: Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and then P value was calculated. Results: Significantly lesser emergence time and extubation time in group D compared to group I (7.53±2.11 vs 15.10±1.7 and 10.87±1.961 vs 18.20±1.92). Perioperative haemodynamics were among comparable between both groups. Intraoperative brain relaxation was also comparable between 2 groups with more patients in desflurane group having grade 1 relaxation. Incidence of emergence hypertension and post-operative complication were also similar with 2 groups. Conclusion: It is concluded from the study that both inhalational agents isoflurane and desflurane can be used in patients undergoing supratentorial surgeries, desflurane has added advantage of faster post-operative recovery and intraoperative brain relaxation and emergence characteristics.

Background: Introduction of sevoflurane and desflurane had increased anaesthetic choices for maintenance of general anesthesia in neurosurgical cases after isoflurane. Aims: To compare emergence characteristics, intraoperative haemodynamic and intraoperative brain relaxation between isoflurane, sevoflurane and desflurane in patients undergoing elective supratentorial craniotomy. Settings and Design: Randomized, prospective and comparative study. Subjects and Methods: In this study, recruited patients were randomly allocated in three groups. Groups I, S, and D received Isoflurane, sevoflurane and desflurane in MAC (0.8-1.2) during maintenance of general anesthesia after endotracheal intubation till skin closure. Emergence time, extubation time, perioperative hypertension and intraoperative brain relaxation were compared between 3 groups across different time period. Statistical Analysis: Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and among three groups by analysis of variance, and then P value was calculated. Results: Significantly lesser emergence time and extubation time was found in group D compared to group I and group S (7.53±2.11 vs 15.10±1.74 vs 10.50±1.19 and 10.87±1.961 vs 18.20±1.92 vs 14.00±2.068). Incidence of emergence hypertension and post-operative complication were found to be similar among 3 groups. Conclusion: It is concluded that although all 3 inhalational agents can be used in patients undergoing supratentorial surgeries, desflurane has added advantage of faster post-operative recovery and emergence characteristics.