Background: Hypotension is common under anesthesia and can cause organ underperfusion and ischemia, especially during induction. This could be because of the cardiovascular depressant and vasodilatory effects of anesthetic agents, as well as lack of surgical stimulation. Aim of Study: The aim was to evaluate the utility of preinduction inferior vena cava (IVC) measurement to predict significant hypotension after induction of anesthesia with propofol. Settings and Design: This was a prospective, open-label study conducted in a tertiary care institute. Subjects and Methods: This study was conducted on 50 patients undergoing general anesthesia. Ultrasound machine (Mindray® M7) was used to visualize IVC. The measurements taken were maximum diameter of IVC (IVC max ) and minimum diameter of IVC (IVC min ). IVC collapsibility index (IVC-CI) was calculated as (IVC max − IVC min )/IVC max and was expressed as a ratio. Statistical Tests Used: Receiver operating characteristic (ROC) curve analysis and Chi-square test were used for statistical tests. Results: The relation between significant hypotension and IVC-CI was evaluated using ROC curve analysis. We found the area under curve to be 0.959 and a cutoff of 0.43 (43% collapsibility). The association of significant hypotension with IVC-CI of >43% was calculated and found to be statistically significant ( P < 0.001). The sensitivity of IVC CI of >43% in predicting development of significant hypotension was 86.67% and the specificity was 94.29%. It had very high negative and positive predictive values (94.29% and 86.67%, respectively) with an accuracy of 92%. Conclusion: Patients with an IVC collapsibility of more than 43%, as assessed by ultrasonography, are more likely to develop significant hypotension after induction with propofol.

Background:Stress-induced neuroendocrine and metabolic changes lead to intraoperative hyperglycemia which is related to surgery and the type of intravenous fluids used.Aims:The primary objective was to assess the incidence of hyperglycemia with use of lactate versus acetate-based intravenous fluids in nondiabetics undergoing major surgeries. Incidence of lactatemia and metabolic acidosis were also assessed.Settings and Design:Prospective parallel group observational study conducted in a tertiary care institute.Subjects and Methods:A total of 208 nondiabetic patients undergoing major head and neck free flap or abdominal surgeries were included in the study. Group A received Ringer lactate, and Group B received Ringer acetate as intraoperative maintenance fluid. Intraoperative blood sugar, pH, and lactate levels were monitored.Statistical Tests Used:Chi-square test and independent “t” test were used for analysis.Results:Intraoperative hyperglycemia was more frequent in Group A than B (17.3 vs. 18.4%). Group B patients undergoing gastrointestinal (GI) surgeries showed higher blood glucose at 2, 4, 6, and 8 h when compared to flap surgeries. In Group A, significantly higher blood sugar values were noted at 2 and 8 h in those undergoing GI surgeries. Group B patients undergoing GI surgeries had significantly higher lactate levels at 6 and 8 h. Group B patients had significant acidosis when surgeries lasted >6 h.Conclusion:Nondiabetic patients undergoing major abdominal surgeries who received acetate-based fluids had relatively higher intraoperative blood sugar levels as compared to those receiving lactated solutions, but the incidence of hyperglycemia was comparable. When the duration of surgery exceeded 6 h, acetate-based solutions resulted in significantly higher lactate levels with progressive metabolic acidosis.

Background: Awake patients complain of burning sensation following nasal application of lignocaine jelly. Aim of the Study: The aim of the study was to assess hemodynamic changes, ease of insertion, number of attempts taken, and time required for insertion of Ryle's tube following nasal application of 2% lignocaine jelly versus lubricant gel in patients undergoing surgeries under general anesthesia. Settings and Design: This was a prospective, randomized, open-label study conducted in a tertiary care institute. Subjects and Methods: Eighty patients undergoing surgeries under general anesthesia who required insertion of a Ryle's tube were included. In Group A, 2% lignocaine jelly was used, whereas in Group B, lubricant gel was used prior to Ryle's tube insertion, after induction of anesthesia. Hypertension and/or tachycardia were managed by increasing sevoflurane by 0.5%–1%, followed by propofol bolus of 0.5 mg.kg −1 . Statistical Tests Used: Chi-square test and Independent samples t test. Results: Both heart rate and mean arterial pressure were significantly higher at 1 min after nasal application of lignocaine jelly and 1 and 5 min after Ryle's tube insertion in Group A compared to Group B. Ease of insertion of Ryle's tube, number of attempts, and time taken for insertion were comparable in both groups. Significantly higher number of patients in Group A required sevoflurane to be increased and needed propofol boluses. Conclusion: Use of lubricant gel for aiding insertion of Ryle's tube in patients under general anesthesia was associated with attenuated heart rate and blood pressure responses without affecting the ease, number of attempts, or time taken for successful insertion of the Ryle's tube.

Background:Apneic mass movement of oxygen by applying continuous positive airway pressure (CPAP) is possible only when the airway is kept patent which helps to reduce the rate of desaturation.Aims:The aim of this study was to check the efficiency of preoxygenation and apneic oxygenation by assessing the drop in partial pressure of arterial oxygen (PaO2) during apnea with and without keeping an oropharyngeal airway to maintain the patency of airway.Settings and Design:This prospective observational study was conducted at a tertiary care center.Materials and Methods:Sixty patients undergoing robotic and laparoscopic-assisted surgeries requiring modified rapid sequence intubation were recruited for the study. In Group A, CPAP was not applied during preoxygenation and oropharyngeal airway was not used, but oxygen was administered at 5 L/min during the apnea. In Group B, CPAP of 5 cmH2O was maintained during preoxygenation and after induction an oropharyngeal airway was inserted. Patients in both the groups were induced and paralyzed following standardized anesthesia protocol.Statistical Analysis Used:Chi-square test, independent t-test, and ANCOVA were used as applicable.Results:Group B showed significantly higher mean PaO2 levels after preoxygenation (525.3 ± 42.5 vs. 500.8 ± 51) and at 90 s of apnea (494.8 ± 42.6 vs. 368.6 ± 98.4) as compared to Group A. The fall in PaO2 was significantly lower in Group B. The rise in partial pressure of arterial carbon dioxide was comparable in both groups.Conclusion:Preoxygenation with CPAP of 5 cmH2O followed by apneic oxygenation with CPAP keeping the airway patent with an oropharyngeal airway results in significantly higher PaO2 after preoxygenation and slower reduction in PaO2 during apnea.