Indian Journal of Anesthesia and Analgesia

  Palliative care can be provided in acute care settings, hospices, patient’s own homes, ambulatory clinics, etc, and aims to provide dignity, respect, and humble care to the sick with the objective of managing pain, understanding their needs, and emotions, requiring careful understanding and observation skills. Patient’s needs are acknowledged and utmost holistic care is provided with an optimistic attitude and hope. Active listening is an important skill as it enables one to understand what the person is saying and to comprehend their feelings through empathy. Patients develop self­awareness and self­confidence by externalizing their feelings, thoughts, and emotions, thereby leading to a decrease in their emotional discomfort and suffering. This review article describes palliative medicine, narrative palliative medicine, empathic process, and compassion in brief. 

  Objective: The aim of the present study is to compare the effectiveness of intravenously administered Granisetron Metoclopramide and Droperidol in the prevention of postoperative nausea and vomiting in patients undergoing gynaecological Diagnostic laparoscopy under general anaesthesia. Design: The antiemetic efficacy of granisetron, and metoclopramide was assessed in postoperative nausea and vomiting for a period of 24 hours. Duration: December 2016 to November 2017. Setting: Department of Anesthesia, Bhaskar Medical College, Ranga Reddy, Telangana. Participants: A total number of 75 female cases between the age group of 18–35 years belonging to ASA grade I and ASA grade II with primary infertility coming for gynecological diagnostic laparoscopy. Methods: Patients were divided into 3 groups of 25 each. Group A received intravenous granisetron (40mcg/kg), Group B received Metoclopramide (0.2mg/kg) and Group C received droperidol (25mcg/kg) prophylactically for prevention of postoperative nausea and vomiting. The primary end point was the occurrence of PONV. The main outcomes were monitored for study period of 24hours postoperatively. Postoperatively the patients were observed in postoperative ward for 24hours for postoperative nausea, retching and vomiting, headache, sedation, dizziness, allergic reactions, extra pyramidal symptoms. Nausea and vomiting were evaluated on three point ordinal scale (0 = none, 1= nausea, 2 = vomiting/retching), with no distinction between vomiting and retching (i.e. retching was considered a vomiting event). Results: In the early postoperative period (0­4hrs), the incidence of nausea & vomiting was effectively controlled with use of granisetron & droperidol, it was significantly higher in metoclopramide group. In the late postoperative period (4­24hrs), PONV was significantly lower with granisetron and droperidol when compared to metoclopromide (p value <= 0.001). Conclusion: Administration of granisetron preoperatively is superior to metoclopramide and droperidol in long term prevention of PONV following gynecological diagnostic laparoscopy. 

  Objective: To compare the anesthetic efficacy and postoperative analgesia between 0.5% bupivacaine and 2mg dexamethasone and 0.5% bupivacaine alone in peribular block for small incision cataract surgery. Methods: 50 patients were randomized into 2 groups of 25 each to receive peribulbar anesthesia using 0.5% bupivacaine and 2mg dexamethasone in group I and 0.5% bupivacaine alone in group II. The patients were assessed for onset and duration of akinesia and postoperative analgesia. Results: Akinesia was achieved faster (6.32±1.11 mins) in group II when compared to group I (14.12±2.99 mins) which was statistically significant. The duration of akinesia was longer in group I (2.52±0.51 hrs) when compared to group II (1.36±0.40 hrs) which was also significant. The VAS scores were significantly lower at 0, 1, and 2 hrs in group I than in group II. Conclusion: The addition of dexamethasone to bupivacaine in the peribulbar block provided a prolonged duration of akinesia and analgesia with lower VAS scores postoperatively. 

  Context: Spinal anesthesia is considered safe over general anesthesia but has some side effects. To overcome its side effects, it can be given in sitting position and after two minutes patient can be kept in supine position. Aims: To compare the effect of positioning after induction of spinal anesthesia in orthopedic procedures. Settings and design: A Randomized controlled prospective double blind study was undertaken at Shadan Institute of Medical Sciences. Methods and material: 50 patients were divided into two groups of 25 each; group L and group S. Both the group patients were ASA 1 and 2 patients aged between 20 to 40 years, posted for lower limb orthopedic surgery. Group L patients were made supine immediately while group S patients were made supine after two minutes of giving anesthesia. Statistical analysis: Student’s t test was applied to compare the mean values. P value less than 0.05 was taken as statistically significant. Results: Both the groups were comparable in baseline characteristics like age, weight, MAP, SBP, DBP. The vasopressor requirement, lowest SBP and DBP were similar in two groups. Group L patients required more fluids, they had more mean fall of SBP, mean heart rate was more and lowest MAP was more compared to group S patients. These differences were statistically significant (p < 0.05). Conclusion: A 2 minute sitting post spinal anesthesia is a safe, reliable alternative for anesthetic management of orthopedic lower limb fracture surgeries. 

  Objective: To compare the anaesthetic efficacy and postoperative analgesia of 0.75% ropivacaine and 2mg dexamethasone with 0.5% bupivacaine and 2mg dexamethasone in peribulbar block for patients undergoing small incision cataract surgery. Methods: 50 patients were divided into 2 groups of 25 each and were randomized to receive peribulbar anaesthesia using 0.5% bupivacaine and 2mg dexamethasone in group I and 0.75% ropivacaine and 2mg dexamethasone in group II. The patients were compared for the duration of akinesia and postoperative analgesia. Results: Akinesia was achieved slower in group I (14.12±2.99 mins) when compared to group II (8.24± 1.05 mins) which was statistically significant. Group I showed significantly longer postoperative akinesia (2.52±0.51 hours) than group II (0.77±0.12 hours). Also the VAS scores were significantly lower at 1 hour in group I (2.94±0.54) when compared to group II (4.96±0.89). Conclusion: Ropivacaine and dexamethasone showed faster onset of akinesia but bupivacaine and dexamethasone showed prolonged postoperative akinesia, better postoperative analgesia and prolonged time to first recue analgesic. 

  Context: Endotracheal intubation is a routine since the discovery of general anesthesia. Passage of endotracheal tube is not without morbidity, dental damage and sore throat being the commonest and serious complications. An attempt to solve this problem lead to the invention of many oropharyngeal devices. For their successful placement in the larynx, the technique of insertion along with proper insertion conditions­ plane of anesthesia and no response from patient are required. Aims: To assess patients response for laryngeal mask airway insertion while maintaining hemodynamic stability using appropriate dose of induction agent. Settings and Design: A comparative randomised prospective double blind controlled study. Methods and Material: Sixty patients who underwent surgery under general anesthesia with laryngeal mask airway were randomized and divided into three groups (20 in each group): Group NS­patients receiving Etomidate plus normal saline, Group S1­patients receiving Etomidate plus 0.25mg/kg Suxamethonium, Group S2­ patients receiving Etomidate plus 0.5mg/kg Suxamethonium. We compared parameters like heart rate, mean arterial pressure and response from patient while inserting laryngeal mask airway ­ jaw relaxation, coughing, gagging, swallowing, movement of head and limbs, laryngospasm; among all three groups. Statistical analysis used: Pearson ChiSquare test to compare success rate between the groups for all the parameters assessed. Variables were analysed using One way ANNOVA test. Results: Low dose of Suxamethonium when combined with Etomidate provides better conditions for laryngeal mask airway insertion than etomidate alone. Conclusions: Intravenous 0.5mg/kg Suxamethonium produces better insertion conditions for Laryngeal Mask Airway than intravenous 0.25mg/kg Suxamethonium. 

  Background: Laparoscopy is now preferred because of various advantages such as reduced post operative pain, faster recovery and shorter hospital stays. It is associated with pneumoperitoneum, variations in patient positioning, and stress response leading to various haemodynamic changes. Various anaesthetic interventions like epidural, combined epidural and general anaesthesia, and pharmacologic interventions like nitroglycerine, esmolol have been used. Aims and objectives: To evaluate and compare the effects of oral clonidine v/s placebo in obtunding haemodynamic response to laryngoscopy, intubation and pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Postoperative sedation and other side effects were also observed. Materials and Methods: Patients were randomized into two groups­ Group C: 150 mcg of clonidine. Group P: Vitamin – C tablets 500mg, each receiving drugs orally 90 minutes before induction. Effect of oral clonidine in obtunding hemodynamic response and post operative sedation were monitored. Result: No significant difference was observed in mean age, gender and preoperative vital parameters (p>0.05). Significant difference in Heart rate, SBP, DBP, MAP after intubation, during incision, starting and release of pneumoperitoneum between the two Groups (p<0.05). Post­operatively patients in group C were sedated but aurosable as compared to Group P. Conclusion: Premedication with 150 mcg of oral clonidine is safe and improves perioperative haemodynamic stability and reduces postoperative sedation, nausea and vomiting in patients undergoing laparoscopic cholecystectomy. 

  Low back pain is a leading cause of disability and the commonest cause is intervertebral disc degeneration. We decide to compare the efficacy and safety of transforaminal epidural triamcinolone with or without local anaesthetic in the patients of Lumbar Disc Herniation for pain relief. Patients of low back pain with unilateral radiating pain not benefited by 6 weeks of conservative analgesia, having lumbar disc prolapse on X­ray and one­two level compression on MRI were included in the study. They divided into 2 groups; Group I receive fluoroscopic guided triamcinolone with bupivacaine, while Group II received Triamcinolone with normal saline. The patients were observed for improvement in VAS, ODI and at 3 weeks, 6 weeks and 9 weeks and analgesic intake after 9 weeks. The results showed improvement in VAS and ODI in both the groups but improvement was more in group I (p<0.05). Analgesic intake was also decrease in both the groups but more in Group I. We conclude fluoroscopic guided transforaminally injected triamcinolone is effective modality of treatment in lumbar disc degeneration patients. Its efficacy is improved by adding local anaesthetic with steroid. 

  Background: The pre anesthetic medication forms an integral part of anesthetic management. Some form of premedication is almost universally given before induction of anesthesia. In ancient days both wine and opium were given to lessen the fear of surgery. Objective: To assess the Compliance and Sedation Score of Intranasal Midazolam and dexmedetomedine Premedication among Children between 1 to 5 years of age. Methodology: A longitudinal study was conducted from June 2012 to December 2012 at Department of Anesthesiology of Shri M.P. Shah Medical College, Jamnagar, Gujarat. A total of 30 Cases were selected based on age sex matched with each group for the purpose of the study randomly as per the computer generated random Numbers. Group 1 received intranasal midazolam spray and Group 2 was given intranasal dexmedetomedine. Results: The sedation score was found to be statistically significant at 30 and 45 min post induction. Postoperative recovery score at 30 min was found to statistically highly significant with suggested that postoperative recovery score was better in group 1 as compared to group 2. Conclusion: Intranasal dexmedetomidine spray better sedative condition, response to IV cannulation, separation and induction as compared to intranasal midazolam in majority of patients. This study concludes that intranasal dexmedetomedine is better than intranasal midazolam as premedication in pediatric patients. 

  Objective: To compare the efficacy of dexmedetomidine as a hypotensive agent with esmolol in elective ENT Surgeries in ASA grade I­II patients. Methods: This study was a prospective, randomized, double blinded study that included 60 ASA grade I and II patients, undergoing ENT surgeries 30 patients in each group. They were allocated to receive either esmolol (Group E) or dexmedetomidine (Group D) to maintain mean arterial blood pressure (MAP) between (55­65 mmHg). Intraoperative analgesic and additional hypotensive agent requirements were recorded. Standard Average Category Scale (ACS) was used for assessment of blood loss intraoperatively. Hemodynamic variables, emergence time, postoperative recovery time and sedation score following tracheal extubation were recorded. Post­operative pain, nausea and vomiting score and time needed to first analgesic were also recorded. Independent student T test was used for comparision of continuous variables and Chi square test for categorical variables. A P value of < 0.05 was considered statistically significant. Result: There were no inter group differences in haemodynamics and ACS. Emergence time, postoperative recovery and sedation score were significantly higher in Group D. VAS score was significantly lower in Group D. Time to first analgesic request was significantly longer in Group D. No postoperative nausea or vomiting was observed in both groups. Conclusion: Both dexmedetomidine and esmolol were effective in providing ideal surgical field. Both were safe agents for controlled hypotension. Dexmedetomidine offers the advantage of analgesia, amnesia and sedation with better intraoperative and postoperative patient satisfaction as compared to esmolol. 

  Background and Aims: Supraglottic device can provide adequate ventilation for laparoscopic surgeries. This study was aimed to compare Proseal Laryngeal Mask Airway and I­Gel as airway device in laparoscopic hernioplasty. Methods: This was a prospective randomised study, conducted on 60 American Society of Anaesthesiology I­II adult patients posted for laparoscopic hernioplasty. Anaesthesia was induced with propofol and rocuronium. PLMA or I­Gel were introduced and fixed and Ryle’s tube was inserted. The attempts, ease of insertion, quality of airway sealing, haemodynamic changes, oxygenation, ventilation, respiratory mechanics and postoperative adverse event were noted. Statistical analysis was done with EPI 2000 software and
ease of insertion was the primary outcome variable. Results: Success rate of I­Gel insertion was 100% and that of PLMA was 96.67%. I­Gel was inserted at first attempt in 96.67% patients but for PLMA it was possible in 73.34% patients. Ease of insertion was more with I­Gel (score 3­93.33%) as compared to PLMA (score 3­ 70%). Difference between two device was statistically not significant in quality of airway sealing, haemodynamic parameters, attempts of Ryle’s tube insertion, oxygenation and ventilation (p>0.05). After capnoperitoneum, the peak airway pressure was 19±3.47 cmH2O, 21.03±3.77 cmH2O in I­Gel and PLMA group respectively. Insignificant adverse event were noted in both groups. Conclusion: Both I­Gel and PLMA can be used as airway
device in laparoscopic hernioplasty. Insertion of PLMA is more difficult than I­Gel but it provides effective ventilation similar to I­Gel, with minimum increase in peak airway pressure as compared to I­Gel.

