Airway emergencies are among the life-threatening events that are encountered in the operating room, emergency department or intensive care unit. They are important causes of preventable morbidity and mortality where time is the essence. It can be extremely challenging to rapidly assess the airway for early diagnosis and perform appropriate interventions simultaneously. Outcome depends on the implementation of an optimal strategy to establish a patent airway. Equally important is the overall stabilisation of the patient and management of the primary clinical condition as appropriate. Key components of management include early recognition of threatened airway, appropriate and timely airway intervention, and maintaining oxygenation. In this review, we describe aetiology, evaluation and management of airway emergencies.

Background and Aims: Subarachnoid block is the most commonly used anaesthesia technique for lower limb surgeries. Opioids are the most commonly used adjuvants with local anesthetics (LA). Adjuvants are given premixed with LA loaded in a single syringe. This study was conducted to evaluate differences in level of sensory and motor block and incidence of hypotension whilst administering hyperbaric bupivacaine and fentanyl either in a single syringe or different syringes. The effect of administering opioid prior to LA and vice versa on these parameters was also assessed. Methods: One hundred and twenty patients were randomly allocated into three groups of 40 each: Group A received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25 microgram) of fentanyl in a single 3.0 ml syringe, Group B received 0.5 ml (25 microgram) of fentanyl in a 3.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe, Group C received 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe followed by 0.5 ml (25 microgram) fentanyl in a 3.0 ml syringe. All statistical calculations were done using SPSS 21 version statistical program for Microsoft Windows. Results: The mean time for onset of sensory and motor block was least in group C followed by group B. The duration of sensory and motor block was prolonged in groups B and C. Patients in group A experienced more hypotension as compared to groups B and C. Conclusion: Administering hyperbaric bupivacaine first followed by fentanyl leads to an early onset and prolonged duration of sensory and motor block.

Background and Aims: The present prospective, randomised study was done to evaluate induction characteristics with bispectral (BIS) index guided infusion of propofol and etomidate. Materials and Methods: After institutional ethical committee approval, 70 patients, aged 18–60 years, American Society of Anaesthesiologists (ASA) I and II scheduled for elective surgery were included. Patients were randomly allocated into one of the two groups. In Group E, patients received etomidate infusion at a rate of 0.07 mg kg^-1 min^-1 and in Group P, received propofol infusion of 0.7 mg kg^-1 min^-1. Time from start of infusion to loss of palpebral reflex (T_P), loss of verbal command (T_V), BIS to reach 50 (T_BIS50), mean induction dose and incremental dose of each drug required to keep BIS_50., haemodynamic parameters and adverse effects like pain, myoclonus, apnoea and postoperative nausea and vomiting (PONV) were also noted. Results: T_P,T_V, and T_{BIS 50} was faster in E as compared to P group and was statistically significant for all parameters. Mean induction dose of drug required till BIS 50 was 2.68 ± 0.56 mg kg^-1 and 0.242 ± 0.11 mg kg^-1 in group P and E, respectively. There was a significant difference between the groups with group E requiring incremental dose in a significant proportion of patients (P = 0.004). There was a significant decrease in MAP in P group as compared to E. In group P, more number of patients experienced pain and had apnoea episode as compared to group E. (P < 0.001). Myoclonus was observed in group E only (P = 0.016). Conclusion: BIS-guided titration of propofol and etomidate infusion for induction did not result in reduction of the dose, haemodynamic variations and other effects.

