Indian Journal of Anesthesia and Analgesia

Background: Premedication is used to provide sedation and anxiolysis and to enhance the quality of induction, maintenance and recovery from anaesthesia. The present study was carried out to study the pressor responses to laryngoscopy and intubation during induction with ketamine and scoline, using prior diazepam and clonidine as premedication. Method: A total of 60 normotensive patients of ASA grade I of both genders, aged 20 to 50 years, were randomized for this prospective study and divided into two groups of 30 patients each. Group I patients received Tab. Diazepam 0.2 mg/kg body weight and Group II patients received Tab. Clonidine 3 microgram/kg body weight. Both groups were assessed for changes in pulse rate, blood pressure and sedation. Scoring was taken every 15 minutes after giving this medication till induction. Result: The pulse rate rise, systolic blood pressure and diastolic blood pressure were more in control group as compared to clonidine group. There was statistically significant difference between mean pulse rate change, systolic blood pressure and diastolic blood pressure of both the groups during 1st min of intubation. And also there was significant difference between the two groups for sedation score (p<0.001) and pain score (p<0.001). Conclusion: Oral clonidine premedication 3 microgram/kg body weight given 90 minutes prior to induction of anaesthesia with ketamine is an effective and safe method for controlling the rise in pulse rate and rise in blood pressure associated with laryngoscopy and intubation. It also gives adequate analgesia in the immediate postoperative period without undue sedation.

Osteogenesis imperfecta (OI) is a rare, genetically inherited syndrome involving connective tissues which leads to fragile bones, short stature, disorders of other organs and body systems. Children with OI are more susceptible for bone fractures. OI poses various anaesthetic challenges like difficult intubation, problems with positioning, tendency to develop malignant hyperthermia, coagulopathy, cardiovascular and pulmonary abnormalities and spinal abnormalities. We report a case of 9 year old male boy with OI type IV, presented with fracture shaft of femur, posted for intra medullary nailing. It was successfully managed under spinal anaesthesia.

Background: Propofol is a commonly used intravenous induction agent but it is associated with intense pain on injection in majority of patients.Various methods have been studied to reduce the propofol induced pain. Lignocaine, a local anesthetic agent and Ondansetron, a 5HT3 receptor antagonist,both have been shown to effectively reduce the pain due to propofol injection. So aim of our study was to compare the efficacy of low dose lignocaine (0.1 mg/kg) and ondansetron (0.1 mg/kg) pretreatment to reduce the propofol induced pain on injection. Methods: The present study was conducted at our institute included one hundred adult patients of either sex, aged 18-60 years, with American Society of Anesthesiologists (ASA) grade 1 and 2 scheduled for various elective surgeries under general anesthesia. All the patients were randomly allocated into two groups of 50 patients each; Group L (Lignocaine group) received lignocaine (2%, preservative free) 0.1 mg/kg and Group O (Ondansetron group) received ondansetron 0.1 mg/kg (both diluted up to 5ml in normal saline) as pretreatment before induction of general anesthesia using propofol 1%, 2 mg/kg. A tourniquet was applied on the same upper arm with a pressure of around 70 mm Hg for venous occlusion to about 20 seconds. After giving the pretreatment drug, the tourniquet was released, propofol was administered thereafter and the patients were assessed for level of pain intensity using the scale advocated by McCririck and Hunter. Results: The incidence of propofol induced pain in Group L and Group O were 46% and 40% respectively.(P>0.05) In Group L, out of 23 patients, 6 patients recalled pain whereas in Group O, 13 patients recalled pain out of 20 patients, but both incidence and recall of pain were found to be statistically insignificant between two groups. (P>0.05) 24% patients in Group L and 16% patients in Group O had experienced post operative nausea and vomiting (PONV) which was also statistically insignificant (P>0.05). The various hemodynamic parameters remained stable. Conclusion: Although we had used lignocaine at its lower dose (0.1 mg/kg) as pretreatment but both lignocaine and ondansetron were found to be equally effective in reducing propofol induced pain on injection.

Background: Dexmedetomidine is an alpha-2 receptor agonist having sympatholytic properties which provides very good hemodynamic stability during surgery without any adverse effect on respiration. But its anti-nociceptive property has not been studied much. Aim: To study the effects of intra operative infusion of dexmedetomidine on perioperative analgesics requirement, sedation and recovery characteristics in patients undergoing laparoscopic surgery. Material and Methodology: Total 50 subjects posted for elective laparoscopic surgery were selected and divided in group D and C, 25 in each. D group subjects were given an initial loading dose of dexmedetomidine 1 g/kg IV over 10 min before the induction of anesthesia, followed by continuous infusion at 0.6g/kg/hr. while Group C patients received equal amount of 0.9% saline intraoperative. Requirement of analgesic in postoperative period was estimated along with visual analog score, sedation score and recovery characteristics. Results: In D group 20 out of 25 subjects required either one or two doses of analgesic while in C group 19 out of 25 subjects required either three or four doses (P<0.05). Duration of analgesia was 8.32±1.55 hours in D group while 1.20±0.35 hours among C group (P<0.05). Among D group Statistical significant increase in sedation score at 10 minutes (4.57±0.38) postoperative till 24 hours postoperative (1.10±0.64) was found as compared to the group C [3.94±0.55 (10 minutes); 1.44±0.49 (24 hours)]. Modified post anesthetic discharge score was 12.25±1.35 and 9.49±1.39 among D and C group subjects respectively (P<0.05). Conclusion: Dexmedetomidine provides excellent analgesia. It induces sedation but do not alter recovery.

Introduction: There are three classical stages in the control of gastric secretion, which are mediated by short myenteric reflexes and long vagal reflexes and by systemic hormone secretion. More recently the role of local peptides in modulating secretion and motility has become evident. Methodology: With simple random sampling technique, 60 patients were selected who fulfil the inclusion criteria and exclusion criteria and divided them into two groups of 30 each.Group P: received intravenous pantoprazole 40 mg i.v.Group E: received intravenous esomeprazole 40 mg i.v. Results: 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. Conclusion: Esomeprazole reduced the volume of gastric juice to < 6ml and pantoprazole < 10 ml

Introduction: Laparoscopic surgeries are associated with an appreciably high rate of post operative nausea and vomiting (PONV). This study was designed to compare the effectiveness of Granisetron with that of Palonosetron for prevention of PONV after laparoscopic surgery. Methods: In a randomized, prospective study, 60 adult patients of both sexes received Granisetron 2.5mg and Palonosetron 75mcg intravenously at the end of surgery. Perioperative anaesthetic care was standardized in all patients. Patients were then observed 24 hours after administration of the study drug. Results: A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 75% of the patients given Granisetron and 86% of the patients given Palonosetron with (P<0.05%). No significant difference observed in the recovery time from anesthesia between the two drugs and slight difference in the adverse events were observe d between the two groups. Conclusion: This study concludes that the prophylactic intravenous administration of Palonosetron is more effective drug than Granisetron for controlling postoperative nausea and vomiting with less incidence of side effects.

Introduction: General anaesthesia predisposes a patient to regurgitation andaspiration of gastric substances into otherwise healthy lungs leading to fatal acidaspiration syndrome. Historically, the syndrome most commonly described as aspiration pneumonitis or Mendelson’s syndrome, 1 was reported in 1946 in patientswho aspirated while receiving general anaesthesia during obstetrical procedure. Everypracticing anaesthesiologist thus has a key concern to this preventable devastatingclinical condition which causes progressivelung damage due to the acidic solution. Methods: This is a prospective, controlled, randomised, single blinded studyconducted in 60 patients of American Society of Anaesthesiologists grade I and IIposted for elective surgery under general anaesthesia. The patients enrolled in thestudy were randomly assigned to two groups having 30 patients in each. Group Preceived i.v pantoprazole 40mg, Group E received i.v esomeprazole 40 mg a nightprevious to surgery. The observer was totally blind about the groups or drugs given tothe patients. On the day of surgery, after induction of anaesthesia gastric juice wasobtained via nasogastric tube and was checked for pH using pH meter. Results: Mean pH of group P was 5.15± 0.68 which is significantly lower  thangroup E, who received i.v esomeprazole sodium with mean pH of 6.6±0.67, (P<0.001), as shown by two-tailed independent T test. Conclusion: From the observations and analysis of the present study, it can beinferred that esomeprazole sodium 40 mg i.v is more effective than pantoprazole 40mg i.v to raise the gastric pH for prevention of aspiration pneumonitis.

Introduction: The adverse reactions commonly reported for palonosetron were headache and constipation. All other reactions such as diarrhea, dizziness, abdominal pain, fatigue, insomnia occurred at an incidence of <1%. There were no electrocardiographic changes or dose response effects, including QTc prolongation due to palonosetron up to a 2.25 mg iv dose, a 9-fold safety margin. Methodology: In post anaesthesia care unit blood pressure and heart rate were recorded every 10 min for 30 min. Episodes of nausea and vomiting experienced by each patient were recorded by direct questioning. The number of patients who suffered nausea/vomiting were noted during the period’s 0-4hrs, 4-12hrs, and 12-24hrs in the post operative period and statistical analysis was done accordingly. Results: Systolic, Diastolic BP, Heart rate and oxygen saturation showed no statistically significant difference recorded in PACU between the study groups. Conclusion: The number of patients who suffered side effects was more in granisetron group.