  Background: There is significant postoperative pain in major gynecological cancer surgery patients. Ultrasound (USG) guided Transversus Abdominis Plane (TAP) block is a novel approach to provide analgesia to anterior abdominal wall. We evaluated the analgesic efficacy of the morphine added to bupivacaine in USG guided TAP block to patients undergoing major gynecologic cancer surgeries in a prospective randomized controlled clinical study. Method: After ethical committee approval, 60 ASA grade I and II adult female patients were included and randomly divided into 2 groups (30 each) to receive either 20ml 0.5% bupivacaine +morphine 0.1mg/kg diluted in 20ml saline (BM group) or 20ml 0.5% bupivacaine alone diluted in 20ml saline (B group) bilaterally in USG guided TAP block. Observation was done for time for first rescue analgesic requirement, total analgesic requirement, VAS score at rest and on movement, hemodynamics and drug related side effects for 24 hours in postoperative period. Results: Time for requirement of first rescue analgesic was significantly longer in BM group 11.20±3.16 hours in comparison to B group 8.10±2.13 hours (p<0.001) Total diclofenac sodium requirement in 24 hrs in BM group was 30.70±10.20mg and in B group was 93.20±20.36 mg (p<0.001). In BM group VAS score at 6, 8, 12hours were significantly lower compared to B group (p<0.001). No significant difference in hemodynamic changes and side effects. Conclusion: The USG guided TAP block using morphine with bupivacaine provided superior postoperative analgesia when compared to bupivacaine alone after major gynecological cancer surgeries without any significant side effects. 

  Adjuvant drugs are used to prolong the analgesic effects of local anesthetics in regional nerve blocks. This study was done to show the efficacy of Dexamethasone as a potent adjuvant in Supraclavicular Brachial plexus block. 60 patients who underwent upper limb surgeries were chosen for supra clavicular brachial plexus block and randomly allocated to two equal groups,one to receive Dexamethasone and the other to receive normal saline along with Lignocaine Bupivacaine mixture. Time of onset and duration of motor and sensory blockade were noted. The quality of Anesthesia and occurrence of complications was also observed.The mean onset time of sensory blockade in group A is 19.30, and in group B is 16.43 minutes. (p<0.005). The mean onset time of motor blockade in group A is 15.13 minutes, in group B is 13.33 minutes (p<0.005). In group A the quality of Anesthesia is 3 for 26 patients, 2 for 4 patients and in group B it is 3 for 29 patients and 2 for 1 patient. Statistical analysis shows the p value is 0.161, which is not significant. The mean duration of motor blockade in group A is 207.67 minutes, in group B is 374.93 minutes (p<0.005). The mean duration of sensory blockade in group A is 318.77 minutes, in group B is 642.33 minutes (p<0.005). There were no complications reported. We conclude that addition of dexamethasone to local anesthetic mixture fastens the onset of action of motor and sensory blockade, and prolongs the duration of motor blockade and analgesia significantly. 

  Context: Incidence of postoperative pulmonary complications is between 30­50% in patients undergoing abdominal surgery. Addressing pain at surgical site and improving respiratory mechanics , to reduce postoperative hypoxia have a key role in mitigating hospital stay and costs. Aims: To observe the changes in lung function tests and effect of different postures on postoperative oxygen saturations in patients undergoing upper abdominal surgery on the first, fourth and seventh postoperative days and to compare the respective pain scores. Settings and Design: Prospective observational study. Methods and Material: The study was done on 40 patients undergoing upper abdominal surgeries under general anaesthesia. Peripheral oxygen saturations (SpO2) was measured using pulse oximeter and lung function tests using Medispiror preoperatively and on postoperative day 1, 4 and 7. The SpO2 was measured in supine, sitting and standing positions. The FVC, FEV1 and PEFR was measured in the sitting position on all 4 days. Pain was recorded using Numeric Rating Scales. Statistical analysis used: The Statistical software
namely SPSS 18.0, and R environment ver. 3.2.2 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables. Results: The improvement in oxygen saturation from supine (mean 95.95±1.77) to sitting (97.98±1.37) on the first postoperative was statistically significant with a p value of <0.001. Reductions in FVC from the preoperative (mean 2.35+0.48) value to the first post operative day (mean 1.29+0.39) was statistically significant with a p value of < 0.001. The FVC , PEFR and FEV1 were not at preoperative values even on the 7th postoperative day with a significant p value < 0.001 Conclusions: Postoperative oxygen saturations improve statistically in the sitting and standing position after upper abdominal surgery as compared to supine position. Simple maneuvers like change in position from supine to sitting and mobilization in the early postoperative period can improve the oxygen saturation and lung functions significantly and help in reducing lung atelectasis and resulting postoperative pulmonary complications. 

  Background: Phlebitis refers to the inflammation of a vein which can occur after repetitive intravenous injections through peripheral or central venous cannulation. Various preventive modalities are available but, none has been established Topical heparin drops have an edge over other therapeutic modalities being a non­aqueous, non­volatile, non­irritant and non­staining with significant penetration through the skin.

Aim: The present study aims to evaluate the efficacy of topical heparin for the prevention of phlebitis. Study design: A prospective, randomised and double blind study. Material and Methods: Two hundred patients were divided into two equal groups. Topical heparin sodium solution (1000IU/mL) was applied to one group following 3 hours of cannulation and was repeated every 8 hours for the next 72 hours. A placebo in the form of normal saline was applied to another. Statistical Analysis Used: It was done using SPSS 13. Values for pain and eight other variables associated with phlebitis were calculated before and after intervention in both the groups (Group A and Group B) where there were no signs of pain and phlebitis in the first place. The results were considered statistically significant if the p­value <0.05. Result: The redness around the cannula site and pain as assessed by VAS score was statistically significant between the two groups (p<0.05). Conclusion: The heparin sodium is effective as a prophylactic measure in reducing redness and pain following peripheral and central venous cannulation. 

  Background: Subarachnoid block is popular and commonly used worldwide. The advantage of an awake patient, minimal drug cost and rapid patient turnover has made this the method of choice for many surgical procedures. Among the popular drugs used for subarachnoid block are bupivacaine and and its enantiomer Levobupivacaine. Objectives: A clinical study to compare the effect of spinal anaesthesia with 0.5% hyperbaric levobupivacaine and 0.5% hyperbaric bupivacaine in patients undergoing elective below umbilical surgeries. Materials and Methods: 60 patients of American Society of Anaesthesiologists physical status class1 and 2 patients with 18 to 70 years of age posted for elective lower limb surgeries under subarachnoid block technique were randomly assigned into 2 equal groups. Group L received intrathecal hyperbaric 0.5% levo bupivacaine [total 3.5ml], Isobaric levobupivacaine made hyperbaric by adding 0.5ml of 50% dextrose to 3ml of levobupivacaine, Group B received intrathecal 15mg hyperbaric 0.5% bupivacaine with 0.5ml of normal saline.[total 3.5ml]. Results: Group L and Group B had similar onset of sensory blockade. Group L had delayed onset of motor blockade, lesser degree of motor blockade and lesser quality of intraoperative anaesthesia, similar level of sensory and maximum upper spread of sensory blockade, time  taken for two segment regression time and duration of motor blockade but shorter duration of analgesia when compared to Group B. Conclusion: Hyperbaric 0.5% bupivacaine remains effective choice than hyperbaric 0.5% levobupivacaine for spinal anaesthesia in elective surgeries, But hyperbaric levobupivacaine is also a better option for shorter procedures and outpatient spinal anaesthesia.

  Background: Relief of pain during operation is one of the mainstay of balanced anesthesia. So, any experience acquired in this field should be extended to the postoperative period also which could be done by use of suitable anesthesia. Objectives: To compare the effects of Clonidine and Low Dose Dexmedetomidine along with Bupivacaine on Pulse Rate, Blood Pressure and Respiratory Rate.). Materials and Methods: A Comparative study was carried out by the Department of Anesthesiology, G.R. Medical College and J.A. Group of Hospitals, Gwalior (M.P.). The study was done on 120 patients of ASA grade I & II of either sex with age group 18­60 years scheduled for elective lower limb surgeries. 40 Patients were allocated into different groups by randomization technique. Results: The demographic data of the three groups was comparable and the differences were not statistically significant (p>0.05).There was no statistically significant difference of (mean±SD) of Pulse Rate, Blood Pressure and Respiratory rate at different time intervals between three groups. Conclusion: We conclude that either, Intrathecal administration of clonidine (30µg) or dexmedetomidine (5µg) with hyperbaric bupivacaine 0.5% resulted without producing significant Hemodynamic or Respiratory Complication either during the time or surgery or post­surgery. Moreover, dexmedetomidine did not offer significant advantage over clonidine. 

  Background and AIMS: Subarachnoid blockade is widely used due to its simplicity, low cost and reduced complications due to general anaesthesia. Subarachnoid space can be approached from midline or paramedian approach (PMA). Accurate identification of the subarachnoid space is paramount as multiple attempts at needle insertion may cause patient discomfort, backache and Post Dural Puncture Headache (PDPH). The most commonly practiced technique is the midline approach. This approach is technically difficult in pregnant women due to inability to flex the spine adequately. The aim of the study is to compare the characteristics of midline approach (M) vs paramedian (P) for administration of spinal anaesthesia in patients posted for LSCS with respect to number of attempts, highest level of analgesia, duration of anaesthetic procedure and side effects such as blood tap, backache and PDPH after 48 hours. Materials and Method: 60 patients posted for caesarean section under spinal anaesthesia were divided into Group M: Spinal anaesthesia by Midline approach and Group P: Spinal Anaesthesia by Paramedian approach. The number of attempts, highest level of analgesia, duration of anaesthetic procedure and side effects such as blood tap, backache and PDPH after 48 hours were noted. Results: Paramedian group took fewer attempts and less time and a higher level of spinal block was achieved with the midline technique of spinal anaesthesia. Conclusion: Paramedian approach may be a better approach in the parturient as compared to the midline for administering spinal anaesthesia for LSCS. 

  Background: MAC is most common method of titration of volatile anesthetics and BIS is used to measure the hypnotic effect of anesthetics. This study was undertaken to evaluate and compare the BIS value produced by different inhalational agents at their 1 MAC end tidal concentration. Method: 200 patients of ASA I ­ II of either sex between 20­50 years , for laparoscopic cholecystectomy were divided into 4 groups of 50 each and received either halothane, isoflurane, sevoflurane or desflurane. General anesthesia was administered using fentanyl, propofol, inhalational agents and vecuronium and maintained with 67% nitrous in oxygen. After achieving and maintaining 1 MAC for 15 min, BIS value were recorded for next 15 min at an interval of 1 min .Collected data was analyzed using ANOVA test. Results: At 1 MAC end tidal concentration mean BIS value for halothane was 57.0±3.51, for isoflurane 51.57±3.84, for sevoflurane value was 49.621± 3.82, and for desflurane BIS value 42.11±4.68, and difference among groups were statistically significant. Conclusion: At 1MAC, BIS values are agent specific and BIS value of halothane > isoflurane > sevoflurane > desflurane. 

  Background: Opioid like Buprenorphine has been widely used as adjuvant intrathecally for providing prolonged post operative pain relief. Their advantages of neuraxial narcotics over systemic narcotics are well established. IntrathecalMidazolam, abenzodiazepine derivative apart from its own analgesic and sedative effect, it potentiate the analgesic effect of Bupivacaine. This study was conducted to compare the efficacy of intrathecal Buprenorphine (150µg) with intrathecal Midazolam (2.5mg) when used as an adjuvant to 0.5% Bupivacaine for lower abdominal surgeries and also to observe any side effects. Methods: After approval from hospital ethical committee, 90 patients between the age group of 20­60 years was taken. Informed consent from the patient was taken. All patients from ASA I and ASA II were allotted in three groups of 30 patients each. Group B was given 3.5 ml of 0.5% bupivacaine (heavy) with 150µg (0.5ml) buprenorphine intrathecally. Group M was given 3.5 ml of 0.5% Bupivacaine (heavy) with 2.5 mg (0.5ml) midazolam (preservative free) intrathecally. Group C was given 3.5 ml of 0.5% bupivacaine (heavy) with (0.5 ml) of Normal Saline intrathecally as controlled group Statistical analysis was performed using ANOVA test and T­test. p value < 0.05 was considered significant. Result: Onset of sensory and motor is fastest in Midazolam group while Buprenorphine provided prolonged duration of analgesia post­operatively (827.17+67.77 min.) as compared to Midazolam (297.5+33.21min.). Conclusion: Addition of Buprenorphine provides prolonged post­operative analgesia compared to other groups but sensory & motor onset is fastest with Midazolam. 

  Background: CMAC is a video laryngoscope with the unique advantage of having a blade design very similar to the most commonly used Macintosh laryngoscope. We conducted this study to compare the efficacy of intubation with the conventional Macintosh Laryngoscope and CMAC laryngoscope as measured by total time for successful intubation, number of attempts, laryngeal view, hemodynamic changes and airway morbidity. Material and Method: Seventy patients (n=35 in each group) were randomly allocated to be intubated with either CMAC or Macintosh laryngoscope (ML). Parameters measured were time taken for successful intubation, number of attempts, Cormack Lehane grading of laryngoscopic view, airway morbidity, blood pressure and heart rate at first, third and fifth minutes after Intubation. Results: The total intubation time was 26.6±3.71 seconds in CMAC group and 29.7±4.68 seconds in ML group. All the patients were intubated in first attempt. The increase in systolic blood pressure at first (121.43±9.71) and third minutes (116.60±9.53) following laryngoscopy was significantly lower in CMAC group as compared with Macintosh group (127.77±13.53 and 122.31±12.23 respectively) p=0.027 at minute 1 and p=0.021 at minute 3. Heart rate too showed a significantly lesser increase in CMAC group than in ML group (p =0.001, 0.02 and 0.009 at first, third and fifth minutes respectively). Conclusion: Intubation with CMAC is associated with shorter intubation time and better hemodynamic profile compared to conventional Macintosh laryngoscope in patients with no predicted airway difficulties. 

Background and Objectives: Inguinal hernia surgery is one of the commonest day care procedures and have very high incidence of moderate to severe postoperative pain which remains a great challenge for the anesthesiologist to treat it. Multimodal analgesic techniques like parenteral analgesics or regional analgesia are commonly practiced. Peripheral nerve block after surgical closure provide effective postoperative analgesia without any major side effects. This study was designed to compare the analgesic efficacy of Bupivacaine (B) and Ropivacaine (R). Materials and Methods: Fifty adult male patients scheduled for elective inguinal hernia repair were randomly allocated into two groups of 25 each. Group B ­ Bupivacaine, Group R ­ Ropivacaine respectively. General anaesthesia was given. Nerve block was administered at the end of surgery with 15 ml of the study drug. Visual Analog Score (VAS) was noted immediately at the end of surgery and hourly up to 8 hours and the time for rescue analgesia was noted. Independent ‘t’ test, SPSS version 16 was used for analysis. Results: We have found that both the drugs provided excellent postoperative pain relief for inguinal hernia repair with hemodynamic stability. Duration of analgesia was significantly longer in bupivacaine than ropivacaine. (389.96± 25.37mins Vs 301.24±20.72 mins with ‘p’ value < 0.01). Conclusion: At equal concentration, bupivacaine provided prolonged postoperative analgesia than ropivacaine. 

