Introduction Videolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle and low-income countries. An improvised and cost-effective form of customized videolaryngoscope was proposed and studied for patient care in underprivileged areas however there were no distinct conclusions on its performances. Method The study follows PRISMA guidelines for systematic review and the protocol in International Prospective Register for Systematic Reviews. The primary aim was to assess the first attempt success of customized videolaryngoscope for endotracheal intubation. The secondary objective was to evaluate the number of attempts, laryngoscopic view in terms of Cormack Lehane score and Percentage of glottic opening, use of external laryngeal maneuver and stylet and, the airway injuries after the endotracheal intubation. Result Five studies were analyzed for risk of bias using the National Institute of Health Quality Assessment Tool for cross-sectional studies. Most of the studies had a poor to a fair level of evidence with only one study with a good level of evidence. Certainty of evidence was “very low” for all eligible studies when graded using the Grading of Recommendation, Assessment, Development and Evaluation approach for systematic review. Conclusions The certainty of the evidence regarding performance of custom-made videolaryngoscope compared to conventional laryngoscope was very low and the study was performed in small numbers with fair to the poor risk of bias. It was difficult to establish and do further analysis regarding whether the customized form of videolaryngoscope will improve the first attempt success rate for tracheal intubation, reduce the number of attempts, improve the laryngoscopic view, require fewer external aids and reduce the incidences of airway injury with the given low-grade evidence. Some properly conducted randomised clinical trials will be required to further analyze the outcome and make the strong recommendations.

Background: Ultrasound guided abdominal nerve blocks are increasingly being used for anaesthesia and analgesia for surgeries like appendectomy, hernia repair in our centre. The aim of the study was to compare abdominal nerve blocks and subarachnoid block for appendectomy.Method: Retrospective data of patients that underwent appendectomy either under subarachnoid block (Group-S) or abdominal nerve blocks (Group-A) for three months were collected from hospital records. The groups were compared for conversion to general anaesthesia as a primary end point of study and also for the time taken for the procedure, the first requirement of opioids, total opioid consumption and length of hospital stay.Result: Out of 116 patients studied, 75 surgeries were performed under subarachnoid block and 41 under abdominal plane blocks. Two patients in Group-S and 1 patient in Group-A were converted to general anaesthesia due to inadequate blockade. The time taken to perform the block was around four minutes in Group-S and 12 minutes in Group-A. The mean pethidine consumption in 24 hours was 62.33+16.63 mg and 23.17+15.19 mg in Group-S and Group-A respectively. The time to the first dose of pethidine in Group-S groups was 224.66+43.56 minutes and 813.17+361.80 minutes in Group-A. The mean duration of hospital stay in Group-S was 5.14+0.72 days and Group-A was 2.24+0.58 days.Conclusion: Appendectomy can be safely performed under subarachnoid block as well as the abdominal nerve blocks. The abdominal nerve block technique is found to be advantageous in terms of better postoperative analgesia, less opioid consumption and early hospital discharge.

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Background: Laryngoscopy and intubation has adverse effects like tachycardia, hypertension, myocardial ischemia and cerebral hemorrhage. There are many studies on various pharmacological agents to attenuate pressor response. Aim of the study was to compare efficacy and safety of oral clonidine versus oral pregabalin premedication to attenuate stress response in patients undergoing elective surgery. Methods: 106 patients of American Society of Anesthesiologist (ASA) class I, aged between 18-60 years of either sex scheduled for elective surgery were randomized into two groups. Group A received oral clonidine 0.2mg and group B received oral pregabalin 150mg, 90 minutes before surgery. Primary objectives of the study heart rate(HR), systolic blood pressure(SBP) diastolic blood pressure(DBP) and mean blood pressure(MBP) were noted baseline, before induction, immediately after intubation (0) and at 1, 3, 5, 10 and 15 minutes after intubation. sedation, postoperative pain scores and any adverse effects were also noted. Results: The demographic data were comparable in group A and group B. There was no significant difference at baseline for mean (SD) HR, SBP, DBP, and MBP in both groups (p>0.05). The mean (SD) HR was significantly lower in group A as compared to group B, before induction and at 1, 3, 5, 10 and 15 minutes (p <0.05). The mean (SD) SBP, MBP was significantly lower in group A as compared to group B, before induction immediately after intubation and at 1, 3, and 5 minutes (p <0.05). The mean (SD) DBP was significantly lower in group A as compared to group B, before induction (p 0.012). but post-operative analgesia was better in pregabalin group. Bradycardia was more in clonidine group and sedation was more with the use of pregabalin. Conclusion: We concluded that oral premedication with either clonidine or pre.gabalin attenuates hemodynamic response to laryngoscopy and tracheal intubation, but Clonidine is superior to pregabalin.

The practice of continuous spinal anaesthesia is not common. Though underutilised, it offers significant advantage when compared to the single-shot technique nonetheless. Time and again, it has proven its worth in patients with advanced cardiac illness, spinal deformities, and obesity. We here successfully employed this neuraxial anaesthetic technique in a sixty-two-year-old male patient with skeletal dysplasia, who presented for surgical fixation of intertrochanteric fracture of the femur. With short stature, anticipated difficult airway, and poor pulmonary status complicating the anaesthetic plan, we opted for continuous spinal anaesthesia. The procedure was carried out uneventfully with 8 mg of hyperbaric bupivacaine used in titration to anaesthetic needs. Patients with skeletal dysplasia present with wide array of clinical conditions that pose a formidable challenge to anaesthesiologists. Continuous spinal anaesthesia can be safely practiced in such patients as it provides a titratable form of neuraxial blockade with reduced dose of local anaesthesia. This, in turn, ensures a predictable block and, thus, hemodynamic stability.