Indian Journal of Anesthesia and Analgesia

A patient with Chronic Kidney Disease (CKD) having history of Ischaemic Heart Disease (IHD) and Interstitial Lung Disease (ILD) was planned for CAPD catheter insertion with omentectomy. Usually CKD patients requiring general anaesthesia (GA) or spinal anaesthesia present a number of challenges to anaesthesiologist. This patient carried high risk for general anaesthesia due to interstitial lung disease. We managed this high risk case with bilateral Transversus Abdominis Plane (TAP) block and spinal fentanyl with very low dose bupivacaine hyperbaric 0.5% (0.5 ml) to reduce perioperative morbidity. Anaesthesia technique was adequate for conduct of surgery with minimal supplementation and no complications noted in the perioperative period. It was observed that this technique may be a feasible alternative option especially in patients who carry high risk of morbidity with general anaesthesia/spinal anaesthesia with regular dose of bupivacaine.

Keywords: Renal Insufficiency; Chronic; Peritoneal Dialysis; Continuous Ambulatory; Fentanyl; Spinal Anaesthesia; TAP Block. 
 

Regional blocks are gaining popularity to perform surgery by blocking an isolated part of the body. Trauma is one of the consequences of this fast moving world. To deal with the surgeries related to upper limb, brachial plexus block is the most popular and effective technique with less side effects and bypasses the exposure of general anaesthesia and its related consequences and side effects. Many drugs are used as adjuvants to local anaesthetic agents to increase its efficacy, for early onset of block and to prolong the duration of block. Bupivacaine has been the most popular and frequently used local anaesthetic agent in various regional blocks but ropivacaine has also been successfully used since this drug has come in existence. In compare to bupivacaine, this drug has less cardiotoxic effects, less arrhythmogenic and less toxic to the central nervous system and has intrinsic vasoconstrictor property. Clonidine is one of the most attractive adjuvant used in regional blocks. It has analgesic and sedative effects and also reduces the anaesthetic requirements, enhances the efficacy and duration of block without any respiratory depression. In this study clonidine has been used as adjuvant to ropivacaine to analyze its effectiveness in brachial plexus block for upper limb surgeries. This study was done on 100 patients of either sex of ASA grade I & II undergoing for upper limb surgeries. It was observed that the degree of sedation was more in the clonidine group in the post-operative period. It was concluded that the addition of 150µgm of clonidine to 20 ml (0.75%) Ropivacaine for brachial plexus block prolongs the duration of motor block, sensory block and post-operative analgesia with adequate and acceptable sedation with minimum side effects.

Background: Spinal anaesthesia is safe, reliable and inexpensive technique of providing surgical anaesthesia. The intrathecal use of clonidine is shown to be effective and safe. Several studies indicate that clonidine extends duration of local anaesthetics action and can decrease the dose of local anaesthetic drug. Midazolam, a benzodiazepine when added to local anaesthetic bupivacaine has significant synergistic effect in terms of quality of spinal anaesthesia, duration and prolong post-operative analgesia without having any significant side effects.

Aims: To evaluate the synergistic effect and safety of adding 50µg clonidine to intrathecal 0.5% hyperbaric bupivacaine in spinal anaesthesia compared to 2mg of midazolam to intrathecal 0.5% hyperbaric bupivacaine for infra-umbilical surgeries. 

Material and Methods: Mean onset of sensory blockade in Group A was 151.8±36.8 sec and in Group B was 170±53.5 sec. Mean time taken for two segment regression in Group A was 210.5±62.1 min and in Group B was 162.7±54.9 min which was statistically significant. Mean Duration of analgesia in Group A was 312.4±53.8 min and in Group B was 404.5±63.6 min.

Results: Mean onset of sensory blockade in Group A was 151.8±36.8 sec and in Group B was 170±53.5 sec. Mean time taken for two segment regression in Group A was 210.5±62.1 min and in Group B was 162.7±54.9 min which was statistically significant. Mean Duration of analgesia in Group A was 312.4±53.8 min and in Group B was 404.5±63.6 min.

Conclusions: Midazolam as an additive to intrathecal bupivacaine prolongs the duration of analgesia with minimal side effects when compared to clonidine.

Background: Levobupivacaine is a s enantiomer of bupivacaine has been introduced in clinical practise in India, with lower cardio toxicity and neurotoxicity in comparison to bupivacaine [7,8]. We have designed present study as a prospective comparative study with an aim evaluate the onset and duration of sensory and motor block when0.5% Levobupivacaine and 0.5% ropivacaine are used for supraclavicular brachial plexus anaesthesia.

Material and Method: Present study is a randomised prospective comparative study conducted in the dept. of anaesthesia Konaseema institute of medical science Amalapuram from Sept 2015 to Feb 2018. Patients were allocated randomly into two groups using computer generated block randomization. Group A (n=40) received 30ml of 0.5% Levobupivacaine and Group B(n=40) received 30ml of 0.5% Ropivacaine. Parameters observed were onset-of sensory and motor block, duration of analgesia andrequirement of opioid supplementation.

