Background:Oxygen supplementation through Hudson type face mask is frequently used in perioperative settings. Hudson mask is a variable rate performance device with the risk of rebreathing. Studies using capnography to find out an actual fraction of rebreathing in spontaneously breathing patients are not available.Aims:In this study, we analyzed the effects of different flow rates through Hudson mask with capnography on fractional inspired carbon dioxide (FiCO2).Setting and Designs:Forty patients posted for minor surgeries under monitored anesthesia care were divided into four groups. They received oxygen flow rate of 3 L/min, 4 L/min, 5 L/min, and 6 L/min as per group division, through Hudson mask.Materials and Methods:Parameters such as pulse rate, noninvasive blood pressure, oxygen saturation, respiratory rate (RR), end-tidal carbon dioxide (EtCO2), and FiCO2 were noted at baseline. After starting oxygen supplementation, these parameters were monitored every minute for ten minutes. Statistical analysis was done using analysis of variance and Kruskal–Wallis test. Pearson correlation was used to establish a relation between RR and FiCO2.Results and Conclusions:EtCO2 and FiCO2 were comparable in all four groups with no statistical significance. There was strong positive correlation seen between RR and FiCO2 at a flow rate of 3 L/min while negative correlation in other groups. We conclude that FiCO2 is similar at all flow rates while breathing through Hudson mask. Increase in RR can cause increase in FiCO2 at lower flow rate, which is within physiological tolerance limits.

Background: Modern anesthesia practice utilizes preemptive analgesia for providing pain relief postoperatively using oral drugs such as pregabalin and gabapentin which are otherwise used for chronic pain management. We aimed to determine which among the two is more proficient. Materials and Methods: This randomized double-blinded control study was done among 72 subjects undergoing lower abdominal surgeries under the subarachnoid block and they were randomly divided into three groups: Group 1 received a single dose of tablet pregabalin 150 mg orally, Group 2 received tablet gabapentin 600 mg orally, and Group 3 received placebo drug orally (tablet B-complex) 2 h before subarachnoid block. Pain scores, time of 1st rescue analgesic, total number of rescue analgesics, sedation score, and occurrence of side effects were also noted for 24 h. The data were analyzed using SPSS 16 with Chi-square/Fisher's exact test or analysis of variance/Kruskal–Wallis test. A statistically significant difference was considered when P < 0.05. Results: Pain scores were lesser in Group 1 and 2 except at 2nd h. Total rescue analgesic time among maximum subjects in Group 1 was 4 h 30 min, in Group 2 was 3 h 30 min and 4 h, whereas in Group 3 was 3 h (P < 0.001). The total dose of analgesics in the first 24 h was 2 doses in Group 1, 2 doses in Group 2, and 3 doses in Group 3 (P < 0.001). Sedation score was more on Group 1 and 2 in comparison to Group 3 with no side effects in all groups. Conclusions: We conclude that pregabalin to be the effective preemptive drug because of its lesser pain intensity scores and good sedation property.

BACKGROUND Suxamethonium chloride was a time-tested depolarising muscle relaxant with quick onset of action and produced excellent intubating conditions, but it is contraindicated and hazardous in certain situations. Rocuronium bromide had the most rapid onset, intermediate duration of action, minimal cardiovascular side effects and with no histamine release, emerged as a good alternative. The present study was undertaken to evaluate the efficacy of rocuronium bromide in comparison to succinylcholine for use during rapid sequence induction of anaesthesia. Fifty patients posted for elective surgeries were divided into two groups of 25 each randomly. Group S received succinylcholine 1.5 mg/kg and Group R received rocuronium bromide of 0.9 mg/kg. Laryngoscopy and intubation was done at 60 seconds after assessing the relaxation of jaw, vocal cords status and response to intubation using a standard intubation scoring system by a double-blind assessor. Results were tabulated and analysed using appropriate statistical methods. Excellent intubating conditions were seen in 100% of Group S and 90% in Group R respectively. Haemodynamic changes returned to pre-induction baseline values by the end of 5 minutes in both groups. Hence, we concluded that rocuronium bromide was a safer and a good alternative to succinylcholine for rapid sequence intubation of anaesthesia in adult patients where succinylcholine was contraindicated provided that there was no anticipated difficulty in intubation.

We may have many devices in this 21st century, which can be used to secure the airway in patients who have been predicted to have a difficult airway. There are many studies about difficult airways and suggested various devices such as flexible fiberoptic scope, video laryngoscope, and the specialized intubating laryngeal mask airway and they ended up concluding one device better than another. Furthermore, ET intubation requires continued practice and carries with it its own set of complications. Technical problems with the placement of endotracheal tubes have been the most frequent cause of anesthetic deaths in published analyses from all over the world. The basic responsibility of an anesthesiologist is to maintain adequate gas exchange in patients by securing a patent airway through a proper device. Fiberoptic bronchoscopy and intubation have the advantage of being easier, with shorter intubation time and continuous oxygenation and ventilation throughout the procedure, especially in the case of children. We report two such cases, where “Awake flexible fiberoptic-guided intubation” was considered the only desirable choice.