Indian Journal of Anesthesia and Analgesia

Diabetic patients presenting for elective surgical procedures will place an increasing burden on anaesthetic services. The effects of surgical stress and anesthesia result in a a hypermetabolic stress response, referred to as “stress hyperglycemia”. The aim of the study is to compare stress response to general anaesthesia by measuring the rise in blood glucose levels in controlled diabetics posted for elective surgical procedures in comparision with non-diabetic patients .Study was conducted in Department of Anaesthesiology, Osmania Medical College/Hospital, Hyderabad during 2010- 2012 in Fifty ASA Grade I & Grade II patients. Institutional Ethics Committee has approved the study, written and informe consent was obtained from the patients. The study population were in the age group of 35-55 years, of either sex divided into two groups scheduled for elective surgical procedures of 2 hours of duration (viz., laporatomy, thyroidectomy). A Opiod (Fentanyl) and Propofol based balanced general anaesthesia technique adequately attenuates Hyperglycemic Stress Response in Controlled Diabetics.

Background: This randomized study was conducted to compare the synergistic effect of intrathecally administered fentanyl and hyperbaric bupivacaine on hemodynamic, sensory and motor block characteristics alongwith their side effects.

Context: This randomized study was done on pregnant women undergoing caesarean section under spinal anaesthesia.

Aims: To compare and determine the efficacy of spinal anaesthesia with bupivacaine alone and in combination of different low doses of bupivacaine with additive fentanyl.

Settings and Design: This study included 75 pregnant women scheduled for caesarean section who were then randomized into three groups of twenty five each. Group 1 (B group) received 12.5 mg (2.5 ml) of 0.5% of hyperbaric bupivacaine intrathecally, Group 2 (BF1 group) received 10 mg (2 ml) of 0.5% of hyperbaric bupivacaine + 12.5µg (0.5ml) fentanyl intrathecally, Group 3 (BF2group) received 8 mg (1.6ml of 0.5%) of hyperbaric bupivacaine + 12.5µg (0.5ml) fentanyl + 0.4 ml normal saline intrathecally.

Statistical analysis used: The data of the study were recorded in the record chart and results were evaluated using statistical tests (ANOVA, student t-test, chi-square test and post hoc test, F-test whichever was applicable. 

Results: Onset of sensory block to T10 dermatome occurred faster with increasing bupivacaine doses. Onset of motor block and duration of motor block was also longer in group B as compared to BF1 and BF2. The addition of Fentanyl to Bupivacaine significantly delayed the postoperative pain and sensory recovery.

Conclusions: Spinal anaesthesia for cesarean delivery using low dose hyperbaric bupivacaine in combination with fentanyl is associated with significantly less hypotension, vasopressor requirement and nausea.

Introduction: Oro-maxillofacial surgeries are done worldwide. Extensive blood loss is a major concern in these surgeries. To make these procedures uncomplicated we need a good co-operating surgical and anesthesiologist team, very less issue bleeding making surgical field clean and clear. Controlled hypotension1,2 technique is employed or maxilla facial surgeries in which the systolic blood pressure is reduced to 80-90 mm of Hg, mean arterial pressure reduced to 55% to 60% or mean arterial pressure reduced 30% of baseline value.

Aim of the Study: In this study we compared dexmeditomedine and esmolol and their effectiveness and advantage for controlled hypotension in oral-maxillofacial surgeries.

Materials and Methodology: This study was conducted at Karpaga Vinayaga Institute of Medical Sciences and Research Centre as a double-blind randomised control trial involving 50 patients 25 in each group posted for our-maxillofacial surgery. Heart rate and Blood pressure were measured preoperatively, at 15 minutes 30min and 45 min after induction and during surgery, 10 min after infusion drug stoppage, at the end of surgery. After extubation emergence time of both the drugs after surgery was recorded. In both groups sedation scores were measured at 15,30 and 60 min after surgery ended. Intraoperative serum cortisol level were measured in both the groups and recorded separately.

Results: In both groups target mean arterial pressure of 55-60 mm of Hg was achieved. In esmolol group heart rate and blood pressure was higher than dexmeditomedine group at 5 and 10 min. stoppage of study drug and at end of surgery. Dexmeditomedine group showed higher emergence time and sedation score at 15 and 30 min of surgery. There was no difference found intraoperatively in relation to serum cortisol level between the two groups.

Conclusion: The observation in this study shows that dexmeditomedine and esmolol are equally effective in producing controlled hypotension with haemodynamic stability in oro-Castillo facial surgeries. Apart from the above dexmedetomidine has additional advantage of sedation and analgesicsparing effect in compared to esmolol.

