Among the hematopoietic stem cells disorders, polycythemia vera (PV) constitutes a rare entity. The excess production of erythrocytes with thrombocytosis and leukocytosis in patients lead to both thrombotic and hemorrhagic complications. These complications may cause significant perioperative morbidity and mortality. Anesthetic challenges in a patient of PV and brief review of literature are described in this report.

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Context: During endotracheal intubation, as we aim for smooth induction, smooth extubation is also mandatory. During extubation, coughing, sore throat, hoarseness, and laryngospasm are not desired and have to be prevented. Aims: The aim of the study is to study the effects of inflating the endotracheal tube (ETT) cuff with alkalinized lignocaine (Group L) or dexamethasone (Group D) or saline (Group S) on the emergence phenomena of endotracheal extubation. Settings and Design: Tertiary hospital, randomized double-blinded prospective study. Subjects and Methods: A total of 90 patients undergoing surgery under general anesthesia were randomly allotted into three groups, 30 in each group. After endotracheal intubation, the tube cuff was inflated with alkalinized lignocaine (Group L) or dexamethasone (Group D) or saline (Group S) as per the randomization sequence. At emergence and 1 h after surgery for hemodynamic indices and incidence of postextubation, sore throat, cough, hoarseness, and laryngospasm were assessed. Results: With respect to cough and sore throat, Group L and Group D were significantly better than Group S but the hoarseness was the worst in Group D. Conclusions: Inflating the ETT cuff with alkalinized lignocaine or dexamethasone helped in preventing sore throat and cough to a better extent than saline, the hoarseness, however, being the worst in dexamethasone group.

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Context: Improvement in perioperative care can reduce anesthesia-related morbidity. Noncompliance to protocols and poor working practices can compromise patient safety. Aims: The objective was to survey the working practices of anesthesiologists in India and find out the most commonly overlooked aspects in perioperative period. Setting and Design: Prospective cross-sectional survey involving practicing anesthesiologists in India, conducted over a period of 2 months. Methods: An online questionnaire, including questions pertaining to pre-, intra- and post-operative phases during conduct of anesthesia was mailed to anesthesiologists (members of the Indian Society of Anesthesiologists) over a period of 2 months through the online survey builder SurveyMonkey. The questionnaire was delivered to 13,700 anesthesiologists, of which 2055 responded. Results are expressed as numbers or percentages. Results: Checklist compliance, equipment check, and perioperative record-keeping are the most commonly overlooked aspects by anesthesiologists in perioperative period. The survey also highlights the shortage of postanesthesia care units across the country. Conclusions: Checklist compliance, equipment check, and record-keeping are potential areas for improvement. Professional societies should promote better practices, monitoring standards and should also formulate minimum standards for different setups where anesthesia can be delivered safely.

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Background: Management of preoperative anxiety in surgical patients is usually required for better perioperative hemodynamics and patient management. Various pharmacological and nonpharmacological entities have been used for the management of anxiety. The aim of this study was to analyze the effect of oral melatonin on patient anxiety scores and dose requirement of propofol using bispectral index (BIS)-guided induction of general anesthesia. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical Status I and II between 18 and 45 years of age scheduled to undergo elective surgery of more than 30 min participated in this study. Patients were divided into control and melatonin groups, comprising 30 patients each. Group M patients received two melatonin tablets (3 mg each) and Group C patients received two placebo tablets 120 min before induction. Anxiety scores using visual analog scale-anxiety at baseline and 120 min, mean dose requirement of propofol, time to attain BIS value of 55 in seconds, and hemodynamic parameters were studied in-between the groups. Results: There were significant differences between two groups in anxiety scores 120 min after drug dosage (P = 0.0013) with Group M patients with reduced levels of anxiety, and mean requirement of propofol in Group C (104.67 ± 16.34 mg) was found to be statistically significantly higher than Group M (70.67 ± 16.39 mg), P < 0.001. Hemodynamic parameters in terms of heart rate and mean arterial blood pressures were better for Group M in comparison to Group C. Conclusion: 6 mg of melatonin 120 min before elective surgery can allay anxiety in patients along with reduced dose requirement for propofol for BIS-guided induction of general anesthesia without any adverse effects.

