European Journal of Molecular & Clinical Medicine

Aspiration of gastric content during anesthesia and its life-threatening consequences in form of aspiration pneumonia and respiratory failure is a rare but still catastrophic complication of anesthesia. Keeping patients’ nil per oral (NPO) from midnight has been followed as a standard practice worldwide for a long time.Various anesthesia society has modified their fastingrecommendations time by time but still, traditional midnight NPO practice is followed in many non-institutional hospitals in India. The present study was conducted to assess that does clear liquid intake up to 2 hr. before surgery improves perioperative patient comfort and is it safe to practice in elective surgeries.
Methodology: A observational prospective study was conducted among patients who were posted for elective surgeries under general anesthesia. Patients who were having a higher risk of aspiration including obesity, pregnancy, emergency surgeries, diabetes, difficult airways, and were not willing to participate in the study were excluded from the study. The patients were divided into 2 groups (Group1- that followed the instruction of taking clear liquids up to 2 hrs prior to surgery and group 2- not followed the instruction and followed traditional fasting).
Data collection and analysis: Patients were assessed with a questionnaire, which included perception of thirst, hunger, anxiety, and weakness as a measure of subjective comfort. The proportion was calculated for categorical variables and mean and Standard deviation were calculated for continuous variables. T-test for continuous variables and Chi-square test for categorical variables were used to compare the data between the two groups. The level of significance was kept at 0.05 level.
Results: Perioperative comparison of both the groups showed no statistically significant difference in Mean FBS, Events of aspiration, post-op pain, PONV, pre-op hunger, and pre-op weakness between the two groups.Statistically, a significant difference was found in satisfaction level, pre-op thirst, and pre-op anxiety levels in both groups.
Conclusion: Liberal preoperative fasting in form of allowing clear liquid up to 2 hr. before surgery is safe to practice.

Background:Supraglottic-airway devices (SAD) are divided into first-generation and second-generation devices. Baska Mask and i-gel device are the two commonly used second-generation SADs in anaesthetic practice. This study compares the i-gel and Baska Mask in terms of efficacy and safety as a ventilatory device in anaesthetized patients undergoing elective surgeries.
Materials and Methods: The study was carried out in Department of Anaesthesiology, Government Medical College and Dr.Sushila Tiwari Hospital, Haldwani. Patients were allocated into 2 groups: Group A (i-gel, n=35) and Group B (Baska Mask, n=35). All patients were pre-oxygenated for 3-minutes and anaesthesia was induced. Successful insertion of the device was confirmed by chest wall movement, auscultation of breath sounds and square wave capnographic tracing. At the end of the surgical procedure, anaesthesia was discontinued and patients were reversed with the standard dose of neostigmine and glycopyrrolate after proper suctioning. Complications, if any were noted after 2 hours and 24 hours period.
Results: The mean age of the study population was 35.83±9.50 years. Among i-gel group, there were 24 (68.6%) males and 11 (31.4%) females. Among Baska Mask group, there were 20 (57.1%) males and 15 (42.9%) females. The percentage of patients with easy insertion was 80% and 68.6% for i-gel and Baska Mask respectively. The mean time taken for SAD was significantly more among Baska Mask (24.49±4.39) in comparison to i-gel (16.19±2.38). Sore throat at 2 hours was seen in 3 (8.6%) and 2 (5.7%) patients of i-gel and Baska Mask group respectively. Dysphagia at 2 hours was seen in 2 (5.7%) and 1 (2.9%) patient of i-gel and Baska Mask group respectively, while dysphagia at 24 hours was seen in 1(2.9%) patient of i-gel group only, also hoarseness at 2 hours was seen in 1(2.9%) patient of i-gel group. Incidence of all the complications reported with i-gel and Baska Mask group were comparable.
Conclusion: This study demonstrated that both Baska Mask and i-gel provided a similar performance in airway management. In terms of the total time taken for insertion, i-gel has a lesser time of insertion than the Baska mask. The success rate of insertion of Baska Mask and i-gel was comparable and ease of insertion was also comparable. Complications observed in both devices were minimal.

