Background and Aims: Post-operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N-methyl-D-aspartate receptor antagonist, has anti-nociceptive and anti-inflammatory properties, and has been found to be useful in POST prevention in various trials. We conducted this systematic review and meta-analysis to study the efficacy of topical magnesium in preventing POST in adult patients undergoing surgery under general anaesthesia with single lumen tracheal tube. Methods: Comprehensive literature search was performed in PubMed, Google Scholar, EMBASE, Scopus and the Cochrane central registers of controlled trial databases through July, 2018 and data were pooled using fixed effect modelling followed by random-effect methods (after assessing heterogeneity with fixed modelling). The primary outcome was the incidence of POST at 24 h after surgery/extubation. Comparative results were deliberated as pooled mean difference for continuous variables and Mantel–Haenszel (MH) odds ratio for dichotomous variables. Statistical analysis was done using Comprehensive Meta-Analysis-Version 3 (Biostat Inc., USA). Results: Seven trials involving 726 study participants were included in the final analysis. Incidence of POST at 24 hours was significantly lower in magnesium group (26/363) in comparison to active and non-active control group (89/363); P = 0.00- RR 0.22 (95%CI = 0.12-0.39, I² = 0%). No significant adverse events were reported with the use of topical magnesium. Conclusion: Prophylactic use of topical magnesium before the induction of general anaesthesia seems to be an effective measure to decrease the incidence of POST.

Background and Aims: Pecs block and its variations provides perioperative analgesia, reduce PONV and other opioid related side effects. We hypothesized that COMIBPES block in addition to general anaesthesia will provide better postoperative analgesia when compared to general anaesthesia alone in breast cancer surgery patients. Methods: After obtaining permission from the institutional review board and registering the trial with Clinical Trials Registry of India (CTRI), we conducted a double blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection. Patients were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, postoperative nausea vomiting (PONV) and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively. Results: Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, compared to nil in group P, P< 0.01). COMBIPECS block group had lower pain scores and PCA morphine requirements, less PONV and better shoulder mobility on POD1. Conclusion: COMBIPECS block is a valuable addition to general anaesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

Background and Aims: PEEP is commonly used to improve postoperative respiratory outcomes in surgical and ICU patients. It is thought to increase ICP by impending CSF outflow and cerebral venous drainage. Hyperventilation is used to decrease ICP in patients having intracranial hypertension. We investigated the effect of various levels of PEEP and EtCO₂ on ONSD as an indirect predictor of ICP in patients undergoing surgery under GA. Methods: After induction, different levels of PEEP and EtCO₂ were applied to 50 patients. Sonographic ONSD was measured 5 minutes after stabilization of each new setting. Haemodynamic parameters like pulse, SpO₂, BP were also recorded. Quantitative variables were expressed as Mean ± SD and compared across between follow-ups using paired t-test. Qualitative variables were expressed in number and percentage. Results: Baseline ONSD was 0.44 ± 0.06 cm. It increased significantly to 0.45 ± 0.07 cm, 0.47 ± 0.07 cm and 0.49 ± 0.07 cm after applying PEEP of 8, 12 and 15 cm H₂O PEEP, respectively. It significantly decreased to 0.42 ± 0.06 cm, 0.41 ± 0.06 cm and 0.40 ± 0.06 cm after hyperventilation, EtCO₂ range 35–37, 32–34 and 29–31 mm Hg. Results were statistically significant but clinically not significant. Conclusion: We conclude that there are acute and dynamic alterations in ONSD in response to hyperventilation and presence of PEEP in anaesthetised patients. Ocular sonography may be used as a reliable indicator of acute variations in ICP.

Background and Aims: Airway management in patients with cervical spine pathology is challenging. The aim of the study was to evaluate GlideScope (GVL) and D blade of C-MAC (CMAC-D) using manual inline axial stabilisation (MIAS) for tracheal intubation in patients with cervical spine injury/pathology. Methods: This is a randomised, single-blind, hospital-based study. After obtaining informed consent, 54 patients with cervical spine pathology/injury were grouped into GVL group or CMAC-D group, (n = 27 each) based on computer-generated random number table. Preoperative airway difficulty score (ADS) was calculated. The primary outcome of the study was intubation difficulty score (IDS) and the secondary outcomes included total time taken to secure airway, failure to intubate, haemodynamic parameters and adverse events. Data was represented in the form of number (%) or mean and standard deviation and median and interquartile range as appropriate. Chi square test was used for analysing IDS. Results: The mean ± SD of IDS of the CMAC-D and GVL groups were 0.04 ± 0.2 (0.04–0.11) and 0.19 ± 0.40 (0.03–0.34), respectively, (P value = 0.096). The number (%) of patients with IDS > 0 was 1 (3.7) in CMAC-D and 5 (18.5) in GVL group, (P value = 0.192). Demographic data, ADS, Cormack–Lehane grading, success rate, time of tracheal intubation, type of surgeries, haemodynamic parameters and post-operative complications were similar in both the groups. Conclusion: Both GVL and CMAC-D with MIAS are equally efficacious in tracheal intubation in cervical spine injury/pathology patients without other difficult airway management criteria.