Introduction: Dexmedetomidine hydrochloride, an imidazole compound is the pharmacologically active s-enantiomer of medetomidine. It is described chemically as (+)-4-(s)[2, 3 – (dimethylphenyl) ethyl] – 11 H-imidazole monohydrochloride. Methodology: This study was carried out on 60 patients (30 in each group) belonging to American Society of Anesthesiologists (ASA) physical status I and II and scheduled for elective general surgical, urological and gynecological surgeries. Results: In group C (Control), the basal mean SBP was 123.97±11.44. 10 min after bolus drug administration the mean SBP was 125.40±10.97 which is not statistically significant (p=0.232). In group D (Dexmedetomidine), the basal mean SBP was 126.53±9.06. 10 min after bolus drug administration and after induction the mean SBP were 108.07±10.13 and 107.03±9.95 representing a significant fall in SBP (p=0.000). Conclusion: There was marked decrease in SBP, DBP and MAP 10 min after dexmedetomidine administration. 

Introduction: Opioids are used as adjuncts with the local anaesthetic for longer duration of action and better postoperative analgesia [4]. Nalbuphine, is a mixed agonist-antagoniste and its analgesic potency is equal to morphine and less side effects like respiratory depression, urinary retention and pruritus. Intrathecaldexmedetomidine increased the duration of analgesia. Aim: To compare the duration of postoperative analgesia and the incidence of side effects of intrathecalnalbuphine and intrathecaldexmedetomidine for lower abdominal and lower limb surgeries. Materials& Methods: 60 patients of ASA I & II, underwent lower abdominal and lower limb surgeries using spinal blockade included. Group I (n=30) patients received Inj. Bupivacaine heavy 15 mg with Inj. Nalbuphine 0.8 mg. Group II (n=30) patients received spinal anaesthesia with Inj. Bupivacaine heavy 15 mg & Inj. Dexmedetomidine (5 mics) Results: The mean onset of sensory block (3.5±0.7 Vs 4.2±0.8) and motor block (1.7±0.7 Vs 2.6±0.9). Both were shorter in nalbuphine group which was statistically significant. The mean duration of analgesia was longer in patients who received dexmetomidine (197±6 min Vs 99.6±6 min), Incidence of hypotension and bradycardia were higher in dexmetomidine group but amenable to medical management. Conclusion: Intrathecalnalbuphine (0.8mg) decreases the mean duration of onset of both sensory and motor block. Intrathecaldexmedetomidine prolongs the duration of analgesia but the incidence of bradycardia and hypotension are higher.

Background and Objective: Total intravenous anaesthesia currentlypracticed during short surgical process.Propofol due to its favourable pharmacokinetic profile is widely used in TIVA butlacks analgesic property, decreased cardiac index and pain on injection. To overcome these disadvantage we added ketamine in Group K and butorphanol in Group B for TIVA technique for comparative study. Methods: We studied 60 patients of either sex aged 18-60yrs of ASA-I and II grade, undergoing short surgical procedures less than one hour. They were randomly allocated into 2 groups, group K, receiving ketamine 1mg/kg and propofol 1.5mg/kg and group B received butorphanol 20 g/kg and propofol 1.5mg / kg as inducing agent Anaesthesia was maintained with propofo l9mg/kg/hr via infusion pump in both group. Baseline, intra and postoperative haemodynamic parameters, sedation, postoperative nausea, vomiting were evaluated every 10min interval upto 40 minutes. Pain on injection with propofolwas also noted. Data recorded andanalysed by t-test, chisquare and F test. Results and Observation: Significant variation was observed in hemodynamic parameter in Group B whereas no statistically significant change in group K. The incidence of postoperative sedation was 36.7% in Group K whereas in group B it was 46.7%. Attenuation of pain on injection with propofol, was 23.3% in group B as compared with 56.7% in group K showing pain.There was no statistically significant difference in two groups regarding incidence of PONV. Interpretation and conclusion: We concluded thatPropofol-ketamine, offered better haemodynamic stability over propofol-butorphanol. Pain on injection was better attenuated by butorphanol. Post operative sedation was more with butorphanol. No significant difference in PONV between two groups.

Background & Aim of the Study: The main objective of the Pharmacovigilance programme of India is to create a nationwide system of adverse drug reporting by health care professionals and patients. Nurses are the most essential health care givers who closely monitor the patient health and safety. This study was conducted to assess the Knowledge, Attitude, and Practices (KAP) of Nurses about Pharmacovigilance & Adverse drug reactions (ADR) reporting in tertiary care hospitals in Tamilnadu. Materials and Methods: This is a questionnaire based study with both open and close ended questions on different aspects of Knowledge [6], Attitude [8], and Practice [6] questions. Among 200 OT and ICU Nurses of tertiary care hospitals, 174 responded (87%). KAP among study subjects was measured in Percentages based on their responses. Results: ADR reporting was considered very important by 93.10% of nurses, primarily for improving patient’s safety (69.54%) and identifying new ADRs (57.47%). Majority of nurses (79.88%) opined that all ADRs should be reported, 25.28% are aware about Pharmacovigilance Centre in the hospitals. However, 88.50% said that proper training should be provided to report ADR. Conclusion: The Nurses are aware of ADR reporting and their importance. However, under reporting and lack of knowledge are clearly evident.

Fractures are a known entity in old age due to various physiological changes, the most common being osteoporosis. These patients also come with an array of comorbidieties like diabetes mellitus, Hypertension, thyroid disorders or neurological problems. Such patients require emergency close reduction under anaesthesia in the emercency department or on opd basis in the casualty. The objective of our study was to compare the favourable haemodynamic changes in terms of HR, BP and MAP before, during and after the procedure using the age old thiopentone and the now easily available in India ethomidate. These procedures were restricted to fractures of upper limb requiring closed reductions.

Background: Over the last three decades, spinal anaesthesia has been widely used for herniotomy and other lower abdominal surgeries in paediatric age group. However the children undergoing surgery under regional Anaesthesia require sedation and closed monitoring. General Anaesthesia in paediatric age-group has its own sets of complications like difficult airway and sometimes life threatening complications as bronchospasm, laryngospasm etc may also occur. Methods: In this prospective study, 50 patients of 2 to 7 years divided into two groups, group SA and GA. SA group received spinal anaesthesia, patient were sedated in preoperative room with Dexmedetomidine 1mcg/kg(over 20 minutes infusion) and throughout procedure sedation was maintained on Dexmedetomidine 0.5mcg/kg with infusion. For group GA standard protocol of General anaesthesia was followed. The results were analysed using the Chi- Square Test. Results: The haemodynamic pattern and respiratory function were stable and smooth recovery was seen in group SA. While in group GA, oxygen desaturation was observed in 16% patients in immediate postoperative period. Incidence of nausea vomiting and sore throat was seen in 8% patients of GA group. Conclusion: It can be concluded that spinal anaesthesia is a suitable & alternative anaesthetic technique for paediatric surgery to avoid the incidence of postoperative respiratory complications of general anaesthesia.

Context: Various additives are mixed with local anaesthetic agents to increase the quality of block in spinal anesthesia. We want to compare quality at low doses and effective adjuvant among them. Aims: Comparing the efficacy of lowest possible doses of clonidine, fentanyl and buprenorphine with minimal side effects by evaluating onset and duration of sensory and motor block, when added as adjuvants to bupivacaine in patients posted for caesarean section under spinal anaesthesia. Settings and Design: Prospective randomized and comparative study of 60 ASA I and II patients undergoing LSCS under spinal anaesthesia. Methods and Material: Patients were randomly allotted into 3 groups(n=20). Group BC received 1.8ml of 0.5% injection hyperbaric bupivacaine with 30 µg (0.2ml) of Clonidine. Group BF received 1.8ml of 0.5% injection hyperbaric bupivacaine with 20µg (0.2ml) of fentanyl. Group BB received 1.8ml of 0.5% injection hyperbaric bupivacaine with 60µg (0.2ml) of buprenorphine. Statistical Analysis Used: For categorical data chi-square test and continuous data was compared using ANNOVA test. Results: The onset of motor blockade was faster in Clonidine group. The duration of block and post-operative analgesia were prolonged in BC when compared to BB and BF (P <0.001). No significant difference noted in the onset time of sensory block. Clonidine 30µg is optimal low dose for LSCS cases without causing much hemodynamic variation and sedation. Conclusions: Intrathecal Clonidin 30µg is an effective spinal adjuvant when compared to 20µg fentanyl or buprenorphine 60µg in LSCS patients with better haemodynamic stability, no sedation with nil side effects.

Introduction: In order to maximize quality of anesthesia and effective analgesia, a number of adjuvants have been added to intrathecal local anesthetics but none of them have yet been identified without any adverse events. Material & Methods: 90 patients scheduled for lower limb orthopaedic surgery under spinal anaesthesia were included in this prospective randomized double blind study. Patients were randomly allocated into any of three groups. Group A– Patients receiving 0.5% hyperbaric bupivacaine 3ml (15mg) + 0.1ml (10µg) dexmedetomidine hydrochloride. Group BPatients receiving 0.5% hyperbaric bupivacaine 3ml (15mg) + 0.1ml (50mg) magnesium sulphate. Group C – Patients receiving 0.5% hyperbaric bupivacaine 3ml (15mg) + 0.1ml normal saline as control. The onset time for sensory and motor block, the regression time for block, duration of effective analgesia, hemodynamic parameters and any adverse events were recorded at timely intervals. Results: The onset time of sensory and motor block was faster with Group A (2.16 and 3.30 min) as compared to Group C (3.72 and 4.88 min), whereas it was significantly prolonged with Group B (6.1 and 7.03 min). Duration of sensory and motor block was significantly prolonged with Group A (344.67 and 318.67 min) and to a lesser extent with Group B (273 and 246 min) when compared to control Group (195 and 169.5 min). The duration of effective analgesia was longer with Group A (375 min) and Group B (294.3 min) when compared with Group C (216 min). Conclusion: Addition of Dexmedetomidine as an adjuvant to hyperbaric Bupivacaine intrathecally leads to rapid onset and prolonged duration of anesthesia. With intrathecal Magnesium sulphate, the onset of block was delayed but the duration of block was prolonged although to a lesser extent. Duration of effective analgesia was prolonged in both the study groups although more pronounced with Dexmedetomidine. Hemodynamic parameters where stable in all the three study groups without any significant group specific side effects.