Introduction: Videolaryngoscopes facilitate the tracheal intubation by enabling anaesthetists to have a superior vision of the larynx with minimal manipulation of the oral-pharyngeal-laryngeal structures. Studies have indicated that video laryngoscopes improve the success rate of intubation and significantly reduce intubation difficulties. However, an improved view is not always an assurance of intubation success due to the nature of oral-pharyngeal-laryngeal axis. For this reason, Endotracheal tube be must be at an angle between 450 and 900 to enter the larynx.

Aim: This study was conducted to determine the optimal angles (between 600 and 900) of the stylet when using McGrath video laryngoscopes for the ease of intubation.

Methods: This study involved 100 patients of both male and female who were undergoing elective surgeries that required endotracheal intubation. The patients involved were aged between 19 years and 70 years. atients were indiscriminately divided into two equal groups, 50 patients for 600 (n=50) and 50 patients for 900 (n=50). This study excluded patients that required rapid sequence intubation; ASA III, IV, and V; patients that required emergency surgeries; and patients who had a scored four in the mallampati test. The following parameters Intubation time (Sec), Glottic opening Grade, Failure of First Attempt, Ease of Intubation, the presence of Bleeding were assessed. 

Results: Category variables were analyzed using the Chi-square test while continuous variables were analyzed using the independent t-test between 600 and 900 groups. All the selected 100 patients completed this study. All the patients in 600 group intubated successfully with 1st attempt and within 50 seconds. In contrast, intubation of six patients failed in the group 900.

Conclusion: The results of this study indicated that the level intubation difficulty and glottic grade were not significantly different between two groups.

Context: In view of the wider application of regional anesthetic procedure in modern anaesthesia practice, there is a need for local anesthetic with desirable properties like longer duration of sensory blockade for post operative analgesia
and moderate duration of motor paralysis for surgical relaxation.

Null hypothesis: Epidurally administered 20 ml of 0.75% Ropivacaine is not effective in comparison to 20 ml of 0.5% Bupivacaine for major lower abdominal surgeries in adult patients.

Aims: To study the efficacy of epidurally administered 20 ml of 0.75% Ropivacaine in comparison to 20 ml of 0.5% Bupivacaine for major lower abdominal surgeries in adult patients.

Settings and design: Hospital based double blind randomized controlled study carried out at Department of Anesthesiology, Shadan Institute of Medical Sciences, Hyderabad.

Methods: 50 eligible patients were included. They were divided into two groups of 25 each randomly. Group R with 25 patients were given 20 ml of 0.75% Ropivacaine epidurally. Group B with 25 patients were given 20 ml of 0.5% Bupivacaine epidurally.

Results: There was no statistically significant difference among the two groups in terms of duration, quality and onset of sensory as well as motor blockade. Post operative analgesia duration was also similar among them. Two groups did not differ significantly in terms of side effects and hemodynamic stability. (p value > 0.05; statistically insignificant).

Conclusion: Our study concluded that 20 ml of 0.75% epidural Ropivacaine produced equally effective and good quality as well as duration of sensory and motor blockade and post operative analgesia when compared to 20 ml of 0.5% epidural Bupivacaine for various lower abdominal surgeries.

Introduction: Vaginal hysterectomy is the most common surgery done under spinal anaesthesia. The combination of local anaesthetics with adjuvants is getting more popular for better post-operative analgesia.

Aim: The purpose of our study is to evaluate and compare the addition of clonidine and neostigmine to intrathecal bupivacaine for prolongation of post-operative analgesia.

Materials & Methods: This was a prospective, randomized, controlled, double blind study carried out in patients undergoing vaginal hysterectomies. 50 patients of ASA grade I & II between 45-60years of age were assigned to 2 groups. Group BC: received 0.5ml of intrathecal clonidine (75g) along with 2.5ml of 0.5% Bupivacaine Group BN: received 0.5ml of intrathecal neostigmine(50g) along with 2.5ml of 0.5%bupivacaine.

Results: Sensory block onset, level of sensory block, duration of analgesia, motor block onset, duration of motor block, degree of motor block and recovery from motor block and incidence of side-effects are evaluated.

Conclusion: We concludefrom our study that intrathecal neostigmine 50g added to 12.5 mg hyperbaric bupivacaine significantly hastens the onset of sensory and motor block when compared to 75g clonidine and duration of analgesia is more prolonged with clonidine than neostigmine.

Background: Various studies have been conducted regarding efficacy of Bupivacaine, Levobupivacaine and Ropivacaine; all these drugs provide adequate analgesia without significant effect on duration of Labour and neonatal outcome. But Levobupivacaine and ropivacaine has been encouraged in low dose that is 0.1%, because of more safety and less motor block. 

