Indian Journal of Anesthesia and Analgesia

Neurofibroma is a multi-systemic disorder which may produce considerable challenges in airway management by way of facial asymmetry, macroglossia, parapharyngeal tumors and neurofibromas of pharynx and larynx. Anaesthetic management may further be complicated due to concomitant kyphoscoliosis, sensitivity to neuromuscular blockers and hypertension. We report the case of a 50 year old female, known case of neurofibromatosis, who was posted for open reduction and internal fixation for fracture neck of femur. Patient was planned for General Anesthesia due to multiple neurofibromas over the back and kyphoscoliosis which precluded the use of spinal anesthesia.

A 3 year old male child, with 13 kg body weight, referred from a peripheral hospital with suspected foreign body (FB) bronchus. Chest radiograph from that hospital showed absentairo-gram below right bronchus and hyper-inflated left lung, but foreign body could not be seen. Rigid bronchoscopy was performed in emergency theatre under general anaesthesia, with resistance in passing the scopethrough the glottis. The foreign body was difficult to remove after multiple attempts and finally it was removed by the tracheotomy as a life-saving procedure followed by tracheostomy. This patient required an unplanned ICU admission for one day and later shifted to high dependency and then to the ward and he is doing well.

Background: The synergism between epidural local anaesthetics and opioids is well established but studies regarding combination of local anaesthetic with Dexmedetomidine as a continuous infusion for epidural analgesia are very few. This study compares the effectiveness of epidural infusion of Ropivacaine with Dexmedetomidine and Ropivacaine with Fentanyl for postoperative analgesia in lower limb vascular surgerieswith respect to the Quality of analgesia, Motor block, Sedation, Patient satisfaction, Hemodynamic effects and Adverse effects if any. Methods: Sixty patients scheduled for lower limb vascular surgeries between 18-70yrs of ASA 1, 2, 3 were prospectively randomized by computer generated method into 2 groups of 30 each. Group 1: Ropivacaine + Fentanyl . Group 2: Ropivacaine + Dexmedetomidine. Ethics committee approval was granted and patients consent was taken. Data was analyzed with the help of Chi-square test and SPSS software version 21.0. Epidural catheter was inserted at the start of surgery and used for both anaesthesia and postoperative analgesia. 0.75% Ropivacaine 3- 4mg/kg was administered as a bolus dose at the start of surgery for anaesthesia. After the surgery, patient was shifted to the recovery room. 3 hours after the elapse of the bolus Ropivacaine dose, a continuous infusion of 0.1% Ropivacaine + 0.04micrograms (mcg)/kilograms (kg)/hour (hr) of Dexmedetomidine or 0.1% Ropivacaine + 0.2mcg/kg/hour Fentanyl for 48 hours at the rate of 4millilitres (ml)/hour was started through the epidural catheter. The patient was assessed at regular intervals for 48 hours. Results: There was no statistically significant difference between the two groups in terms of VAS at rest and on movements, Motor blockade, sedation, hemodynamics , Patient satisfaction (p > 0.05). There was no adverse adverse effect in any patient. Conclusion: Dexmedetomidine as an adjuvant to Ropivacaineprovides good postoperative analgesia, stable hemodynamics, no unwarranted motor blockade and minimal sedation without any adverse effects. This is comparable to Fentanyl.

Introduction: Regional anesthesia Is becoming an increasing important aspect of anesthesia practice. Aims and Objectives: To Study efficacy of conscious sedation using Midazolam plus Fentanyl versus Midazolam plus Propofol during regional Anaesthesia. Methodology: We conducted a comparative study of conscious sedation using midazolam with fentanyl in group- I vs. midazolam with propofol in group-II. In the department of anesthesia at Dr.V.M. Govt. Medical college In the period between January 2005 to December 2005. 60 patients of ASA Grade I, II, & III, were randomly divided in two groups, 30 in each group, of between 15 to 60 years of either sex undergoing any surgery under regional anesthesia. The statistical analysis was done by unpaired t-test and Chi -square test calculated by SPSS software version 19. Result: Recovery at the end of surgery. In Group II (Midazolam+propofol) 83% of patient were calm and quiet while 40% Group I (Midazolam + Fentanyl). In group II, 7% of patients were asleep, arousable and in Group I, 33% of patients were asleep, arousable. Recovery at end of surgery is highly statistically significant, in group II. There was significantly less number of recall of events in Group II (Midazolam +propofol) Preoperative and intraoperative events, than Group I (Midazolam+Fentanyl). Conclusion: It can be concluded from our study that Midazolam plus Propofol was found superior to Midazolam plus Fentanyl in terms of smooth and early recovery at the end of surgery and less number of recall of events.

