Indian Journal of Anesthesia and Analgesia

Anatomical and physiological changes of pregnancy make the airway management risky, which has resulted in the increased use of regional anaesthesia for caesarean section. Pathological conditions causing airway compromise in these patients can increase the risk making the situation life threatening during the perioperative period. Though regional anaesthesia avoids airway manipulation, it can often result in emergency situations necessitating airway control which can be catastrophic in them. We present the successful management of a patient with compromised airway due to huge lymphoma in front of the neck having retrosternal extension for elective caesarean section under continuous epidural anaesthesia with good maternal and neonatal outcome.

Labour is an extremely painful process. Labour pain is of major concern since most parturients experience significant pain of extremely severe intensity. Labour pain can have deleterious effects on the mother, on the foetus and on the labour outcome. Among the current methods of obstetric analgesia, regional analgesia (the most widespread technique being epidural analgesia) offers the best effectiveness/safety ratio. We conducted this study to compare the efficacy of a mobile epidural using 0.0625% bupivacaine and 0.0002% fentanyl versus a conventional epidural using 0.125% bupivacaine for labour analgesia.

Background: Aspiration of gastric content, during induction and intubation is a major risk factor which determines the outcome of anaesthesia. As all the patients undergoing caesarean section are considered full of stomach due to delayed gastric emptying, rapid intubation is mandatory in them. The ideal muscle relaxant is the one who produces faster onset of action; resultant in to reduction in the incidence of side effects. The aim of this study was to determine the effects of rocuronium during tracheal intubation on patients who were scheduled for elective caesarean section.

Material and Methods: Total 90 ASA grade I and II near term patients who were to undergo elective caesarean section were included. Selected patients were randomly divided in to 3 groups consisting 30 patients in each. Group I (S60) patients received suxamethonium 1.5 mg/kg with intubation attempted at 60 seconds and patients of groups II (R60) and III (R90) received rocuronium 0.6 mg.kg with intubation attempted at 60 seconds and rocuronium 0.6 mg.kg with intubation attempted at 90 seconds respectively.

Results: The intubating conditions were acceptable in all the patients belonging to group I (S60) and group III (R90), while 04 patients in group II (R60) had unacceptable intubating conditions. Rocuronium found haemodynamically stable as suxamethonium.

Conclusion: Rocuronium provides acceptable intubating conditions in patients undergoing elective caesarean section with no incidence of side effects or complications.

Background and Aims: Hyperglycemia and hemodynamic perturbations are the main features of neuroendocrine stress response to surgical trauma and anesthesia. We conducted a study to evaluate and compare dexmedetomidine and fentanyl as anesthetic adjuvants in attenuating neuroendocrine stress response by measuring the changes in the perioperative serial blood glucose levels and monitoring hemodynamic variations during laparoscopic cholecystectomy.

Methodology: Sixty healthy adult patients scheduled for elective laparoscopic cholecystectomy were randomly assigned into two groups (Group D and Group F) of 30 each. Group D patients received dexmedetomidine 1µg/kg/15min whereas group F patients received fentanyl 2µg/kg/15min as loading dose and then the patients were infused with 0.20.7 µg/kg/ h of the respective drug till the end of surgery. Blood glucose levels were measured preoperatively before administration of premedication (baseline) (T0), at 30 minutes after beginning of surgery (T1) and 5 minutes postextubation (T2). Heart rate (HR), oxygen saturation (SpO2), systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP) were assessed at specific time intervals.

Result: Blood glucose concentration increased in both groups, though group F showed a more obvious increment than group D. T1 and T2 mean values in group D (115.57 and 118.80mg/dl respectively) were significantly (p=0.020 and p< 0.001 respectively) lower than that in group F (122.37 and 128.90mg/dl respectively). HR, SBP, DBP and MAP were also significantly lower in group D than group F at various time points.

Conclusion: Dexmedetomidine is a better anesthetic adjuvant than fentanyl in attenuating the neuroendocrine stress response during laparoscopic cholecystectomy.

Background: In general anaesthesia rapid and safe endotracheal intubation is critical. Aspiration of gastric content, during induction and intubation is a major risk factor which determines the outcome of anaesthesia. The ideal muscle relaxant is the one who produces faster onset of action; resultant in to reduction in the incidence of side effects. With this background present study was done to compare the effects of rocuronium and suxamethonium on intubating conditions.

Material and Methods: Total 90 ASA grade I and II patients who were scheduled to laparoscopic appendectomy under general anesthesia selected. These patients were randomly divided in to 3 groups consisting 30 patients in each. Group I (S60) patients received suxamethonium 2mg/kg with intubation attempted at 60 seconds and patients of groups II (R60) and III (R90) received rocuronium0.6 mg.kg, with intubation attempted at 60 seconds and rocuronium 0.6 mg.kg, with intubation attempted at 90 seconds respectively.

Results: The intubating conditions were acceptable in all the patients belonging to group I (S60) and group III (R90), while 04 patients in group II (R60) had unacceptable intubating conditions. Rocuronium found haemodynamically stable as suxamethonium.

