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70%). Percentage of easy insertion was also significantly higher in Group B (95% vs. 65%). Time taken to insert ProSeal was significantly shorter in Group B (30.8 ± 7.8 vs. 59.5 ± 44.6 s). No patient in Group B had blood-stained secretion versus 70% in Group P. Mean arterial pressures at and after ProSeal insertion were significantly higher in Group P. However, heart rate remained comparable in both the groups.

Bougie-guided ProSeal insertions had significantly higher first-attempt insertion success rates and were significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

Bougie-guided ProSeal insertions had significantly higher first-attempt insertion success rates and were significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

The incidence of postoperative recall under total intravenous anesthesia (TIVA) is not yet fully established. Avoidance of inhalational agent is a known risk factor for awareness. In addition, lack of reliable technique to monitor drug concentration needed for adequate depth of anesthesia makes TIVA challenging. Hence, we intend to evaluate our standard anesthesia practice for postoperative recall.

This questionnaire-based observational study was done over the period of 2 years. We enrolled 1080 adult (American Society of Anesthesiologists physical status Class I or II) patients undergoing TIVA for Endoscopic retrograde cholangiopancreatography (ERCP). All patients received fentanyl, midazolam and propofol-based anesthesia. Manual boluses of propofol were given to achieve adequate sedation. (Ramsay sedation scale of 5) in accordance with clinical signs as judged by the primary anesthesiologist. Postoperatively within 12-24 h, patients were assessed for recall using Brice questionnaire. Primary outcome was number of patients reporting postoperative recall in the Brice interview. Secondary outcome was the incidence of dreaming.

On postoperative interview, none of the patients reported awareness. 12.5% of patients had dreams which were pleasant. None of the dreams was unpleasant. The worst thing about surgery was pain.

Our study suggests that if adequate doses of propofol are adhered to and necessary action is taken against responses indicating wakefulness, postoperative recall under TIVA is an uncommon occurrence.

Our study suggests that if adequate doses of propofol are adhered to and necessary action is taken against responses indicating wakefulness, postoperative recall under TIVA is an uncommon occurrence.

Various adjuvants to local anesthetics are used in spinal anesthesia for improving the quality and prolonging postoperative analgesia. We aim to compare the analgesic efficacy of morphine or dexmedetomidine given intrathecally as adjuvants to isobaric levobupivacaine.

Seventy patients of age group 18-60 years, American Society of Anesthesiologists 1 and 2 undergoing elective abdominal hysterectomy, were randomized into two groups. Group M received spinal anesthesia with 3 mL of 0.5% isobaric levobupivacaine with 250 μg of preservative-free morphine. Group D received 3 mL of 0.5% isobaric levobupivacaine with 5 μg of dexmedetomidine. Quality of anesthesia, sensory and motor block characteristics, duration of effective analgesia, and incidence of side effects were compared.

The time for the first analgesic request was 320.80 ± 41.75 min in the dexmedetomidine group as compared to the morphine group (451.63 ± 38.55 min),

= 0.000. The analgesic requirement in the first 24 h was significantly higher in Group D as compared to Group M,

= 0.000. Adverse effects were similar in both the groups, except pruritus which was seen only in Group M.

Our study shows that the use of intrathecal morphine as an adjuvant to isobaric levobupivacaine provides better analgesia than intrathecal dexmedetomidine; however, adverse effects such as nausea and pruritus may be seen.

Our study shows that the use of intrathecal morphine as an adjuvant to isobaric levobupivacaine provides better analgesia than intrathecal dexmedetomidine; however, adverse effects such as nausea and pruritus may be seen.

Intraoperative fluid strategy may affect the graft viability in head-and-neck surgeries with free flap reconstruction (HNS-FFR). Studies to guide regarding association of intraoperative fluid with metabolic parameters during such surgeries are infrequent.

This study aimed to compare plasmalyte (PL) and normal saline (NS) (0.9%) in terms of acid-base balance and electrolytes in the peri-operative period along with graft viability during above-mentioned surgeries.

Prospective, observational cohort study was conducted in patients, 18-65 years, undergoing HNS-FFR at a tertiary care center.

The cohort was categorized into two groups based on the intraoperative fluid used, i.e., PL (Group A) and NS (Group B) group. The primary objective was to compare arterial blood gas parameters at seven time points till the 3

postoperative day. We studied the effect on graft viability and length of hospital stay.

The independent

-tests, Chi-square, or Fisher's exact test were used to evaluate the categorical variables with a repeated measures analysis of variance for inter-group comparison with

< 0.05 as significant.

Seventy-one (36 in Group A and 35 in Group B) patients were included in the study with comparable baseline characteristics. Group A had a better acid-base status, especially after the conclusion of vascular anastomosis (pH 7.37 ± 0.06 vs. 7.33 ± 0.04,

= 0.014) and in the postoperative period (pH 7.35 ± 0.07 vs. 7.31 ± 0.05,

= 0.013). No statistically significant difference was observed in outcome parameters between the groups.