Background: Opioids and local anaesthetics act synergistically and it’s a popular technique to combine bupivacaine and fentanyl in spinal anaesthesia for caesarean delivery. The aim of the study was to find out optimal dose combination of bupivacaine and fentanyl for spinal anaesthesia for better quality of perioperative analgesia and reduction of feto-maternal adverse outcome during caesarean section.
Methods: Three hundred and four parturients scheduled for caesarean delivery were randomly allocated to four groups of 76 each. Data of 298 parturients (Gp I=73, Gp II=75, Gp III=75 and GP IV=75) was included in the primary outcome analysis. The control group received 12 mg of 0.5% hyperbaric bupivacaine for spinal anaesthesia. Fentanyl 15, 20 or 25 μg was added to each study group who received 9 mg of 0.5% hyperbaric bupivacaine in spinal anaesthesia. Onset and duration of spinal anaesthesia, hemodynamic parameters, intraoperative nausea & vomiting (IONV), failed block, APGAR score and other side effects were noted.
Results: The duration of effective and complete analgesia was significantly longer in all fentanyl groups. However, increasing the dose of fentanyl from 15 to 25 μg had little effect on further prolongation of analgesia. Duration of motor blockade was significantly prolonged in control group. The incidence of hypotension and IONV episodes were significantly low in the study groups.
Conclusion: Bupivacaine and fentanyl have super additive effect in spinal block. However, strict drug dose calculation is required in spinal anaesthesia to minimize adverse outcomes during caesarean delivery. Spinal anaesthesia with fentanyl 15 μg and 0.5% hyperbaric bupivacaine, 9 mg provides optimal surgical conditions for caesarean delivery with negligible side effects as compared to other dose combinations.

Introduction: I-gel is a novel supraglottic airway device with anatomically designed,
non-inflatable mask, which is soft gel like and transparent made of medical grade
thermoplastic elastomer called styrene ethylene butadiene styrene.The present study is
carried out to evaluate the efficacy of I-gel with regard to easiness of insertion of I-gel,
number of insertion attempts, time taken and maneuvers required; time taken to
establish effective ventilation and gastric insufflation.
Material and Methods: A prospective randomized controlled study was conducted on 40
patients scheduled for elective surgical procedures and requiring controlled ventilation.
Patients were induced with thiopentone 4-6 mg/kg. Size 3 I-gel was used in patients
weighing 30-60 kg and size 4 I-gel was used in patients weighing 60-90 kg. Correct I-gel
insertion was assessed clinically by subjective assessment of appropriate length of
airway tube outside the mouth, gastric insufflation and adequacy of manual ventilation
which was assessed by proper chest expansion and presence of CO2 waveform.
Results: The study included the patients with MMP classI/II and ASA grade I/II. The
mean time taken for insertion was 14.75±1.48 seconds and 95% patients required single
attempt for successful device insertion and 5% patients required second attempt for
successful device insertion. In two patients head tilt and chin lift maneuver was used for
the correct placement of the device.In 38(95%) patients the insertion of the I-gel was
scores very easy(grade1) and in 2(5%) patients it was scored easy(grade 2).
Conclusion: I-gel is an effective supraglottic airway device which can be rapidly
inserted. It provides a leak free glottis seal during positive pressure ventilation. The
nasogastric tube can be easily placed

Background: Patients with the chronic obstructive pulmonary disorder (COPD) are at risk of developing postoperative respiratory failure. That is the reason they may require artificial respiration for longer periods than others. However, being on mechanical ventilation for a long time leads to lung damage and infections.
Objective: The present study was undertaken to observe the relation between the severity of COPD in patients of spinal surgery and the prevalence of respiratory failure.
Materials and Methods: 40 patients with COPD who had undergone spinal surgery were part of the study. The data was collected from the medical records department including the demographics, spirometry results, blood gas analysis, comorbidities, postoperative and other variables. The important outcome is a respiratory failure within one week after the surgery.
Results: Data was presented in table 1 and table 2. Table 1 presents the demographic and clinical parameters of the participants. Table 2 presents the risk factors for respiratory failure of the participants. A longer duration of anesthesia was required for the mild COPD patients. Comorbidities were present in all levels of COPD patients. Table 2 presents the risk factors for respiratory failure of the participants. Length of stay was longer in patients with severe COPD. Extubating time, and endotracheal intubation after surgery were more in the severe COPD patients. Pulmonary infection is present in all groups of patients.
Conclusion: There is no significant relationship between the severities of COPD with postoperative respiratory failure. However, there is a strong need to conduct a prospective study with more defined parameters to understand better these relations. So that better and more effective treatment strategies can be developed.