  Background: Ano­rectal malformation is a common anomaly seen in newborns and is associated with multiple anomalies like renal, vertebral, muscular and cardiac. Associated cardiac anomalies determine the morbidity and mortality of newborn. It is mandatory to properly evaluate the child for cardiac anomalies in children with ARM. Objective: The aim of the study is to evaluate the incidence of associated cardiac anomalies in thenew­borns with Ano­rectal malformation admitted ina tertiary care centre. Method: Total number of Ano­rectal Malformation admitted from June 2017 to May 2018 in our hospital was recorded. All cases after examination and evaluation were classified into Low ARM and High ARM. All cases after preoperative evaluations and basic haematological tests were taken for emergency colostomy or cut back anoplasty. Patients during postoperative period were performed echocardiogram for cardiac evaluation. Total number newborns with ARM having associated cardiac anomalies were determined. The incidence of cardiac anomalies in two types of ARM was determined. Results: Total number of newborns with ARM admitted for sugery in the period of June 2017 to May 2018 were 182. Out of which 21 cases were having congenital cardiac anomalies (11.53%). ASD is found to be commonest cardiac anomaly comprising 15 (60%). Other cardiac anomalies associated with ARM were VSD 7 (22%), Dextrocardia 2 (8%), Tetrology of Fallot 1 (4%). Newborns with High ARM have higher
incidence of cardiac anomalies when compared to Low ARM (18/7). All cases needed extra perioperative care like antibiotic prophylaxis, avoidance of air entry through ivcanula, avoidance of hypothermia and avoidance of fluid overload. Conclusion: The incidence of associated cardiac anomalies in newborns with ARM were found to 11.53%. High Type of ARM have grater incidence of associated cardiac anomalies. ASD was found to be commonest cardiac anomaly. Our study showed that cardiac evaluation during preoperative evaluation should be a pre­requisite for all cases of ARMs. 

  Transposition of great arteries is a rare and serious congenital cyanotic disorder in which two main arteries leaving the heart are reversed or transposed. Transposition of the great arteries changes the way blood circulates through the body, leaving a shortage of oxygen in blood flowing through the heart to the rest of the body. These patients are at high risk of peri­operative mortality due to ventricular dysfunction, chronic hypoxia, hyper­cyanotic spells, polycythemia and infective endocarditis [1].  Very limited studies are available regarding anaesthetic consideration in patients with uncorrected D­TGA with other congenital cardiac defects like ventricular septal defect (VSD) and pulmonic stenosis. This case report highlights the anaesthetic challenges in an uncorrected transposition of great arteries along with other congenital cardiac defects for an emergency non­cardiac surgery in a critically ill pediatric patient.

  Context: Percutaneous nephrolithotomy (PCNL) under general anesthesia plays a major role in larger size kidney stones, but  in many times spinal anesthesia will be more advantageous owing to better hemodynamic stability and also equally effective in relieving pain. Aim: The aim of this current study is to compare the safety and effectiveness of spinal anesthesia with general anesthesia in percutaneous nephrolithotomy. Settings and Design: It is a randomized prospective study done in MelmaruvathurAdhiparasakthi Institute of Medical sciences and research from April 2016 to April 2018. Methods and Material: 100 patients who were undergoing PCNL were randomly selected and divided into two groups. Group SA (n=50) received total dose 3.4 ml of 0.5% hyperbaric Bupivacaine with 0.6mg of Nalbuphine. Group GA (n=50) received premedication with Glycopyrolate and Fentanyl and they were anesthetised with Propofol and Succcinylcholine Anesthesia was maintained with Vecuronium and N 2O/O2/Isoflurane. Heart rate, mean arterial blood pressure and complications like hypotension, bradycardia were recorded
intraoperatively and postoperatively. Statistical analysis used: Statistical analysis were calculated with the graph pad prism 5.0 software. The data were expressed as a mean and standard deviation.All the quatitative variables were analysed using Unpaired t­test. Results: Pulse rate at 5, 10, 45, 60 minutesintra operatively and at 0, 3, 5 hours postoperatively were significantly less in patients receiving spinal anesthesia group when compared to general anesthesia group (p<0.0001). Mean arterial pressure at 5, 10, 15, 20, 25, 30, 45, 60 minutes intra operatively and at 0, 3, 5 hours postoperatively was found to be less in spinal anesthesia group then the GA group (p< 0.0001). The VAS score at 0, 3, 5, 8 hours was found to be less and statistically significant in spinal anesthesia group as compared to general anaesthsia group (0.66±0.51/4.14±0.75, 1.38±0.49/5.4±0.61, 1.8±0.45/4.32±0.47, 3.78±0.58/4.34±0.47). Moreover analgesic requirement of tramadol more than 100mg was lower in SA group than GA group. Conclusions: Our study shows that spinal anesthesia for PCNL is relativelysafe and equally effective alternative to general
anesthesia with better hemodynamic stability, lower postoperative pain, minimal analgesic requirements, and early recovery. 

  Introduction : Electroconvulsive Therapy (ECT) induces seizure to treat depression and other psychiatric disorders .To prevent musculoskeletal injuries and to produce amnesia, anaesthesia is needed during ECT. Aim: To compare propofol and thiopentone in patients posted for modified ECT. Materials and Methods: Study was conducted on ASA Grade I and II patients (total 100) posted for ECT. They were randomly divided equally in Propofol Group (Group P) and Thiopentone Group (Group T) (n=50 for each group). Each patient underwent series of bilateral ECT. In both the groups, Inj. Oandansetron 4 mg and Inj. Glycopyrrolate 0.2 mg were given intravenously (iv) 3 minutes before giving the drug under study. Inj.Thiopentone (2.5%)was given in the dose of 2 mg/ kg iv in Group T and Inj. Propofol (1%) was given in the dose of 1 mg/kg iv in Group P, followed by Inj Succinlyscoline 0.5 mg/ kg iv in both the Groups. Onset of action(induction time), mean stimulus charge, duration of seizure, number of missed seizures, vital parameters (hemodynamic parameters), duration of recovery from anaesthesia (response to verbal command), complications were compared. All patients were evaluated by the psychiatrist on the BDI (Beck Depression Inventory) scale after completion of the treatment. Results: Mean seizure duration was shorter in Group P than Group T (44.18±1.24 seconds versus 55.52±1.05 seconds). Mean stimuls charge was 149.50±1.25 mC (Millicoulomb) in Group P and 136.22±0.96 mC in Group T. Number of ECTs required to attain therapeutic goal was higher in Group P than Group T (8.16±0.24 versus 6.46±0.21). Propofol was associated with lower increase in blood pressure. Induction time and Recovery were faster in Group P than Group T. There was
no difference in treatment outcome. Conclusion: Propofol decreases seizure duration even with higher stimulus charge. Propofol increases number of ECT required for treatment. Induction time and recovery both were faster with propofol. 

  Background: Many drugs have been used for attenuating hemodynamic response to intubation and laryngoscopy during general anesthesia, to provide post operative analgesia and to decrease the analgesic consumption in post operative period. The present study was conducted to evaluate the effects of low dose Melatonin and Alprazolam combination in patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: Fifty adult patient of either sex, aged between 20­ 50 years with American Society of Anesthesiologist (ASA) grade I and II presenting for laparoscopic cholecystectomy were divided into two groups. Group I (Gp I, n=25) acted as a control group and received placebo as tablet B complex and Group II, (test group Gp II, n=25) received Tab. Melatonin (3mg) and Alprazolam (0.25mg) combination one hour before surgery. The primary objectives were to assess the sedation score, effect on induction dose of Propofol and hemodynamic response to laryngoscopy and intubation. Secondary objectives were to assess the post operative Fentanyl consumption in first 24 hours. Statistical Analysis: The data thus obtained was analyzed using Epi­info and SPSS 16 software and various suitable statistical tests like Student t test, ANOVA, Chi­square test, Mann Whitney test etc. were applied. P­values > 0.05 were considered to be not significant, p­values <  0.05 were considered to be significant and p­values < 0.001 were considered to be highly significant. Results: The level of sedation in Gp II was significantly higher as compared to Gp I at one hour of giving the test drug(0.88±0.332 vs. 0.00±0.00, p value <0.001). The mean dose of Propofol for induction of general anesthesia was significantly reduced in Gp II (109.20±17.540 in Gp I and 87.60±17.388 in Gp II respectively, p value< 0.001). Both groups showed rise in heart rate and mean blood pressure following laryngoscopy and intubation up to three minutes but the rise was significantly more in Gp I as compared to Gp II at all time intervals . Significant decrease in total number of doses (5.12 ±0.833 vs. 4.12±0.332, p<0.001) as well as mean total fentanyl consumption (316.88 vs. 246.86, p<0.001) was noted in Gp II. No adverse effect was noted during the study which can be attributed to test drug. Conclusion: Low dose melatonin and alprazolam combination when given one hour before the surgery provides many advantages. It produces sedated patients which are easily arousable, decrease dose of induction agent, decrease the increase in heart rate and mean arterial blood pressure following laryngoscopy and intubation. It also reduces the post operative fentanyl consumption in first twenty four hours following surgery. 

  Aim: To compare effectiveness of Dexmedetomidine with Pentazocine ­ Promethazine combination for intraoperative sedation under MAC for tympanoplasty under local anesthesia (LA). Methodology: Total 120 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV dexmedetomidine 1 g/kg over 10mins followed by 0.2 g/kg/h infusion (Group D) or Pentazocine 0.6mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10ml normal saline over 10mins followed by 0.2 g/kg/h infusion of normal saline (Group P). Sedation was titrated to RSS of 3. Vital parameters like HR, BP, SpO2, requirement of rescue analgesics, intraoperative bleeding scale, surgeon satisfaction score (Likert Scale) and Post Anesthesia Recovery Score (Modified Aldrete Score) were recorded and analyzed. Results: Intraoperative HR and MAP in Group D were lower than the baseline values and corresponding values in Group P (p<0.05). Intraoperative sedation in Group D was more than Group P (4 vs. 2 in a scale of 6). Intraoperative bleeding scale and surgeon satisfaction score was better in Group D than Group P (median interquartile range (IQR) 9 (8­10) vs. 8 (6.5­9.5) and 9 (8.5­9.5) vs. 8 (6.75­9.25), p = 0.0001 for both). Mean VAS for pain was more in group D than group P. Time for rescue analgesic was high with Group P while modified Aldrete score was high in Group D. Rate of occurrence of adverse drug reaction (ADR) was not statistically significant among two groups (p > 0.05). Conclusion: Dexmedetomidine is comparable to pentazocine ­ promethazine combination for sedation and analgesia in tympanoplasty with better surgical field and surgeon satisfaction, with better hemodynamic stability. 

  Background and Aims: Propofol is widelyused for induction andmaintenance of anaesthesia. It has the disadvantage of causing sharp pain on injection which can interfere with smooth induction of anaesthesia. The aim of the study was to compare the incidence and intensity of injection pain with medium chain triglyceride/ long chain triglyceride (MCT­LCT) propofol and long chain triglyceride (LCT) propofol during intravenous induction of anaesthesia. Methods and Material: Two hundred adult patients belonging to ASA physical status I or II, scheduled for elective surgeries under general anaesthesia were selected and randomly allocated to two groups L and M. Group L received 3 cc of LCT propofol and Group M received 3ccof MCT­LCT  propofol . Patients were observed and questioned after 30sec of injection and pain was scored on a 4 point scale. Pain recall was done on the same 4 point scale 30 minutes postoperatively. Statistical Analysis: Data was collected and analysed using Fisher’s exact test and unpaired t test. Statistical significance was taken as p< 0.05. Results: Both the incidence and intensity of pain was greater in group L compared with group M (p=0.0002). The mean pain score was also higher in group L (2.71) when compared with group M (1.08). The difference between two groups with regard to recollection of pain on injection of propofol was statistically significant (p=0.0001). Conclusion: Propofol MCT­LCT reduces both intensity and incidence of pain on injection. 

  Aim: Pre­hospital trauma students first aid skills assessment at various stages of training. Design: Retrospective observational study. Material and Methods: In our study, First Aid skills and knowledge were assessed of five batches of Pre­hospital Trauma Technicians. From each batch twenty students were pre­tested for knowledge in Basic Life Support Skills (BLSS) work shop. These Pre­hospital trauma technician students were from science stream, high school Pass out, who were selected on the basis of merit and counseling, the consent of students was obtained after an explanation of nature and purpose of study. These students were assessed as follows: (1) As fresher during ten days orientation program. (2) As pre­hospital trauma students (8­month completion)
(3) As Pre­hospital Trauma technician interns, posted at PGIMER, Dr RML Hospital, New Delhi and its ambulances (11 month).
Statistical Analysis: Quantitative variables were compared using Kruskal Wallisand Mann Whitney test was used for comparison between two groups. Jonckheere­Terpstra Test was used for comparison across various time periods. A p value of <0.05 was considered statistically significant. Results: In our study, statistically significant improvement in performance was seen after 8 months and again statistically significant improvement was seen at 11 months completion of Pre­hospital Trauma Technician training Program. Conclusions and Recommendation: Our Study shows that teaching alongwith practical workenhancesfirst aid skills and performance. Repeated teaching and learning by doing practical work enhances performance. Practising lifesaving skills periodically is significant for good performance outcome. 

  Context: Dexmedetomidine is an alpha 2 receptor agonist with sympatholytic, analgesic and sedative effects. This study was designed to study the anaesthetic sparing effect of dexmedetomidine and to compare the efficacy of dexmedetomidine with fentanyl. Aims: 1) to study the effect of dexmedetomidine and compare dexmedetomidine with fentanyl in patients undergoing ENT surgeries. Methods and Material: After approval from institutional ethical committee a prospective randomized controlled study was conducted in forty ASA class 1 and 2 patients posted for ENT surgeries. Patients were randomly divided into two groups. Dexmedetomidine group received a bolus dose of 1mcg/kg body weight over ten minutes followed by infusion at the rate  of 0.4mcg/kg/minute. Fentanyl group patients received 2mcg/kg fentanyl five minutes before the induction. Haemodynamic parameters were measured at specific end points. The anaesthetic and analgesic requirement was noted. Statistical analysis used: Data was analysed using computer statistical software system openepi. The unpaired t­test was used for intergroup comparisons except where specified. Probability values p < 0.05 were considered significant and p < 0.001 were considered highly significant. Results: It was noted that there was no significant difference haemodynamic parameters and quality of surgical field. The average sevoflurane during the first hour of surgery was significantly lower in group D. The incidence of post­operative nausea and
vomiting was significantly lower in group F. Conclusions: Dexmedetomidine used in the dose of 1mcg/kg IV bolus followed by 0.4mcg/kg/hour provides effective and well tolerated alternative to fentanyl in reducing the requirement of analgesic and anaesthetic agents. 