Introduction: The ICU environment produces high level of stress, strain and discomfort to the patients with physiochemical, physiological psychological alterations. So adequate level of analgesia and sedation to the patient is necessary for better outcome. We compared a relatively new sedative dexmedetomidine to gold standard sedative propofol with respect to sedation, analgesia, effect on hemodynamic parameters in patients admitted in ICU. Aims & Objective: 1. To compare the effectiveness of sedation with dexmedetomidine and propofol in critically ill patient in ICU. 2. To compare haemodynamic and any adverse events observed in both groups. Method: To evaluate this Forty (40) patients of ASA grade I to III, aged 18–60 yr, who were admitted in the ICU were divided into two equal groups in a randomized, double blinded fashion. Group A received I.V Dexmedetomidine 1 µg/kg in 10 mints as initial loading dose followed by 0.2-0.7 µg/kg/min. Group B received I.V. propofol 75 µg/kg/min in 10min followed by maintenance dose of 12.5µg/kg/min.The Ramsay sedation scores and hemodynamic (SBP and HR) and respiratory (RR) variables were recorded at baseline, at 10 min, at 30 min, at 1hr and 4hrly for 24 hr. Observation: Following parameter will be monitored (1) Quality of sedation using Ramsay sedation score. (2) H.R (3) R.R (4) NIBP (5) Spo2 (6) Adverse events. Conclusion: Dexmedetomidine has excellent sedation for the patient admitted in ICU as compare to Propofol. Dexmedetomidine is a safe sedative agent with patient easily aroused to co-operative without showing irritation. Patients remained hemodynamically stable with minimal depression of cardiovascular system and respiratory functions in Dexmedetomidine group when compared to Propofol group.

Introduction: Supraglottic airway devices are helpful in patients with difficult airways and in emergency situations and in cardiopulmonary resuscitations [1]. Some supraglottic airway devices are used for blind or fibreoptic bronchoscopy {FOB} guided intubation in the airway management . They can be efficiently used as rescue airway devices in patients with difficult airway and their use has increased in anaesthesia practice and emergency medical services [2]. Aim: This study is done to evaluate the efficacy of supraglottic airway devices I-GEL and ILMA as emergency ventilatory devices by comparing ease of insertion and as conduits for blind endotracheal intubation which can be used in difficult intubating conditions. Methods: 60 patients posted for surgical procedures under general anaesthesia. Patients fulfilling inclusion criteria were included in the study and were enrolled and analysed.Patients induced with appropriate Induction gents and Non depolarizing muscle relaxants and ventilated for 3 min prior to SAD insertion and again ventilated for one minute prior to blind ETT intubation. Group A: ILMA ( 30 ) inserted after 3 min ventilation followed by blind ETTintubation. Group B: I GEL (30) inserted after 3 min ventilation followed by blind ETTintubatio. Variables such as ease of insertion, number of attempts and duration of insertion of SADS, number of attempts and duration of blind ETT insertion and postoperative sorethroat, dysphagia etc were compared. The collected data were statistically analysed and tabulated. Results: The statistical analysis tools used in this study for the comparison of demographic variables, ease of insertion, number of attempts and duration of insertion of SAD, number of attempts and duration for ETT insertion ,failure and postoperative sorethroat and dysphagia were chi square test and fishers exact test. The p value derived for ease of insertion, number of attempts, and duration of insertion of SGADS I-GEL and ILMA were p < 0.001 favouring I- GEL. Likewise the p value derived for number of attempts and duration for ETT insertion through I-GEL and ILMA were p< 0.0001 favouring ILMA . The p value derived for incidence of postoperative sore throat and dysphagia was p<0.0125, favouring I-GEL. It was concluded that from above results that I-GEL is a better device for emergency rescue ventilation because of its ease of insertion and lesser incidence of postoperative sore throat and dysphagia as compared to ILMA whereas ILMA is a better device for blind endotracheal intubation compared to I-GEL. Conclusion: It can be safely concluded that I-GEL is easier to insert and a better airway device for emergency rescue ventilation compared to ILMA and ILMA is a better conduit for blind endotracheal intubation than I-GEL.

Background and Aim: For several decades, suxamethonium was the gold standard relaxant for rapid sequence intubation. However, the unintended side-effects such as muscle fasciculation, hyperkalemia, rise in intracranial and intraocular pressures led to the search of newer relaxants. In this study we compared the most recent rocuronium and cisatracurium at a dose as regard the onset of action, intubating conditions, efficacy, and safety during general anesthesia for adult gynecological ambulatory surgery. Materials & Methods: Total of 90 patients were randomly selected and included in the present study. The age range for the patient was found to be 25 to 65 years. All the included patients were randomly divided into two groups, 45 patients in each group. In the first group Rocuronium 0.6 mg/kg was administered and in other group 0.1 mg/kg was administered. Results: The time to achieve maximum blockade was 160.4 sec and 85.94 sec respectively in Group A and Group B. The clinical duration was found to be 48.9 mins and 32.8 min respectively in group A and B. Total intubation score achieved at 60 secs was 6.36 and 8.12 seconds respectively for group A and group B. Conclusion: Rocuronium has a rapid onset of action with good intubating conditions, Cisatracurium has an intermediate duration of action, and both are potent and safe with excellent cardiovascular stability and without apparent histamine release.

Introduction: Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. Materials and Methods: It is a randomized controlled study. The study was approved by institutional ethical committee and consent was obtained from the patients. 60 consecutive patients who are posted for the major knee surgeries selected according to inclusion and exclusion criteria and randomized in to two groups. Group I CEA (continuous epidural analgesia) had an epidural catheter using 16 or 18 G epidural needle inserted at L2-L3 interspace whereas in Group II CFB (continuous femoral block), femoral catheters was done using ultrasound guidance. VAS scores (0-10) for pain, the use of rescue analgesic and side effects like hypotension, vomiting, itching and urinary retention were recorded. Results: There is no significant difference in the age distribution between the two groups. In this study we did not notice any significant difference in the pain level after 6hrs of the post op period between the two groups as evident in the VAS scores. There was a significant fall in the BP in Group I compared to Group II during most of the hours of monitoring. Incidence of vomiting, bradycardia and urinary retention are more in Group I whereas patient acceptance is more with Group II. Conclusion: Within the limitations of this study, we conclude that CFB using ultrasound guidance provides equivalent analgesia with decreased exposure to potentially significant neurological complications.

Postoperative pain management is one of the vital duty of an anaesthesiologist apart from managing the patient intraoperatively. Patients presenting for gynaecological surgeries receive subarachnoid block with hyperbaric bupivacaine. Levobupivacaine the pure S-enantiomer of racemic bupivacaine, is a new long-acting local anesthetic that has recently been introduced in the clinical practice with predominant sensory analgesia. By and large opioids are used as adjuvants intrathecally, but their complications at times lead to few unwanted side effects. Intrathecal clonidine has been evaluated as an alternate to neuroaxial opoid for control of pain and has proven to be a potent analgesic This prospective, randomized, double-blind study compared the clinical efficacy, motor block and haemodynamic effects and postoperative analgesia of using 3mL of 0.5% isobaric levobupivacaine plus 0.2ml of 0.9% normal saline (Group LB) Vs 3 mL of 0.5% levobupivacaine with clonidine 30 micrograms (Group LC) for spinal anaesthesia in gynaecological surgery. Results: Sensory onset time, (5.12±1.92min) was faster in group LC but no difference in the motor block onset time was found between the groups. Duration of sensory and motor blockade and two segment regression time were significantly lower in levobupivacaine (LB) compared to Levobupivacaine clonidine (LC) group. In group LC, mean arterial pressure was lower than group LB, starting from 10 min until 30 min after injection (p < 0.05). Bradycardia was noted in 27% of group LC whereas 3% in LB group. Anaesthesia was adequate and patient satisfaction was good in all cases. Side-effects were minor and infrequent in both groups. Conclusion: We conclude that 3 mL of 0.5% levobupivacaine with clonidine 30 micrograms is more effective than 3 mL of 0.5% levobupivacaine alone in spinal anaesthesia for gynaecological surgeries.

Cardiac surgery creates a high risk for the development of post operative infections. Aims: The objective of this study was to evaluate the incidence, characteristics and risk factors for nosocomial infections after cardiac surgery. Methods and Material: All patients who underwent cardiac surgeries under cardiopulmonary bypass (CPB) were enrolled in this study. Preoperative, intraoperative and postoperative variables were collected and examined as possible risk factors for development of infections. Results: Infection occurred in 18 of 171 patients (10.5%). Five members with infection died. Infections occurred at different sites like sternal wound infection 11.5%, pneumonia 30.7%, bacteremia 23%, mediastinitis 15.3%, surgical site other than sternotomy 11.3% and central venous catheter infections contributing to 7.6% of infections. Conclusions: Use of IABP, reintubation and reexploration are independent risk factors for the development of postoperative infection in cardiac surgery patients.

