Introduction: Anesthetic management for high-risk patients undergoing foot care surgery is a critical aspect of minimizing perioperative complications and optimizing recovery. High-risk patients often present with comorbidities such as diabetes mellitus, cardiovascular diseases, and peripheral vascular disorders, which complicate both the surgical procedure and anesthesia. Preoperative evaluations and the careful selection of anesthetic techniques are essential to managing these patients' complex needs. Aim of the Study: This study aimed to evaluate the anesthetic management of high-risk patients undergoing foot care surgery. Methods: This cross-sectional observational study was conducted at the Department of Anesthesiology, BIHS General Hospital, Dhaka, Bangladesh, from January 2023 to December 2024. A total of 36 high-risk patients requiring foot care surgery were selected through purposive sampling. Inclusion criteria included ASA III and IV patients aged 18 years or older, while those with severe conditions preventing surgery or who refused to participate were excluded. Clinical data were recorded, including preoperative evaluations, anesthetic techniques, intraoperative monitoring, and postoperative outcomes. SPSS was used to analyze the data. Results: The study included 36 high-risk patients undergoing foot care surgery. Most participants were aged between 41-70 years, with 33.9% having Diabetes Mellitus (DM) and 24.8% having Hypertension (HTN). Preoperative clinical parameters showed a mean pulse of 90.18 and a mean SpO₂ of 96.78%. Physiologically, 82.1% had a normal pulse, 61.5% had high blood pressure, and 52% had low SpO₂ levels. Postoperative complications included good anesthesia in 28.6% of patients, while 21.4% had blood pressure maintained. Common diagnoses were gangrene, abscess, and wound debridement, each found in 13.8% of cases. Other diagnoses included amputation, non-healing ulcer, and diabetic foot. Conclusion: Anesthesia for high-risk patients undergoing foot care surgery requires a personalized approach. This study highlights the prevalence of diabetes and hypertension, which complicate surgery and anesthesia. Regional anesthesia is often safe, especially for heart patients, but careful blood pressure monitoring is crucial. Tailored anesthetic plans and attentive postoperative care lead to positive outcomes.

Background: Major orthopaedic surgeries impose substantial physiological stress, particularly in elderly or high-risk patients. Neuraxial techniques such as spinal anaesthesia (SA) and combined spinal epidural anaesthesia (CSEA) are commonly employed, yet the optimal approach remains debated. Objective: This systematic review critically compares the clinical outcomes of CSEA and SA in patients undergoing major orthopaedic procedures, focusing on haemodynamic stability, block characteristics, analgesia duration, and complication rates. Methods: A comprehensive search identified randomized trials and observational studies comparing CSEA and SA. Primary outcomes included intraoperative haemodynamic stability, block quality, postoperative analgesia, and incidence of adverse effects. Results: Evidence consistently demonstrates that CSEA offers superior haemodynamic stability, prolonged and adjustable sensory blockade, and extended postoperative analgesia compared to SA. Complication rates, including post-dural puncture headache and urinary retention, were comparable, although CSEA was associated with fewer conversions to general anaesthesia and lower vasopressor requirements. Conclusion: CSEA provides significant clinical advantages over SA for major orthopaedic surgeries, particularly in high-risk or elderly populations requiring haemodynamic control and prolonged analgesia. Nonetheless, SA remains a practical choice for shorter, lower-risk procedures. An individualized anaesthetic strategy, based on patient and procedural factors, is advocated to optimize perioperative outcomes.

Background: Shoulder pain is a common clinical issue and suprascapular nerve block (SSNB) is a well-known intervention for its management. In resource-limited settings where ultrasound is unavailable, Meier’s technique for SSNB offers an effective alternative. This case series aims to evaluate the efficacy of SSNB combined with intra-articular steroid injections for managing shoulder pain in such settings.In settings lacking ultrasound guidance, anatomical landmark-based techniques like Meier’s offer a safe alternative [1]. Methods: We conducted a retrospective case series included 30 patient’s at Zonal Hospital, Dharamshala, where SSNB was performed using Meier’s anatomical landmark technique, with intra-articular steroid injections for patients suffering from chronic shoulder pain.Pain was assessed via VAS scores pre-procedure and at 4 weeks post-procedure. ROM, complications and satisfaction were documented. Results: Thirty patients with chronic shoulder pain were treated with SSNB and intra-articular steroid injections. Significant pain relief was observed in 90% of the cases, with a reduction in Visual Analog Scale (VAS) scores from a mean of 8.2 to 3.1. ROM gains included abduction (+50°), external rotation (+30°) and flexion (+40°). No major complications like pneumothorax or neurovascular injury were observed. Two patients reported mild, self-limited shoulder ache. Eleven of twelve patients expressed high satisfaction. Conclusion: SSNB using Meier’s technique, along with intra-articular steroid injection, is an effective and feasible intervention for shoulder pain in resource-limited settings. It provides significant pain relief and functional improvement without the need for ultrasound guidance.

Background: General anesthesia is an essential medical procedure used in surgeries to induce unconsciousness and prevent pain during operations. Despite its critical role, public knowledge about general anesthesia, its associated risks, and safety measures remains limited, particularly in regions like Kangra, Himachal Pradesh. This study aims to assess the knowledge and awareness levels of the general public regarding general anesthesia, including its purpose, risks, and post-operative care. Material and Methods: A descriptive, cross-sectional study was conducted through an online survey among 400 residents of Kangra district, Himachal Pradesh. A structured, pre-validated questionnaire was used to collect data, consisting of two sections: socio-demographic details and knowledge assessment of general anesthesia. The knowledge assessment included 20 multiple-choice questions covering aspects such as the purpose, risks, safety measures, and post-anesthesia care. Data were analyzed using descriptive statistics, including frequencies and percentages, and categorized into four knowledge levels: Very Good (>80% correct responses), Good (60–79%), Fair (41–59%), and Poor (<40%). Results: The study sample included 400 respondents, with a gender distribution of 54.8% females and 45.2% males. The age group of 26–35 years was the most represented (36.0%). The majority of participants had secondary (27.5%) or undergraduate education (30.0%). Awareness levels varied, with 26.0% of respondents demonstrating very good knowledge, 36.0% having good knowledge, while 28.0% and 10.0% were categorized as fair and poor, respectively. Key knowledge gaps were identified in areas such as intraoperative awareness, preoperative fasting, and post-anesthesia recovery.Conclusion: The findings suggest that while a significant proportion of the population has a general understanding of anesthesia, notable gaps persist, particularly regarding procedural risks and post-operative care. Targeted awareness programs, community engagement, and the use of digital platforms can help bridge these gaps and enhance public understanding of anesthesia. Addressing these issues will empower individuals to make informed decisions, comply with medical advice, and ultimately improve surgical outcomes.