  Introduction: Diastolic dysfunction is a cause of morbidity and mortality in patients of coronary artery with normal systolic  function. Diastolic dysfunction is highly predictive of adverse events after myocardial infarction. Transesophageal Echocardiography (TEE) is a non­invasive tool to investigate and diagnose perioperative diastolic dysfunction, which may influence the anesthetic management and post­operative outcome. This study was designed to compare the effects of Isoflurane Sevoflurane and desflurane on left ventricular diastolic dysfunction, using TEE in patients posted for CABG. Materials and Methods: 90 consenting adult patients, below the age of 70 years with grade 1 diastolic dysfunction posted for elective CABG surgery were included in this randomized cross sectional observational study and randomly divided in 3 groups of 30 patients each using a sealed envelope method. Group I received isoflurane, group S received sevoflurane & group D, desflurane. Ventricular relaxation criteria measured by the TEE were E (early diastolic peak velocity across the mitral valve), A (late diastolic peak velocity across the mitral valve), E/A ratio, S/D ratio, deceleration time (DT), e’ (early mitral annular velocity), E/e’ ratio. Parameters measured by the PA catheter were pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), pulmonary vascular resistance (PVR). Other hemodynamic parameters recorded were mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), oxygen saturation (SpO2). Statistical analysis and Results: Descriptive statistics like mean, median and proportions
were used to describe the study results. Binary or ordinal data were expressed as number (%) and continuous numeric  variables were expressed as Mean±SD. Qualitivedata was analyzed by Pearsons chi square test. Analysis of variance was done for repeated measure of continuous variables by one way ANOVA. A p value of < 0.05 was considered as statistically significant. Significant improvement was seen in all the left ventricular relaxation indices as measured by TEE after using the three inhalational agents in the study. Conclusion: Our study establishes the safety of all the three inhalational agents which are currently used in cardiac anesthesia. The pre­existing grade 1 diastolic dysfunction in patients remained the same. It is recommended to study this with larger sample size. 

  Backgroud and Aims: The advent of ultrasound guided techniques has led to increased interest in Transversus Abdominis Plane block (TAP) for abdominal surgeries. Recently the transversus abdominis plane block (TAP block) has been used as a part of multimodal analgesia with promising results. The oblique subcostal approach (OSTAP block), a variant of the TAP block, produces reliable supra umbilical analgesia. This study aimed to compare the efficacy of ultrasound guided OSTAP block with portsite infiltration in laparoscopic cholecystectomy for postoperative analgesia. Methods: Eighty patients scheduled to undergo laparoscopic cholecystectomy under general anaesthesia were divided into two groups: Group A (n=40) patients received oblique subcostal transversus abdominis plane block with 15 ml of 0.25% bupivacaine on each side and Group B (n=40) received local portsite wound infiltration with 30 ml of 0.25% bupivacaine in all four ports. The primary and secondary outcome variables were postoperative pain relief, duration of analgesia, rescue analgesic requirement and any side effects, which were noted. Results: The postoperative VAS scores were significantly lower in group A (OSTAP) compared to group B (Portsite) at 0, 1, 2 and 3 hours postoperatively. OSTAP block resulted in longer duration of analgesia as compared to portsite infiltration. The mean duration of analgesia recorded in OSTAP group A was 5.68±2.08 hours and in portsite infiltration group B was 2.53±1.19 hours. The total dosage demand for rescue analgesia in first 24 hours was also less in the study group A compared to group B i.e 91.87±31.71mg of diclofenac sodium in group A and in group B was 135.01±34.80 mg. Postoperative nausea vomiting score though was less in group A than in group B but there was no statistically significant difference in between the groups. Conclusion: The results suggest that the use of Ultrasound guided bilateral oblique subcostal transversus abdominis plane block reduces postoperative pain scores, prolongs the duration of analgesia and decreases demand for rescue analgesia without causing any adverse effects in comparison to portsite infiltration. 

  Background: Emergence agitation (EA) is a known fact after general anaesthesia which is observed more in children and that too after sevoflurane anaesthesia. Dexmedetomidine and propofol are both known to reduce EA when used in prophylactic doses. The aim of our study was to compare the incidence of EA in preschool age group (< 5 years) with that of older children (> 5 ­ 12 years) in both dexmedetomidine and propofol group. Methods: Total 100 children having age less than 12 years and belonging to ASA I and II were included in the study. All of them received sevoflurane as inhalational anaesthetic agent. They were randomly divided in to two groups. About 5 minutes before the end of surgery, patients in group A received 0.3 µg/kg dexmedetomidine and group B patients received 1mg/kg propofol. The incidence of EA in both the groups was measured with Aono’s four point scale upon arrival in the post anaesthesia care recovery room. The database was analyzed using stata 12, epiinfo software and p value of < 0.05 was considered as level of significance. Results: The incidences of EA in < 5 years age group in group A and B was 21.05% and 40.91% respectively whereas; it was 3.23% and 21.43% in > 5 ­12 years age group. Conclusion: The incidences of EA were higher in pre­school (ï‚£ 5 years) age group as compared to older children (> 5 ­12 years) age group in both group A and B who received dexmedetomidine at a dose of 0.3 ug/kg and propofol at a dose of 1mg/kg respectively.

  Context: Cardiac arrest whether in the hospital or outside hospital is considered as a major medical emergency and it should be treated immediately.The survival and outcome of a cardiac arrest depends on the early initiation of BLS. The nurses are expected to update their knowledge as per BLS­AHA guidelines to ensure timely recognition of cardiac arrest and to initiate the chain of survival as early as possible. Aims: To evaluate the knowledge about cardiopulmonary resuscitation among nurses before and after the formal certified CPR training program in a tertiary care hospital. Material and Methods: It is a cross sectional descriptive study and it was conducted by the department of Anaesthesiology by involving the Nurses at Melmaruvathur Adhiparasakthi Institute of Medical sciences and Research from February to March 2018.Totally 186 nurses were consented from various workplace and different educational status for this study. A validated and pre­tested questionnaires which contains 20 questions which evaluated the knowledge, attitude and practices towards the cardiopulmonary resuscitation (CPR) was distributed to the nurses for pretest and posttest after training. The correct answer score assigned was 1 and wrong answer score was 0 thus making the total score as 20. Results: Among the total 186 nurses 98.92% (n=184) were females and 1.08% (n=2) were ales. Majority were between the age group of 26 to 30 years and their working experience ranging from 2 to 10 years. Many of the participants 45.7% (n=85) had no formal training in CPR and (n=101) 54.3% had undergone CPR training during their study period. 118 (63.44%) nurses had studied B.Sc nursing and 68 (36.56%) were Diploma in nursing. Among them 113 (60.75%)were working in medical and surgical ward, 22 (11.83%) in casualty, 30 (16.13%) in ICU, 21 (11.29%) in OT. The mean±SD of the overall total knowledge score was 42.37±4.8 and 67.1±3.37 in pre and post test respectively there was significant improvement and association between the total scores in pretest and post test (P<0.05) and also there was a strong association between the workplace and the total scores (p<0.0001). Conclusion: In conclusion the Knowledge practices and attitude of the participants regarding CPR were low before training and found adequate after training. Thus, more educational interventions and training programs should be provided periodically among the nurses. 

  Introduction: Direct laryngoscopic endotracheal intubation is associated with varying degrees of sympathetic activity which may be detrimental in patients with coexisting conditions, such as coronary artery disease, elevated intracranial pressure and asthma. Lightwand intubation, on the other hand, by avoiding direct laryngoscopy, is expected to cause lesser hemodynamic variations. Aim: This randomised and prospective study intends to compare the hemodynamic response to intubation and ease of intubation by both these procedures. Settings and design: Prospective randomised single blind study. Material Methods: Hundred normotensive patients of either sex, age 18 to 60 years, ASA I & II, with normal airway scheduled to undergo elective surgeries under general anaesthesia were included in the study. They were randomly divided into two groups­DL (direct laryngoscopic intubation) & LW (lightwand intubation). Preoperatively heart rate, systolic, diastolic and mean blood pressure were recorded. Above parameters were also noted at 0, 1, 3, 5 minutes after intubation in both the groups. The time taken and the number of attempts required for successful intubation were noted. Results were statistically analysed. Statistical analysis used: Paired and unpaired student’s t­test. Results: Hemodynamic response was more in DL group than in LW group which was statistically significant. Whereas, time taken for intubation was statistically significantly more with lightwand (20.08±7.07 secs) as compared to direct laryngoscopic intubation (16.94±4.55 secs). Conclusion: Lightwand intubation was associated with lesser hemodynamic response however the time taken for intubation by lightwand was more as compared to direct laryngoscopic intubation. 

  Introduction: Peripheral nerve blocks are used in varieties of surgical and diagnostic procedures. Various methods or approaches have been tried to prolong the duration of nerve blocks. Dexmedetomidine acts selectively on alpha­2 adrenergic receptor agonist and can be a promising adjuvant to local anaesthetics. Our study evaluates the clinical efficacy of dexmedetomidine added to Ropivacaine for sciatic nerve block. Material and Methods: Patients undergoing foot surgeries were divided randomly into two groups. Group RS (n = 30): received 19.5 ml of 0.75% Ropivacaine and 0.5 ml saline for sciatic nerve block via popliteal approach and Group RD (n = 30): received 19.5 ml of 0.75% Ropivacaine with 0.5 ml (50 mg) of dexmedetomidine. Result: The onset time of sensory block (mean) in minutes was 8.64±2.4 in RS Group, 5.78±2.7 in RD Group (p < 0.001). The mean time for onset of motor block, in minutes, was 10.42±3.6 in RS Group, 8.78±1.7 in RD Group (p < 0.001). The difference in regards to duration of sensory and motor block was statistically significant, with RD Group faring better than RS Group. The mean time to rescue analgesia, in minutes, was 339.8±29.31 in Group RS and 512.43±30.92 in Group RD (p < 0.001). The quality of anaesthesia was better and sedation scores were more in group RD versus group RS. Conclusion: The overall quality of anesthesia achieved with 50 g dexmedetomidine as an additive to 0.75% Ropivacaine is more effective in terms of duration and intensity of analgesia in comparison to 0.75% Ropivacaine alone. 

  Context: The study was planned to assess the comparative efficacy, duration of analgesia block characteristics and hemodynamic or any adverse events on combining clonidine in two different doses with epidural Bupivacaine as adjuvant. Settings and Design: This study was an interventional, prospective, double blind, parallel group, randomised clinical study conducted on patients undergoing elective lower abdominal and lower limb surgeries. Methods and Material: This study was conducted on 80 patients of the American Society of Anesthesiologists (ASA) grade I or II, age 18 to 59 years and included both genders. In Study group A (n =40) 5ml (75µg) of the clonidine hydrochloride­bupivacaine solution added to 10 ml of 0.5% Bupivacaine to make a volume of 15 ml and given via epidural route. Study group B (n =40) 4ml (60µg) of clonidine hydrochloride­bupivacaine solution added to 11 ml of 0.5% Bupivacaine to make a volume of 15 ml and given via epidural route. Our aim was to compare the following factors in two groups – Onset of sensory and motor block, Level of sensory block, Duration of motor blockade and sensory analgesia, hemodynamic changes and adverse events if any. Statistical analysis used: The statistical analysis was done using the sample “t” test and chi­square test. The cleaned and checked data was entered in the computer through software Graph Pad Instat 3.1 and output was assessed. P < 0.05 was considered significant. Results: Onset of anesthesia was shorter in group B as compared to group A. The mean time for onset of sensory block and motor block in group A were 8.17±1.15 and 19.55±1.5 minutes respectively and in group B were 7.42±1.01 and17.17±1.37 minutes respectively and they were statically very highly significant (p < 0.001). The establishment of complete motor blockade was earlier in B group which was statistically highly significant (p < 0.001). There was no significant difference in respiratory depression, systolic and diastolic blood pressure in both the groups (p>0.05). Conclusions: both the doses of clonidine (60µg and 75µg) when administered through the epidural route with 0.5% Bupivacaine provide effective analgesia during intraoperative period. But in postoperative period, 75µg clonidine with 0.5% Bupivacaine provide prolonged analgesia as compared to 60µg clonidine without any significant increase in side effects and change in hemodynamic profile. 

  Background: Spinal anaesthesia is a safe, reliable, inexpensive technique of providing anaesthesia and blunts autonomic, somatic and endocrine responses. It has many advantages; the limited duration of action appears to be one of its downsides. Clonidine, a partial 2 adrenoceptor agonist, has been shown as an effective and safe drug. It prolongs the action of local anaesthetics and reduces the dosage requirement. Aims: To compare the efficacy of intrathecal bupivacaine in combination with 50 µg and 75 µg of clonidine in lower abdominal surgeries. Materials and Methods: 60 patients scheduled for lower abdominal surgeries, aged 18­65 years with ASA grade I­II satisfying inclusion criteria were recruited for the study and were randomly divided into two groups of 30 each. Group C50 received Inj. clonidine 50 µg added to 15mg hyperbaric bupivacaine and Group C75 received Inj. clonidine 75 µg added to 15mg hyperbaric bupivacaine. Spinal block characteristics, haemodynamic changes and side effects were recorded. Results: Onset of sensory and motor blockade was earlier in group C75 as compared to group C50 but statistically insignificant. Maximum sensory block achieved was T4 in group C75 and T5 in group C50. Two segment regression duration, duration of analgesia, duration of sensory blockade and motor blockade were statistically significantly prolonged in group C75 as compared to group C50. Patients maintained haemodynamic stability. Sedation scoring and side effects were comparable in both the groups. Data was analysed using Chi­square test and Independent t test. Conclusions: 75µg Clonidine when added to intrathecal bupivacaine prolongs anaesthesia and postoperative analgesia compared to clonidine 50µg. 

