Indian Journal of Anesthesia and Analgesia

Background: Laryngoscopy is the most important step in the process of endotracheal intubation for administration of general anaesthesia. Airtraq optical laryngoscope is a new rigid indirect optical device with exaggerated curvature of the blade and an internal arrangement of optical components, a view of the glottis is provided without alignment of oral, pharyngeal and tracheal axes. Objective: To compare the efficacy of laryngoscopy and the haemodynamic response to endotracheal intubation between Airtraq and Macintosh laryngoscopes. Methods: One hundred patients of either sex in the age of 20–60 years under ASA grade I and II with Mallampati grading I and II posted for elective surgery under general anaesthesia were selected for the study. Patients were randomly divided into two groups (n = 50). Induction of anaesthesia was standardized. The efficacy of laryngoscopy was compared according to Cormack and Lehane grading and haemodynamic response to endotracheal intubation were compared. Results: In group A (Airtraq), all 50 (100%) patients had Cormack and Lehane grading I and in group M (Macintosh), 33 (66%) patients had Cormack and Lehane grading I and 17 (36%) patients had Cormack and Lehane grading II ( p = 0.000). In x Group A, mean heart rate increased from 83.54±10.19 bpm prior to intubation to 90.08±9.98 bpm after intubation and mean arterial pressure increased from 91.06±8.16 mmHg prior to intubation to 95.30±8.40 mmHg after intubation. In Group M, mean heart rate increased from 80.94±6.71 bpm prior to intubation to 103.30±7.86 bpm after intubation and mean arterial pressure increased from 91.80±7.70 mmHg prior to intubation to 114.20±6.69 mmHg after intubation (p = 0.000). Conclusion: Airtraq optical laryngoscope provides a better exposure of the glottis when compared to Macintosh laryngoscope while triggering minimum haemodynamic response to endotracheal intubation.

Keywords: Laryngoscopy; Hemodynamics; Airtraq; Macintosh. 

General anaesthesia is the gold standard technique for breast cancer surgery but risks of general anaesthesia outweigh the benefits particularly in patients with known cardio pulmonary disorders. Here we discussed a patient with known bronchiectasis undergone mastectomy with axillary lymphnode dissection under thoracic spinal block at mid thoracic level without any intra and post operative complications

Right Internal Jugular Vein (IJV) is the commonest approach for central venous cannulation in patients undergoing major abdominal surgeries. Though highly useful in managing these high risk patients, it can be associated with vascular, pulmonary and cardiac complications,along with catheter misplacement an guide wire related problems. Though anatomical variations and use of blind technique can contribute to these, operator skill and routine use of ultrasound guided approach can prevent many of these catastrophes. We report a case of unexpected haemothorax following an unsuccessful attempt of right IJV cannulation using landmark technique, which was detected and managed in time, which saved the life of the patient.

Introduction: Rapid induction with propofol causes fall in arterial pressure and tachycardia.Our study aims at comparing the hemodynamic changes between rapid dose and priming dose, measure propofol requirement and evaluate complications between the two groups. Materials and Methods: Hundred consecutive patients posted for elective surgery under general anaesthesia with endotracheal intubation were randomly divided into two groups of 50 patients each (Group I and II). Group I (priming dose) received 20% of the total calculated dose of inj. Propofol (2 mg/kg) and 30 seconds later the remaining calculated dose of propofol was injected at a rate of 30 mg/10 seconds till the loss of eyelash reflex and group II(rapid induction dose) were injected propofol at a speed of 30 mg/ 10sec until the loss of eyelash reflex. Heart rate, arterial pressure, total induction dose and complications were recorded. Results: The mean induction dose of propofol was 109.60 in group II and 90.84 in group I.The mean heart rate were higher and mean arterial blood pressure were lower in control group at one and three minute after induction compared to study group. It was also observed that 50% in  control group and 68% in study group had developed various complications. Discussion: In our study priming dose reduced the total induction dose requirement of propofol by 18%. There were lesser hemodynamic fluctuations with priming dose. Apnea and fasiculations were more in priming group. Conclusion: Priming principle requires lesser dose of propofol and prevents hemodynamic fluctuations caused due to propofol.
 

Introduction: Dexmedetomidine can provide controlled hypotension, analgesia, and sedation. The present study aimed to evaluate advantages of dexmedetomidine as an adjuvant in anesthesia fo FESS (Functional Endoscopic Sinus Surgery). Materials and Methods: Study was conducted in 50 patients form April-2015 to March -2016 after obtaining approval from ethical committee and informed consent from the patients. who were ASA grade I/II, aged between 18-55years scheduled for FESS. Patients were randomly allocated into two groups of Group D (n=25) which received injection Dexmeditomidine as loading dose of 1 mcg/kg intravenously followed by maintenance infusion of 0.6mcg/kg intravenously and Group NS (n=25) received normal saline in similar volume. Results: The baseline mean systolic blood pressure was lower during surgery in patients of group D, but not statistically significant . At the end of surgery and after recovery, blood pressure is significantly lower in group D (114± 11 vs. 131 ± 9 mmHg; P < 0.05). Baseline values of the mean heart rate intraoperatively was significantly reduced compared with the baseline value in group D (P < 0.05), After extubation, the heart rate was found to be higher in patients of the GroupNS (98 ± 4 vs. 86 ± 3 beats/ minutes). Blood losses were lower in group D as compared to group NS ( p= 0.03 ).The Visual Analogue Scale (VAS) scores in the immediate postoperative periods were also significantly lower in the group D ( p =0.03 ). The only side effect noted was bradycardia in 3 patients in group D. Isoflurane requirement was also reduced in the maintenance of anaesthesia. Conclusion: Dexmedetomidine as an adjuvant for hypotensive anaesthesia is effective and decreases bleeding thus providing relatively bloodless field during FESS.

This study designed to test the hypothesis that the preoperative use of pregabalin will reduce th consumption of analgesics after laparoscopic cholecystectomy and to compare its efficacy and side effects with that of gabapentin. It is observed that preoperative single-dose pregabalin (150mg) was comparable to gabapentin (300mg) in reducing both the static and the dynamic components of postoperative pain along with postoperative analgesic consumption in subjects undergoing laparoscopic cholecystectomy. A decrease in VAS pain scores was found in patients who received pregabalin one hour before surgery in comparison to patients who received gabapentin. Although pregabalin was found more effective than gabapentin in the present study, usage of both was associated with decreased analgesic consumption. In conclusion, oral Pregabalin 150 mg administered before surgery was effective than Gabapentin 300mg in reducing postoperative pain and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. Gabapentin and Pregabalin, both can be an effective tool in the armamentarium of  anaesthesiologist in treatment of postoperative pain. They can be used as part of multimodal therapy if not as sole analgesic.

Background & Aim: Right ventricle function significantly decreases after coronary artery bypass surgery; as one of the likely causes, such a condition is attributed to the use of cardiopulmonary pump (CPB). Because nowadays there is a tendency toward increasing use of off-pump coronary artery bypass (OPCAB) surgery, this study was conducted to evaluate the right ventricle function perioperatively by TAPSE and simultaneously assess the influence of RV systolic function on the perioperative outcome in terms of duration of ventilation, inotropic support, length of intensive care unit stay etc. in the perioperative period in off pump coronary artery bypass grafting. Methods: This Prospective observational study was conducted on 54 triple vessel disease patients elective OPCABG surgery. RV systolic function assessed by measuring
Tricuspid Annular Plane Systolic Excursion(TAPSE) by both TEE & Transthoracic ECHO. Results: RVEF is most used index of RV contractility normal RVEF – 40-76%. Statistically significant improvement of TAPSE values observed post grafting. The improvement of TAPSE values are observed irrespective of whether RCA or PDA grafted or  not. In this study, improved TAPSE values did not significantly improve periop outcome in elective OP CABG patients in terms of length of ICU stay, inotropic support and duration of ventilation. Conclusions: The RV systolic function can be assessed routinely in perioperative setting by using TAPSE with relative easy. There is significant improvement in RV systolic function post grafting in elective OFFPUMP CABG surgeries. The improvement of RV systolic function in irrespective of right coronary artery grafting. The improvement of RV systolic function did not influence perioperative outcome significantly. Limitations of this study may be small sample size, Intra observer variations associated with echocardiography.
  

Context: Spinal anaesthesia is the most common method of regional anaesthesia used for lower limb and abdominal surgeries below umbilicus.There is always interest in finding adjuvants that prolong the duration of anaesthesia and analgesia. Aims: To evaluate whether clonidine when given by three different routes- oral, intrathecal and intravenous, has any effect on spinal anaesthesia. Settings and Design: The study was a prospective, case control study conducted in the deparment of Anaesthesiology. Methods and Materials: All the patients posted for surgery under spinal anaesthesia and who met the selection criteria were randomly then divided into four groups of 30 patients. Group I: Spinal anaesthesia with bupivacaine 3ml. Group II: Spinal anaesthesia with bupivacaine 3 ml + oral clonidine 3µg/kg. Group III: Spinal anaesthesia with bupivacaine 3 ml + inrathecal clonidine 75 µg. Group IV: Spinal anaesthesia with bupivacaine 3 ml + intravenous clonidine 3µg/kg. Statistical Analysis: Computer software SPSS version 20 was used for the statistical analysis of the data. For analysis Chi square test and one way ANOVA with bonferroni was used. Results: The onset of  sensory and motor block was earlier in oral, intrathecal and intravenous clonidine group as compared to control group. The duration of motor block was longer in oral (154.52±12.18 min), intrathecal ( 168.80± 7.46 min) and intravenous ( 215.63±26.26 min) clonidine group as compared to control group (149.25±26.42min). Demand for analgesia was delayed in oral(295.81± 10.32min),intrathecal (364.80± 6.69min) and intravenous group(571.31±8.86min) as compared to the control group(137.50± 30.63min). Conclusion: Clonidine is a good alternative to opioids as adjuvant to bupivacaine in spinal anaesthesia.

Background: When adjuvant is used along with local anaesthetic agents they augment the onset of action, prolong the duration of analgesia and improve quality of block. Nowadays different drugs have been used as an adjuvant with local anesthetics in brachial plexus block to achieve quick, dense and prolonged block. Objective: To evaluate the effects of adding  a2 receptor agonist Dexmedetomidine and Clonidine to local anaesthetics in brachial plexus block through Supraclavicluar route in upper limb surgeries. Materials and Methods: The present study was conducted on 100 patients of 18 to 60 years age group of either sex of ASA physical status I or II planned for upper limb surgery. According to the adjuvant along with anaesthetic agent given to the patients; they were randomly divided into two groups of 50 patients each. Group A received Dexmedetomidine while in Group B; Clonidine was used as an adjuvant to local anesthetics. Supraclavicluar brachial plexus block was performed according to the group selected. All patients were observed for onset and duration of sensory and motor block, duration of analgesia, VAS score. Results: In Group A Mean age of patients was 35.64 years while in group B,it was 37.48 years. The average duration of surgery was 139.6 minutes in Group A while 147.2 minutes in Group B. Dexmedetomidine (3.5 mins, 6.48 mins) and Clonidine (4.2 mins, 6.48 mins) has similar onset of sensory and motor block time respectively. Both have longer motor block duration than sensory block duration. Dexmedetomidine has significantly prolonged sensory and motor block duration than clonidine (p<0.0001). Dexmedetomidine also has longer duration of analgesia in compared to clonidine withp<0.0001. Conclusion Dexmedetomidine has better profile in terms of duration of sensory and motor block and duration of analgesia, as an adjuvant to supraclavicular brachial plexus block in comparison of clonidine.

