Emergence characteristics comparing Endotrachael tube vs Laryngeal Mask airway during nasal surgery with general anaesthesia using intravenous anaesthetic agents like propofol and remifentanyl.

INTERVENTION: After randomisation they will be allocated to either group A or B. In group A RAE tube size 7 will be used in females and 8 in males. In group B RLMA size 3 or 4 (Flexiplus) will be used in females and males based on the patient recommended body weight. Correct insertion of either airway will be confirmed by the ability to manually ventilate the patient’s lungs and adequate cuff inflation by the absence of an audible gas leak when at the APL valve setting of 15‐20cmH2o. Throat pack will be inserted to all participants in the group A to reduce the risk of contamination. In group B it is not inserted, because of the minimal space, with possibility of displacing the RLMA. Blood and secretions from the pharynx contaminating the trachea is prevented by regular suction by the surgeon. Though in group B when RLMA is inserted without the use of muscle relaxants, adequate depth of anaesthesia maintained with total intravenous anaesthesia method and ventilation setting will be pressure controlled ventilation to maintain the eTCO2 in normal limits. Failure of RLMA insertion will be backed with ETT intubation. Blood loss will be measured during intraoperatively and in the postoperative period. At the conclusion of surgery, with anaesthesia maintained, surgeon performs fiberoptic endoscopy to inspect the interior of the laryngeal mask above the larynx or the tracheal tube to its tip. Anaesthetist performs oral suction above the RLMA with the cuff inflated before removal, when the patient is awake and responding to command. Once the patient is extubated, the RLMA airway is examined for the grading of the contamination. Grade 1‐ Clean, Grade2‐lightly soiled, Grade 3‐fully soiled and Grade 4 blood inside the RMLA. No strategies but any deviation from protocol a note recorded in data sheet. CONDITION: Anaesthesiology ‐ Anaesthetics Anaesthesiology; ; Anaesthesiology PRIMARY OUTCOME: time taken to opening eyes on command or respond after termination of the anaesthetic agents[Immediately after the termination of the anaesthesia; Outcome Assessment is done by the assistant using timer on monitor] SECONDARY OUTCOME: adverse effects on return of airway reflexes like cough and laryngospasm, aspiration of blood, post‐operative sore throat ; Outcomes measured by observations of events[at emergence ] grading the contamination of the Reinforced laryngeal mask airway (RLMA ) ; Outcome measured by observing the RMLA and referring to grading given in the protocol.( grading of LMA is as follows: Grade 1‐ Clean, Grade2‐lightly soiled, Grade 3‐fully soiled and Grade 4 blood inside the RMLA. [after extubation] cost difference between the groups. ; Resource: Hospital pharmacy and business manager who know the consumable costs[end of the study] haemodynamic response to emergence from anaesthesia ; Outcome measured is Mean arterial BP mesuared by non invasive Blood pressure by manual sphygmomanometer prior, at and after extubation[at the extubation time ; Haemodynamic outcome is Mean arterial BP which is measured 2 sets by prior, at and after extubation] INCLUSION CRITERIA: Age between 18‐80yrs, ASA I–III scheduled for elective rhinoplasty, mini endoscopic surgery, nasal septal or any other intranasal surgery will be included