Background and Aims: Doppler renal resistive index (RI) has been studied to find its association with postoperative acute kidney injury (AKI). This study was conducted to evaluate the usefulness of preoperative RI, postoperative RI and RI variation before and after surgery expressed as a percentage (% RI) for early AKI detection in major abdominal surgery. Methods: This was a single-centre, prospective observational trial performed in the critical care unit of an academic hospital. Eligible patients posted for major abdominal surgery under general anaesthesia using intraperitoneal approach with at least two predefined risk factors for AKI were included in the study. Renal RI was measured preoperatively and on postoperative day zero. Statistical comparisons were performed for various parameters between the AKI and the non-AKI groups. Pre- and postoperative RI receiver operating characteristics (ROC) curves were drawn and areas under the curves computed. Positive and negative predictive values, sensitivity, specificity and positive and negative likelihood ratios were calculated. Results: A total of 69 subjects were enrolled, of which 14 developed AKI in the postoperative period. The mean resistive indices measured were 0.65 ± 0.09 and 0.74 ± 0.09 in the pre- and postoperative periods, respectively. The area under the ROC curve in the postoperative RI was 0.732 with 95% confidence intervals of 0.592–0.871. This most accurate cut-off value to detect postoperative AKI with sensitivity 57.1% and specificity of 85.5% was 0.77. Conclusion: Postoperative RI can detect early AKI after major abdominal surgery.

Background and Aims: The Ambu^® AuraGain^• is a new single-use supraglottic airway device with gastric channel, designed to facilitate intubation. The study aimed to assess the success rates of proper placement and intubation using Ambu^® AuraGain^• compared with intubating laryngeal mask airway (ILMA). Methods: One hundred and twenty patients (18–60 years) were enrolled into this prospective, randomised, comparative study. After inducing general anaesthesia, appropriate size ILMA (group I)/Ambu^® AuraGain^• (group A) was placed as per the manufacturer's recommendations and correct placement was confirmed. Appropriate size endotracheal tube was passed through the device. The success rate of insertion and intubation, number of attempts, Cormack–Lehane grading before insertion and haemodynamics were recorded. Data were analysed using Mantel–Haenszel Chi-square test, Student's t-test and Fisher's exact test. Results: Demographic and airway parameters were uniformly distributed in both the groups. The success rate for insertion was 100% in both devices. The success rate for intubation was 96.6% (58/60) in group I and 36.6% in group A (P < 0.001). In group I, patients with mean thyromental distance >7.62 ± 0.75 cm had higher successful intubation compared with patients with mean thyromental distance <5.25 ± 0.35 cm (P = 0.014). Cormack–Lehane grading did not correlate with intubation attempts or success rate in group I (P = 0.45), whereas in group A the rate of successful blind intubation with Cormack–Lehane grade 1 was 50% (19/38). Conclusion: Both devices have 100% insertion success, though Ambu^® AuraGain^• has lower success rate for facilitating intubation compared with ILMA.

Background and Aims: There have been various methods tested for reducing preoperative anxiety in children, but very limited literature is available in the Indian scenario. Our aim was to analyse the effect of an informative video about the anaesthetic technique on preoperative anxiety in children. Methods: In all, 94 children were randomly allotted into two groups. Children in the study group were shown a peer modelling video depicting induction of general anaesthesia and recovery during the preanaesthetic check (PAC). Patients in the control group were given only verbal information during PAC. Anxiety was assessed on visual analog scale (VAS) for anxiety at two times. Baseline VAS score was recorded during PAC and preoperative VAS score was assessed prior to induction of anaesthesia. The VAS score was represented as median value. Data were analysed using the Mann–Whitney U-test for ordinal data and skewed quantitative data. Categorical data was analysed by using Chi-square test and t-test was applied for quantitative data. The significance threshold of P value was set at <0.05. Results: The median (interquartile range) preoperative VAS score was significantly lower in the study group [1 (0–1.3)] when compared with the control group [5 (3–5)] (P < 0.001). The mean preoperative pulse rate, mean preoperative systolic blood pressure and mean preoperative diastolic blood pressure were significantly lower in the study group when compared with the control group (P < 0.001). Conclusion: Multimedia information in the form of a peer modelling video helped reduce preoperative anxiety in children between 7 and 12 years of age.

Background and Aims: Various aspects of retracted articles authored by Yoshitaka Fujii and their retraction notices have been examined. Yuhji Saitoh has coauthored many articles with Yoshitaka Fujii which were subsequently retracted. Japanese Society of Anesthesiology (JSA) recommends retraction of various articles by Yuhji Saitoh, but various attributes of those and their retraction notices have not been examined. Methods: A list of retracted articles was retrieved from PubMed, Retraction Watch Database and relevant journals. Their retraction notices were obtained from the journal's webpage. Predefined characteristics of the retracted articles and their retraction notices were evaluated against those proposed by Committee on Publication Ethics (COPE). Results: Fifteen such articles were retracted. Two of them were not identified as retracted in the journal webpage. Half of the papers mentioned by JSA are yet to be retracted. Among those retracted, only 13.3% retraction notices were in line with the guidelines published by the COPE. Two retracted articles are yet to be flagged as retracted in PubMed. The median (interquartile range) time required for retraction from the date of declaration of being eligible for retraction is 14 (3) months. Data were analysed with Microsoft Excel™ (2007). Conclusion: Even after more than 1 year of recommendation, many articles containing evidence of scientific misconduct are yet to be retracted. Among those retracted, the relevant authority failed to follow the prevalent and well-regarded standards of ethics in scholarly publication.

While the Haberland syndrome was first reported in 1970, the anaesthetic management of this rare cohort of patients has not been described. With only 54 such cases reported, describing primarily the unilateral cutaneous, ocular, and neurologic malformations associated with this syndrome without focussing on the anaesthetic management. We describe the case of a 7 year old case of Harberland syndrome with special focus on the difficulties faced by us in mask ventilation, as well as intubation and the need for elective ventilation and planned extubation. We also discuss the precautions to be taken while undertaking such a case like preparations for emergency tracheostomy and possibility of re-intubation after extubation. A meticulous preoperative workup along with neurological and airway examination along with preparation for elective ventilation and tracheostomy is a prerequisite for the successful management of this case.