Result: Mean sensory onset time in group A (Levobupivacaine) was 14.065 min in comparison to 16.829+5.01 mins in group B, with P value 0.172372. Mean time required for the onset of motor blocks in group A was 18.0225+6.33 min but in group B it was 21.35+5.49 with P value 0.007096. Out of forty patients four patients in group A require opioid supplementation and eight patients out of 40 patients in group B required opioid supplementation with p value 0.210406.

Discussion and Conclusion: From present study we would like to conclude that the onset of sensory and motor block was earlier in Levobupivacaine group than ropivacaine. The duration of sensory and motor block was also longer in Levobupivacaine group then ropivacaine.

Background: Preoperative anxiety is described as a state of uneasiness that mostpatients awaiting elective surgery experience and is a challenging concept in the preoperative care of the patients. Benzodiazepines are the most commonly used to reduce this anxiety.

Materials and methods: This prospective double blind study was designed to compare the effects of sublingual melatonin, alprazolam and melatonin alprazolam combination for premedication of adult patients during cataract surgery under topical anesthesia. 120 patients aged 40-80years scheduled for cataract surgery procedure were classified into three groups. Group 1 patients received melatonin 10mg, group 2 received alprazolam 0.5mg, group3 received melatonin 3mg and alprazolam 0.25mg combination, and all drugs were given sublingual 60min before the procedure. Sedation, anxiety and orientation score were quantified before premedication (T1) and 30min (T2), 60min (T3) and 90mins (T4).

Results: Mean ageof the study subjects was 61.3±7.92, 63.2±7.19 and 63.55±7.15 respectively. On applying t test, there was statistically significant difference between group 2 and group 3 at T3 and T4, also between group 1 and group 3 at T3.

Conclusion: Melatonin and melatonin alprazolam combination reduced anxiety scores,better sedation and provided excellent operating condition without hang over effect.

Introduction: Recent advances in pharmacology introduced newer local anaesthestic drugs which can be used in subarachnoid block with less motor blockade and less effect on bladder had changed the patient care from prolonged hospital stay to day care.

Aim: This study is to compare the efficacy of 0.5% hyperbaric Bupivacaine and 0.5% isobaric Levo-bupivacaine on spinal anaesthesia, in patients scheduled for Lower Abdominal Surgeries.

Materials and Methods: The study is a randomized control study, including 2 groups of 40 patients each group B and L. group B studied with 3ml of 0.5% hyperbaric bupivacaine, group L studied with 3ml of levo bupivacaine.

Results: Levobupivacaine has more delayed onset of both sensory and motor blockade with more time taken to attain maximum sensory level and faster two segment regression and lesser duration of both sensory and motor block when compared with the bupivacine when the hemodynamic parameters were compared with the two groups, the decrease in HR < 20% of the baseline was not significant in both groups. The decrease in SBP <20% of base line  5/40, levo bupivacaine no fall in SBP/DBP. Adverse effects like bradycardia, shivering, vomiting was not seen in the two groups when compared.

Conclusion: Levobupivacaine has more hemodynamic stability, delayed onset of action and shorter duration of anesthesia than 0.5% Hyperbaric Bupivacaine with comparable duration of motor blockade.

Introduction: Newer supraglottic airway devices, LMA-Proseal & I-Gel [2,3] have gastric channel which reduces the risk of aspiration when the baby is placed in lateral for caudal epidural placement [5]. We designed a prospective randomized study in which the clinical performance of I-Gel was compared with LMA-Proseal in paediatric elective surgeries under general anaesthesia. 

Aim of the study: The aim is to compare clinical performance of I-Gel and LMA -
Proseal in anaesthetized, spontaneously breathing, paediatric patients posted for elective, below umbilical surgical procedures.

Methodology: After getting informed written parental consent and ethical committee approval 100 pediatric cases posted for below umbilical surgeries were selected based on inclusion and exclusion criteria. Optimal conditions for supraglottic device insertion were attained with Inj.Propofol 3 mg/kg I.V mixed with Inj. Lignocaine 0.5 mg/kg and 2% to 3% Sevoflurane Either Igel or Proseal was inserted. Ease of insertion, first attempt success rate, Number of attempts,Time taken for insertion, Airway seal pressure Ease of gastric tube placement were monitored.

Results: I-Gel supraglottic airway device is advantageous over LMA-Proseal in terms of short insertion time, ease of insertion, ease of gastric tube placement and less incidence of complications in children; whereas LMA- Proseal has got advantage over the I-Gel in regards to high airway sealing pressure.

