A Comparative Study of Ease of Insertion of Laryngeal Mask Airway with Propofol and Thiopentone with Lignocaine Spray

Introduction: Study was conducted to determine the conditionsfor insertion of LMA following induction of anaesthesia with(Propofol, 2 mg/kg) and (Thiopentone, 5 mg/kg, preceded by10%Lignocaine spray to the posterior oropharyngeal wall) byobserving six different parameters (gagging, laryngospasm,body movements, coughing, ease of insertion, jaw relaxation)and assessing all six parameters together with Lund andStovner gradingsystem. The hemodynamic parameters wererecorded during induction of anaesthesia and following LMAinsertion.Material and Methods: Patients were allocated randomlyinto two groups, (40 patients per group), Group A- Propofoland Group B- Thiopentone, preceded with 10%Lignocainespray.Results: In Group A significant decrease in HR (p<0.05),systolic BP (p<0.01), diastolic BP (p<0.01) and mean BP(p<0.01) was observed as compared to Group B. The overallassessment for the ease of insertion of LMA was 100%inGroup A and 97.5%in Group B which was statistically notsignificant (p=0.314). No significant difference was observedin gagging (p=0.152), laryngospasm (p=0.314), bodymovements (p=0.221), coughing (p=0.221), jaw relaxation(p=0.314) and the ease of insertion (p=0.314).Discussion: 10% Lignocaine spray suppresses upper airwayreflexes in Thiopentone group and facilitates LMA insertionwithout any adverse response.Conclusion: Thiopentone preceded with 10%Lignocainespray to the posterior oropharynx (Group B) provides almostequal conditions for LMA insertion as compared to Propofol(Group A) with better hemodynamic stability

Pharmacotherapy in idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis or cryptogenic fibrosing alveolitis is a form of chronic, progressive interstitial lung disease causing scarring of lung tissue and usually affect adults. Treatment is usually aimed at controlling inflammation and thus slowing the process of fibrosis. With only few patients responding to treatment and the disease being ultimately fatal with poor progression, the underlying lesion was considered to be fibrotic rather than inflammatory. Fibrotic foci, deposition of collagen, and lack of inflammatory cells are a predominant finding. Pirfenidone and N-acetyl cysteine are the only effective pharmacotherapy available till date. Interim results of PANTHER Trial clearly indicate more risk with triple therapy. However, in Indian patients, trial of steroid therapy may be tried when there is doubt of chronic hypersensitivity pneumonitis. BIBF 1120 has also shown positive results in Phase II clinical trial and shows a positive response in deteriorating lung function. Supplemental oxygen, education of patient, pulmonary rehabilitation, and Streptococcus pneumoniae and influenza vaccine are the most important supportive care. Pulmonary rehabilitation should be used as a treatment in the majority of patients.