Introduction: Foot ulcers are serious complication of Diabetes Mellitus and are known to be resistant to conventional treatments. They may end in severe complications like amputations if not treated wisely at the earliest. Foot ulcers affect 10-25% of Diabetic patients. Management of a Diabetic Foot Ulcer (DFU) is often a challenging problem. Healing of these ulcers often takes a long time and may need one or more methods of treatment. In particular Vacuum assisted wound closure (VAC) therapy has gained popularity for treatment of chronic and complex wounds in patients with Diabetes. Aims and Objectives: To evaluate the efficacy of vacuum assisted wound closure (VAC) therapy for the treatment of diabetic foot ulcers.

Aim of the study is to analyse the accuracy and speed of ultrasound guided transversus abdominis plane block with two different monitor positions. Materials and Methods: Prospective observational study was conducted after institutional hospital ethics committee. Twenty four male patients posted for open inguinal hernia repair posted under spinal anaesthesia were selected and divided randomly into two groups and at the end of surgery USG TAP block was given. Group I -USG monitor was kept in line, whereas in Group II -USG monitor was kept in perpendicular to the participant. Twelve anaesthetists who had performed more than 20 procedure were selected and they performed one procedure in each group. History of back pain and neck pain was elicited and any discomfort during procedure was recorded. Accuracy of USG image was recorded. Time taken for the procedure was recorded for both groups. Result: Twelve anaesthetists were selected for this prospective study. Time taken to perform USG TAP in Group I vs Group II was (69.08 ± 8.19 s vs 80.16 ± 4.84s). Difference was statistically significant (p<0.001). Needle placement was significantly more accurate when anaesthetists had the monitor in front of them than to the side (Score was 15 vs 24). Out of 12 anaesthetists, 4 had history of neck pain previously and one was taking treatment for the same. When performed in Group I they had no discomfort but when performed in Group II, anaesthetists with positive history had discomfort during the procedure. Conclusion: It was concluded that the performance of USG TAP block was comfortable and more accurate and the procedure time was shorter, if the monitor was kept in line of the sight of the operator.

Background and Aims: Various pharmacological and non-pharmacological strategies have been employed to minimise hypotension during obstetric spinal anaesthesia. We compared a prophylactic combination of glycopyrrolate, ondansetron, and ephedrine in terms of total vasopressor consumption, with standard treatment in this randomised controlled trial. Methods: One hundred patients undergoing elective caeserean sections were randomly divided into two groups of 50 each, the study group received prophylactic ondansetron and glycopyrrolate boluses followed by an infusion of ephedrine, while the control group received ephedrine boluses as required. The total ephedrine consumption (primary objective), incidence and degree of hypotension, heart rate variations, and neonatal APGAR scores (secondary objectives) were analysed. Results: The median ephedrine requirement was lesser in the study group compared to the control group [13.2 mg (10--15.75) vs. 27.7 mg (12--24)], with a P value of 0.02. Fewer participants experienced hypotension in the study group before baby delivery compared to the control group (12 vs. 36, P = 0.004). Heart rate was higher in the study group. No significant differences were observed in neonatal APGAR scores and incidence of adverse events. Conclusion: A combination of glycopyrrolate, ondansetron, and ephedrine might offer better haemodynamic stability and reduce vasopressor consumption in obstetric patients undergoing spinal anaesthesia as opposed to standard treatment.

Background: Postoperative pain inadequately treated result in suffering, as well as multiple physiological and psychological consequences which may adversely affect perioperative outcomes and contribute to increased length of stay. Paracetamol a NSAID is an Analgesic and Antipyretic agent. Tramadol an Opioid, has been shown to provide effective analgesia after both intramuscular and intravenous administration for the treatment of postoperative pain. This prospective study is to compare the Analgesic efficacy of intravenous paracetamol and intramuscular tramadol postoperatively. Aims and Objectives: To compare the effect of Paracetamol infusion versus intramuscular Tramadol injection as post operative analgesia after gynaecological surgeries over 48 hours. 1. To compare patients' demand for analgesia and VAS score at different period of time over 48 hours. 2. To compare the number of doses given over 48 hours including the Rescue Analgesia given in less than 6 hours interval between doses 3. To compare the number of rescue analgesia needed in between the 6 hours interval between doses. Methods: The study was conducted in the

Oral and maxillofacial surgeries associated with complications due to endotracheal tube (ETT) damage are being reported in literature increasingly. In this case, we report a rare case of accidental perforation of a flexometallic ETT intraoperatively during an orthognathic corrective surgery, in a 19-year-old female patient in whom submental intubation had been performed. The complication was managed conservatively as the tissue debris created during the osteotomy drilling occluded the damage and caused a good seal of the damage, with minimal leak, and no airway compromise. The purpose of this article is to highlight these hazards and discuss alternative airway management approaches so that anesthesiologists can recognize these complications and be prepared to deal with them in a proper manner.