Objective:To evaluate theease of insertion ofLaryngeal Mask Airway (LMA) and hemodynamic response during insertion of LMA with two adjuvants, dexmedetomidine & clonidine along with induction agent propofol. Methods: Hundred patients scheduled for elective surgical procedures were recruited in this study. The hemodynamic effects and ease of insertion of LMA with adjuvants, dexmedetomidine & clonidine with propofol was compared. The hemodynamic responses were assessed byheart rate, non-invasive blood pressure, respiratory rate and oxygen saturation. The overall conditionof patient was assessed according to modified scheme of Lund and Stovener. The condition of insertion was assessed as jaw relaxation and response to LMA insertion in the form of coughing, gagging, laryngospasm and involuntary limb movements. Results: The incidence of coughing, gagging, laryngospasm and involuntary limb movements were comparable in both the group, whereas, jaw relaxation, overall insertion condition and hemodynamic responses were better {p value for heart rate:<0.001} in dexmedetomidine group.Conclusion: Dexmedetomidine as an adjuvant to propofol  provides better LMA insertion conditions, fewer side effects & prevent hemodynamic response to LMA insertion compared to clonidine.

Aim and objective: The aim of this study was to compare postoperative side effects produced by spinal bupivacaine plus buprenorphine with femoral and sciatic nerve blocks plus spinal bupivacaine. Settings and Design: Randomly patients were divided in to 2 groups by using computer generated randomization, 25 patients weretaken in each group they are Group – A (spinal bupivacaine plus buprenorphine) and Group – B (Combined femoral and Sciatic Nerve Block plus spinal bupivacaine ). Patients and Methods: Postoperative side effects like nausea and vomiting, itching, drowsiness, sedation and prolonged sensory & motor block produced and hemodynamic variability was documented and compared between both groups (A and B). Statistical analysis: Done using Chi-square test. Results: The Nausea and vomiting,itching, drowsiness and sedation was high with Group A and prolonged sensory & motor block was high with Group B (p value < 0.01 highly significant). Hemodynamic variability was not significant between both groups. Conclusion: Nerve blocks (femoral & sciatic) compared to intrathecal buprenorphine are very useful, with less side effect for post operative pain relief. 

Aims: This study was been done with a purpose to evaluating the benifit of the Hyomental Distance [Hmd] neutral and extended position for predicting accurately difficult visualization of the larynx (DVL) in normal looking patients. Settings and Design: 198 normal looking patients ASA status I and II, scheduled to undergo general anesthesia and intubation were assessed. Each patient underwent a preanaesthetic assessment. Patients and Methods: A scale was used on the surface of the skin nearest to the hyoid bone, and the leanth from the nearest point mentum to the hyoid bone was measured and it was explained as the Hyo-mental distance at neutral position. After IV induction and paralysis, vocal cords visualisation was done and assessed by using Cormach and Lehane (C&L) classification. Statistical Analysis: was done using students‘t’ test and chi-square test. Results: The highest specificity of Hmd at the straight (neutral) position 98.89 % and Hmd at the head extension had a specificity of 95.56%. Conclusion: Hyo-mental Distance in straight and extended position are clinically reliable predictor of Dvl, because of their high specificity and negative predictive value .
 

Background: Spinal anesthesia is an age old, tested, effective and economical technique of regional anaesthesia especially for lower-limb orthopaedic surgeries because of its excellent muscle relaxation and intraoperative and postoperative analgesia profile. Aims: To compare the efficacy of adjuvants dexmedetomidine and fentanyl when added to intrathecal bupivacaine. Setting & Design: 120 patients were enrolled in the study. They were randomly allocated into dexmedetomidine group (BD) and fentanyl group (BF) and received 5 µg dexmedetomidine and 25 µg fentanyl respectively as adjuvants  to 2.5 ml intrathecal bupivacaine. Materials & Methods: Both group BD and BF were compared with respect to age, sex, weight, height, time to onset of maximum motor blockade (Bromage 4 ), maximum level of sensory level achieved, intraoperative VAS score, hemodynamic, postoperative VAS score, time to two – segment regression, time to regression to S2 level and regression to Bromage 0 were noted. Statistical Analysis: Unpaired t-test and ch i- square test were used. Conclusion & Results: Significant difference was found between both groups with BD group having prolonged time to regression in two-segment and S1 level and Bromage - 0 postoperative VAS scores were lesser with BD group.

Background:  Laparoscopy provides various advantages than conventional cholecystectomy but may lead to alteration in cardiovascular and pulmonary physiology and stress response. Objective: The aim of this study is to assess the outcome of oral clonidine as a premedicant for haemodynamic stability in laparoscopic cholecy stectomy and as a postoperative analgesic. Materials and Methods: One hundred and fifty adult patients categorized as ASA physical status I or II, time lined for laparoscopic cholecystectomy were chosen and randomly allotted to two groups P & C. Group C (clonidine) received Tab. clonidine 150  g orally and Group P (placebo) received Tab.ranitidine 150mg orally as premedication 90 minutes before scheduled laparoscopic cholecystectomy. Haemodynamic response in the intraoperative period and postoperative analgesic requirements were recorded.Results: Significant haemodynamic variation was noted in the group P as compared to group C. Mean heart rate varied from 74.42 ± 9.13 to 91.84 ± 9.11 (Mean±SD ) in group C and 84.64 ± 9.25 to 110 ± 13. 95 in group P. Systolic, Diastolic and Mean blood pressures also showed similar  variations. Intensity of pain, nausea and vomiting was also less in the group C in the early postoperative period. Conclusion: It can be concluded from these results that,premedication with oral clonidine 150 µg provides stable haemodynamics and prevents against stress response due to pneumoperitoneum in laparoscopic cholecystectomy patients and reduces postoperative analgesic requirements.
 

The international association for the study of pain has defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Unrelieved postoperative pain can lead to lot of problems. Gabapentine is an anti convulsant which can be used as a preemptive analgesic. Aim: to assess the optimal dose of preemptive oral gabapentine Materials and Methods: The patients were divided into following groups: Group 1: Patient receiving only postoperative Epidural analgesia with 6 ml of 0.125% Bupivacaine plus 1 mcg/Kg Fentanyl. Group 2: Patient receiving postoperative Epidural analgesia with 6 ml of 0.125% Bupivacaine plus 1 mcg/Kg Fentanyl with 10 mg/ Kg Oral Gabapentin 1 Hour before induction with a sip of water.Group 3 Patient receiving postoperative Epidural analgesia with 6 ml of 0.125% Bupivacaine plus 1 mcg/Kg Fentanyl with 15 mg/Kg Oral Gabapentin 1 Hour before induction with a sip of water. Group 4: Patient receiving postoperative Epidural analgesia with 6 ml of 0.125% Bupivacaine plus 1 mcg/Kg Fentanyl with 20 mg/Kg Oral Gabapentin 1 Hour before  induction with a sip of water. All patients surgery was carried out under standart general anaesthetic technique and for postoperative pain epidural catheter was placed in L1-L2 space before induction. Results: on comparing VAS score there was not much difference in each group while shifting. Number of epiduaraltopups was significantly reduced in group 3 and 4. Patient satisfaction was good in group 3 and 4. But complication were less in group 3 compared to group 4 Conclusion: So oral Gabapentin 15mg/kg dose would be the optimal preemptive dose for postoperative epidural analgesia.
 

Background: Various adjuvants have been used with local anaesthetics in spinal anaesthesia to prolong the postoperative analgesia.Dexmedetomidine, alpha2-agonist is now being used as a neuraxial adjuvant The aim of the present study was to compare the block characteristics of dexmedetomidine 5mcg and buprenorphine 75 mcg as adjuvants to 0.5% hyperbaric bupivacaine spinal anaesthesia in infra-umbilical surgeries. Methods and Material: Sixty four patients scheduled to undergo infra-umbilical surgeries were randomly allocated to receive either 12. 5mg hyperbaric bupivacaine plus 5mcg dexmedetomidine (group D, n=34) or 12.5 mg hyperbaric bupivacaine plus 75mcg buprenorphine (group C,n=34) intrathecally Statistical Analysis Used : Chi-square test and student t test was used where applicable to determine whether there was a statistical difference between the groups in the parameters measured .P less than 0.05 was considered as statistically significant. Results: Patients in group D had significantly longer regression of sensory and motor block time than patients in group B. The two segment regression time was 134 ±34.76 min in group D and 106.26 ± 43 min in group B (P<0.05). The regression to Bromage 0 was 330 ± 68 min in group D and 253 ± 58 min in group B  ( P<0.05 ). Conclusion : Addition of dexmedetomidine to hyperbaric bupivacaine intrathecally prolongs the regression of sensory and motor blockade, but does not produce appreciable prolongation of postoperative analgesia or reduce the postoperative analgesic requirement when compared to buprenorphine.

Context: Post Cesarean section substantial postoperative discomfort and pain can be anticipated. Pain inadequately relieved is deleterious and lead to number of complications in the postoperative period.The analgesic regime needs to meet the goals of providing safe and effective analgesia with minimal side effects for the mother and child. We conducted this study to formulate post-operative pain management strategies regarding the use of non-opioid analgesics. Aim: This study was conducted with aim to comparethe analgesic efficacy of Tramadol and Diclofenacsodium as rectal suppository in post-operative cesarean section.Settings and Design:This study was a randomized, controlled trial, carried out at tertiary care centre in India.The sample size for this study was calculated to be 50 in each group. Methods and Material: Adult (19-30 years) American Society of Anesthesiologist grade-I and II posted for cesarean section were included in the study. Patients were randomized by simple randomization method to receive either rectal suppository of Tramadol (Supradol) 100 mg or Diclofenac (Justin) 100 mg. Suppository  was introduced immediately after the surgery before shifting the patients to postoperative ward. Pain measurement in the postoperative period was performed using Visual Analog Scale at 0, 2, 4, 6, 8, 10 hours. Statistical Analysis Used: All data on categorical variables were presented as frequencies and percentages. Chi square test was used to compare the frequencies and percentages.All the statistical analysis were carried out at 5% level of significance and p value <0.05 was considered significant. Chi square test was used to compare the frequencies and percentages. Results: Statistically significant differences between two groups in VAS score was seen at 4,6,8 and 10 hours after surgery.80.4% of cases among Tramadol group needed rescue analgesia at 8 hours and 98.2% at 10 hrs. among Diclofenacgroup Only 4.2 %cases needed rescue analgesia at 8 hrs and 6.3 % at 10 hours. Conclusion: Diclofenacsuppository has better analgesic effect as compared with Tramadol suppository on postoperative pain.

