Indian Journal of Anesthesia and Analgesia

After the discovery of xenon in 1898, xenon anaesthesia has been studied for decades. The search for an inert gas to replace N2O led to introduction of xenon in anaesthesia practice. Xenon’s anaesthetic properties were discovered in 1939. Since then, a number of studies of xenon anaesthesia have been conducted. The anaesthetic properties of xenon is mainly conferred by the inhibition of N-methyl-D-aspartate receptors in the central nervous system. Xenon is an inert gas and, theoretically, is not metabolized to toxic metabolites, does not react with absorbent, and does not deplete vitamin B12, as opposed to other inhaled agents. Xenon is described as having many of the characteristics of an ideal inhalational anaesthetic agent, including rapid induction and emergence, analgesic properties, cardiovascular stability, and neuroprotective qualities. It is non-flammable, non-explosive, non-toxic, devoid of teratogenic effects and does not contribute to the greenhouse effect. Clinically, there are certain disadvantages to xenon anaesthesia. Because of its high density, xenon was found to increase airway resistance and work of breathing in an animal study. Nevertheless, it may be a good choice for high-risk patients with unstable haemodynamics, cardiovascular diseases, expected prolonged recovery from anaesthesia, or advanced age. Moreover, the high cost of xenon associated with its production has discouraged more widespread use. This article reviews the benefits and drawbacks of xenon anaesthesia, and discusses future perspectives.

IASP defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of the actual damage.” This definition embraces various concepts especially the subjectivity of the symptoms which is the basis of the non-pharmacologicaloptions in the treatment of labour pain. We conducted this study to compare the efficacy of the equipotent 0.125% Bupivacaine and 0.2% Ropivacaine in labour.

The severity of labour pain was recognized by the Romans, who termed delivery the poenamagna—the “great pain” or “great punishment.” Pregnancy, though is one of the most pleasant part of a woman’s life is marred by the anxious awaiting of a painful labour. Although labour is painless in a few women, the vast majority considers it painful, and a clear majority rates it as severe pain. Melzack, one of the authors of the gate control theory of pain, developed a questionnaire to assess the intensity and emotional impact of pain. Using this tool, he observed that labour pain was rated as more painful than cancer pain and that, among nulliparous women with no prepared childbirth training; it was nearly as painful as amputation of a digit without anaesthesia.Traditionally a number of techniques have been employed to provide labour analgesia. But Epidural analgesia is considered to be the gold standard in labour analgesia.

Background: Central venous catheters (CVC) are an essential component of modern critical care. They allow delivery of medications, intravenous fluids, parenteral nutrition, hemodialysis and monitoring of hemodynamic variables. Thus, percutaneous placement of a catheter into a central vein is a frequent procedure in many clinical settings. Aims: To compare the ease of insertion between Internal jugular vein (IJV) and Subclavian vein (SCV) catheterisation, frequency of mechanical complications between the two routes like- Arterial puncture, Pneumothorax, Hemothorax/Hydrothorax, Subcutaneous hematoma, Misplacement of catheter. Materials and Methods: 100 patients admitted to The Trauma Care Unit of our institution requiring CVC divided into two groups of 50 each. Group A Patients had CVC via IJV and Group B Patients had CVC via SCV. A prospective randomized double blinded clinical study has been conducted in patients of either sex fulfilling the inclusion and exclusion criteria after taking ethical committee approval and informed consent from the patients. The data was analysed using statistical methods like Chi square test, independent samples T test. Results: The age, sex in the two groups were found to be comparable. Ijv catheterisation was significantly easier than scv (P value <0.05) and the mechanical complication like pneumothorax and misplacement of catheter was less in Ijv (P value <0.05) compared to scv although arterial puncture, subcutaneous hematoma more in scv (P value <0.05) than Ijv. Conclusion: According to the observations and analysis of this study, catheterisation in IJV was significantly easier than SCV and has significantly lower risk of catheterisation related complications.