Introduction: Laryngeal mask airway (LMA) insertion has emerged as an alternative to endotracheal (ET) intubation for maintaining airway and anaesthesia.This study was done to compare the haemodynamic responses associated with LMA and endotracheal intubation in ASA Grade I and II patients undergoing elective surgeries. Aim: To compare the heamodynamic responses associated with laryngeal mask airway insertion and endotracheal intubation. Methods: Informed consent was taken for the study. The patient was examined and evaluated on the day before surgery. They were explained the procedure of anaesthesia to allay anxiety and apprehension. In this randomized prospective study 50 ASA Grade I and Grade II patients posted for elective surgery under general anaesthesia was entered. The patients were allocated by computer-generated random numbers into two groups of 25 patients each: Group-I (ET group) and Group- II (LMA group). All the patients were given anaesthesia in a standardized manner. Heart rate, blood pressure, oxygen saturation and ECG monitored during intubation and insertion of laryngeal mask airway at an interval of 1, 3, 5 & 10 minutes. After adequate recovery patients was extubated. Observations: The Parametes observed are- Mean arterial pressure (MAP), Heart rate (H.R), Oxygen saturation (SPO2), Electrocardiogram (ECG) at 10min, 1min before intubation, 1min after induction, just after insertion of ET tube/LMA, 3min, 5min, 10min after intubation/LMA insertion. Data observed and analysed. Test of significance were carried out by student t-test or modified t-test. Results: The heart rate, systolic, diastolic blood pressure was found to be increased at laryngoscopy and endotracheal intubation or laryngeal mask insertion.But the increase in HR, SBP and DBP in the laryngeal mask airway group was not as much as in the endotracheal tube group. There was a significant difference in these haemodynamic parameters between the two groups at the end of 5 minutes. Conclusion: The haemodynamic responses are attenuated and short lived with laryngeal mask airway insertion as compared to laryngoscopy and endotracheal tube insertion. Laryngeal mask airway insertion is advantageous where ever there is a concern about the pressor response for airway instrumentation.

Background: Neuraxial adjuvants are used with local anaesthetic agents to enhance the quality of anaesthesia. The Present study aims at comparing the efficacy & safety of adding 2- adrenergic agonist, Dexmedetomidine to 0.75% Ropivacaine with Ropivacaine alone epidurally for lower limb & lower abdominal surgery. Methodology: 50 patients (age 20-60 years, ASA grade I or II, of either sex), were randomly allocated to: Group I (n=25) epidural bolus of 20 ml(150mg) 0.75% Ropivacaine+1 ml NS, Group II (n=25) epidural bolus of 20 ml 0.75% Ropivacaine + Dexmedetomidine 1µg/kg diluted in NS Intra operative haemodynamics; onset, level & duration of sensory & motor block; level of sedation; post op analgesia & side effects were recorded & statistically analyzed using t- test, chi- square test & Mann Whitney test. Results: Groups were comparable in terms of the demographic profile, pre operative haemodynamic parameters & duration of surgery (p> 0.05). In Group II, onset of sensory block was faster in but not statistically significant(p=0.05), duration of sensory block was significantly prolonged (p<0.001), motor block onset was significantly faster (p<0.01) & duration significantly prolonged (p<0.001). Gpoup II showed significant decrease in heart rate (p<0.001), significantly higher (p<0.001) intra-op sedation scores, significantly prolonged duration of analgesia (p<0.001) & higher incidence of dry mouth as side effect (p=0.02). Conclusion: Addition of Dexmedetomidine to local anaesthetic agent Ropivacaine 0.75% epidurally as an adjuvant provides better sensory and motor block, intra-op sedation and prolonged post -op analgesia.

Background and Aim: Brachial plexus blocks provide excellent anaesthesia and post operative analgesia for upper limb surgeries. Various adjuvants like opioids, midazolam and 2 agonists have been used to improve the quality of block. Present study was undertaken to compare the onset and duration of Supraclavicular block between clonidine and dexmedetomidine when added as adjuvant to local anaesthetic. Methods: The study was conducted at Department of Anesthesia, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. 50 patients undergoing forearm surgery under ultrasound guided supraclavicular block were randomized to receive 20ml of 0.25% bupivacaine with dexmedetomidine 1g/kg (Group BD) or 20ml of 0.25% bupivacaine with clonidine 1g/kg (Group BC). The onset and duration of sensory and motor block was assessed. The duration of post operative analgesia was also noted. Results: The mean time of onset of sensory and motor block was significantly faster in Group BD (8.8±0.91min, 11.3±0.952) than Group BC (11.14±1.13min, 13.6±1.11), respectively. The mean duration of sensory and motor block in group BD (9.3±0.667hrs, 8.5±0.692hrs) were found to be significantly longer than in group BC (7.06±0.664, 6.66±0.657). Conclusion: Dexmedetomidine produces faster sensory and motor block and prolongs the duration of analgesia as compared with clonidine when used as an adjuvant to Bupivacaine in supraclavicular block.

Background: Preeclampsia is hypertensive and multisystem disorder of pregnancy. It is a leading cause of maternal and foetal morbidity and mortality. There is increased rate of lower segment caesarean section in preeclamptic parturient. So we designed a comparative study to assess the effects of general anaesthesia and subarachnoid block on maternal and foetal outcome in preeclamptic patients. Materials and Methods: One hundred consenting patients of age 16 to 32 years with severe preeclampsia posted for elective or emergency lower segment caesarean section were randomly assigned to one of the two groups; group GA, group SA who received general anaesthesia and subarachnoid block respectively. Variables in mother like systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) was recorded before induction, just after induction then 5, 10, 30, 60 minutes after induction and postoperatively at 15, 30, 60, 90, 120 minutes after the completion of operation. After delivery of the baby the APGAR score at 1 min and 5 min was recorded. Result: No maternal mortality is noted in either of the two groups. Hypertension (10% group GA), hypotension (14% group SA), and pulmonary oedema 4% in GA group whereas none in SA group was seen intraoperatively. Birth asphyxia was developed in foetus 8% in group GA and 2% in group SA. Foetal APGAR score at one minute was 7.42±1.16 & 8.96±0.66 in GA and SAB respectively higher with subarachnoid block. Conclusion: subarachnoid block serves better as a mode of anaesthesia for LSCS in severe preclamptic parturients in terms of both intraoperative and postoperative morbidities.

Pulmonary aspiration during induction of general anaesthesia is an important cause of anaesthetic mortality and morbidity. Many agents have been tried to reduce this risk. Aim: To assess and compare the antacid and analgesic efficacy of a single dose of intramuscular tramadol. Method: The study was carried out in 50 patients of either gender, age between 18 to 60 years, belonging to ASA I & ASA II status under going surgical procedures. All patients were randomly allocated to receive either tramadol 100mg or Ranitidine 50mg intramuscularly one hour before induction of anaesthesia. Results: Tramadol is equally effective in reducing gastric acid pH compared to ranitidine (3.41±2.34 Vs 3.50±2.54). Even though tramadol decreased gastric volume, the reduction in mean gastric volume was not as much as ranitidine (13.96±11.55ml Vs 11.24±9.49). Conclusion: Tramadol can be safely used as a premedicant in patients undergoing for general surgeries.

Background: Osteoarthritis (OA) is the second most common rheumatologic problem and it is the most frequent joint disease with a prevalence of 22% to 39% in India. Incapacitating the patients and compromising the quality of life. Conservative treatments may not be effective always, and that some of them have serious adverse effects. Various surgical methods have been used to treat OA. Genicular nerve neurotomy is currently being evaluated for the treatment of chronic knee pain due to Osteoarthritis. Aim and Objectives: The study was aimed to evaluate the efficacy of single radiofrequency thermocoagulation (RFT) of the knee joint with the objective to compare the success rates at the end of first, third and sixth month and to study the complications. Materials and Methods: A total number of 88 patients were included in the study of age ranging from 40 to 80 years of age from Jan. 2016 to Dec. 2016. The patients with knee pain of more than 6 months and not responding to the conventional line of treatment, were included in the study. Two groups, 44 each group, were made depending on the severity of osteoarthritis changes of knee joint on X- ray findings of the knee joint. After diagnostic blocks was given to all of the patients and on satisfactory pain control RFTC was done. Pain score was assessed immediately after the procedure, while discharge i.e. two hrs after the procedure, 2nd day on telephonic call, 1 week, 4 week and 12 week and 6 months. Results: Out of 88 patients 50 (56.81%) were males and 38 (43.18%) females included in the study. Majority of the patients 36 (40.90%) tried analgesic drugs for pain relief and 27 (30.68%) patients tried analgesic drugs + physical therapy + intra-articular injection prior to RFT treatment. At the 3rd-month follow-up, 73 (82.95%) patients were pain-free and at the end of 6 months, 62 (70.45%) were pain-free. There was no significant statistical difference between both groups at the end of 6 months. Conclusion: It was concluded that PRF, applied to the knee joint of patients suffering from chronic knee pain due to OA and not responding to the conservative treatment methods sufficiently, seems to be an effective and safe method.

Introduction: The epidural analgesia is popular and effective method of labour analgesia since the parturient remains awake, pain free and comfortable, watches her delivery and immediately can feed her baby. Bupivacaine is causes cardio toxicity and the discomfort due to motor blockade that limits its use. Motor blockade reduces her mobility and increase the chances of assisted deliveries. Ropivacaine induces less lower extremity motor blockade and has a lower potential for cardiovascular and central nervous system toxicity. Material and Methods: A total of 90 patients were included in the study, of which 45 patients were randomly allocated to each one of the ropivacaine or bupivacaine group. In ropivacaine group patient Inj. Ropivacaine 0.2% vol. 8 to 10 ml and in Bupivacaine group Inj. Bupivacaine 0.2% 8 to 10 ml a bolus dose was given. Adequate analgesia visual analogue scale [VAS] of 3 was considered as an endpoint. Intermittent bolus doses were given of 50% of initial bolus dose on SOS basis which was on an average 1 to 1.5 hrs after initial dose. Vital parameters, VAS score, motor block was noted. Results: The VAS score in Ropivacaine 0.2% group was excellent i.e. 0 to 3 in 38 (84.4%) patients , out of which 26 patients were absolutely pain free after 15 mins of the bolus dose. Among the Bupivacaine group excellent score AVS < 3 was found in 29 (64.5%) patients. 18 parturients (40%) in the Bupivacaine group and 35 (77.8%) in the Ropivacaine group did not show any motor block (Bromage=0) throughout labour. The study showed that 21 (46.7%) patients of Bupivacaine group and 25 (55.5%) patients of ropivacaine group delivered spontaneous vaginal delivery and 18 (40%) patients of Bupivacaine group and 13(28.8%) patients of ropivacaine group delivered with instrumental vaginal delivery. There was no significant difference in the outcome or the mode of delivery in both the groups. The delivery time was shortened in both the groups. Conclusion: It can be concluded that both the drugs are effective in producing labor analgesia. Ropivacaine group parturients; had a faster onset and significantly longer duration of analgesia with a single dose and required lesser top-ups and there was less motor blockade.