Conclusion: Rocuronium provides acceptable intubating conditions as comparable with suxamethonium with no incidence of side effects or complications.

Introduction: The minimum alveolar concentration (MAC) which prevents movement in response to surgical incision in 50% of patients for halothane and enflurane is less than that which prevents movement in response to laryngoscopy and tracheal intubation. Desflurane may differ from older anaesthetics in its capacity to prevent movement in response to laryngoscopy and tracheal intubation. Aim: To calculate the minimum alveolar concentration of desflurane for effective endo tracheal intubation.

Materials and Method: It was a prospective study conducted at Nizam’s Institute of Medical Sciences, between July 2015 and September 2015. The study recruited seventy patients scheduled for general anaesthesia for an elective surgery with age ranging between 18 to 60 years of either gender with ASA physical status I and II. After giving the induction drugs, nitrous oxide in oxygen (50:50), each at 4 litres/minute with desflurane was commenced. Desflurane was started at 2% and increased by 2% every 30 sec, until patient lost consciousness, with entropy less than 60 and permitted manual ventilation. Then the dial setting was changed to achieve predetermined endtidal desflurane concentration within the first 5 min, to start with 6% in the first patient (best guess for MACEI). After establishing and maintaining the target endtidal concentration for 5 more minutes, tracheal intubation was attempted at 11th minute without neuromuscular relaxants and ±0.5% difference in the predetermined/target endtidal desflurane concentration was allowed. Each concentration at which tracheal intubation was attempted was predetermined according to the upanddown method (with 1% as step size). Outcome measure of success/failure (unresponsive/responsive) for intubation was based on a score formulated on parameters like, ease of intubation, vocal cords position & movement , reaction to intubation (in terms of movements)score of 36 being regarded as success and 7 as failure. The Dixon’s methodological principles were applied to determine MACEI in the present study. Values for MACEI were obtained by calculating the midpoint concentration of all independent pairs of patients involving a crossover, i.e., responsive (failure) to unresponsive (success). We also calculated the eighteen crossover pairs, success to failure. Minimum alveolar concentration was defined as the average of the crossover midpoints in each crossover subgroup. Blood pressure (SBP & DBP), heart rate, saturation, response entropy, state entropy and train of four count (neuro muscular junction monitor) were noted at baseline. Along with these, desflurane dial setting, inspired concentration, endtidal concentration, FIO2 and ET N2O were also noted at 5minutes, 10minutes (preintubation) and 1 min, 3 min & 6 min postintubation.

Results: The state entropy similar to the response entropy decreased across the time periods with least value noted just before intubation. The post hoc analysis showed significant decrease in all periods when compared to base line. There were no significant changes in oxygen saturation. Post hoc analysis of the heart rate data showed that there was a significant increase in heart rate when compared to base line at the time of intubation and one and 3 minute after intubation but this returned to normal at 6 min after intubation. There was significant decrease in Systolic and diastolic blood pressure across all periods when compared with the base line and was significant. The difference in desflurane dial concentration and inspired desflurane across the time periods was clinically not significant. The end tidal desflurane rose to the level of set concentration at the end of 5min, and was maintained at this level till intubation. The krushkal wallis test of the desflurane dial concentration, inspired concentration and end tidal concentration compared at different time periods revealed significant changes only in time period 1 (5 minutes after starting Desflurane). Although the desflurane decreases the entropy very fast, there is still a difference between failure and success groups and there is a difference also in the end tidal desflurane concentration between the success and failure groups, successful cases had a greater concentration of end tidal desflurane which corresponded to lower entropy values and successful intubation The MACEI for desflurane in 50% N2O was calculated to be 6.37%.

Conclusion: The minimum alveolar concentration of desflurane for effective endo tracheal intubation is 6.37 using 50% N2O. Desflurane is a safe and effective option to intubate patient, but it cannot be used as a sole agent because of risk of bronchospasm.

Background: Cardiovascular complications are one of the most common causes of anesthesiarelated morbidity and mortality.The present work was undertaken to compare the effect of lignocaine (Xylocard) with esmolol on blunting the hemodynamic responses to endotracheal intubation.

Methods: Laryngoscopy and intubation was done within 15 to 20 seconds.In group I: Inj. Lignocaine (Xylocard) i.v. was administered 3 minutes before laryngoscopy and intubation.In group II: Inj. Esmolol i.v. was administered 3 minutes before laryngoscopy and intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were measured before induction of general anesthesia (baseline), 1, 3, and 5 min after tracheal intubation.

Results: The heart rate response between lignocaine (Xylocard) and esmolol was very significant at all times starting from 1 to 10 minutes (p ï‚£ 0.05) with esmolol showing a favorable response towards attenuation of heart rate. In systolic blood pressure, Esmolol group showed a better attenuation compared to lignocaine group (Xylocard) until 3 minutes postlaryngoscopy. Attenuation of diastolic blood pressure was significant with esmolol than with lignocaine (Xylocard) group until 3 minutes (p<0.05). In mean arterial pressure, Esmolol caused significant attenuation of pressor response (p<0.05) at 1 minute and 3 minute postlaryngoscopy.