Preoperative anesthesia assessment visit (PAC) can be used as a golden opportunity for counseling of the patient posted for elective surgery, its effects are time-tested on better perioperative recovery. Aims: To assess anxiety level and its effects in perioperative period in patients undergoing surgeries under General Anesthesia, secondly to assess postoperative recovery status with respect to cooperation, sedative and analgesic requirement, and finally to assess effect of counseling on final postoperative recovery status. Settings and Design: PAC clinic of Chirayu Medical College and Hopital. Methods and Material: Sixty ASA grade 1/2 patients, age group 18-60 years, were randomized to 2 groups: study group receiving detailed anesthesia and surgery counseling during preanesthesia check-up (PAC) one day prior and on the day of surgery. Control group undergo through conventional method of counseling one day prior to surgery. Study group will be given verbal and written advice on anaesthetic and medical risk as part of the informed consent for anesthesia. Protocol of anesthesia will be same in both the groups. Both groups were given APAIS questionnaire at time of PAC, reassessed in immediate preoperative period. VAS along with vital parameters were recorded at PAC time and again in immediate preoperative period, and then in immediately post extubation and then after every 15 mins till 2hrs in recovery room. Patient’s anxiety in postoperative period was assessed with APAIS after 12 & 24 hrs. Modified Aldrete Score was used to assess overall recovery of patients. Statistical analysis used: Statistical analysis was done using ‘unpaired t test’ with p value<0.005 as significant, after calculating standard deviation (SD) and mean value of different parameters. Results: The level of anxiety was significantly low in study group as compared to control group in immediate preoperative as well as postoperative periods at various time intervals, as assessed by APAIS & VAS, though both scores were lower in both groups in postoperative periods as compared to PAC time. In both groups, difference in vital parameters, that is, pulse rate, blood pressue, SpO2, was insignificant, at various time durations, although the decrease in pulse rate from the time of PAC to postoperative period was more in study group. Aldrete score of 10 (out of 10) was achieved earlier in study group (p statistically significant) than in control group. Conclusions: This study shows that a proper elaborative verbal and written counseling at time of preanesthesia check up can alleviate patients’ anxiety or stress, resulting in decreased morbidity and better outcome.

