Comparison of C-MAC Miller blade video laryngoscope with conventional Miller blade in infants undergoing elective surgery- A prospective randomised trial.

Background and Aims: Endotracheal intubation (ET) in infants is considered a challenging task over the decades. Infants have short safe apnoea time, and this difficulty has been vanquished to some extent by using the videolaryngoscopes (VLs), but there exists a dearth of research particularly in this vulnerable subset. Therefore, this trial was conducted to evaluate intubation times obtained with C-MAC VL and conventional Miller laryngoscopes in infants. Methods: A total of 80 infants aged between 1 month and 1 year with American Society of Anesthesiologists physical status I-II requiring ET were randomised in two groups; the C-MAC VL or Miller laryngoscope ML. Anaesthesia was induced with sevoflurane 1-8% and atracurium 0.5 mg/kg IV. The primary outcome was evaluated as the total time taken to intubate. Secondary outcomes were time to achieve best glottic view (TBGV), tube insertion time (TIT), percentage of glottic opening (POGO) score, number of attempts and intubation difficulty score (IDS). Results: The median (interquartile range) of time taken for ET was less in VL; 22.5 (20.75-26) compared to ML; 26 (21.75-31). TBGV was achieved early in VL group than the ML group (6.03 ± 1.33s/7.88 ± 2.44) respectively (P-value < 0.001). POGO was better in VL (99.12 ± 4.795s) compared to ML (85.50 ± 31.13s). IDS was less in the VL group (0.07 ± 0.27) than in ML (0.70 ± 1.14). Other parameters, such as the number of attempts, bougie usage, adverse effects and TIT, were comparable across the two groups. Conclusion: When compared to the ML group, the C-MAC VL group exhibited a decreased intubation time, early TBGV, better POGO score, reduced IDS and subjective intubation difficulty. As a result, we consider VL to be a more efficacious device for intubating the trachea in infants.

Recent advances in paediatric anaesthesia.

Recent development in science has led to a significant improvement in safety for the anaesthetic management of children. Enhanced recovery after surgery is one of the novel approaches aiming to enhance paediatric surgical outcomes and their quick recovery. Preoperative counselling, minimal fasting, and no routine pharmacological premedication are critical components of enhanced recovery after surgery. As anaesthetists, management of airway is our priority and introduction of paraoxygenation in addition to preoxygenation has resulted in reduction in desaturation episodes during periods of apnoea. Safe care has been made possible by improvements in monitoring, equipment, medications, techniques, and resuscitation protocols. We are motivated to collect more evidence regarding ongoing disputes and issues, such as the effect of anaesthesia on neurodevelopment.

Recent advances in perioperative blood management.

Transfusion of blood and blood products has many adverse effects and should be done only if patient benefits outweigh the associated risks. Current understanding of blood transfusion has improved dramatically, revolutionising the care of surgical, trauma, obstetric and critically ill patients. Most guidelines advise a restrictive approach for stable patients with non-haemorrhagic anaemia for red blood cell transfusion. The rationale for red blood cell transfusion has historically been to improve oxygen transport capacity and consumption-related parameters in anaemic patients. Current understanding casts serious doubts about the true potential of red blood cell transfusions to improve these factors. There may not be any benefit from blood transfusion beyond a haemoglobin threshold of 7 g/dL. In fact, liberal transfusion may be associated with higher complications. Guideline-based transfusion policy should be adopted for the administration of all blood products including fresh frozen plasma, platelet concentrates and cryoprecipitate etc. This should be integrated with clinical judgement.

A randomized comparative evaluation of C-MAC video-laryngoscope with Miller laryngoscope for neonatal endotracheal intubation.

