Expert airway management is the most essential requirement of an anesthesiologist. Difficult and failed intubation is the leading causes of anesthetic related morbidity and mortality. AIM OF STUDY: The purpose of this study was to compare the effectiveness of McCoy laryngoscope and McGrath video laryngoscope in tracheal intubation in patients using Manual in-line stabilization (MILS) for cervical spine injury. MATERIALS AND METHODS: This study was conducted in King George Hospital, Visakhapatnam, Andhra Pradesh on 60 patients aged 20-70, of American Society of Anesthesiologists physical status I-III, posted for elective surgery for cervical spine injury under general anesthesia. The patients were assigned to two groups. One group was named as MC where McCoy laryngoscope was used, other group named as MG, where McGrath video laryngoscope was used for laryngoscopy during tracheal intubation. Two groups were compared on the basis of demographic data, airway examination, comparison of visualization of vocal cords with McCoy laryngoscope and video laryngoscope and comparison of laryngoscope time. RESULTS: There was no significant difference between male and female sex. Most of the patients falls into Mallampati score I (60%), followed by score II and III (25 and 14% respectively). Statistically highly significant improvement in laryngoscope view was noted with video laryngoscope than with McCoy laryngoscope with Chi-square value=49.52; DF=10; p-value=0.000(highly significant). Statistically highly significant difference was seen in effective laryngoscopy time of McCoy and Video laryngoscope. CONCLUSION: We conclude McGrath video laryngoscope is superior to McCoy laryngoscope in terms of providing better intubating conditions in patients requiring MILS, though there is a little prolongation of effective laryngoscope time. KEY WORDS: McCoy Laryngoscope-McGrath video laryngoscope-Cervical spine injury-MILS-Manual inline stabilization-Intubation time-Cormack and Lehane classification. INTRODUCTION: Expert airway management is the most essential requirement of an anesthesiologist. Difficult and failed intubations are the leading causes of anesthetic related morbidity and mortality. AIM OF STUDY: The purpose of this study was to compare the effectiveness of McCoy laryngoscope and McGrath video laryngoscope in tracheal intubation in patients using Manual inline stabilization (MILS) for cervical spine injury. (1)

CONTEXT: Post-operative pain after laparoscopic cholecystectomy is less than open cholecystectomy, but many patients require strong analgesia postoperatively. Intraperitoneal administration of local anaesthetics alone or in combination with various adjuvants can control postoperative pain. AIM: To compare the analgesic effect of the intraperitoneal administration of Bupivacaine, Bupivacaine plus Tramadol and Bupivacaine plus Dexmedetomidine. SETTINGS AND DESIGN: 80 patients undergoing laparoscopic cholecystectomy were randomly allocated to one of four groups: Group C; Group B, Group T and Group D. METHODS AND MATERIAL: 80 patients undergoing laparoscopic cholecystectomy were randomly allocated to one of four groups: Group C received 20 ml of saline; Group B received 20 ml of 0.25% Bupivacaine. Group T received 20 ml of 0.25% Bupivacaine with 100 mg Tramadol and patients allocated to Group D received 20 ml of 0.25% Bupivacaine with 1μg/kg of Dexmedetomidine intraperitoneally post-operatively. Faces pain scale was recorded at 0.5, 1, 2, 4, 6 and 24 hours postoperatively. Time of requirement of rescue analgesia was calculated. Level of sedation postoperatively was assessed. Incidence of postoperative nausea and vomiting (PONV) was also recorded. STATISTICAL ANALYSIS: Data was analyzed by two-way analysis of variance, Student's t-test, Kruscal-Walis and Mann-Whitney U-test. RESULTS: Pain intensity, time of requirement of rescue analgesia, sedation score, as well as PONV were significantly lower in Group D, Group T and Group B than in Group C. Duration of post-operative analgesia was highest with Bupivacaine plus Dexmedetomidine. There were no differences between the three groups receiving Bupivacaine and Bupivacaine with Tramadol and Bupivacaine with Dexmedetomidine in FPS score, incidence of PONV and postoperative analgesic and antiemetic consumption. CONCLUSIONS: Bupivacaine with or without adjuvants provides significant pain relief when administered intraperitoneally after laparoscopic cholecystectomy. Bupivacaine with Dexmedetomidine is superior to plain Bupivacaine or Bupivacaine with Tramadol in providing analgesia for greater duration. No side effects were noticed with instillation of local anaesthetic with or without adjuvants. It significantly reduced the need for antiemetic medication.

