Introduction: The Intubating Laryngeal Mask Airway (LMA) is a Supraglottic Airway (SGA) device through which endotracheal intubation can be performed. Laryngoscopy and intubation are known to initiate a haemodynamic response. LMAs in general produce a lesser pressor response, but intubating LMA provokes a higher response due to the invasiveness of tracheal intubation. Aim: To compare dexmedetomidine and clonidine in attenuating the haemodynamic response to intubating LMA, Ramsay sedation score, and the incidence of laryngopharyngeal injury. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India, over a period of one year spanning from June 2020 to May 2021 to compare the two drugs in patients with American Soceity of Anaesthesiology (ASA)-I. The doses of clonidine and dexmedetomidine were 2.5 mcg/kg and 0.5 mcg/kg, respectively. The study parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Blood Pressure (MBP), Peripheral Saturation of Oxygen (SpO2 ) were recorded at baseline, pre- and post-induction, and at various time intervals (0, 1, 3, 5 minutes) after intubation. Sedation score was also recorded before intubation and after extubation. Statistical Packages of Social Sciences (SPSS) version 23.0 was used to analyse the data (χ2 test for categorical variables and analysis of variance for continuous data). Results: There was no statistically significant difference between the two groups for the duration of surgery (p=0.267), duration of anaesthesia (p=0.197), and the duration between closure and extubation (p=0.407). Dexmedetomidine better attenuated the response of HR and SBP just before induction, post-induction, and immediately post-intubation. All the haemodynamic parameters were better controlled by dexmedetomidine immediately after intubation. Sedation was better with dexmedetomidine in the pre-intubation as well as post-extubation period, except at five minutes post-drug infusion when clonidine was better. Conclusion: Compared to clonidine, dexmedetomidine was more effective in attenuating the patient’s haemodynamic response to intubating LMA in the immediate peri-intubation period. However, from 1 minute post-intubation onward, both drugs behaved similarly in controlling the pressor response.

Background: Basic life support (BLS) is a lifesaving skill which every health-care personnel must know. It has been added to the curriculum but still studies have shown poor knowledge and skill among them in India. Aims and Objectives: The aim of our study was to assess attitude and knowledge of BLS among healthcare personnel in a tertiary care center of Sikkim and to recommend training of BLS according to the finding of our study. Materials and Methods: A questionnaire based cross-sectional study was done among junior doctors, physiotherapists, and nursing staffs, who were willing to participate. The questionnaire collected data under the heading of demographics, attitude, awareness, and knowledge about various domains of BLS. Analysis was done with standard statistical software. Results: Among 208 completed surveys, 24 (11.5%) were males and 184 (88.5%) were females, majority of them (76.4%) were nursing staff and belonged to 20–30-year age group (76%). Mean score of the participants were 13.43 ± 3.725 with a range from 2 to 21. The necessity of BLS training and the requirement of mandatory renewal was strongly agreed by 77.4% and 33.2% participants respectively. Conclusion: We conclude that they all need the trainings at frequent interval to know about the importance of BLS, to gain confidence and to improve their skill which will help them in timely saving of many lives in as well as outside the hospital. This can be achieved if institutes help in conducting the BLS session regularly despite being already in curriculum.

Background: Intubating laryngeal mask airway is used for blind endotracheal intubation and is also considered to cause less stress response as compared to intubation following conventional laryngoscope. Aim: To determine whether Intubating laryngeal mask airway or Laryngoscopy cause minimal stress response following intubation in normotensive as well as in hypertensive patients. Methods: This was a randomized control trial study. Two control groups were formed. They were age 18 to 65 years belonging to ASA I and II. Group, I patients was intubated with Macintosh laryngoscope and group II were intubated with the help of ILMA. Vitals monitored were Heart rate, Systolic blood pressure, diastolic blood pressure and mean arterial pressure at baseline, before induction, after induction, after intubation at 1, 3 and 5 minutes intervals. Pharyngolaryngeal morbidity was also recorded and followed for 24 hours following procedures. Results were analyzed using Mann-Whitney Test and the Independent t-test. The qualitative variables were analyzed using the Chi-Square test/Fisher’s Exact test. Result: Demographics, as well as vital parameters, showed no significant differences between the two groups. The decrease in stress response was seen in normotensive patients only in group II but not in hypertensive patients. Conclusion: Intubating laryngeal mask airway did not help in blunting the stress response when compared with Macintosh laryngoscope in hypertensive patients but a decrease in stress response was seen in normotensive patients at 3 minutes after intubation. Though it can be used as an alternative method for intubation.