Background: Laparotomy surgery carries significant risk of postoperative mortality due to patient related factors and perioperative events. This observational study was aimed to find out how these factors  affect the mortality outcome in patients undergoing laparotomy surgeries. Methods: All patients who underwent major laparotomy and shifted to Intensive Care Unit/ Post Anaesthesia Care Unit (ICU/ PACU) were analyzed. The parameters studied were age,gender, American Society of Anaesthesiologists’ Physical Status (ASA PS), elective or emergency nature of the surgery, anaesthetic technique used and major complications.The study was conducted over a period of 18 months. The data was analyzed using statistical software version 21.0 and significance was tested by setting the p value at 0.05. Observations: Out of 486 patients, the overall mortality was 37(7.6%). Females predominated (62.1%) with a higher mortality rate of 9.6%. There was no statistically significant difference in mortality amongst the different age groups. The mortality rate was observed as steadily increased as per increased ASA PS score. Patients operated as elective procedure were higher (65.6%),  but the mortality was higher in those patients operated as emergency procedures (18%). Most of the surgeries (93.4%) were under general anaesthesia, but the choice of anaesthetic technique did not affect the mortality. The patients who required vasopressors therapy and mechanical ventilation were higher in the non survivors. Conclusion: The mortality rate of patients undergoing major laparotomy was comparable with similar studies. Females formed the majority and had an increased mortality. Mortality did not increase with age in this study, but increased with higher ASA PS score and emergency surgical procedures. Majority of the surgeries were done under general anaesthesia, but the choice of anaesthetic technique did not affect the outcome. Patients who were dependant on vasopressors and mechanical ventilation had higher mortality rates.

Background: Sevoflurane, a widely used volatile anaesthetic in children is associated with an increased risk of emergence agitation. Agitation can lead to increased bleeding from the operative sites, pulling out drains or catheters and often a major cause of dissatisfaction for parents and health care providers. Dexmedetomidine, a newer alpha 2 adrenoreceptor agonist, hassedative, analgesic and anxiolytic actions A i m :This study was to evaluate the effect of a single dose of dexmedetomidine given before extubation, on reducing emergence agitation. Method and Materials: In this prospective study, 60 children aged 3–8 years, scheduled for adenotonsillectomy were divided into two groups.Induction and maintenance of anaesthesia was with sevoflurane. One among the two groups received dexmedetomidine 0.3mcg in 10ml normal saline 10 minutes before extubation and the other group did not receive dexmedetomidine. Emergence agitation was assessed on a 5 point Watcha scale.Adverse airway events during extubation like coughing or breath holding and adverse hemodynamic effects such as bradycardia, hypotension and the time taken for recovery were also assessed.  Results: Incidence and severity of emergence agitation was significantly reduced in children who received dexmedetomidine prior to extubation (p value <0.05). No significant difference was noted in the incidence of adverse airway events, adverse hemodynamic effects and time taken for recovery. Conclusions: A single dose of dexmedetomidine 0.3 mcg, given prior to extubation significantly reduces the emergence agitation seen after sevoflurane anaesthesia. Administration of dexmedetomidine was not associated with any adverse effects on hemodynamics or recovery.
 

Context: Dexmedetomidine a wonderful drug with vital organ protective properties. When combined with other intravenous anaesthetic agents useful in surgical procedure without intubation. Less research work was done on this subject.Objectives: The aim of this study was to compare the effects of dexmedetomidine +propofol with dexmedetomidine+Ketamine combinations for sedation and anesthesia in patients undergoing hysteroscopy and procedures regarding hemodynamic changes, drug requirements and the recovery criteria and postoperative complications. Patient and Methods: Sixty patients aged between 20 50 years, ASA I& II scheduled for hysteroscopy were enrolled in this study. Patients were randomly allocated into two equal groups: dexmedetomidine+propofol (DP) group and dexmedetomidine+ Ketamine (DK) group. Every patient received a loading dose of intravenous (IV) dexmedetomidine 1g/kg over 10 min and Propofol 1mg/kg (DP) or ketamine1mg/kg (DK) group and then maintained by a 0.5 g/kg/h of dexmedetomidine. Mean arterial pressures (MAP) and heart rates(HR),drug  consumption,recovery time visual analog scale (VAS ) and postoperative complications were recorded. Results: The intra and post procedural HR and MAP showed statistically significant differences between the both groups throughout the procedure with lower values in DP group (p < 0.01). After procedure recovery time was significantly shorter in DK group (12.2 ± 8.2 min) compared with (15.7±9.6 min) DP group (p = 0.012). VAS was comparable in the two groups. Drug consumption similar in both the groups. Conclusion Dexmedetomidine +propofol combination as total intravenous anaesthesia showed better intra-and postprocedural hemodynamic stability with fewer complications.

Background and Aims: PostOperative Nausea and Vomitting (PONV) Continues to be a highly undesirable outcome of anaesthesia and SX. We compared the efficacy of Palanosetron, Ondansetron an Metoclopramide in the control of PONV. Methods: A total of 60 Patients were randomly allocated to three groups, Group (P): received intravenous Palanosetron 0.25mg, Group (O): received intravenou Ondansetron 4mg, Group (M): received intravenous Metoclopramide 10mg. Incidents of Early (0- 2 Hours) and Late Post-Operative (2- 24 hours) Nausea and Vomiting were assessed. Statistical analysis were performed using Chi- square and Fisher ‘f’ probability test. Results: Incidence of Early Post operative nausea (0-2 hours) in Group (P) was 0% (0/20) Compared to Group (O) and Group (M) which were 5% (1/ 20) and 0% (0/20) respectively. Incidence of late post-operative (2 -24 hours) Nausea in Group (P) was 5% (1/20), Group (O) was 20% (4/20) and Group (M) 10% (2/20) respectively. There is no significant difference in the anti nausea efficacy of Palanosetron compared to ondansetron and metoclopramide. The incidence of early post-operative (0-2  hours) vomiting in Group (P) was 0% (0/20), Group (O) 10% (2/20) and Group (M) 5% (1/ 20). Incidence of Post operative (2-24 hours) vomiting in group (P) 5%(1/20), Group (O) 15 (3/20), Group (M) 15% (3/20). Comparing overall incidence of vomiting showed that the antiemetic efficacy of Palanosetron is the same as Ondansetron and Metoclopramide for Post Operative emisis Conclusion: Prophylactic administration of Palonosetron, Ondansetron and Metoclopramide for PONV, there was no significant difference in the anti-nausea and anti-emetic efficacy of Palonosetron compared to Ondrasetron and Metoclopramide. The magnitude of effect against PONV appears to be similar to that of other established drugs.

Background: Interlaminar and trans-foraminal epidural steroid injections are commonly performed interventions in managing low backache with lumbosacral radicular pain.However, controversy exists to the superiority of one over the other. Material and Methods: Sixty six patients with low back ache with unilateral single level lumbar radiculopathy were randomly allocated to group IL (interlaminar approach)and group TF (trans-foraminal approach).In group IL needle was placed in epidural space by loss of resistance technique and in group TF, needle was placed in epidural space under C-arm guidance. In both the groups, Omnipaque ®  (Iohexol) radio contrast dye was used for confirmation of correct placement of respective needles. A solution of 1 ml (40 mg) triamcinolone with 3 ml of normal saline was injected into the epidural space. The primary outcome measure was pain relief at the end of 2nd and 3rd week. Secondary outcome measures werestraight leg raising test (SLRT),reduction inanalgesic use, reversal of paraesthesia and subjective improvement in walking tolerance.Results : In Group IL ,NRS score decreased from preprocedural score of 7.77±1.2 to 4.73±1.1 and 4.27±1.5 at the end of 2nd and 3rd week  post procedure respectively. Where as in Group TF,NRS score decreased from preprocedural score of 7.8±1.3 to 2.77±1.7 and 2.63 ±1.7 at the end of 2nd and 3rd week respectively. This difference in NRS score was statistically significant both at the end of 2nd week and 3rd week with Group TF having better pain relief. There was no statistically significant difference among the 2 groups with respect to improvement of SLRT and walking tolerance, reduction in analgesic use and reversal of paraesthesia at the end of 3rd week. Conclusion: Epidural steroid injection by transforaminal approach provides better subjective pain relief than interlaminar approach in the short term.

Introduction: Laryngoscopy and intubation results in a stimulation of larynx, pharynx, epipharynx and trachea, which are extensively innervated by autonomic nervous system. The parasympathetic supply is via the vagus and sympathetic supply via superior cervical ganglion. Fentanyl seem to provide minute to minute haemodynamic control from intubation to recovery. Aims and Objective: To determine efficacy of intravenous fentanyl 2 microgram/kg body weight administered before laryngoscopy and endotracheal intubation in attenuating the changes in the hemodynamic parameters in normotensiv individuals Methods: Sixty normotensive patients of both sexes, aged between 18-65 years belonged to ASA physical status 1, free from intercurrent cardiovascular and neurological disease were posted for elective surgical procedures under general anaesthesia requiring orotracheal intubation were selected. Patients were informed. Written consent was obtained and the study protocol was approved by the Institutional Ethical committee. Results: When compared with control group, the rise in pulse rate in group II was significantly smaller (p<0.001) a all instances  except at 30 sec (p>0.5), increase in mean systolic blood pressure in group II was significantly smaller (p<0.001) at all instances except at 5 min, increase in diastolic blood pressure in group II was significantly smaller (p<0.001), rise in mean arterial pressure in group II was significantly smaller(p<0.001) at all instances except 5 min, rise in rate pressure product in group II was significantly small (p<0.05) Conclusion: Thus fentanyl in addition to its narcotic analgesic activity is addition to anaesthesiologist’s armamentarium for attenuation of sympathetic stimulation by laryngoscopy and endotracheal intubation.