Pain is the most common symptom that brings the patient to a health care provider. The fear of pain during and after surgery affects the psychological state of the patient immensely. The technical skills and the extensive pharmacological knowledge on pain relief place the anesthesiologist in an ideal position to treat pain in the perioperative setting. Comparisonof analgesic efficacy and safety of two different doses of intrathecal buprenorphine (30 µg and 60 µg) along with bupivacaine (2.2 ml) in geriatric patients 60-80 years undergoing hemiarthroplasty.

Introduction: Supraclavicular approach to brachial plexus block produces the most complete upper limb block as it blocks the brachial plexus at the level of the trunks formed by C5-T1 nerve roots.Ropivacaine is a pure S enantiomer with greater differentiation between sensory and motor block with better margin of safety due to reduced toxic potential. The aim of this study was to compare sensory and motor block effectiveness of 0.5% ropivacaine to that of 0.5% bupivacaine for supraclavicular brachial plexus block in upper limb surgeries. Materials and Method: In this prospective randomized study total 60 patients undergoing upper extremity surgeries were given block using a peripheral nerve stimulator. Group A received 0.5% ropivacaine, 30ml and Group B received 0.5% bupivacaine, 30ml. Sucess of the block was assessed by determining loss of shoulder abduction and loss of pinprick in the C5- T1 dermatomes. The onset of action (sensory and motor) and duration of action (sensory, motor) were recorded. Post operative analgesia was assessed by using visual analog scale. The results were tabulated and statistically analyzed. Results: There was statistically significant difference in the mean onset time to achieve maximum sensory level between group A(7.87+/-2.13mins) and group B(9.53+/-2.45mins). Duration of sensory block and analgesia was similar in both the groups. However motor block was more prolonged in group B(556+/-93.7mins) as compared to, group A(467+/-92.5 mins). Conclusion: Ropivacaine is a suitable alternative to bupivacaine in supraclavicular brachial plexus block for upper limb surgeries.

Introduction: Monitored Anaesthesia care (MAC) has been defined by the American Society of Anaesthesiologists as a diagnostic or therapeutic procedure done under local anaesthesia along with sedation and analgesia. Advantages of performing tympanoplasty under MAC with local anaesthesia are less bleeding, improved post-operative analgesia, early and smooth recovery and discharge from hospital with least expenditure. The biggest advantage is intra-operative communication and assessment of hearing in the patient. Aim: The study was done to evaluate the efficacy of dexmedetomidine and midazolam for intra-operative sedation and analgesia in monitored anaesthesia care and to compare and assess any adverse effects in different groups of study. Methodology:The study was Conducted in the Department of Anaesthesiology, Gandhi Medical College and Hamidia Hospital, Bhopal on ASA Grade I and II patients scheduled for tympanoplasty. 90 patients of either sex of ASA Grade I and II, aged between 16 and 40 years were studied.All patient were premedicated with injection glycopyrolate 0.01mg/kg IV and Inj pentazocine 0.3 mg/kg over 1 min. Group A received Dexmedetomidine: Bolus dose 1mcg/kg IV followed by 0.4mcg/kg per hour, and Group B received Midazolam: Bolus dose of 0.04 mg given over 1 min. Oxygen supplementation through nasal catheter was given. Sedation was titrated to Ramsay Sedation score of 3. Rescue sedation with Midazolam 0.01mg/kg was given if RSS was <3 . Surgery was allowed to commence when Visual Analogue Scale (VAS) was <3. Sedation was assessed using Ramsay sedation Scale. Result and Conclusion: Sedation with Dexmedetomidine was found to be better alternative to midazolam in monitored anaesthesia care performed in minor ENT surgical procedures. It provides a calm sedated patient. Also, fall in the HR and MAP was seen in more number of patients of Group A than in Group B. This caused decreased bleeding, thus providing bloodless surgical field comfortable for the surgeon.