Conclusion: Esmolol is more efficient than lignocaine (Xylocard) in attenuating the sympathetic responses to laryngoscopy and intubation.Esmolol at a bolus dose of 1.5 mg/kg i.v. administered 3 minutes before laryngoscopy appears to be very effective and should be viewed as potential treatment strategy for attenuating hemodynamic changes during induction of anesthesia.

The aim of this study is to study and compare two supraglottic airway devices Igel and supreme laryngeal mask airway, in anaesthetised adult patients with spontaneous ventilation, with respect to Ease of insertion, Number of insertion attempts and Haemodynamic changes like heart rate, mean arterial pressure, Systolic and diastolic blood pressure.

Background: The clinical study was undertaken to compare the recovery of elderly patients from general anaesthesia with sevoflurane or desflurane with reference to spontaneous eye opening, obeying verbal commands, recall of name, squeezing fingers, time to extubation and orientation and Modified Aldrette Score.

Material and Method: Study was conducted on 60 patients of either sex, belonging to ASA I, II and III posted for elective surgeries. Age of the patients were above 60 years and were divided into groups of 30 each (group D and group S).All patients were pre medicated with inj. glycopyrrolate 0.004 mg/kg i.v, inj. fentanyl 1microgram/kg i.v., inj ondansetron 0.1 mg/kg i.v., inj.ranitidine 50mg i.v. After preoxygenation with 100% for 5 minutes, patients were induced with injection propofol 12 mg/kg i.v. and intubation facilitated with injection succinyl choline 1.5mg/kg i.v. Anaesthesia was maintained with either desflurane (group D) or sevoflurane (group S) in combination with N2O 50% in O2 50% . All patients were mechanically ventilated. Both group received Fresh gas Flow of 4 lit/min for first 10 mins. After 10 mins FGF was reduced to 2 lit/min. with desflurane and sevoflurane adjusted so as to maintain hemodynamic parameter within 20% of baseline values or according to clinical parameters. Muscle relaxation was maintained by using injection atracurium i.v (loading dose) and top up doses were guided by PNS. Desflurane/Sevoflurane and N2O were turned off after the last skin suture. Neuromuscular blockade was reversed by inj. neostigmine 0.05 mg/kg and inj. glycopyrrolate 0.008 mg/kg and patients were extubated . Time to extubation was recorded as time from discontinuation of inhalation to extubation. Pulse rate (P.R), systolic blood pressure (SBP), Diastolic blood pressure (D.B.P), oxygen saturation (SpO2), electrocardiography (ECG) were observed throughout the surgery at every 10 mins. Recovery was assessed in the PACU by using the Modified Alderete Score every 5 minutes for intial 10 minutes and then every 10 minutes till 60 minutes.

Result: The recovery parameters of spontaneous eye opening, obeying verbal commands, recall of name, squeezing of fingers, time to extubation and place of stay were significantly shorter in patients of Desflurane group as compared to patients of Sevoflurane group (p<0.05). Patients given desflurane achieved Modified Aldrete Score of 9 significantly faster than patients given sevoflurane.

Conclusion: We concluded that although sevoflurane and desflurane provided similar intraoperative conditions, desflurane provided more rapid recovery and the return of cognitive functions in the early post operative period.

Abstract: Nausea and vomiting is known to be associated with the use of anaesthetic technique for many years. Ondansetron a gold standard drug used for treatment of post operative nausea and vomiting (PONV) is short acting and multiple doses are needed. Objective of the present study is to compare the efficacy of palonosetron and ondansetron for prevention of PONV in patients undergoing abdominal surgery under general anaesthesia.

Methods: 140 patients undergoing abdominal surgery under general anesthesia were randomised and allocated into two groups after taking into consideration inclusion and exclusion criteria. Group I received ondansetron 8mg intravenously and Group II received palonosetron 0.075mg intravenously 5 min before the induction of anesthesia. In all patients general anaesthesia given using thiopentone as inducing agent. Occurrence of PONV was noted and was scored for 24 hrs.

Results: The incidence of PONV was significantly lower in the palonosetron group compared with the ondansetron group (24.3% vs 78.6%, respectively). Emetic episodes were observed in 5.71% of patients in palonosetron group compared to 61.4% of patients in ondansetron group (P value <0.001). The results were clinically and statistically significant.

Conclusion: Incidence of PONV and emetic episodes is less in patients who had received palonosetron in comparison to those who had received ondansetron. From the study we conclude that palonosetron is more efficacious than ondansetron for prevention of PONV in patients undergoing abdominal surgery under general anesthesia.