Backgrounds and Objectives: Supraclavicular Brachial plexus block provides safe,effective,low cost anaesthesia with excellent post operative analgesia . The current study was an attempt to compare Bupivacaine 0.5% with Bupivacaine 0.5% plus Clionidine 2mcg/kg in supraclavicular brachial plexus block with respect to Onset time and Duration of Sensory blockade, Duration of Analgesia, Side effects. Materials and Methods: Present study was carried out in the Department of Anaesthesiology and critical care, MVJ Medical College and RH, Bangalore from December 2014 to July 2016. Each patient was randomly allocated to one of the two groups of 50 patients each. Bupivacaine Group (A): Receives 30ml Bupivacaine 0.5% and 1ml of normal saline Clonidine Group (B): Receives 30 ml Bupivacaine 0.5% and clonidine 2mcg/kg in 1ml saline. Parameters: The effect was studied with respect to Onset time and Duration of Sensory and Motor blockade, Duration of Analgesia and Side-effects. Results: Onset of Sensory block: In our study, we observed that onset of sensory block was earlier in Clonidine group (Group B) having a mean value 7.20±1.95 minutes in comparision with Bupivacaine group (Group A) having a mean value of 17.63±3.25 minutes which is statistically significant. Onset of Motor block: In our study, we observed that onset of Motor block was earlier in Clonidine group (Group B) having a mean value of 9.87±2.60 minutes in comparision with Bupivacaine group ( Group A) having a mean value of 20.57±2.92 minutes which is statistically significant . Duration of Sensory block : The Duration of sensory block was 359.00±60.53 minutes with Bupivacaine group (Group A) and 552.67±32.05 minutes with Clonidine group (Group B). The duration of sensory block was longer in Clonidine group compared with Bupivacaine group, which is statistically significant. Duration of Motor block: The Duration of Motor block was 390.00±55.52 minutes with Bupivacaine group (GroupA) and 597.33±27.91 minutes with Clonidine group (Group B). The duration of Motor block was longer in Clonidine group compared with Bupivaine group, which is statistically significant. Duration of Analgesia the Duration of Analgesia was minutes with 361.67±59.77 Bupivacaine group (GroupA) and 563.67±33.16 minutes with Clonidine group (Group B). The duration of Analgesia was longer in Clonidine group compared with Bupivaine group, which is statistically significant. Variations in Heart rate, Blood pressure, SpO2, Respiratory rate were statistically not significant in both the groups. No patient in our study developed any significant side effects. Conclusion: Addition of 2mcg/kg of Clonidine to Bupivacaine 0.5% has Early onset of Sensory blockade, Early onset of Motor blockade, Prolonged Duration of Sensory blockade Prolonged Duration of Motor blockade, Prolonged Duration of Analgesia when compared to Bupivacaine 0.5% at equal volumes. Both the groups maintain stable Hemodynamic profile Perioperatively and are devoid of any Side effects at the concentration and volumes used for the study.

Aims: This study was done to determine the efficacy of melatonin as a pre-operative anxiolytic and to compare the effect of two different doses of melatonin for the same. Settings and Design: This is a randomised double blinded study. Methods and Material: 90 patientsundergoing elective surgery under general anesthesia were enrolled in the study. They were randomised to three groups using a computer generated random number table. They received the study drugs (either placebo, tab. Melatonin 3mg, or tab Melatonin 6mg) placed in identical opaque envelopes. Anxiety was assessed using the VAS anxiety scale and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Heart rate and blood pressure were measured as the physiological markers of anxiety. Sedation was assessed with the Ramsay Sedation Scale. All these values were recorded before and 60- 90 min after administration of the study drugs. Haemodynamics were also recorded 1 min after intubation. Statistical Analysis Used: One-way ANOVA was used for intergroup comparisons of normally distributed data. For comparison of beforeafter data within a group, students t- test was used. For comparing binomial data like sex and ASA status, the Chi square test was used. Results: Anxiety and sedation scores were found to be significantly reduced in patients receiving melatonin 3mg or 6mg, compared to those receiving placebo. Patients receiving melatonin also had lower heart rate and blood pressure after medication and also 1min after intubation. Conclusions: We conclude that oralmelatonin is effective for pre-operative anxiolysis in adult patients and a dose of 3mg is adequate for anxiolysis.

Background: Paediatric epidural anaesthesia (PEA) is very safe and effective and in combination withGeneral anaesthesia (GA) offers the advantages of reduced GA drugs, stable haemodynamics and excellent analgesia extended into the post-operative period. Aims: To evaluate the efficacy of GA+PEA in comparison to GA with regard to (i) Haemodynamic parameters (ii) dose requirement of Neuromuscular Blocking Agents (NMB) (iii) Quality of surgical relaxation. Material and Methods: 80 children of ASA statusI & II (2 to 12 yrs), scheduled for elective surgeries were randomly assigned to GA or GA+PEA groups. Both the groups received routine GA. In GA+PEA, an epidural catheter was inserted and Bupivacaine 0.25% was administered intraoperatively. Haemodynamic parameters, doses of NMB and quality of surgical relaxation (graded by surgeon) were recorded. Statistical Analysis: Chi-square test, student-t test and repeated measures ANOVA test were used to analyse categorical, demographic and haemodynamic parameters respectively. A p-value<0.05 was considered significant. Results: Rise in heart rate (HR) and mean arterial pressure (MAP) from base-line was significantly lower in GA+PEA with p value of 0.017 and <0.001 respectively. Doses of NMB agents required in GA+PEA were significantly lower with p value <0.001. The grading of quality of surgical relaxation was same in both the groups. Conclusion: GA+PEA is more favourable for patients with regard to stable haemodynamics, reduced requirement of NMB agents with equally good surgical relaxation when compared to GA alone.