Aim: To compare the haemodynamic responses, during laryngoscopy and intubation, using Macintosh and McCoy blades, in patients of ASA grades I and II, undergoing craniotomy for supratentorial lesions, under general anaesthesia, with monitoring of entropy, to ensure uniform depth of anaesthesia. Methodology: A prospective, randomized, comparative study conducted at Nizam’s Institute of Medical Sciences , between January 2013 and April 2013 . Total 60 patients were included in study with 30 patients in each group divided as Group A - Macintosh laryngoscope was used & Group B -- McCoy laryngoscope was used. Patients included were undergoing elective supratentorial lesion surgery, aged between 18 to 60 years & belonged to ASA grade I & II. Depth of anaesthesia by monitoring entropy was kept uniform during laryngoscopy and intubation (Between 40 to 60). Airway assessment and difficult intubation scoring systems and also intubation related parameters were noted and compared between the 2 groups . Heart rate, Invasive blood pressure, which included systolic, diastolic and mean arterial pressure, RE and SE were recorded and compared at the following time points: preinduction (baseline Tb), before laryngoscopy (T0), during laryngoscopy (TL) , during intubation (In), post intubation at 1, 2, 3, 4 and 5 minutes (T1-T5) , between the 2 groups. Results: Haemodynamic response consisting of an increase in HR, SBP, DBP and MAP were seen during laryngoscopy and intubation, using Macintosh and McCoy blades in this study. It was also observed that, the haemodynamic responses to laryngoscopy and intubation was slightly greater with Macintosh blade than with McCoy blade. This was due to better laryngeal visualization and shorter time of ETT insertion with the McCoy balde, than with the Macintosh and this was contributory to the lower haemodynamic responses seen with the McCoy blade. But these responses were statistically insignificant between the two blades (p>0.05), when depth of anaesthesia by monitoring entropy was kept uniform throughout the study (Between 40 to 60 ). The stress responses were also short lived in both groups, as uniform depth of anaesthesia using entropy monitoring, blunted the overall responses to laryngoscopy and intubation, and the awareness component, which could have occurred if not monitored. Conclusion: We conclude that, although McCoy blade was superior in terms of better glottic visualization, ease of intubation and overall operability, the haemodynamic responses produced during laryngoscopy, intubation and post intubation were similar and comparable with the Macintosh blade and statistically insignificant (p>0.05), when depth of anaesthesia is uniform and adequate.

Introduction: Unilateral spinal anaesthesia has been extensively studied for short duration elective lower limb surgeries with favorable results i.e when block is desired on operative side only with absence of block on non- operative side. Unilateral block minimizes cardiovascular effects, avoids motor block of nonoperative limb thereby early ambulation and early discharge. Aim: The aim of this study was to determine the sensory and motor block characteristics and haemodynamic variables (HR, MAP, RR) by comparing 7.5 mg of 0.5% hyperbaric bupivacaine used alone and along with 30g clonidine. Methods: It was a prospective, double blind , hospital based study undertaken at Department of Anaesthesiology, Gandhi Medical College, Bhopal after approval of the Institutional Ethics Committee. 60 patients of either sex aged 20-60years with ASA grade I and II scheduled for elective lower limb surgery with informed consent were randomly allocated into two groups. All patients received subarachnoid block with 7.5 mg of 0.5% hyperbaric bupivacaine. In group BC 30 g of clonidine and in group BS 0.2 ml of Normal Saline was added to bupivacaine and the volume was kept similar (1.7 ml) for each group. Statistical Analysis Used: Chi-Square (c2) test and Unpaired Student’s t-test Results: Although there was not much significant difference between the haemodynamic parameters in both the groups, the onset of sensory block (6.0±0.58 mins in group BS and 3.9±0.48 mins in group BC) and the onset of motor block (10.08±0.54 mins in group BS and 7.03±0.57 mins in group BC) was significantly earlier and the average duration of analgesia and motor block was significantly prolonged in patients receiving clonidine as an adjuvant along with bupivacaine. Likewise, the time for the first rescue analgesic request (258±20 & 331±23 mins respectively in groups BS & BC, p<0.0001) was delayed in patients receiving clonidine as an adjuvant. Conclusion: From our study we conclude that 7.5mg of 0.5% hyperbaric bupivacaine used along with clonidine is superior than 7.5mg of 0.5% bupivacaine used alone in prolonging duration of analgesia and motor block while maintaining the unilaterality of spinal block and haemodynamic stability.