This is an interesting case report of anesthetic management of a case of rare thyroglossal cyst on posterior part of tongue in a eight year old child who was posted for cyst removal under general anaesthesia. This case highlights the technique of railroading also called retrograde intubation which was done under sedation ultimately resulted in successful intubation of the patient. This technique is used for the first time in this age group with successful intubation.

Congenital adrenal hyperplasia (CAH) is the result of an autosomal recessive disorder.It affects one of the step required for the synthesis of cortisol from cholesterol by the adrenal cortex. 11-hydroxylase deficiency accounts for 5- 8% of all cases of CAH with an incidence estimated at 1 in 100,000 - 200,000 newborns [1]. We present a 2.5-year-old girl with CAH due to 11- hydroxylase deficiency who presented for surgical treatment of cliteromegaly with hypoplastic lower third of vagina for clitoroplasty with stage 1 vaginal reconstructions. The perioperative care of patients with CAH should address issues related to the deficient and excessive production of specific corticosteroids and mineralocorticoids by the adrenal cortex. We will discuss the perioperative implications of the disorder.

Context: In the modern era of surgical field laparoscopic surgeries are more frequently performed than open surgeries. Postoperative nausea and vomiting is a common complaint encountered in the patients who have undergone laparoscopic surgeries because of pneumoperitoneum created by CO2. A number of anti-emetics are given as prophylactic agents to prevent postoperative nausea and vomiting. Among them 5-hydroxytrypatmine type 3 receptor antagonists are highly effective in prevention and treatment of PONV. With this background we conducted a study for evaluating the effectiveness of two 5-HT3 receptor antagonists in prevention of PONV in patients undergoing laparoscopic surgeries under general anesthesia. Aim: To compare the efficacy and safety profile of two 5 HT3 antagonists namely palonosetron and ondansetron in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgeries. Settings & Design: This was a prospective, randomized, single-blind comparative study. Sixty patients of age group between 18-60 years of Ameri can Society of Anaesthesiologists physical status class I and II undergoing laparoscopic surgeries were enrolled. They were randomly allocated into two groups namely Group A and B with 30 patients in each group. Group A received 0.075mg of injection palonosetron and Group B received 4mg of injection ondansetron intravenously 30 minutes before induction of anaesthesia. Statistical Analysis used: Statistical work up was performed using the SPSS version 16. Student’s t –test was used for quantitative data and Chi- square test was used for qualitative data. P value of less than 0.05 was found to be statistically significant. Results: The incidence of PONV in group A (palonosetron) was found to be 13% which is lesser than group B (ondansetron) where the incidence was 23%. The need for rescue antiemetic was also comparatively lesser in group A than group B. (23% vs 51%). The number of complete responders were 26 (86%) and 23 (76%) for palonosetron and ondansetron respectively. Conclusion: Palonosetron is effective antiemetic for preventing PONV during the late postoperative period while compared to ondansetron.

Background and Aims: Paravertebral and interpleural blocks are indicated for providing intraoperative and postoperative analgesia in unilateral surgeries of the chest and abdomen. The aim of this study was to evaluate the intraoperative analgesic requirement, efficacy and duration of postoperative analgesia, complications, if any and the time to discharge of patients receiving paravertebral block or interpleural block as an adjuvant to general anaesthesia in patients undergoing breast surgery. Methods: Sixty patients scheduled for breast surgery were randomly allocated into three groups after induction of general anaesthesia: Control group (Group C), paravertebral block group (Group PVB) and interpleural block group (Group IPB). The block was given with 20 ml of 0.5% bupivacaine and 2 µg/kg of clonidine. Results: Sixty five percent patients required intraoperative fentanyl supplements in group C while only 15% patients in group PVB and 35% patients in group IPB required intraoperative fentanyl supplements [P(C/PVB/IPB) <0.01, P(PVB/IPB) = 0.14]. Patients of PVB group had the longest time to first rescue analgesic requirement (13.8 hrs) followed by IPB group (9.6 hrs) and Control group (6.5 hrs). The mean VAS score at rest as well as on movement was significantly lower in PVB group and IPB group compared to Control group. None of the other complications were noted. Conclusion: The use of paravertebral block or interpleural block with bupivacaine and clonidine is a safe and effective technique to enhances the intraoperative and postoperative analgesia, in patients undergoing breast surgery, although the duration of analgesia provided by paravertebral block is more than interpleural block.

Introduction: Spinal anaesthesia is popular anaesthetic technique for lower abdominal and lower extremity surgery. Lidocaine and bupivacaine has been commonly used as anaesthetic agents. Ropivacaine had been found to be relatively cardiostable. Levobupivacaine is a long-acting local anaesthetic. Hyperbaric solutions of local anaesthetics, were compared to isobaric ones, were faster in onset of sensory and motor block, and improved quality of anaesthesia. Aim and Objectives: To evaluate the efficacy of hyperbaric intrathecal ropivacaine, and levobupivacaine versus racemic bupivacaine, for spinal anaesthesia in patients admitted for infra-umbilical surgeries. Material and Methods: The present randomized control study was carried out between Jan. 2013– Dec. 2013, on 120 patients admitted for elective infra-umbilical surgeries. The patients were allocated to three groups: Group I: Bupivacaine 0.5%, 15 mg (3 ml), Group II: Ropivacaine 0.75%, 22.5 mg (3 ml) + 0.5 ml, 25% dextrose, and Group III: Levobupivacaine 0.5%, 15 mg (3 ml) + 0.5 ml, 25% dextrose =3.5 ml. Results: Onset of sensory block was significantly faster with levobupivacaine onset to T10 in 1-2 minutes and 67.5% in 3-4 minutes than bupivacaine than ropivacaine. Level and time required for sensory block was similar with all three drugs. In group I mean time of maximum level of analgesia was 17.12±3.5607 minutes, In group II mean time was 17.47±5.4935 minutes and in group III was 17.10±4.5487 minutes. Onset of motor block was faster with levobupivacaine and bupivacaine than ropivacaine. Mean and SD of time of motor onset in groups I, II and III is 6.125±1.265 minutes, 7.275±1.585 minutes and 5.475±1.086 minutes respectively. Degree of motor block as well as quality of anaesthesi was similar in the three treatments. Conclusion: Intrathecal ropivacaine produced a shorter duration of motor and sensory block. Hyperbaric levobupivacaine was more haemodynamically stable.

Background: Subarachnoid block is commonly used technique for anaesthesia in different surgical specialties. Ondansetron is a selective 5-HT 3 antagonist. It is an effective drug for prevention and treatment of nausea and vomiting, so being used generously as antiemetic drug in premedication. Any interaction with regional anaesthesia including the effect on sensory and motor block would be particular interest for anaesthesiologist. This study was done to compare the effect of intravenous ondansetron on sensory and motor blockade induced by intrathecal spinal hyperbaric bupivacaine in patients undergoing orthopaedic surgery. Methods: 60 unpremedicated patients of male sex, age 20- 45 years belonging to an ASA physical status I or II is undergoing lower limb orthopaedic procedures being performed under intrathecal spinal anaesthesia were recruited for this study. Group C received i.v saline 2ml and Group O received i.v Ondensetron 4 mg (2ml) 15 min prior to the intrathecal spinal hyperbaric bupivacaine. Sensory and motor block level was assessed in this study. Results: We found that in patients group C (control) had the highest block level T4 as compare to group O (ondansetron pretreatment group) in which the highest sensory block level was T6. For maximum sensory block level comparison between group C and group O found significant (p<0.001). Duration of the block is also decreased in ondansetron group, i.e. those who had received ondansetron prior to spinal anaesthesia. Conclusion: It was observed in our study that the level of maximum sensory block height was significantly lower in ondansetron pretreatment group for hyperbaric bupivacaine. It was also noted that the ondansetron pretreatment group had faster regression of sensory block level. No significant differences were detected between the study groups for motor block.

Background: Inguino-scrotal surgery is one of the commonest procedures in children and is associated with significant postoperative pain. Regional block is employed to provide analgesia in these procedures. The aim of the present study is to compare ilioinguinal/iliohypogastric block and caudal block for postoperative analgesia in children undergoing inguinoscrotal surgeries. Methods and Material: Hundred children aged 1-6 years scheduled to undergo inguino-scrotal surgeries were randomly allocated to receive either ilioinguinal/iliohypogastric block (group 2) or caudal block (group 1) with 1ml/ kg of 0.125% bupivacaine. Postoperative pain was assessed with modified objective pain scale. 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: The duration of analgesia produced by ilioinguinal/iliohypogastric block was comparable to caudal block (342±112.4 min in group 1 and 354±98.6 min in group 2, P>0.05). the time to first voiding was earlier with group 2 compared to group 1. Conclusion: Ilioinguinal/iliohypogastric block is comparable to caudal block in providing postoperative analgesia in inguino-scrotal surgeries.