Conclusion: we conclude that I-Gel aids easy and rapid insertion with an acceptable airway seal pressure when compared to proseal. Both devices can be safely used in anaesthetized spontaneously ventilating children for short surgical procedures.

Introduction: Unanticipated difficult laryngoscopic tracheal intubation accounts for a significant proportion of adverse anaesthetic outcome in clinical practice. Hence, it is important to identify patients with difficult airway preoperatively. In our study, we have compared the upper lip bite test with modified Mallampati classification in predicting difficulty in endotracheal intubation.

Materials and Methods: The study was conducted on 150 ASA I patients of either sex, aged more than 18 years scheduled to undergo elective surgery under general anaesthesia and endotracheal intubation. Pre-operatively airways of the patients were evaluated using modified Mallampati test and upper lip bite test. MMT class III and class IV and ULBT class III were considered potentially difficult intubation. Experienced anaesthesiologists unaware of pre-operative airway evaluation, will perform laryngoscopy and grade the glottic view as per Cormack and Lehane’s classification. Grade III and IV were considered as difficult intubation. Sensitivity, specificity, accuracy, positive and negative predictive values of ULBT and MMT were calculated.

Results: MMT was more sensitive (71.43%) than ULBT (28.57%). MMT had a specificity of 81.82 as compared to 96.5% for ULBT. Positive predictive value for MMT is 16.3% and 28.57% for ULBT. Negative predictive value was 98.32% and
96.50% for MMT and ULBT respectively. Accuracy of MMT was 81.33% while it was 93.33% for ULBT.

Conclusions: Modified Mallampati test is an inherently better test at predicting difficult endotracheal intubation when compared to upper lip bite test. Both modified Mallampati and upper lip bite test are better predictors of easy intubation rather than as positive predictors of difficult intubation.

Background: The pressure response, which is part of a huge spectrum of stress response, results from the increase in sympathetic and sympathoadrenal activity. This study aims to evaluate the effect of dexmedetomidine and labetalol on cardiovascular response to laryngoscopy and intubation.

Methods: Seventy ASA physical status I and II patients scheduled for elective surgery under general anesthesia requiring tracheal intubation were randomized into two groups, Group D received intravenous (IV) Dexmedetomidine (1.0µg / kg) diluted to 10 ml with normal saline, infused over 10 mins, 10min prior intubation and group L received IV labetalol 0.3mg/kg diluted to 10ml with normal saline over 2mins, 5min prior intubation. Heart rates (HR), systolic blood pressure (SBP), diastolic blood pressure(DBP) Mean arterial pressure(MAP), rate pressure product (RPP) and adverse effects were recorded at baseline (T0) , 2 min after administration of study drug (T1), 1min after induction (T2) and at 1min (T3), 3min (T4), 5 min (T5) and 10min (T6) after intubation.

Results: There was a significant fall in HR, MAP and RPP in group D than group L at T1 and T2. After intubation HR (83.20±11.396 vs 94.00±8.898), MAP (87.09±10.942 vs 94.94±10.942) and RPP (9.46±1.777 vs 11.82±1.855) were significantly lower in group D than group L.

Conclusion: Administration of a single preinduction IV dexmedetomidine at the dose of 1µg/kg resulted in significant attenuation of the rise in the heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure and rate pressure product than labetalol 0.3mg/kg. 

Context: Anxious patients require larger dosage of anaesthetics for induction of anaesthesia which leads to hemodynamic disturbances. Melatonin, as premedication decreases the required dose of induction agent and cause pre-operative anxiolysis.

Aims: To compare effect of oral melatonin with placebo on required induction dose of thiopentone sodium, pre operative anxiety, orientation and sedation.

Materials and Methods: This study was conducted on 80 ASA I & II patients scheduled for surgeries under general anaesthesia. Patients were randomised into two groups to receive melatonin (Group-M) and placebo (Group-P) as premedication. The required dose of thiopentone, anxiety score, sedation score and orientation score were studied at 0 min, 30 min and 60 min. Student t-test has been used to find the significance of study parameters on metric parameters and Mann– Whitney U test was used to find the significance of study parameters on ordinal between two groups.

Results: The mean dose of thiopentone required for SE to reach 50 in group M is 3.69 mg/kg and in group P is 5.46 mg/kg. (p<0.001).The mean dose of thiopentone required for loss of eyelash reflex in group M is 3.56 mg/kg and 5.15 mg/kg in group P. (p <0.001) Patients were less anxious and more sedated at 30 and 60 min of premedication without any change in orientation.

Conclusion: Melatonin 6 mg when compared to placebo given 60 minutes before surgery as a premedicant significantly reduced the induction dose of thiopentone sodium and provided better anxiolysis and sedation without affecting orientation.

