Indian Journal of Anesthesia and Analgesia

Background: Dexamethasone and dexmedetomidine are commonly used perineural adjuncts, but their comparative effects may differ across blocks, operations, doses, and local anesthetics. Objective:To compare perineural dexamethasone with perineural dexmedetomidine for analgesic duration, block characteristics, analgesic consumption, pain, rebound pain, and adverse events in adults receiving single-injection peripheral nerve or fascial-plane blocks for surgery. Methods: PubMed and Scopus were searched from inception to 1 August 2026, and ClinicalTrials.gov was searched for ongoing or unpublished trials. Direct randomized or quasi-randomized head-to-head trials in adults were eligible. The primary outcome was duration of analgesia or time to first rescue analgesia. Risk of bias was assessed with RoB 2 and certainty with GRADE. Mean differences (MDs), standardized mean differences (SMDs), and risk ratios (RRs) were synthesized using DerSimonian-Laird random-effects models when outcomes were compatible. Results: The search identified 440 records; 357 unique records were screened and 40 unique studies were provisionally included. Twenty-three studies (1,465 participants) contributed to the primary meta-analysis. Dexmedetomidine did not clearly prolong analgesia compared with dexamethasone (MD 19.6 minutes, 95% CI -34.7 to 74.0; I²=97.6%; prediction interval -231.8 to 271.1). Results were similarly inconclusive after excluding high-risk studies. Analgesic consumption, sensory-block duration, and motor-block duration also showed no clear difference and substantial heterogeneity. Two small studies suggested more bradycardia with dexmedetomidine (RR 4.15, 95% CI 1.41 to 12.20). Certainty was very low for all key outcomes. Conclusions: Current evidence does not establish a consistent overall advantage of perineural dexmedetomidine or dexamethasone for analgesic duration. Apparent subgroup differences are exploratory and likely confounded. Sparse safety reporting and very low certainty preclude strong clinical recommendations.

Background: During general anesthesia procedure direct laryngoscopy along with endotracheal intubation has a transient sympathoadrenal response characterized by elevating heart rate(HR) and arterial BP. Although these physiological changes are usually tolerated by healthy individuals, there is a chance of precipitation of significant cerebrovascular and cardiovascular complications in patients with limited physiological reserve. Dexmedetomidine and esmolol are used because of rapid onset of action and good cardiovascular effects among the many agents used to blunt the pressor response.1,2 Objectives: To compare and find out the effectivity of the Dexmedetomidine and Esmolol for reduction of stress response to laryngoscopy and endotracheal intubation by assessing changes in HR , SBP, and DBP during general anesthesia. Methodology: A comparative study was done in Department of Anesthesiology Department at Peerless Hospital, Kolkata, for 18 months. The study included 180 patients aged between 18 and 60 years with ASA physical status I and II who were scheduled for elective surgery under general anesthesia. Two groups were considered, Patients in Group D received dexmedetomidine at a dose of 1 μg/kg given intravenously over 10 minutes before induction, whereas those in Group E received intravenous esmolol 0.5 mg/kg 2 minutes prior to laryngoscopy. A standardized anesthetic protocol was followed for all patients. Hemodynamic variables, including HR, SBP, DBP, and MAP, were measured at baseline and at 1, 3, 5, 10, and 15 minutes after tracheal intubation. Data analysis was done using SPSS version 22, and a p-value of less than 0.05 was found to be statistically significant. Results: Patients receiving dexmedetomidine exhibited significantly better control of SBP at 1, 3, 5, and 10 minutes (p<0.05) after intubation, as well as significantly lower DBP across all post-intubation assessment points (p<0.05). MAP was also significantly lower in the dexmedetomidine group up to 10 minutes following intubation (p<0.001). Although heart rate values remained consistently lower among patients administered dexmedetomidine, the differences between the two groups did not reach statistical significance (p>0.05). Conclusion: Dexmedetomidine showed more effectiveness than esmolol in controlling the hemodynamic response during laryngoscopy and endotracheal intubation. It provided superior control of arterial blood pressure while maintaining comparable heart rate stability, making it a more suitable pharmacological option for achieving perioperative hemodynamic stability during induction of general anesthesia.