  Background and Aims: Dilatation and evacuation is a common Obstetrics day care procedure. However, it is a painful experience for the woman both during the intraoperative and postoperative period. Hence the purpose of this study was to compare single dose intravenous Paracetamol and intravenous Fentanyl for intraoperative and postoperative pain relief in dilatation and evacuation. Materials and Method: Sixty female patients were randomly included and divided into two groups of 30 patients each. Group P received intravenous (IV) paracetamol 15 mg/kg in the preoperative waiting area 15 min before starting the procedure. Group F received IV fentanyl 2 mcg/kg at induction of anaesthesia. Intraoperative and postoperative vitals along with postoperative pain scores on a numerical rating scale at 5, 15, and 30 min intervals after surgery were recorded. Results: Pain scores observed with paracetamol were not significantly different from that of fentanyl. Side effects were observed less with paracetamol.

Conclusion: The study demonstrates the usefulness of IV paracetamol which may be as effective as fentanyl in dilation and evacuation procedures without the major side effects of fentanyl.Paracetamol is also more cost effective. 

  Background: Elective or emergency caesarean sections are routinely done under spinal anaesthesia (SA) with bolus dose of local anaesthetic drugs. SA with bolus dose injection provides rapid onset of action but with profound hypotension and can compromise the uteroplacental blood flow which in turn may lead to foetal acid base abnormalities.In our study we hypothesised that by using low dose bupivacaine in fractionated manner to achieve the adequate anaesthesia and stable haemodynamics andcompared with bolus dose of local anaesthetic drug in SA. The following variables were observed: onset of sensory and motor blockade, Mean Arterial Pressure (MAP) Heart Rate (HR), and duration of analgesia in patients undergoing elective lower segment caesareansection (LSCS). Methods: This study was conducted in sixty pregnant women who are undergoing elective lower segment caesarean section (LSCS) after taking permission from the institutional ethical committee. The pregnant women were divided into two groups. Group A patients received single bolus dose of bupivacaine heavy (0.5%) and Group B received the same dose of drug Bupivacaine in fractionated dose with two third of it initially followed by remaining one third dose after 60 secs. The intraoperative haemodynamics (MAP, HR) and duration of analgesia, time of onset and regression of sensory and motor blockade were recorded and analysed with appropriate statistical analysis. Results: The haemodynamics were more stable in group B patients as compared to group A. The requirement of vasopressor was significantly less in group B in contrast to group A (2.40±3.1 vs 5.50±3.79). There was statistically significant (p<0.05) delay in the sensory and motor onset in group B. The duration of analgesia was significantly longer in group B than group A (188.97±18.80 vs 154±22.56).There was no significant difference in the Apgar scores between the two groups (p>0.05). Conclusion: Fractionated dose of local anaesthetic drug in SA provided more haemodynamic stability and longer duration of analgesia compared to the bolus dose of local anaesthetic drug. 

  Introduction: Various intravenous induction agents like propofol, ketamine and etomidate are available now a day to the anaesthetist but they also cause attenuation of axis leading to a decrease in heart rate and blood pressure. To achieve haemodynamic stability during induction is one of the major challenge and goal of the anaesthetist. Aims and objectives: To evaluate the hemodynamic effect of propofol and etofol as induction agents in elective surgeries under general anaesthesia . Material and Methodology: Sixty (60) ASA grade I and II patients of age group (18­60 years) were divided randomly into two study groups of thirty patients each, as follows: Group I­Propofol 2 mg/kg was given intravenously as induction agent Group II­Etofol (0.15mg/kg etomidate and 1mg/kg propofol) was given intravenously as induction agent. Results: In group II ( Etofol) lesser fall in haemodynamic parameters at induction and upto 60 minutes (p>0.05)of induction as compared to group I (Propofol). Conclusion: Etofol is more haemodynamically stable than propofol alone during induction. 

  Aim: Aim of study was to compare Percutaneous Tracheostomy ( PT) and Surgical Tracheostomy (ST) both for complications, duration of procedure ,cost and easy of doing it. Objective of our study was to find out time taken to heal tracheal stoma. Method: 100 of Tracheostomy patients were randomly divided in to two groups (n =50 for both groups) with confidence level of 95%. Two consultants allocated 25 patients of each group for to do procedure. Procedure­related variables (length of skin incision, duration, difficulty), early complications like ‘bleeding & trauma, pneumothorax, pneumomediastinum, subcutaneous emphysema, loss of airway’, vitals, economic aspects were evaluated by the operating consultant. Procedure related (up to14 days) complications like local infection, haematoma & bleeding, trachea­innominate fistula, tracheo­esophageal fistula, were evaluated daily by consultant blinded to the technique used. Air leak closure/healing and long­term complications like cosmetic deformity, tracheal stenosis, tracheomalacia, delayed stomal healing were evaluated 3 months after decannulation by another consultant blinded to the surgical technique. Results: PT had more incidence of minor perioperative complications and ST had more long­term complications, statistical significance between two groups was absent. Time taken to perform PT and tissue trauma with PT were lesser than ST Group. Vitals were better maintained with PT Group. Air leak closure after decannulation was earlier in PT group and aesthetically, scar was smaller with PT group. Conclusion: PT was preferrable because of lesser duration of procedure, smaller incision with comparable complication rate and faster stomal healing. 

  Introduction: I­gel and LMA­C are most commonly used supraglottic air way devices to secure the airway during general anaesthesia our main objectives were to compare the ease of insertion, duration of insertion and number of attempts of insertion between I­gel group and LMA­C group. Methodology: Prospective randomized study conducted in SVMCH & RC Puducherry, during the period Oct 2015 to Mar 2017. Total patients 120 were divided into two groups LMA­C, n = 60 and I­gel, n = 60 by randomized method. SPSS 23 Version software was applied for t test as mean±SD for continuous variables and chi­square test used for categorical variables. Results: I­gel was more easily inserted then LMA­C group (90%, 85%) respectively and was statistically non­significant (p>0.05). Duration of insertion was shorter in I­gel group compared to LMA­C group (9.7±1.02 Vs 17.2±1.99) respectively and statistically highly significant (p<0.001). First attempt success rate was (95% Vs 91.6%) between I­gel and LMAC group. Number of insertion attempts between these groups were statistically non significant (p>0.05). Conclusions: Duration of insertion of highly shorter in I­gel group. Ease of insertion and first attempt success rate makes and I­gel a suitable alternative for elective surgeries under general anaesthesia. 

  Background: Newer 2 agonist agents have created a new chapter in faster and prolongation of neuraxial block and good postoperative analgesia. Intrathecal Dexmedetomidine studied in comparison with clonidine along with bupivacaine given intrathecaly for gynaecological surgeries. Materials & Method: patients belonging to the age group of 30­60 years posted for gynecological surgeries were taken for study. Patients were randomized into two groups, group D (30) received 15mg hyperbaric bubivacaine with 15 mcg Dexmedetomidine and group C received 15mg hyperbaric bubivacaine with 60mcg clonidine intrathecal. The quality of anaesthesia is evaluated by the onset of sensory and motor block, maximum height of sensory block, segmental regression of sensory block and total duration of motor block. Rescue analgesia required during the postoperative period was recorded. Result: Prolonged duration of sensory and motor block was feature of patients received dexmedetomidine. These patients are also hemodynamically stable with lack of sedation. Which is statistically significant (p < .001). The rescue analgesia time was 587 minutes in dexmedetomidine when compares to clonidine 408 minutes. Conclusion: Intrathecal dexmedetomidine causes good quality of anesthesia in the intraoperative period with prolonged postoperative analgesia with less requirement of rescue analgesia when compare to intrathecal clonidine. 

  Introduction: One of the most common post­operative complaints after spinal anaesthesia is post­operative urinary retention (POUR). The prophylactic effect of tamsulosin in reducing POUR in post spinal anaesthesia has not been investigated in a large scale; therefore the present pilot study was conducted to investigate the efficacy of tamsulosin compared with placebo in preventing POUR before undertaking larger study. Material and Methods: After obtaining the approval from ethical justification committee of Indira Gandhi Medical College and associated hospitals, Shimla 50 patients of ASA I and ASA II aged 20­60 years of either sex posted for lower limb /lower abdominal surgery under spinal anaesthesia were included in the study. Patients were randomised into two groups of single dose of 0.4 mg Tamsulosin and placebo. Conclusion: It was found that single dose of Tamsulosin decreases the incidence of POUR in patients post spinal anaesthesia.

  Context: Many agents are being tried to prevent acute changes in hemodynamics taking place during surgery as a result of intubation and other invasive procedures. Over the period of time dexmedetomidine has evolved as safe and hemodynamically stable anesthetic agent over most of the other agents. Aims: To study efficacy of dexmedetomidine over oral pregabalin in patients undergoing laparoscopic cholecystectomy. Settings and design: Present study was prospective randomized controlled study carried out at Apollo hospitals, Jubilee Hills, Hyderabad. Material and methods: 50 eligible patients undergoing laparoscopic cholecystectomy as per study criteria were divided randomly into two groups. One group with 25 patients received dexmedetomidine (Group D) and other group with 25 patients received oral pregabalin. Both the groups were compared for mean arterial pressure and heart rate from pre­operative period till post­operative period. Statistical analysis: Students t test was used to find the association between two mean. p value less than 0.05 was taken as statistically significant. Results: Both the groups were comparable to each other in terms of baseline characteristics. Pre­operative mean arterial blood pressure and heart was also comparable between the two groups. But it was significantly lower in group D compared to group P right from induction to extubation. Conclusion: We hereby conclude that dexmedetomidine is superior to oral pregabalin and provides better hemodynamic stability to patients undergoing laparoscopic cholecystectomy. 

  Background: Various modalities have been used for treatment of chronic knee osteoarthritis but with limited benefits. Radiofrequency neurotomy of genicular nerve is emerging as newer modality for pain relief with few complications. The present study was designed with an aim to compare combination of intra articular sodium hyaluronic acid and genicular radiofrequency neurotomy with intra articular sodium hyaluronic acid alone in chronic osteoarthritis patients. Methods: 40 patients of either sex, age 40­65 years suffering from knee pain due to advanced osteoarthritis with no benefit from conservative measures were randomly allocated into two groups. In Group A, intra articular sodium hyaluronic acid 6mL was injected under aseptic precautions. In Group B, intra articular sodium hyaluronic acid was followed by radio frequency neurotomy of genicular nerves. All patients were followed with pre­operative and post­ operative procedure outcome measurement at 1 week, 4 weeks, 12 weeks and 6 months. Results: Both groups were comparable with respect to age, height, weight, gender and BMI (Body Mass Index). Reduction in VAS (Visual Analogue Scale) and improvement in OKS (Oxford Knee Score) was better in Group B as compared to Group A at 1 week, 4 weeks, 12 weeks and 6 months post procedure, all differences being highly significant (p<0.001).

Conclusion: Combined therapy with intra articular sodium hyaluronic acid and genicular radiofrequency neurotomy is a safe, effective and minimally invasive procedure for knee osteoarthritis. It provides better pain relief and functional recovery of joints as compared to intra ­ articular sodium hyaluronic acid alone. 

  Introduction: Monitored Anaesthesia Care (MAC) involves administration of local anaesthesia (LA) with intravenous sedatives, anxiolytic and analgesic drugs with detailed monitoring of vital parameters. In tympanoplasty, reconstruction of tympanic membrane with or without ossicular reconstruction is done. To avoid pain, decrease bleeding IV sedation with local anaesthesia is preferred. In this study we compared the effects of Inj. Dexmedetomidine and Inj. Nalbuphine versus Inj. Dexmedetomidine and Inj. Fentanyl. Aims and objectives: 1. To compare the sedation effects and analgesic effects of Dexmedetomidine (1mcg/kg) / Nalbuphine (100 mcg/kg) and Dexmedetomidine (1mcg/kg) /Fentanyl (1mcg/kg) in I.V. sedation in Tympanoplasty. 2. To compare Heart rate, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Arterial Pressure, Respiratory Rate, Oxygen Saturation (SpO2) and Surgeon’s Satisfaction Score. Material and method: 60 patients undergoing tympanoplasty surgery under MAC were randomly divided in two groups of 30 each according to chit block method in addition toInj. Dexmedetomidine 1µgm/kg received either inj. Nalbuphine 100µgm/kg (Group N) or inj. Fentanyl 1µgm/kg (Group F) intravenously for sedation along with local anaesthesia during surgery. Ramsay sedation score (RSS), Visual analogue score (VAS), Heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean arterial pressure (MAP), Respiratory Rate (RR), Oxygen Saturation (SpO2) were recorded after giving both the drugs at the interval of 2, 4, 6, 8, 10, 30, 60, 90, 120 minutes. Result: We observed that RSS score was more and VAS score was less in group N than group F. This indicates that sedation and analgesia was better in Dexmedetomidine with Nalbuphine group than Dexmedetomidine with Fentanyl group. Decrease in heart rate, Systolic Blood Pressure and Diastolic Blood Pressure, Mean Arterial Pressure was statistically significant in group N than group F. This indicates that Dexmedetomidine with Nalbuphine provides better cardiovascular stability. Rescue analgesic requirement was comparable in both groups. Conclusion: From this study, we concluded that, intravenous Inj.Dexmedetomidine with Inj. Nalbuphine provides better sedation and analgesia, good hemodynamic stability, good surgeon’s satisfaction score without side effects. It also reduces the requirement of rescue sedation and analgesia as compared to Inj.Dexmedetomidine with Inj.Fentanyl in patients undergoing Tympanoplasty under local anaesthesia with monitored anaesthesia care. Thus Dexmedetomidine with Nalbuphine is a better alternative to Dexmedetomidine with Fentanyl as sedation for middle ear surgery.