Background and aims: SBB is the widely used excellent regional anaesthetic technique for upperlimb surgeries. Various LA agents are used for it. They have specific actions regarding time. Various novel adjuvants are used for prolonged sensory and motor blockage. We used 2 alpha agonists clonidine and dexmedetomidine for? Use of ultrasound becamepopular worldwide because we can give block to the site and dose and volume of the drug can be decreased so better blockage achieved with less adverse effects.

Material and Methods: 60 ASA grade I/II adult patients of upperlimb surgery were randomly allocated into 2 groups. 
Group C – 20 ml of 0.5% bupivacaine + 1 ug/kg clonidine
Group D –20 ml of 0.5% bupivacaine + 1 ug/kg dexmedetomidine

Results: Onset of sensory and motor blockage noted in each group . duration of sensory and motor blockage in group C 310.52±40.51, 368.22±42.58 min In group D 505.42±42.38, 560.38±32.48 min Duration of analgesia group C 340.32±38.49 min No signicant adverse reactions group D 525.38±45.36 min 

Conclusion: Addition of dexmedetomidine prolongs duration of sensory and motor blockage and duration of analgesia as compared to clonidine with 0.5% bupivacaine in SBB.

Caudal epidural is the most common regional anaesthetic technique being performed in paediatric day care procedures. Several adjuvants have been tried to prolong the duration of caudal analgesia and to increase the efficacy of analgesia. Among them Clonidine is the popular adjuvant in current paediatric practice.In this study 100 children in the age group of 1 to 10 years were selected and divided in to two groups (Group A and Group B) of 50 children each. Group A children received Bupivacaine 1 ml/kg and 1mcg/kg of Clonidine, Group B children received Bupivacaine alone at 1ml/kg in the caudal epidural route. Heart rate, respiratory rate, mean arterial pressure during intraoperative and postoperative period have been monitored. Post operative sedation was assessed by simple sedation score and the duration of analgesia by the need for first analgesic requirement. The duration of analgesia is significantly prolonged in Group A and no significant changes in the haemodynamic parameters also. So addition of 1 mcg/kg of Clonidine to Bupivacaine in the caudal route significantly prolongs the duration of analgesia without causing any major haemodynamic and respiratory effects.
 

Background: The various supraglottic airway devices with their advent have created a revolution in the management of airway. We have made an attempt to compare the clinical performance of the two types of supraglottic devices namely Igel and LMA proseal during general anesthesia in spontaneously breathing patients.

Materials and Methods: Sixty ASA grade I and II adult patients of either sex were randomly assigned into two groups. Group I (n=30) for I-gel and Group P (n=30) LMA ProSeal. We assessed the ease of insertion, attempts for insertion, ease of gastric tube placement, airway sealing pressure and postoperative sore throat and hoarseness of voice. Results: There were no significant differences in
demographic data. The airway sealing pressure was higher with Group P (27.87±2.29cm H 2O) than with Group I (23.77 ±2.13cm H 2O) (p < 0.05). The ease of insertion was comparable between Group I (29/30) with Group P (26/30) (> 0.05). The success rate of first attempt of insertion was 29/30 in Igel and 28/30 in proseal group (p> 0.05). Ryles tube could be inserted easily in all the 30 patients of each of the two groups. The adverse effects like Blood stain on LMA coughing on insertion, sore throat and hoarseness assessed at 6 hours and 24 hours of postoperative period were statistically insignificant among the two groups.

Conclusions: Proseal provides a better airway sealing pressure than Igel with comparable performance in ease of insertion , number of attempts at insertion and postoperative adverse events.

Spinal anaesthesia is commonly used in elderly patients who undergo transurethral resection of the prostate (TURP), especially in those with compromised cardiorespiratory functions.

Aims: To evaluate the efficacy of Nalbuphine when used as an adjuvant to Ropivacaine in spinal anaesthesia for Transurethral resection of the prostate in terms of providing adequate sensory and motor blockade along with post-operative analgesia and to look for any adverse effects.

Methods: Fifty patients of the American Society of Anaesthesiologists (ASA) physical status II and III within the age group of 60 to 80 years were chosen for a prospective randomized double-blinded comparative clinical study. Patients were divided into two groups. Group R received 2.5 ml of 0.75% Ropivacaine and 1 ml of normal saline. Group RN received 2.5 ml of 0.75% Ropivacaine and 1 mg of Nalbuphine (in 1 ml of normal saline). Sensory and motor blockade characteristics, postoperative analgesia and adverse effects if any were studied.

Statistical analysis: The data which was collected was tabulated using Microsoft Excel and analysis was done using SPSS version 16.0. Student t-test was used to analyze the demographic and hemodynamic variables. Unpaired t-test and chi-square test were used to analyze the parameters which included onset, time, duration of sensory and motor blockade and also the duration of analgesia. p-value <0.05 was taken as statistically significant and p-value <0.01 was considered as highly significant.