Background and Aims: An efficient neonatal airway management is peculiarly challenging even in the most experienced hands. Considering the recent interest in assessing the performance of various video-laryngoscopes (VL) in pediatric cohort, the prospective randomized study was contemplated to stage a comparative evaluation of C-MAC with Miller laryngoscope for neonatal endotracheal intubation. Material and Methods: 150 neonates were randomized to undergo intubation with either the C-MAC VL (n = 75) or the Miller laryngoscope (n = 75) performed by an experienced anesthesiologist in a tertiary care perioperative setting. The percentage of glottic opening (POGO), time to best glottic view (TTBGV), time to intubation (TTI), number of attempts, optimal external laryngeal manipulation (OELM) employed, and the complications were assessed and compared between the two groups. Results: C-MAC group demonstrated a significantly higher POGO, compared to the Miller group (88 ± 26.7%;76.8 ± 32.1%, respectively, P = 0.022). TTBGV was significantly lower in the C-MAC (7.7 ± 0.1s) group as opposed to the Miller group (11.3 ± 1.1s). The C-MAC group displayed higher TTI values compared to the Miller group (25.4 ± 1.6s; 19.7 ± 1.2s, respectively, P < 0.01). The first-attempt intubation success rate and the number of attempts were comparable in both the groups. OELM was required in 24% of the patients in the Miller group as opposed to 10.7% in the C-MAC group (P = 0.031). Higher patient percentage in the C-MAC group required the need of stylet for assisting a successful intubation, although the difference between the two groups was not statistically significant. Conclusion: Despite an improved view of the glottis, the TTI was higher for C-MAC compared to direct laryngoscopy with a comparable first-attempt success rate in the two techniques.

Anesthesia management in a post Covid-19 obstetric patient-What we need to know.

The outbreak of the coronavirus disease (COVID)-19 pandemic has led to unprecedented challenges globally. At the outset of the receding second wave and third wave of COVID-19, many patients who have recovered from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are coming for elective/emergency surgery. This demands a noteworthy emphasis on the post-COVID-19 obstetric patients. The administration of quality and safe obstetric anesthesia are quite challenging in this mentioned subset due to the overlap of signs and symptoms of COVID-19 with the constitutional signs and symptoms of pregnancy. The physiological changes in normal pregnancy and vascular, metabolic alterations in high-risk pregnancy may affect or exacerbate the pathogenesis or clinical presentation of COVID-19, respectively. This article highlights the specific concerns in recovered COVID-19 pregnant patients with associated comorbidity posted for surgery and their repercussions on anesthesia management.

Affect of Secondary Beam Non-Uniformity on Plasma Potential Measurements by HIBD with Split-Plate Detector.

In a Heavy Ion Beam Diagnostic (HIBD), the plasma potential is obtained by measuring the energy of the secondary ions resulting from beam-plasma collisions by an electrostatic energy analyzer with split-plate detector (SPD), which relates the secondary ion beam energy variation to its position determined by the difference in currents between the split plates. Conventionally, the data from SPD are analyzed with the assumption that the secondary beam current is uniform. However, the secondary beam presents an effective projection of the primary beam, the current of which, as a rule, has a bell-like non-uniform profile. This paper presents: (i) the general features of the secondary beam profile formation, considered in the simplistic approximation of the circular primary beam and the secondary ions that emerge orthogonal to the primary beam axis, (ii) details of spit-plate detection and the influence of the secondary beam non-uniformity on plasma potential measurements, (iii) supported experimental data from the tokamak ISTTOK HIBD for primary and secondary beam profiles and the SPD transfer characteristic, obtained for the 90° cylindrical energy analyzer (90° CEA) and (iv) the implementation of a multiple cell array detector (MCAD) with dedicated resolution for the measurements of secondary beam profile and MCAD operation in multi-split-plate detection mode for direct measurements of the SPD transfer characteristic.

The nexus between remittances, natural resources, technological innovation, economic growth, and environmental sustainability in Pakistan.

Globally, the issues about sustainable development are on the increase. Moreover, these issues are rising every day in Pakistan, as remittances are increasing, technology innovation is ambiguous, natural resources are degraded, and economic expansion might pose serious challenges to the environment. Thus, this research looks at how remittances, natural resources, technological innovation, and economic growth affect carbon dioxide (CO2) emissions in Pakistan by controlling energy consumption and urbanization from 1990 to 2019. The Bayer and Hanck test of combined cointegration discloses a cointegration between remittances, natural resources, technological innovations, economic growth, and CO2 emissions. Moreover, the autoregressive distributive lag model (ARDL) proposes a significant positive association between remittances and CO2 emissions in the long run, indicating that the increase in remittances distresses the environmental performance of Pakistan. Our study confirms that natural resources decrease CO2 emissions while technological advancement, economic progress, energy use, and urbanization increase CO2 emissions. In addition, the results of robustness checks by employing fully modified ordinary least squares and dynamic ordinary least squares are parallel to the conclusions of ARDL estimations. Furthermore, the frequency causality test results show that remittances, natural resources, technological innovation, economic growth, energy use, and urbanization cause CO2 emissions at different frequencies. Therefore, to achieve the sustainable development goals, appropriate policy repercussions can be developed toward advanced and environmentally sustainable sources of energy.