Material and Method: Parturients with singleton pregnancy, cephalic presentation and active labour were selected for this study as per exclusion and inclusion criteria, they were randomized by computer generated randomization table into two groups. Each group consists of 30 patients – group I and group II. Group I parturients received 3mg of isobaric Levobupivacaine with 25ug fentanyl intrathecally followed by epidural top ups of 14ml 0.125% isobaric Levobupivacaine and 30ug fentanyl making total volume of 15ml. Group II parturients in this group received 4mg isobaric ropivacaine with 25ug fentanyl intrathecally followed by epidural top-ups of 14ml 0.2% isobaric ropivacaine and 30ug fentanyl making total volume of 15ml.

Result: Similar both group were statistically comparable to each other with respect to height, weight, ASA scare and cervical dilatation. Regarding block characteristics, the maximal dermatomal level of sensory block achieved in group I was T5 and in group II it was T6 with P value 0.04. Seven parturient in group I and five parturient in group II has developed grade 1 motor blockade. The mean time of onset of analgesia was 4.52 min in group I and 5.95 min in group II with P value 0.00001. The duration of analgesia was longer in group I then group II (107.06±13.06 versus 91.43±9.38) with P value 0.00001. The number of epidural top up requirement was less in group I then group II (1.287±0.192 versus 1.71±0.267) with P value 0.00053.

Discussion and Conclusion: Onset of analgesia was early in group I then group II.The duration of analgesia was longer in group I then group II, The number of epidural top-up requirement was more in group II. To conclude both drugs found to be effective in respect to onset and duration of analgesia but Levobupivacaine was better than ropivacaine.

Background and Aim: Tramadol is atypical opioid having central as well as peripheral analgesic action. It acts on opioid receptors as well as having effect on neuronal reuptake of nor epinephrine and serotonin. In this study, the effects of tramadol given by two different routes, intravenous and rectal, were compared in terms of analgesic efficacy and duration as well as its side effects in appendectomy patients.

Material and Methods: Forty patients of acute appendicitis undergone appendectomy under spinal anesthesia between age group of 20 to 50 years, of either sex having weight of 40 to 70 kg and ASA 1 or 2 physical status were included in the study to receive either Tramadol 100mg intravenously (Group A) or 100 mg rectal suppository (Group B) at the end of surgery. First onset of pain, VAS score, rescue analgesic requirement and side effects noted.

Results: Demographic parameters were comparable in both groups. Mean duration of first onset of pain in group B (417.5±128.22min) was longer than group A (304±86.16 min) and it was statistically significant (tailed significance value of 0.0010). Rescue analgesic requirement was significantly prolonged in group B than group A. Also incidence of postoperative vomiting was less in group B than group A (5% Vs 20%).

Conclusion: Rectal tramadol can be better alternative to intravenous tramadol for postoperative analgesia in appendectomy.

Background: Pain is constant and predominant complaint of individual following, most surgical intervention. Epidural narcotics have been in large number of studies for treatment of postoperative epidural n arcotic like morphine has adverse effects like respiratory depression, drug dependence and cannot be used in elderly. Hence this clinical study of epidural bupivacaine and epidural bupivacaine plus tramadol is undertaken to evaluate the feasibility has effective analgesia for postoperative pain relief.

Objectives: To compare epidural bupivacaine and epidural bupivacaine plus tramadol for postoperative analgesia focusing on onset of analgesia, duration of analgesia, cardiorespiratory effects like pulse rate, blood pressure and respiratory rate, sedation.

Methods: 100 patients belonging to ASA physical status I & II scheduled for abdominal, pelvic, lower limb surgeries, were randomly selected for study are divided into two groups of 50 patients each. Group B patient received 10 ml of 0.125% bupivacaine epidurally. Group B+T patient received 10ml of 0.125% bupivacaine+ 50 mg tramadol epidurally during their postoperative period, when they complain pain for the first time onset and duration of analgesia, haemodynamic parameters and adverse effects if any were studied. 

Results: There was no significant difference be tween two groups in mean time of onset of analgesia, 14.40±0.85 minutes with group B and 14.62±0.69 minutes with group B+T (p-value 0.14), total duration of analgesia in group B was 231.6±9.1 minutes and in group B+T was 350.60±15.9 minutes which was significant (p-value <0.05). Quality of postoperative analgesia, haemodynamic parameters and side effects were comparable between both groups.

Conclusion: Epidural bupivacaine (10ml of 0.125%) plus 50 mg tramadol combination not only provides an adequate, rapid, excellent postoperative analgesia, but also has significant longer duration of analgesia compared to bupivacaine alone.

