Difficulties arising during tracheostomy tube insertion can be rapidly fatal if the airway is not adequately controlled. We report a case of difficult tracheostomy in a gentleman with severe subcutaneous emphysema following a previously failed tracheostomy attempt. Tracheostomy tube insertion through the pre-existing stoma failed repeatedly due to rapidly increasing distance of trachea from the skin and unexpected false passages; however, the trachea was eventually cannulated using a regular endotracheal tube.

Aim:To compare the efficacy of wound infiltration with Bupivacaine or Bupivacaine with fentanyl for post operative analgesia.Background:The role of Bupivacaine and fentanyl mixture as wound infiltration for post operative analgesia is less explored in human subjects.Materials and Methods:This prospective, randomized included 60 ASA grade I, II, and III patients in the age group of 20-75 years of age. The patients were randomized into two groups of 30 patients each: Group A received wound infiltration with a solution containing 0.5% bupivacaine (2 mg/kg), while, Group B received infiltration with a solution containing fentanyl 25 μg added to 0.5% bupivacaine (2 mg/kg).Results:None of the patients in both groups had unbearable incisional pain but addition of fentanyl to 0.5% bupivacaine reduced analgesic consumption in the postoperative period (P<0.05).Conclusion:Addition of opioids to local anesthetics results in better postoperative analgesia and reduced opioid requirement post operatively.

Objective:Laryngoscopy and intubation are associated with sympathetic stimulation which can prove deleterious in patients with cardiovascular compromise; so, various methods have been tried to obtund this pressor response. In this study, we have assessed the efficacy of pregabalin in attenuating the pressor response to laryngoscopy and intubation.Methods:This prospective randomized study included 80 patients with American Society of Anesthesiologists physical status grades I-II, in the age group of 18–60 years of age. The patients were randomized into two groups of 40 patients each. Group A received the placebo orally, 90 min prior to surgery. Group B received 150 mg of pregabalin orally, 90 min prior to surgery. These patients were assessed in terms of sedation with Ramsay sedation scale (RSS). In the operation theatre, the heart rate (HR), systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation recorded at baseline and 1, 3, 5, and 10 min after intubation. The rate pressure product (RPP) was calculated for these time intervals. In the postoperative period, patients were assessed for complications like dizziness, nausea, and blurred vision. Statistical analysis was performed using Chi-square and ANOVA tests.Findings:The group receiving 150 mg of pregabalin as premedication was found to be adequately sedated at 1 h post-premedication with 52% patients having a RSS score of 3 compared to 4% with the same RSS score in the placebo group (P < 0.0001). Hemodynamics was more stable post-intubation with significant stability in the HR (P = 0.002) and RPP (P = 0.004) in the pregabalin group.Conclusion:Pregabalin when given as a premedication provides adequate sedation and obtunds the pressor response seen with intubation.