Results: Patients in group RN had an early onset of sensory block at T10 (4.46±0.23min v/s 5.39±0.24 min). The duration of sensory (242.31±10.36 min v/s 175.70±9.78 min) and motor blockade(150.72±5.79 v/s 126.98±3.49) along with two segment regression times were prolonged in group RN when compared to group R. Postoperative analgesia was also superior in group RN as total analgesic consumption was less in group RN (230.46±10.8 v/s 320.6±13.2).

Conclusion: The addition of 1 mg of Nalbuphine to 0.75% Ropivacaine provided a faster onset of sensory and motor blockade. Sensory and motor blockade was also prolonged. The postoperative analgesia was enhanced in group RNs with low visual analogue scale scores (VAS scores). Haemodynamic stability was well maintained without any incidence of adverse effects.
 

Background: Sedation is a common practice in ICU in order to reduce the anxiety, increase tolerance and to improve the outcomes of intervention is the Intensive care Unit. This is due to patients admitted to the ICU require invasive and uncomfortable interventions such as mechanical ventilation. The sedation of the patient reduces the stress response, provides anxiolysis, improves the tolerance of ventilator support and facilitates nursing care.

Objective: To compare the effect of Dexmedetomidine versus Midazolam for sedation of critically ill patients.

Materials and Methods: A prospective, randomized, double blinded study was undertaken in the Department of Emergency Medicine, of Chigateri General Hospital and Bapuji Hospitals attached to JJM Medical College, Davanagere from March 2012 to March 2013. A total of 100 patients aged above 18 years who were critically ill and admitted to Intensive care units of the above hospitals were included as subjects.

Results: The mean age of the subjects of Dexmedetomidine group was 41.9 (±12.4) years and patients of midazolam group was 41.1 years.The mean weight of the patients in Dexmedetomidine group was 57.2 (±13.5) kgs and the mean weight of the patients in Midazolam group was 57.8 (±12.2) Kgs.The mean sedation score was 0.6 in dexmedetomidine group and 0.1 in Midazolam group at 5 mins after admission.

Conclusion: This study had shown the efficacy of Dexmedetomidine as equal as Midazolam. The hemodynamic parameters also remained normal while use of this drug. This study had also shown that the less adverse effects and number of add on sedative agents were less in Dexmedetomidine group compared to midazolam.

Background: Over three decades revival interest developed in effective use of regional anesthesia techniques for surgery and pain management.

Objective: To evaluate the efficacy of combined spinal epidural block and epidural block.

Materials and Methods: Prospective study was conducted on American Society of Anesthesiologists grade I and II patients (20 to 60 years old) posted for infraumbilical gynecological and orthopedic surgeries. Sixty patients were randomized divided into two groups of 30 each such as group A (combined spinal epidural) and group B (epidural). Various parameters were studied to evaluate efficacy of combined spinal epidural anesthesia and epidural anesthesia regarding sensory blockade (by pinprick method), motor blockade (modified Bromage scale method) and total amount of bupivacaine required. Data was analyzed using unpaired t test and chi square test with the help of MS Excel and SPSS software.

Results: Onset of anesthesia (sensory blockade) in group A (combined spinal epidural) was reduced significantly (p<0.05) as compared to group B (Epidural). Extent of motor blockade, group A showed all patients had grade 3 blockade which was 100%, whereas grade 3 blockade was found in only 3 patients of group B which was 10% only. The total amount of bupivacaine required was less in group A when compared with group B.

Conclusion: Combined spinal epidural anesthesia showed effective and promising future over epidural anesthesia by offering rapid onset of action, superior quality of analgesia, better muscle relaxation and less dose of local anesthetic required.

Microvascular reconstruction surgery operated for more than 5 hours duration under general anaesthesia with endotracheal intubation is challenging to the anaesthesiologist. Post op cough, hoarseness and sorethroat are side effects, causing dissatisfaction to the patient and can prolong recovery time.

Materials and Methods: Our prospective study of sixty patients was randomized into two groups of thirty each. Group D patients received iv dexamethasone 8 mg and group N patients received  normal saline 2 ml after intubation. Postop cough, sore throat and hoarseness will be noted immediate after extubation, 30 minutes, one hour and twenty fours post extubation.

Results: The incidence of postop cough was lower in dexamethasone group patients than normal saline group patients at extubation (but not statistically significant with p=0.166). Dexamethasone group patients also had lower postop hoareseness score at 60 minutes post extubation (p= 0.181).

Conclusion: Administration of intravenous dexamethasone can reduce the incidence of postop cough in patients undergoing microvascular reconstruction surgery.

Background: Peri-operative hypothermia is very common and associated with many complications. Hypotheremia is most evident in first two hours due to redistribution of heat after induction of general anaesthesia. The study was conducted to compare the effect of pre-warming and intraoperative warming with only intraoperative warming in patients undergoing long duration surgeries under general anaesthesia where following parameters were studied: Core body temperature as a primary outcome and hemodynamic parameters, extubation time, post anaesthesia recovery and postoperative shivering as secondary outcomes.