Introduction: Caudal block is commonly performed in paediatric anaesthesia for post-operative analgesia using various adjuvants. Aim of Study: To compare efficacy and safety of dexmedetomidine and dexamethasone in view of post-operative analgesia along with haemodynamic stability when used as adjuvant to local anaesthetic. Material and Method: After the approval of ethical committee, an observational study of 60 pediatric patients calculated using website http://openepi.com (2-6 years old) of either gender and ASA I and II scheduled for infra umbilical surgeries under general anesthesia allocated to 2 groups of which Group A received inj dexmedetomidine and group B received inj dexamethasone as an adjuvant to inj ropivacaine 0.2% (1 ml/kg) caudally after completion of surgery Haemodynamic parameters and pain score (FLACC) were recorded every 2 hourly upto 8 hours in post operative period. Rescue analgesia was given when score was 4. Total duration of analgesia was recorded. Statistical Analysis: Numerical variables were presented as mean and standard deviation while categorical variables were presented as frequency and percent. For analysis, unpaired student – t test and chi – square test were used. Results: The groups were comparable in demographics and haemodynamics. The mean duration of analgesia was similar in both the groups. The pain score in the two groups were comparable. Conclusion: Both dexamethasone and dexmedetomidine prolonged the duration of analgesia with no significant difference between them. Dexamethasone can be used as an alternative to dexmedetomidine as an adjuvant in caudal block in paediatric patients.

Background: Fracture of the femur is a common orthopaedic problem following trauma in patients of all ages. This study was undertaken to compare the effectiveness of intravenous (IV) fentanyl with femoral nerve block (FNB) in positioning the patients for combined spinal epidural anesthesia (CSE). Methods: 100 patients between the ages 25 to 75 years, of ASA grade I, II and III, scheduled for elective surgeries of femur fracture were evaluated in 2 groups. Group-1 (n=50) received femoral nerve block with 15ml of 1.5% lignocaine and Group-2 (n=50) patients received one dose of IV fentanyl 1g/kg. Assessment of pain was carried out using visual analog scale (VAS). This was rated before, during and after the procedure of positioning for spinal/combined spinal epidural anesthesia (CSE). Vital parameters were tabulated. Results: VAS scores were noted at 0, 2, 5, 10, 15 minutes and at the time of positioning. The average VAS scores at 15 minutes in Group-1 was 1.47 and 3.82 in patients in Group-2. Time taken for CSE was significantly less in Group-1 (13.02 minutes) as compared to Group-2 (19.66 minutes). Patient satisfaction scores were significantly higher in Group-1 (45/50) 1.49 as compared to non Group-2 (10/50) 0.34. Quality of patient positioning was better in Group-1 (2.78) as compared to Group-2 (1.38). Conclusions: This study concludes that FNB is highly effective in giving good pain relief for positioning for regional anaesthetic procedures improving performance time and offers higher acceptance among patients with femoral fractures as compared to IV fentanyl.

Caudal analgesia is one of the most popular method for intra and post-operative method for abdominal, perennial and lower limb surgeries for children’s. For local anesthetic common drug used is Bupivacaine. In children caudal epidural block is one of the common anesthetics techniques in children. It is the general, simple and safe procedure for local anesthetics. It is administered as single shot technique. Several adjuncts such as opioids, ketamine, midazolam, clonidine and neostigmine have been used with bupivacaine to prolong its action & thus extend the duration of post-operative analgesia provided by the ‘single shot’ caudal technique.

Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removal of calculi in pelvicalyceal system which is usually performed under general anaesthesia. We conducted a prospective, randomized, comparative study to compare epidural block and general anesthesia with respect to hemodynamic stability and postoperative analgesia in patients undergoing PCNL. Methods: 80 urological patients of ASA I and II grade,posted for percutaneous nephrolithotomy were included in our study. They were divided into two groups of 40 each. In patients belonging to Group G, surgery was performed under General Anaesthesia and in Group E, surgery was performed under Epidural Anaesthesia using 1.5mg/kg of 0.5% bupivacaine and 1mcg/kg of Fentanyl to a maximum of 50mcg. Intraoperative hemodynamics, postoperative analgesia, amount of rescue analgesic required and patient satisfaction were compared between the two groups. Complications, if any were also compared. Results: In our study, we found that the Heart rate, Mean arterial pressure were increased in the initial 5 minutes after giving General Anaesthesia in patients belonging to Group G when compared to Group E. Time duration of post-operative analgesia was more in Group E with less amount of analgesic requirement than in patients belonging to Group G. Post-operative complications were also less in Group E than in Group G. With the results obtained in our study, we concluded that Epidural anaesthesia is better than General anaesthesia in patients undergoing PCNL.

Endotracheal tube (ETT) is always considered as a standard device to keep an airway patent during surgery. Airway management of patients has also progressed form endotracheal tube to lesser invasive laryngeal mask airway. The proseal laryngeal mask airway (PLMA) is a recently introduced supraglottic airway device. It provides higher seal pressure and offer a better protection against regurgitation and gastric insufflation. Aims and Objective: To compare the efficacy of PLMA and ETT in terms of pulmonary ventilation, ease and no of attempts of placement and hemodynamic parameters. Material and Method: A prospective, simple randomized and comparative study was carried out after ethical committee approval in 60 patients, aged 20-50 years, with ASA grade I and II of either gender undergoing elective surgery under general anaesthesia at tertiary care centre in india during 2015 and 2016 to compare the efficacy of PLMA and ETT in terms of pulmonary ventilation, ease and no of attempts of placement and hemodynamic parameters. Result: Both the groups were comparable regarding age, gender, height and baseline vitals. Patients intubated with PLMA showed no or minimal change in heart rate and mean arterial pressure as compared to ETT. The intubation time was comparable in both groups. The two groups were comparable with respect to number of attempts required for insertion of both the devices, (P> 0.05). Conculsion: The comparative study showed PLMA has a good hemodynamic stability. It is concluded from our study that placement of PLMA is relatively easy and simple. The performance of PLMA is as good as the conventional ETT in providing general anaesthesia.

Purpose: Spinal anaesthesia is a useful technique for infraumbilical and lower limb surgeries. The misconceptions regarding its overall safety, feasibility and reliability can be better known with greater use, its applications and research. We have designed this study to analyze the success rate, complications, and hemodynamic stability related to spinal anaesthesia in paediatric patients aged 5 years to 12 years. Methods: Total 60 patients were included in this study. Spinal anaesthesia was given with injection hyperbaric bupivacaine (0.5%) in a dose of 0.3 mg/kg. Demographic data, vital parameters, number of attempts for lumbar puncture, sensory-motor block characteristics and complications were noted. Results: Lumbar puncture was successful in 1st attempt in 46 (76.66%) patients and 2nd attempt was required in 14 (23.34%) patients. Vital parameters were not altered. Mean peak sensory level achieved was T7.1 ± 1.67 (T4-12) and mean time for two segment regression was 45.33±4.71 minutes. Modified Bromage score was 3 in all patients. Sensory and motor block recovery was complete in all patients. Mean duration of surgery was 77.2 ± 11.88 minutes. The incidence of complications was minimal with hypotension and bradycardia. Conclusion: Our study concludes that spinal anaesthesia in paediatric patients is feasible owing to its safety, higher success rate, and very low complications. Due to its early motor recovery, batter postoperative analgesia with minimal physiological alteration, no risk of respiratory depression and pulmonary aspiration, it reduces overall morbidity and mortality. Hence it is a preferred technique for daycare lower abdominal and lower limb surgeries.

