BackgroundVideo laryngoscopes improve tracheal intubation success, but evidence comparing channeled devices (TAScope- The anaesthetic society scope) with non-channeled video laryngoscopes is limited. This prospective randomized controlled trial evaluated their comparative efficacy and safety. Objectives Primary: Compare the number of intubations attempts between channeled (TAScope) and non-channeled video laryngoscopes. Secondary: Assess intubation time, frequency of additional maneuvers, hemodynamic changes, and airway complications. MethodsTwo hundred adult patients undergoing elective surgery under general anesthesia were randomly assigned to TAScope (n = 100) or a non-channeled video laryngoscope (n = 100). Data were collected prospectively by blinded research personnel. Statistical analyses included chi-square, t-tests, Mann-Whitney U tests, and repeated measures ANOVA (p < 0.05). ResultsThe median number of intubation attempts was significantly lower with TAScope (1 [IQR: 1–1]) versus the non-channeled device (2 [IQR: 1–3]; p < 0.001). Intubation times were comparable (38.5 ± 6.2 seconds for TAScope vs. 40.1 ± 7.8 seconds; p = 0.08). TAScope required fewer additional maneuvers (22% vs. 45%; p < 0.001) and caused less pronounced hemodynamic changes post-intubation (p < 0.05). Airway complications were less frequent with TAScope (8%) than the non-channeled device (18%; p = 0.03). Subgroup analysis showed TAScope performed better in difficult airways (Mallampati ≥3 or Cormack-Lehane ≥3). ConclusionTAScope demonstrated superior performance over non-channeled video laryngoscopes, with fewer intubation attempts, reduced need for additional maneuvers, better hemodynamic stability, and fewer complications. These findings suggest TAScope may be advantageous in anticipated difficult airways or for less experienced operators.

Background and Aim: Open hernia surgery is a common surgery and is often associated with signifi cant postoperative pain. Regional blocks are part of multimodal analgesia to enhance pain management in post post-operative period. Here we are comparing two different blocks, namely Transversus Abdominis Plane block (TAP) and the Transversalis Fascia block (TFB), in inguinal hernia surgery, with aim of fi nding out which is better in optimizing pain relief in post post-operative period. Study Design: Prospective comparative double-blind randomized study Methods: Forty-six individuals have been enrolled in this research after meeting exclusion as well as inclusion criteria. They have been divided into two groups. Following surgery, Group A had TAP block or Group B received TFB block. Both groups used 20 cc of 0.25 % injections of bupivacaine and adrenaline (5 mcg/ml). Patients' VAS ratings and the need for analgesics at 4-hour intervals were tracked for a whole day. Result: Statistical analysis has been performed by utilizing SPSS (Version 28) along with G*Power 3.1.9.4 software. Statistically significant difference was indicated by times for first rescue analgesic needed in Group A and B, which were 10.9 ± 5.64 and 14.2 ± 5.04 hours, respectively. The p-value was 0.019. With a p-value of 0.006, Group A's and Group B's respective twenty-four hour total analgesic requirements were 1.52 and 1.0. Conclusion: According to the findings, the TFB is superior to TAP block regarding to controlling postoperative pain after inguinal hernia surgery

Introduction. In contemporary intensive care units, clinical practice is shifting from prolonged deep sedation with benzodiazepines and opioids toward lighter, controlled, and «cooperative» sedation. This change is driven by the association of deep sedation with an increased risk of delirium, longer duration of mechanical ventilation, higher mortality, and adverse long-term outcomes. At the same time, the role of analgosedation with minimal use of benzodiazepines and an emphasis on maintaining patient interaction is increasing. The aim of this work is to summarize modern aspects of analgosedation in critically ill patients, focusing on the pharmacological properties of midazolam and dexmedetomidine and analyzing their use in anesthesiology and intensive care. The objectives of the work are to outline the evolution of sedation approaches in intensive care units, to describe the pharmacodynamic and pharmacokinetic characteristics of midazolam, to analyze its potential for sedation of varying depth, and to compare it with the effects of dexmedetomidine. The article also considers the specific features of using these agents in clinical situations requiring prolonged, controlled, or sequential sedation. Conclusions. Analgosedation is a key component of managing critically ill patients, and modern approaches aim to reduce the depth of sedation and avoid the routine use of benzodiazepines. Midazolam remains an important agent for short-term sedation, induction of anesthesia, anterograde amnesia, rescue sedation, and control of anxiety and seizures, although analgosedation generally requires its combination with opioids. Dexmedetomidine provides dose-dependent sedation while preserving patient interaction, has minimal respiratory depressive effects, modulates sleep and sympathetic activity, and can be used in sepsis, septic shock, delirium, and withdrawal states, which aligns with modern concepts of cooperative sedation. Sequential use of midazolam and dexmedetomidine may be effective when prolonged sedation is required in selected patients

