Indian Journal of Anesthesia and Analgesia

  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.