Background and Objectives: Caudal epidural analgesia is most popular and commonly performed regional blocks in paediatric anaesthesia.To prolongpost operative analgesia local anesthetics have to be combined with adjuvants. Adjuvants like narcotics, alpha-2 agonists, epinephrine, tramadol, neostigmine, and s-ketamine have been studied. Of these clonidine and tramadol are drugs with minimal side effects. Hence study performed with the primary objective being, comparing the two drugs when combined with bupivacaine regarding prolongation of the post operative analgesia Methods: The study was conducted among Ninety children in the age group of 2 to 8 years posted for elective sub-umbilical surgical procedures lasting less than one hour, after obtaining ethical committee clearance.They were divided into 3 groups, 30 each. Group C received 0.5ml/kg of 0.25% Bupivacaine with 0.1ml/kg of normalsaline, Group BC 0.5ml/kg of 0.25% Bupivacaine with 1g/kg of Clonidine(0.1ml/kg) and Group BT 0.5ml/kg of 0.25% Bupivacaine with 1mg/kg of tramadol (0.1ml/kg). The various parameters studied were duration of post operative analgesia, haemodynamic changes and incidence of side-effects. Results: The mean duration of analgesia was 539.83±19.32 minutes inclonidine group which was significantly longer than 412.00±26.05 minutes in tramadol group. The requirement of rescue analgesic was also lesser in theclonidine group. Incidence of post-operative nausea andvomiting was slightly higher in the tramadol group. Conclusion: Addition of clonidine in the dose of 1g/kg andtramadol 1 mg/kg to 0.25% bupivacaine (0.5ml/kg) increased the duration of postoperativeanalgesia and clonidine provided a longer durationwith lesssideeffects than tramadol.

Introduction: Lignocaine with adrenaline is used in oral surgical procedures widely. Catecholamines have a significant role in increasing haemodyanmic parameters like blood pressure, blood glucose level and pulse rate. In this sudy we study the effect of lignocaine with adrenaline on blood pressure and pulse rate. Material and Methods: A comparative double blind study was designed on 40 healthy males and females who needed extraction of tooth. In 20 patients only lignocaine was used and in other 20 subjects lignocaine was added with adrenaline. The changes in blood pressure were recorded after injection in the both the groups. Results: There was increase in variables like mean systolic and diastolic blood pressure and heart rate in patients where adrenaline was used with lignocaine where as there was decrease in the same variables in the patients in whom only lignocaine was used. However, the results weren’t stastically significant. Conclusion: There is change in heamodyanmic variables in patients in whom lignocaine with adrenaline was used; however the use of adrenaline doesn’t bring any significant change in studied variables.

Keywords: Adrenaline; Blood Pressure; Pulse Rate. 

Aim: To evaluate the effect of ropivacaine versus Dexmedetomidine and ropivacaine in epidural anaesthesia in lower abdominal surgeries. Materials and Methods: This study is a prospective double blinded randomized study which was carried out on 100 patients who were admitted in Department of Anaesthesia in Government Medical College Gulbarga & ESIC Medical College, Gulbarga, Karnataka. This study was conducted in the period of 2014 to 2017. Patients were randomly divided in to two groups each of 50 each, which were Group A in which ropivacaine and normal saline were administered, Group B in which ropivacaine and dexmedetomidine were administered. Results: There was no statistical significant variation between the two groups with respect to age, height, weight and ASA I/II grading (p>0.05). The mean onset of analgesia in group A was 11.33±1.89, in group B was 8.99±0.97, the mean time to attain maximum sensory level was 15.00±1.45 in group A and in group B, it was 12.58±2.58, the mean time for complete motor block was 20.41±1.47 in group A and in group B it was 15.22±2.89. Mean time to two segment regression was 95.85±5.48 in group A and in group B it was 161.59±9.87, mean duration of analgesia was 201.25±4.26 in group A and in group B it was 290.87±8.99 and mean time to complete recovery of motor block was 133.49±5.87 in group A and in group B it was 214.21±4.25. Sedation score of 1 was observed in 12% patients in Group A, whereas in group B, 50% patients showed a score of 1 and 50% patients showed a score of 2. The sedation was more in group B compared to group A. Side effects are significantly more in group B compared to group A. (p=0.001). Conclusion: The onset of action, better analgesic effect with dexmedetomidine is fastened with the addition of alpha 2 agonists and incidence of side effects insignificantly.