  Introduction: Laryngoscopy and intubation of trachea are integral part of general anesthesia which can trigger adverse hemodynamic responses. These are unpredictable reflex sympathetic stimulations that may cause tachycardia, hypertension and arrhythmias. These short duration responses get amplified in high risk patients with likelihood of even pulmonary oedema and cerebrovascular accidents. These responses can be blunted by means like drugs and nerve blocks. Our study was designed to compare actions of intravenous (IV) esmolol (1mg/kg) and ditiazem (0.2mg/kg) to attenuate these responses. Material and Methods: 80 consenting, ASA I/II adults posted for elective non­cardiac, non­ neurologic operations were included in this randomised, double blinded, clinical comparative study. Parameters recorded were ECG, heart rate (HR), systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP), ST segment values, SpO2, arrhythmia analysis and incidence of any required rescue medication. Baseline values (mean of three readings, 1 minute apart) of HR, SBP, DBP, MAP, ST segment and SpO2 were recorded before induction of anesthesia. General anesthesia was given and study drug was injected 1 min. after muscle relaxant and intubation was done 2 min. thereafter. Abovesaid parameter values were recorded at intubation and every minute thereafter, till 10 min. post­intubation. Effects were statistically analysed. Statistical analysis and results: Unpaired t­test and generalized estimation equation were used for quantitative variables (e.g. HR, BP) to compare mean levels at different times points between two groups. Paired t­test was used for determining significance within the group at different time points. Chi­square/Fischer exact test (for categorical variable like arrhythmia) and non­parametric Mannwhitney test (in case data did not follow normal distribution) were planned,but were not required. Results: Both drugs control the heart rate well. Esmolol controls it better. At 10 minutes after intubation both achieve similar HR values. Both drugs control the SBP, DBP and MAP. Diltiazem controls it better. At 10 min. after intubation, both achieve similar BP values. Both drugs safely attenuate hemodynamic response to laryngoscopy and
intubation, as there were no arrhythmias, ST changes of significance or requirements of rescue medications in any patient.

  The success of anaesthesia in obstetrics depends largely upon surgical demand and materno­foetal well being. Hence the aim of anaesthesia is to provide safety and comfort to the mother, minimal neonatal depression and optimal working condition for the obstetrician. Propofol 2.5 mg/kg was compared with thiopentone sodium 5mg/kg as induction agent for elective caesarean section. A total of 90 healthy pregnant patients of ASA I and II, who were scheduled for elective caesarean section were included in this study and were randomly allocated into 3 groups. Group I­ Thiopentone sodium 2.5% (5mg/kg), group II­ Propofol 0.5% (2 mg/kg) and group III­ Propofol 1% (2mg/kg). Induction was smooth and rapid with both Propofol and Thiopentone with minimal incidence of side effects. Induction time was found to be shortest with Propofol 1% (40.1±6.11 seconds) as compared to Thiopentone sodium 2.5% (47.2±7.26 seconds) and Propofol 0.5% (70.5±19.58 seconds). Mean arterial pressure was lower in Propofol 1% group during the induction and intra­operatively. Other hemodynamic changes were similar in all three groups. Apnoea occurred less frequently with Propofol 1% (10%) than with Thiopentone sodium (43.33%). Pain on injection (6.66%) and awareness (10%) was found with Propofol whereas cough (3.33%), hiccup (6.66%) and nausea & vomiting (33.33%) were observed with Thiopentone sodium. Recovery time was shorter with clear headedness with Propofol. There was no significant neonatal depression as assessed by Apgar score. Propofol appears to be a better alternative to Thiopentone sodium as induction agent for caesarean section.

  Background and objectives: Though the breast surgeries are usually performed under general anesthesia (GA), it is not without any attendant risks. Thoracic Epidural anesthesia (TEA) is gaining more attention in view of better intraoperative conditions, postoperative recovery profile and fewer postoperative complications. This study was designed to determine the efficacy and safety of TEA as an alternative anesthetic technique to GA for Modified radical mastectomy (MRM). Methodology: Group G (n = 25) was administered conventional GA. The Group T (n = 25) received TEA with 0.25% Bupivacaine and Fentanyl. Postoperative pain management was provided with Tramadol for GA patients and epidural infusion for TEA patients. The need for anesthesia supplementation, sedation, hemodynamic changes, respiratory depression and other intercurrences like pruritus, nausea, vomiting were recorded. The duration of surgery, length of stay in the recovery room and quality of post­operative analgesia were also recorded. Results: In group T, Supplementation with axillary infiltration was required in 20% of patients and all patients required sedation. Hypertension was more frequent in group G, whereas hypotension and bradycardia were more frequent in group T. Postoperatively, the incidence of nausea and vomiting were observed frequently in group G. The group G patients had longer duration of stay in recovery room (202.32 vs 160.80 minutes). The Visual Analog scores and requirement of supplementary analgesics upto 24 hours of postoperative period were significantly lower in group T patients. Conclusion: TEA is a safe, reliable and better alternative to GA in patients undergoing MRM. 

  Spinal anaesthesia is always a safe, cost effective and a better option in patients where general anaesthesia can be complicated and to fulfill the purpose of post­operative analgesia. After conducting many upper abdominal surgeries and open cholecystectomy under spinal anaesthesia, this study was conducted on single, three and conventional four port laparoscopic cholecystectomy under spinal anaesthesia to assess its efficacy, safety, reliability and as an alternative to general anaesthesia with minimum risk. This study was conducted on 300 patients of either sex belonging to ASA­I & II, age 20­70 years admitted for planned laparoscopic cholecystectomy. Bupivacaine (2.5 to 4ml) was injected indurally in lateral position at the level of L2. Dose of bupivacaine varied according to the feasibility and compatibility of the operating surgeon. Pneumoperitoneum with CO2 was created with the range of 10­14mmHg intra­abdominal pressure, according to the ease of the surgeon,at the rate of 1 L/min. Patients were sedated with Inj pentazocine 30mg and midazolam 2mg/diazepam 10mg intravenously after performing spinal anaesthesia. Any discomfort and intensity to the patient due to right shoulder pain was observed and managed accordingly from right shoulder massage to supplementation with propofol 1mg/kg. No patient was converted into general anaesthesia with tracheal intubation. Mean age was 41.7 years. Mean surgical duration was 53.19±12.55 min. Mean duration of sensory block was 157.39±23.47 min and mean duration of motor block was 134.17±19.52 min. Laparoscopic cholecystectomy can be performed under spinal anaesthesia with better outcome and safety without having any major complication.

  Introduction: It is imperative for an anaesthetist to know the adverse effects of shivering and hypothermia on human body which may occur when the patients are under anesthesia, so that timely treatment can be provided. Aim: To compare tramadol and dexmedetomidine in the treatment of shivering after spinal anesthesia. Materials and Methods: This was a randomized, prospective study in which 80 patients posted for elective surgeries given spinal anesthesia who developed shivering were included in the study. Results: The incidence of shivering was 40% in our study. The difference in the time interval between administration of drug after the onset of shivering and cessation of shivering was significantly shorter in the dexmedetomidine group when compared to the tramadol group. Changes in Heart rate, body temperature, mean blood pressure are not significant in our study in both groups. Nausea and vomiting observed in tramadol group, and not in the dexmedetomidine group. Conclusion: Dexmedetomidine can be a substituent to tramadol for cessation of post spinal anesthesia shivering.

Background: The fundamental responsibility of anesthetist is to maintain the airway and provide adequate oxygenation. Failure to do this will lead to hazardous complication. So identification of difficult airway is important during pre operative evaluation. Difficult intubation can be predicted by modified mallampati test (MMP), inter­incisor distance, thyro­mental distance (TMD), sterno­mental distance, upper lip bite test and hyo­mental distance ratio, but no single factor reliably predicts difficult intubation. AASI, a relatively new test, based on surface land mark, has been suggested to reliably predict difficult visualization of larynx. Methods: A total of 250 adult patients, of either sex, aged 18­ 65 years, belonging to ASA class 1, 2 and 3 who were candidates undergoing elective surgery under general anaesthesia requiring tracheal intubation participated in a prospective, comparative, observational study. Preoperative airway assessment was carried out with AASI, TMD and MMP. Sensitivity, specificity, positive predictive value, negative predictive value, odd’s ratio, positive likelihood ratio, negative likelihood ratio were calculated for MMP, TMD and AASI. Chi­square test was used to analyze data. P value of less than 0.05 was considered
statistically significant. Results: The demographic data was normally distributed in terms of age, height, weight, bmi, and gender distribution. The sensitivity between MMP and TMD was statistically significant. There was no significant difference between the Specificity, positive predictive value & negative predictive value of MMP and TMD (p>0.05). There was no significant difference between the Sensitivity, Specificity, positive predictive value & negative predictive value of MMP and AASI. (p>0.05) There was significant difference in Sensitivity of TMD & AASI. But, there was no significant difference between the Specificity, Positive predictive value & Negative predictive value between TMD and AASI. Conclusion: Upon comparing AASI, MMP and TMD, AASI was found to be better only with regards to sensitivity no difference in any of the measured parameters in comparison to modified mallampati test. To conclude we would recommend further studies with larger sample size before validating or refuting the ASSI. 

  Aim: The aim of our study was to compare the efficacy, block parameters and safety profile of intrathecal hyperbaric bupivacaine and isobaric levobupivacaine for urological surgery. Methods: Urological patients who were scheduled for elective surgery under spinal anesthesia were enrolled in two groups. Group A received intrathecal 2.5 ml of (0.5%) hyperbaric bupivacaine, while Group B received intrathecal 2.5 ml of (0.5%) isobaric levobupivacaine. Sensory & motor block parameters, hemodynamic parameters and adverse effects in patients of both the groups were recorded. Results: The onset of sensory block, motor block and duration of motor block was comparable in both groups. Maximum height of sensory block was significantly higher in hyperbaric bupivacaine group and duration of sensory block was significantly higher in group B. Hemodynamic stability was better with levobupivacaine compared to hyperbaric bupivacaine. Hypotension and bradycardia were more common with hyperbaric bupivacaine group. In addition, nausea was noticed more frequently with hyperbaric bupivacaine. Other side­effects such as headache, backache, itching, vomiting, and shivering were almost similar in both the groups. Conclusion: We conclude that isobaric levobupivacaine is superior to hyperbaric bupivacaine in terms of longer sensory blockade and shorter motor blockade and also that intrathecal use of isobaric levobupivacaine is hemodynamically more favorable than that of hyperbaric bupivacaine.

  Context: Fentanyl was commonly used previously but due to its short duration of analgesia and more requirements of analgesics, efficacy of dexmedetomidine was evaluated by some studies and found to be effective. Aim: To compare the efficacy between dexmedetomidine and fentanyl when used for patients undergoing lower abdominal surgeries Settings and design: Present study was hospital based comparative study carried out at Department of Anesthesiology, Malla Reddy Institute of Medical Sciences. Methods: 60 consecutive eligible patients undergoing surgeries for lower abdomen were divided into two groups of 30 each. First group received dexmedetomidine 5 mcg and the other group received fentanyl 25 mcg. They were compared for the time taken for sensory regression and requirement of analgesics Statistical analysis: Student’s t test was used for mean values and chi square test for proportions. Results: Both the groups were comparable to each other in terms of baseline characteristics, types of surgeries performed. Mean duration of surgery was significantly more in the dexmedetomidine group than fentanyl group. The height of sensory level was significantly different between the two groups. Both the drugs took equal time of three minutes from injection to reach the highest sensory level. But the time required for sensory regression to S1 from highest sensory level was significantly higher for dexmedetomidine group patients compared to fentanyl group patients. The requirement of analgesics was significantly higher for fentanyl group compared to the dexmedetomidine group. Conclusion: Dexmedetomidine was found to be more effective than fentanyl in terms of long lasting anesthesia, and lesser requirement of analgesics.

  Background: Postoperative sore throat is one of the most common complications afterendotracheal intubation. Both Ketamine and magnesium can block N­methyl­D­aspartic acid receptors and provide central and local analgesia. Objectives: To compare the efficacy of magnesium sulfate and ketamine gargle in preventionof postoperative sore throat. Methodology: A total of 90 patients posted for general anaesthesia with endotrachealintubation were enrolled in the study. Patients in ketamine group received ketamine gargle (50 mg) and magnesium group received magnesium sulfate gargle (20 mg/kg up to 30 mL normal saline) 15 minutes before the operation. Patient’s complaint of postoperative sore throat, and its severity were measured and recorded at baseline in recovery room, and then 0, 4, 8, 12 and 24 hours after operation. Results: To analyse the association of sore throat in two groups Chi square test wasused. p <0.05 was considered statistically significant Number of patients with sore throat were significantly lower in magnesium group compared to ketamine group at 0hr (p<0.001), 4th hr (p <0.001), 8th hr (p <0.001), 12th hr (p<0.001) and 24th hr (p =0.006) after the operation. Conclusions: Magnesium sulphate decreases sore throat and pain severity more effectively compared toketamine gargle.

  Background: Transversus abdominis plane block is a safe, simple and effective technique, widely used to provide postoperative analgesia for various abdominal surgeries. We evaluated the efficacy of Transversus abdominis plane block in laparoscopic tubal sterilisation surgeries in providing intraoperative and postoperative pain relief. Materials and Methods: 40 ASA I and II adult female patients undergoing laparoscopic sterilisation surgeries were randomised into two groups. Group T (n=20) received TAP block with 20 ml of 0.375% Ropivacaine and Group C (n=20) received general anaesthesia with local infiltration with 10 ml of 0.375% Ropivacaine. Intraoperatively, hemodynamic parameters, Pulse oximetry, end tidal Carbon dioxide concentration and total Propofol requirement were noted. Postoperatively, the recovery profile (Modified Aldrete Score) and Visual analog scale scores were noted at emergence and at 1st, 2nd, 6th, 12th and 24 hours. Results: Patients who underwent surgery under TAP block had a longer time to request for rescue analgesic (Group T 313±77.61 minutes; Group C 34.77±6.72; p<0.001) with a reduced VAS
at Trescue (Group T=4.00±0.00; Group C=4.32±0.89; p<0.001).The mean VAS scores of the patients in Group T were lower when compared to Group C at all time intervals. The Propofol requirement was lower in Group T (Group T =18.88±17.85 mg and Group C =119.54±9.5 p<0.001) and recovery profile better in patients in Group T. Incidence of postoperative nausea and vomiting was the same in both groups. Conclusion: TAP block with sedation can be considered as a suitable alternative to general anaesthesia with local infiltration in laparoscopic sterilisation surgeries.