Evaluation of Nebulised Dexmedetomidine Given Pre-operatively to Attenuate Hemodynamic Response to Laryngoscopy and Endotracheal Intubation: A Randomised Control Trial.

Background and aim A variety of medications have been studied to reduce the hemodynamic response to laryngoscopy and intubation. Dexmedetomidine has been used intravenously in many studies to reduce the hemodynamic response to laryngoscopy and intubation. In high-risk patients, this pressor response can increase morbidity and mortality. As dexmedetomidine has a good bioavailability via the nebulisation route, we formulated this study to evaluate the effect of nebulised dexmedetomidine on the hemodynamic response to laryngoscopy and endotracheal intubation. Methods This is a prospective, randomised controlled trial conducted on 100 patients with the American Society of Anesthesiologists grade I and II. The primary objective of the study was to see if nebulised dexmedetomidine at a dose of 1 microgram/kg could reduce the stress reaction to laryngoscopy and intubation. The secondary objective was to study the dose sparing effect of nebulised dexmedetomidine on the amount of propofol used during induction of general anaesthesia. The study population was randomly divided into two groups: group A (n = 50) included patients nebulised with dexmedetomidine 1 microgram/kg and group B (n = 50) included patients nebulised with 5 ml saline 30 minutes before induction of anaesthesia in a sitting position. Results The demographics were similar in both groups. Following laryngoscopy and intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate showed a significant increase in the control group B as compared to the treatment group A. In group A, there was attenuation in SBP (one minute = 113.2 ± 14.503, P < 0.001; five minutes = 109.86 ± 8.342, P < 0.001; 10 minutes = 114.24 ± 7.797, P = 0.010), DBP (one minute = 73.72 ± 10.986, P = 0.011; five minutes = 71.62 ± 9.934, P = 0.005; 10 minutes = 76.1 ± 8.006, P = 0.009), MAP (one minute = 86.80 ± 11.86, P = 0.001; five minutes = 84.44 ± 8.97, P = 0.006; 10 minutes = 88.72 ± 7.44, P = 0.018), and heart rate (one minute = 83.34 ± 12.325, P = 0.001; five minutes = 81.56 ± 13.33, P = 0.003; 10 minutes = 80.16 ± 14.086, P = 0.013) following laryngoscopy and intubation. Induction dose of propofol was significantly lower in the dexmedetomidine group (73 ± 19.509, P < 0.001). Conclusion Nebulised dexmedetomidine effectively blunts the hemodynamic response to laryngoscopy and intubation and also has a dose sparing effect on the induction dose of propofol.

The Nexuses Between Social Media Marketing Activities and Consumers' Engagement Behaviour: A Two-Wave Time-Lagged Study.

This study examined how social media marketing activities (SMMA) influence consumers' engagement behaviour in developing countries. Based on the stimulus-organism-response theory, we examined the effect of SMMA on consumers' engagement intention and further investigated the moderating effect of social media sales intensity. The study employed a time-lagged design with two waves to confirm the hypothesised framework. The study findings showed that SMMA positively influence consumers' engagement intention and engagement behaviour. In addition, social media sales intensity strengthens the link between engagement intention and engagement behaviour. This study adds to the literature on social media and discusses its practical implications.

Evolution of videolaryngoscopy in pediatric population.

Direct laryngoscopy has remained the sole method for securing airway ever since the inception of endotracheal intubation. The recent introduction of video-laryngoscopes has brought a paradigm shift in the pratice of airway management. It is claimed that they improve the glottic view and first pass success rates in adult population. The airway management in children is more challenging than adults. The role of videolaryngoscopy for routine intubation in children is not clearly proven. This review attempts to discuss various videolaryngosocpes available for use in pediatric patients.