Background: Airway management is a core skill for an anaesthesiologist. However, the patterns of airway management practice vary among different practitioners, institutions, hospitals, and regions in India. In view of the limited literature in this regard, a survey was undertaken to assess different airway approach among anaesthesiologists of Karnataka. Materials and Methods: This was a prospective survey of 300 anaesthesiologists from Karnataka of varying backgrounds, from freelancers to academic departments. A prospective four-part questionnaire with 30 questions was sent to individual anaesthesiologists. Information was collected and data analyzed for demographic data, type, and preference of airway techniques and devices, availability of support, training, and complications. Results: i-gel was the most commonly used supraglottic airway device (SGAD) across age groups. There were significant differences in choice of drugs for insertion of SGAD among practitioners and academic consultants. For intubations, Vecuronium was preferred for adult patients, while Atracurium for children. The most common complication reported was desaturation and bradycardia (46%) in children. Conclusion: Survey shows differences in the practice patterns between academic and freelance setups in terms of device, technique, and drugs used. There appears to be a need to address the reasons for this difference.

Background: Shivering is a frequent and distressing complication of spinal anaesthesia. Various drugs and physical methods are used to control shivering. Among pharmacological interventions, dexmedetomidine, a congener of clonidine, is a highly selective α2 adrenoreceptor agonist found to be effective in controlling shivering. The aim of this study is to evaluate the effect of the prophylactic administration of dexmedetomidine for prevention of shivering during spinal anaesthesia. Materials and Methods: A prospective, randomised and double-blind study was conducted among patients from either gender, aged 20–60 years, of American Society of Anesthesiologists (ASA) grade I or II who were scheduled for various surgeries under spinal anaesthesia. The patients were randomly divided into two groups of 60 each to receive either dexmedetomidine (Group D) 0.5 μg/kg or saline (Group S) immediately after spinal anaesthesia. Intraoperative incidence and grade of shivering, level of sedation, hemodynamic parameters and adverse reactions such as nausea and vomiting were recorded. Results: Seventeen patients in group S (28.3%) and 8 (13.3%) patients in group D experienced shivering (P = 0.043). Three patients in group S (3.3%) and 4 patients in group D (6.6%) had bradycardia (P = 0.69). Five patients in group S (8.3%) and 8 patients in group D (13.3%) had hypotension (P = 0.378). No patients in either group experienced nausea or vomiting. Conclusion: Prophylactic administration of dexmedetomidine significantly reduced shivering associated with spinal anaesthesia without any major adverse effect. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anaesthesia.

Context: Opioids as adjuvants have been frequently used to prolong the neuraxial blockade for postoperative analgesia and are known to cause adverse effects. Nalbuphine, as an opioid with minimal adverse effects was tried for its effectiveness. Aims: Research was done to evaluate the effects of intrathecal Nalbuphine on the speed of onset of sensory and motor blockade, duration of analgesia and its side effects. Materials and Methods: Randomized clinical trial with a sample size of 60 adults in two groups of 30 each scheduled for lower abdominal and orthopaedic surgeries were included. Group 1 received 3 ml of hyperbaric bupivacaine 0.5% + 0.8 ml nalbuphine (0.8 mg) intrathecally, whereas group 2 received 3 ml of hyperbaric bupivacaine 0.5% + 0.8 ml of normal saline intrathecally. The onset of sensory and motor blockade, regression time of sensory blockade, duration of motor blockade, and analgesia, visual analogue scale (VAS) pain score and side effects were compared between the groups. Statistical Analysis Used: All the data was analyzed statistically and the significance was measured as probability of occurrence by the Student's t-test and Mann–Whitney U test. The values were expressed as mean ± the standard deviation and a P value less than 0.05 was considered statistically significant. Results: The onset of sensory blockade was slower with increased duration of analgesia. Regression time of sensory blockade and duration of effective analgesia was prolonged in the study group with no significant side effects. Conclusions: Improvement in the duration of sensory and motor blockade with minimal side effects was observed, thus proving that it is an effective intrathecal adjuvant for postoperative analgesia.

Submental intubation is a very good alternative to tracheostomy when short term airway management is required with undisturbed access to oral or nasal airways. We report a case of basal cell carcinoma over the left nasolabial fold, involving the upper lip and alae of nose with coexisting coronary artery disease, old inferior wall myocardial infarction, and low ejection fraction managed successfully under general anesthesia with submental intubation.

Prevention of postdelivery intraoperative nausea and vomiting (IONV) is one of the concerns of anesthesiologist during surgery. The main aim is to keep the patient as comfortable as possible perioperatively. Various drugs, especially prokinetics and serotonin receptor antagonists, are frequently used to overcome IONV. Among them, ondansetron is most commonly used due to lack of drug interactions and good potency. Although rare, various side effects including cardiovascular system are found with this drug. We encountered a case of symptomatic sinus bradycardia with ventricular ectopic beats after rapid intravenous ondansetron in a 31-year-old pregnant lady posted for emergency lower segment cesarean section.

Central venous catheterization is usually carried out using modified Seldinger technique. Usually the mechanical complications such as looping and kinking are associated with the guide wire. We present a case of intravascular looping of a central venous catheter despite straightforward insertion and withdrawal of an intact undamaged guide wire.