Background: The first focus on haemodynamic response to laryngoscopy and tracheal intubation was done in 1950 by Burstein. King et al in (1951) described the abnormal circulatory reaction to laryngoscopy. Its association with a rise in blood pressure, tachycardia and increased level of catecholamines was highlighted by PrysRoberts in (1971) and by Siedlecki in 1975. Recognizing the hazardous effect of such reflex reactions, many techniques were studied and clinically tried to obtund these reactions. At the same time, The first publication on diagnostic laparoscopy by Raoul Palmer appeared in the early 1950s, followed by the publication of Frangenheim and Semm. Hans Lindermann and Kurt Semmpractised CO2 hysteroscopy during the mid1970s. However this procedure is not risk free, In fact it produces significant changes in haemodynamically compromised patients.The hallmark of laparoscopy is creation of carbon dioxide pneumoperitonium and change in the patients position from trendelenburg to reverse trendelenburg. It also results in stress hormone responses (cortisol, epinephrine and non–epinephrine) especially when CO2 pneumoperitonium is used concomitantly. Laryngoscopy with or without tracheal intubation amounts to a highly noxious stimulus to the homeostasis of the patient.

Aims: Designed to assess the effect of oral Clonidine premedication on hemodynamic response to endotracheal intubation and to compare intraoperative haemodynamic parameters, pain and sedation scores, time of first postoperative analgesia and dverse effects

Material and Method: Total 60 patients ASA grade I and II in the age group 20 to 55 years were included in this study and they were randomly divided into two groups:

Group 1 (n=30), patient received oral clonidine 150 mcg orally 90 min before induction

Group 2 (n=30), patients received oral vitamin C 100 mg orally 90 min before induction

All patients were posted for elective surgeries and were randomly selected.

Conclusion: The basal and perioperative arterial blood pressure and heart rate after giving premedication was lower in clonidine group as compared to placebo group. Time for 1st postoperative analgesia requirement in clonidine group was significantly prolonged in comparison with the ranitidine group.

Context: Various adjuvants have been used with Ropivacaine in supraclavicular blocks to enhance sensory and motor block along with prolongation of postoperative analgesia.

Aim: To compare the effect of dexmedetomidine and clonidine as adjuvant to 0.5% ropivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of analgesia.

Methods and Material: After ethical committee’s approval, a prospective randomised study of 60 patients aged1860 years were randomly divided into two groups (Group C and Group D) of 30 each. Group C received 50mcg clonidine with ropivacaine (29ml), Group D received 50mcg dexmedetomidine with ropivacaine (29ml), via supraclavicular approach. Onset and duration of sensory and motor block and duration of analgesia in both groups were evaluated. Intraoperative hemodynamics and adverse effects were observed.

Statistical Analysis: Numericalvariables were presented as mean & standarddeviation while categoricalvariables were presented as frequency and percent. For analysis, unpaired student ttest and chisquare test were used.

Results: Early onset and prolonged duration of sensory and motor block and prolonged duration of analgesia was seen in group D, as compared to group C.

Conclusion: Dexmedetomidine produces rapid onset and prolonged duration of sensory and motor block and also prolonged duration of analgesia with good hemodynamic stability with no side effects as compared to clonidine.

Aim: To evaluate efficacies of dexmedetomidine and clonidine as adjuvants to ropivacaine in Epidural Anaesthesia in patients undergoing lower limb orthopaedic surgeries.

Materials and Methods: A randomized prospective study to compare the efficacies of dexmedetomidine and clonidine as adjuvants to ropivacaine in epidural anaesthesia (60 patients in each group.) Patients who were ASA physical status class I and II, Age 1860 years, either sex, Height 150170 cms and Elective lower limb orthopaedic surgeries are included in study.

Results: Present study was undertaken to compare the efficacy of epidural Clonidine or Dexmedetomidine with ropivacaine in patients undergoing elective lower limb orthopaedic surgeries. 120 ASA I and II patients of either sex, posted for elective lower limb orthopaedic surgeries were chosen for the study and the patients were divided into two groups of 60 each. Group RC received 17ml of 0.75% of ropivacaine with clonidine 30mcg. Group RD received 17ml of 0.75% of ropivacaine with dexmedetomidine 50mcg. The time of onset of sensory block was tested with bilateral pin prick method and motor block was assessed by onset of Bromage scale 3, and it was found that the onset of sensory block with Dexmedetomidine was earlier compared to Clonidine. During the procedure we observed bradycardia was more in Dexmedtomedine and hypotension was more in Clonidine Group. Bradycardia was treated successfully with vagolytic agents. Hypotension was successfully treated with vasopressors. Also few patients developed nausea and dry mouth,which were negligible. Intraoperatively sedation score was assessed using Ramsay Sedation Scale and there was higher incidence of sedation with Dexmedetomidine group. Regression of motor block to Bromage 1 was observed and the time to regression was significantly prolonged to 450.6±29.37 in the Dexmedetomidine group while it was 343.2±30.99 in the Clonidine group. Post operative analgesic requirement was low in Dexmedetomidine group compared to Clonidine group.

Conclusion: In conclusion, Dexmedetomidine (50mcg) is a better adjuvant when administered epidurally with ropivacaine 0.75% than clonidine (30mcg), as there is significantly longer duration of sensory and motor block, additional benefits of intraoperative sedation and prolonged postoperative analgesia.

Introduction: The aim of the study was to compare the effectiveness of two different techniques in blocking obturator nerve (ON) and adductor spasm during transurethral resection of bladder tumor (TURBT).