Methods: In this prospective interventional study, 40 patients between 18-70 years of age were divided into two groups. Group A received preoperative as well as intraoperative forced air warming. Group B received only intraoperative forced air warming with Bair Hugger. Intra-operatively, core body temperature and hemodynamics were monitored. Extubation time and post operative recovery score were recorded after surgery.

Results: It was observed that after induction of general anaesthesia core temperature started decreasing in both the groups but the fall was more in group B, which was statistically significant till 150 minutes. After that period the
difference was insignificant till the end of the surgery. No significant difference in any other parameter studied was observed in both the groups.

Conclusion: Preoperative warming with forced air warmer is definitely effective in preventing redistribution hypothermia for initial two hours of surgery. However, the overall immediate outcome is not affected as per observations made in our study.

 

Context: Inguinal hernia surgeries are associated with moderate to severe pain postoperatively and various pain management strategies have been employed.

Aims: To compare the efficacy of US guided IIN/ILN block with US guided TAP block for postoperative pain management in adult patients undergoing inguinal herniorrhaphy under spinal anaesthesia.

Settings and Design: Prospective randomised double blinded study.

Methods and Material: Sixty adult patients undergoing inguinal herniorrhaphy under spinal anaesthesia were randomly allocated into two groups each having thirty patients: group T who received US guided TAP block after the surgery and group I who received USG IIN/IHN block after the surgery. The postoperative visual analogue scale (VAS) was measured at 3,6,9,12, and 24 hours respectively. The time to first request for analgesia was recorded in the groups.

Statistical analysis used: Student’s t test (two tailed, independent) and Chi square /Fisher Exact test were used for statistical analysis.

Results: The mean VAS scale at rest in Group T at 6, 12 and 24 hours were 2.97±1.85,3.20±1.77 and 4.33±1.67 as compared to 1.57±0.86, 1.83±0.87 and 1.90±0.92 in group I respectively. The mean VAS on movement at 6, 12 and 24 hours in group T were 3.57±2.22 , 4.40±1.83 and 5.23±1.55 respectively as compared to, 2.40±1.00, 3.37±1.35 and 2.70±1.26 respectively in Group I. The mean time to first analgesia was 7.10±3.94 hours in group T as compared to 10.15±4.44 hours in group I.

Conclusions: US guided IIN/IHN block provides better analgesia and longer duration of analgesia compared to ultrasound guided TAP block for inguinal heriorrhaphy.

Background & Objectives: Post-operative nausea and vomitting is the second major problem in the post-operative period that causes patients much discomfort by itself and by prolonging the patients, stay in the hospital. In the present scenerio incidence of PONV has reduced to 20-30% due to refined techniques of anaesthesia, proper pre-operative preparation and by heeding the risk factors. However it remains a big problem. This study evaluates the protection offered by Palonosetrone and Granisetrone in the prevention of PONV in female patients undergoing laparoscopic surgery under general anaesthesia.

Materials and Methods: Total ninety-six premenopausal female patients (forty eight in each group) of aged  18 years of age of ASA class I/II and posted for gynaecological laparoscopic surgery under general anaesthesia were enrolled in this randomised, prospective, single blind, comparative, clinical trial. Group P received Inj.Palonosetrone 0.075mg and Group G received Inj.Granisetron 2.5 mg intravenously one minute before induction of anaesthesia. All episodes of PONV (complete response, nausea, retching, vomiting, emetic episode) were recorded for 0-3 hours in post-anaesthesia care unit and for 3-48 hours in postoperative ward.

Results: All the parameters and variables studied were subjected to statistical analysis using Chi-square test and unpaired student ‘T’ test. During 0-24 hours, the incidence of nausea and vomiting were comparable in both the groups. whereas, between 24-48 hours, incidence of nausea and vomiting was significantly high in Group G as compared to Group P(p<0.01).

Conclusion: prophylactic single intravenous dose of palonosetron 0.075mg is more effective than granisetron 2.5mg for controlling postoperative nausea and vomiting between 24-48 hours post operatively with less incidence of side effects.

Background: Various adjuvants are being used with local anesthetics for prolongation of analgesia like opioids, but the onset and duration of analgesia is improved when a local anesthetic is combined with alpha2 adrenergic agonist. Though, the effects of clonidine on local anesthetics have been extensively studied, there are limited studies demonstrating the effects of epidural dexmedetomidine on local anesthetics.

Aims and objectives: To compare the efficacy, onset and duration of postoperative analgesia and side effects of clonidine and dexmedetomidine when used epidurally as an adjuvant to ropivacaine in patients undergoing lower limb orthopedic surgeries.