Aim: The aim of this study was primarily to compare the efficacy of single pre operative dose of oral pregabalin versus oral clonidine in attenuation of pressor response to direct laryngoscopy and intubation and on the intra operative haemodynamic stability in patients undergoing elective lumbar spine surgery. The secondary outcome was to evaluate the intra operative opioid consumption in both the drug groups. Background: Direct laryngoscopy and intubation are painful stimuli which cause reflex sympathetic nervous system stimulation resulting in untoward haemodynamic response. This study compares the effect of single oral pre-operative dose of clonidine versus oral pregabalin in attenuation of the pressor response to direct laryngoscopy and intubation and the intra-operative haemodynamics in patients undergoing lumbar spine surgery. Materials & Methods: This randomized double blinded trial was conducted in our tertiary care hospital. After obtaining informed written consent, sixty adult patients belonging to ASA I and ASA II undergoing elective lumbar spine surgery under general anaesthesia were randomly divided into two groups of thirty each. Group C received 100 g of oral clonidine and Group P received 150 mg of oral pregabalin ninety minutes prior to induction of anaesthesia. Systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR) were measured at three time points; baseline ( 3 min before induction),just before laryngoscopy, 1, 3, 5, 10 and 15 min after intubation.The intra operative haemodynamics and fentanyl consumption was recorded for all patients. Statistical analysis was done using students’t test and chi square test. Results: Both drugs attenuated the haemodynamic pressor response associated with laryngoscopy and endotracheal intubation. The reduction in SBP, DBP, and MAP was comparable in both groups but the tachycardia was attenuated significantly in the clonidine group (P value< 0.05). The intra operative fentanyl consumption was lesser in the clonidine group than the pregabalin group (P value=0.0069). Conclusions: Oral pregabalin and clonidine successfully attenuated the pressor response to direct laryngoscopy and intubation. No adverse effects were observed with the doses used in our study. The intraoperative analgesic consumption was less in both the groups.

Keywords: Clonidine; Lumbar Spine Surgery; Pregabalin; Premedication; Pressor Response. 

Backround and Aims: Mastoid surgery can be performed under general anaesthesia (GA) or sedation both combined with regional anaesthesia ((RA). There are very few studies comparing both the techniques. Dexmedetomidine is the sedative agent of choice in modern era. Our primary aim was comparison of haemodynamic variation and bleeding under GA or sedation with dexmedetomidine and secondary being, adequacy of sedation and patient comfort under dexmeditomedine sedation, post operative analgesia and duration of stay in post anaesthesia care unit. Methods: 60 patients posted for mastoidectomy were randomly divided into two equal groups, GA or sedation. In GA after conventional technique of induction and intubation, anaesthesia was maintained with oxygen, nitrous oxide, isoflurane and propofol infusion. In sedation group dexmedetomidine 1 g/kg was given over ten minutes followed by infusion at rate 0.2-0.8 g/kg/hr. RA was given in both the groups. Intraoperative parameters were noted in both the groups. Statistical software version SPSS 19 was used. Results: Heart rate was lower in sedation group throughout surgery. Bleeding was less in both groups. None of the patients in sedation group were converted to GA. Maximum patients had discomfort to noise and neck position. Shifting of patients was earlier with sedation than in GA. There was longer post operative analgesia with dexmedetomidine sedation. Conclusion: Dexmedetomidine sedation with regional anaesthesia can also be a better choice for mastoid surgery. It maintains haemodynamic stability, minimal bleeding, adequate sedation and patient comfort. It also aids early ambulation of patients and has perioperative analgesic action.

