Indian Journal of Anesthesia and Analgesia

Low back pain with radiating pain, tingling or numbness in lower limbs is most commonly due to prolapsed and herniated intervertebral disc. The pain is neuropathic and usually increases with walking. We report a patient with severe back pain with radiculopathy of one monthduration in a patient with cerebellar ataxia for 30 years with increasing unsteadiness of gait for last 30 years.

Introduction: Ropivacaine is nowadays replacing bupivacaine as the drug of choice in epidural anesthesia It has a high therapeutic index in a study conducted in humans.it is less neurotoxic and cardiotoxic than bupivacaine. One among the disadvantage in adding opioids is respiratory depression. To overcome this many studies emphasized adding clonidine with the local anesthetic drugas epidural anesthesia. This provides a marked reduction in the need for using hypnotics, inhaled opioids analgesics for treating postoperative pain. Aim of the Study: The clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine and to evaluate the synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia. Materials and Methods: After approval of the study by our institutional ethics committee, the study was conducted on 50 patients of both sexes, aged between 25 to 55 years and physical status according to the American Society of Anesthesiologists (ASA) Ior II, undergoin gelective inguinal hernia repair surgeries. Lumbar epidural anesthesia was performed to all the patients. Weight was ranging from 55-70 kg and height ranging from 150-172 cm. Group I: (n = 25): Patients received 1 ml of 0.9% normal saline + 19 ml of 0.75% hyperbaric ropivacaine. Group II: (n = 25): Patients received dexmedetomidine 1 µg /Kg + 0.9% normal saline so that total volume was completed to 1 ml + o.75% hyperbaric ropivacaine 19 ml was given. Results: The mean time required for the onset of sensory block Group –R 9.0800, Group-R Dex 8.0900 in both groups was not statistically significant. Group RDex achieved complete motor blockade (Bromage scale) much earlier than group R 22.8400 and Group-R Dex 19.0000 there was statistically significant difference noticed in between these two groups (‘p’ value < 0.05). Out of 25 patients, there are 2 in group-R and group- R Dex 5 had bradycardia with the heart rate of <55 beats /minute and it as treated with 0.3 mg of atropine. The sedation score between R and R Dex groups reveals a statistically significant difference (P<0.001). The side effects in both the groups were comparable; no statistical difference was noticed between the group-R and RDex. Conclusion: Present study obviously reveals that an apparent synergism between the two drugs namely dexmedetomidine and ropivacaine without any additional morbidity, which has been proved statistically significant using quantitative and qualitative analysis.

Background: Endotracheal intubation is the standard practice for general anaesthesia inspite of many supraglottic airway devices have arrived. Various drugs have been used till date to attenuate the hemodynamic response to endotracheal intubation. This study compared the effects of intravenous Clonidine (2.5 µg/kg) and Lignocaine (1.5 mg/kg), for attenuation of hemodynamic response in laryngoscopy and endotracheal intubation. Methods: Ninety patients of ASA class I & II were divided into two groups of 45 each. Group L patients received injection Lignocaine and Group C patients received injection Clonidine. Hemodynamic parameters were monitored by using multiparameter monitor before intubation and at 1, 3, 5 and 10 minutes after endotracheal intubation. Results: No significant difference between two groups was observed in terms of hemodynamic parameter including heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure. Pretreatment with injection Clonidine is equally better alternative to lignocaine with similar advantages for blunting the undesirable hemodynamic response associated with laryngoscopy and intubation.

Aim: To maximize availability of Ambulance equipment before dispatch. Design: Retrospective observational study. Material and Methods: A team of doctors, nurses and paramedics of our tertiary care central government hospital of capital city in a lower middle income economy background country were assigned the task of inspection of ambulances prior to sending these for a national event. These ambulances were inspected for preparedness for patient care. The tertiary care center was the nodal center for inspection where ambulances from different organizations like CATS and corporate tertiary care hospitals were assembled for inspection on day 1, day 3 and day 7, while on the 8th day these ambulances were dispatched for patient care. Ambulances were checked consequetively for three days according to existing standardized check list [3]. A separate logistic cell was managed by the inspection team for procurement and maintenance of equipment. The ambulance pilot supervisor was responsible for checking the mechanical component of ambulances. Statistical Analysis: Quantitative variables were compared using Wilcoxon signed- rank test (as the data sets were not normally distributed) across follow up. A p value of <0.05 was considered statistically significant. Results: In between series of inspections, the task of functional completion of ambulance equipment significantly improves thereby pointing out to the success of methods employed in the present study. Our inspection was successful in terms of maximizing the availability of life saving equipment. Conclusions and Recommendation: A series of Ambulance inspection is essential for ascertaining the availability of disposable and consumable items in a fully equipped ACLS ambulance. The Ambulance team should be open to adding new evidence-based life- saving equipment to the existing standardized checklist.

Background: Upper abdominal surgeries were coneventionally done under general anaesthesia. Now a days epidural anaesthesia is being used for upper abdominal surgeries as it can be used for both intraoperative anaesthesia & postoperative analgesia thus decreasing postoperative morbidity. Materials & methods: 50 patients in the age group of 20 to 50 years of either sex, with ASA physical status score 1 or 2, scheduled to undergo elective upper abdominal surgeries were included in the study. Epidural catheter was inserted in T8-T9 interspace in all patients considered for the study. 10cc 0.5% bupivacaine was given in all patients. All the observations were noted down & results analysed. Conclusion: Thoracic epidural anaesthesia is an excellent option for upper abdominal surgeries. It provides good intraoperative anaesthesia & postoperative analgesia facilitating early recovery. It prevents the risks associated with general anesthesia. Hence, we conclude that thoracic epidural anaesthesia should be a part of the armamentarium of anaesthesiologists in upper abdominal surgeries.

Spinal anaesthesia is preferred regional anaesthesia technique in lower abdominal surgeries. Advantages are conscious and spontaneously breathing patient [25], good muscle relaxation, cost effectiveness and adjuvants injected intrathecally prolong the anaesthetic effects [26,27]. Aim of the study: To compare Fentanyl Citrate and Magnesium sulfate as adjuvants to 3 ml of 0.5% bupivacaine in infraumbilical surgeries under spinal anaesthesia, about onset and duration of sensory and motor block, intraoperative hemodynamics, postoperative pain and side effects. Materials & Methods: After Institutional ethics committee approval, a double-blinded comparative study was conducted in 100 patients at Osmania General hospital during 2014-2017. Patients were divided into two groups of 50 no.’s each Group F- 3 ml 0.5% Heavy Bupivacaine & Fentanyl citrate 25 mcg, Group M –3 ml 0.5% Heavy Bupivacaine & MgSO4 100 mg were deposited intrathecally. Intraoperatively Sensory and Motor block onset and duration, HR, SBP, DBP & MAP, SpO2, side effects were assessed. Results: In group M– onset of sensory and motor block is significantly prolonged , duration of analgesia, motor block is comparable to group F and patients in group M were hemodynamically stable perioperatively, and at end of 24 hrs postoperatively VAS score was ≥ 3 at indicates a quality post operative analgesia. Conclusion: Fentanyl citrate as adjuvant to 0.5% heavy bupivacaine effectively augmented quality of spinal anaesthesia; its advantages are limited by incidence of side effects. MgSO4 100 mg provides excellent perioperative analgesia and stable hemodynamics and is an attractive non-opioid adjuvant alternative to fentanyl.

Objectives: To compare the effects of intrathecal dexmedetomidine given mixed or sequential with 0.5% hyperbaric bupivacaine for spinal anaesthesia. Method: 60 patients posted for elective lower abdominal procedures were included in this study. They were randomly divided into two groups. Group M: 30 patients received 5 μg dexmedetomidine intrathecally mixed with 0.5% hyperbaric bupivacaine & group S: 30 patients received 5 μg dexmedetomidine sequentially with 0.5% hyperbaric bupivacaine. Results: The age and weight distribution were comparable in the two groups. The onset of sensory and motor blockade was faster in the sequential group as compared to the mixed group. The degree of sedation was higher in the sequential group. There was a statistical significance among the two groups with respect to duration of post operative analgesia with the sequential group having the longest duration. There was a statistical significant difference in the intraoperative and post operative hemodynamics with the sequential group having a lower systolic and diastolic blood pressure and lower heart rate. There were no significant adverse effects. Conclusion: When dexmedetomidine is given sequentially with 0.5% hyperbaric bupivacaine for spinal anesthesia, it provides early onset of sensory and motor block and prolongs the duration of anesthesia and analgesia. It also provides sedation which is unique to alpha 2 agonists, among which dexmedetomidine provides conscious sedation, with sequential groups demonstrating lower hemodynamic parameters.