Background: Post operative pain relief is an integral part of anaesthetic management especially when it comes to pediatric patients where it requires special attention. Aim: to study two different techniques – peri inscisional infiltration with bilateral infra orbital nerve block for post operative pain relief in case of cleft lip repair surgery done in pediatric patients below two years of age for pain relief in post operat period Material and Methods: Sixty patients of either sex were randomly divided in two equal groups with comparable age and weight with duration of surgery lasting around 75 to 90 minutes – one to receive Inj. Bupivacaine 0.25% 1 ml for infraorbital nerve block each side and other for peri inscisional infiltration with Inj Bupivacaine 0.25% 2 ml. After premedication with anticholinergics, general anaesthesia was given with Inj. Ketamine and relaxant Inj. Suxamethonium as per body weight. And bilateral infra orbital nerve block and peri inscisional infiltration was done after intubation. The patients were monitored for vitals, pain relief using Objective Pain Score (Hanallah’s) for pain free period post operatively at the interval of 2, 4, 6, 8, 10, 14, 24 hours. Results: The basic vital. parameters were comparable in both groups and were well within normal range per and post operatively. Hanallah’s paediatric objective pain score [6]at the interval of 2, 4, 6, 8, 10, 14, 24 hours post operatively showed that the average pain relief in infraorbital nerve block group was around 23.12±2.21 hours as compared to 16.33±1.73 hours in the peri inscisional group. The use of rescue analgesia was also earlier in the peri inscisional group. Conclusion: Both techniques are effective in providing good pre emptive and post operative analgesia but bilateral infra orbital nerve block provides a better relief for longer duration avoiding the use of early rescue analgesia.
 

Definition of chronic pain is “pain that extends beyond the expected period of healing”. Chronic pain affects the psyche of an individual apart from the physical agony that it gives [1]. The objective of this study was to evaluate the somatic and psychological aspects of chronic pain of cancer and non cancer pain using Visual Analogue Scale (VAS) [2] and General Health Questionnaire (GHQ-28) [3] and treating the psychological aspect when GHQ-28 was more than 9 with an anti depressant (imipramine) along with neurolytic blocks and analgesics (morphine for cancer patients and Pregablin for non cancer pain) A prospective study comprising of thirty patients of cancer pain (Group – C) (head and neck malignancy) and thirty patients of non cancer pain (Group N)(Trigeminal Neuralgia) of either sex between 21-90 years of age were selected. After detailed history, physical examination and proper pain mapping patients were evaluated for physical component with VAS and psychological component with GHQ-28. They were subjected to neurolytic block as per presentation and then given either morphine 30 mg b.i.d. (group C) or Tab Pregablin 75 mg b.i.d. and were followed on  3,7 and 10th day of block with VAS and GHQ-28. Tab. Imipramine 150 mg o.d. was added if GHQ-28 was found to be more than 9 on first follow up visit. There was improvement in VAS in both the groups on 2nd 3rd and 4th follow up visit. Group C showing VAS improvement of 33.61±21.9, 50.53 ±2 5.32 and 67.05 ± 23.91 while Group N showed 27.34 ± 20.86, 73.53 ± 6.58 and 89.77±25.3 respectively and these changes were statistically significant (p<0.01). The percentage improvement in GHQ-28 at subsequent sittings was 16.87±12.77, 30.87±12.88 and 41.47±14.27 for Group C (p<0.01) while in Group N it was 2.05±7.33 at all subsequent sittings (p>0.05) (absence of psychological component) VAS being a sensitive tool for assessing the improvement in pain relief and GHQ-28 helpful in detecting diagnosable changes in mental health with sensitivity of 77% and specificity of 67% in depressive disorders in patients with chronic pain are both quite helpful in assessing the severity of chronic pain and thereby helping us to guide for further action in guided management of chronic pain

Background: Postoperative nausea and vomiting (PONV) is considered most unpleasant experience by the patients in postoperative period. In particular, following laparoscopic procedures the incidence of PONV is very high. The present study is aimed to assess the magnitude of PONV after laparoscopic cholecystectomy and to compare the relative effectiveness of two drug Ondansetr Dexamethasone Subjects and Methods: Ninety adult patient of either sex in the age group of 20 to 50 years of ASA I or II were randomly divided into one of the two groups of forty-five each. Group A patients received 4 mg of ondansetron intravenously towards end of surgery. Group B patients received 8 mg of Dexamethasone injection at the time of induction of anaesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting and need for rescue antiemetic at intervals of 0–1, 1-2, 2-4, 4-8, 8-12, 12-24 hours. Results: The incidence of PONV up to 4 hours after surgery was 6 and 9 in Group A and Group B respectively (p>0.05). Thereafter during 4 to 12 hours after surgery, the incidence of PONV was 12 and 4 respectively in Group A and Group B (p<0.05). About 38% female patients had PONV compared  to 20% male patient in-group A. Also 27% female patients had PONV compared to 18% male patient in-group B. Conclusion: Prophylactic Ondansetron in a dose of 4 mg given near the end of surgery and prophylactic Dexamethasone in a dose of 8 mg given at the time of induction is highly effective in reducing the incidence of PONV for 4 hours and 8 hours respectively after surgery. Compared to male population female sex seems to be an independ nt risk factor for PONV.
 

AIM: Clinical evaluation of efficacy of adding Dexmedetomidine and Fentanyl to Ropivacaine in lower abdominal and lower limb surgeries . Method: This was a randomized double blind study of postoperative epidural analgesia was done in 100 patients divided into 50 patients each, Group-A Patients received 15ml of 0.2% Ropivacaine + 1mcg/kg of Dexmedetomidine and Group-B Patients received 15ml of 0.2% of Ropivacaine + 1mcg/kg of Fentanyl and onset, duration of analgesia, sedation score, visual analogu scale(VAS) were assessed. Results: The onset of analgesia in Group A was 8.21min and in Group B it was 10.23 min, which is statistically significant (P<0.05). Duration of analgesia in Group A was 336 min when compared to Group B which was 260min (p<0.05). No. of Patients with Sedation score of grade 2 and 3 are more in Group-A than in Group-B. There was a significant difference of VAS score between the two groups at 15 minutes, 30mins, 45mins, 60mins, 120 min, 180 min, 240 min and 330mins post operatively (p value < 0.05) that the A group had lower VAS score then B group. Conclusion: Dexmedeto-midine as an adjuvant to Ropivacaine in epidural analgesia seems to be  a better alternatiec to Fentanyl, as it provides comparable stable hemodynamics, early onset of analgesia, prolonged post-op analgesia, and much better sedation levels.

Background: Endotracheal intubation using an induction agent is usually facilitated by the use of depolarizing neuromuscular blocking agents like succinylcholine however it may be associated with various side effects. Propofol and sevoflurane can be used for endotracheal intubation as both provides adequate intubating conditions but propofol is associated with several adverse effects when used alone. So this study was aimed to compare  the intubating conditions, haemodynamic changes and side effects using combination of low dose of propofol and lower concentration of sevoflurane with propofol alone at its usual dose. Material and Methods: The present study was conducted on sixty patients of ASA grade I or II , aged 20-40 years of either sex scheduled for various elective surgeries under general anaesthesia. The patients were randomly allocated into two groups of 30 each: Patients in Group P were induced with 67% N 2O in O2 and propofol 3 mg/ kg given intravenously over 30 seconds while patients in Group PS were induced with sevoflurane 0.5-4% inhaled concentration with 67% N 2O in O2 and propofol 1.5mg/kg given intravenously over 15 seconds. Endotracheal intubation was attempted at 4 minutes after the start of induction in both the groups.The intubating conditions, hemodynamic parameters (HR,SBP, DBP, MAP) and any side effects were observed and noted. Results: Intubating conditions were found to be significantly better in Group PS, (P<0.001). Intubating conditions were clinically accepted in 90% of patients in group PS compared to 73.3% in group P, which was highly significant, (P = 0.028). In Group P, HR, SBP, DBP and MAP were reduced significantly from their baseline values, (P<0.05). No significant difference in side-effects was noted between two groups, (P>0.05). Conclusion: The combination of sevoflurane and propofol seems to be a better alternative to propofol alone for endotracheal intubation in terms of better intubating conditions with minimal haemodynamic changes and side effects. 

Postoperative nausea & vomiting (PONV) is one of the most common and distressing complication during postoperative period increasing morbidity and cost of medical care. This study was conducted to compare the efficacy of Ondansetron with that of Ondansetron and Dexamethasone combination in PONV prophylaxis. Methodology: This prospective randomized controlled study was conducted at our institution over a period of one year where 80 patients belonging to ASA 1 & 2 who were posted for elective middle ear surgery were included. Pts were randomly divided into two groups group 1 & group 2 having 40 pts in each. Group 1 pts received Ondansetron 4 mg at the end of surgery and group 2 pts received Dexamethasone 8 mg at induction of anaesthesia and Ondansetron 4mg at the end of surgery for PONV prophylaxis. Number of epiosodes of nausea, vomiting and doses of rescue antiemetics used were recorded during 0 - 6hrs, 6- 12 hrs & 12 – 24 hrsduring the postoperative period. Results: The no. of pt who had nausea & vomiting were more in group 1 compared to group 2, but the result was not statistically significant. But no. of pts who required rescue  antiemetic in group 1 was significantly higher than that of group 2. Conclusion: So for effective PONV prophylaxis combination of Ondansetron and Dexamethasone is superior to Ondansetron alone.

Aim: Present study was carried out to compare the efficacy of trapezius squeeze test and jaw thrust as clinical tests to indicate an adequate depth of anaesthesia for insertion of the Proseal laryngeal mask airway after induction of anaesthesia with sevoflurane in children. Method: Eighty eight paediatric patients between age group 2 to 8 years of either genders weighing between 10 to 20 kg with ASA grade I & II were selected who were undergone for planned lower abdominal surgery. This study was a single blind prospective type in hospital settings, carried out during May 2014 to April 2016. Results: Trapezius squeeze test and Jaw thrust, both are effective as an indicator to assess the depth of anesthesia for PLMA insertion in children under sevoflurane anaesthesia. Trapezius squeeze test provides excellent conditions and higher success rate for PLMA insertion in spontaneously breathing children without any untoward effects.