Background: The introduction of adjuvants, have decreased the dose requirement of local anaesthetics, increased their onset of action, prolonged their action and improved the analgesia. Aim: To compare Clonidine and Dexmedetomidine as an adjuvant with Bupivacaine in epidural anaesthesia Material and Methods: 90 patients of either sex, between 18 to 65 years of age and belonging to ASA Grade I & II physical status were divided into 3 groups with 30 patients each. Group 1: 20ml 0.5% plain bupivacaine + 0.5ml saline (preservative free), Group 2: 20ml 0.5% plain bupivacaine + 2µg/kg clonidine, Group 3: 20ml 0.5%plain bupivacaine + 1 µg/kg dexmedetomidine. Statistical analysis was done using the statistical package(SPSS 15.0 evaluation version). Continuous co-varieties were compared using analysis of variance (ANOVA). The qualitative data comparison were studied using the Chi-squares test. Result: Time of sensory onset to T-10 in group 1 was 10.02±2.6 min, in group 2 was 9.82±3.10 min, and in group 3 was 7.10±2.10 min.The time of motor block onset to bromage 3 in group 1 was 20.36±34 min, in group 2 was 17.80±4.08 and in group 3 was 14.50±5.18 minutes. The time of motor block regression to bromage 0 in group 1 was 152 ± 12.2 minutes, in group 2 was 226.42±26.17 and in group 3 was 248.70±28.40 minutes. The incidence of side-effects was statistically non significant. Conclusion: Clonidine and dexmedetomidine are good alternatives to opioids as adjuvant to bupivacaine in epidural anaesthesia.

Context: Transversusabdominis plane block (TAP) has emerged as a simple, safe technique for post-operative analgesia in lower abdominal surgeries for adults. Its superiority over the most preferred caudal block in paediatric surgeries is unclear. Aims: To evaluate the efficacy of the Ultrasound (USG) guided -TAP block in comparison with the Caudal Block, for pain relief in paediatricinguinal herniotomies. Settings and Design: After obtaining institutional ethical committee approval, a Randomised Control Trial was conducted in 60 children,undergoing elective unilateral inguinal herniotomy in our tertiary care hospital. Methods and Material: Childrenof age 1 7years, weighing 5-20kg of ASA I/II were randomly allocated into two groups after obtaining parental consent.Group T received USG-guided TAP block (0.5ml/kg of 0.25% bupivacaine) and Group C received Caudal block (1ml/kg of 0.25% bupivacaine). The intra-operative hemodynamics and analgesic requirement were recorded. Pain in the post-operative period was assessed using FLACC pain score. Time to first rescue analgesia, cumulative opioid consumption, along with the incidence of side effects were noted in the first 12hrs of the post operative period. Statistical analysis was performed using SPSSv16. Results: The duration of postoperative analgesia in Group T (8.6hrs±1.84), was significantly more than that of Group C, (4.57hrs±1.406). The pain scores and the mean opioid consumption were significantly less with Group T. Time to urine voiding was prolonged in Group C. Conclusions: ThoughCaudal block provided better intra-operative analgesia; the duration of post operative analgesia was longer with USG-guided TAP block for pediatric inguinal herniotomy.

Background: Intrathecal Buprenorphine is an adjuvant to spinal anaesthesia offers the advantage of providing good analgesia, but is associated postoperative nausea and vomiting. Dexamethasone is a potent steroid and has good antiemetic effect. The aim of this randomized controlled trial was to compare the antiemetic efficacy of dexamethasone 4 and 8mg. Methods: 180 patients of either sex undergoing elective lower extremities and infra umbilical surgeries were included in the study. The patients in group D0, D4 and D8 received 5ml normal saline, 4 mg and 8mg dexamethasone respectively before spinal anaesthesia. Spinal anaesthesia was established with a single bolus of 0.5% hyperbaric bupivacaine 15 mg and buprenorphine 60mcg. The primary end point of this study was the total nausea and vomiting rate for 8 hours post spinal anaesthesia. The secondary end points were the incidence of nausea, vomiting and the occurrence of adverse events like pruritis. Statistical Analysis: The incidence of nausea, vomiting and pruritus was analyzed using a series of 3×2 2 tests. Results: Demographic profile was similar between the groups. The incidence of nausea was 16% in group D0 and was 5% in the groupD4 and D8. The incidence of vomiting was 5%, 3.3%and 1.7% in the D0, D4 and D8 groups respectively. The incidence of nausea and vomiting was not very different in the D4 and D8 groups. Conclusions: Both doses of prophylactic dexamethasone 4/8 mg significantly reduces the nausea and vomiting associated with intrathecal Buprenorphine. A dose of 4mg of dexamethasone is as efficacious as 8mg.