Background: Laryngeal mask airways(LMA) have many advantages over endotracheal intubation in airways management, but has a risk of gastric insufflations, vomiting and aspiration. The aim of our study was to know how effective and safe ProSeal laryngeal mask airway (PLMA) is as compared to Classic laryngeal mask airway (CLMA) when used for adult patients posted for elective surgery under general anaesthesia using muscle relaxants. Methods: Study was conducted in a tertiary care teaching government institute.Sixty American Society of Anesthesiologists (ASA) I and II patients of either sex in the age group of 18–60 years who were scheduled for an elective surgery with general anesthesia were included in study and were divided randomly to either proseal laryngeal mask airway (PLMA) or classic laryngeal mask airway (CLMA) group. Both group patients received same induction, maintenance and reversal medications. Insertion success rates and attempts, time required to secure the device, oropharyngeal leak pressure, intra-operative & post-operative complications were observed and compared using statistical software Graph Pad Prism 6.01. Results: No significant difference was observed in the number of insertion attempts, success rates of insertion, intraoperative and post-operative complications amongst the two groups. The classic laryngeal mask airway was quicker to insert as compared to the PLMA. The PLMA provided a better airway seal as shown by the oropharyngeal leak pressure. The mean oropharygeal leak pressure in PLMA group was 26.45±1.41 cm H2O and in CLMA group it was 17.43±1.17 cm H2O. Conclusions: In anesthetised, paralyzed patients CLMA is easier as well as quicker to insert, but more effective seal was found when PLMA was used. Comparing the incidence of intraoperative complications and postoperative complications it was found to be similar.

Background and Objective: Intravenous regional anaesthesia with conventional large dose of local anaestheticis associated with serious systemic toxicity when the tourniquet deflates unexpectedly during the procedure or when it is deflated intentionally at end of surgery. Therefore modifications in IVRA have been done with the use of low dose of local anaesthetic to decrease systemic toxicity and addition of muscle relaxant and opioid to local anaesthetic to get same quality analgesia as high dose local anaesthetic. Hence the present study is carried out to compare the sensory and motor characteristics, cardiovascular and respiratory parameters and side-effects during intra-operative and postoperative period between the patients who received 0.5% lignocaine alone and those who received combination of 40 ml of 0.25% lignocaine with 30 mg pentazocineand 0.5 mg pancuronium in intravenous regional anaesthesia for upper limb orthopaedic surgeries. Materials and Methods: Sixty unpremedicated ASA class 1 and 2 patients scheduled for elective upper limb orthopaedic surgeries were randomly allocated to receive IVRA either with 40ml of 0.5% lignocaine alone (Group A, n = 30) or combination of 40 ml of 0.25% lignocaine with 30 mg pentazocineand 0.5 mg pancuronium (Group B, n = 30). The sensory and motor characteristics, cardiovascular & respiratory parameters and side effects were studied during the intra-operative and post-operative period. Conclusion: The study indicated that the triple combination of 40 ml of 0.25% lignocaine,30 mg pentazocineand 0.5mg pancuronium produces the same quality of analgesia as 40ml of 0.5% lignocaine in IVRA. But the short delay that was observed in the onset and attainment of complete sensory and motor block in the former group will delay the start of surgery by 10-15 minutes after application of tourniquet. Thus, this modified technique of intravenous regional anaesthesia allows the reduction in the dose of local anaesthetic agent and hence the potential toxicity of the local anaesthetic agent.

Background: Femoral nerve block (FNB) is an option for pain management in patients with femur fractures. Aim: Compare the analgesic effects of femoral nerve block (FNB) with intravenous (IV) fentanyl prior to positioning patients with fractured femur for spinal block. Materials and Methods: It is randomized prospective study was undertaken at for a period of 9 months. Total 50 Subjects participated in study, divided into 2 groups, Group-L(lignocaine) 25 patients received 20 ml of 1% lignocaine around femoral nerve under ultrasound guidance and in plane approach. Group- F(Fentanyl)-25 patients received 1 mic/kg of fentanyl intravenously. Results: All the demographic details are not significant in both the groups. Mean arterial pressure is significantly decreased (p-value<0.05) during positing in group F and there is significantly decreased O2 saturation in patients also.Pain score during positioning is decreased significantly in group- L. Out of 25 patients in Group L, 22 were found satisfactory with this method. Conclusion: Femoral nerve block provides better analgesia, patient satisfaction, less time for anaesthesia and satisfactory positioning.

Context: Laryngeal mask airway (LMA) has revolutionized airway management in the administration of general anesthesia. Proseal LMA offers advantages like better sealing pressure, drain tube and lesser risk of aspiration. The present study is designed to compare the efficacy of Classic LMA (CLMA) and Proseal LMA (PLMA) in anesthetized patients coming for Gynaecological surgery. Methods and Material: 60 female patients of age group 18 years and older of American society of anaesthesiologists (ASA) physical status 1 and 2 who underwent elective gynaecological surgeries under general anaesthesia were divided into 2 groups, Group P (n = 30) comprised of patients who were managed with Proseal LMA and Group C (n = 30) comprised of patients who were managed with classic LMA. Outcomes measured were Fibreoptic grading of LMA placement, Oropharyngeal sealing pressure (OSP), Ease of insertion, Time taken for insertion, Number of attempts and incidence of Complications. Results: The oropharyngeal sealing pressure was found to be significantly higher with proseal LMA(31.27±5.0 cm H2O) than classic LMA (17±3.4 cm H2O). The best fiberoptic score (grade 4) were found in 22 patients of Proseal LMA group and 7 patients of Classic LMA group which was statistically significant. Conclusions: Proseal LMA is superior to Classic LMA in anatomical placement defined in terms of clinical end points, oropharyngeal sealing pressure and fiberoptic view in anesthetised patients coming for Gynaecological surgery.

Background: Many studies show that, Dexmedetomidine hastens the onset of sensory and motor block, prolongs anaesthesia and analgesia of local anesthetics in various neural blocks. Very few studies are done using Dexmedetomidine in peribulbar block. The objective of the present study was to evaluate the effect of adding Dexmedetomidine to local anesthetics in peribulbar block for patients undergoing cataract surgery. Methods: Forty adult patients, scheduled for cataract surgery were randomly assigned to two equal groups. Group C (Control group) received 2.5 ml each of a mixture of 2% Lidocaine with Adrenaline and 0.5% Bupivacaine plus Hylase 150 i.u., and 0.5ml saline. Group D (Dexmedetomidine group) received 2.5 ml each of a mixture of 2% lidocaine with Adrenaline and 0.5% Bupivacaine plus Hylase 150 i.u and Dexmedetomidine 25 g in 0.5 ml saline. Onset of sensory and motor block, duration of motor block and duration of analgesia was recorded. Pain was graded using the verbal analogue scale and recorded. Hemodynamic, and sedation parameters were recorded perioperatively. Results: Onset of sensory (0.925±0.348 minutes) and motor block (9.5±0.827 minutes) was significantly shorter in group D compared to group C (1.225±0.334 minutes and 11.75±1.70 minutes, being onset of sensory and motor block respectively). Duration of motor block (277±85.75 minutes) and duration of analgesia (408.8±142.456 minutes) was more prolonged in group D than in group C (163.25±46.29 minutes and 171±103.41 minutes, being duration of motor block and duration of analgesia respectively). Both groups were pain free intraoperatively. Sedation score was similar in both groups. Heart rate and blood pressure were maintained around baseline in both groups. Conclusion: Dexmedetomidine (25µg) as an adjuvant to a mixture of Lidocaine and Bupivacaine in peribulbar block hastens the onset of sensory and motor block, prolongs the duration of motor block and analgesia, with no side effects, and is a safe and effective for cataract surgery.

Background: General anaesthesia has effects on various systems including intraocular pressure (IOP). Anaesthetic drugs also lead to changes in IOP. Though rare, IOP measurement is important as acute glaucoma is a major cause of blindness postoperatively. Aims: Present study was undertaken to compare the changes in IOP with inducing agents Thiopentone, Propofol & Ketamin with and without Midazolam. Material & Methods: We measured IOP after giving three inducing agents, Thiopentone, Propofol & Ketamin individually and then compared along with same inducing agent with Midazolam. The patients were randomly divided in six groups each of 35. First three groups received three inducing agents individually and other three groups received same inducing agent with Midazolam. Results & Conclusion: After administration of inducing agent there is fall in IOP. With addition of Midazolam there is more fall in IOP which is desirable to counteract the increase in IOP caused due to Suxamethonium & endotracheal intubation.

Background: The administration of a single dose of propofol is reported to be effective in decreasing the incidence and severity of emergence agitation in children following sevoflurane anesthesia. Aim: Tocompare the effect of propofol and fentanyl with the control group to prevent emergence agitation in children receiving sevoflurance for adenotonsillectomy. Materials and Methods: Sixty childrens of ASAI of either sex divided into three groups. Twenty children in each group. Group FF: Children given 1.5 mcg/kg fentanyl during induction, and 1.0 mcg/kg fentanyl at the end of surgery, Group FP: Children given 1.5 mcg/kg fentanyl during induction, and 1 mg/kg propofol, Group FN: Children given 1.5 mcg/kg fentanyl during induction, and 0.1 ml/kg normal saline at the end of surgery. Results: In our study group the age of the children, sex distribution, weight, are not statically significant. Intra operative monitoring of pulse rate, spo2 and duration of sevoflurance administration, duration of surgery are also not statistically significant. Aono’s four point scale which is used to determine the presence of emergence agitation showed statistically significant reduction in group FPand group FF compare with the group FN. The PAED score used to find out the severity of the emergence agitation and the CHIPPS score are statistically not significant. The P value of Ramsay sedation score in the group FN and Group FF is 0.016. and it’s statistically significant and the P value between group FN and group FP is 0.035. it’s also statistically significant. Conclusion: Propofol and fentanyl has been useful in reducing the incidence of emergence agitation for adenotonsillectomy surgeries in children receiving sevoflurane.