Introduction: The role of peripheral nerve blockade was expanded for management of post operative pain and chronic pain. Tramadol and fentanyl had been successfully used as adjuvant to local anaesthetic in brachial plexus block. Clonidine seems to provide analgesic benefit without major adverse effects. Aim: To evaluate whether additional anesthetic and analgesic effects could be derived from administration of Clonidine, an α 2- adrenergic agonist, into brachial plexus sheath. To compare the effects of Inj. Bupivacaine and Injection Bupivacaine with Clonidine as adjunct, used for Supraclavicular approach to brachial plexus block. Materials and methods: The study was a prospective, randomized, double-blind study. Sixty patients aged between 18 and 60 years of physical status ASA 1 and 2 undergoing upper limb surgeries lasting more than 30 minutes were included in the study. Patients were randomized into 2 groups of 30 each. All patients received brachial plexus block with 40 ml of 0.25% Bupivacaine. In addition, Bupivacaine+clonidine group received Clonidine at the dose of 2 µg/kg. Results: Onset of sensory blockade (time between injection and total loss of sensation to temperature) was faster in group C (22.33±4.1 min) compared to group B (27.17±3.64 min), which was statistically significant. Duration of sensory blockade (the time between injection and complete recovery from sensory disturbance) was also longer in Bupivacaine +clonidine group (524.00±83.91 minutes) compared to Bupivacaine group (339.00±57.44 minutes) and this difference was both clinically and statistically significant (p=0.001). Onset of motor blockade was faster in Bupivacaine +clonidine group (26.83±3.34 minutes) compared to Bupivacaine group (29.50±2.74 minutes).The duration of motor blockade was longer in Bupivacaine +clonidine group (524.00±83.91 minutes) compared to Bupivacaine group (339.00±57.44 min) and this difference was both clinically and statistically significant (p=0.001). Also, the time for demand of analgesics was significantly prolonged in group C (527.67±81.79 minutes) compared to group B (340.00±58.07 minutes) this difference was also statistically significant (p= <0.001). Conclusion: Addition of Clonidine to Bupivacaine solution for brachial plexus block can modify the action of local anaesthetic solution by its local action. There were no clinically significant side effects noticed. Hence, Clonidine can form an useful adjuvant for Bupivacaine when used for brachial plexus block.

"Sepsis" was characterized as the foundational reaction to infecdon, showed by at least 2 of the conditions recorded above for SIRS. "Serious sepsis" was characterized as sepsis related with organ dysflmction, hypoperfusion, or hypotension. Hypoperfijsion and perfusion abnomialities may incorporate however are not constrained to lactic acidosis, oliguria, or an intense change in mental status. Aim: To Study the N-Acetylcysteine and Vitamin C effect on Oxidative stress in Abdominal sepsis and controle Patients with different weight range. Material and Methods: The present Study was conducted in the intensive care Unit of the the Dept of Anesthesiology, Rajiv Gandhi Institute of Medical Sciences, Kadapa. Conclusion: Along these lines, the sex, age and weight of the patients can impact the dimension of hematological and biochemical markers in patients with sepsis. In any case, since the statistic profile of the patients in our examination was similar between the nominal control and sepsis patients and furthermore between the gatherings, it didn't impact the in general outcome.

Background and Aims: This study aimed to compare the sedation using Entropy of Midazolam and Propofol in regional anesthesia in terms of Onset, Recovery and Side Effects. Introduction: Regional anesthesia is a safe and popular anesthetic technique. Effective sedation is essential for regional anesthetic technique too, to allay anxiety in the patients and improve their comfort, co-operation. Use of entropy will reduce over sedation of the patient and better monitoring of the hypnotic state of the patient. Methods: 100 ASA I/II adult patients undergoing elective surgery under regional anesthesia for lower abdominal and lower limb surgeries were enrolled in the study and randomly allocated into two groups. Group M: Midazolam 0.1% IV infusion started with 0.5 mg/kg/hr, Group P: Propofol 1% IV infusion started with 6 mg/kg/hr till entropy value reaches 60 then titrated to maintain entropy of 50 to 60 through syringe pump and was continued till the last suture was completed. Results: Dose required to reach the level of sedation was 0.5 mg/kg/hr vs 6mg/kg/hr and to maintain sedation was 0.17±0.04 mg/kg/hr vs 1.23±0.25 mg/kg/hr and onset of sedation was 4.17± 0.42 vs 2.81±0.44 minutes where as time for recovery from sedation was 9.57±2.67 vs 6.76±0.83 minutes in GroupM vs Group P respectively. Hemodynamic changes were significantly higher in Group P than Group M. Conclusion: Both Midazolam and Propofol can be used for sedation under regional anesthesia. Onset of action and recovery is faster with Propofol and Midazolam is more cardio stable.

Aim: The aim of our study was to evaluate the efficacy of intrathecal fentanyl as an adjuvant to bupivacaine on the block characteristics, hemodynamic stability and side effects in patients undergoing lower abdominal surgeries. Methods: Sixty patients aged between 18-60 yrs, belonging to ASA I and II posted for elective lower abdominal surgeries under spinal anaesthesiawere recruited for the study. Patients were randomly divided into two groups of thirty each. One group received 2.5 ml of 0.5% Inj. bupivacaine with 0.5 ml of fentanyl (Group FB) and the other group received 2.5 ml of 0.5% Inj. bupivacaine with 0.5 ml of normal saline (Group B). Patients were monitored for onset, duration and quality of sensory and motor block, duration of analgesia, highest dermatomal level, hemodynamic parameters and side effects. Results: Onset of sensory block, motor block, time to reach highest dermatomal level duration of motor block was comparable between the groups. Duration of sensory block and two segment regression was prolonged in group FB compared to Group B which was statistically significant (p < 0.001). Hemodynamic stability was maintained throughout intra and post-operative period in Group FB compared to Group B. Incidence of pruritis was higher in Group FB compared to Group B which was statistically significant ( p< 0.001). Conclusion: Fentanyl as an adjuvant to bupivacaine provided sufficient post-operative analgesia with hemodynamic stability.

Aims and Objectives: To compare the duration of post operative analgesia with different doses of magnesium sulphate as an adjuvant in USG guided supraclavicular brachial plexus block and its side effects. Material & methods: Ninety patients aged 18-50 yr ASA Gr 1-2 divided into 3 groups of 30 each undergoing upper limb surgery under USG guided supraclavicular brachial plexus block. Group C (control group)- (n=30) received 20 ml of 0.5% Bupivacaine + 5 ml of normal saline (NS). Study group 1 (S1) - (n=30) received 20 ml of 0.5% Bupivacaine + 4 ml of NS + 100 mg (1ml) of magnesium sulfate. Study group 2 (S2) - (n=30) received 20 ml of 0.5% + Bupivacaine + 3 ml of NS & 2 ml (200 mg) of magnesium sulphate. Results: Onset of sensory block in Group S2 (6.5±1 min), in S1 (10±2.8 min) and in C (15±3 min). Onset of motor block in S2 (9±2 min), in S1 (13±2.2 min) and in C (19±2 min). Duration of post-operative analgesia in S2 (540±25 min), in S1 group, (440±20 min) and in control group C (200±15 min). Addition of MgSO4 as adjuvant hastened the onset of sensory and motor block in study group as compared to control. Duration of sensory and motor block were more in group S2 as compared to S1 and C. Duration of postoperative analgesia was significantly prolonged in group S2 as compared to S1 and C (p<0.001) without increased incidence of side effects. Conclusions: Addition of magnesium sulphate to local anesthetics in brachial plexus block prolongs the duration of postoperative analgesia. It is dose related, 200mg has greater efficacy than 100mg without increased side effects.

Context: Difficult intubation is associated with serious complications, more so when there is failure of intubation. Inability to secure the airway during general anaesthesia remains one of the leading causes of morbidity and mortality worldwide. The principle goal of this study was to find the best predicting test in patients who are apparently normal by a combination of Modified Mallampatti test and Thyromental distance and comparing it with Cormack and Lehane Score. Aims: To use Mallampatti test & Thyromental distance test during pre-operative assessment to determine incidence of difficult laryngoscopy and intubation; To combine sensitivity and specificity of both the tests and determine, if the combination of both the tests increases the predictability of difficult intubation. Settings and Design: Prospective clinical study. Methods and Material: The preoperative airway assessment of Mallampatti grading & thyromental distance was done on 300 ASA grade 1 & 2 patients, aged between 18-60 yrs presenting for surgeries under general anesthesia. The preoperative Mallampatti test grading and the thyromental distance was compared with Cormack & Lehanelaryngoscopic grade. Statistical analysis used: Data was entered in to Microsoft Excel Worksheet and analyzed using SPSS (ver. 18) statistical package. In addition to sensitivity and specificity, the positive and negative predictive values were calculated. Results: The Mallampatti grade 3 & 4 were considered as predictors of difficult intubation 28 cases out of 300 patients (9.3%) of the study population belong to this group. Thyromental distance < 6 cm was considered as predictor of difficult intubation There were 17 cases out of 300 patients (5.7%) belonging to this group. When a combination of Mallampatti test and thyromental distance was used as a predictor of difficult intubation, there were 16 patients, which constituted 5.3% of the total cases. The incidence of difficult intubation is found to be 5%. Conclusions: The above result shows that the discriminative power is greater in combination of test than when used alone.