Introduction: Tracheal Intubation without the use of neuromuscular blocking drugs was used to assess the airway by laryngoscopy. We compared the effect of midazolam and lignocaine on intubating conditions along with propofol and
fentanyl for intubating without neuromuscular blockers.

Aim: To compare the intubating conditions and cardiovascular changes (post induction) between fentanyl, midazolam, propofol and fentanyl, lignocaine, propofol groups without using neuromuscular blocking agents.

Materials and Methods: It is a prospective double blind randomized controlled study. After getting the ethical committee approval and informed written consent hundred patients undergoing elective surgical procedure under general anaesthesia with endotracheal intubation were selected. Group (M) received propofol 2.5mg/kg, fentanyl 2µg/kg, midazolam 0.03mg/kg. Group (L) received propofol 2.5mg/kg, fentanyl 2µg/kg, lidocaine 1.5mg/. Laryngoscopy was done 40 s after propofol administration. The patient’s trachea was intubated with an appropriate size cuffed tracheal tube.

Results: There is no statistical significance in patient characteristics and mallampatti and Cormack–lehane grading between these two groups.The statistical significance less time for laryngoscopy duration and Intubation attempt was successful in all (100%) patients in the M group than in the L group 43 out of 50 patients (86%). Changes in Mean arterial pressure was less with midazolam group than lignocaine group.

Conclusion: We conclude that the propofol–fentanyl – midazolam combination is better compared to propofol– fentanyl– lignocaine combination in providing clinically acceptable conditions for intubation without significant cardiovascular changes without the use of neuromuscular blocking agents

Background: Spinal anaesthesia is the primary anaesthetic technique for many types of surgery. Limiting the dose of local anaesthetic used in spinal anaesthesia has been an aggressive topic of study as it will achieve rapid anaesthetic recovery as well as reduce the incidence and severity of its side effects.

Context: In our study we compared clonidine and magnesium as adjuvants to hyperbaric bupivacaine in spinal anaesthesia in terms of duration of sensory and motor block, sedation, respiratory depression and haemodynamic parameters.

Aim: To compare Clonidine and Magnesium sulphate as adjuvants to bupivacaine heavy 0.5% for spinal anaesthesia in patients undergoing infraumbilical surgeries in terms of analgesic efficacy, duration of sensory block and adverse effects.

Settings and Design: Conducted in ASA I-II patients with age group 18-60 years undergoing infraumbilical surgical procedures. Patients were randomly divided into three groups each of 25 patients. Group 1 (B) received 14 mg (2.8ml of 0.5%) preservative free hyperbaric bupivacaine 0.2 ml NS; Group 2 (BC) received 14 mg (2.8ml of 0.5%) preservative free hyperbaric bupivacaine+0.2 ml clonidine (30µg); Group 3 (BM) received 14 mg (2.8ml of 0.5%) preservative free hyperbaric bupivacaine+0.2 ml MgSO4 (100mg.

Statistical analysis used: The data of the study were recorded in the record chart and results were evaluated using statistical tests (ANOVA, student t-test, chi-square test and post hoc test, F-test whichever was applicable).

Results: The onset of sensory block and motor block was significantly delayed in group BM as compared to group B and BC. The duration of motor block was significantly prolonged in the Group BM and BC as compared to Group B.

Conclusions: Magnesium is superior to Clonidine as an adjuvant to bupivacaine for infraumbilical and lower limb surgeries.

Context: Caudal analgesia is the most preferred technique for pain relief in paediatric population using local anaesthetic drug along with other adjuvants such as morphine, fentanyl, nalbuphine, tramadol, clonidine.

Aim: To compare the efficacy and assess the complications of morphine and nalbuphine as an adjuvant to caudal bupivacaine for postoperative analgesia.

Settings and Design: It is a prospective randomized double blind control study , conducted in Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research over a period of six months from August 2017 to January 2018 after getting ethical approval.

Methods and Material: Children fulfilling the inclusion criteria were randomly allocated to receive 1ml/kg of caudal bupivacaine 0.25% either with morphine 50ug/kg (group M ) or nalbuphine 0.2 mg/kg (group N) following general anaesthesia. Post operative pain scores assessed using FLACC score and sedation using Modified Wilson scoring. Complications such as respiratory depression, vomiting, & pruritis were also noted.

Statistical analysis used: Statistical analysis was performed using appropriate test with Graphic prism 5.0 software.

Results: Two groups are comparable in age, sex & weight. The post operative pain scores were less in group M compared to group N and they are statistically significant (p<0.05) only at 0 (0.500±0.124 vs 0.866±0.114), 1 (0.667±0.66 vs 1.200±0.78) & 2 (1.400±0.498 vs 2.000±0.830) hours but they were not statistically significant at 4 (2.133±0.776 vs 2.567±1.006), 8 (3.400±0.959vs 4.200±1.003), & 12 hours (5.733±0.827 vs 6.500±1.841). Requirement of rescue analgesic were significantly longer in group M (11.93±1.98 hrs) compared to group N (9.150±1.29) and they are statistically significant (p< 0.05). Post operative sedation score are statistically significant between two groups.