Background: Endotracheal intubation using an induction agent is usually facilitated by the use of depolarizingBackground: Endotracheal intubation using an induction agent is usually facilitated by the use of depolarizing neuromuscular blocking agents like succinylcholine however it may be associated with various side effects. Propofol and sevoflurane can be used for endotracheal intubation as both provides adequate intubating conditions but propofol is associated with several adverse effects when used alone. So this study was aimed to compare the intubating conditions, haemodynamic changes and side effects using combination of low dose of propofol and lower concentration of sevoflurane with propofol alone at its usual dose. Material and Methods: The present study was conducted on sixty patients of ASA grade I or II , aged 20-40 years of either sex scheduled for various elective surgeries under general anaesthesia. The patients were randomly allocated into two groups of 30 each: Patients in Group P were induced with 67% N 2O in O2 and propofol 3 mg/ kg given intravenously over 30 seconds while patients in Group PS were induced with sevoflurane 0.5-4% inhaled concentration with 67% N2O in O2 and propofol 1.5mg/kg given intravenously over 15 neuromuscular blocking agents like succinylcholine however it may be associated with various side effects. Propofol and sevoflurane can be used for endotracheal intubation as both provides adequate intubating conditions but propofol is associated with several adverse effects when used alone. So this study was aimed to compare the intubating conditions, haemodynamic changes and side effects using combination of low dose of propofol and lower concentration of sevoflurane with propofol alone at its usual dose.Material and Methods: The present study was conducted on sixty patients of ASA grade I or II , aged 20-40 years of either sex scheduled for various elective surgeries under general anaesthesia. The patients were randomly allocated into two groups of 30 each: Patients in Group P were induced with 67% N2O in O2 and propofol 3 mg/kg given intravenously over 30seconds while patients in Group PS were induced with sevoflurane 0.5-4% inhaled concentration with 67% N2O in O2 and propofol 1.5mg/kg given intravenously over 15 seconds. Endotracheal intubation was attempted at 4 minutes after the start of induction in both the groups.The intubating conditions, hemodynamic parameters (HR,SBP, DBP, MAP) and any side effects were observed and noted.Results: Intubating conditions were found to be significantly better in Group PS, (P<0.001). Intubating conditions were clinically accepted in 90% of patients in group PS compared to 73.3% in group P, which was highly significant, (P = 0.028). In Group P, HR, SBP, DBP and MAP were reduced significantly from their baselinevalues, (P<0.05). No significant difference in side-effects wasnoted between two groups,(P>0.05).Conclusion: The combination of sevoflurane and propofol seems to be a better alternative to propofol alone for endotracheal intubation in terms of better intubating conditions with minimal haemodynamic changes and side effects.

 Fracture of tracheostomy tube is a rare complication. We are reporting a unique case of a broken tracheostomy tube in a patient who had recently undergone tracheostomy and was being gradually weaned in the Intensive Care Unit (ICU). The detached portion of tracheostomy tube was lodged within the trachea and was timely retrieved by the anesthetist. There is limited literature on such occurrences. Nearly all reports highlight this complication in chronic users with metallic tubes. Prompt bedside diagnosis and effective instantaneous management circumvented a more grave and fatal complication of serious respiratory compromise by further migration of the severed tracheostomy tube into bronchus.

 Kyphoscoliosis is associated with physical and functional problems which are challenging both to the anaesthesiologist and obstetrician. We present a parturient at 34 weeks of gestation having severe kyphoscoliosis and chronic hypertension with fetus in transverse lie. She underwent classical Caesarean section under combined spinal and epidural anaesthesia. Perioperative period was uneventful, but the neonate had multiple congenital anomalies.

 Background and Aim: MIPH (Minimal invasive procedure for prolapsed piles) is preferred over conventional hemorrhoidectomy and performed at day stay unit. Conventional hemorrhoidectomy patients are usually admitted and operated under saddle anaesthesia. Choice of anaesthesia for MIPH at day care unit needs to consider more safe technique which helps early recovery and discharge with minimum complications. Present study was performed with an aim to compare saddle anaesthesia and general anaesthesia utilizing i­gel in patients with minimal invasive procedure for hemorrhoids. Material and Method: A total of 60 patients of ASA Grade 1 & 2, between age of 18 and 60yrs undergoing MIPH as day stay surgery were randomly allocated by a computer generated list in to two groups. Group­S received saddle anaesthesia and GroupG received general anaesthesia with i­gel. Patients were observed for per operative events and post operative pain, nausea, vomiting, urinary retention and postural hypotension. Any adverse events were recorded. Time and Number of patients that could be successfully discharged in both the group were recorded. Results: Group­S had less pain and needed less analgesic as compared to Group­G in immediate post operative period and had less nausea and vomiting but urinary retention and postural hypotension was more common in them which delayed their discharge and needed unplanned admission. Conclusion: Aim of surgery to treat patient at day stay unit could be achieved more by selecting general anaesthesia over saddle anaesthesia with less chances of urinary retention. Saddle anaesthesia is associated with increased risk of unplanned admission after hemorrhoidal day surgery.

 Background: General anesthesia predisposes a patient to regurgitation and aspiration of gastric substances into otherwise healthy lungs leading to fatal acid aspiration syndrome. Historically, this syndrome most commonly described as aspiration pneumonitis or Mendelson’s syndrome, was reported in 1946 in patients who aspirated while receiving general anesthesia during obstetrical procedure. Every practicing anesthesiologist thus has a key concern to this preventable devastating clinical condition which causes progressive lung damage due to the acidic solution. Objective: To assess the effect of single intravenous dose of esomeprazole sodium 40 mg and pantoprazole 40 mg administered a night before elective surgery and anesthesia in reducing intragastric pH and volume of gastric juice. Methods: This is a prospective, controlled, randomized, single blinded study conducted in 60 patients of American Society of Anesthesiologists grade I and II posted for elective surgery under general anesthesia. The patients enrolled in the study were randomly assigned to two groups having 30 patients in each. Group P received ivy pantoprazole 40 mg; Group E received iv esomeprazole 40 mg a night previous to surgery. The observer was totally blind about the groups or drugs given to the patients. On the day of surgery, after induction of anesthesia gastric juice was obtained via nasogastric tube and was checkedfor pH using pHmeter. Results: Mean pH of group P was 5.15± 0.68 which is significantly lower than group E, who received ivy esomeprazole sodium with mean pH of 6.6±0.67, (P<0.001), as shown by twotailed independent T test. Among the group P the mean gastric aspirate volume was 9.56±2.52 ml, and in group E mean gastric aspirate volume was 5.66±2.36 ml, which was statistically lower in group E as compared to group P. Conclusions: From the observations and analysis of the present study, it can be inferred that esomeprazole sodium 40 mg i.v is more effective than pantoprazole 40 mg iv to raise the gastric pH for prevention of aspiration pneumonitis.

 Present study was carried out in randomly choosen 150 patients of ASA grade­I and grade­II having neither respiratory nor cardiovascular diseases, no obecity.Study included children, adult as well as middle age group posted for various surgical operations under general anaesthesia.The aim of study was to detect early up to one hour postoperative hypoxemia by continuous monitoring of oxygen saturation by pulse oximetry and role of oxygen therapy to treat the hypoxemia. In our study base line hypoxemia was taken at SaO2 92%.All patients were premedicated with i.v atropine/ glycopyrollate, i.v diazepam, i.v fortwin and was induced with i.v thiopentone sodium or ketamine hydrochloride and endotracheal intubation was done under effect of suxamethonium and anaesthesia was maintained on oxygen + nitrous oxide + i.v norcuron+intermittent halothane for few patients with controlled ventilation.At the end of surgery all patients were extubated after reversal with i.v neostigmine and i.v atropine/i.v glycopyrollate and observed on operation table for first 15. min without supplementation of oxygen to detect the incidence of early postoperative hypoxemia. In first 15 min . Out of 150 patients 53(35.33%) patients became hypoxemic and were treated with supplementation of 4lit/min 100% oxygen through face mask for 15 min.on operation table, then shifted in recovery room which was very near to operation theatre. All patients those who received oxygen as well as not received were observed in recovery room up to one hour. Out of 53 patients only 3 patients became hypoxemic in second episode in between 16 to 30 min.and were treated as above then not a single patient became hypoxemic.

 Introduction: Direct laryngoscopy and endotracheal intubation is an integral part of many fields of medical care including anaesthesia, intensive care and emergency medicine. Aim: The aim of the study was to assess the relative efficacy of traditional didactic method of teaching and videolaryngoscopy­assisted feedback as instructional methods for endotracheal intubation. Materials and Methods: This was a prospective randomised study done in Kasturba Medical College, Manipal, over a period of 2 years. Sixty medical doctors doing a 15­day posting in the Department of Anaesthesiology as a part of their Compulsory Rotating Internship training were included in the study. They were divided into two groups of 30 each and received training for laryngoscopy and endotracheal intubation bydidactic method (DID) and by videolaryngoscopic method (VLS). Patients aged 18 to 60 years of either gender, belonging to American Society of Anesthesiologists Physical Status (ASA­PS) I and II, scheduled for elective surgery under general anaesthesia requiring oral endotracheal intubation were enrolled for the study. Results: The mean overall success rate in the DID group was 77.33+20.83% while it was 93.33+12.12% in the VLS group. The difference was statistically highly significant (p = 0.001). There was statistically significant difference in the first intubation success rate among DID and VLS groups 60% vs 83.3% (p = 0.042). Duration of laryngoscopy, intubation and total time, laryngopharyngeal morbidity, best laryngoscopic view obtained, ease of laryngoscopy and intubation were also compared. Conclusion: Teaching of endotracheal intubation to novice medical doctors using videolaryngoscopic feedback results in higher overall success rate, including first intubation success rate, when compared with conventional didactic method of teaching. The teaching technique used does not influence the time taken for intubation nor does it alter the degree of laryngopharyngeal morbidity.

 Background: LMA is a device commonly used in the practice of anaesthesia . Insertion of LMA however needs obtundation of upper airway reflexes and relaxation. Aim: Conditions for insertion of LMA, haemodynamic stability and respiratory depression following induction with Propofol was compared with Thiopentone preceded by topical Lignocaine spray. Methodology: Sixty ASA I and II patients undergoing short elective surgical procedures like breast surgeries, minor plastic surgeries, short surgical procedures of upper limb and hernia repair, in patients aged between 16­60yrs, were included in the study. They were randomly allocated into two groups of thirty each. The presence of coughing, gagging, laryngospasm, head movements, limb movements and Jaw relaxation during LMA insertion were noted. Number of attempts for insertion and postoperative sore throat were also assessed. Haemodynamic parameters and respiratory depression (presence or absence of apnea) were also observed. Results: Adequate jaw relaxation was significantly better in Propofol group than Thiopentone with topical lignocaine group (100% versus 70%). Incidence of apnea, fall in BP and tachycardia was significantly more with Propofol than Thiopentone with topical lignocaine group (p<0.05). Conclusion: Thiopentone preceded by topical lignocaine spray could be considered for induction prior to LMA insertion, in view of significant haemodynamic fluctuations and respiratory depression caused by Propofol.