Propofol is one of the most commonly used induction agent. Pain on injection still remains a considerable concern for anaesthesiologist. The aim of the study was to assess the efficacy of granisetron HCL and ligocaine HCL to alleviate the pain on propofol injection. Methods: Fifty patients aged 18-50 years, ASA grade 1-2, posted for elective surgeries under general anaesthesia were randomly divided into two groups. Group G received 2 ml (1 mg/ml) granisetron while group X received 2 ml (2%) ligocaine intravenously before propofol injection. Manual venous occlusion was done for 1 minute after pre-treatment drug. 2 ml of total calculated dose of propofol was given over a period of 4 seconds. Patients were asked about the pain on injection with use of verbal rating score chart after 15 seconds. HR, SBP, DBP, SpO2 was measured 0, 1, 3 minute after propofol injection. Results: HR, SBP and DBP were significantly raised in granisetron group as compared to lidocaine group. Average pain score in group G was 2.1 while in group X it was only 0.8, which was statistically significant. (p<0.05). Conclusion: We conclude that lignocaine HCL is better than granisetron for alleviating pain after propofol induction.

Background: Inadequately controlled postoperative pain causes discomfort, increased use of medications, slower recovery, longer hospital stay and increased risk of pulmonary complications [5]. Postoperative analgesia with safer drugs and minimal side effects is the first choice. This study was undertaken to evaluate the role of Inj. Paracetamol vs. Inj. Tramadol in post-operative pain relief after head and neck cancer surgeries. Material & Method: After IRB approval and informed consent, this prospective, randomized study was conducted in 100 patients (ASA I & II) with age group of 18-60 years undergoing elective head and neck cancer surgery. Patients were divided into two groups. A) Group P: Inj. Paracetamol 15 mg/kg IV over 15 min, 30 min prior to the end of surgery and subsequent doses at 6 hours interval 24 hours. B) Group T: Inj. Tramadol 1 mg/kg diluted in 10 ml saline IV slowly over 10 min, 30 min prior to end of surgery and subsequent doses at 8 hours interval for 24 hours. Results: Postoperative VAS decreased at various time intervals in both groups. Time to 1st dose of rescue analgesia requirement was lower in Group T, with mean postoperative rescue analgesic free time interval of 6.23±1.72 hours as compared to Group P where it is 5.01±1.16 hours. Frequency of rescue analgesic requirement was lower in Group T, with mean of 1.20 (±0.41), in comparison to Group P 1.67 (±0.71). Postoperative nausea, vomiting is more in group Tas compared to group P. Conclusion: Intravenous paracetamol administration in peri-operative period provided adequate postoperative analgesia with fewer side effects in patients undergoing head and neck cancer surgery. Intraoperative IV paracetamol appears to be a reasonable choice for postoperative analgesia in this patient population.

Background: Spinal anaesthesia provides sensory as well as motor blockade. Levobupivacaine is less cardio toxic than bupivacaine, as it has decreased potency at the sodium channel. Ropivacaine is similar in chemical structure to bupivacaine, but it is less potent than bupivacaine. Intrathecal Ropivacaine is safe, has shorter duration of action than bupivacaine and lesser incidence of neurological symptoms as compared with intrathecal lignocaine. Literature suggest that potency of Ropivacaine is less when compared with levobupivacaine since it has lower lipid solubility, and thereby using an equipotency ratio of 1.5:1 between Ropivacaine and Levobupivacaine provides nearly similar efficacy outcome. Method: The study was carried out as prospective, interventional, double blind in 60 patients divided in two equal groups using equipotent doses of intrathecal hyperbaric Ropivacaine and hyperbaric Levobupivacaine (with ASA grading I and II). Results: The distribution of patients with respect to age, height, weight was statistically not significant in both the groups. (p value > 0.05). Mean time to onset of motor block was 25.07±1.97 minutes in group-L and 24.37±1.70 minutes in group-R. Average duration of motor block was 116.73±29.95 minutes in group-L and 112.93±15.40 minutes in group-R. Mean time to onset of sensory block was 17.07±1.93 minutes in group-L and 15.5 ± 1.81 minutes in group-R. Mean time to attain highest level of sensory block was 22.07±1.93 minutes in group-L and 20.5±1.81 minutes in group-R. Mean time to two segment regression of sensory block was 69±8.5 minutes in group-L and 61.83±6.31 minutes in group-R. Average duration of sensory block was 188.73±29.94 minutes in group-L and 192.2±36.01 minutes in group-R. There were no changes in vital parameters and oxygen saturation in the intra-operative and post-operative period. Mean duration of post-operative analgesia was 137.70±28.01 minutes in Group L and 131.2±38.97 minutes in Group R. Analgesic consumption for 24 hours postoperatively was similar in both the groups. It was observed that both the molecules showed similar time of onset of motor and sensory block and also nearly similar duration of motor and sensory blocks. Both the drugs were also found to be safe in terms of impact on hemodynamic parameters and no complications observed. Conclusion: Both drugs are reliable in terms of efficacy and safety and can be used interchangeably. Ropivacaine can be specifically used for population that is at higher risk of cardiac toxicity, without compromising on time of onset or duration of motor and sensory blocks.

Background and aims: Subarachnoid block can be performed with many local anaesthetic agents. Besides hyperbaric bupivacaine even isobaric levobupivacaine and ropivacaine can also be used with minimal cardiotoxicity. Adjuvants like opiods and alpha-2 agonist prolongs the duration of levobupivacaine action. The aim of the present study is to compare fentanyl and clonidine effect used as adjuvants to levobupivacaine with respect to onset of sensory and motor blockade; maximum level attained and the required for the same; duration of blockade and post operative analgesia. Materials and Methods: After ethical committee approval, 80 patients posted for infraumblical surgeries divided into two groups. Group LF received 15 mg of levobpivacaine with 25µg fentanyl whereas group LC received 15 mg of levobupivacaine with 30µg clonidine. The volume of solution was 3.5 ml in both groups. Hemodynamic, sensory and motor characteristics were monitored. Results: Onset of sensory and motor blockade as well as regression of both was faster with fentanyl than clonidine. There was slight fall in heart rate and mean arterial pressure in both the groups after intrathecal drugs but it was more with clonidine. Bradycardia and hypotension was noted more with clonidine than fentanyl which was easily manageable. Though the onset was delayed, sensory, motor and analgesic effect was prolonged with clonidine. Conclusion: Levobpiacaine can be safely used for spinal anaesthesia in infraumblical surgeries. Adding fentanyl causes early onset of action whereas clonidine has more prolonged action.

Introduction: Laryngoscopy and intubation are almost always associated with hemodynamic changes due to sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimulation. Aim: To study the efficacy of oral Nebivolol in attenuating the cardio vascular reflex responses to laryngoscopy and endotracheal intubation. Materials and methods: The attenuation of cardiovascular reflex responses to laryngoscopy and endotracheal intubation has been done with oral nebivolol, a long acting beta-1 blocker in 25 healthy ASA grades 1 patients of both sexes b/w age groups 25-60 yrs. and compares with 25 others in the same age group, termed as control. The study group receives oral nebivolol 5 mg once daily for those below 50 kgs. In the premedication inj. Glycopyrolate 0.2 mg IM and inj. Ketorolac 1 mg/kg IM was given in both groups, inj. Glycopylate was preffered over injection atropine as it has better antisecretory properties with minimal cardiac effects, which would change basic monitoring values. Results: Laryngoscopy and endotracheal intubation there was significant increase in blood pressure (SAP, DAP and MPA) and heart rate in the control group, but was significantly less in the study who received the beta blocker nebivolol. In control group rate pressure product, a measure of myocardial oxygen demand was increased significant after laryngoscopy and endotracheal intubation. Conclusion: Hence, because of long duration of action and being beta, selective agent, oral nebivolol agent when used prior to surgery ensures a stable normotensive or a mild hypotensive field during surgery.

Context: The use of clonidine as adjuvant to newer anaesthetic agents like levobupivacaine or ropivacaine in caudal block enhance postoperative analgesia. Aims: the purpose of the study was to compare the efficacy of levobupivacaine 0.25% with clonidine 1 mcg/kg to that of ropivacaine 0.25% with clonidine 1 mcg/kg with respect to post-operative analgesia following caudal administration in children. Settings and Design: Prospective, double blinded, randomized controlled trial. Materials and Methods: sixty children aged 2-6 years, of American Society of Anesthesiologists (ASA) physical status I or II, undergoing subumbilical surgeries were randomly allocated to two groups. After induction with general anaesthesia, Group L received 1 ml/kg of 0.25% levobupivacaine with clonidine 1 mcg/kg and Group R received 1 ml/kg of 0.25% ropivacaine with clonidine 1 mcg/kg caudally. Duration of analgesia (primary outcome), pain scores, number of rescue analgesic doses and side effects if any were recorded. Statistical analysis used: All the results were tabulated and analysed statistically. After checking for normality assumption, Student’s t test was used for numerical data and Chi-square test for categorical data. p values<0.05 were considered significant. Results: Groups were comparable with respect to age, weight, sex, type and duration of surgery. Mean duration of analgesia in Group L was 11.05±0.26 versus 10.86±0.22 hours in Group R, hence comparable between the two groups. None of the groups had nausea, vomiting, bradycardia or hypotension and no significant sedation was noted. Conclusion: Clonidine(1 mcg/kg) when used as an adjuvant in caudal block along with either levobupivacaine 0.25% or ropivacaine 0.25% produces similar post-operative analgesia with fewer side effects.

