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1.  Comparison of classic laryngeal mask airway with Ambu laryngeal mask for tracheal tube exchange: A prospective randomized controlled study 
Indian Journal of Anaesthesia  2013;57(3):259-264.
Background and Aim:
Exchanging endotracheal tube (ETT) with classic laryngeal mask airway™ (CLMA™) prior to emergence from anaesthesia is a safe technique to prevent the coughing and haemodynamic changes during extubation. We had compared CLMA™ and AMBU laryngeal mask™ (ALM™) during ETT/laryngeal mask (LM) for haemodynamic changes and other parameters.
A total of 100 American Society of Anesthesiologist Grade I and II adult female patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were selected and randomly divided into two groups of 50 patients each. In Group I, CLMA™ and in Group II, ALM™ was placed prior to tracheal extubation. Haemodynamic parameters were recorded during ETT/LM exchange. Glottic view was seen through the LM using flexible fibrescope. Coughing/bucking during removal of LM, ease of placement and post-operative sore throat for both groups were graded and recorded.
Statistical Analysis:
Data within the groups was analysed using paired t-test while between the groups was analysed using unpaired t-test. Chi-square test was used to analyse grades of glottic view, coughing, and post-operative sore throat.
In Group I, there was a significant rise in systolic blood pressure and heart rate in contrast to insignificant rise in Group II. Glottis view was significantly better in Group II. Incidence of coughing, ease of placement and post-operative sore throat was identical between both groups.
ALM™ is superior to CLMA™ for exchange of ETT before extubation due to greater haemodynamic stability during exchange phase and is better positioned.
PMCID: PMC3748680  PMID: 23983284
Ambu laryngeal mask™; classic laryngeal mask airway™; endotracheal tube; extubation
2.  Upper limb musculoskeletal abnormalities in type 2 diabetic patients in low socioeconomic strata in Pakistan 
BMC Research Notes  2013;6:16.
Musculoskeletal manifestations of diabetes in the upper limb are well recognized. No data has been available in this regard from Pakistan. Our aim was to find out the frequency of upper limb musculoskeletal abnormalities in diabetic patients.
This was an observational study in which type 2 diabetes patients attending our diabetic clinic were enrolled along with age and gender matched controls. Data was analyzed on SPSS 16.
In total, 210 Type 2 diabetics (male 34.3%, female 65.7%) and 203 controls (male 35%, female 65%) were recruited. The mean age was 50.7± 10.2 years in diabetic group as compared to 49.5±10.6 years in the control group. The frequencies of hand region abnormalities were significantly higher in the diabetic subjects as compared to the controls (20.4%, p-value <0.001). Limited joint mobility (9.5% vs 2.5%), carpal tunnel syndrome (9% vs 2%), trigger finger (3.8% vs 0.5%), and dupuytren’s contracture (1% vs 0%) were found more frequent as compared to controls (all p-values <0.05). In the shoulder region of diabetic subjects, adhesive capsulitis and tendonitis was found in 10.9% and 9.5% respectively as compared to 2.5% and 2% in control group [p- value <0.001]. A weak but positive relationship was observed between age and duration of diabetes with these upper limb abnormalities. However, no correlation was found between the frequencies of these abnormalities with control of diabetes.
A higher frequency of upper limb musculoskeletal abnormalities was observed in Type 2 diabetic patients as compared to control group.
PMCID: PMC3556491  PMID: 23327429
Type 2 Diabètes mellitus; Adhesive capsulitis; Carpal tunnel syndrome; Dupuytren’s contracture; Trigger finger; Pakistan
3.  Neiguan and Jianshi Acupoint Stimulation Aids Hemodynamic Stability in a Cervical Cord Trauma Patient 
Archives of Trauma Research  2012;1(3):123-125.
A 36-year-old male patient with posttraumatic cervical cord damage and resultant quadriparesis, demonstrated hypotension and periods of bradycardia. For most of his two-month stay in the Intensive Care Unit (ICU), he was dependent on dopamine support to maintain hemodynamic stability. Keeping in mind evidence from the literature, that electrostimulation of acupoints Neiguan (PC - 6) and Jianshi (PC - 5) has therapeutic efficacy in restoring hypotension, we treated this patient with two six-hour periods of electrostimulation at these acupoints. We noted beneficial hemodynamic effects, with a resultant successful withdrawal of dopamine support lasting for up to 48 hours. This case report demonstrates the therapeutic efficacy of electrostimulation of PC - 5 and PC - 6 acupoints to wean a patient off chronic dopamine support, and this warrants further investigation.
PMCID: PMC3876545  PMID: 24396760
Acupuncture; Hypotension; Shock; Hemodynamic
6.  Airway management in trauma 
Indian Journal of Anaesthesia  2011;55(5):463-469.
Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.
PMCID: PMC3237145  PMID: 22174462
Airway algorithms; airway management; airway trauma
7.  Fentanyl and Midazolam induced Respiratory Arrest and Neuromuscular Paralysis during Day Care Surgery 
We report a 44 year-old, American Society of Anesthesiologist Class I (ASA I), female patient scheduled for elective excision of a small lipoma of the left thigh. She went into a 90 minute apnea and complete muscle paralysis as evidenced by the absence of all stimulatory responses by a peripheral nerve stimulator after receiving midazolam (1.0 mg) and fentanyl (100 μg) intravenously for sedation and analgaesia. The patient made an uneventful recovery after 90 minutes. No cause and effect relationship could be established between the administered drugs and this unusual response.
PMCID: PMC3074711  PMID: 21509238
Day case surgery; Midazolam; Fentanyl; Apnea; Muscle paralysis; Case report; Oman
8.  An Unnoticed Broken Sheathed Metallic Stylet in an Endotracheal Tube 
We report a 58-years old patient, who underwent surgery for a fracture to the neck of the femur. Tracheal intubation was performed with the aid of a stylet; however, 15 minutes later, it was brought to the notice of the attending anesthesiologist that a broken piece of stylet had been left inside the lumen of the endotracheal tube. Prior to this, there was no evidence of a foreign body in the endotracheal tube or tracheobronchial tree. The broken piece of stylet was successfully retrieved with the help of a Kocher’s forceps.
PMCID: PMC3074643  PMID: 21509094
Broken stylet; Endotracheal tube obstruction; Foreign body; Case report; Oman

Results 1-8 (8)