Indian journal of anaesthesia
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In recent years, we have seen a surge in introduction of newer devices with new technology for management of difficult airway. These devices have made our management procedures easier and safer. In the absence of availability of these devices earlier, anaesthetists had developed specific clinical skills to manage these situations, which have been passed on from one generation to the other as table side teaching. ⋯ They are expensive and may not be affordable for most of our institutions and may not be available in all the hospitals in our country. These devices are new addition to our armamentarium, not as substitute but a complement to our clinical skills. Now, the question is how the usage of these devices has affected our clinical practice pattern and do these devices have any limitations? Let's try to understand.
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Rocuronium produces faster neuromuscular blockade compared with other neuromuscular blocking drugs. It produces comparable intubating conditions to that of succinylcholine, but does not have the short intubation time of the latter. Hence, it may not be preferable for rapid sequence intubation, but rocuronium with priming may produce comparable intubating time and conditions to that of succinylcholine. Rocuronium with priming may be an alternative to succinylcholine in rapid sequence intubation in conditions where succinylcholine is contraindicated. The present study was conducted to compare the intubating conditions and intubation time of rocuronium with and without priming. ⋯ Priming with rocuronium provides excellent intubating conditions in less than 60 s with no adverse effects.
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Optimal depth of endotracheal tube (ET) placement has been a serious concern because of the complications associated with its malposition. ⋯ Fixing the tube at recommended 23 cm in males and 21 cm in females will lead to carinal stimulation or endobronchial placement in many Indian patients. The lip to carina distance best correlates with patient's height. Positioning the ET tip 4 cm above carina as recommended will result in placement of tube cuff inside cricoid ring with currently available tubes. Optimal depth of ET placement can be estimated by the formula "(Height in cm/7)-2.5."
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In the present study, we compared isoflurane with sevoflurane in day care surgeries in order to determine the suitability of each agent for anaesthesia with Classical laryngeal mask airway (LMA). ⋯ It can be concluded that both isoflurane and sevoflurane are suitable for day care anaesthesia. Sevoflurane has little advantages of less airway hyper reactivity and quicker emergence and discharge from PACU-1.
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Spinal anaesthesia is the most common approach which is used for lower limb surgery. Dexmedetomidine is the recent drug which acts on α2-adrenergic receptors in the dorsal horn of the spinal cord to produce analgesic effects. ⋯ The addition of dexmedetomidine to ropivacaine intrathecally produces a prolongation in the duration of the motor and sensory block.