Indian Journal of Anesthesia and Analgesia

  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.