Conclusions: As an adjuvant to bupivacaine ,morphine has prolonged the duration of analgesia and decreased the use of rescue analgesic for around 12 hours but at this therapeutic dose, it is associated with higher life threatening complications such as respiratory depression, and other complications like nausea and vomiting whereas Nalbuphine has decreased the use of rescue analgesic for more than 8 hours and has not produced above mentioned complication . Hence the usage of morphine as an adjuvant can be replaced with nalbuphine in Pediatric surgeries.

Background: Subarachnoid block is the most preferred technique for anaesthetic management for lower limb surgeries. Various adjuvants have been used to improve the efficacy local anaesthetics by hastening the onset and prolonging the duration of sensory and motor block. The present study aims to compare the efficacy of intrathecal nalbuphine with butorphanol as adjuvant to 0.5% hyperbaric bupivacaine for lower limb surgery.

Methods: 90 patients belonging to ASA status I and II of either sex were randomly divided into three groups of 30 each to receive either butorphanol 25 µg (Group A) or nalbuphine 400 mcg (Group B) or normal saline 0.5 ml (Group C) with 2.5 mL 0.5% hyperbaric bupivacaine, making intrathecal drug volume to 3mL in each group. Sensory and motor block characteristics in terms of time to onset and duration were recorded as the primary end points. Drug related side effects of pruritus, nausea/vomiting, and respiratory depression were recorded as the secondary outcomes.

Results: The three groups were comparable regarding the demographic profile. The time to onset of sensory block was shortened in patients of group A and B as compared to group C, more so in group A. The mean time of 2 dermatomal regression was significantly more in Group B as compared to Group A and Group C (p=0.003, p<0.001) and significantly more in Group A as compared to Group C (p<0.001). Onset of motor block and time required to attain complete motor block (motor bromage 2 and 3 respectively) were comparable between the three groups and statistically not significant Duration of motor block was significantly more in group B as compared to Group A and Group C (p<0.001, p<0.001) and comparable between Group A and Group C .Furthermore, duration of motor block was maximum in Group B as compared to Group A (<0.001). No drug related side effects were observed in either group.

Conclusions: Intrathecal Butorphanol 25 mcg showed faster onset of sensory block whereas nalbuphine 400 mcg showed prolonged duration of sensory and motor block as adjuvant to hyperbaric bupivacaine 0.5%.

Aim: 1. To compare the analgesic efficacy of combined spinal epidural with epidural for labour analgesia using lower concentrations of Bupivacaine and Fentanyl. 2. To asses the effects of these agents on the maternal physiology, progress and duration of labour, mode of delivery, foetal and neonatal outcome.

Methods : A total of 40 labouring parturients of ASA 1 & 2 have been divided in to 2 groups (Epidural group & Combined Spinal Epidural group) with 20 in each group. Epidural group received 10 ml of 0.0625% Bupivacaine and 50 mcg of Fentanyl epiduraly as initial bolus, followed by intermittent epidural top ups of 7 ml of 0.0625% Bupivacaine and 2mcg/ml of Fentanyl every 1 hr. Combined Spinal Epidural group received 1.5 ml solution containing 0.625 mg of Bupivacaine and 25 mcg of Fentanyl intrathecally and followed 2 hrs later by intermittent top ups of 6 ml of 0.0625% Bupivacaine and 2mcg/ml of Fentanyl every 1 hr.

Results : With respect to the onset and quality of analgesia in Epidural and CSE groups, there were statistically significant differences. Analgesic efficacy was compared in terms of Time of first painless contraction, Time of loss of sensation to pin prick, visual analogue pain scales during first and second stage, Episiotomy pain relief and global assessment of quality of analgesia. CSE group showed statistically significant differences in terms of onset and quality of analgesia. No significant variations in duration and mode of delivery, maternal side effects and neonatal outcome.

Conclusion: CSE when compared to plain Epidural produced statistically significant pain relief and the side effects produced by combining Fentanyl and Bupivacaine on maternal power, passage and passenger were minimal, proving that the CSE is a safer and good alternative to epidural or labour analgesia.