Methodology: We designed a prospective, randomized, doubleblind study, in which fifty patients with American Society of Anesthesiologists Status II and III were scheduled to undergo TURBT for lateral and posterolateral bladder wall tumor was. Group I (ultrasound only group, n = 25) patients received 4 ml of bupivacaine 0.5% each at anterior, and posterior division of ON under realtime US visualization and Group II (ultrasoundnerve stimulation group, n = 25) received the same amount of bupivacaine 0.5% for each division using USguidance with nerve stimulationassisted technique. Block success and performance time and complications were measured along with patient and surgeon satisfaction into two groups. We did two sample independent ttest and Pearson’s Chisquare/ Fisher’s exact test.

Results: A success rate of 88% was achieved in Group II as compared to 70% in Group I with increased block performance time in Group II (5min) versus (3 min) in Group I. A better patient and surgeon satisfaction were seen in Group II with combination of US and nerve stimulation technique. No complications were encountered.

Conclusion: We conclude that both techniques are safe and easy to perform; however, nerve stimulation along with US results in a higher success rate.

Introduction: Opioids have been extensively used as an adjuvant because of excellent results in neuraxial blocks. Fentanyl is widely used but is found to have higher incidence of pruritus for which Nalbuphine was considered as an adjuvant.

Aim: To compare the efficacy of Fentanyl and Nalbuphine as an adjuvant to bupivacaine 0.5% heavy.

Methods and Material: Randomised control trial was carried out on 60 patients between 1860 years of age and ASA grade I and II with groups having 30 patients each: GROUP A Bupivacaine (2.5 ml) + Fentanyl 25µg (0.5 ml), GROUP B Bupivacaine (2.5 ml) + Nalbuphine 400ug (0.5 ml). The observation and results were compared and statistical analysis was done. Statistical analysis was performed by the SPSS program for Windows. For comparing the two main groups Paired t test was applied. In this study p value < 0.05 is considered as statistically significant.

Results: Onset of sensory block was significantly rapid with nalbuphine (2.05±0.887 mins) as compared to fentanyl group (4.67±0.816mins) (p<0.001). The duration of analgesia was statistically prolonged with fentanyl (244.27±5.457mins), compared with the nalbuphine (243.25±8.091 mins). (p< 0.05) but it was clinically not significant.

Conclusion: 400 mcg intrathecal nalbuphine is superior to 25mcg intrathecal fentanyl regarding the duration of analgesia and reduced the analgesic requirement in the early postoperative period.

Postoperative sore throat (POST) is a frequent complaint following endotracheal intubation with incidence rates varying from 14.4% to 61%. Regardless of the incidence or duration, POST is rated as a patient’s 8th most undesirable outcome in the postoperative period, and is certainly an opportunity to improve patient outcomes.

Background and Objectives: Various nonpharmacological and pharmacological trials have been used for attenuating POST with variable success. The aim of the present study was to compare the effect of ketamine, tramadol and 1.5% saline gargle in prevention of postoperative sore throat.

Methods and Material: Following institutional ethical committee approval and written informed consent, a prospective randomized doubleblinded study was conducted in 100 cases divided into four groups of 25 patients in each group. Patients included in the study were of age group 1860 years, ASA grade III, undergoing elective surgeries with duration of surgery approximately 2 hrs or more requiring tracheal intubation. Patients were allocated randomly to four groups, Group A, Group B, Group C and Group D. After shifting patient to operation theatre 5 mins prior to induction of anesthesia, Group A received 30ml of normal saline, Group B preservative free ketamine 1ml (50 mg) in 29 ml of normal saline, Group C received tramadol 1ml(50 mg) in 29ml normal saline and Group D received 30ml of 1.5% saline to gargle for 30 seconds. Postoperatively presence of sore throat was noted at rest and on swallowing immediately after extubation, at 2 h, 4 h, and 24 h.

Statistical Analysis Used: IBMSPSS_21 was used for statistical analysis.

Results: There was no significant difference in POST at rest (Figure 1) at 0 hr, 4 hr and 24 hr postoperatively among the four groups. Incidence of POST at rest at 2hr was significantly lower in ketamine group. Ketamine caused significant reduction in POST at swallowing (Figure 2) at 2 & 4hrs. Tramadol caused significant reduction at 2 & 4 hrs. 1.5% saline caused significant reduction in POST at swallowing at 2hrs.

Conclusions: Among all the groups ketamine was found to be most effective in prevention of POST followed by tramadol. Based on the risk estimate analysis even 1.5% saline reduces incidence of POST.

Background: Paravertebral block (PVB) has been successfully used to provide good analgesia with fewer side effects in inguinal herniorrhaphy. So, the present study was conducted to compare the characteristics of two segments with four segments PVB for anaesthesia and postoperative analgesia.

Material & Methods: Fifty patients of ASA grade I and II, aged between 1880 years scheduled for inguinal herniorrhaphy of a tertiary care teaching hospital were randomly selected in two groups of 25 each; Group F [Four segment block – T10, T 11, T 12, L1 (5ml 0.75% plain ropivacaine with 1:400000 epinephrine per segment)] and Group T [Two segment block – T10, and L1 (15ml 0.75% plain ropivacaine with 1:400000 epinephrine at T10 and 5 ml at L1)]. Onset, duration of surgical anaesthesia, duration of complete analgesia and effective analgesia were recorded. Postoperative pain was assessed at predetermined time intervals using visual analogue scale (VAS).