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Introduction: Propofol (2,6 di-isopropyl phenol) is a widely used agent for induction of anesthesia, although pain during its injection remains a concern for all anesthesiologists. Pain on intravascular injection of propofol is very incapacitating, and the trouble still remains and has never been eradicated. Materials and Methods: After taking approval from the Institutional Review Board, this randomized controlled study was conducted on patients undergoing elective surgeries under general anesthesia. Two hundred and ten adult patients of either sex aged 28–60 years weighing between 40 and 80 kg were included into three groups: Group L – received 60 mg of preservative-free lignocaine hydrochloride, Group D – received 12 mg of dexamethasone sodium phosphate, and Group T – received 100 mg of tramadol hydrochloride. Venous occlusion was done at the level of mid-fore-arm by inflating a noninvasive blood pressure cuff to a pressure of 60 mmHg. Study drug was then injected over 10 s by consultant who was blinded to the procedure. After 2 min of study drug, venous occlusion was released following which propofol 0.5 mg/kg was injected over 5 s. Spontaneous complaints of pain and behavioral signs which included facial grimace, arm withdrawal, vocal and verbal rating score were recorded by the second anesthesiologist who was unaware of the group allocation. Results: All three drugs reduced the intensity and severity of propofol-induced vascular pain. Incidence of pain in lignocaine, dexamethasone, and tramadol Groups were 15%, 32.8%, and 31.4%, respectively. There was significant pain relief (P = 0.045 and 0.042, respectively) when comparing Group L and D, Group L and T. Pain relief between Group D and T was statistically similar (P = 0.8). The incidence of hand withdrawal was significantly higher in the tramadol group (P < 0.05) as compared to dexamethasone and lignocaine. The incidence of facial grimace was similar in dexamethasone and tramadol group and was higher as compared to that of lidocaine group; however, the incidence was not statistically significant (P = 0.25 between D and L, 0.3 between T and L group). Conclusion: Use of pretreatment with drugs is required to prevent propofol-induced vascular pain. Both tramadol and dexamethasone are equally efficacious in reducing propofol-induced vascular pain, though both are less effective when compared with lignocaine. Dexamethasone has an added advantage of preventing postoperative nausea and vomiting when compared with both lignocaine and tramadol.

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Objective: Classic laryngeal mask airway (cLMA) is a prototype supraglottic airway device, and Air-Q is a newly introduced device for use as a primary airway and as an aid for intubation. Due to paucity of literature comparing Air-Q with cLMA, this prospective, randomized, single-blinded study was performed, to evaluate their clinical performance as a primary airway conduit. Methods: Sixty patients of either sex with the American society of anesthesiology Grade I or II, weighing between 50 and 70 kg, were randomly allocated to either the cLMA (n = 30) or Air-Q (n = 30) group. After induction of anesthesia, the assigned airway device was introduced. The ease of insertion, vital parameters, oropharyngeal seal pressure (OSP), airway morbidity, and fiberoptic grades of laryngeal view was recorded. Results: There was no significant difference in ease of insertion, the time taken for successful device placement, number of attempts, or postoperative morbidities. Air-Q was found better with respect to hemodynamic stability during placement of the device. There was a significant difference in the OSP between the Air-Q (22.12 ± 1.740 cm H₂O) and cLMA (16.28 ± 2.052 cm H₂O), P < 0.001. Fiberoptic laryngeal view through Air-Q was also superior (P < 0.001). Conclusion: Air-Q was found to be superior to cLMA for controlled ventilation in view of better OSP and a superior fiberoptic laryngeal view.

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Crouzon syndrome is an autosomal dominant disease occurs in approximately 1 in 25,000 births, due to a mutation in the fibroblast growth factor receptor 2 gene on chromosome 10 characterized by craniosynostosis, mid-face hypoplasia, hypertelorism, high-arched palate, skull base abnormalities, and exophthalmos. Patients present in early childhood for cranial reconstructive surgery. We describe here the successful management of a 5-year-old child with Crouzon syndrome with hypertrophic adenoids and Arnold-Chiari malformation type 1 posted for bifrontal craniotomy with fronto-facial advancement and application of a rigid external distraction frame.

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Aplastic anemia (AA) is a rare hematologic disease and a unique example of bone marrow failure syndromes. The disease presents with clinical features of reduction in all blood cell counts, i.e., anemia, infections, and hemorrhage. We are reporting the successful anesthetic management of a case of 6-year-old, 20 kg male child, diagnosed case of AA operated for a fungating lesion (osteomyelitis) in the right wrist.

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Goldenhar syndrome is ocular-auriculo-vertebral dysplasia with cardiac, renal, visceral, and facial abnormalities. Presence of craniofacial and vertebral anomalies increases the risk of difficult airway. Here, we present a case report of a child with Goldenhar syndrome and atrial septal defect (ASD) posted for bone anchored hearing aid surgery. The case report highlights a successful awake retrograde intubation under conscious sedation and topical airway anesthesia, in an 11-year-old child with Goldenhar syndrome and ASD.

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