PL may be preferred over NS due to better metabolic milieu during HNS-FFR surgery.

PL may be preferred over NS due to better metabolic milieu during HNS-FFR surgery.

Liver produces most of the blood coagulation factors, so it is not surprising to see a deranged coagulation profile in patients receiving liver transplants. Besides standard laboratory methods to evaluate coagulation profile, point-of-care assays are being used regularly since their results are rapidly available. However, sparse information is available on the comparability of point-of-care coagulation assays with laboratory coagulation assays in this special setting. In this study, our aim is to observe the changing hemostatic profile during different stages of liver transplant surgery using laboratory-based tests and thromboelastography (TEG).

Fifty patients undergoing living donor liver transplantation surgery were selected. Coagulation tests (prothrombin time [PT], activated partial thromboplastin time [APTT], platelet count, and fibrinogen) and TEG were performed at various intervals during liver transplant surgeries - before induction of anesthesia, 2 h into dissection phase, 30 min into anhepatic p

TEG can be used to estimate platelet count and fibrinogen concentrations in all phases but PT and APTT only before induction and anhepatic phase of liver transplant surgery. The decision regarding transfusion of blood products should be based on a combination of the clinical assessment of surgeon and anesthesia personnel combined with results from laboratory and TEG.

Total knee replacement (TKR) surgeries are associated with significant postoperative pain. Ultrasound-guided adductor canal block is associated with better pain scores. The addition of Clonidine and Dexmedetomidine as additives to local anesthetics was the recent focus of interest. However, there are minimal studies comparing the duration of analgesia as additives to Ropivacaine in ultrasound-guided adductor canal block for TKRs.

Prospective, randomized, double-blind design was followed. One hundred and two American Society of Anesthesiologists I to III patients undergoing unilateral TKR surgeries were included in the study and randomized into two groups. Group C received Clonidine 150 mcg and Group D received Dexmedetomidine 100 mcg as an add on to 30 mL of 0.2% ropivacaine for adductor canal block. Postoperatively, duration of analgesia, sedation score, rescue analgesic requirement, hemodynamics, and any other adverse effects were monitored.

The total duration of analgesia in Group D (16.01 h [standard deviation [S. D]-0.5]) was significantly higher as compared to Group C (13.02 h [S. D-0.5]) (

< 0.0001). The numerical rating score (NRS) was significantly lower in Group D compared to Group C (

< 0.05) at multiple postoperative timelines. Group D (2.25(S. D-0.44)) had better sedation scores as compared to Group C (2 [S. D-0]) (

= 0.001).

Dexmedetomidine has longer duration, lower pain, and better sedation scores as compared to clonidine in adductor canal blocks for postoperative pain relief in TKR surgeries.

Dexmedetomidine has longer duration, lower pain, and better sedation scores as compared to clonidine in adductor canal blocks for postoperative pain relief in TKR surgeries.Town centres in the economically developed world have struggled in recent years to attract sufficient visitors to remain economically sustainable. However, decline has not been uniform, and there is considerable variation in how different town centres have coped with these challenges. The arrival of the coronavirus (COVID-19) pandemic public health emergency in early 2020 has provided an additional reason for people to avoid urban centres for a sustained period. This paper investigates the impact of coronavirus on footfall in six town centres in England that exhibit different characteristics. It presents individual time series intervention model results based on data collected from Wi-fi footfall monitoring equipment and secondary sources over a 2-year period to understand the significance of the pandemic on different types of town centre environment. The data show that footfall levels fell by 57%-75% as a result of the lockdown applied in March 2020 and have subsequently recovered at different rates as the restrictions have been lifted. The results indicate that the smaller centres modelled have tended to be less impacted by the pandemic, with one possible explanation being that they are much less dependent on serving longer-distance commuters and on visitors making much more discretionary trips from further afield. It also suggests that recovery might take longer than previously thought. Overall, this is the first paper to study the interplay between footfall and resilience (as opposed to vitality) within the town centre context and to provide detailed observations on the impact of the first wave of coronavirus on town centres' activity.Human Epidermal growth factor Receptor 2 (HER2) overexpression or HER2 gene amplification defines a subset of breast cancers (BCs) characterized by higher biological and clinical aggressiveness. The introduction of anti-HER2 drugs has remarkably improved clinical outcomes in patients with both early-stage and advanced HER2+ BC. read more However, some HER2+ BC patients still have unfavorable outcomes despite optimal anti-HER2 therapies. Retrospective clinical analyses indicate that overweight and obesity can negatively affect the prognosis of patients with early-stage HER2+ BC. This association could be mediated by the interplay between overweight/obesity, alterations in systemic glucose and lipid metabolism, increased systemic inflammatory status, and the stimulation of proliferation pathways resulting in the stimulation of HER2+ BC cell growth and resistance to anti-HER2 therapies. By contrast, in the context of advanced disease, a few high-quality studies, which were included in a meta-analysis, showed an association between high body mass index (BMI) and better clinical outcomes, possibly reflecting the negative prognostic role of malnourishment and cachexia in this setting.