Background: Endotracheal intubation by William McEwan in1878 remained the foundation stone of modern anesthesia. After successful use of laryngoscope and demonstration of laryngoscopy technique by Chevalier Jackson in 1913, endotracheal intubation achieved many milestones but it is not without complication. Following tracheal intubation, surgery, post-extubation there is an association of laryngotracheal morbidities such as a sore throat and hoarseness of voice [3,4] even in short duration of surgeries.

objectives: To evaluate the efficacy of perioperative cuff pressure monitoring in decreasing the incidence of a postoperative sore throat and hoarseness of voice after oro-tracheal general anesthesia.

Materials and Methods: We conducted this study as a double-blind randomized control trial in sixty patients who met the study criteria and underwent endotracheal general anesthesia in Karpaga Vinayga Institute of Medical Sciences and Research Institute. Totally sixty patients, each group has thirty patients. Group A - Study group (those who underwent cuff pressure monitoring) Group B - Control group.

Results: The incidence of a sore throat and hoarseness of voice were present in both groups. The percentage of above two sequelae were found appreciably lower in Group A compared to roup B.

Conclusion: Patients undergoing general anesthesia with endotracheal intubation show significantly reduced the relative risk of developing post-operative sore throat and hoarseness of voice when endotracheal tube cuff pressure  monitoring is done.

Background and Aims: Selection of inhalational anaesthetic agents are based on their safety, emergence and recovery characteristics and side effects. This study was to assess the emergence and recovery characteristics and side effect profile of desflurane and sevoflurane.

Methods: 110 patients undergoing general anaesthesia for procedures below two hours were randomly assigned into two equal groups (n = 55). After intravenous induction, anaesthesia was maintained with 1.0 MAC (Minimum Alveolar Concentration) of desflurane (Group D) or sevoflurane (Group S) which was discontinued on skin closure. In Post-Anaesthesia Care Unit (PACU) patients were assessed by Modified Aldrete Scoring System and the emergence time was noted as the time to respond to verbal command. Patients were then assessed by Modified Post Anaesthetic Discharge Scoring System (PADSS) for their recovery from anaesthesia. Post-anaesthesia complications if any were also recorded. All parametric data were statistically analysed using Student’s t-test and non-parametric data by Chi-square test.

Results: Both groups were similar demographically with respect to age and sex (p > 0.05). Administration of desflurane resulted in faster emergence than sevoflurane (19±3.7 min vs. 27.04±6.7min, p < 0.01). The early and delayed recovery time were faster with desflurane than sevoflurane with P< 0.01. Side effects were also lesser with Group D when compared to Group S.

Conclusion: Desflurane was found to be superior to sevoflurane as inhalational anaesthetic agent for short surgical procedures in terms of its faster emergence and rapid recovery with minimal side effects.

High levels of post operative pain and anxiety increases patient discomfort and post operative morbidity. Anxiolytic and analgesic effects of melatonin improves control of post operative pain by controlling higher anxiety that accompanies surgical intervention. This study compares antinociceptive effects of both melatonin and gabapentin premedication on post operative pain and analgesic requirement.

Methods: Ninety female patients undergoing modified radical mastectomy were randomly divided into three groups of 30 each where Group G given Gabapentin 600 mg, Group M given Melatonin 6 mg, Group C given placebo tablet 90 minutes before surgery. Post operative pain, sedation scores and post operative analgesic consumption was assessed for 24 hrs.

Results: Visual analogue scale (VAS) score were lower in the group G and group M as compared to group C. Sedation score recorded highest in Group M followed by Group G and least in Group C. Time to first analgesic requirement was 16.58±4.47 hrs in Group G, 6.09±5.12 hrs in Group M and 2.80±0.83 hr in Group C (p<0.0001). Total 24 hr post operative diclofenac requirement in Group G (96.77±34.60) was significantly lower than Group C (166.93±31.87) and M (142.74±44.81) (p<0.0001).

Conclusion: Both melatonin and gabapentin reduced post operative pain and analgesic consumption. Gabapentin had higher analgesic effect while melatonin was more sedative. Administration of melatonin before surgery may accelerate the resynchronization of circardian rhythm in the post operative period suggesting better recovery quality.

Aim: In the present study we compared the clinical performance of the I-gel and LMA in terms of the effectiveness and safety administration in anesthetized patients.

Materials & Methods: A total of 100 patients with requirement of different abdominal surgery were included in the study. Water soluble jelly was used to lubricate I-gel and LMA-Proseal. An experience anaesthesiologist inserted each of the devices. Both the devices were set by taping the tube over the chin and lubricated gastric tube was situated into the stomach through the gastric channel.

Results: The average airway sealing pressure with LMA – ProSeal was 29.6 cm H2O and with I-gel was 25.27 cm H2O, the difference was set up to be statistically significant (p<0.05). There was no occurrence of bronchospasm/laryngospasm, aspiration/regurgitation and hoarseness in both the groups.