Background: Undiagnosed syndromic conditions in obstetric patients can significantly complicate anaesthetic management, particularly during emergency situations. Anatomical variations, spinal deformities, and altered physiological responses may predispose to regional anaesthesia failure and airway difficulty. Case Presentation: We report a case of a 31-year-old primigravida with unrecognized syndromic features who underwent emergency caesarean section. Routine preoperative investigations were within normal limits. Initial spinal anaesthesia failed, necessitating conversion to general anaesthesia. Mask ventilation was difficult due to facial dysmorphism and required a two-person technique. Anticipated difficult airway management with video laryngoscopic intubation was successfully performed. Both maternal and neonatal outcomes were favourable. Conclusion: This case underlines the necessity of meticulous preoperative assessment, vigilance for syndromic features, and preparedness for airway challenges and anaesthetic conversion in obstetric emergencies.

Background: Hymenoptera stings are common in India and can result in systemic envenomation with manifestations ranging from localized allergic reactions to lifethreatening multiorgan dysfunction. Case Description: We report a patient with multiple bee stings who developed acute as well as delayed complications of massive envenomation, including toxinmediated multiorgan injury and acute pancreatitis. Management and Outcome: The patient was managed conservatively in the intensive care unit. Despite a stormy and prolonged clinical course, he showed gradual recovery with a favorable outcome. Conclusion: Massive bee envenomation can lead to severe systemic complications, including rare delayed manifestations such as pancreatitis. Early recognition and supportive critical care management are crucial for favorable outcomes. Highlights: This case highlights a rare but serious presentation of delayed complications following massive envenomation. Markedly elevated LDH levels suggested extensive tissue injury and hemolysis while renal failure was likely multifactorial due to venom toxicity, rhabdomyolysis and hypotension.

Atrial septal defect is a common congenital cardiac abnormality encountered in adults, with ostium secundum defects representing the most frequent subtype. Transcatheter closure is widely preferred for anatomically suitable defects because it avoids surgical intervention and is associated with shorter recovery. Anaesthetic management may be challenging when prolonged transesophageal echocardiographic guidance is required, particularly in patients with complex septal anatomy. General anaesthesia provides airway protection and procedural immobility but may delay recovery and necessitate airway instrumentation. Conscious sedation preserves spontaneous ventilation and may facilitate earlier recovery, although careful patient selection and continuous monitoring are essential. Transnasal humidified rapid-insufflation ventilatory exchange can support oxygenation during procedural sedation while maintaining spontaneous ventilation, but its application during structural cardiac interventions remains less established. Additional considerations may arise in lactating women, where early recovery and appropriate medication selection are important. We report the successful use of THRIVE-assisted conscious sedation for transcatheter closure of an aneurysmal secundum ASD in a lactating woman.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, histologically benign but highly vascular and locally aggressive tumor occurring predominantly in adolescent males. Surgical excision, often preceded by preoperative embolization, remains the treatment of choice; however, anesthetic management is particularly challenging because of the risks of difficult airway, massive intraoperative hemorrhage, aspiration, and significant hemodynamic fluctuations. We report the successful perioperative anesthetic management of a 16-year-old male with JNA who underwent preoperative embolization followed by coblation-assisted surgical excision. Comprehensive preoperative assessment, meticulous airway planning, invasive arterial pressure monitoring, adequate blood product preparation, and goal-directed fluid therapy were integral to successful management. The patient remained hemodynamically stable throughout the procedure and had an uneventful postoperative recovery. This case highlights the importance of meticulous perioperative planning, effective communication within the multidisciplinary team, and individualized anesthetic strategies in minimizing perioperative morbidity and optimizing outcomes in patients undergoing JNA excision.

Congenital diaphragmatic hernia (CDH) can be associated with herniation of abdominal viscera into the thoracic cavity, leading to pulmonary hypoplasia and severe respiratory compromise. A 3-day-old neonate diagnosed with left-sided congenital diaphragmatic hernia exhibited severe respiratory distress requiring preoperative mechanical ventilation and stabilization. After preoxygenation,anaesthesia was induced with intravenous fentanyl and ketamine , Muscle relaxation with atracurium , intubated with a 3.0 mm uncuffed endotracheal tube. Anaesthesia was maintained with oxygen, air, and sevoflurane along with intermittent atracurium and fentanyl. Pressure-controlled ventilation was used with low peak inspiratory pressures (<25 cm H2O), low tidal volumes, and permissive hypercapnia to avoid barotrauma , Nitrous oxide was avoided to prevent bowel distension and worsening pulmonary hypertension, the neonate was electively ventilated and shifted to NICU. Successful anaesthetic management of congenital diaphragmatic hernia in neonates requires meticulous perioperative planning and gentle ventilation strategies.