Aim of the Study The aim of the study is to compare the recovery times when Propofol with Fentanyl or Propofol with Ketamine are used for maintenance of anaesthesia in day case surgery and also to determine which agent combination is suitable to make the patient home fit at the earliest.

Background and Objective: The clinical study was undertaken to evaluate the efficacy of Thiopentone & Etomidate with reference to time to loss of eyelash reflex, hemodynamic parameters, pain on injection, myoclonus & other side effects if any. Material and Method: Study was conducted on 60 patients (according to Solvin’s formula) of either gender, ASA I & II, 20- 60 years old, posted for elective surgeries for general surgery and Ear Nose and Throat surgery. All the patients were premedicated with inj. Fentanyl 2 mcg/kg iv slowly along with other pre medicating drugs and divided into 2 groups. Group E induced with inj. Etomidate 0.3 mg/kg iv and the group T induced with inj. Thiopentone 5 mg/kg iv. The induction time was calculated from the start of injection to the loss of eyelash reflex. The patient’s hemodynamic changes during baseline, at the time of induction and 1 min, 2 mins, 5 mins & 10 mins after the induction were recorded. Pain on injectionand myoclonus were recorded during induction and other side effects were noted. Results: Induction time was faster in Group E (23.23±5.2 seconds) when compared with group T (32.60±4.5 seconds) (p value<0.05). Hemodynamic changes were more stable in group E and Pain on injection and Myoclonus were observed only in group E (8 & 10 patients respectively). Conclusion: Etomidate causes good hemodynamic stability with rapid induction than Thiopentone.

Introduction: Ultrasound has gained popularity in the last few years for peripheral nerve blocks which provides real time visualization of the nerves to be blocked and also reduces the volume of drug to be injected. Aims and Objectives: To study the effect of 50µg of Dexmedetomidine added to the local anaesthetics for ultrasound guided supraclavicular block in respect to onset, duration of sensory and motor block along with haemodynamic variables. Materials and Methods: This prospective randomized and double blind study was conducted in 60 ASA I and II patients scheduled for elective upperlimb surgeries under ultrasound guided Supraclavicular brachial plexus block were randomized into two groups. Group I patients received 0.5% bupivacaine (10ml) + 2% lignocaine with adrenaline (10ml) + dexmedetomidine (0.5ml-50mcg) and Group II patients received 0.5% bupivacaine (15ml) + 2% lignocaine with adrenaline (15ml) + normal saline (0.5ml) Onset and duration of Motor and sensory block block were recorded. Results: Though sensory block was achieved earlier in group I, it was not statistically significant but motor block onset times was statistically significant in group I as compared to group II (p<0.05). Sensory and motor blockade duration were longer in group I than in group II (p<0.05). Intra-operative hemodynamics was significantly lower in group I (P < 0.05) without any appreciable side-effects. Conclusion: We conclude that dexmedetomidine added to bupivacaine- lignocaine with adrenaline in ultrasound guided supraclavicular brachial plexus block is extremely effective in reducing the time of onset and prolonging the duration of both sensory & motor blockade.