 Context: Succinylcholine has extremely rapid onset of action and its shorter duration of action make it the ideal muscle relaxant for rapid sequence intubation. Because of these adverse effects and risks associated with succinylcholine, extensive laboratory research has been undertaken to synthesize a nondepolarising neuromuscular blocking agent. Rocuronium a structural analogue of vecuronium was recently synthesized and has been demonstrated to have fastest onset of action compared to any nondepolarizing neuromuscular blocking agent. Aims: To compare the two muscle relaxants i.e., succinylcholine and rocuronium on tracheal intubating conditions. Settings and Design: This study was a double blinded, randomized, controlled trial, carried out at tertiary care centre in India between March 2014 and June 2016. The sample size for this study was calculated to be 45 in each group. Methods and Material: All patients included in the study were premedicated with inj.glycopyrolate 0.2mg intramuscularly ½ hr before surgery. General anaesthesia was induced with propofol 2mg/kg and fentanyl 2mg/kg intravenously. All Group A patients received succinylcholine (2mg/kg) and all patients of group B received rocuronium (1.2 mg/kg). After giving the muscle relaxant, patient was ventilated with oxygen, nitrous oxide, and isoflurane for 90 seconds. The intubating condition is evaluated and scored according to the four step scale proposed by Goldberg and colleagues. Statistical Analysis Used: Analysed using Microsoft Excel 2010 and SPSS (Version 19) software. All data on categorical variables were presented as frequencies and percentages. Chi square test was used to compare the frequencies and percentages. All the statistical analysis were carried out at 5% level of significance and p value <0.05 was considered significant. Chi square test was used to compare the frequencies and percentages. Results:There were no statistically significant changes in heart rate, systolic and diastolic between the succinylcholine group (A) and rocuronium group (B) at various time intervals. In succinylcholine group (A) 95.5% had excellent intubating conditions at 90 seconds. In rocuronium group (B) 93.3% of patients had excellent intubating conditions at 90 seconds. All the patients of rocuranium group could be intubated at 90 seconds. Conclusion: Rocuronium does not produce significant haemodynamic changes.Higher dose (1.2 mg) of Rocuronium would be suitable for rapid intubation conditions.

 Background: Neuraxial anaesthesia is the preferred anaesthesia technique for delivery by caesarean section. Despite controversies, there is evidence that supports the use of spinal anaesthesia in severe preeclampisa group. Present evidence suggests that gestational hypertension and preeclamsia are distinct entities, however very few attempts are made to study the hemodynamic changes and vasopressor requirement in mild gestational hypertension parturients following spinal anaesthesia for caesarean delivery. The aim of the present study was to compare heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, Mephenteramine requirement and neonatal outcome between normotensive and mild gestational hypertension parturients undergoing caesarean delivery under spinal anaesthesia. Materials and Methods: A total of 60 parturients not in labour, scheduled for elective caesarean section, meeting inclusion criteria, were included in the study, 30 were in normotensive group and 30 were in mild gestational hypertension group, with blood pressure <160/ 110mm hg. Spinal anaesthesia was administered using 2.2ml of 0.5% hyperbaric Bupivacaine (Heavy). Baseline hemodynamic parameters were recorded before spinal anesthesia and then at every 2 minute interval after spinal block for the first 30 minutes and thereafter every 5 minutes until completion of surgery. Hypotension was defined as, more than 30% of decline in mean arterial pressure compared to baseline in both groups (or systolic blood pressure <100 mmHg in healthy parturients) and was treated with injection Mephenteramine, 5mg bolus intravenously, Apgar score was noted at 1 and 5 minutes after birth. Results: The minimum systolic blood pressure, mean arterial pressure and heartrate recorded were lower in normotensives but the difference between the two groups was not statistically significant. The average Mephenteramine requirement in normotensive group (8.5 mg) was slightly more than in mild gestational hypertension (8.25mg) group. Apgar scores at 1 and 5 minutes after birth were comparable in both the groups. Conclusion: Hemodynamic response and vasopressor requirement following spinal anesthesia in mild gestational hypertension group was similar to normotensive group with comparable Apgar scores. 

 Introduction: The supraclavicular brachial plexus is one among the most popular regional nerve blocks performed. The easy and predictable landmarks make it a popular approach. The advantages are –It provides long lasting post operative analgesia, there by reducing the systemic analgesic requirement; it aids in early ambulation, overcoming the disadvantages of general anaesthesia. Methodology: 60 patients undergoing upper limb surgery lasting more than thirty minute were included in the study. The elective surgical interventions were internal fixation of bones with plates and screws, excision of bone cysts, reconstructive and other surgeries involving upper limb Results: Onset of sensory blockade (time between injection and total abolition of pinprick response) was 20.47+/­3.64 min in group A and 19.49+/­4.90 min in group B. However there was no significant change in time of onset (p=0.373). Duration of sensory blockade (the time between injection and complete recovery from sensory disturbance) was comparable in both groups (group A 385.67+/­66.67 min, group B 380.50+/­80.15 min) without any statistical significance (p=0.787). Conclusion: There was no statistical significance in terms of onset, durations of surgery, sensory blockade and motor blockade between the two groups However the average duration of analgesia were 14.13+/­8.41 hrs and 22.18.+/­12.13 hrs in groups A and B respectively, showed statistical significance.

 Background: Propofol has been the widely used sedative agent for colonoscopy.However, in elderly population, propofol causes an exaggerated cardiorespiratory depression. Etomidate causes sedation with minimal effect on cardiovascular and respiratory system. Objective: The primary objective was to compare the hemodynamic, respiratory and recovery profiles of Etomidate versus Propofol for sedation in colonoscopy. Secondary objective was to evaluate the effect on pain post colonoscopy with these drugs. Materials and Methods: Sixty patients aged 60 years and above, for colonoscopy were randomly divided into two groups.All patients received fentanyl 1mcg/kg. Group E received etomidate 0.1mg/kg over one minute, followed by 5­10 mcg/ kg/minute. Group P received propofol 0.5mg/kg over one minute, followed by 0.05mg/ kg/minute. Colonoscope was inserted when Ramsay sedation score was 4. The time required for induction, vitals every 5 minutes, and the time for modified aldrette score to reach 9 were noted. Visual analog pain score was assessed in all patients. Results: During the procedure the fall in heart rate, mean arterial pressure was significantly more in group P than in group E (p <0.001). The fall in oxygen saturation was greater in group P but was not significant. The time taken to induce the patients was the same in the two groups.The recovery time was significantly longer in group E(p<0.001). There was no difference in the visual analog score of pain. Bradycardia, hypotension and hypoxia were encountered in group P. Conclusion: Etomidate fentanyl sedation is safer than propofol fentanyl combination in elderly patients undergoing colonoscopy.

 Pain of any kind is distressing to the life style of human being and relief of pain becomes mandatory all the time. Intraoperative as well as postoperative pain is of concern as it results in morbidity and mortality. Postoperative pain relief is beneficial in al aspects and hence efforts have been going on to introduce new techniques or newer drugs to relieve pain. Intrathecal use of adjuvant with conventional local anaesthetic agents has proved to be beneficial in this regard. Clonidine is an imidazoline derivative with 2 adrenergic agonist activity has analgesic effect at spinal level mediated by post­synoptically situated 2 adreno­receptors in dorsal horn of spinal cord. It has intrinsic analgesic effect to control postoperative pain with potentiating quality of subarachnoid block. 100 patients of either sex were divided into 2 equal groups. In group A 0.5% Bupivacaine 3cc with normal saline was administered and in group B 0.5% Bupivacaine 3 cc with 30 µgm of Clonidine with normal saline was administered intrathecally. It was observed that, in Clonidine group, the onset of sensory block, highest dermatome level, onset of motor block, duration of sensory block, duration of motor block, time for 2 segment regression of sensory block, total duration of surgical anaesthesia, quality of sensory and motor block sedation score, requirement of analgesic supplementation was superior in Clonidine group as compare to control group. The haemodynamic parameters as mean changes in pulse rate and systolic blood pressure and incidence of intraoperative and postoperative complications was negligible in both groups. Thus it was concluded that, intrathecal Clonidine is efficient adjuvant along with 0.5% Bupivacaine intrathecally as it improves the quality of sensory block and provides satisfactory prolonged postoperative analgesia with haemodynamic stability and minimum side effects. It is recommended to use Clonidine along with local anaesthetic intrathecally for lower abdominal surgeries requiring postoperative pain relief.

 Background: Brachial plexus blockade for upper limb surgeries is the most common major peripheral nerve block technique and a significant difference exists between the onset times of various agents when these blocks are used. Adjuvants are added to improve the quality of anaesthesia and the duration of post­operative analgesia. The study was aimed to compare the addition of potassium chloride to bupivacaine in supraclavicular brachial plexus block and to assesss the onset of blockade – sensory and motor blockade, duration and quality of sensory and motor blockade. Methods: Sixty patients of age group between 18 and 60 years with ASA grade I and II, were selected for the study . Each patient was randomly assigned to one of the two groups of 30 patients each, group I or group II. Group – I was bupivacaine who received 30 ml of 0.375% bupivacaine. (control group) and group – II received 30 ml of 0.375% bupivaccine with 0.2 mmol of potassium chloride (prepared by adding 0.1ml of potassium chloride and 10 ml of normal saline to 20ml of 0.5% bupivaccine). (Study group). Both group were compared with respect to onset, duration and quality of sensory and motor blockade. Results: The onset of sensory and motor blockade was early in study/potassium group when compared to plain bupivacaine group. The duration of blockade was prolonged in study/potassium group when compared to other group. However, the quality of sensory blockade was better in potassium group when compared to other group. But the quality of motor blockade was similar that of plain bupivacaine group. Conclusion: Addition of potassium to bupivacaine when compared to plain bupivacaine is beneficial in supraclavicular brachial plexus blockade .

Background: A difficult airway is not only a problem during intubation but also equally a problem post­operatively in controlling the airway and if reintubation is required. A limited research study reports are available on this subject. Aim: This present study was aimed to evaluate peri­operative airway problems (ventilation and intubation, post­operative extubation and reintubation) in elective and emergency surgical cases with the difficult airway. Materials and Methods: This prospective study was conducted in teaching institute on 145 anticipated and unanticipated difficult intubation cases from January 2016 to December 2016. Both emergency and elective cases were included. The demographic data, problems of difficult ventilation, difficult intubation as well as post– operative ventilation and reintubation data were collected. The data compared, the outcomes and results between these two groups were analyzed by Microsoft excel­SSSA by ANOVA and student t­test. Results: There is no statistical difference demographic data. In difficult airway cases frequency of Ventilation and intubation problems were more in emergency cases. Ventilation problems in elective/ emergency problems were 13.79%/ 18.62% and intubation problems in elective/emergency were 23.45%/30.34% respectively. Extubation problems also occurred more in emergency cases (elective/ emergency was 5.52%+8.28%)/(8.97% +11.02% respectively). Reintubation problems were more in emergency cases (2.76%) as compared to elective cases (2.07%). Conclusion: Intubation and Extubation of the difficult airway is more problematic. Adequate preparation planning and perform the action. Only awake extubation has to be done in these patients. High­risk patients should be identified early and after following safety guidelines, the difficult airway problems should be tackled.