Aim: Evaluate The Intraoperative Anaesthesia Management and Postoperative Pain Scores
after Caesarean Section.
Methods: This analytical observational study conducted in the Department of
Anaesthesiology, Madha Medical College Kovur Chennai, India during Feb 2021 to Feb
2022. All patients either receiving GA or spinal anaesthesia for CS receive IV tramadol
infusion for post-operative pain control, which is started either at the request for first
analgesia in the PACU or at 60 min, whichever comes first. Patients are assessed for pain
using numerical rating scale (NRS) immediately in the PACU and at regular intervals. Any
patient having NRS >4 is given rescue analgesia.
Results: Percentage of patients having NRS >4 and who required rescue analgesia on
immediate assessment (time zero) was 15 (15%). After that, 13 patients (13%) at 30 min, 10
(10%) patients at 45 min and 5 (5%) patients at 60 min had NRS of >4 and required first
rescue analgesia. There was no statistically significant difference among patients in PACU
having NRS >4 from those having NRS <4 in terms of the type of incision, ASA grading and
duration of surgery. Patients receiving RA had a statistically significant (P-value < 0.01) low
percentage of patients with NRS >4 and need for first rescue analgesia at time zero and at 30
min when compared to the percentage of patients operated under GA. The difference became
insignificant after 30 min. Overall, 18% of patients received some sort of co-analgesia,
mainly in the form of IV paracetamol 15% and only two patients received TAP block.
Conclusion: The pain management in the PACU was adequate as all patients were given
rescue analgesia if they had NRS of >4 and no patient was shifted from PACU with NRS of
>4.

Due to its rarity, iatrogenic spinal cord damage during spinal anaesthesia subsequent to lumber puncture is a somewhat less well-known phenomenon. Syrinx development or myelomalacia of the lumbar spinal cord due to direct cord damage is extremely rare. We present five patients who had this consequence, which resulted in a variety of neurological impairments, and whose MRI revealed myelomalacia or syrinx in the conusepiconus region. During follow-up, some of our patients showed symptomatic partial to complete recovery. As a result, practitioners must be aware of the risk of lumber puncture during spinal anaesthetic and proceed with caution to avoid neurological problems.

Background: Spinal anaesthesia is the most commonly used technique for lower abdominal
surgeries as it is very economical and easy to administer. Dexmedetomidine, a new highly
selective α2-agonist, is under evaluation as a neuraxial adjuvant as it provides stable
hemodynamic conditions, good quality of intraoperative and prolonged postoperative
analgesia with minimal side effects.
Methods: Prospective double blinded, placebo-controlled study was undertaken in 60
patients allocated randomly by envelop method, divided into 2 groups (30 in each) between
18-50 years of age of either gender belonging to ASA class I and II scheduled for elective
lower segment caesarean section. Group A received 2 mL of 0.5% hyperbaric bupivacaine
and 0.2ml dexmedetomidine and Group B received 2ml of 0.5% hyperbaric bupivacaine with
0.2ml normal saline. The comparison was studied using the Chi-square test or Fisher's exact
test as appropriate, with the P value reported at the 95% confidence interval. P<0.05 was
considered statistically significant.
Results: The addition of dexmedetomidine resulted in a dose dependent prolongation of
sensory regression to S1 segment, prolonged motor block, the time to first analgesic rescue
was significantly prolonged in Group B as compared to Group A and showed Lower pain
scores as compared to placebo group.
Conclusion: Based on study results we recommend addition of dexmedetomidine 5 μg to
intrathecal hyperbaric 0.5% Bupivacaine 9 mg in elective lower segment caesarean section.