Background: Sevoflurane, a halogenated volatile anesthetic agent and premedication with fentanyl and midazolam are both helpful in deepening the plane of anaesthesia. When used in synergism, these can aid in a smooth laryngeal mask airway (LMA) insertion. Materials and Methods: 80 patients of ASA I and II status, posted for minor elective surgery were randomized in a double-blind study to compare the conditions for LMA insertion following premedication with fentanyl 0.6µg/kg and midazolam 9µg/kg with Sevoflurane (Group I) and Sevoflurane alone (Group II). The time to loss of eye reflex, time for LMA insertion, ease of LMA insertion was noted and hemodynamic variables (heart rate, mean arterial blood pressure) were recorded prior to induction of anaesthesia, prior to LMA insertion and every minute after LMA insertion for 5 minutes. Secondary outcomes included evaluation of adverse effects in two groups. Results: The groups were comparable with respect to the demographic profile and baseline parameters. The time to loss of eye reflex as well as time taken for insertion of LMA was significantly lower in the study group as compared to the control group (p<0.001). The composite scoring system (comprising Jaw opening, ease of insertion, coughing, gagging, laryngospasm, movement at insertion) was higher in the study group, demonstrating better LMA insertion conditions in the study group as compared to control group, even though it is not statistically significant. Adverse effects like apnea, movement, cough, nausea, shivering were comparable in both the groups. Conclusion: Addition of low dose fentanyl and midazolam intravenously preceding vital capacity induction with Sevoflurane 8% in O2 6l/min provides better conditions for LMA insertion with insignificant hemodynamic effects.

Background: Supraclavicular brachial plexus block is a good alternative to general anaesthesia for upper limb surgery below shoulder as it avoids the untoward effects of general anaesthesia. Block when given only with local anaesthetic can’t prolong postoperative analgesia. Presence of opioid receptors in the peripheral nervous system allows us to use various opioids as an adjuvant to achieve prolong postoperative analgesia. This study was done to compare tramadol and buprenorphine as an adjuvant to 0.35% bupivacaine in supraclavicular brachial plexus block in terms of efficacy and safety. Methods: A prospective, randomized study was done in 80 patients of American Society of Anaesthesiologist (ASA) class I and II undergoing elective upper limb orthopedic surgeries under supraclavicular block. Patients were randomized into two groups of 40 each. Group BPatients received inj. bupivacine 0.35%, 2mg/kg + inj. buprenorphine 6g/kg. while in group T- Patients received inj. bupivacine 0.35% 2mg/kg+ inj. tramadol 2 mg/kg. Onset and duration of sensory and motor block, duration of postoperative analgesia and adverse effects of study drugs were compared in both the groups. Results: Sensory and motor block onset times were shorter in group B than in group T (p < 0.05). Motor block duration was longer in group B than in group T (p < 0.05).Similarly, duration of analgesia was longer in group B compared to group T (942.83±124.51 min vs 478.31±52.60 min) (p<0.001). Conclusion: Buprenorphine when added to bupivacaine in supraclavicular block shortened the onset of sensory and motor block, enhances the duration of motor block and duration of analgesia compared to tramadol without significant side effects.