 Introduction: Endotracheal intubation is an integral part of administration of anaesthesia during surgical procedures. Administration of muscle relaxants facilitates endotracheal intubation. Various drugs and techniques have been used to facilitate rapid endotracheal intubation during emergency surgical procedures and in critically ill patients.Rocuronium and Suxamethonium are two such drugs. Aim of Study: To compare the intubating conditions of Rocuronium with Suxamethonium at 60 seconds in emergency surgeries following rapid sequence intubation. Materials and Methods: This was a prospective comparative study carried out at DurgabaiDeshmukh Hospital and Research Centre, Hyderabad, over a period of 10 months, from September 2011 to June 2012. The subjects were 80 adult patients divided into two groups of 40 each. Group R received Rocuronium and Group S received Suxamethonium. The subjects were studied forscoring response to intubation, jaw relaxation, vocal cord position and hemodynamic responses and adverse effects to the drugs. Results: Rocuronium at a dose of 0.6mg/kg produced acceptable intubating conditions as that of Suxamethonium 1.5mg/kg. There was no statistical significance between the groups in jaw relaxation response to intubation and in grading of intubating conditions. Mean arterial pressure and heart rate were slightly higher in group R compared to that of group S statistically not significant. Group R had a few adverse effects which were insignificant. Conclusion: Both Rocuronium and Suxamethonium produced good intubating conditions for rapid sequence intubation. Rocuronium (0.6 mg/kg) has acomparable hemodynamic profile to Suxamethonium. Rocuroniumis safe and has less adverse effects. It can be used as a safe alternative to Suxamethonium, when the latter is contraindicated.

Keywords: Rocuronium; Suxamethonium; Rapid Sequence Intubation; Hemodynamics.

 Aim : To compare the efficacy of classical subarachnoid block using 0.5% bupivacaine (3.5 ml) and unilateral spinal anaesthesia using 0.5% bupivacaine (2ml) in patients undergoing unilateral lower limb surgeries. Materials and Methods: The present prospective study was done for a period of 2 years. 60 cases undergoing unilateral lower limb surgeries were chosen. They were divided into two group 30 patients of control group received 3.5 of 0.5% bupivacaine and turned to supine position immediately. 30 patients of Study group­ received 2ml of 0.5% bupivacaine and kept in lateral decubitus position for 15 minutes and then turned supine. Pre operatively, heart rate, Systolic and diastolic blood pressure were checked and were recorded. Intraoperatively hemodynamic parameters, onset and duration of sensory and motor blockade were recorded every 1 minute until 10 minutes thereafter every five minutes for 30 minutes and thereafter every 15 minutes until 60. Results: The demographic data reveals that both the groups are comparable in age, sex and height ratios. The baseline SBP, DBP, HR were recorded every 1 minute until 10 minutes every 5 minutes until 30 minutes and thereafter every 15 minutes until 60 minutes. Heart rate variation was statistically significant at 7 minutes, 8 minutes, 9 and 10 minutes, with more fall in heart rate in control group than in study group. The SBP was 129.7 +/­ 6.48 at the time of giving spinal anaesthesia showed a gradual fall until 20 minutes and gradually increased to baseline at 60 minutes. P­values are statistically significant at 5 minutes 6 minutes 7 minutes 8 minutes 9 minutes 10 minutes 15 minutes 20 minutes with more fall in blood pressure in control group compared to study group. The fall in diastolic blood pressure observed in control group is statistically significant at 6,7,8,10,15,20,25,30,45,60 minutes. Analysis of motor blockade in the 2 group shows that unilateral spinal block induced lesser degree of motor blockade to the classical subarachnoid block group. This difference was found to be statistically significant. There was no statistically difference in the level of sensory blockade between the groups. There was no statistically difference in the onset time and duration of sensory blockade between the groups. There was statistical difference in duration of motor blockade with longer blockade in both groups. Conclusion: Unilateral low does subarachnoid block offers better hemodynamic stability in the intra­operative period.

 Introduction: To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in infra­umblical surgeries. Aims and Objectives: To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs­epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine. Material and Methods: A prospective, randomized controlled, doubleblinded study was undertaken in 60 patients scheduled for infra­umblical surgeries. Group I received epidural butorphanol 2 mg + bupivacaine 0.125% as first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group II received epidural tramadol 2 mg/kg + bupivacaine 0.125% as first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post­operative period. Time for request of rescue analgesia was noted in all the patients. Results: Visual analog scale better with butorphanol group than tramadol at 30 min after first dose. Onset of action faster with butorphanol but duration of analgesia longer with tramadol. Sedation was seen more commonly in patients with butorphanol group where as incidence of nausea and vomiting was hign in tramadol group. Conclusion: Epidural butorphanol has better quality of post­operative pain relief but the reduced duration of analgesia and sedation are the limiting factors. Epidural tramadol along with antiemetic administration is prefered for bariatric, geriatric patients, ambulatory surgeries and in patients with compromised respiratory system where sedation can be disastrous.

 Introduction: The onset time of neuromuscular blockade can be influenced by factors such as hypnotics which interfere with muscle blood flow and muscle relaxation induced by nondepolarizing neuromuscular blockers. Aim: This study was designed to test whether etomidate, with its favourable haemodynamic characteristics, is associated with a shorter onset time of neuromuscular block or propofol with its action on the neuromuscular junction is associated with faster onset of neuromuscular block. Settings and Design: A prospective randomised comparative study. Methods and Material: 60 patients scheduled for elective surgery were randomly allocated into 2 groups to receive 0.4mg/kg of etomidate or 2mg/kg of propofol, vecuronium 0.1 mg/ kg was administered and ulnar nerve was stimulated supramaximally and train of four responses was recorded with kinemyography. Time to 100% neuromuscular block, NIBP and HR were measured. Results: The onset time was faster in etomidate group compared to propofol but it was not statistically significant. There was a negative correlation between onset time and the maximum percent change in mean arterial pressure. Conclusions: Propofol and etomidate had a similar behaviour regarding time for vecuronium­induced neuromuscular block. The onset time of the vecuronium induced neuromuscular block depends not only on the circulatory factors but also on the noncirculatory factors too.

 Background: This study was conducted to compare efficiency of plain lidocaine with combination of adjuvant tramadol with lidocaine in intravenous regional anesthesia in terms of onset and duration of sensory and motar blockade. Methods: Sixty patients were divided in to 2 groups; the first group received 0.5% of 40 ml of plain lidocaine and the second group received 0.5% of lidocaine with tramadol 100 mg 40 ml. Preoperative and intraoperative hemodynamic parameters were monitored and recorded at 1,5,10,20,30,40 minutes after anesthesia. Results: The onset time of sensorial block was shorter and duration of sensorial block was longer in group 2 than group 1. The onset of motor blockade and duration of motor blockade was longer in group 2 than group 1. There was no comparatively significant differences in hemodynamic vital parameters in both groups. Conclusions: IVRA with addition of adjuvant tramadol ligocaine is effective and safer than the 0.5% ligocaine.

 Background and Aim: Post operative pain relief is an essential part of responsibility for an anaesthesiologist. Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia. The present study compared the efficacy and safety profile of epidurally administered butorphenol and fentanyl. Methods: In this double blinded study, 60 patients undergoing lower abdominal and lower limb surgery were randomly divided into two groups by computer generated random number. In all patients, epidural space is located at L2­ L3 space using 18G Tuohy needle with loss of resistance technique.20G catheter passed through needle till about 2­3cm of catheter was in space. Test dose was injected. After 5 min, induction was done with spinal anaesthesia with inj. Bupivacaine heavy 0.5% 3cc at same lumber space in sitting position. Group A patients received epidural Butorphenol 1mg diluted in 10ml Ns as first dose post op when VAS>5 and top up dose 0.5 mg diluted in 10ml NS when VAS>5. Group B patients received epidural fentanyl 100microgram diluted in 10ml NS as first dose post op when VAS>5 and top up dose fentanyl 50microgram diluted in 10ml NS when VAS>5.Vital parameter, onset, duration, quality of analgesia, side effects, VAS score, sedation score were observed. The data was collected and tabulation formed and statistical analysis of continuous data was done by unpaired student “t” test and chi­square test was applied for discrete data. Results were considered statistically significant with p value <0.05 and highly significant with p value <0.001. Results: Demographic profiles of patients were comparable in both the groups. Onset of analgesia was earlier in fentanyl group than butorphenol group. Butorphenol provides longer duration of analgesia compared to fentanyl group. Quality of analgesia was better with butorphanol than fentanyl. Conclusion: Butorphanol and fentanyl both drugs are safe to provide analgesia via epidural route in post operative period without significant side effects. Fentanyl is having earlier onset with short duration of analgesia while butorphanol provide analgesia for longer duration with delayed onset.

 Backgruond: Dexamethasone as an adjuvant in brachial plexus block has been reported to prolong the duration of action of local anesthetic. We performed a prospective, randomised, double blind study to evaluate the effect of dexamethasone 4 mg added to local anaesthetic on the onset and duration of ultrasound guided supraclavicular brachial plexus block. Materials and Methods: 60 adult patients undergoing ultrasound­guided supraclavicular brachial plexus block were randomly divided into 2 groups of 30 each. In group1 patients received 15 ml of 2% lignocaine with adrenaline +15 ml of 0.5% bupivacaine +1 ml of normal saline (NS), in group 2 patients received 15 ml of 2% lignocaine with adrenaline +15 ml of 0.5% bupivacaine + 1 ml of dexamethasone (4 mg). The onset and duration of sensory and motor blockade in the either groups were compared. Using software package SPSS16 statistical analysis was done. Numerical variables compared by Independent samples t­test. Categorical variables compared between groups by Chi­square test. All analysis has been two tailed and p < 0.05 has been taken to be statistically significant. Results: The groups were comparable in demographic data. The onset of sensory and motor blockade in group 2 [228.33±32.386 sec; 313.33±33.767 sec] was significantly more rapid compared to group 1 [328.50±40.538 sec; 405.50±41.259 sec] [p<0.001 (HS)]. The duration of motor blockade was significantly longer in group 2 [479.83±37.312 min] compared to group 1 [325.33±36.434 min] [p<0.001(HS)]. In addition the duration of analgesia in group 2 [601.67±58.492 min] was significantly more compared to group1 [390.50±38.019 min] [p<0.001(HS)]. Conclusion: We conclude that addition of 4 mg dexamethasone as adjuvant to local anesthetics hastens the onset of sensory and motor blockade with prolongation of the duration of analgesia and motor blockade.

