Background: Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB. Methods: Thirty-two patients undergoing surgeries under combined general-epidural anaesthesia, with an expected duration of surgery of 2–4 h, were randomised to receive either the heat-band or RHB. The core body temperatures of the two groups were compared at several perioperative times, in addition to the incidence of post-anaesthesia shivering, time to extubation and intraoperative blood loss. Results: The core body temperatures were comparable between the two groups in the pre-operative period, immediately after the induction of anaesthesia and skin incision, 1 h after the incision, at the time of complete skin closing, at extubation, upon arrival to the recovery room and 1 h post-operatively. There were no significant between-group differences in the incidence of post-anaesthesia shivering, time to extubation and intra-operative blood loss. Conclusion: The heat-band is as effective as the RHB in preventing IPH and its complications in gynaecological laparotomies.

Background: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia. Methods: A total of 110 severe TBI patients, aged 18–60, who underwent emergency brain surgery were randomised into Group T (TCI) (n = 55) and Group S (sevoflurane) (n = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3–6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1.0–1.5. Both groups received TCI remifentanil 2–8 ng/mL for analgesia. After the surgery, patients were managed in the intensive care unit and were followed up until discharge for the outcome parameters. Results: Demographic characteristics were comparable in both groups. Differences in Glasgow Outcome Scale (GOS) score at discharge were not significant between Group T and Group S (P = 0.25): the percentages of mortality (GOS 1) [27.3% versus 16.4%], vegetative and severe disability (GOS 2–3) [29.1% versus 41.8%] and good outcome (GOS 4–5) [43.6% versus 41.8%] were comparable in both groups. There were no significant differences in other outcome parameters. Conclusion: TCI propofol and sevoflurane anaesthesia were comparable in the outcomes of TBI patients after emergency surgery.

Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neurointensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid–base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU. Methods: Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS (n = 33) and BF therapy groups (n = 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid–base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA. Results: The NS group showed a significant lower base excess (-3.20 versus -1.35, P = 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, P = 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, P < 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80 mmol/L, P < 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO2, lactate, and sodium level. Conclusion: BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.

Awake craniotomy is a brain surgery in patients who are kept awake when it is indicated for certain intracranial pathologies. The anaesthetic management strategy is very important to achieve the goals of the surgery. We describe a series of our first four cases performed under a combination of scalp block and conscious sedation. Scalp block was performed using a mixture of ropivacaine 0.75% and adrenaline 5 μg/ ml administered to the nerves that innervate the scalp. Conscious sedation was achieved with a combination of two recently available drugs in our country, dexmedetomidine (selective α 2-agonist) and remifentanil (ultra-short acting opioid). Remifentanil was delivered in a target controlled infusion (TCI) mode.

Background: Existing techniques of predicting difficult laryngoscopy are inadequate requiring evaluation of Maxillopharyngeal Angle (MP-A) on lateral cervical radiograph described. Objectives: This study aimed to compare MP-A test with Modified Mallapati Test (MMT) in predicting their diagnostic values and Area Under Curve of Receiver Operating Characteristic Curve (AUCROCC) of both test. Methods: This is a double blinded interventional study of 93 patients. Each patient’s MMT score was assessed during preoperative assessment and subsequent MP-A test done by obtaining lateral cervical radiograph with the head in neutral position. Laryngeal view was assessed using Cormack-Lehane grade after induction of anesthesia, was used as reference standard to determine the diagnostic values of MMT and MP-A respectively. Results: The MP-Acompared to MMT in predicting difficult larngoscopy had higher sensitivity (77.78 vs 44.44) specificity (88.10 vs 67.86) and accuracy (87.10 vs 65.59) with higher Odd Ratio(26.12 vs 1.68). The AUCROCC was significantly higher in MP-A test 0.83(95%CI: 0.67, 0.99) (P = 0.001) vs MMT 0.56(95%CI: 0.36, 0.76) (P = 0.546) with LR+ of 6.53 vs 1.38. Conclusion: The Maxillopharyngeal Angle test was superior in predicting difficult laryngoscopy as compared to Modified Mallampati Test.difficult intubation