Introduction: Even though Laparoscopic Cholecystectomy (LC) is far less traumatic compared to open cholecystectomy, it is still associated with considerable postoperative pain. Apart from routine analgesics, several attempts have been made to establish intraperitoneal analgesia as a useful perioperative pain relief modality. Aim: To determine the optimal concentration (or dilution) and volume of intraperitoneal lignocaine among three preparations of 100 mg lignocaine for postoperative analgesia after LC. Materials and Methods: Study was designed as a randomised controlled, double blinded study. Patients undergoing elective LC for symptomatic cholelithiasis were included in the study. Patients (n=105) were randomised into three groups. Group A received 5 mL 2% lignocaine in 5 mL normal saline (100 mg/10 mL=10 mL solution of 1% lignocaine). Group B received 5 mL 2% lignocaine in 100 mL of normal saline (100 mg/100 mL=100 mL solution of 0.1% lignocaine). Group C received 5 mL 2% lignocaine in 500 mL normal saline (100 mg/500 mL=500 mL solution of 0.02% lignocaine). Three groups were compared for postoperative pain using Visual Analog Score (VAS), requirement of rescue analgesia, nausea and vomiting, vital parameters (heart rate, respiratory rate, mean arterial pressure, transcutaneous saturation) and hospital stay. Analysis of Variance (ANOVA) was used to compare mean and χ2 test was used to compare categorical data. Results: The mean VAS of group B (100 mg lignocaine in 100 mL of normal saline) was significantly lower than the overall mean VAS at different postoperative time intervals, and consistently lower than those of groups A and C. The study found a consistent (r=0.15 to 0.33) and significant (p<0.05 at all-time intervals) positive correlation between pain and duration of surgery. Demand for rescue analgesia was significantly higher in group A. Pulse rate was least in all postoperative time and significantly lower at 4th hour. The difference in mean arterial pressures, respiratory rate and transcutaneous saturation among the three groups was not significant statistically. Nausea and vomiting were uncommon. Conclusion: The study concluded that for a total dose of 100 mg lignocaine, 100 mL solution is more effective compared to 10 mL or 500 mL solution.

Background Attenuating pain in severe acute pancreatitis (SAP) remains a challenge for clinicians specially in first 48-72 hours. Randomized trials are difficult to plan and execute as the pain is very severe and management is frustrating. Moreover, most of the have on comparison of two drugs rather than comparing the pain regimens as multi-modality treatment. Objectives The objective of the study was to compare step-up versus step-down approach of pain management in SAP patients admitted in surgical critical care unit. Methods Retrospective analysis of data related to control of pain in SAP was carried out. Patients of acute pancreatitis classified as severe or critical as per Atlanta or determinant based classification were included in the study. Chronic pancreatitis, Etiology other than or alcoholic pancreatitis (BP and AP) and incomplete data entry were the major exclusions. Patients’ files were reviewed, and they were re-classified as SAP. VAS and analgesia requirement were tabulated and . Patients of and alcoholic pancreatitis were divided into two subgroups viz step-up ( started later) and step-down ( started from the beginning). Data of 84 patients was calculated and . Mean age of BP patients was significantly less than AP. Males were the major sufferers in AP and females in BP. The mean VAS on arrival was not significantly different between BP and AP. The difference in mean VAS remains insignificant for up to 8 hours of admission, after which, patients with AP started having relief at a faster rate compared to patients with BP. From 4th hour , the fall in VAS was more and significant in step down approach. The time when the difference in mean VAS between the step-up and step-down groups of patients with AP was found significant was 10th hour from admission. The difference persisted till 72 hours of observation. Patients of AP responded more to routine analgesics or when the were added later compared to patients of BP. The difference in mean VAS between step down sub-groups of BP and AP did not show significance. An overall comparison of step-up and step-down sub-groups of both BP and AP patients revealed a significant difference in mean VAS from 4th hour . Conclusion Patients who followed step-down approach of pain management significantly better compared to those who followed step-up approach.

A case of a 60-year-old male who presented to the endocrine surgery outpatient department with complaints of neck swelling for last 6 years with h/o rapid growth for 11⁄2 months, associated with 3 Ds, i.e., dysphagia, dysphonia, and dyspnea. Fine-needle aspiration cytology was reported as suspicious for a follicular neoplasm. On examination, he was found to be having a huge nodular goiter with impending ulceration of overlying skin. Operability and difficult intubation were serious challenges. Patient was taken up for surgery. Intubation was a challenge for the anesthetist. Awake intubation was tried but because of plenty of 1,2,7,8Assistant Professor, 3-6Junior Resident, 9Senior Resident 1Department of Endocrine Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 2,7,8Department of Anaesthesia, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India 3-6,9Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India Corresponding Author: Roma Pradhan, Assistant Professor Department of Endocrine Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India e-mail: drromapradhan@yahoo.com EndocrinE imagE 10.5005/jp-journals-10002-1236 E tortuous multiple vessels in oral cavity, there was bleeding and the vision was obscured. As informed by our anesthetist, the air bubbles coming from the trachea during patient’s breathing was the only guide for her to direct the endotracheal tube. At operation, left carotid was found to be encased, but could be separated with sharp dissection. Left internal jugular vein and left vagus were encased, could not be saved, and hence, sacrificed. Right recurrent laryngeal nerve and right superior and inferior parathyroid were preserved. Thus, a total thyroidectomy could be performed. The specimen weighed 3 kg (Fig. 1). After removal of the 3 kg mass, patient had difficulty in holding his head upright due to postural compensation. Postoperatively, patient had difficulty in swallowing, which was evident by pooling of saliva during laryngoscopy postoperatively; however, right vocal cord was mobile. Literature is sparse about the problem which the patient developed after removal of huge goiter weighing more than 3 kg. This is probably the largest thyroid cancer operated in India.

Oxygen supplementation is one of the commonest drugs required for a patient in hospital. Appropriate oxygen supplementation as per the requirement of the patient is essential. This requires optimal oxygen delivery device from the vast armamentarium. This requires understanding basics of oxygen delivery devices and its appropriate selection. This review describes various commonly available devices. The author would also propose a chart for aiding oxygen delivery devices based on the existing literature.