Introduction: General anesthesia (GA) is the common mode of anesthesia for spine surgery. However, with spine surgeries being increasingly performed in lateral, as against prone position, spinal anaesthesia (SA) is becoming more acceptable. This study was conducted to compare general and spinal anaesthesia in lumbar spine surgeries performed in lateral position. Materials and Methods: Patients with ASA I-II, planned to undergo single level lumbar laminectomy in lateral position were randomized into GA and SA group by computer generated random numbers. The former were given GA with endotracheal intubation as per standard protocols and latter were given SA with 3.2mL 0.5% hyperbaric bupivacaine. Surgery was performed in lateral position. Intra-operative hemodynamic events, post-operative sedation score, pain status, surgeon satisfaction, total time and complications were recorded and analysed. Results: 79 patients were studied. Mean heart rate and blood pressure were lower in SA group at various stages during surgery. Total time in operation room was 119 minutes in GA while only 94 minutes in SA group. VAS score was higher in GA group at 2 and 12 hrs post-operatively (5.2 v/s 2.4 and 4.0 v/s 2.7 respectively). Total consumption of tramadol in 24 hrs was higher in GA as compared to SA group, (mean ampoules, 3.12 v/s 2.19). Sedation score (mean grade, 1.18 v/s 0.06) and blood loss > 400 mL were higher and surgeon satisfaction lower in GA group. Conclusion: Spinal anaesthesia is a better alternative to general anaesthesia for lower lumbar spine surgeries when operated in lateral position.

Introduction: Dexmedetomidine is being increasingly used to prolong the duration of subarachnoid block. Various doses of dexmedetomidine are in practice. Isobaric Ropivacaine for its reduced cardiotoxicity and early motor recovery has gained edge over bupivacaine for subarachnoid block. Aims and objectives: To assess the efficacy and safety of two different doses of dexmedetomidine i.e 10µg and 15µg as an adjuvant to 0.75% isobaric ropivacaine intrathecally for abdominal hysterectomy surgeries. Materials and Methods: This prospective randomized and double blind study was conducted in 60 female ASA I and II patients scheduled for hysterectomy surgeries were randomized into two groups A and B. Group A received 2.5ml of 0.75% isobaric ropivacaine and 10µg dexmedetomidine whereas group B received 2.5ml of 0.75%isobaric ropivacaine and 15 µg dexmedetomidine. Onset and duration of sensory and motor block, hemodynamic variables were recorded and compared between the two groups. Results: The mean onset time of sensory and motor block of group A was 5.52±0.28mins and 6.95±0.22mins respectively whereas in group B was 4.48±0.35 and 6.1±0.28 mins which was statistically significant (p<0.0001).Duration of sensory and motor blockade in group A was 423±12.85 and 382±9.25mins respectively whereas in group B was 587±10.83 and 530±15.78 mins which was statistically significant (p<0.0001). There was no significance in hemodynamic and side effects between two groups. Conclusion: Our study showed that 15µg of Dexmedetomidine provided rapid onset and prolonged duration of subarachnoid block with isobaric 0.75% ropivacaine without significant side effects.

Background and Objectives: This observational study is designed to compare the intrathecal preservative free  midazolam and clonidine, used as an adjuvant with hyperbaric bupivacaine for post operative analgesia in patients undergoing elective hernia surgeries. Material & Methodology: The observational study was conducted on 60 patients (using formula for Estimation of mean difference) of ASA grade I/II aged between 20 and 55 years posted for elective hernia surgeries under spinal anaesthesia. Group BM (midazolam group)– 15mg 0.5% hyperbaric bupivacaine+2mg preservative free midazolam made 3.5 ml with normal saline and Group BC (clonidine group) –15mg 0.5% hyperbaric bupivacaine +30µg preservative free clonidine made 3.5ml with normal saline. Onset and duration of sensory and motor blockade, Duration of Analgesia, Hemodynamic changes, Postoperative analgesic consumption in 24 hrs, Side effects/Complications (if any) were recorded. Results: There was a statistically significant difference in onset of sensory & motor block (pvalue< 0.01), and Duration of sensory & motor block (p value< 0.01) in BM group than BC group. Duration of analgesia was significantly prolonged in BM group (351.6±39.1min) as compared to BC group (252.5±21.1 min) (p value<0.01). Conclusion: Addition of 2mg midazolam (preservative free) to 0.5% hyperbaric Bupivacaine as an adjuvant intrathecally leads to early onset of sensory and motor block, prolongation of duration of sensory and motor blockade and prolongation of duration of analgesia as compared to 30 µg clonidine (preservative free) without any side effects in both the groups.