  In paediatric patients, smooth induction with rapid endotracheal intubation without morbidity and mortality is of prime importance. Many of the inhalational anaesthetic agents have been tried for this purpose. In the present study, Sevoflurane due to its high potency, rapid induction, excellent intubating conditions with haemodynamic stability was compared with Halothane in paediatric patients. In the present study, 60 paediatric patients of ASA grade I and II of either sex were divided into 2 equal groups of 30 each according to inhalational anaesthetic agent used for induction of anaesthesia. In group S Sevoflurane 8% and group H Halothane 3% were used for induction of anaesthesia with Nitrous oxide/oxygen mixture on Boyles’ machine. All patients received Inj. Glycopyrolate 5­8µgm /kg and inj. Midazolam 0.25 µgm /kg as premedication 10 minutes prior to induction of anaesthesia. It was observed that, mean induction time in group S was 210±17 secs and in Group H 262±21 secs. Sevoflurane has low blood/gas coefficient of 0.69 as compared to Halothane 2.5, so quicker induction time with Sevoflurane as compared to Halothane. In group S, 90% of patients had excellent intubating conditions, 7% good and 3% had fair while in group H 84% had excellent intubating conditions, 13% had good and 3% had fair intubating conditions. During intubation, mean pulse rate decreased significantly in both groups and increased after intubation. The decrease in pulse rate was comparatively less in group S than group H and also there was significant increase in pulse rate after intubation in both groups. Similar changes were observed with mean systolic blood pressure and mean arterial pressure in both groups. Thus Sevoflurane provided better cardiovascular stability during and after intubation as compared to Halothane. We conclude that, Sevoflurane due to its cardiovascular stability, smooth induction, and excellent intubating conditions may be preferred over Halothane in paediatric patients for endotracheal intubation.

  Aim: To compare the effectiveness of mouth dissolving antiemeticsprochlorperazine and granisetron in the prevention of postoperative nausea and vomiting in patients undergoing abdominal hysterectomy under spinal anaesthesia Materials and Methods: A total number of 50 cases of ASA Gr.I and Gr. II were taken into a double blind randomized study and divided into two groups. 25 of them received Granisetron 1mg mouth dissolving tablet and the other 25 patients received Prochlorperazine 5mg mouth dissolving tablet for preventing postoperative nausea and vomiting and observed for a period of 24 hours. Results: There were no statistically significant differences between the groups with respect to patient characteristics, type of surgery and duration of anesthesia. Administration of Prochlorperazine and Granisetron 60min before surgery, effectively controlled nausea and vomiting during early postoperative period i.e., within 6 hours after surgery. Postoperative nausea and vomiting in the 6 – 24 hours postoperative period was significantly lower with Granisetron when compared to Prochlorperazine. (p value <0.01) Conclusion: Administration of Granisetron 1hr before surgery was superior to Prochlorperazine in long term prevention of postoperative nausea and vomiting following Total abdominal hysterectomy under spinal anesthesia.

  Ropivacaine has a lower and different toxicity profile compared to Bupivacaine. It is a new long­acting, enantiomerically pure (S­enantiomers), amide local anaesthetic with a high pKa and low lipid solubility. T. Ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardio toxicity. Ropivacaine should be a favorable local anesthetic for day­case surgery and could be associated with earlier postoperative mobilization than Bupivacaine. Objective of Study: To compare the effects of intrathecal hyperbaric 4 ml of 0.5% Ropivacaine with 4 ml of hyperbaric 0.5% Bupivacaine in a ratio of 1:1 by volume (Ropivacaine 16.5 mg and Bupivacaine 11 mg) for lower abdominal/lower limb orthopedic surgeries with regard to: Onset and duration of sensory block, motor block. Maximum height of sensory block. Quality of anesthesia and Adverse reactions if any after taking written informed consent. Observations: Onset of motor blockade was slower and duration of motor blockade was shorter with Ropivacaine compared to Bupivacaine. However, all the patients in either groups attained complete motor blockade. With respect to hemodynamic parameters intrathecal Ropivacaine provided a higher Degree of cardiovascular stability with a lesser incidence of hypotension and bradycardia was observed. Result: There is delayed onset of motor block and shorter duration of motor block with Ropivacaine compared to Bupivacaine. Cardiovascular stability is better than Bupivacaine. Hence, Ropivacaine can be used successfully for lower limb/abdominal surgeries where early recovery is well appreciated by the patients

  Aims: To assess the efficacy and compare the duration of analgesia, level of sedation and side effects of 0.75% ropivacaine with  50 mcg dexmedetomidine to 0.75% ropivacaine with 50 mcg fentanyl given epidurally. Study setting: Department of Anaesthesiology, MOSC Medical College, Kolenchery. Study period: An observational descriptive study on 66 patients over a period of one year. Methods and Material: 66 patients of ASA physical status I and II of either sex in the age group of 18­65 years undergoing abdominal hysterectomy or inguinal hernioplasty were observed in the study under two groups of 33 patients in each. Epidural anaesthesia was given after a test dose of 3ml 2% lignocaine with adrenaline followed by 15 ml 0.75% ropivacaine with Group I receiving 50 mcg fentanyl as adjuvant and Group II receiving 50 mcg dexmedetomidine. Two groups were compared with respect to sensory and motor block characteristics, hemodynamic changes, level of sedation and side effects. Statistical analysis used: The data was analyzed using Chi­square test, Fisher’s exact test and Student t­test. p < 0.05 was considered to be significant and p < 0.001 as highly significant. Results: Significant prolongation of analgesia, motor blockade and two point regression time was observed in Group II as compared to group 1. A maximum sedation score of 4 was attained in 78.8% patients in Group II vs 3% in Group I, which was highly significant. Conclusions: Dexmedetomidine is a very good epidural adjuvant to ropivacaine providing prolonged duration of analgesia, excellent sedation with minimal side effects as compared to fentanyl.

  Background and Aims: Total abdominal hysterectomy (TAH) is one of the commonly performed major surgical procedures resulting in substantial postoperative pain and discomfort. Hence, the study was carried out to compare the postoperative analgesic effect of Ropivacaine hydrochloride with Bupivacaine hydrochloride in transversus abdominis plane (TAP) block after total abdominal hysterectomy (TAH). The primary objective was to compare the post operative analgesic duration and secondary objective was comparing the hemodynamic parameters, nausea and sedation score. Methods: The Prospective, double blind and randomized comparative trial was conducted in 60 ASA physical status I and II patients scheduled for elective total abdominal hysterectomy. Patients were randomly divided into two group R and group B and they were given TAP block by ‘double pop off ’ technique with Ropivacaine and Bupivacaine respectively. Heart rate, systolic and diastolic blood pressure, NRS NRS nausea and sedation score were measured. Data was analysed with Mann Whitney U Test and Chi square test. Results: Haemodynamic variables like heart rate, systolic and diastolic blood pressure does not show significant difference with p value > 0.05. Time for rescue analgesia was significantly higher in patients with group B when compared with group R with p value of < 0.001. Nausea and Sedation score also remains normal without any significant changes with p value > 0.05.

Conclusion: Bupivacaine hydrochloride gave longer duration of postoperative analgesia compared with Ropivacaine hydrochloride and there is no significant differences in hemodynamic variables, nausea and sedation score.

  Background: Hyperosmolar solutions are most commonly used to relax brain and facilitate intracranial surgery. This study was planned to compare the effects of three equiosmolar, equivolemic solutions (mannitol, 3% hypertonic saline, and mannitol+3% hypertonic saline) on intraoperative brain relaxation. Material and Methods: This prospective randomized study was conducted in 90 patients of age group 18­65 years with traumatic brain injury undergoing craniotomy only after approval from the institutional ethics committee. Patients were randomly allocated into three groups; Group M ( received mannitol 300 ml), GROUP S (Group received 3% Hypertonic Saline 300 ml), and GROUP M+S (received mannitol 150 ml and 3% Hypertonic Saline 150 ml). Brain relaxation score was assessed by neurosurgeon on a four point scale as perfectly relaxed­1, satisfactorily relaxed­2, firm brain­3, bulging brain­4. All the patients were assessed for Glasgow coma score at 24 hrs postoperatively and at the time of discharge from the intensive care unit. Results: Grade 1 and Grade 2 brain relaxation scores were 4/14, 4/16 and 8/12 in Group M, Group S and Group M+S respectively. (p>0.05) Total urine out was 1453.33±376.68 ml in group M, 823.33±238.43 ml in group S and 1313.33±156.96 ml in group M+S respectively. (p<0.001) There was non­significant rise and fall of electrolyte (Na+ and K+) level amongst the groups. Additional rescue dose of mannitol was required in all three groups in 12, 8 and 10 patients respectively. Conclusion: All three hyperosmolar solutions are equally effective in providing adequate intraoperative brain relaxation during decompressive craniotomy in traumatic brain injury.

  Introduction: This study aims at comparing the anaesthesia characteristics between Buprenorphine and Fentanyl when added as an adjuvant to intrathecal 2­Chloprocaine 1% in an attempt to prolong the duration of spinal analgesia post operatively and are compared with the plain 2­Chloprocaine 1% intrathecally for perianal and perineal surgeries. Methods: The study was
conducted on 63 patients divided into 3 groups. The control A was given 30mg (3 ml) of 2­Chloprocaine 1% with 0.5cc normal saline and study groups B and C were given 30mg (3ml) of 2­Chloprocaine 1% with 0.5cc (25µ) of Fentanyl and 0.2cc (60µ) of Buprenorphine with 0.3cc of normal saline respectively. Study included ASA I and II patients and were subjected to the following perennial and perineal surgeries like haemorrhoids, fissure­in­ano, fistula­in­ano, perianal and scrotal abscess, carcinoma rectum for rectal biopsy, hydrocele, phimosis. Standard spinal anaesthesia techniques were chosen for all patients including lateral position, midline approach with 25G quinke spinal needle. Results: There was no significant difference in time of onset of sensory block and motor blockade between the 3 groups and also no significant haemodynamic changes between the 3 groups. But there was a significant difference in mean total duration of analgesia and VAS score between 3 groups post operatively. Conclusion: The study shows that 2­Chloprocaine 1% provides an adequate block for perianal and perineal surgeries lasting 40­60 min. Addition of Buprenorphine 60µ and Fentanyl 25µ improves the quality of spinal anaesthesia and prolongs the duration of analgesia post operatively and Buprenorphine prolongation being much longer than Fentanyl.

  Context: Tonsillectomy is the second most common surgical procedure performed in pediatric patients. Post­Tonsillectomy pain is regarded as a major morbidity in early post­operative period which delays the oral intake & discharge of patients. Topical application of Local Anesthetic like Bupivacaine at the site of trauma reduces post­operative pain resulting in early oral intake & early discharge unlike local infiltration in which complication rate is high for intravascular injection and convulsions. Settings and Design: Prospective randomized and comparative study of 40 ASA I and II patients of age group 6 to 15 years undergoing tonsillectomy under general anaesthesia. Methods and Material: Patients were divided into two groups randomly, group B (Bupivacaine group) – in which 2 cotton pledgets soaked in 0.1ml/kg of 0.5% Bupivacaine was kept in the tonsillar fossa for 5 minutes and group C (control group) which received 2 cotton pledgets soaked in 0.1ml/kg of 0.9% NaCl and kept in fossa for 5 mins. Statistical Analysis Used: One­way ANOVA was used for analyzing the data. For comparing binomial data like sex and ASA status, Chi square test was used. Results: The group with topical bupivacaine had less tonsillar fossa pain and requested postoperative analgesics very lately or not till discharge Conclusion: We conclude that topical application of cotton pledget soaked in 0.5% bupivacaine in tonsillar fossa for 5 minutes is effective in providing relief of post tonsillectomy pain and promote recovery. 

  Introduction: Effective post surgical pain management is essential for the recovery and rehabilitation process. Intravenous injection brings more rapid pain relief than other methods.In this study, We had compared Inj. Nalbuphine, Inj. Tramadol and Inj. Ketorolac given intravenously for post operative pain relief in patients who underwent ower limb orthopaedic surgeries Aim: To compare the analgesic efficacy and side effects of intravenous Nalbuphine, Tramadol and Ketorolac for postoperative pain relief in patients undergoing lower limb orthopaedic surgeries under spinal anesthesia. Methodology: After obtaining informed consent and institutional ethical committee approval, 1 50 patients were randomly assigned to one of the three study groups (Group T, Group K, and Group N) based on computer generated random numbers Each group consists of 50 patients
Group ‘T’ received Inj. Tramadol 2mg/kg IV
Group ‘K’ received Inj. Ketorolac 0.4mg/kg IV
Group ‘N’ received Inj. Nalbuphine 0.3mg/kg IV
Spinal anaesthesia was performed in sitting position using 25 G spinal needle under aseptic precaution using 0.5% Bupivacaine hyperbaric solution. Intra operatively hemodynamic variables like pulse rate, Blood pressure, ECG, SpO2 monitored. 90 minutes after spinal Anaesthesia each group of patients were administered their respective drug intravenously irrespective of completion
of surgery. Post operatively following parameters were monitored every hour for a period of 24 hours. 1. hemodynamics
2. Pain score
3. Sedation Score.
Results: There is no significant difference in demography.The changes in hemodynamics and sedation are more in Group N than other groups.
Conclusion: Nalbupine has more analgesic effect than ketorolac and tramadol with more sedation.

Objectives: Comparison of block characteristics and postoperative analgesic efficacy of Fentanyl and Dexmedetomidine, as a adjuvant to intrathecal hyperbaric 0.5% Bupivacaine for patients undergoing Transurethral resection of Prostate(TURP). Methods: 100 patients belonging to ASA physical status I & II were divided into two groups of 50 each. Group F (Fentanyl group) received
2ml Inj. Bupivacaine heavy with 25µg of Fentanyl. Group D (Dexmedetomidine group) received 2ml Inj. Bupivacaine heavy with 5µg of Dexmedetomidine. The time of onset of sensory and motor block, haemodynamic status, duration of motor blockade and postoperative analgesia and adverse effects, if any were compared in both the groups. Results: Time from injection to highest sensory level and Onset of Bromage 3 was similar in both groups. The time taken to reach the level of T10 after injection was significantly less and the time taken to regression to Bromage 0 was significantly more in group D compared to group F (p<0.001). Intraoperatively both groups remained haemodynamically stable. Incidence of bradycardia was more in Group D and incidence
of pruritus was more in Group F, though it was not statistically significant (p=0.402). Intraoperative sedation was higher in Group D (p<0.001) and postoperatively Visual analogue scores were significantly lower with group D (p<0.001). Conclusion: Dexmedetomidine appears to be an attractive adjuvant to intrathecal Bupivacaine than Fentanyl as there is significantly longer duration of motor block. It provides good quality of intraoperative analgesia, haemodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia.