Conclusion: I-gel is a straight forward tool which is uncomplicated to insert without much of manipulations quickly. It has a possible benefit of effectual seal force which is fewer as compared to LMAProseal, but is sufficient to avoid aspiration and preserve an effective ventilation and oxygenation.

Background: Fiberoptic nasal intubation (FONI) is an effective technique for establishing airway access in patients with both anticipated and unanticipated difficult airways. Utilization of fiberscope without the use of any facilitating techniques has proven to be a difficult task. In this study we compare conventional versus Nasal- 18 method for fiberoptic nasal intubation.

Aims and Objectives: To compare time for successful FONI in both the groups. To see procedure related adverse effects.

Method: A randomized controlled trial was carried out at our hospital. Fifty patients aged 20-60 years with American Society of Anesthesiologist (ASA) class I and II undergoing elective surgery under general anesthesia were allocated to two groups of fiber optic nasal intubation using either the Nasal -18 technique or the conventional method. In the Nasal- 18 group, a nasal tube was gently inserted into the nasopharynx till mark 18, then a fiberscope was glided over it and advanced through the nasal cavity till the glottis could be visualized. Finally the nasal tube was rolled over the fiberscope. Time from the start of insertion of fiberscope into nares till visualization of vocal cord (T1) and from visualization of vocal cord to complete intubation (T2) was recorded.

Result: T1 values in nasal 18 and conventional group were 33.16±7.96 and 56.76±17.08 seconds respectively [p < 0.05]. T2 duration were 35.16±9.83 and 31.20±6.89 seconds in nasal 18 and conventional group respectively [p = 0.10].

Conclusion: Nasasl- 18 method significantly reduces the time to visualize the glottis compare to conventional technique for FONI. This method should be added as a preferred technique to facilitate FONI.

This study was done to evaluate the efficacy of nitroglycerine and dexamethasone as adjuncts to lignocaine in the terms of onset, duration, quality and efficacy of IVRA (Bier’s block). This study was done on randomly selected 90 adult patients of either sex belonging to ASA grade I & II, aged 20 to 60 years undergoing for upper limb surgery duration lasting not more than 90 mins in three groups. Group 1- Plain lignocaine 2% diluted with saline (40ml), Group 2- lignocaine 2% and nitroglycerine, (40ml) Group 3- lignocaine 2% and dexamethasone (40ml). Patients were premedicated with 0.05mg/kg midazolam 5 minutes prior to surgical procedure. Basal vitals were monitored in all the patients. Two venous cannulae were placed, with all aseptic measures, one in dorsum of the operating hand and the other in the opposite hand for intravenous fluid infusion. Operative hand was exsanguinated with an esmarch bandage to squeeze the circulating blood, a double cuffed pneumatic tourniquet was placed around the upper arm and proximal cuff was inflated to 250mm Hg. Regional anaesthesia was injected slowly. Sensory block was assessed by pin prick cutaneous test. Onset of motor block was noted by asking the subject to flex and extent his/her wrist and fingers. As the sensory and motor block was achieved, distal cuff was inflated and the proximal cuff was released and surgery was started. Tourniquet pain was assessed using Visual Analogue Scale. The mean duration of surgery in group 1 was was 44.0±10.5 minutes, in Group2 was 41.2±9.7 minutes and Group3 was 43.3±9 minutes. The addition of 200µgm nitroglycerine improved the speed of onset, quality of anaesthesia, prolonged the sensory and motor block recovery time, increase the duration of post-operative analgesia. The addition of 8mg dexamethasone improved the quality of anaesthesia but did not cause significant difference in time. According to this study, it can be assumed that the addition of nitroglycerine and dexamethasone to lignocaine in Intravenous Regional Analgesia definitely improved the quality of anaesthesia.

Introduction: We aimed this study to evaluate the efficacy, quality and safety of combined sciatic and Fascia Iliaca Compartment Block with Unilateral Spinal Anaesthesia for selected lower limb surgeries.

Materials & Methods: Data collected retrospectively from prescheduled 60 patients of ASA grade I & II, were equally distributed in two groups - pinal group and the Block group. The time taken for the application of the block, number of attempts, qualilty of anaesthesia, hemodynamic parameters, duration of block & post op first analgesic need were compared.

Results: The patients of Block group had a greater hemodynamic stability, longer duration of sensory & motor blockade with a longer time for the need of rescue analgesic although the block application time was shorter in spinal group and quality of blockade was significantly better requiring no additional sedation or analgesia intraoperatively. Complication rates were comparable in both groups though tourniquet pain was common in block group & hypotension in spinal group. Bilateral blockade was seen only in spinal group.