Background and Aims: Videolaryngoscopes are crucial components of a difficult airway cart. Issues of cost and availability, however, remain a problem. We compared the combination of an endoscope used in conjunction with the Macintosh laryngoscope with established videolaryngoscopes and the Macintosh laryngoscope using the intubation difficulty scale (IDS) score. Materials and Methods: A prospective randomised study including 120 adult patients, American Society of Anaesthesiologists (ASA) physical status I–III, with an anticipated difficult airway scheduled for elective surgery were randomly allocated to one of four groups: Truview EVO2 (group 1), C-MAC D Blade (group 2), videoendoscope (group 3), or Macintosh laryngoscope (group 4). The IDS score was the primary outcome. Secondary outcomes included the Cormack–Lehane grade, time to tracheal intubation, haemodynamic responses, and adverse events. Results: A significant proportion of patients in groups 2 and 3 had an IDS score of zero (73.3 and 70%, respectively). IDS scores were significantly lower in the C-MAC D blade and videoendoscope groups attributable to differences in parameters N4, N5 and N6 [C/L grades, lifting force and laryngeal pressure required] (P < 0.001). The C-MAC D blade and the Macintosh laryngoscope required less time for intubation as compared to the Truview EVO2 and videoendoscope. No differences were noted in post-intubation haemodynamic parameters and other adverse events. Conclusion: The performance of videoendoscope was comparable to C-MAC D Blade and superior to Truview EVO2 and Macintosh laryngoscope with respect to the IDS score and may thereby provide an effective alternative to commercial videolaryngoscopes in low resource settings.

Background and Aims: The aim of the study was to evaluate and compare three different ultrasonographic calculation methods for tongue volume in a real time 2D ultrasonography and correlate with Modified Cormack–Lehane grading observed under direct laryngoscopy. Methods: This prospective observational study was conducted in a tertiary care institute. Tongue volume was assessed ultrasonically in 50 adult patients using three techniques in all the patients undergoing surgery under general anesthesia and correlated with Modified Cormack–Lehane grading. In METHOD A, the tongue volume was calculated as multiplication of mid sagittal cross-sectional area and width in transverse plane; METHOD B, Cross-sectional area obtained in vertical plane was multiplied with the maximum width of tongue in transverse plane; METHOD C. the volume was calculated by multiplying length, width, and height in vertical, transverse, and mid-sagittal/oblique plane, respectively. The analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Receiver operating characteristic (ROC) curve was used to find out cutoff point of different methods for predicting difficult laryngoscopy. Results: The specificity and sensitivity of three different methods were statistically compared and area under the receiver operating characteristic (ROC) curve for method A, B, and C was 0.562, 0.502, and 0.548, respectively. Conclusion: In our study, we found all three methods to calculate tongue volume to be equally good to assess difficult laryngoscopy.

Background and Aims: An ultrasound-guided quadratus lumborum (QL) block provides both somatic and visceral analgesia in abdominal surgeries. We aimed to evaluate the postoperative tramadol sparing effect of single-shot anterior QL block in inguinal hernia surgery patients. Methods: This prospective, randomised controlled trial was conducted in a single tertiary care centre over a period of 1 year. A total of 50 patients, American Society of Anaesthesiologists (ASA) physical status I–II of both sexes aged 18–80 years with body mass index (BMI) ≥20 to ≤35 kg/m² undergoing uncomplicated unilateral inguinal hernia surgery under spinal anaesthesia (SA) were randomly allocated to either of the two groups. The block group (n = 25) received single-shot anterior QL block with 20 ml of 0.5% ropivacaine and the control group (n = 25) received no block. Postoperatively, patients received intravenous (IV) paracetamol 1g every 6 h and tramadol patient-controlled analgesia up to 24 h. Primary outcome was total tramadol consumption at 24 h postoperatively. Results: The total tramadol consumption mean ± SD [95% CI (range)] at 24 h in the block group was 84.00 ± 37.86 [68.37–99.63 (20–160)] mg versus 93.60 ± 34.99 [79.16–108.04 (20–160)] mg in control group, (p value = 0.36). Postoperative VAS score, haemodynamics, and patient satisfaction score were similar in both the groups. No adverse events were reported. Conclusion: A single-shot anterior QL block did not establish a postoperative tramadol-sparing effect at 24 h as compared to no block in patients undergoing inguinal hernia surgery under SA.