Background and Aims:Epidural infusion analgesia (EIA) is among the common procedures performed in children to provide analgesia. However, the administration of epidural is not without complications. Limited studies are available regarding the safety of EIA in children with no studies from the Indian subcontinent. The aim of this study was to analyse all the complications that occured during administration and maintenance of EIA in paediatric patients.Methods:All children undergoing elective or emergency surgeries under general anaesthesia and given concomitant epidural analgesia for post-operative pain management were included. Data were collected by reviewing patient medical records, anaesthesia registers and post-operative intensive care unit charts. Statistical averages were drawn to assess the complication rates.Results:Seventy children received epidural analgesia during the span of study, of them five were neonates and fifteen were infants. No major complications that were life-threatening or leading to permanent disability were documented. Two children (2.85%) had blood tap during procedure. Eleven children (15%) had peri-catheter leaks and 14 children (20%) had catheter dislodgements.Conclusion:EIA seems to be a relatively safe method of providing analgesia. It is associated with the occurrence of complications which are at best temporary.

Background and Aims: The area of lumbar spinal canal decreases with age, and hence the level of sensory blockade is higher in the elderly after spinal injection. The present study optimised the dose of local anaesthetic in elderly patients based on the lumbar dural sac cross sectional area (DSCSA) determined using ultrasound. Methods: Sixty patients of age above 60 years undergoing transurethral resection of prostrate (TURP) surgery in a tertiary care hospital were included in the study. Patients were categorised into two groups of 30 each based on a computer-generated random number table. In the control group (C), 2 ml of 0.5% hyperbaric bupivacaine was given and in the ultrasound group (U), the drug dose was modified according to DSCSA which was measured using the formula area = p (diameter/2) 2. Results The DSCSA and bupivacaine dosage were significantly lower in group U compared to control group (P = 0.0001). The maximal level of cephalad spread of sensory blockade was significantly lower in ultrasound group, than in control group (P = 0.002). The two-segment block regression time and motor recovery time was less in group U. Higher mean arterial pressure (105.8 ± 9.66 mmHg; P = 0.007), and a lower decrease from baseline (14.15 ± 7.55%; P = 0.041) was noted in group U after subarachnoid block. Conclusion The estimation of DSCSA is an effective parameter and can be used to modify the dose of local anaesthetic for subarachnoid block in elderly patients undergoing TURP surgery.

Background: The current study is aimed to compare the effect of fixed cuff volume and fixed cuff pressure technique on hemodynamic parameters and on postoperative complications. Methods: The prospective, randomised, controlled study was conducted in a tertiary care hospital with 100 patients aged between 18 to 60 yrs. The patients who are undergoing for elective surgeries under general anaesthesia were enrolled after obtaining ethical committee approval. Patients were randomized based on computer generated random numbers into two groups, fixed volume (7ml) group (group V, n-50) and fixed cuff pressure group (group P, n-50). The ETT cuff was filled with 7 ml of air in the fixed volume technique, and in the fixed cuff pressure group -cuff pressure was maintained at 20 cmH2O, after intubation. Tracheal tube cuff pressures were measured by AMBU cuff pressure gauge manometer. Hemodynamic parameters SBP, DBP, MAP and PR were noted at the time of cuff inflation, after extubation in the both the groups. Post-operative sore throat, hoarseness and cough was assessed at the time of extubation in the both the groups. Results: Mean age in both the groups was 41 years. Statistical significance (P< 0.0001) was observed in Group P in systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP, HR whereas no significance was seen in group V. The percentage of post-operative complications like hoarseness, cough, sore throat, and dysphagia were seen to be less in group P when compared to group V. Conclusion: With present data we could conclude that the fixed minimal cuff pressure (20 mm H2O) is an ideal and reliable technique in reducing the post-operative complications along with maintenance of hemodynamic parameters.

Introduction: The main aim of this study is to determine if ultrasonography (USG) based measurement of subglottic diameter is the best size predictor for endotracheal tube (ETT) in pediatric surgical cases over age-based formula with micro cuff tube. Also, to test reintubation percentage and post-operative complications in children. Methodology: This research is double-blind randomized control study with 68 children undergoing elective surgery requiring general anaesthesia with micro cuff tube. They were divided into 2 groups i.e. ETT size by USG (group U) and ETT size by age-based formula group A) (with 34 children in each. Both groups ETT measurement was calculated by independent Samples t-test, and correlation of both groups with actual ET Tube was measured by Pearson’s correlation coefficient. Reintubations or post-op complications was measured by Chi-squared test. Results: Mean age of group A and U are 5.65 ± 2.77 and 5.97 ± 2.77 respectively. Mean weights were from 13.5±2.06 kgs to 27±4.63kgs. Statistical significance with a P-value (P=0.0460) is observed in group U whereas no significance was seen in group A. A strong positive correlation (R=0.960) between USG-estimated ETT size and actual ETT size is observed. The difference in reintubations and post-op complications in group U were statistically significant with P < 0.002. Conclusion: The present study concludes that the sub glottis diameter measured by USG is a good predictor for correct size of micro cuff endo tracheal tube in children.