 Background and Aim: Regional anesthesia offers several benefits over general anesthesia. But to the patient it may be stressful as they stay awake. Sedation during regional anesthesia plays an important role in reducing the stress and patient satisfaction. Present study was designed with an aim to compare 2 different IV sedation protocols midazolam and Dexmedetomidine with respect to dreaming during sedation under regional anesthesia. Methodology: The study was conducted at Department of Anesthesia Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. One hundred and twenty adult patients were randomly assigned to 2 groups; Group M received IV inj midazolam and Group D received inj dexmedetomidine for sedation during spinal anesthesia. Sedation was assessed on Ramsay Sedation Score. Patients were interviewed on emergence and 30 minutes later to determine the incidence of dreams. Postoperatively, patient satisfaction with the sedation was also evaluated. The patients satisfaction was assessed using a scale from 1– 100. Any untoward side effects were noted. Results: 60 patients in each group were included in the final analysis. The incidence of dreaming was 16% in the midazolam group and 3% in the dexmedetomidine group. High level of satisfaction with the sedation was observed in dexmedetomedine group. In this group 66% patients expressed sedation as excellent, 11%­ good and 15% termed it as satisfactory. Midazolam was associated with decreased patient satisfaction; 26% patients termed it as excellent, 58% good and 15% satisfactory. Conclusion: During spinal anesthesia with sedation, patients receiving midazolam had 5 times more dreaming than those receiving dexmedetomidine. However, dexmedetomidine provides better quality of sedation during regional anesthesia resulting in superior patient satisfaction than midazolam.

 Background and Aim: Postoperative nausea and vomiting still occur with unacceptable frequency and the description of it as the ‘Big Little Problem’ encapsulates much of the general perception. The incidence is quite high even after laparoscopic surgeries including gall bladder surgeries. Present study was conducted to assess the level of PONV following laparoscopic cholecystectomy and the effect of dexamethasone and ondansetron, individually on PONV following laparoscopic cholecystectomy. Materials & Methods: The study was conducted at Department of Anesthesia Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. 60 patients presenting for elective laparoscopic cholecystectomy were randomised to 3 groups. Group 1 as control, group 2 received dexamethasone and group 3 received ondansetron for PONV prophylaxis. All three groups were evaluated for incidence of post­operative nausea and vomiting. Comparison of the observation among different groups was done and statistically analyzed using Fisher’s exact test and Mannwhitney­U test. Results: The incidence of PONV was 50% in the control group, compared to 12% in the dexamethasone group and 22% in the ondansetron group during the first 24 hours. At 1 hour the total incidence of PONV was 85% in control group, 30% in dexamethasone group and 25% in ondansetron group. At 4 hours the total incidence of PONV was 60% in control group, 5% in dexamethasone group and 15% in ondansetron group. The incidence of PONV at 8 hours was 55% in control group, 10% in dexamethasone group and 40% in ondansetron group. Conclusion: The incidence of PONV following laparoscopic cholecystectomy is high and both dexamethasone and ondansetron effectively reduce the incidence of PONV in these patients.

 Background: This study was to evaluate the postoperative clinical outcome of high risk surgical patients admitted to Intensive Care Unit (ICU). Methodology: This retrospective study reviewed the details of all the 501 postoperative patients admitted to the ICU during a one year period during 2016. The data analyzed were the age and gender distribution, American Society of Anaesthesiologists (ASA) physical status, surgical specialty, emergency or elective nature, type of anesthesia, inotropic and ventilator support provided and the clinical outcome was evaluated. Results: Among the 501 patients admitted to the ICU, majority were of the age 51­70 years with a male predominance of 56.1%. Majority of the patients were of ASA grade II, followed by III and IV. 79.7% were general surgical patients followed by urologic and ENT patients (5.9% each). 73.3% of patients were operated as elective procedure, and the rest were done as emergency. Most of the patients were operated under general anaesthesia (92.6%) and the remaining was administered regional. 9.98% patients required hemodynamic instability with inotropic support and 51.09% required ventilator support. The clinical outcome was graded as good (57.5%), fair (36.1%) and poor (6.4%) depending on whether the patient was shifted to the postoperative ward, concerned specialty ICU or expired. Conclusions: Increasing ASA physical status, hemodynamic instability requiring inotropic and ventilatory support was found to be bad predictors in the outcome of these patients. Choice of anaesthetictechnique did not have a significant effect in the postoperative outcome.

 Context: Internal jugular vein (IJV) is cannulated in a variety of patients. Left IJV cannulation sometimes becomes necessary. Aim: This study was done to evaluate the usefulness of ultrasonography (USG) in performing left and right IJV cannulation compared with use of surface anatomy landmarks. Setting and Design: Prospective randomized study in a tertiary care teaching hospital. Methods: Ninety one American Society of Anesthesiologists (ASA) class I, II or III adult patients scheduled for elective cardiothoracic, vascular, neurosurgical or major abdominal surgeries requiring IJV cannulation were randomized to undergo either right IJV cannulation using surface landmarks (Group 1) or USG (Group 2) or left IJV cannulation using surface landmarks (Group 3) or USG (Group 4). The number of attempts, time taken, the success rate, any change in technique or side of cannulation and any complications were recorded. Results: There was a significant difference in the success rate and number of complication between group 3 and group 4 (p<0.05). There was a statistically significant difference in the time taken for cannulation between Group 3 and Group 4 (273.9±127.6 Vs 135.2±105.1 sec, p<0.001). There was a significant difference in the number of attempts between Group 1 and Group 2 (2.05±1.2 Vs 1.46±0.64, p<0.05) and between Groups 3 and Group 4 (2.78±1.41 Vs 1.69±0.18, p<0.01). Complications (carotid puncture) were significantly more common on left side using surface landmarks (p<0.05). Conclusion: Ultrasound significantly improves the success rate of left and right IJV cannulation when compared to use of surface landmarks. It also reduces the number of attempts, the time required for cannulation and incidence of complications.

 Background and Objectives: The study was conducted to compare the differences in onset, duration of analgesia of intrathecal hyperbaric bupivacaine 0.5% (Group­I) versus intrathecal hyperbaric bupivacaine 0.5% with buprenorphine 3 mg/kg (Group­II) in spinal anesthesia for lower abdominal and lower extremity surgeries. The combination of bupivacaine and buprenorphine helps anesthesiologist to prolong duration of analgesia without significant side effects. Materials and Methods: The study was prospective, randomized and double blinded. It involved 100 patients (50 per group) of ASA­I and II, aged 18­60 years undergoing lower abdominal and lower extremity surgeries under spinal anesthesia. The time of onset of sensory and motor block, duration of sensory and motor block, hemodynamic stability, visual analogue scale and postoperative analgesia were assessed. Results: The onset of sensory and motor blockade was significantly faster in group­II compared to group­I . The two­segment regression of sensory level and time to complete sensory recovery were significantly longer in group­II. The duration of analgesia was significantly prolonged in group­ II compared to group­I, Patients treated with intrathecal buprenorphine had a better pain relief as judged by visual analogue scale postoperatively. Adverse effects were minimal and easily treatable. Conclusion: Addition of intrathecal buprenorphine 3 mg/kg to hyperbaric bupivacaine 0.5% in spinal anesthesia provides better quality of anesthesia with hemodynamic stability and prolonged duration of analgesia postoperatively without significant side effects.

Introduction: Laparoscopic surgery poses a challenge to its successful anesthetic management due to its significant alteration of hemodynamics resulting from pneumoperitoneum. Dexmedetomidine although frequently used in laparoscopic surgeries produces sedation, analgesia and anxiolysis, alongwith decreasing heart rate and blood pressure. We intended this study to use a lower loading dose of 0.6 µg/kg and maintenance dose of 0.3 µg/kg/h dexmedetomidine so as to utilize its wonderful properties without causing the adverse effects of hypotension and bradycardia, which are common at its usual loading dose of 1 µg/kg and also to study its opioid sparing effect. Methodology: A double blinded randomised placebo controlled trial was conducted on sixty adult patients, ASA grade I or II of either sex, aged 18 to 60 years who underwent elective laparoscopic cholecystectomy. Patients were divided into two groups who received dexmedetomidine and normal saline and intraoperative hemody­namicswere studied at different time­points. Results: The two groups were comparable with respect to mean duration of surgery (46.67±4.35 vs 47.43±3.96), mean extubation time (6.77 ± 0.73 vs 7.00 ± 0.58), and response to oral commands (8.59 ± 0.7 vs 8.78 ± 0.72). Mean heart rate and blood pressure variations were significantly lower in dexmedetomidine group at all time­points. Fentanyl requirement and post­operative nausea/vomiting was also significantly less in dexmedetomidine group and none patient had any episode of bradycardia, hypotension or hypertension. Conclusion: Dexmedeto­midine 0.6 µg/kg followed by maintenance of 0.3 µg/kg/h provides perioperative hemodynamic stability, facilitates smooth emergence from anesthesia, has opioid sparing properties and reduces post op nausea and vomiting.

Background: Opioids administered before caesarean section under general anaesthesia reduce maternal stress response related to intubation and surgery but may decrease the Apgar score after delivery and when opioids are used. Aim: effect of low dose of short­acting opioid alfentanil on haemodynamic changes due to tracheal intubation during general anaesthesia for caesarean sections. Materials and Methods: Patients were taken for a period of 2 years in 60 pregnant patients between the ages of 18 and 40 years, scheduled for elective caesarean section, were assigned to two equal groups. Group­A:(N=30) Received alfentanil 10 mg/kg, diluted in normal saline (total volume of 10 ml), GroupP:(N=30) Received 10 ml normal saline as placebo for premedication. Results: There were no significant statistical differences among the two groups regarding age, weight, BIS and maternal pre­operative haemodynamic parameters. Following alfentanil administration, systolic blood pressure decreased at 1, 5 and 10 min after endotracheal intubation. Diastolic blood pressure decreased only 1 min after intubation and heart rate decreased 1 and 5 min after intubation. There were significant statistical differences between the two groups in regard to mean heart rate 1 min after induction of anaesthesia (P = 0.01), 1 min after endotracheal intubation (P = 0.000) and 5 min after endotracheal intubation (P = 0.04). Mean BIS  values were not significantly different between the two groups (P = 0.3). Mean of neonatal Apgar scores at 1 and 5 min and neonatal SpO2  were not significantly differerent between the two groups . Conclusion: Alfentanil as premedication decreased maternal systolic, diastolic blood pressure and heart rate in the 1st min of general anaesthesia for caesarean sections.

 Conventionally, anesthesiologists practice as perioperative physician, providing preoperative, intraoperative and postoperative care to their surgical patients. Though primarily they focus on providing anaesthesia to their surgical patients, they usually function as a perioperative physician providing ‘non-operative care’ to them [1]. With the skills they have acquired in this, along with the technological advancements, their service is no longer confined to the operating rooms. Emerging requirements away from our routine comfort zone of operating suites has posed new challenges to the specialty. Perioperative Physician is a qualified medical person competent to address the requirement of surgical patients with regard to the decision to operate till they are discharged safe after the procedure. Among the multiple specialists involved in this, anaesthesiologists are best suited to lead them due to their skills, training and experience in this field. A sensible anesthesiologist can reduce the requests for unnecessary consultations and unexpected surgical cancellations due to inadequate preoperative preparation [2].