  Context: Entropy monitoring enables us to administer the anaesthetic doses of induction agents with precision so as to avoid intraoperative awareness, light planes of anaesthesia on one hand and delayed recovery, haemodynamic instability on the other. Aims: To evaluate the haemodynamic effects of induction doses of propofol and etomidate under entropy guidance, in patients undergoing under general anaesthesia. Study design: A prospective, observational study. Methodology: This study was conducted on 100 patients of ASA I and II between the age group 18­60 years. The patients in group A, were induced with etomidate and group B, with propofol till entropy reached a value of 40. Haemodynamic parameters at and after induction were noted. Results: All statistical calculations were done using SPSS 21 version. The mean of mean arterial pressure at 1 minute after induction in group A and B was 85.9±10 and 75.5±8 respectively (p=0.00) and after laryngoscopy, in group A and B was 98.4±8.1 and 105.3±9.1 respectively (p=0.00). Significant rise in the heart rate was seen with propofol after laryngoscopy and intubation. (p=0.018) Conclusion: On induction doses under entropy guidance, the haemodynamic effects observed with propofol were more pronounced than that of etomidate. Propofol caused more hypotension than etomidate after induction, whereas, there was statistically significant rise in heart rate after laryngoscopy and intubation. 

  Background: Pain due to knee joint osteo arthritis is one of most common health problems in old age and many treatment options have been used to control pain but none of them is completely effective and also have their side effects. The knee joint is supplied by genicular nerves which convey the sensory input to higher centers. The aim of present study was to evaluate the effectiveness of radio frequency ablation of genicular nerves in controlling pain due to knee joint osteo arthritis and to compare the pain relief and effect on analgesic intake with control group at 1st, 4th, 8th and 12th week of post procedure period. Materials and Methods: Fifty, American Society of Anaesthesiologist, grade 1 and 2 adult patients in age group of 40 to 70 years and suffering from knee joint osteoarthritis and on regular analgesic drug intake were randomly divided into two groups. 22G Radiofrequency cannula with 100 mm length and 10mm active tip and radio frequency machine G4 Cosman was used for sensory and motor stimulation for locating and ablation of genicular nerves. In Group I (Control group), the radiofrequency needles were placed extra articularly around knee joint under C­Arm guidance and genicular nerves were located with sensory and motor stimulation and one ml of 1%xylocaine was given at each needle site. No thermal or pulsed RF was given. In Group II (Study group), the RF needles were placed extra articularly at specified genicular nerves and after sensory and motor stimulation one ml of 1% xylocaine was given at each needle site. Radio frequency was given with target temperature of 70°c for three cycles, each of 1.5 minutes duration. Post procedure observations were made by an independent anesthetist not associated with procedure team. The post procedure VAS scores and analgesic intake were noted at 1st, 4th, 8th and 12th week in both groups. Statistical Analysis Used – SPSS version 14.0 (SPSS Inc., Chicago, IL), Chi square test, student’s t test. p­Value < 0.05 was taken as statistically significant. Results: The VAS score in Gp I, in immediate post procedure period was 0.80±0.500 as compared to base line score of 6.80±0.645 9 (p< 0.001). The VAS at 1st, 4th, 8th and 12th week follow up was 6.56±0.651, 6.88±0.666, 6.92±0.640 and 6.92± 0.572 and change was statistically insignificant (p >0.05). In immediate post procedure period the VAS score in Gp II, was 0.92±0.572 as compared to pre procedure VAS of 7.0±0.707 (p <0.001). The VAS at 1st, 4th, 8th and 12th week follow up was 1.84±0.987, 1.96±0.978, 2.36±1.075 and 2.60±1.041 respectively and the change in VAS was highly significant (p <0.01). The mean consumption of capsule Raceclo per week in pre procedure period in Gp I & II was 6.44±0.917 and 6.44±0.961 showing no significant intergroup difference statistically (p >0.05).In Gp I, the mean weekly consumption of capsule Raceclo at 1st, 4th, 8th and 12th week follow up was 5.52±0.823, 6.161 ±0.746, 6.28±0.737 and 6.68±0.690 respectively and the change was statistically insignificant(p >0.05). The mean post procedure weekly consumption of capsule Raceclo in Gp II, at 1st, 4th, 8th and 12th week was 0.60±1.190, 0.56±1.356, 0.96±1.567 and 1.52±1.447 respectively and the decrease in analgesic consumption was statistically highly significant on intra group and inter group comparison. All the Gp II patients except one were relieved of pain. Two patients in Gp II reported pain relief in other knee also. No complications such as infection hemorrhage; thermal injury and sensory or motor weakness/loss were reported.

  Background: Prolonged post­operative analgesia helps in early ambulation and prevents chronic post­surgical pain. Hence, effectiveness of using a combination of two adjuvants with ropivacainefor epidural analgesia is required to be known. Objectives: To compare the effectiveness, duration of post­operative analgesia and side effects of fentanyl and clonidine used alone with ropivacaine or in combination. Materials and Methods: 105 American Society of Anaesthesiologists physical statusclass1 and 2 patients with 18 to 70 years of age posted for elective lower limb surgeries under combined spinal epidural technique were randomly assigned into 3 equal groups. Surgery was done under spinal anaesthesia and postoperatively, Group RC received 8ml 0.2% Ropivacaine + Clonidine 60mcg, Group RF received 8ml 0.2% Ropivacaine
+ Fentanyl 75mcg and Group RFC received 8ml 0.2% Ropivacaine + Clonidine 30mcg + Fentanyl 37.5mcg epidurally. The Visual Analogue Scores, onset of analgesia, peak effect of analgesia, duration of analgesia, haemodynamic parameters and side effects in each group were recorded and statistically analysed with p<0.05 considered as significant. Results: Group RFC had faster onset of analgesia, earlier peak analgesic effect and longer duration of analgesia compared to group
RC and RF. VAS scores were comparable between group RC and RFC. No statistically significant difference between the groups was noted with respect to haemodynamic parameters. Only one patient had nausea and vomiting in group RFC. Conclusion: Both clonidine and fentanyl can be used as adjuvants in lower doses without compromising the analgesic efficacy and also lower the incidence of side effects.

  Background: Selective left endobronchial intubation in right thoracoscopy is technically demanding. We are presenting our mid term experience of selective left bronchus intubation using the previously published maneuver with single lumen endotracheal tube. Methods: 135 consecutive children below 12 years underwent right thoracoscopy from June 2014­Jan 2017. Endotracheal tube was kept in the freezer for 60 seconds to provide slight stiffness. Selective left bronchial intubation was done using neck extension, head tilt towards the right and left chest elevation maneuver. The tip of tube was rotated by 90° after 9cm to guide it towards left main bronchus. Maximum of three attempts were tried and ET tube kept in the trachea if selective intubation was not possible. Results: Selective left bronchus intubation could be done in 131 (97.03%). Follow­up ranged from 3 to 12 months. All cases were asymptomatic at last follow up. Selective intubation could be done on first attempt in 126 (93.33%), second attempt in 3 (2.22%), third attempt in 2 (1.48%). In 4 (2.96%) cases left endobronchial intubation could not be achieved. Mean operating time was 1.30 hours (Range: 1.00­2.30 hours). There were 115 empyeama (tubercular­13), 18 hydratid cysts and 2 esophageal duplication cyst. The intercostal drain was kept for a mean period of 3 days (Range: 2­4 days). All the cases were kept nil orally for 6 hours and
discharged at a mean duration of 5 days (Range 4­6 days). Conclusions: Thoracoscopic procedures for right sided pathology could safely and easily be performed using this novel technique.

  Context: Atracurium is associated with hemodynamic instability in patients. Cisatracurium has been developed to overcome this side effect which is an isomer of atracurium. Aim: To study the efficacy of Cisatracurium in patients undergoing lower abdominal surgeries. Settings and Design: Present randomized controlled trial was conducted at Department of Anesthesiology, Malla Reddy Institute of Medical Sciences, Hyderabad. Methods: The patients being operated for lower abdominal surgeries were randomly allocated into two groups. 30 patients were in Atracurium group while 30 patients were in Cisatracurium group. The changes in the heart rate and mean arterial pressure was observed after giving injection of anesthetic and immediately after the intubation. Statistical analysis: The data was analyzed using means and proportions. Student’s t test for means and chi square for proportions was used. Results: Both the groups were comparable in baseline characteristics. The baseline heart rate was similar for both the groups. But heart rate after injection and after intubation in Atracurium group was significantly more compared to the heart rate after injection in Cisatracurium group (p < 0.05). The change of mean MAP was significantly more in Atracurium group after giving injection from baseline compared to Cisatracurium group. But the difference of means of change in MAP from giving injection to intubation was statistically not significant between the two groups (p > 0.05). Again the change in mean MAP was significantly more in Atracurium group after intubation from baseline compared to Cisatracurium group. Conclusion: Cisatracurium was found to be more effective than Atracurium in terms of stabilized heart rate and mean arterial pressure. 

  Background and aims: Effective postoperative pain relief from epidural analgesia has numerous benefits including earlier ambulation, rapid weaning from ventilators, lowered circulating stress hormone levels. Precise placement of epidural catheters ensures selective blockade of dermatomes affected by surgical procedure, allowing reduction of doses of local anaesthetics and additional analgesics. The aim of the study was to analyse efficacy of epidural analgesia in relation to distance between catheter placement and site of surgery. Methods: This was prospective observational study carried out for a year, total of 44 paediatric patients who underwent thoraco­abdominal surgery under general anaesthesia with epidural analgesia were considered and studied for general practice in our institute for epidural catheter placement, efficacy of epidural analgesia in relation to distance between catheter placement and site of surgery, complications of epidural catheter placement.Data were expressed as means (with standard deviations) and percentages (for categorical data). Unpaired t test and chi square test were used to compare continuous and categorical data respectively. Results: The total volume of local anaesthetic required in first 24 hrs postoperative in congruent group was 6.67±2.56ml/kg as compared to 8.60±2.938ml/kg incongruent group (p=0.025). In congruent group 16% of children required additional analgesic as compared to incongruent group where 36.84% of children required additional analgesics. Conclusion: Our study shows that putting the epidural catheter congruent to surgical incision required less of volume of local anaesthetic and additional analgesics and should be practiced preferably.

  Introduction: Opioids are well studied adjuncts although the evidence regarding the analgesic benefit of opioid adjuncts remain equivocal. The effectiveness of buprenorphine and butorphanol administered as adjuncts to local anaesthetic solution into brachial plexus sheath was evaluated. Aim: The objectives of this study are to compare between Butorphanol and Buprenorphine as an adjunct to local anaesthetic solution in supraclavicular brachial plexus block with respect to – Duration of sensory and motor block, duration of analgesia and untoward side effects. Materials and Methods: The study was a randomized prospective double blind and comparative study carried in 60 ASA grade I and II patients undergoing elective upper limb surgeries, aged between 18­60 years were randomly allocated into 2 groups of 30 each. All patients received 1% lignocaine
plain 2mg/kg and 0.5% bupivacaine at 2mg/kg body weight. In addition, 30 patients in group A received butorphanol tartarate (30mcg/kg) while the 30 patients of group B received buprenorphine hydrochloride (3mcg/kg). Using VAS score the analgesia was evaluated every hourly for six hours, every two hours for next twelve hours and then every six hours till 48 hours. Result: heart rate pattern of both groups shows statistical significance at 10th to 13th hour of the study period. systolic blood pressure changes between two groups shows statistical significance between 9th to 11th and 14th, 15th, 16th, 18th, 20th and 24 hrs. diastolic blood pressure between two groups show statistical significance between 8th­12th hr and 18th, 20th and 24th hr. Statistical significance with respect to respiratory rate at 2nd to 5th hr, 14th hr, 16th hr to 20th hr, 28th hr and 48th hr.postoperative pain using visual analogue scale (VAS) between the two groups with statistical significance at 3rd, 9th, 11th­13th, 17th and 18th hrno statistical significance in terms of onset, duration of surgery, sensory and motor blockade between the two groups. Average duration of analgesia were 14.13±8.41hr and 22.18±12.13hr in groups A and B respectively, showed statistical significance. The group B showed prolonged analgesia produced by addition of buprenorphine to local anaesthetic. Side effects like nausea, vomiting and numbness were comparable in both groups without any significance. Conclusion: We conclude that buprenorphine as an adjunct administered with local anaesthetics into brachial plexus sheath is an efficient way to overcome the perioperative pain in upper limb surgery. 

  Varients of supraglottic airway devices are generally used in difficult airways or in day­care surgeries to bypass the consequences of endotracheal intubation or to replace tracheal intubation. In this study, the aim was to evaluate the advantages of proseal LMA over endotracheal tubes in the prospects of ease of insertion and efficacy for positive pressure ventilation without the risk of
regurgitation and aspiration and without any detrimental variations in hemodynamics. A randomized clinical study was carried out on 80 patients of either sex belonging to ASA Grade I and II, proposed for abdominal surgeries under general anaesthesia and were randomly allocated in two groups (Group I­ Proseal LMA and Group II­ Endotracheal intubation). Parameters observed
were ease of insertion (number of attempts), insertion or intubation time of device and nasogastric tube and effects on hemodynamics. 40 patients were included in each group. Success rate for insertion of device in first attempt was 93% in group I and 99% in group II. Mean insertion time in group I was 15.57 seconds and 22.24 seconds in group II, which was statistically insignificant (p<0.1). Mean nasogastric tube (Ryle’s tube) insertion time in group I was 9.96 seconds in compare to group II, where the mean time was 12.55 seconds, which was statistically significant. The conditions for proper and adequate ventilation to maintain 100% oxygen saturation in both groups were satisfactory without any air leak. According to this study, it can be concluded that Proseal LMA is a safer and effective alternative for endotracheal tubes in general anaesthesia. 

  Background: Surgery is the treatment of choice in breast cancer and the current moto is towards less extension of removal of tissue with axillary dissection for removal of lymph nodes to guide further treatment. Aim: The present study compare thoracic epidural with general anesthesia in cancer surgeries of the breasts. Materials and Methods: It is a comparative study in 60 patients divided into two groups, epidural group (n = 30) underwent epidural thoracic block and other group(n = 30) underwent conventional general anesthesia. Following variables were noted as duration of the surgery, the need of anesthesia or sedation, and intraoperative hemodynamic parameters. In the postoperative period, length of time until discharge from the recovery room and from the hospital, severity of pain, adverse effects, and satisfaction with the anesthetic techniques were noted. Results: Both groups have no significance in the duration of the surgery was observed. The rate of hypertension was more in the group of patients who underwent general anesthesia, while hypotension was more in the epidural group. Postoperatively, pruritis (40%) has more incidences in the epidural block group. Nausea (20%) and vomiting (33%) was more in general anesthesia group. The length of stay in the recovery room and hospitalization were lower in the epidural group; Satisfaction with the anesthesia is more with epidural block. Conclusions: Epidural block is advantages when compared with general anesthesia and can be used as anesthesia option in oncologic mastectomies with axillary lymph node dissection.

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.