Introduction: A growing body of evidence indicates that Homocysteine acutely rises as a side effect of exposure to Nitrous oxide during surgery in adults. Under normal conditions, Homocysteine is remethylated back to Methionine by the enzyme Methionine synthase which requires the reduced form of Vitamin B12 as a coenzyme and 5-Methyltetrahydrofolate as the methyl donor. Exposure to N2O inhealthcare workers is associated with alterations of Vitamin B12 metabolic status. Aim: To find the Effect of Chronic Exposure to Trace Anaesthetic Gases on Plasma Homocysteine levels in Operating Room Personnel. Objective of my study is to find plasma Homocysteine levels in operating room personnel compared to non exposed. Materials and Methods: This study is conducted on 60 personnel. A total of 30 subjects exposed to waste Anaesthetic gases for a minimum of 5 years in unscavenged operation theatres and also 30 controls who were not exposed to Anaesthetic gases were selected at random to compare. From all the cases and controls detailed information pertaining to various epidemiological parameters and evaluated the level of serum Homocysteine by using ADVIA Centaur and ADVIA Centaur XP systems. Results: Mean Homocysteine value in over all analysis OT exposed group is 13.285 μmol/L and in controls is 10.545 μmol/L which are not equal. The p-Value of 0.00135 is “statistically significant”, there is a difference in the Homocysteine levels between the two groups which is because of an effect of the Anaesthetic gas exposure. Conclusion: Subjects in the exposed group are distributed in the Homocysteine values of >12 μmol/L while the subjects in the control group are distributed within the Homocysteine value of <12 μmol/L. Statistical analysis showed significant difference in Homocysteine levels between OT exposed and non exposed groups. So we conclude that long term exposure to trace Anaesthetic gases like Nitrous oxide can lead to elevated Homocysteine levels in health care workers.

Introduction: Nasopharyngeal Fibroangioma (NPF) is a rare, benign, but locally invasive tumor removed with nasal endoscopy which is minimally invasive and provides a magnified view of the tumor. Hypotensive anaesthesia technique is required to assist in decreasing blood loss and providing bloodless clear field to facilitate surgery. Aim: To compare Nitroglycerin and Dexmedetomidine groups for hypotensive anaesthesia in patients undergoing endoscopic resection of Nasopharyngeal Fibroangioma. Materials and Methods: This is a prospective, randomized, single blinded study conducted on 40 patients between the age group of 10-20 years undergoing endoscopic resection of Nasopharyngeal Fibroangioma. The patients were randomly divided into two groups of 20 patients each. Group D – Patients who received ‘Dexmedetomidine’ Group N – Patients who received ‘Nitroglycerin’. Results: There was no statistically significant difference between the two groups regarding mean arterial pressures. There was statistically significant difference between the two drug groups regarding pulse rate. The mean pulse rate in Dexmedetomidine group was significantly less than in Nitroglycerin group. The average blood loss was more with Nitroglycerin when compared to Dexmedetomidine. Conclusion: Nitroglycerine and Dexmedetomidine can be used safely for maintaining hypotensive anaesthesia to achieve the target mean arterial pressure around 60-70 mm/Hg. The blood loss was significantly less in Dexmedetomidine group. Dexmedetomidine was superior to Nitroglycerin in reducing blood loss during the resection.

Background: Postoperative pain relief is one of the important component which needs to be managed in patients undergoing lower segment cesarean section. Midazolam is a drug which can be used for postoperative pain relief as an adjunct to anaesthetic medication. Methods: The study was conducted at tertiary care health institute. Total of 90 patients, 30 patients in each group were included in the study. Each group was evaluated for onset, intensity and duration of sensory and motor block, central side effects, time to first pain medication. Visual analog scale was used to assess the postoperative pain. Result: Time to first pain medication was significantly prolonged in group XM1 (n=30 with 2 mg midazolam) as compared to group X (n=30, 5% xylocaine hydrochloride). Nevertheless VAS at first pain medication was comparable in all the three groups. The side effects were no different in three groups. Conclusion: Addition of intrathecal midazolam at these dosages appears safe and has clinically proven analgesic properties with no major side effects.

Aims and objectives: The aim of the study was to compare quality and duration of intra and post operative analgesia and need of rescue analgesia of 0.5 ml/kg of 0.25% Bupivacaine. and 0.5 ml/kg of 0.2% Ropivacaine. Methodology: We conducted a prospective, randomized, double blind study, in which 60 paediatric patients undergoing lower abdominal and genitourinary surgeries. Group A received 0.5 ml/kg of 0.25% Bupivacaine and Group B received 0.5 ml/kg of 0.2% Ropivacaine. Quality and duration of motor block, Adjunct to general anaesthesia, Margin of safety of ropivacaine over Bupivacaine was assessed. Results: Both the drugs provided post-operative analgesiaMean duration of post-operative analgesia is 344.5±29.37 min in group A & that In group B is 346.3±10.66 min (paired) two tailed p value is 0.749 which is comparable & statistically not significant. Mean duration of motor block in group A is 176.6±21.02 min and in group B was 103.8±11.79 min with P value of 0.0001 which is statistically significant. The incidence of the side effect between the two groups is not statistically significant. Conclusion: Caudal block with 0.2% Ropivacaine resulted in equal duration of analgesia with less duration of motor block as compared with 0.25% caudal Bupivacaine, without an increase in incidence of side effects when administered pre-operatively in a volume of 0.5 ml/kg to children undergoing lower abdominal and urogenital surgeries.

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Background: In spite of tremendous advances in contemporary anesthesia practice, airway management continues to be of paramount importance to anesthesiologist. Hemodynamic changes are the major undesirable consequences of endotracheal intubation and laryngoscopy. The supraglottic airway device is a novel device that fills the gap in airway management between tracheal intubation and use of face mask. In view of this, the present study was undertaken to compare the performance of two supraglottic airway devices LMA supreme and LMA proseal. Methodology: Sixty ASA I-II patients scheduled for elective surgeries under general anaesthesia were randomised into two groups of 30 each. In Group S (n=30) LMA supreme and Group P (n=30) LMA proseal were used respectively. Both the devices were compared in relation to Ease of insertion assessed in terms of attempts taken and duration, Oropharyngeal leak pressure (OLP), Intracuff pressure(ICP), Ease of passing gastric tube and device related postoperative complications. Results: The insertion attempts were similar between two groups. Time taken to provide an effective airway was less in LMA supreme (Group S; 15.9 2.5 Group P; 17.8 1.6) p (0.001). OLP was significantly less in LMA supreme at 1, 15 and 30 min during anesthesia (Group S; 25.2 1.2, 22.8 1.3, 21.1±.9, Group P; 27.5±1.2,25.6±1.5,23.3±1.1) p (<0.05). ICP increased significantly in proseal LMA at 15 and 30 min during anesthesia (Group P; 68.3±1.3,76.8±2.6, Group S; 63.4±1.1, 68.3±1.32) p (<0.05). There was no significance difference in passing gastric tube and device related complications between both groups. Conclusion: Our finding suggested that LMA supreme was better in term of ease of insertion but LMA proseal had better OLP inspite of increase in ICP. Ease of passing gastric tube was similar in both. The complications of usage of LMA are minimal and similar in both the devices.

  Piriformis muscle is a muscle of gluteal region. The Piriformis syndrome is caused by compression of sciatic nerve by the muscle as it passes through sciatic notch. The pain of Piriformis syndrome is neuropathic and is often confused with pain of prolapsed intervertebral disc. We report a case of chronic pain of one and a half years treated by giving an ultrasound guided injection of local anaesthetic and steroid. 