Objectives: Cerebral palsy (CP) is a group of non-progressive neurological disorders caused by an injury to the area of the brain that controls muscle movement and posture. Physical and cognitive signs and symptoms that indicate CP vary widely, depending on which parts of the brain are affected, severity of the disease, and the age of the baby or child when symptoms first appear and one such symptom is delay in crying at birth. Methods: Data collected from the mothers of 177 children of CP children with history of delayed cry at birth, admitted or attended to Rani Chandramani Devi Government Hospital, Visakhapatnam from the period of 2014–2020. Results: The data collected retrospectively from the mothers of 177 CP children with history of delayed cry at birth were analyzed. Among them, 114 were male and 63 were female. Considering the age of the mother at the time of conception in the mothers of 177 CP children with delayed cry at birth, it was found that, more number of cases were reported in the maternal age between 19 and 30 years 106 (60%). The age of the mother at the time of conception, extremes of mother age both below 18 years and above 30 years, poses risk both to the mother and the fetus. In the present study, it was found to be 40%. Mothers with anemia were reported to be high 32.2% and act as a most prevalent antenatal factor of CP cases. By performing a student “t” test between the CP cases with associated factors and CP cases without associated factors, the results were highly significant p<0.001. Conclusion: Delayed cry at birth should be taken as an early hint that the child might develop neurodevelopmental problems in the future. This should alert the parents and the family physicians and should be attended with appropriate consultation of a team of doctors to address any deviations observed at an early age for a better outcome.

Though spinal block has several advantages like sensory block, muscle relaxation, awake patient, the most common and serious problem with spinal anaesthesia for caesarian section remains rapid profound hypotension due to sympathetic blockade. Preloading is an established method to prevent hypotension due to spinal anaesthesia. AIM: This study is an attempt to compare the usefulness of hetastarch (colloid) with ringer lactate solution (crystalloid) for volume preloading in the prevention of spinal hypotension in caesarian sections. MATERIALS AND METHODS: Informed consent was taken from a total of 120 parturients of ASA grade I, IE without maternal or fetal complications scheduled for elective or emergency for primary or repeat caesarian section at term, for this study in King George Hospital, Visakhapatnam. The study subjects were allocated into 3 groups of 40 each. Group A (40 parturients)-without preloading, Group B (40 parturients)-Crystalloid group-received preload infusion of Ringer lactate solution, 1000 ml, Group C (40 parturients)-Colloid group-received preload infusion of 6% Hydroxy Ethyl starch, 500 ml. CONCLUSION: From this study we conclude that 6% hydroxyethyl starch is better choice for prevention of hypotension following spinal anaesthesia in caesarian section in comparison to lactated ringer solution.

INTRODUCTION:Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Most often the problems occur during pregnancy; however, they may also occur during childbirth, or shortly after birth. Often the cause is unknown. AIM: To study the different antenatal maternal risk factors associated with cerebral palsy in the study group. MATERIALS AND METHODS: Retrospective study was done to assess possible associated antenatal risk factors for cerebral palsy. Mothers of 100 cerebral palsy children were selected who are treated in Rani Chandramani Devi Hospital, a Government hospital in Visakhapatnam, Andhra Pradesh State, India, from 2012 to 2014 and 100 controls, mothers of normal children were studied. Detailed antenatal history was obtained from the mothers of the children in both affected and control group. RESULTS: From the data, we conclude that the association of maternal anaemia with cerebral palsy is 7.3 times higher; association of maternal hypertension with cerebral palsy is 6.6 time higher, association with Pre-eclampsia is 6 times higher; association with Eclampsia is 8.6 times higher; with antepartum haemorrhage, the association is 8.6 times higher and association of multiple pregnancy with cerebral palsy is 4.8 times higher than with controls. CONCLUSION: From this study of the role of antenatal risk factors, in the occurrence of cerebral palsy in children it is concluded that the most common risk factor associated with cerebral palsy is the maternal anaemia and the other important risk factors associated being hypertension, pre eclampsia, eclampsia, antepartum haemorrhage and multiple births.