Background: Laparoscopic surgeries under are associated with unique hemodynamic changes thus a basic need is felt among the anaesthesiologist fraternity for the desired availability of a drug that effectively suppresses all the hazardous responses to obnoxious stimuli with a maximum safety margin. Dexmedetomidine due to its distinct sedation, analgesia and sympatholytic properties can be used as an anaesthetic adjuvant in anaesthesia for Laparoscopic surgeries. Thus we undertook this double blind, prospective comparative study. Methods: Fifty women undergoing Laparoscopic gynaecological Surgeries divided randomly by a computer generated table into two groups of 25 each. D group - Dexmedetomidine loading dose 1µg/kg followed by maintenance infusion of Dexmedetomidine at 0.4µg/kg/hr M Group – Midazolam loading dose 0.03 mg/kg followed by maintenance infusion of saline. Both the group were given Fentanyl citrate 1ug/kg. We undertook this double blind, prospective comparative study to evaluate efficacy and safety and its effect on sedation, hemodynamic, anaesthesia and analgesia requirement and recovery characteristics. Results: Baseline Mean degree of sedation was same but after 5 min study drug it was 2 for group D compared to group M -1.32 and postoperative 1.16 for group D and 1.08 for group M. Mean heart rate was 73.84 for group D and 74.52 for group M. Mean blood pressure was 100.84 for group D and 102.56 for group M. Same trend observed at the time of induction, intubation, mean during pneumoperitonium and mean value in PACU. Mean dose of fentanyl required was less 65µg compared to 93.4µg in group M. Conclusion: This randomised, double blind study demonstrated that when compared to Midazolam Dexmedetomidine is more effective anaesthetic adjuvant that causes adequate sedation without respiratory depression, decreases requirement of anaesthetic and opioid, attenuate sympathoadrenal response, maintains stable haemodynamics perioperatively at the same time provide excellent recovery profile without any adverse events but continuous monitoring for hypotension and bradycardia is essential during first two hours of postoperative period if higher infusion rate are used.

Background: The most commonly used isoosmolar fluid in neurosurgery is 0.9% saline, which is known to produce hyperchloraemic metabolic acidosis. A balanced salt solution, like PlasmaLyte A, is not only isoosmolar, but also maintains acid –base balance and is stated to produce less serum chloride changes. Our aim was to study the effects of PlasmaLyte-A on acid base balance, serum osmolarity and serum electrolytes in neurosurgical procedures. Methodology: 70 patients posted for elective supratentorial craniotomies were randomly allocated to two groups, to receive either 0.9% saline or PlasmaLyte A as the sole intravenous fluid. Arterial Blood Gas Samples were analysed at regular intervals and the variables noted were: serum osmolarity, pH, base deficit or excess, serum chloride, serum lactate, serum sodium, serum potassium, serum calcium, and glucose levels. Intergroup data was analysed statistically by student’s T test (continuous) and chi-square test (categorical) while repeated ANNOVA and post-hoc Tukey Kramer test was used to analyze data within each group using NCSS statistical software version 9.0. Results: Towards the end of the surgery, pH was found to be low in the normal saline group (7.334±0.05 and 7.275±0.05) as compared to the plasmalyte group (7.402±0.03 and 7.406±0.03), this difference being statistically highly significant (p<0.0001). The difference in base deficit was also highly significant at the same time intervals. Chloride levels were significantly higher in the normal saline group in comparison to the study group at different time intervals (112.8±8.002 and 103.63±6.17) and (115.77±9.84 and 103.15±2.95) (p value<0.0001) while serum electrolytes and serum osmolarity was found to be comparable in both the groups. Conclusion: We conclude that 0.9% saline when used as sole intravenous fluid in neurosurgical procedures, causes significantly higher chloride levels and significant acidosis when compared to plasmalyte A used for the same purpose.