Conclusion: Combined sciatic-fascia iliaca compartment block is a suitable alternative to spinal anaesthesia when hemodynamic stability and analgesia is considered, especially in high risk patients.

Background: The prolongation of local anesthetic induced sensory and motor block after co-administration with intrathecal clonidine [1,2] is well documented, but with oral clonidine the effect remains controversial [1.3].

Aim: To assess the effects of oral clonidine premedication in bupivacaine spinal anaesthesia (SA).

Materials and Methods: 40 patients of ASA I & II undergoing spinal anesthesia were randomly divided into two groups of 20 each. Group C: Oral clonidine 150µg premedication 90mins before SA with15 mg of 0.5% Bupivacaine heavy. Group P: SA with15 mg 0.5% bupivacaine heavy. 

Result: The time of onset of sensory blockade in group C was 2.95±0.68 min and in group P 6.75±0.71 min [p<0.0001], duration was 370.55±39.10 min in Group C and 253.50±43.95 min in Group P [p<0.0001]. The duration of motor block was 296.45±33.15 min in Group C and 196.3±32.7 min in Group P [p<0.0001]. No significant difference was found on demographic data, hemodynamic parameters and frequency of complications.

Conclusion: Pre medication with 150 µg oral clonidine in bupivacaine spinal block, can be instituted to prolong the duration of both sensory and motor blockade n routine practice without the fear of added complications.

Background: Ropivacaine has been chosen for supraclavicular brachial plexus blockfor its safety profile. Magnesium Sulphate is used as an adjuvant to local anaesthetics as it is known to potentiate sensory and motor blockade.

Aims: Our aim was to assess and compare the effectiveness of adding Magnesium Sulphate to Ropivacaine for supraclavicular brachial plexus block.The variables compared included onset, duration of sensory and motor blockade and duration of analgesia. Any adverse effects were also documented.

Methods: A prospective randomized double blinded controlled study was conducted involving 50 adult patients between the ages of 20 and 50 years belonging to American Society of Anaesthesiologists (ASA) grade 1 and 2 who underwent upper limb orthopaedic surgeries. Patients were randomly assigned into two groups of 25 each. Group R was administered 0.75% Ropivacaine while Group RM received 0.75% of Ropivacaine along with 250 mg Magnesium Sulphate. Sensory and motor blockade characteristics along with analgesic efficiency was determined.

Statistical analysis: The collected data was entered and tabulated in Microsoft excel and were subjected to analysis using SPSS version 16.0. Student t test was used for analysis of the demographic and hemodynamic data. Unpaired t test was used for statistical evaluation of the data which comprised of onset, duration of both sensory and motor blockade as well as duration of analgesia. The results were statistically significant if p value obtained was <0.05. P value < 0.001 was considered as highly significant statistically.

Results: Patients in group RM had rapid onset of sensory and motor blockade (7.8±1.24min v/s 9.6±1.76min and 10.36±1.22min v/s 12.24±2.26min). There was also prolongation of sensory and motor blockade along with reduced analgesic requirements in the post operative period.

Conclusion: Adding Magnesium Sulphate to 0.75% Ropivacaine provided faster onset and longer duration of sensory and motor blockade along with superior post operative analgesia without any adverse effects.

Aim of the study: To evaluate and compare the efficacy, safety and adverse effects of combining intrathecal neostigmine with transdermal nitroglycerine patch for pain relief in patients undergoing hysterectomies under bupivacaine spinal anaesthesia.

Materials and Methods: The study was conducted on 78 patients aged 30 to 60years of ASA grade I and II, planned for hysterectomies. Patients were allocated into 3 groups, each group containing 26 patients.
Group C: Patients received 15mg [3ml] of intrathecal bupivacaine.
Group N: Patients received 15mg [3ml] of intrathecal Bupivacaine and 25µg [1ml] of neostigmine.
Group P: Patients in addition to 15 mg [3ml] of intrathecal Bupivacaine and 25µg [1ml] of neostigmine, received transdermal NTG patch [5mg / 24hours] at chest wall in non- anaesthetized area 15 minutes after intrathecal administration of drug solution. Sensory level during anaesthesia, Postop VAS score and incidence of side effects were noted in all patients.

Observation and Results: Duration of analgesia was longest in Group P (316.3 minutes) compared to other two groups. (Group N 211.3 minutes and Group C 150.4 minutes) which was statistically significant. Incidence of nausea and vomiting were higher in Group N and P compared to Group C.

Conclusion: Addition of transdermal nitroglycerine patch [5mg/24hrs] and intrathecal 25µg neostigmine to 3ml of 0.5% bupivacaine spinal anaesthesia provided prolonged uration of analgesia but with increased incidence of nausea and vomiting.