Background: Based on well-known properties of propofol over last few years this study was
undertaken to evaluate whether priming principle applied for the induction dose of propofol
would affect the total induction dose requirement and reduce the associated side effects.
Methods: The prospective randomized study was undertaken in 100 patients allocated
randomly by envelop method, between 18-55 years of age of either gender belonging to ASA
class I and II scheduled for elective surgeries under general anaesthesia. In group I Inj.
fentanyl 2 μg/ kg administered over a period of 30 seconds intravenously and then induced
with the calculated dose of Inj. Propofol 2mg/kg until the loss of eyelash reflex. In group II,
30 % of the total calculated dose of Inj. propofol 2mg/kg 30 seconds after the administration
of Inj. Fentanyl 2μg/kg over 30 seconds, which will be followed by the administration
remaining calculated dose till the loss of eyelash reflex. Statistical analysis of the
demographic data was done using chi-square test. Comparison between the groups for the
induction dose and haemodynamic parameters was done using student ‘t’ test.
Results: The average induction dose required was 1.53mg/kg with a mean reduction of
23.89%in the induction dose requirement of propofol was observed in the study group. The
haemodynamic parameters were better in study group II compared to the control group I.
Conclusion: Based on study result we recommend application of ‘priming principle’ for
induction dose of propofol.

Background: The use of anesthetics and opioids leads to motor and behavioral
inhibition, body movements and consequently a decrease in body temperature, which
results in shivering. So, the objective of this study to evaluate the efficacy Of Ketamine
and Ondansetron for prevention of shivering during anesthesia.
Materials and Methods: Total 120 cases were included in this study. We were divided in
to 2 groups. This study was conducted in the Department of Anaesthesia in Pacific
Medical College and Hospital.
Results: We were included 120 cases in this study. Among all 70 were female and rest
were male. We were divided in to three group which were Ketamine (60) &
Ondansetron (60). We were found in this study, the frequency of shivering in the groups
who received Ketamine was significantly lower than the Ondansetron group.
Conclusion: This study concludes that, Ketamine in dose of 0.25mg/kg has been found
to be significantly more effective than ondansetron (4mg) during spinal anesthesia.

Background and Aims: Difficult endotracheal intubation is a major challenge for the anesthesiologists. Many parameters assist to predict difficult intubation, hence inter incisor distance (IID), Sternomental distance (SMD) were used to predict the possibility of difficult intubation in patients posted for Head and Neck Oncosurgeries perioperative.
Methods:106 patients, airway was assessed who were posted for head and neck oncosurgeries especially the oral cancer patients. Using Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy and graded difficult intubation as grade 3 and 4.
Results: Difficult endotracheal intubation was found in 20.75% of the said population, which was much higher than general population. Inter incisor distance less than 3 cm, Sternomental distance less than 12.5 cm were the cut off points for difficult intubation. The predicting difficult intubation by inter incisor distance was about 59% sensitivity and 77% specificity with a positive predictive value of 38% and with higher negative predictive value of 88%. The predicting difficult intubation by sternomental distance was about 24% sensitivity and 51% specificity with a positive predictive value of 10 % and with higher negative predictive value of 74% odds ratio of 5.22.
Conclusions: Inter incisor distance had high specificity with significant P value 0.007, hence was a better predictor compared to Sternomental distance in assessing airway in patients posted for head and neck oncosurgeries.

A retrospective study was conducted at Dr Bhubaneswar Borooah Cancer Institute, Guwahati Assam in
55 patients who had undergone free flap reconstructive surgery following resection of head and neck
cancers over a period of 2 years from 2018 to 2020. General anaesthesia with either endotracheal
intubation or cuffed tracheostomy tube was used. Anterolateral thigh, radial forearm and free fibular flaps
were used for reconstruction. The mean anaesthesia time was 29.8 hours which included the time from
induction to extubation. Out of which the surgery mean time was 10.6 hours. Of the 55 free flap surgeries,
there were 4 failures, two of which were intraoperative leading to the surgeon abandoning the procedure.
Optimal utilization of advanced anaesthesia techniques as well as improvement in surgical expertise can
further increase the use as well as reduce the complications associated with free flap surgeries.