One-lung ventilation (OLV) is routinely used to provide surgical exposure during thoracic procedures, but separation of the lungs can produce clinically important changes in oxygenation. We describe the perioperative anaesthetic management of a 76-year-old woman weighing 44 kg who underwent pulmonary lobectomy. A thoracic epidural was placed before induction, and lung isolation was achieved with a 28 Fr left-sided double-lumen tube. After initiation of OLV, oxygen saturation fell from 99% to 90%, with an arterial PaO2 of 68 mmHg. Tube position was reassessed by fibreoptic bronchoscopy, inspired oxygen was increased to 1.0, recruitment of the dependent lung was performed, and PEEP was adjusted. CPAP of 5 cm H2O was subsequently applied to the non-dependent lung. Oxygen saturation rose to 97% and PaO 2 to 118 mmHg, with no further desaturation. The operation lasted 310 minutes, with 520 mL blood loss and stable haemodynamics. Postoperative analgesia was provided through the thoracic epidural, and the patient had an uncomplicated recovery. This case illustrates the value of systematic assessment and stepwise intervention when hypoxaemia develops during OLV.

Background: Pediatric patients with congenital spinal dysraphism frequently present with associated hydrocephalus and neurological abnormalities, making anesthetic management challenging. Thoracic meningomyelocele may be associated with respiratory dysfunction, altered spinal anatomy, positioning difficulties, and a potentially difficult airway. The presence of raised intracranial pressure secondary to hydrocephalus further increases the risk associated with induction and perioperative hemodynamic and respiratory disturbances. Case presentation: We present the perioperative anesthetic management of an 8-months old female infant with hydrocephalus and thoracic meningomyelocele scheduled for medium pressure ventriculoperitoneal shunt (MPVP) shunt procedure. Preoperative assessment focused on neurological status, signs of raised intracranial pressure, respiratory function, nutritional status, airway evaluation, and assessment of the meningomyelocele sac. Particular attention was paid to airway management and prevention of pressure injury to the thoracic swelling during positioning. General anesthesia was administered with appropriate precautions to avoid hypoxia, hypercarbia, hypotension, and sudden changes in intracranial pressure. The infant was successfully managed perioperatively and shifted to neonatal intensive care unit (NICU) for close postoperative neurological and respiratory monitoring. Conclusion: Anesthetic management of pediatric patients with hydrocephalus and thoracic meningomyelocele requires meticulous preoperative assessment, careful positioning, avoidance of secondary brain injury, anticipation of difficult airway and respiratory problems, and vigilant postoperative monitoring.

Neurofibromatosis (NF) especially Type 1, is a autosomal dominant disorder characterized by multiple neurofibromas, café-au-lait spots, and possible airway, spinal, and systemic involvement. These features pose significant anaesthetic challenges, particularly in emergency obstetric situations like LSCS. A 33 year old G2P1L1 with 37 weeks 2 days gestation with cephalic presentation with previous LSCS in active labour with known neurofibromatosis who underwent emergency lower segment caesarean section for foetal distress. The patient presented with multiple cutaneous neurofibromas and possible airway involvement, raising concerns regarding difficult airway and neuraxial anaesthesia safety. Preoperative evaluation was limited due to the emergency nature of the procedure. Airway assessment suggested potential difficulty, and spinal abnormalities could not be ruled out. Considering these factors, a carefully planned anaesthetic approach was undertaken. Regional anaesthesia was administered with caution after assessing the absence of obvious spinal deformities, and the procedure was successfully completed under subarachnoid block. Intraoperative and postoperative periods were uneventful, with stable maternal and fetal outcomes. Emergency LSCS in NF patients requires: Rapid assessment, Airway preparedness, Careful selection of anaesthetic technique. Spinal anaesthesia can be safely given in selected cases. Key Messages: Neurofibramatosis, Subarachnoid block.