Introduction: Airway management in deep neck infection are contraversial. In our study we retrospectively reviewed perioperative airway management methods practiced in the last 30 consecutive cases of deep neck infection. Materials and Methods: Inclusion criteria was deep neck space infection patients requiring surgical drainage under general anaesthesia. Exclusion criteria were small abscess managed medically and abscess drained under local anaesthesia. Patients were grouped into tracheostomy, fiberoptic intubation, blind nasal intubation and rigid laryngoscopic intubation. Results: In our study all 19 patients who had trismus were planned for fiberoptic intubation. It was successful in all 19 patients. Laryngoscopic intubation was attempted in 11 patients, 7 patients with good mouth opening and in 4 patients with severe stridor. However 2 patients in stridor who could not be intubated with laryngoscope, underwent emergency tracheostomy. In 6 patients tracheostomy was done along with incision and drainage for post-op airway management. Five patients were sent to intensive care unit with endotracheal tube, 3 out of this proceed to tracheostomy within 4 days. Rest of the patients were extubated immediately after surgery. Discussion: Fiberoptic intubation is a very safe airway management in trained hands when adequate time is available. Trial of rigid laryngoscopy can be given only with tracheostomy backup during emergency. Patients with advanced deep neck infection requiring post-operative airway are better managed with tracheostomy than with endotracheal tube. Conclusion: Fiberoptic intubation for general anaesthesia and tracheostomy for postoperative airway in advanced cases gave good results in our study.

Background Information: One of the challenges in postoperative care in a developing country is the non-availability of narcotics. Morphine and fentanyl have excellent analgesic action but they are difficult procure as they are under Narcotics act. Besides this, they have undesirable side effects like vomiting and respiratory depression. So alternatives for pain relief in the postoperative care are under constant search. Aim: Our aim was to primarily assess and compare the efficacy and safety of nalbuphine and tramadol as a preventive analgesic in patients undergoing elective inguinal hernia repair surgeries. Methods: This was a prospective, randomized, double-blind where sixty male patients undergoing elective inguinal hernia repair surgeries under spinal anaesthesia were randomly allocated to receive i.v nalbuphine (N) or tramadol (T) when the sensory level regressed to T10. Time to first rescue analgesic (duration of analgesia), rescue analgesic consumption in 24 hours, sedation, respiratory depression, postoperative nausea and vomiting were studied. Results: VAS values for group N at 4th and 6th hour were significantly lower than group T (p< 0.001)(p< 0.000). Mean VAS score remained less than 4 throughout the study in group N .Time to first rescue analgesia in group N (320.87±18.46) was statistically significant than group T (P=0.00) Requirement of total rescue analgesic in term of total number of doses in Group N (50) and Group T (72) (P=0.00). Conclusion: Our study concludes that pre-emptive administration of nalbuphine has a better analgesic profile than tramadol.

 Aim: 1. To study, the use of Ultrasound in confirming tracheal intubation. 2. To identify Oesophageal intubation and time taken for it. 3. Subsequent, evaluation of the time taken to confirm tracheal intubation by Ultrasound and Capnography. Methods and Material: 30 patients with ASA physical status 1 and 2, scheduled to undergo elective surgeries under general anesthesia were included in the study. The patient’s characteristics, airway measurements and baseline hemodynamic parameters were recorded preoperatively. Anesthetic management was standardized. The ultrasound transverse high frequency linear probe (9.3MHz-15MHz) was kept on suprasternal notch and moved slightly towards left. The esophagus on this view at the level of suprasternal notch lied posterolateral to the trachea. When, laryngoscopy was performed, the cormack-lehan grade was noted. The anesthesiologist doing ultrasonography, simultaneously evaluates the time taken to confirm endotracheal intubation by Ultrasonagraphy and Capnography. In case of oesophageal intubation,it is identified by appearance of “double track” sign. The time taken to identify the same is noted. Statistical Analysis Used: Mean, standard deviation, difference in mean. Results: The patient characteristics and demographic profile were found to be statistically similar. In our study, oesophageal Intubation is identified by ultrasound as early as 2 seconds in one case. The mean time taken to confirm endotracheal intubation in the rest of 29 patients by ultrasound was 17.5 seconds and by capnography was 41.63 seconds.The confirmation of endotracheal intubation by USG was on average 24 seconds earlier than by Capnography. Conclusions: Ultrasound is a rapid and reliable way to confirm proper endotracheal intubation.

Background: Baricity is the density of a substance compared to the density of human cerebrospinal fluid which used in anaesthesia to determine the manner in which a particular drug will spread in the intrathecal space and produce shorter duration of onset, greater level of blockade and fast recovery. Aim: To compare the clinical efficacy of hyperbaric Ropivacaine and Bupivacaine under spinal anaesthesia in terms of duration of onset, blockade and recovery. Settings and Design: Prospective, comparative and randomized double blind study. Methods and Material: About 80 patients from K S Hedge Medical College Hospital, NITTE University, Mangaluru, Karnataka, India were enrolled between January 2015 to August 2016 by random sampling method and divided into two groups as A and B. Group A received 3ml of 0.5% hyperbaric Bupivacaine and Group B received 3ml of 0.5% hyperbaric Ropivacaine. Subarachnoid block in L3-L4 space was performed by considering following parameters such as Onset and duration of block and recovery following injection. Statistical Analysis: Unpaired t test and Chi square test. P<0.05 was considered as statistically significant. Results: The duration of onset of sensory block to T10 with 0.5% hyperbaric Bupivacaine was 5.9±0.955 min when compared to 0.5% hyperbaric Ropivacaine which was 5.50±1.219 min with p value of 0.107. Conclusions: Hyperbaric Ropivacaine has showed more favourable profile than hyperbaric Bupivacaine in terms of shorter duration of onset, with higher level of sensory blockade and faster recovery.

This randomized double blind study was conducted to know the efficacy of ondansetron as prophylactic agent for reduction in incidence of hypotension and bradycardia in patients undergoing caesarean section under spinal anaesthesia. Methodology: 60 ASA 1 & 2 patients were divided randomly into two groups(saline and ondansetron ) having 30 in each group. Saline group was administered with 10 ml of saline IV and ondansetrongroup received Ondansetron 4mg(10ml) 5 mins before spinal anaesthesia.Heart rate, systolic, diastolic & mean blood pressures were recorded at the time of spinal drug administration and at 2 mins interval upto 20 mins, followed by 5 mins interval until end of surgery. Results: There was significant reduction in systolic, diastolic and mean BP in saline group compared to ondansetron group. But the heart rate in both the groups was comparable. Conclusion: Prophylacticondansetron decreases incidences of hypotension after spinal anaesthesia in caesarean section.

Background: Therefore the present study was undertaken to study on comparison of 6% hydroxyl ethyl starch with Ringer’s Lactate for preloading in caesarean section under spinal anaesthesia. Objectives: To study the effects on heart rate and blood pressure after pre-load with 6% hydroxy ethyl starch and ringer’s lactate in elective caesarean section after spinal anaesthesia. Methods: Total of one hundred patients belonging to ASA Grade I and II were included in the study during study duration. Patients in the age group of 18-35 years were selected. Through pre-operative examination was done one day prior to access the fitness for anaesthesia. Routine investigation like Haemoglobin, urine for sugar and albumin were done. Other investigations were carried out whenever necessary. The patients were randomly divided into two groups comprising of 50 patients in each group. Group A: received Lactated Ringer’s solution 1000ml. Group B: received 500ml. of 6% Hydroxy Ethyl Starch. Results: There was no statistically significant difference found in pulse rate and blood pressure parameters at baseline between two groups (p>0.05). It was found that there is no statistically significant difference of pulse rate during first hour after the Subarachnoid injection between the two groups (p>0.05). It was found that, there is no statistically significant difference of changes in respiratory rate and SpO2 between the two groups (P>0.05). Conclusion: From the present study, it was conclude that, preloading subjects with 6% hydroxyl ethyl starch is useful than preloading with ringer lactate solution as it produces better hemodynamic stability to subjects.

Aims: This study is to observe the effect of barbotage on sensory spread during subarachnoid block with 0.5% of Heavy Racemic mixture Bupivacaine. Methods and Material: 50 ASA grade 1 and 2, were randomised to receive 3cc of 0.5% heavy Bupivacaine into subarachnoid space at L3-L4 space with patient in right lateral position using 25 gauze quincke’s spinal needle (25 patients with barbotage/25 patients without barbotage). Primary objective of the study included the highest level of analgesia using pin prick, the time taken to achieve the highest level of sensory block and time taken for modified bromage scale 3 motor block. Secondary objective included hemodynamic parameters and the usage of vasopressor. Statistical Analysis used: Mean, Standard Deviation, Student ’t’ test, P Value. Results: The highest level of analgesia obtained was similar in both group (mean T5 Dermatome).The time to reach the highest dermatome (9.65 minutes vs. 4.88 minutes with P value <0.001), the modified bromage scale 3 level motor blockade (7.47 minutes vs. 3.35 minutes with P value< 0.001) and the two segment regression of analgesia was faster in barbotage group (65.94 minutes vs. 53.82 minutes with P value <0.001). Conclusions: In this study, the quality of analgesia was similar in both groups. There was no incidence of uncontrolled cephalad spread in barbotage group.