Settings and Design: This study was designed to compare the efficacy, onset and duration of postoperative analgesia and side effects of clonidine and dexmedetomidine when used epidurally as an adjuvant to ropivacaine in patients undergoing lower limb orthopedic surgeries.

Methods and Material: Patients were randomized into two groups- group ropivacaine with dexmedetomidine (RD) received 20 ml of 0.2% ropivacaine with 1 g/kg dexmedetomidine epidurally and group ropivacaine with clonidine (RC) received 20 ml of 0.2% ropivacaine with 2 g/kg clonidine. Onset and duration of analgesia and Ramsay sedation score and hemodynamic parameters were monitored and side effects if any noted.

Statistical analysis used: mean±standard deviation for quantitative continuous data and compared by unpaired t-test.

Result: The onset of analgesia (RD-4.4±0.67min, RC-6.3±0.74min) and duration of analgesia (RD-665.16±29.8min, RC-462.16±29.8min) were found to be significantly better in dexmedetomidine group. Better sedation score was seen in dexmedetomidine group.

Conclusion: Epidural dexmedetomidine (1mcg/kg) and clonidine (2mcg/kg) with ropivacaine 0.2% had good efficacy however the dexmedetomidine provided faster and prolonged duration of postoperative analgesia and good sedation compared to clonidine.

Background: The study aimed at comparing the efficacy of Airtraq with McCoy laryngoscope on ease of intubation with cervical immobilization in patients undergoing elective surgery.

Methods: Sixty consenting American Society of Anaesthesiologist’s physical status I-II patients (ASAPS-I, II), aged 18-50 years, scheduled for various surgeries requiring tracheal intubation were randomly assigned into two groups of thirty each to undergo intubation with Airtraq or McCoy laryngoscope with neck immobilisation using cervical collar. The ease of intubation based on Intubation Difficulty Scale (IDS) score, Cormack-Lehane grade of glottic view and impact on haemodynamic parameters were recorded. Statistical analysis was performed with independent student t test and chi square test.

Statistical analysis: Chi Square test and t-test. 

Results: All patients in two groups had a comparable demographic profile and were successfully intubated. The Airtraq laryngoscope significantly reduced the IDS (mean = 0.663) as compared with both McCoy (mean = 2.2) (p = 0.001) and improved the Cormack-Lehaneglottic view (80% grade 1 view and no patients with grade 3 or 4 view). There were less haemodynamic variations during laryngoscopy with the Airtraq compared to the McCoy laryngoscope group.

Conclusion: In patients undergoing endotracheal intubation with cervical immobilisation, Airtraq laryngoscope was superior to the McCoy with greater ease of intubation and lower impact on haemodynamic variables.

This study was carried out to compare the effectiveness of I.V. nitroglycerine and clonidine for controlling the pressor response to laryngoscopy and endotracheal intubaltion during general anaesthesia. This study was done on 90 adult patients of either sex belonging to ASA grade-1, aged 20-50 years and were randomly allocated into three groups according to the agents to be used before induction of anaesthesia, comprising of 30 patients each. Group-1 : control group (not receiving any pre-medication), Group-2 : IV nitroglycerine, Group-3 : IV clonidine. All the patients were prepared with adequate pre operative fasting. Tablet alprazolam 0.5mg given orally night before surgery for quiet and calm sleep. After checking the patient’s blood pressure, H.R. and ECG at basal stage, pre-treatment was started. Group- 2 patients were pre-medicated with 200µg/min slow intravenous Nitroglycerine is given till the systolic blood pressure fell down by 20-30% of the basal. Group-3 patients were pre-treated with 0.3 mg of clonidine IV. Systolic arterial pressure, diastolic arterial pressure,mean arterial pressure, heart rate were measured at base line(3 min before induction), just before laryngoscopy and post intubation at 1, 3, 5, 10 and 15 min after laryngoscopy and intubation. Anaesthesia was maintained on nitrous oxide, oxygen, 0.5% isoflurane and a long acting muscle relaxant. While comparing inter-group comparison, it was observed that there was significant increase in heart rate in Group-1 and Group-2, but heart rate remains controlled and stable in group 3. Hence, it was found that nitroglycerine had no role in controlling the heart rate during intubation, whereas there was significant change in blood pressure in Group-2 and Group-3 as compared to Group-1. This suggests that nitroglycerine and clonidine effectively attenuates hypertensive response to laryngoscopy and intubation. ECG changes were observed in all the groups for sinus tachycardia. 