Context: Combined spinal and epidural analgesia is performed by double space or single space technique. It can also be performed through single intervertebral space with a CSE needle or a Spinal needle which is the modified technique we planned. Aims: To compare the effect of different doses of epidural Buprenorphine with spinal Bupivacaine in terms of Onset and duration of Sensory & Motor Block; Duration of post operative analgesia with Visual analog scale. Settings and Design: It is a prospective randomised control study. Methods and Material: A total  of 30 patients who met the enrolment criteria were approached & written informed consent was obtained.Group A were given Buprenorphine in the dose of 4 micrograms per kg with 10 ml Normal saline for epidural and 15 mg of Bupivacaine for spinal and Group B given Buprenorphine in the dose of 6 micrograms per kg with 10 ml Normal saline for epidural and 15 mg of Bupivacaine for spinal. Statistical analysis used: Comparisons between numerical variables were made using Student’s t test or the Mann-Whitney U test, accordingly. To test for potential differences in onset neural block assessments of the two concentrations, a repeated measures analysis of variance (ANOVA) was applied. Results: There was significant increase of mean in Onset of Sensory Block (min) in groupA compared to group B. There was significant increase of mean in Time to two Segment Regression of Sensory Level (min) in groupB compared to groupA. Mean Duration of analgesia is significantly increased in group B compared to group A. Conclusions: CSE can be practised safely with Buprenorphine as additive to subarachnoid block with single needle technique offering good postoperative analgesia. 

 Aims: Methods that avoid use of muscle relaxants during intubation help us when their use would be detrimental to the patient/situation. Here we aim at intubations without muscle relaxants which could be of great significance in difficult airways. Settings and Design: It was a Randomised, prospective, comparative and double blinded study. Methods and Material: After approval by institutional ethical committee the study was conducted 60 patients of ASA I and II who were scheduled for elective surgeries under general anaesthesia. Group P: Direct Laryngoscopy using inducing doses of Propofol (2-3 mg/kg). Group N: Direct laryngoscopy using Triple nerve block technique. • Group P: Direct Laryngoscopy and intubation was done with inducing doses of propofol (2-3mg/kg). • Group N: The lingual branch of the Glossopharyngeal nerve, Bilateral superior and recurrent laryngeal nerve block were given. Statistical analysis used: Haemodynamic values were analysed using the Student’s unpaired‘t’ test. Intubation grades were measured using Mann Whitney U test. Results: Intubating condition, ease of intubation and haemodynamic stability is better in triple nerve block group than propofol group. Conclusions: And Triple nerve block provides better ease and intubating conditions and haemodynamic stability compared to intubations using Propofol. 

Introduction: Adequate maintenance of airways in patients undergoing surgeries under general anaesthesia was through proper intubation. Succinylcholine was the most opted neuromuscular drug in the past 50 years administered for tracheal intubation. A number of adverse reactions with its use. Aim: To evaluate onset time, tracheal intubation conditions, duration of action and maintenance of anaesthesia using two none depolarizing muscle relaxants vecuronium and rocuronium. Materials and methods: The study population consisted of 50 patients of ASA physical status I and II in the age group 18 to 50 years.The present studies was undertaken to evaluate the neuromuscular and haemodynamic properties of Rocuronium bromide and to compare it with Vecuronium bromide. Of the 50 patients studies, 25 patients received 0.6 mg/kg of Rocuronium bromide for the maintenance of anaesthesia and the other 25 patients received 0.1 mg/kg of Vecuronium bromide. The top-up doses administered were 0.15 mg/kg of Rocuronium and 0.025 mg/kg of Vecuronium. In both the groups, the efficacy of nondepolarizing muscle relaxant was assessed. Results: The onset time was significantly shorter in the Rocuronium group (108.8 seconds /mean±SD was ±28.875) compared to Vecuronium group (188.76 seconds/ mean SD±43.78). The duration of action of first dose was significantly longer in Rocuronium group (31.5 minutes) compared to Vecuronium group (24.5 minutes). The duration of action of top-updoses was similar in both the groups (p>0.05). There was no significant difference in any of the haemodynamic variables (Heart rate, Systolic blood pressure, Diastolic blood pressure and meanarterial pressure) between the two groups. All the patients in both the groups were easily reversible with Neostigmine (0.05 mg/kg) and no adverse reactions were found in any patient. Conclusion: Rocuronium has a significantly rapid onset of action and intermediate duration of action. It is easily reversible and produces no significant cardiovascular changes. It also has a good safety profile. Therefore, inspite of its high cost. Rocuronium appears to be the safest drug, near toideal NMBA for rapid sequence intubation and routine intubation when there is no anticipated difficulty in intubation. 

Background: The I-gel TM (Intersurgical, Wokingham, UK) is a novel second generation supraglottic airway device with a non inflatable cuff, made up of a unique soft gel like material (Styrene Ethylene Butadiene Styrene). The device is transparent and latex free. It is easy to insert and has minimal tissue compression. An integrated gastricchannel is provided for passage of gastric drainage tube to empty the stomach. Objectives: The aim of the present study wasto compare the efficacy of I-gel with Endotracheal tube in airway management in children. Materials and methods: This study was conducted at tertiary referral centre for new born and children with Children of age 2 to 6 years, weighing 10 to 18 kg, ASA Grade I-II posted for elective day care procedures. Results: Males were predominant in both the groups. Insertion and ease of placement was successful in first attempt in 86.66% of patients in Group I as compared to 80% in Group II (ET). 13.33% of patients in Group I (3 out of 30) required adjustment like jaw thrust, neck extension or reinsertion because of forward displacement. One patient had been recorded in Group I (I- gel) as failure because of inadequate ventilation and required endotracheal intubation. 20% in Group II required second attempt for ET tube placement because of early learning curve of anaesthesia trainees in the teaching institute. There was a significant rise in HR & BP in Group II during laryngoscopy and intubation and at the time of extubation. Airway related adverse events (coughing, breathholding, laryngospasm) were more in Group II when compared to Group I. Conclusion: The I-gel is ease of insertion, success rates, minimal hemodynamic perturbations and minimum perioperative adverse effects. 

Background and Aim: Shivering is a physiological response to core hypothermia in an attempt to raise the metabolic heat production. Non-pharmacological methods using equipment to maintain normal temperature of the body are effective but expensive and lack practicality, while the pharmacological methods are simple, costeffective and easy to implement. Present study aimed to compare therapeutic efficacy of Dexmedetomidine and Tramadol on post subarachnoid block shivering. Material and Methods: This prospective study was conducted in the department of Anaesthesiology at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat for the period of one year. Seventy ASA Grades-I & II patients of either gender, aged 17 to 61 years scheduled for elective surgeries under subarachnoid block were randomly allocated to two groups (A and B) after obtaining written informed consent. Results: Time interval from injecting the study drug to cessation of shivering was quite less with Dexmedetomidine (39.90±5.98) than with Tramadol (209.14±25.78 seconds). Insignificant difference was noted between the two groups in relation to dizziness. Incidence of sedation (Grade 2) was 17/30 in group D while it was 4/30 in group T and the difference was highly significant (p= 0.0012). Conclusion: Both Dexmedetomidine and Tramadol can be used for treating post sub-arachnoid block shivering but Dexmedetomidine is more efficacious than Tramadol but should be used cautiously in hemodynamically unstable patient. 

Context: Proseal laryngeal mask airway is a supraglottic airway device with an additional drainage tube and a dorsal cuff which provides a better seal and prevents aspiration. Aims: 1) to compare the efficacy of PLMA with standard intubation in patients undergoing laparoscopic cholecystectomy. Methods and Material: After approval from the institutional ethical committee a prospective randomized controlled study was conducted in sixty ASA class 1 and 2 patients. After induction Proseal LMA was introduced in group P and endotracheal tube was introduced in group E. Details of insertion, hemodynamic parameters, and ventilatory performance were recorded. During surgery, oxygenation and ventilation variables were adjusted to maintain SpO2 > 95% and EtCO2< 45 mmHg. Statistical analysis used: Data was analyzed using the computer statistical software system Openness (open source epidemiological statistics for public health). The two-tailed student's t-test for unequal variance was used for intergroup comparisons except where specified. Probability values p < 0.05 were considered significant and p < 0.001 were considered highly significant. Results: There was no failed insertion of devices. The mean time of insertion of Proseal (80+43.56 seconds) was greater than conventional intubation (23+17.71 seconds). The difference was statistically highly significant (p<0.01). There were no statistically significant differences in oxygen saturation (SpO2) or end-tidal carbon dioxide (EtCO2) between the two groups before or during peritoneal insufflation. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. Conclusions: Proseal provides a safe alternative to endotracheal intubation for airway management in patients undergoing laparoscopic cholecystectomy. 

Introduction: In paediatric patients, optimum pain relief is a big challenge. An effective therapy to block or modify the physiological responses to painful stimuli is essential. Hence, here is an attempt to study the addition of dexmedetomidine, an alpha-2 adrenergic receptor agonist to bupivacaine with regard to analgesic potency and side effects. Material and Methods: After approval from the institution's ethics committee, the study was conducted to compare the effect of the addition of dexmedetomidine to bupivacaine in a caudal block for postoperative analgesia in paediatric infra-umbilical surgeries. Written informed parental or guardian consent was obtained.30 cases in the age group of 1 to 6 years were studied. They were randomly divided into two groups, Group N and Group D. • Group N (n=30) – 0.25% Bupivacaine 1 ml/kg+ 0.5 ml normal saline • Group D (n=30) – 0.25% Bupivacaine 1 ml/kg+Dexmedetomidine 1 μg/kg, making the volume to 0.5 ml. The total volume for the caudal block was 1 ml/kg in both groups. • after giving general anaesthesia child was placed in the left lateral position and a caudal block was performed under sterile conditions. The postoperative pain relief was evaluated using FLACC score hourly for the first 6 hours, 2 hourly up to 12 hours and then 4 hourly up to 24 hours. Sedation is evaluated by Ramsay's sedation score. Results and Conclusion: The addition of dexmedetomidine in the dose of 1µg/kg to 0.25% bupivacaine for caudal blockade showed that the duration of analgesia for Group N was 5.86±1.21 hrs and Group D was 15.5±3.02 hrs, without any significant haemodynamic changes, safe for use in paediatric patients without any adverse effects.

