Background: Extubation and emergence from general anesthesia is a stressful event which is a less addressed clinical entity. Problems associated with extubation, recovery, and emergences are more common than problems at intubation. Reports from the UK suggest that respiratory complications are common at extubation and during recovery. Death or brain injury was more common in claims associated with extubation and recovery than those occurring at the time of induction of anesthesia. Subjects and Methods: The Consolidated Standards of Reporting Trials (CONSORT) recommendations for reporting randomized, control clinical trials were followed. After obtaining hospital ethics committee approval, a prospective randomized controlled study was done to compare fentanyl, dexmedetomidine and placebo in attenuating of hemodynamic stress response during extubation and emergence from general anaesthesia; in 150 patients with 50 patients in each of 3 groups. Results: Sedation score at 15 min in group A was 1.64±0.56, in group B sedation score was 2.36±0.53. Among group A & B, there was statistically significant difference at 15, 20 and at 120 minutes following extubation (p<0.050). At remaining interval of observation there was no statistically significant difference (p>0.050). Recovery score at 15 min following extubation in group A, B, C were 13.28±0.50, 13.78±0.46, 13.78±0.42 respectively. Conclusion: There was statistically significant difference in recovery score among the groups (p<0.001) at 15, 20, 25 minutes of study period. But clinically recovery score were nearly similar in all 3 groups.

Aim: This study was intended to evaluate the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. Materials and Methods: A cross-sectional survey research design was employed in this study. A self-administered questionnaire survey was used to validate the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. In this regard, a preliminary study with a convenience sample of 156 anesthesia residents studying in various medical institutions across South India was conducted so as to assess the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. This study, while limited in sample size, benefits the craniofacial surgeons and anesthetists as target readers to assess the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery Results: The results of this study reveal that majority of the anesthesia residents encountered craniofacial surgery during their residency period. However, only 19.87% have performed various intubation techniques that are employed in craniofacial surgery. Nearly 38.46% of the participants felt that blind awake intubation is the most difficult intubation technique to employ in the head-and-neck region and requires expertise. Nearly 78.84% of the participants felt that special training is required for handling craniofacial surgical cases under general anesthesia. Conclusion: The results of this study reveal that there is a dearth of knowledge and clinical exposure among anesthesia residents regarding various intubation techniques employed in craniofacial surgery. Educational and quality improvement initiatives in various intubation techniques could enhance anesthesia residents' knowledge and clinical exposure in managing various craniofacial surgical cases.

Dexmedetomidine does not appear to have any direct effects on the heart. A biphasic cardiovascular response has been described after the application of dexmedetomidine. The administration of a bolus of 1μg/kg dexmedetomidine initially results in a transient increase of the blood pressure and a reflex decrease in heart rate, especially in younger, healthy patients. The initial reaction can be explained by the peripheral α2B-adrenoceptor stimulation of vascular smooth muscle and can be attenuated by a slow infusion over 10 or more minutes. Patients were randomly allotted to each of study group, based on a computer generated random number table using Microsoft excel. 150 patients with 50 in each group of ASA (American Society of Anaesthesiologists) physical status I & II patients aged between 18-55 years undergoing elective surgical procedures, lasting between 1 and ½ hour to 4 hour, under general anesthesia requiring endotracheal intubation were enrolled for study. There was statistically significant (p<0.001) differences among group A, B & C with respect to extubation quality scale and also there was clinically significant difference among the three groups. Extubation quality was superior in decreasing order in group C (Dexmedetomidine); group B (Fentanyl) and group a (control group). Group C had best extubation quality, while group A had relatively poor extubation quality.

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