Recent advances in airway management.

Airway management is a core skill essential for anaesthesiologists and health care providers involved in resuscitation and acute care of patients. Advancements in airway management are continuously evolving. This narrative review highlights the recent advancements with respect to innovations, tools, techniques, guidelines, and research in both technical and non-technical aspects of airway management. These include nasal endoscopy, virtual endoscopy, airway ultrasound, video endoscopes, supraglottic airways with enhanced protection against aspiration, hybrid devices, and the use of artificial intelligence and telemedicine, the utility of which has increased in recent times, thereby improving success with airway management and enhancing patient safety. There has been an increasing emphasis on peri-intubation oxygenation strategies to reduce complications in patients with a physiologically difficult airway. Recent guidelines for difficult airway management and preventing unrecognised oesophageal intubation are available. Large multicentre airway data collection helps us examine airway incidents, aetiology, and complications to expand our knowledge and give us insights for change in practice.

A Study on the Efficacy of the Addition of Low Dose Dexmedetomidine as an Adjuvant to Lignocaine in Intravenous Regional Anaesthesia (IVRA).

INTRODUCTION: Intravenous Regional Anaesthesia (IVRA) is a simple, effective method of providing anaesthesia for short duration surgical procedures on the extremities, its chief drawbacks are tourniquet pain, short duration of block and absence of post-operative analgesia. Dexmedetomidine is known to reduce anaesthetic requirements and also provide analgesia to the patient. AIM: To evaluate the efficacy of dexmedetomidine as an adjuvant to lignocaine in IVRA with respect to the quality of the block, tourniquet pain and post-operative analgesia. MATERIALS AND METHODS: A prospective, randomized, double-blinded study was conducted on 60 patients scheduled for orthopaedic surgery of the upper limb, of American Society of Anaesthesiologist's physical status grades I and II. They were divided into two groups of 30 each. The control group C received 40ml of 0.5% lignocaine with saline and Group D received dexmedetomidine 0.5µg/kg added to 40ml of 0.5% lignocaine. The time taken for the onset and recovery of sensory and motor block, incidence of tourniquet pain, intra-operative and post-operative Visual Analogue Scale (VAS) scores, duration of post-operative analgesia and any side effects were noted. Student t-test was used for evaluation of the demographic data, haemodynamic variables, the onset and recovery times of block, duration of analgesia and intra-operative analgesic consumption and tourniquet pain. Friedman's test was used for intra-operative and post-operative VAS and sedation scores. RESULTS: The onset time of both sensory and motor block were significantly shortened, the recovery of sensory and motor block was prolonged, the incidence of tourniquet pain was comparatively lesser and there was significantly increased duration of post-operative analgesia in the dexmedetomidine group. Haemodynamic parameters were similar in both groups. CONCLUSION: The addition of 0.5µg/kg of dexmedetomidine as an adjuvant to IVRA effectively enhances the anaesthesia and post-operative analgesia obtained with lignocaine. The low dose of dexmedetomidine was effective and did not cause any major side effects.

Efficacy and Safety of Clonidine as an Adjuvant to Bupivacaine for Caudal Analgesia in Paediatric Infra-Umbilical Surgeries.

INTRODUCTION: Caudal analgesia, has gained popularity in paediatric intraoperative and postoperative pain management, more so with the use of adjuvants to prolong its duration, each of them having various results. Clonidine, an alpha2-adrenergic agonist is being used for its analgesic effects in various doses with 0.25% Bupivacaine. AIM: The study was conducted to compare the analgesic efficacy, haemodynamic safety and side effects of 1 µg/kg Clonidine added to 1 ml/kg of 0.125% Bupivacaine solution for caudal analgesia. MATERIALS AND METHODS: A prospective, randomised, double-blind, controlled study was carried out in 60 children of ASA Physical Status I, aged 1-10 years, scheduled for infraumbilical operations in a tertiary care centre. They were randomly assigned for caudal analgesia, to either group B: 1ml/kg of 0.125% Bupivacaine solution or group BC: 1ml/kg of 0.125% Bupivacaine and preservative free Clonidine 1µ/kg. All were premedicated with midazolam 0.75 mg/kg orally 30 minutes prior to induction of anaesthesia. Heart rate (HR), Mean Arterial blood Pressure (MAP) and oxygen saturation (SpO2) were monitored. General anaesthesia was induced with thiopentone (1.25%) 5mg/kg and inhalation of oxygen, nitrous oxide and sevoflurane. Postoperative pain, sedation and motor block was assessed by the various scores and patients were monitored for adverse effects. RESULTS: The mean duration of postoperative analgesia was 3 times longer in group BC. Group B received significantly more doses of rescue analgesic than group BC (p-value of 0.004). There was no significant bradycardia, hypotension, sedation or urinary retention in either of the groups. There was no residual motor blockade at 6 hours. Incidence of vomiting was similar in both the groups. CONCLUSION: Caudal Clonidine in the dose of 1 µg/kg in children is a satisfactory and efficacious adjuvant to caudal Bupivacaine for producing prolonged postoperative analgesia with minimum side effects.