Background: Laryngoscopy and intubation are associated with acute hemodynamic responses. In susceptible patients even this short period (2-7 minutes) of hypertension and tachycardia can result in myocardial ischemia or increased intracranial pressure. Aims and objectives: To evaluate and compare the effect of intravenous (I.V.) Fentanyl and intravenous (I.V.) Clonidine in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation. Settings and design: This study was designed to compare the effect of I.V. Fentanyl and I.V. Clonidine in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing elective surgeries under general anaesthesia. Methods and material: A prospective, randomized, double-blind, comparative study was conducted on 60 patients, randomly allocated into two groups of 30 each i.e. group C and group F receiving 2mcg/kg Clonidine and 2mcg/kg Fentanyl, respectively, 5 minutes prior to induction. Hemodynamic parameters and postoperative sedation scores were recorded. Statistical analysis: Mean ± standard deviation for quantitative continuous data and compared by unpaired t-test. Result: The hemodynamic variables in Fentanyl group were significantly lower than Clonidine group for the first five minutes after laryngoscopy and intubation. Conclusion: Both fentanyl and clonidine were able to attenuate the hemodynamic response to laryngoscopy and intubation, however, fentanyl 2 mcg/kg I.V. given 5 min prior to intubation kept the hemodynamic variables significantly lower than those seen in clonidine 2 mcg/kg I.V. given 5 min prior to intubation. However, after 5 min of intubation the effects of both the drugs were comparable. 

Keywords: Clonidine; Endotracheal Intubation; Fentanyl; Hemodynamic Response; Laryngoscopy.   

Background: Stress response is common in any of the operative or laparoscopic procedure. Anesthetic agents like Dexmedetomidine are roped into, to attenuate these hemodynamic responses and to smoothen the operative and postoperative period. This study evaluates the side effects or complications encountered in patients receiving Dexmedetomidine infusion. Methods: This was a descriptive study done in patients with age group 18-65 years age of either sex undergoing laparoscopic surgery and receiving the Dexmedetomidine infusion. Result: Total of 30 patients were included in the study. The mean + SD age of the patients were 31+13.2 years. Bradycardia and hypotension was present in 10% of patients receiving Dexmedetomidine infusion. Conclusion: Bradycardia and hypotension were most common side effects seen with Dexmedetomidine infusion though were self resolving. Thus it is effective in attenuating haemodynamic response to laryngoscopy, intubation, surgery and pneumoperitoneum without significant complications. 

Introduction: The responsibility of the Anaesthesiologist in obstetrics is arguably greater than in any other fields of anaesthesia. Aim: To compare the quality of epidural analgesia of 0.125% bupivacaine with 0.1% ropivacaine after intrathecal administration of fentanyl 25 μg in combined spinal epidural labour analgesia. Methodology: After obtaining ethical committee approval and written consent 60 term healthy primi gravida with cephalic singleton pregnancy were selected. Intrathecal fentanyl 25 μg initiated in all parturients. Group B receives epidural 0.125% bupivacaine 10 ml with 2 μg of fentanyl/mL agroup R receives epidural 0.1% ropivacaine 10 ml with 2 μg of fentanyl/mL two groups were compared in terms of quality of analgesia, vitals & fetal outcome. Results: Quality of analgesia was excellent in both the groups. Maximum motor blockade (grade 1 Bromage) has occurred during the first stage of labour and doesn’t affect the progression of labour or fetal outcome. Conclusion: We had concluded that both epidural bupivacaine 0.125% and ropivacaine 0.1% provides equal. 

Aim: Containment of a dangerous and fatal disease outbreak and measures to control in present and future. Design: Retrospective observational Study. Material and Methods: A team of researchers studied the demographic characteristics of international passengers, to India during Public health emergency of International concern declared on 8 August 2014 for Ebola Virus disease. A person with history of fever, bleeding from any site, stomach pain, diarrhea, vomiting, headache, joint pain, muscular pain, bleeding from any site and rashes should report to tertiary care center. In our study, we observed person under investigation for Ebola virus disease under integrated disease surveillance program for forty-two days. If the contacts had any clinical symptoms, they were supposed to inform immediately [1]. The tertiary care facility was responsible for treatment and management of suspected patients suffering from Ebola virus disease. Sample collection for confirmation of Ebola disease was responsibility of Airport Authority of India. One passenger was quarantined for 165 days at the airport authority of India, as he was Ebola treated patient. His semen sample tested positive for Ebola virus [2]. Statistical Analysis: Collected data was analyzed and the categorical variables were presented in number and percentage. Qualitative variable was compared using Chi-Square test. Results: Satisfactory containment of Ebola virus disease during Public health emergency of International concern. Conclusion and Recommendation: To design intensive care facilities for future control and spread of Ebola Virus disease.  

Introduction: Peripheral neural blockade remains a well-accepted component of comprehensive anaesthetic care in adults, but nowadays it is gaining popularity for children also. This study aims toevaluate the onset, duration of action, hemodynamic changes and side effects if any of lignocaine 2% plain at 5 mg/kg, lignocaine 2% with epinephrine at 7 mg/kg and bupivacaine 0.5% at 2 mg/kg in children of age group 5-10 years. Materials and Methods: This was a prospective, randomized and double-blinded clinical trial study. 75 pediatric patients of ASA I/ II age group of 5-10 years of either sex, undergoing upper limb surgeries were distributed equally into three groups and given supraclavicular nerve block. Group L patients received lignocaine 2% plain at 5 mg/ kg, Group LE received lignocaine 2% with epinephrine (1:200000) at 7 mg/kg, and Group Breceived Bupivacaine 0.5% plain at 2 mg/kg body weight. Results: 0.5% plain Bupivacaine prolongs the duration of analgesia more than lignocaine 2% plain and lignocaine 2% with epinephrine 1:200000. There was no statistically significant difference in onset of sensory and motor blockade with lignocaine 2% or lignocaine 2% with epinephrine but it is prolonged with 0.5% bupivacaine. There was no significant occurrence of complication in all 3 groups. Conclusion: Lignocaine with or without epinephrine having the quick onset of action than bupivacaine 0.5% plain 2 mg/ kg is good for supraclavicular brachial plexus block in children but for the longer duration of surgery(>2 hr), bupivacaine remains the best option. 

Background and Aims: Emergence from anaesthesia and tracheal extubation are associated with transient surge in catecholamines due to sympathetic stimulation causing hypertension, tachycardia, myocardial ischaemia etc. Various drugs are being studied to attenuate the haemodynamic response to tracheal extubation. This study aimed to compare the effect of a bolus dose of different drugs of alpha 2 adrenergic agonists (clonidine and dexmedetomidine) on haemodynamic, airway reflexes and recovery responses during tracheal extubation. Materials and methods: ninety patients aged 20 to 45 Y of either sex of ASA gr I/II scheduled for elective surgical and gynaecological surgeries studied after randomisation into three groups. Technique of anaesthesia was standardised for all three groups. just 5 minutes before anticipated end of surgery Group A, Cand D received inj. Placebo (normal saline), Clonidine 0.75 µg/kg and Dexmedetomidine 0.5 µg/kg respectively intravenously over 2 min. Monitoring of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were recorded at the time of bolus drug injection and there after 1,2 and 3 min after injection, during extubation, at 1, 3, 5, 10 and 15 min after extubation. Quality of extubation was evaluated immediately after extubation based on cough using five point rating score, postoperative sedation was evaluated on a six point scale. Side effects like laryngospasm, bronchospasm respiratory depression, desaturation, vomiting, hypotension, bradycardia and undue sedation were noted. Results: Haemodynamic parameters (HR, SBP, DBP and MAP) were significantly lower in study groups from 3 min of drug injection till the study period as compared
to the placebo group. In majority of the cases the extubation quality score was 1 and 2 in study groups and score 3 in placebo group. Sedation scale was 2 and 3 group C and group D where as 2 in placebo group. Conclusion: Our study observes that alpha 2 adrenergic agonist are good and safe adjuvants to attenuate the stress response to emergence from anaesthesia and tracheal extubation. Dexmedetomidine behaved slightly better than clonidine to supress the haemodynamic response. 