Results: The mean duration of application was 14.94±3.30 minutes in group F and 6.16±1.57 minutes in group T. (p<0.001) The mean duration of surgery start time in group F and group T was 27.40±2.55 minutes, 22.79±3.55 minutes respectively. (p<0.01) Group T showed 84% satisfaction level while group F showed 76%. VAS score in both the groups was found statistically insignificant at 0, 6, 12, 24, 36, 48Hrs interval.

Conclusion: Two segments technique of PVB can be a viable alternative to the four segments technique for inguinal hernia surgery because it is less time consuming, provides similar analgesia as compared to the four segment technique. Furthermore, decreasing the number of injections in the two segment block technique may further increase patient comfort and satisfaction.

Background and Aim: Studies and research are ongoing to find appropriate adjuvants to intrathecal local anaesthetic agents to make them more effective and economical. In view of the same we undertook a study with Levobupivacaine, being a newer agent with more cardiac stability and compared the outcomes with 3 adjuvants (REF).

Settings and Design: After approval from hospital ethical committee a randomized double blind study was conducted among 60 healthy American Society of Anesthesiologist ASA I and II patients, scheduled for lower limb surgeries. The study was conducted over 1 year at SRMSIMS.

Materials and Methods: Spinal block was administered in L3 and L4 intervertebral space, using 0.5% Levobupivacaine 12mg. Adjuvants were added in group 1, Dexmedetomidine 5mcg, and in group 2, Dexmedetomidine 10 mcg. Anaesthetic level achieved was T10. Onset time to achieve sensory, motor blockade, their regression time was noted. Hemodynamic changes and requirement for other analgesic drug was also noted.

Results: 60 patients were enrolled in our study; the data was recorded and analyzed using statistical analysis.

Conclusion: To conclude, Levobupivacaine with Dexmedetomidine, gives better result for intra as well as for postoperative regional anaesthesia without any adverse effects.

Background: Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgical experience (e.g. agitation, crying, spontaneous urination and the need for physical restraint during anaesthetic induction). Preoperative anxiety has also been associated with the display of a number of maladaptive behaviourspost surgery, including postoperative pain, sleep disturbances, parentchild conflict and separation anxiety [1]. The risk factors associated with high incidence of perioperative anxiety in children include shy and inhibited nature, previous poor quality medical encounters, poor social adaptability and increased parental anxiety [1]. If children are less anxious during the perioperative period, not only will they often exhibit less behavioral disturbances postoperatively, but they may face subsequent medical care more easily [2]. Thus, there are several compelling reasons to treat children’s anxiety preoperatively. The aim of our study was to compare the efficacy and safety of oral midazolam versus oral ketamine for premedication in paediatric surgeries under general anaesthesia.

Materials and Methods: Sixty children belonging to ASA physical status I as outlined by the American Society of Anaesthesiologists (ASA) of either gender were included in the study. They were randomly divided into two groups of 30 children in each group, group A and group B. Group A patients received 0.5mg/kg of oral midazolam as a premedicant 45 minutes before induction and Group B patients received 6mgs/kg of oral ketamine as a premedicant 45 minutes before induction. Time of onset of sedation and sedation score at 30 minutes were noted. Anxiety score at separation from parents, room air saturation, response to preoxygenation, side effects, if any, preoperatively and postoperatively were also noted.

Results: In our study, the mean time of onset of sedation was lower with ketamine group (19.48 minutes) as compared to the midazolam group (25.63). The sedation score at 30 minutes and anxiety score at separation from parents were also satisfactory. In our study we found that the mean sedation score at 30 minutes was 1.9 with ketamine group and 3.03 in midazolam group.The mean anxiety score at separation was 1.8 with ketamine group and 2.53 in midazolam group. All patients allowed calm separation from parents.

Conclusion: It is concluded that ketamine at a dose of 6 mgs/kg orally provides better sedation and anxiolysis in children with minimal side effects than oral premedication with midazolam at the dose of 0.5 mg/kg.

Background and Aims: Dexmedetomidine as an adjuvant to local anaesthetic in supraclavicular plexus block. We compared the onset time of sensory and motor block and postoperative analgesia.

Methods: Sixty patients scheduled for upper limb surgeries were divided into two equal groups, group LD and RD, randomly. The patients received brachial plexus block via supraclavicular route with the help of nerve stimulator. In group LD (n=30) 30cc of 0.5% levobupivacaine with 1µg/kg dexmedetomidine and in group RD (n=30) 30cc of 0.5% ropivacaine with 1µg/kg dexmedetomidine was given. Onset of motor and sensory block and time to first rescue analgesia were recorded.

Results: Sensory and motor onset time was significantly early in Group LD compared with RD (P< 0.05). Duration of post operative analgesia was significantly longer in Group LD compared to Group RD (P<0.05).

