Many techniques have been proposed to help the surgeon select the most distal amputation level that will heal. Skin blood flow measurement with xenon-133 (133Xe) is one of the best documented predictors of amputation healing, but the lowest flow consistent with healing has not been agreed upon. Our early experience with the method is reported. Skin blood flow was measured in 16 patients undergoing 17 lower extremity amputations. Twelve amputations healed (mean skin blood flow 3.69 ? 2.73 m1/100 g of tissue/min) and five failed (mean skin blood flow 0.80 ? 0.61 ml/lOO g of tissuehin) ( P < 0.05). No amputation healed if the skin blood flow was less than 1.0 m1/100 g of tissuehin. A skin blood flow above 1 mVlOO g of tissuelmin, measured with '33Xe, may be a useful guide to the level at which to amputate while minimizing unnecessary proximal amputation, but the method requires further prospective evaluation.

Introduction: Laryngoscopy and intubation result in stimulation of larynx, pharynx, epipharynx and trachea, which are extensively innervated by autonomic nervous system. The parasympathetic supply is via the vagus and sympathetic supply via superior cervical ganglion. To diminish hemodynamic responses to tracheal intubation, Fentanyl along with hypnotic agents commonly used. Keeping in mind, an attempt has been made to assess the efficacy of injection fentanyl for attenuation of sympathetic response to intubation. Aims and objective: To assess efficacy of 2microgram/kg body weight fentanyl and 3 microgram/kg body weight fentanyl administered before laryngoscopy and endotracheal intubation for attenuation of hemodynamicresponse. Materials and Methods: 90 normotensive adult patients, belonging to ASA physical status I, of either sex, age group of 18-65 years, free from inter current cardiovascular and neurological disease, were posted for elective surgical procedures under general anaesthesia requiring orotracheal intubation were selected. All were elective cases. Three groups were made. Group I-Control group-10 cc normal saline IV. Group II-2microgram/kg body weight fentanyl IV diluted to 10 cc with Distillate Water (DW). Group III-3 microgram/kg body weight fentanyl IV diluted to 10 cc with D.W. Each group comprised of 30 patients. Result: The rise in pulse rate in both the fentanyl groups, was less and statistically significant than control group (p<0.001). Mild changes in systolic blood pressure were observed in group I and III from baseline. In our study both fentanyl groups II and III showed increase in diastolic blood pressure from baseline. 2 microgram/kg and 3 microgram/kg IV fentanyl showed less rise in mean arterial pressure, which was statistically significant than control group (p<0.001). Conclusion: Use of intravenous fentanyl in both doses, i.e. 2 mcg/kg as well as 3 mcg/kg is safe and effective for attenuation of hemodynamic response to laryngoscopy and intubation.

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