Aim: To compare between intravenous administration of paracetamol and intramuscular tramadol as a labour analgesic. Methods: The present study is a prospective randomised study conducted in 150 primigravida women for a period of 7 months. Inclusion criteria were primigravida with full-term pregnancy in the age group 20-30 years with spontaneous onset of labour with single fetus with vertex presentation in active phase of labour. Active phase of labour was described as cervical dilatation more than or equal to 3 cm, cervical effacement more than or equal to 60% and good uterine contractions. The women were randomly distributed in two groups, Paracetamol group A-75 women and Tramadol group B-75 women after taking informed consent. Mc Gills pain intensity scale was used to measure the pain intensity. Results: No significant difference was observed before drug administration in the pain intensity. 2.6% women had horrible pain, and 16% had distressing pain in paracetamol group, while in tramadol group, 21.3% women had horrible pain and 60% had distressing pain after 1 hour of drug administration. After 4 hours of drug administration, in paracetamol group, 16% had distressing pain while in tramadol group, 48% had horrible pain and 40% had distressing pain. In paracetamol group, labour duration was 5.0 hours whereas in tramadol group, it was 6.1 hours. In paracetamol group, nausea was seen in 2.0% and vomiting was seen in 1.5% whereas in tramadol group, nausea was seen in 7.0% and vomiting was seen in 4.1%. Conclusion: It can be concluded from this study that intravenous administration of paracetamol is simple, feasible and cost effective and more effective labour analgesic when compared to intramuscular tramadol. Paracetamol has a better analgesic activity, shortening of labour duration and very less side effects.

Aim: Consistent and reliable protection against rise of heart rate and blood pressure during extubation has been aimed at by using propofol in this study. Materials and Methods: It was studied in 50 patients of ASA Grade I & II between age groups 20 - 46 years. 25 patients of comparable age, weight and ASA status were taken as control. Premedication was by glycopyrrolate 0.2 mg 30 minutes prior to induction of anaesthesia. Anaesthesia induced with thiopentone sodium 5 mg/ kg intubation was performed with suxamethonium and maintained with 0 2 and N 2 O with vecuronium as a muscle relaxant, pethidine 1 mg/kg. Patients belonging to the study groups received bolus doses of either 1 mg/kg of lignocaine or 0.5 mg/kg of propofol two minutes prior to extubation. Results: Haemodynamic parameters like Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure, Heart rate were recorded at the following intervals. At induction, at the end of surgery, injection of study drug, 2 minutes after injection of study drug, at extubation, 1 minute after extubation, 2 minutes after extubation and 5 minutes after extubation. Patients who did not receive either of the study drugs showed a significant rise in all the haemodynamic parameters at extubation. In patients who received either of the study drugs the increase in haemodynamic variables were significantly less, thus attenuating the haemodynmic response. No side effects were noted with propofol. Conclusions: It establishes the usefulness of an intravenous bolus dose of propofol 0.5 mg/kg to attenuate the haemodynamic response to extubation. Propofol 0.5 mg/kg is superior to lignocaine 1 mg/kg in prophylaxis of extubation response.

Context: Diabetes mellitus is associated with higher risk for mortality and morbidity in patients undergoing surgery. This risk is reduced if the diabetes is under control prior to the surgery. When a patient is newly detected to have diabetes during preoperative assessment a delay in controlling the blood sugar is encountered before the patient is fit for surgery. The prevalence of undetected diabetes in South India has been reported to be around 10%. Aim: We conducted the study to determine the magnitude of this problem in our surgical population. Materials and Methods: Hospital records of 529 consecutive patients who came for elective surgeries in our hospital were examined to note if they were already detected to be diabetic or were newly detected during the preanaesthetic visit. Results: 5.1% of the surgical patients were found to be diabetic. Among them 1.8% was newly detected to have diabetes. Prevalence of diagnosed and undiagnosed diabetes in patients above 40 years of age was 5.9% and 2.9% respectively. Conclusions: We conclude that the problem of undetected diabetes is not as severe as suggested by previous studies. Further studies among the general population in this geographical area is needed to know if this is due to a genuine reduction in the number of diabetics in this population.

Background: Spinal ropivacaine provides differential anaesthesia with a higher sensory than motor block and is less cardiotoxic than bupivacaine. Small doses of ropivacaine (10- 15 mg) require addition of neuraxial adjuvants to improve the quality of block and duration of analgesia without affecting motor blockade. We designed a randomised double blind study to compare fentanyl and midazolam as additives to spinal ropivacaine 0.5% for patients scheduled for transuretheral resection of prostate (TURP). Methods: Forty patients scheduled for TURP were randomly assigned to group F (13.5mg isobaric ropivacaine 0.5% with 25 ug fentanyl) and group M (13.5 mg isobaric ropivacaine 0.5% with 1 mg midazolam). Evaluation of the performance of block, haemodynamics and side effects were recorded. A Minitab macro for MINITAB® Release 14.13 was used for pair-wise comparisons. Friedman’s Test was applied to estimate statistical significance. A P value 0.05 was considered significant. Results: The changes in heart rate, systolic and diastolic blood pressures were not found to significantly differ between the groups but intragroup differences were statistically very significant in both groups. The time to onset of block was same in both groups but midazolam( 15min) took a longer time to fix than fentanyl (10min). Subsequently, higher levels of block were noticed with midazolam. The time to achieve T10 block (P=0.93) and quality of motor block (P=0.81) were comparable between the two groups. Conclusions: Spinal anaesthesia with isobaric ropivacaine and fentanyl or midazolam provides an adequate sensory and motor blockade for elderly patients undergoing TURP.

Introduction: Trigeminal neuralgia (TGN), is a neurological condition affecting the sensory division of the fifth cranial (i.e., trigeminal) nerve and is characterized by recurrent episodes of severe, shock-like pain confined to the distribution of one or more of the nerve’s three branches. TGN is characterized by sharp, shooting, ‘electric shock-like’ pain sensation that is limited to one or more branches of the trigeminal nerve. Medical line of treatment consists of oral carbamazepine as the main and most effective first line of treatment. Microvascular decompression (MVD) with craniotomy is a surgical procedure with having excellent results. Radiofrequency ablation [7-11] of one or more branches of trigeminal nerve at Gasserian ganglion is one of the best minimally invasive treatment with equally effective as MVD. Its day care procedure performed under light sedation and local anesthesia. Aim and Objectives: The study was aimed to evaluate the efficacy of single radiofrequency thermocoagualtion (RFT) and objective to compare the success rates and its complications. Materials and Methods: A total number of 56 patients with trigeminal neuralgia, of age ranging from 50 to 75 years of age attending the pain clinic during June 2011 to December 2016 were studied. The conventional radiofrequency current was used for ablation at Gasserian ganglion. The patients were followed for first, third and fifth year after procedure. Results: The mean age of patients was 56 ± 4yrs. Patients with single branch involvement were 35 (62.5%) and patients having three branches involved were 06 (10.71%). Excellent pain relief was achieved in 53 (94.64%) patients at the end of the first year follow, 50 (89.28%) patients had pain relief at the end of 3 years and 46 (82.14%) patients had pain relief at the end of 5 years. Out of the 10 (10%) patients those had pain recurrence: 7 (70%) patients had medical treatment to control pain satisfactory and 3 (30%) patients underwent additional surgery, including repeat RFT. Total 13(23.21%) patients had different degrees of facial numbness immediately after RFT; that disappeared gradually on follow. While 9(16.07%) patients experienced mastication difficulties that improved during the follow-up and 8(14.28%) patients had headache. Conclusion: It was concluded that RFT is a safe and effective procedure for TN patients. Facial numbness should be considered as an expected side effect rather than an unexpected complication. Patients who have pain in all 3 trigeminal divisions and patients who desire no facial numbness should be cautious. Medical therapy remains the first line in the treatment of TN.

Background and aim: The studies on effects of amiodarone and diltiazem, on conversion of atrial fibrillation (AF) to normal sinus rhythm (NSR) in patients of rheumatic heart disease (RHD) with AF undergoing valve replacement surgery are very less. In this study, we compared the effect of amiodarone and diltiazem on conversion of AF to NSR. Methods: Seventy five patients of RHD with chronic AF undergoing valve replacement surgery were randomly assigned into three groups(each contained 25 patients). In group C normal saline was given. In group A, injection amiodarone 3mg/kg, IV given over 10 minute before skin incision followed by continuous infusion at 0.3mg/kg/h till the end of surgery. In group D injection diltiazem 0.25mg/kg, IV over 10 minute followed by continuous infusion at 0.1mg/kg/h till the end of surgery. Results: The percentage of patients converted to NSR at aortic declamping was not significantly different in amiodarone and diltiazem group: 80% in amiodarone and 92% in diltiazem group. The conversion to NSR in control group was 28% and the difference was significant when compared to amiodarone (p=0.00) and diltiazem (p=0.00) group. The patients required DC shock in diltiazem group (4%) were significantly less as compare to amiodarone (28%, p=0.02) and control (44%, p=0.00) group. Conclusion: Amiodarone and diltiazem both are equally effective and safe to convert AF to SR. Diltiazem is better than amiodarone to reduce the requirement of defibrillation.

Comparative efficacy of general anesthesia versus spinal anesthesia for laparoscopic cholecystectomy. Objective: The aim was to compare general anaesthesia and spinal anesthesia in patients undergoing cholecystectomy evaluating intraoperative hemodynamic parameters, Post Operative analgesic and side effects. Method: A double blind study was conducted on 50 ASA grade I, II and III patients who received spinal anesthesia in group 1 (N=25) and general anesthesia in group II (N=25). Assessment of the block, vital monitoring and complications were noted. Results: No significant differences were observed in both the groups hypotension, bradycardia were more frequent in patients those who underwent spinal anesthesia. Satisfaction was similar in both groups. Conclusion: General Anesthesia is a better choice for laparoscopic cholecystectomy. Nevertheless in respiratory compromised patients, Spinal Anesthesia is a better choice.

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