Background: In laparoscopic surgery acute postoperative shoulder tip pain is a common entity despite the use of new drugs and novel drug delivery modalities, studies have shown that acute post-operative pain continues to be undermanaged. We tried to evaluate the efficacy of oral gabapentin for the relief of postoperative pain after laparoscopic surgery. Objective: To evaluate the effect of oral Gabapentin on postoperative shoulder pain after abdominal laparoscopy. Method: a prospective, randomized, clinically controlled study was conducted on 60 ASA grade I & grade II patients of either sex, aged between 18 to 65 years, planned for laparoscopic abdominal surgery under general anesthesia. Group G: 30 patients would receive 600 mg oral gabapentin 1 hour prior to surgery. Group M: 30 patients would receive tab multivitamin 1 hour prior to surgery. After that presence of post-operative shoulder pain and its severity was assessed by a Visual Analog Scale (VAS) at the beginning of surgery and 0, 2, 4, 8, 12,18,24 hours after the surgery. Results: The VAS score was lower in Group G when compared to Group M throughout the different time intervals during the first 24 hours. The incidence of post-operative laparoscopic shoulder pain in group M was 21 compared to group G where it was 12 in the first 24 hours postoperatively. 

Background: transversus abdominis plane (TAP) block as an effective chunk of post operative multi modal analgesia for lower abdominal surgeries. Objective: to evaluate the effectiveness of TAP block as a post-operative analgesia technique and usefulness in decreasing requirement of opioids as well as other pain killer medicines. Materials and Methods: This was a prospective study conducted from June 2018 to October 2018. Using convenient sampling technique, a total of 60 patients of American Society of Anaesthesiologists (ASA) physical status grade I or II, randomly divided into two groups: CONT group and TAP group by the sealed envelope technique. The ‘control’ group acted as control and was given spinal anesthesia (SA) with hyperbaric bupivacaine with a 27G BD spinal needle in lateral position. ‘TAP’ group’ received the same spinal anesthesia and TAP block under ultrasound guidance with 23G 100-mm needle with 0.25% bupivacaine 20 ml along with dexamethasone 4 mg on each side. Results: Mean time to rescue analgesia in TAP & Control group was 612.8 min and 84.4 min respectively (p<0.05) and Mean time to rescue analgesia was 612.8 min and 84.4 min respectively (p<0.05). Average VAS score was higher in control group in compare to TAP group participants. Mean tramadol requirement for Group TAP was 55 mg and for the control group was 150 mg (p<0.05). Conclusion: TAP block reduces pain, prolongs the time to first analgesic request and decreases supplemental opioid analgesic requirement when used as a component of multimodal analgesic regimen for pain relief after caesarean section. 

Objectives: To investigate the effect of Magnesium Sulphate on Succinylcholine induced fasciculations during General Anaesthesia & postoperative myalgia. Methods: Double blind randomised clinical trial on patients who were candidates for surgery under general anaesthesia. Patients were selected & divided into two equal groups of Study & controls using block randomisation. Study group received Magnesium Sulphate while Controls received Normal Saline. SPSS 18 was used for statistical analysis. Results: Out of the 100 subjects in the study 49 (49%) were men & 51 (51%) were women (p<0.072). The mean age of the two groups were 37.5±12.2 year & 37.7±12 year (p<0.9). There was significant difference between the two groups in terms of the degree of fasciculations & post operative myalgia (p<0.001). Conclusion: Even low dose of magnesium sulphate can prevent & reduce the degree of succinylcholine induced fasciculation & postoperative myalgia. 

Background: As laparoscopic cholecystectomy is a routinely performed surgery, it is desirable to have a stable intraoperative haemodynamic status. This study is designed to evaluate the efficacy of single intravenous bolus dose of dexmedetomidine, given 10 minutes before induction of anesthesia to provide hemodynamic stability in patients undergoing laparoscopic cholecystectomy. Materials & Methods: A Double blind randomized controlled study was conducted in the department of Anaesthesiology, Manipal Hospital Bangalore, Patients undergoing elective laparoscopic cholecystectomy, under general anaesthesia for a period of one year from June 2013 to May 2014. Total 60 patients belonging to ASA physical status I and II, in the age group of 18 to 65 years scheduled for elective laparoscopic cholecystectomy surgery were selected for this study. The two groups, Dexmedetomidine and control, were comparable with respect to age, sex, weight and ASA physical status. Results: We observed lesser magnitude of variation in HR, SBP, DBP, MAP atinsufflation of pneumoperitoneum until 30 minutes post pneumoperitoneum in dexmedetomidine group compared to control group (p<0.05). During pneumoperitoneum the maximum SBP and MAP attained in dexmedetomidine group was lesser compared to control group (p<0.001). Dexmedetomidine group also had less number of episodes of increase in SBP and MAP of more than 20% of baseline. We also found that the requirement for more than 1% of isoflurane in control group was higher (73%) compared to dexmedetomidine group. The recovery time was found to be similar in both groups. Conclusion: In conclusion, dexmedetomidine at a dose of 1 μgkg-1 bolus given at induction of anesthesia over 10 minutes resulted in statistically significant hemodynamic stability during pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy surgeries. 

Background: Spinal anesthesia is often used for both elective and emergency surgeries. Anesthesia-related mortality is decreased when general anesthesia is avoided. Aim: To compare the anaesthetic behaviour and haemodynamic consequences produced by the intrathecal injections of plain and hyperbaric solutions of Bupivacaine with the patients in supine horizontal position. Materials and methods: Sixty patients of ASA I – II were divided into 2 groups of 30 each. Group-A was given 3 ml. of -0.5% plain Bupivacaine sub arachnoidally whereas Group-B was given 3 ml. of 0.5% hyperbaric Bupivacaine. Results: It was found that extent of sensory blockade was much higher in Group-B as compared to Group-A. The degree of motor blockade was also much more intense in Group-B as compared to Group-A. The duration of analgesia was more in Group-A as compared to Group-B, but the time onset of analgesia was faster in Group-B (hyperbaric). Haemodynamically patients in Group-A were stable due to lesser extent of sympathetic blockade when compared to patients in Group-B. Conclusion: Plain Bupivacaine gives a lesser cephalad spread and can be effectively used for lower limb surgeries, it has to be used with caution for lower abdominal surgery as the spread is relatively unpredictable. 

Background: Spinal anaesthesia is the most commonly used technique for infraumbilical surgeries. Hyperbaric Bupivacaine has limited duration of action. Clonidine has been used to prolong the duration of local anaesthetic. Hence, we studied the effects of oral clonidine premedication on spinal anaesthesia with hyperbaric Bupivacaine vs placebo with reference to sedation, onset and duration of sensory and motor blockade including its effects on hemodynamic status and also on postoperative analgesic requirement. Objectives: To study the effect of oral clonidine premedication on spinal bupivacaine anaesthesia with respect to - The onset time, duration of sensory and motor blockade, Effect on haemodynamic status, Sedation, Duration of analgesia, Need for further analgesics in the first 24 hours postoperatively. Materials & methods: 60 adult (18-65 yrs) ASA physical status class I and II patients scheduled for lower abdominal, perineal and lower limb surgeries under spinal anaesthesia were recruited into the study. Patients were randomized to receive either 150 µg clonidine or placebo tablet using a random number table. Prespinal heart rate, blood pressure, oxygen saturation and sedation score recorded. Subarachnoid block performed with 3.0 ml of 0.5% hyperbaric Bupivacaine. Sensory & motor block assessed along with hemodynamic parameters and interventions required intraoperatively. Postoperatively heart rate, systolic and diastolic blood pressure, time of first request of analgesic and number of analgesics required in 24 hours were recorded and statistically analysed with p value < 0.05 considered as significant. Results: Clonidine group had higher incidence of sedation, faster onset of sensory block without any effect on the onset of motor block, prolonged duration of both sensory and motor block, reduction in blood pressure and heart rate with minimal requirement of haemodynamic interventions, reduced analgesic requirement in the early postoperative period compared to the Placebo group. Conclusion: Oral clonidine premedication in patients receiving hyperbaric bupivacaine spinal anaesthesia produces moderate sedation, hastens the onset of sensory block, prolongs the duration of sensory and motor block. Although causes reduction in blood pressure and heart rate, the haemodynamic interventions required is minimal. It also reduces analgesic requirement in early postoperative period. 