Conclusion: Addition of Dexmeditomidine to Levobupivacaine for supraclavicular brachial plexus block shorthens the onset times for sensory and motor blocks and significantly prolonged the duration of analgesia.

Context: Pneumoperitoneum during laparoscopic surgeries leads to adverse effects on cardiovascular physiology which in turn compromises tissue perfusion.

Aims: To study the effect of premedication with intravenous clonidine in modulating the haemodyanamic responses during laparoscopic surgeries.

Settings and Design: Prospective randomised double blinded study.

Methods and Material: The study was conducted in a group of sixty patients undergoing laparoscopic surgeries who were randomly allocated into two groups each having thirty patients namely group green who received 2µg/kg of intravenous clonidine in 100 ml normal saline 15 minutes prior toinduction and group red who received 100 ml of plain saline 15 minutes prior to induction. Haemodyanamic parameters during induction, intubation, pneumoperitoneum and extubation were monitored. The postoperative pain scores and time to first analgesic request were documented.

Statistical Analysis used: Student’s t test was used for the haemodyanamic parameters. Chi square test was used for non parametric values and corresponding p was computed. P value of <0.05 was considered statistically significant.

Results: There was a 20 to 27% increase in heart rate in group red during haemoperitoneum whereas the increase in group green (clonidine group) was 16%. The mean systolic BP varied from 134±17.75 to 95.23± 9.93 in green groups whereas in red group it varied from 144±14.57 to 129.93±13.44. Postoperative visual analogue score was 3.36 in group green as compared to 7.36±1.54 in red group.

Conclusions: Patients receiving intravenous clonidine as premedication showed stable haemodyanamics and better analgesia and sedation as compared to those who didn’t receive clonidine.

Introduction: One of the major concerns of the anaesthetist during induction of anesthesia is maintenance of haemodynamic stability. Various induction agents have been used during induction like thiopentone, propofol, ketamine and etomidate.

Aim: The aim of this study was to evaluate the hemodynamic effect ofPropofoland Etomidate as induction agents in elective surgeries undergeneral anesthesia.

Material and Methodology: Sixty (60) patients of age group (1860 years) of ASA grade I and II were randomly divided into two groups of thirty patients each, as follows:

Group I: Propofol 2 mg/kg was given intravenously as induction agent.

Group II: Etomidate 0.3 mg/kg was given intravenously as induction agent. The various haemodynamic parameters were recorded and compared.

Result: A significant difference inhaemodyanamic parameters seen between both the groups. In group I (Propofol) HR, SBP, DBP, MBP significantly decrease at the time of induction and upto 60 minutes (p<0.05) whereas in group II (Etomidate) lesserfall in hemodynamics parameters seen as compared to group I (p>0.05).

Conclusion: Induction with etomidate is associated with lesser fall in haemodynamic parameters as compared to propofol.

Introduction: Present study was conducted to compare the analgesic efficacy of 0.25% Bupivacaine and 0.2% Ropivacaine in Transverse Abdominis Plane (TAP) block under ultrasound guidance as a part of a multimodal analgesia regimen for post caesarean delivery pain management.

Materials & Methods: This prospective study was conducted at IMS and SUM Hospital, Bhubaneswar in 100 pregnant women (ASA grade II and III parturient) undergoing either elective or emergency LSCS under spinal anaesthesia by ultrasound guided transverse abdominis plane block randomised in two groups – 0.25% bupivacaine and 0.2% ropivacaine, given 10 ml on each side. The patients were assessed at post anesthesia care unit (PACU) and at 2, 6, 12, 24, 48 hours postoperatively in the obstetric ward for time of first request for analgesia, pain score of the patients analyzed during rest and movement using visual analogue scale (VAS) and side effects during first 48 hours.

Results: The two groups were comparable in demographics and baseline characteristics. The time of full Regression of block (p=0.731), time required for 1st analgesia (p=0.699) and total consumption of analgesia (p=0.833) were comparable in the two groups. The VAS score at rest and movement at multiple time intervals during followup period was similar in both groups.

Conclusion: Analgesic efficacy and safety of bupivacaine 0.25% and ropivacaine 0.2% is similar in TAP block under ultrasound guidance.

Aim and Objectives: 1. to evaluate the effects of dexmedetomidine and clonidine on haemodynamic changes during Laryngoscopy and tracheal intubation. 2. To compare the effect of dexmedetomidine and clonidine on haemodynamic changes during Laryngoscopy and tracheal intubation. 3. To compare the side effects. 

Materials & Methods: After approval of the institutional ethical committee, this prospective observational study was conducted on 60 patients of ASA Grade I & II, undergoing elective surgeries under general anesthesia. 

Group A: Injection Dexmedetomidine 1mcg/kg diluted to 20ml with normal saline were given over 10 minutes.

Group B: Injection. Clonidine 2mcg/kg diluted to 20ml with normal saline were given over 10 minutes. 

