Indian Journal of Anesthesia and Analgesia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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