Background and objectives: Post-operative nausea and vomiting (PONV) is commonly seen in female patients undergoing laparoscopic surgeries under general anaesthesia. Adverse consequences of PONV are patient dissatisfaction, unexpected hospital admission, and delayed recovery. In this randomized double blind prospective study, we compare the efficacy of ondansetron and palonosetron for prevention of PONV. Material and methods: After obtaining ethical clearance and informed consent, 130 female patients undergoing laparoscopic surgery were randomly divided into two groups by sealed envelope method. Group A 8mg ondansetron and group B received 8 mg ondansetron and 0.075 mg palonosetron iv respectively just before induction of general anaesthesia. During the postoperative period occurrence of nausea and vomiting, severity of nausea, rescue antiemetic use and adverse effects were monitored at 0-2 hrs, 2-6 hrs and 6-24 hrs. Results: Number of episodes of vomiting, risk for nausea and vomiting, severity of nausea and need for rescue medication was comparable between the 2 groups during the early post operative period (0- 2 hrs). During 2-6 hrs, the episode of vomiting and use of rescue antiemetic was not different between the two groups but severity of nausea and risk of nausea and vomiting was significantly lower in palonosetron group. During the late post operative period (6-24 hrs), the episodes of vomiting, risk for nausea and vomiting, severity of nausea and need for rescue antiemetics was significantly lower in palonosetron group. Conclusion: Intravenous palonosetron 0.075 mg has a better antiemetic profile when compared to ondansetron 8mg over 24hrs following laparoscopic surgeries under general anaesthesia. 

Introduction: Breast surgery can be emotionally distressing and physically painful. Although regional anesthesia and nerve block techniques are widely used in many situations, many anesthetists are still minded by the simplest way of wound infiltration. Preemptive analgesia is the concept of providing analgesia before surgical incision. Suggested advantages of this technique include a reduction in postoperative pain, analgesic consumption and an improvement in patient satisfaction. In addition adverse effect of opioids consumption such as postoperative nausea and vomiting, drowsiness and risk of respiratory depression can be minimized. Aims & Objective: To evaluate the efficacy of preincision mastectomy flap infiltration with a cocktail of bupivacaine 0.5% and lignocaine with adrenaline over intraoperative and postoperative analgesic requirement compared with patients receiving placebo. To investigate the efficacy of preincision local anesthetic regimen infiltration in postoperative pain score in modified radical mastectomy compared with patients receiving placebo. To study their effect on hemodynamic parameters, any side effects and complication. Material and method: In this randomized single blinded study, 60 patients of ASA grade I and II posted for modified radical mastectomy were randomized into group I and group II. Group I receive pre incision infiltration of mastectomy flap with cocktail of 10 ml bupivacaine (0.5%)+10 ml of lignocaine 2% with adrenaline, Group II receive pre incision infiltration with 20 ml normal saline. All patients undergo standardized general anaesthesia. We assessed intraoperative requirement of analgesic drugs,haemodynamic parameters, postoperative supplementary analgesia, VAS score and side effects. Results: There was no statistical difference between both groups regarding the demographic data. The mean blood pressure, pulse rate was less in group I which was statically significant. The mean supplementary analgesic requirement was significantly less in group I. The postoperative VAS score was significantly less in study group. Conclusion: Preemptive local anaesthetic infiltration at the incision site is safe and effective method for reducing postoperative pain and stress response with a significant reduction of analgesic requirement.

Introduction: The under treatment of postoperative pain is recognized as an important issue to the anesthesiologists and treating surgeons despite of improvement in mechanisms and introduction of acute pain services. Aim: To compare analgesic properties of Intravenous Paracetamol and Tramadol for postoperative analgesia in lower abdominal surgeries under general anesthesia. To study the adverse effects of Tramadol and Paracetamol. Materials and methods: It is a randomized study done in 100 patients ASA grade 1 and 2 of either sex, 20 to 60 years of age who underwent lower abdominal surgery under general anaesthesia. It was conducted to compare the efficacy of IV Paracetamol and IV Tramadol for postoperative analgesia. Group 1 received Intravenous Paracetamol and group 2 Intravenous Tramadol 15 min before the end of the surgery and the study drug was administered every 6th hourly for 24 hours. Patients were monitored for pain at 0, 2, 4, 6, 8, 10, 12 and 24 hours postoperatively. Also the time of first dose of rescue analgesia and number of doses of rescue analgesia given was noted. Side effects like nausea and vomiting was also observed. Results: Found that the pain scores were significant at 2 hours and 4 hours (except in the early postoperative period) and pain scores decreased over time in both the groups. About 60% of the patients in the Tramadol group had nausea and vomiting sensation at 0 hours, 12% at 2 hours, 14% at 4 hours, 48% at 6 hours, 26% at 8 hours respectively whereas in Paracetamol group about 4% of the patients had nausea at 2 hours, 4% at 4 hours and 2% at 6 hours. The rescue analgesia in the form of morphine was required in 22% of the patients of Paracetamol group at 0 hour, 32% at 2 hours and 2.0% at 10 hours after surgery. But Tramadol group required additional rescue analgesia in 10% of the patients. Total doses of rescue analgesic required by the Paracetamol group was 1.04 (± 0.2) and in group 2 (Tramadol) was 1.0 (± 0). There was no significant difference between Paracetamol and Tramadol groups. Conclusion: Paracetamol is as effective as Tramadol when used for postoperative pain relief in patients for lower abdominal surgeries except in the early postoperative period.  

Introduction and Aims: Transdermal drug delivery is a simple non-invasive and compliant method. It provides a sustained drug release. The aims of this study was to assess the analgesic requirement of patients under General Anesthesia postoperatively after application of Buprenorphine Transdermal patch preoperatively, to assess added analgesic sparing effect, and to assess anxiety level and post extubation discomfort after surgery. Methods and Materials: In this prospective randomized controlled study sixty adult patients, undergoing elective open surgery under General Anesthesia were randomized into 2 groups: Group C (control group) receiving conventional intravenous analgesics, and Group B (study group) receiving transdermal Buprenorphine patch of 10 mcg/hr. All patients were monitored for vital parameters, VAS, MRSS, rescue analgesic requirement and adverse effects till fifth postoperative day. The data was analysed statistically using ‘t’ test. Results: Number of patients requiring postoperative rescue analgesics was higher in group C. Total number of drug doses given in group C was also higher. Haemodynamic parameters were statistically insignificant in both groups at all time periods. VAS score was significantly less in group B till POD2, after which VAS was less in Group B, though not significant. MRSS scale was higher in Group B throughout postoperative period and at time of emergence. Number of patients having adverse effects was slightly high in group B but comparable in both groups. Conclusion: Transdermal buprenorphine patch is effective for postoperative analgesia for elective abdominal and head neck oral surgeries under General Anesthesia. It can reduce requirement of rescue post operative analgesics over atleast five days and maintain hemodynamic stability without serious complications. 

Introduction: The aim of the study was to compare effectiveness of single dose epidural 0.125% levobupivacaine with fentanyl 2 mcg/ml and 0.125% levobupivacaine alone in patients undergoing elective lower limb orthopaedic surgery. Methodology: We designed a prospective, randomized, double blind study, in which 60 patients with ASA1 and ASA2 were scheduled to undergo elective lower limb orthopedic surgery. Group A received single epidural block with 8 ml of 0.125% levobupivacaine and Group B received epidural block with 8 ml of 0.125% levobupivacaine and 2 mcg/ml fentanyl. Duration of analgesia, Quality of analgesia,  Degree of motor blockade, sedation score, hemodynamic changes and side effects were
assessed. Results: Duration of postoperative analgesia for group B (366±39.70 min) was longer as compared to group A (236±34.99 min). Quality of anaesthesia was significantly better in group B as compared Group A. Conclusion: We conclude that addition of fentanyl 2 mcg/ml to epidural 0.125% levobupivacaine produces significantly better quality and longer duration of postoperative analgesia, good hemodynamic stability and no side effect as compared to 0.125% levobupivacainealone in patient undergoing elective lower limb orthopedic surgeries.

Sevoflurane has characteristics of rapid inhalational induction of anaesthesia in 60 secs while maintaining spontaneous respiration, bronchodilatation, haemodynamic stability with rapid recovery in elective scenario. This retrospective study analysed 40 (n=40) critically ill patients undergoing induction of anaesthesia with sevoflurane in emergency laparotomy. Standard methods and techniques were used in patient induction and management. Patients were optimized prior to sevoflurane induction were in ASA-III E (72.5%) and ASA-IV E (27.5%) status. Clinical outcome of sevoflurane anaesthesia induction analysed in terms of any airway managment complication and haemodynamic stability. Statistical analysis of haemodynamics done by ANOVA (analysis of variance). Incidence of airway complication such as laryngospasm, aspiration were nil and none of patient required abandoning or modification in induction process. Patients Spo2 improved postinduction (only 2.5% SpO2 between 85%-90%) even in comorbid COPD and smoker patients showing beneficial effects of sevoflurane induction. Induction of anaesthesia with sevoflurane is associated with significant changes (p < .05) in MAP and pulse peaking at 3 minutes postinduction as sevoflurane induction unable to attenuate intubation response on haemodynamics. None of the patient had bradycardia (HR < 60 bpm), hypotension (MAP < 60 mmHg) and arryythemias or required additional vasopressor support post induction and throughout perioperative period. None of patient required postoperative ventilation due to delayed recovery. Study concludes sevoflurane induction is without airway complications and haemodynamic unstability is suitable induction agent in emergency laparotomy in optimized critically ill patients while taking measure to prevent aspiration though unable to inhibit adrenergic endotracheal intubation responses.