All patients received Injection Pentazocine 0.3mg/kg and were preoxygenated for 3minute Anaesthesia was induced with thiopantone sodium (5mg/kg intravenous) till loss of eyelashreflex over 30 second and mask ventilation was confirmed. Injection succhinylcholine 1.5mg/kg was given to facilitate laryngoscopy and intubation. anaesthesia was maintained with oxygen nitrous oxide, halothane with intermittent use of injection Atracurium and controlled ventilation. At the end of surgery the neuromuscular blockade was antagonized with injection Glycopyrolate (.01mg/kg) Intavenou. And injection Neostigmine (.05mg/kg) i.v. and patient were extubated.

Result: Dexmedetomidine is more effective than Clonidine in attenuation of haemodynamic changes during laryngoscopy and intubation.

Conclusion: Dexmedetomidine significantly attenuates the haemodynamic changes during laryngoscopy and intubation. Clonidine also significantly attenuates the haemodynamic changes during laryngoscopy and intubation.Thus we conclude that Dexmedetomidine is a better drug to attenuate the haemodynamic response during laryngoscopy and intubation.

Background: Regional anesthesia is comparatively safer than general anesthesia. Regional anesthesia can be safely used in outpatient anesthesia, patients with full stomach, diabetic patients, associated cardiac, pulmonary, hepatic or renal damage and polytrauma. Bupivacaineroutinely used has side effects relatedto cardiovascular and central nervous system. Ropivacaine a recent addition has the ability to produce differential blockade with less motor blockade and reduce cardiovascular and neurological toxicity. Ultrasound imaging has increased the success rate and has helped in reducing the complications as it gives real time visual image. 

Materials and Methods: A prospective, randomized single blinded study was undertaken in patients posted for upper limb surgeries under Supraclavicular block under ultrasound guidance. 60 patients of ASA class I and II were randomly grouped into two groups. Group R will receive 30ml Ropivacaine 0.375% and Group B will receive 30ml of Bupivacaine 0.375% in supraclavicular brachial plexus blockade. Onset of motor and sensory blockade, duration of motor, sensory blockade and duration of postoperative analgesia were studied. Hemodynamic changes over time were recorded.

Results: Group R patients had earlier onset of sensory and motor block compared to Group B patients. There was no difference in duration of sensory and motor block and duration of analgesia between both the groups.

Conclusion: Ropivacaine is a safer alternative to Bupivacaine with earlier onset of both sensory and motor block and if used along with ultrasound guidance has a higher success rate and lowers the incidence of complications

Objective: Sepsis is a problem that presents a management challenge and its early recognition and intervention clearly improves the outcome. Development of cost effective clinical parameters that would effectively prognosticate the outcome of sepsis would be invaluable. Shock Index, defined as ratio of heart rate (HR) and systolic blood pressure (SBP) may be a good non invasive measure of haemodynamic instability than HR and SBP alone. We conducted a study- 

1. To calculate shock index in patients with severe sepsis and septic shock at 0, 2 and 6 hours of admission.

2. To assess whether shock index (SI) at 0, 2 and6 hours has any prognostic significance in patients of severe sepsis and septic shock.

Methods: Records of 57 patients from August 2015 to January 2016 were collected from Medical Records Department of the hospital and clinical data recorded. Shock index (SI) was calculated at 0, 2 and 6 hours. The patients were divided into two groups according to their outcome as Survival or Death. Mann Whittney test, Pear on coefficicent and Kaplan Mieir Survival analysis curve were used for calculations.

Results: SI at 2 and6 hours significantly predicts mortality with pvalue of 0.001 and 0.0014 respectively. The best Predictor of mortality is where SI at 2 hours or 6 hours is greater than their cut off points.

Conclusion: From the present study, it may be concluded that SI at 2,6 hours was clinically relevant and easily calculated predictor of mortality.

Aim: The present study was conducted to evaluate the efficacy and analgesic effect of mixture of midazolambupivacaine as compared to bupivacaine alone in patients undergoing lower limb and lower abdominal surgeries under subarachnoid block.

Materials and Methods: The present study was conducted on 100 patients aged between 18 to 60 years belonging to ASA Grade I and II of both the sexes posted for lower limb and lower abdominal surgeries.

Results: In 100 patients duration of sensory blockade in both group B and group M. the mean duration of sensory blockade in group B is 89.1±2.95 minutes were as in group M, it is 118.94±10.83 minutes, p<0.05, hence statistically significant. (t = 18.5918, p= 0.000, statistically significant). The mean duration of maximum motor blockade in B is 163.3±16.6 with a range being 135 to 210 minutes. In group M, the mean duration of maximum motor blockade is 180.24±27.40 minutes with a range being 152 to 245 minutes. As p value is 0.0004 it is statistically significant. (T=3.693, P value0.0004, highly significant). In group B, the mean duration of analgesia is 125.46±7.18 minutes with a range of 110 to 142 minutes. In group M, the mean duration of analgesia is 243.26±24.41 minutes with a range of 173 to 273 minutes. In group B, the mean VAS score is 3.98±1 and in group M, it is 3.6±0.6. The t value is 2.869 and the p value is 0.005, hence there is statistical significance between them.

Conclusion: It can be inferred that inj. midazolam 1 mg in combination with inj.bupivacaine 0.5% hyperbaric can be safely administered intrathecally for better postoperative analgesia.