Background The comparative efficacy of epidural bupivacaine with Magnesium sulphate and bupivacaine combined with Tramadol in providing postoperative analgesia remains controversial.This study aims to assess the efficacy of epidural postoperative analgesia using a combination of 0.125%of Bupivacaine with 50mg MgSO4, compared to 0.125%of Bupivacaine with 50mg tramadol in patients undergoing surgeries for the lower limbs. Method 60 patients classified as ASA grade I and II were randomly divided into two groups, Group I and Group II, each containing 30 patients. Group I received a total of 9 ml of 0.125% bupivacaine (8 ml) combined with 50mg tramadol (1 ml), while Group II was given 9 ml of 0.125% bupivacaine (8 ml) with 50mg MgSO4 (1 ml). The analgesic effectiveness was evaluated by the onset of analgesia, duration of analgesia, quality of analgesia, and the time taken to administer the first rescue analgesic. Results The onset of analgesia in Group I was recorded as 6.67±0.80 minutes, while Group II had an onset time of 7.67±0.80 minutes (p=0.001). The duration of analgesia for Group I was 5.16±0.72 hours, compared to 4.51±0.62 hours in Group II (p=0.001). The time until the first rescue analgesia was 5.260±0.716 hours for Group I, whereas Group II required 4.617±0.622 hours (p=0.001). Over a 24-hour period, Group I needed an average of 3.47±0.51 rescue doses, while Group II required 3.97±0.49 doses. The quality of analgesia was evaluated in both groups, showing no statistically significant differences. Adverse effects included nausea and vomiting in 4 patients and pruritus in 1 patient in Group I, while Group II experienced hypotension in 4 patients and bradycardia in 2 patients. Mean systolic and diastolic blood pressures were comparable across both groups, with significant differences only at 5, 10, and 15 minutes. The mean heart rates at 5, 10, and 15 minutes were 94.67±4.15, 89.73±3.85, and 85.40±4.40 in Group I, and 97.00±4.09, 92.20±3.46, and 87.53±3.27 in Group II, indicating statistical significance. The mean post-operative VAS scores recorded upto 24hrs. The mean VAS score was 0.40±0.498 and 0.47±0.507 at 2hrs, 2.87±0.730 and 2.93±0.691 at 4 hrs, 1.60±0.621 and 1.87±0.730 at 6hrs, 2.60±0.621 and 2.87±0.507 at 8hrs, 1.87±0.629 and 2.07±0.691 at 12hrs, 2.60±0.621 and 2.67±0.479 at 24hrs respectively. Conclusion Tramadol proved to be more effective than magnesium when combined with bupivacaine, as it led to a faster onset of pain relief, prolonged the duration of analgesia, and decreased the requirement for extra rescue epidural top-up doses within a 24-hour timeframe.