 

Background and Aims: Moxonidine is a selective Imidazoline type 1 receptor agonist. It has a central sympatholytic action and it is used orally as an antihypertensive agent. Selective stimulation of I 1 receptors in the cardiovascular regulatory centers of the medulla oblongata, causes inhibition of central sympathetic activity, leading to a reduction in blood pressure. Laparoscopic procedures are becoming increasingly common in the current era of minimal- access surgeries and anesthesiologists need to be prepared for the perioperative challenges. Creation of pneumoperitoneum causes hemodynamic changes due to increased intra- abdominal pressures and hypercarbia. Several agents have been studied for attenuating the hemodynamic responses to pneumoperitoneum, including antihypertensives, opioids, alpha- 2 agonists, ventilatory strategies and positional alterations. This study aims to analyze the effect of oral Moxonidine premedication in the attenuation of hemodynamic responses during laparoscopic cholecystectomies.

Methods: Sixty ASA grade 1 and 2 patients were randomly selected after ethical approval. Patients were blinded by sealed envelope technique and randomly allocated into one of the two groups to receive either tablet Moxonidine 0.2mg at 8pm the day before surgery and at 8am on the day of surgery (group M, n=30) or placebo, control group (group C, n=30). The anesthesiologist was also blinded about the groups or medications received by the patients.Standard general anesthesia with endotracheal intubation and muscle relaxation was administered. All vital parameters were recorded at different time intervals as before induction (B), after intubation (AI), before pneumoperitoneum (BPN), after pneumoperitoneum (APN), and later at every 10 minutes (APN 10, APN 20, APN 30, APN 40, APN 50, APN 60, APN 90), at release of pneumoperitoneum (RPN), after reversal (AR) and at 15 and 30 minutes after reversal (AR 15 , AR 30 ). Any change in hemodynamic variables more than 20% from the baseline was considered significant. The observations were recorded and subjected to statistical analysis using SPSS statistical software. Student’s ‘t’ test was used for inter-group comparison, with P value < 0.05 considered significant.

Results: The preoperative baseline mean HR was lower in group M (85.90±17.60) as compared to group C (100.90±9.40). The preoperative basal values of mean (±SD) SBP were significantly lower in group M (121.70±10.10) as compared to group C (129.40±6.10). The preoperative basal values of mean (±SD) DBP were significantly lower in study group (78.80±8.30) when compared to control group (86.00±7.30).

Conclusion: Moxonidine is a new generation centrally acting anti-hypertensive, licensed for the treatment of mild to moderate essential hypertension. The use of oral Moxonidine in minimal-access procedures can be recommended as a routine premedication in view of its safety profile.

Background: Cancellation of elective cases, which may be due to patient factors, administrative and surgeon related factors is an immense burden for all healthcare services economically and also in terms of inconvenience caused to both patients and their families, wastage of resource and loss of income and time to the patient and family members.

Materials and Methods: Medical records of all the patients was collected from Indira Gandhi Institute of Child health, a tertiary care paediatric hospital in Bengaluru, India from Janaury 2016 to December 2017, who had their operations cancelled on the day of surgery in all surgical departments retrospectively. Number of cases cancelled and the reason for cancellation were noted and analysed.

Results: 5,375 elective surgeries were performed of which 749 cases were cancelled on the day of surgery. The most common category for cancellation was time constraint or due to lack of OT time which accounted for 217 ( 28.97%) cancelled cases. Highest number of elective cases as well as cancelled cases were in the surgery department. This was followed by posting of emergency cases (n = 163 or 21.76 %), unexpected sudden infections like URTI, LRTI in children (n = 104 or 13.88 %). 76 cases were cancelled due to lack of instruments or other equipments which accounts to 10.14% of elective cancellations. Most common reason for cancellation of orthopaedic surgeries was due to non-availability of implants. Most common reason for cancellation of ENT surgeries were due to chest infections.

Conclusion: This study shows that the most of the causes for cancellation of operation are avoidable, with careful planning. 

Background and objectives: Spinal anaesthesia is one of the most commonly used technique in anaesthesia. It is economical, safe, cost effective, easy, needs less sophisticated anaesthetic equipment, drugs, post operative care hence preferred over general anaesthesia and most popular because of its profound analgesia and muscle relaxation. Objectives of the present study were to know the incidence of post dural puncture headache (PDPH), number of attempts for successful sub arachnoid block and incidence of failed spinal anaesthesia by using 27G Quincke’s and Whitacre’s spinal needles.

Methodology: This one and half year randomized clinical trial was conducted in the Department of Anaesthesiology, BLDEU’S Shri. B.M. Patil Medical college hospital and research centre, Bijapur during the period of Dec 2012 to August 2014 on 110 patients. The incidence of PDPH, number of attempts and failed spinal anaesthesia were assessed.

Results: In this study female preponderance was seen. In the present study the 12.73% patients had PDPH in Quincke group and 1.82% patients in Whitracre group and this difference was statistically significant using test of proportion (p=0.02759).

Conclusion: Overall the Whitacre 27G needle has better results with respect to PDPH and number of attempts required for successful subarachnoid block whereas the incidence of failed spinal anaesthesia was less with Quincke 27G needle.