Introduction: Sedation & Analgesia are generally taken as one entity in intensive care unit and disproportionate use of sedative is associated with adverse outcomes including patients restlessness, excessive sedation, longer ICU (intensive care unit) and hospital stay, an increased incidence of ventilator-associated pneumonia and greater hospital costs. Pain was considered as the 1st cause of inadequate analgesia/sedation. Dexmedetomidine possesses anxiolytic, hypnotic, analgesic and easy arousability properties. Aim of the study: was to compare the effectiveness of sedation with Dexmedetomidine and midazolam in critically ill patients admitted in ICU and their haemodynamic and respiratory parameter. Methods: The patients were randomly divided into two groups, 20 in each group. Group A receive loading dose of dexmedetomidine 1µg/kg body weight over 10 minutes followed by 0.2 to 0.7 µg/kg/hr of maintenance infusion dose. Group B receives Intravenous midazolam with loading dose of 0.05 mg/kg body weight; followed by 0.05 to 0.1 mg/kg/hr of maintenance dose. Analgesia with tramadol bolus doses 1 to 2 mg/kg body weight was given as per need. Observation: Heart rate (HR), Mean arterial pressure (MAP), Oxygen saturation (SPO2), Respiratory rate (RR), Quality of sedation using Ramsay sedation score (RSS). Result: The mean total sedation requirement was 495±185 µg in dexmedetomidine group and 55.7±21.7 mg in midazolam group. The mean hourly dose of sedative was 0.34±0.13 µg/kg/hr in dexmedetomidine group and 0.042±0.017 mg/kg/hr in midazolam group. Conclusion: Dexmedetomidine provide more acceptable sedation compared to midazolam. Patients remained hemodynamically stable in Dexmedetomidine group when compared to midazolam group.

Background: Respiratory physicians are showing interest in using Dexmedetomidine for awake sedation, since, it is safe and useful when the patient is having spontaneous breathing and also cost-effective. We evaluated the safety and efficacy of dexmedetomidine in a small cohort of thirty patients undergoing awake bronchoscopy under topical anaesthesia using 10% Xylocaine. Methods: Premedication was with midazolam and rescue medication was fentanyl. Dexmedetomidine was infused at one g/kg infused over 10 minutes. The bronchoscope was inserted after bolus infusion followed by maintenance infusion of Dexmedetomidine started with 0.2g/kg/h and titrated optionally to 0.7g/kg/h. We recorded the pre- and intraprocedural vital signs and Ramsay sedation score were recorded every 10 minutes, in addition to adverse events, duration of the procedure, use of rescue sedation with fentanyl one g/kg, and physicians and patient’s satisfaction. Patients were discharged as per the modified post anesthetic discharge scoring system. Results: Mean Duration of procedure was 30±10 min. Percentage of patients requiring rescue sedation was 3/30 (10%). 3/30 (10%) of patients had hypotension, 6/30 (20%) had bradycardia and 1/30 (3.3%) had amnesia. The mean time to recovery was 25±10 min. The physician and patient’s satisfaction score (range, 1 to 5) were five and four respectively. Conclusion: Dexmedetomidine alone is safe, provides satisfaction to both doctors and patients, with fewer anticipated and spontaneously recoverable side effects.

Transversus abdominis plane (TAP) block is an abdominal or truncal field block. Its popularity has increased in the recent times, mainly because it’s widespread applicability in several abdominal surgeries and less incidence of complications. The advent of ultrasound (USG) has revolutionised regional anaesthesia, in general and TAP blocks, in particular. There are various types of TAP block which can be utilised in various abdominal surgeries for effective analgesia, especially after caesarean sections. This article aims to elucidate in a pictorial format, the nerves traversing the TAP plane (Figure 1), the nerve supply of the abdominal wall (Figure 2), the various positions of TAP block (Figure 3) and the sono-anatomy of the USG-guided TAP block (Figure 4). The potential of this block is tremendous and can be useful in patients with coagulopathies, where epidural block is contraindicated. With improved accuracy of USG-guidance, the volume of local anaesthetic injected has also been reduced, bringing down the toxicity rates. Various adjuvants can also be added to local anesthetics for improving efficacy and duration of analgesia with TAP blocks. It is an analgesic boon in the era of minimally-invasive surgeries, especially laparoscopic and robotic surgeries.