Background: Total abdominal hysterectomy (TAH) is commonly associated with significant postoperative pain. Multimodal analgesia incorporating regional blocks is now the standard of care. Among these, the lumbar erector spinae plane (ESP) block and anterior quadratus lumborum (AQL) block are frequently used. Objectives: To compare the efficacy of anterior quadratus lumborum (AQL) block and lumbar erector spinae plane (ESP) block in providing postoperative analgesia for patients undergoing TAH. Methods: This prospective, randomized, double-blind interventional study included 44 patients undergoing TAH. Participants were randomly assigned to receive either a bilateral AQL block (Group A) or a bilateral lumbar ESP block (Group B) before surgery, under ultrasound guidance. All patients underwent general anesthesia. Pain was assessed postoperatively at regular intervals over 24 hours using the Visual Analogue Scale (VAS). Additional analgesic requirements and any complications were documented. Results: Group A (AQL block) had a significantly longer mean duration of analgesia (8.5 ± 0.96 hours) compared to Group B (ESP block, 7.5 ± 1.09 hours; p = 0.00411). Total analgesic consumption in the first 24 hours was also lower in Group A (mean 2.36 ± 0.49) versus Group B (3.23 ± 0.68; p < 0.00001). No block-related complications were noted. Conclusion: The AQL block provided statistically superior postoperative analgesia compared to the lumbar ESP block in patients undergoing TAH. However, the clinical difference in analgesic duration was marginal. Either block may be employed based on clinician expertise and institutional protocol.

Introduction: Ensuring patient safety remains the foremost concern for anesthesia and critical care teams when determining the most suitable anesthetic approach, whether in terms of techniques, drugs, strategies, or guidelines. Among the available options, spinal anesthesia is one of the most widely used and effective methods for patients undergoing hernia repair. Subjects and methods: This study involved a thorough and up-to-date assessment of patients undergoing herniotomy. A total of 100 patients were enrolled and divided equally into two groups: 50 received spinal anesthesia (SA) and 50 received general anesthesia (GA). Key parameters such as age, weight, pulse rate, and blood pressure changes were monitored. Patients aged between 20 and 90 years were allocated to the GA and SA groups for detailed preoperative, intraoperative, and postoperative follow-up. Results: Findings indicate that hemodynamic stability was greater with SA (approximately 56 %) compared to GA (around 40 %). Blood pressure levels were higher in GA (32 %) versus SA (24 %), while hypotension occurred in 28 % of GA cases and 20 % of SA cases. Heart rate stability was also better with SA (56 %) compared to GA (32 %). An increased heart rate was observed in 34 % of SA patients and 60 % of GA patients. Overall, SA showed more consistent effects, with a heart rate reduction of 10 % compared to an 8 % reduction in GA. Conclusions: Spinal anesthesia demonstrated superior outcomes compared to general anesthesia in maintaining stable blood pressure and ensuring minimal or normal heart rate fluctuations.

Incidence of Supine intracranial hypotension(SIH) is 5/100000 in a year and is more common in females. It presents with postural headache secondary to structural dural weakness resulting in atraumatic cerebrospinal fluid leak. Variable treatment modalities exist however, targeted image guided autologous Epidural blood patch(EBP) has proven to be more effective in relieving the symptoms. Six patients diagnosed with SIH presented to us with failure of conservative management and were successfully treated with CT guided targeted EBP with immediate resolution of their symptoms. Targeted image guided epidural blood patch seems to be a promising treatment modality in patients with SIH after failure of conservative strategies

Background. The aim of the study is evaluate the quality and safety of the sedative effect of anesthesia in ambulant ophthalmic surgery by using continuous intravenous infusion of dexmedetomidine. Materials and Methods. Patients were randomized into groups by age (old people from 65 to 75 years old, old age 76 years, middle age, young people, children), by gender (men, women). The physical status of patients was assessed using the ASA scale and the dynamics of vegetatic activity by the Kerdo index. Sedation was assessed using the Richmond Sedation Scale RASS. Results. It was found that the difference in the frequency of adverse effects of the appointment of Dexmedetomidine clearly confirms the need to adjust the dose of Dexmedetomidine, depending on the state of the autonomic nervous system. The use of Dexmedetomidine according to the recommendations made it possible to achieve a safe level of sedation and eliminate side effects in ambulant ophthalmic surgery. Conclusions: Parenteral continuous infusion of Dexmedetomidine provides an effective level of sedation for ambulant ophthalmic surgery and maintaining patient-surgeon contact. Safety is confirmed by a low level of critical incidents, no respiratory depression at the target sedation level. The patency of the upper airways was better compared to previous experience with propofol