Indian Journal of Anesthesia and Analgesia

Introduction: Tracheal extubation produces unfavourable hemodynamic alterations which may result in life threatening. The present study was aimed to assess the effect of injection dexmedetomidine 0.5 µg/kg for attenuation of hemodynamic responses and airway reflexes during extubation following surgery under general anaesthesia. Methodology: Patients of ASA grade I & II posted for surgery under general anesthesia were randomized to receive either dexmedetomedine 0.5 µg/kg body weight diluted to 20 ml in normal saline, over 10 minutes or normal saline 20 ml over 10 minutes. Hemodynamic parameters were recorded during infusion, at the time of reversal and after extubation. Extubation quality, time to eye opening and time to extubation were noted as well. Post extubation sedation was evaluated using Ramsay Sedation Scale and possible side effects during and after the administration of dexmedetomedine and during postoperative period were recorded. Results: We observed the mean heart rate and blood pressures to be significantly lower among patients in the dexmedetomedine group as compared to the control group. Mean time to extubation and eye opening was statistically and clinically significantly prolonged in the dexmedetomedine group as compared to the control group (p<0.01). 93% in the dexmedetomedine group had smooth extubation as against 57% in the control group. The incidence of hypertension and tachycardia was significantly higher among patients in the dexmedetomedine group as compared to the control group. Conclusions: Single bolus dose of dexmedetomidine 0.5 µg/kg administered as infusion over 10 minutes, before tracheal extubation attenuates hemodynamic responses effectively during extubation.

Introduction: Tracheal extubation produces unfavourable hemodynamic alterations which may result in life threatening. The present study was aimed to assess the effect of injection dexmedetomidine 0.5 µg/kg for attenuation of hemodynamic responses and airway reflexes during extubation following surgery under general anaesthesia. Methodology: Patients of ASA grade I & II posted for surgery under general anesthesia were randomized to receive either dexmedetomedine 0.5 µg/kg body weight diluted to 20 ml in normal saline, over 10 minutes or normal saline 20 ml over 10 minutes. Hemodynamic parameters were recorded during infusion, at the time of reversal and after extubation. Extubation quality, time to eye opening and time to extubation were noted as well. Post extubation sedation was evaluated using Ramsay Sedation Scale and possible side effects during and after the administration of dexmedetomedine and during postoperative period were recorded. Results: We observed the mean heart rate and blood pressures to be significantly lower among patients in the dexmedetomedine group as compared to the control group. Mean time to extubation and eye opening was statistically and clinically significantly prolonged in the dexmedetomedine group as compared to the control group (p<0.01). 93% in the dexmedetomedine group had smooth extubation as against 57% in the control group. The incidence of hypertension and tachycardia was significantly higher among patients in the dexmedetomedine group as compared to the control group. Conclusions: Single bolus dose of dexmedetomidine 0.5 µg/kg administered as infusion over 10 minutes, before tracheal extubation attenuates hemodynamic responses effectively during extubation.

Spinal anaesthesia is the preferred mode of anaesthesia for infraumbilical surgeries. Levobupivacaine is an isomer of racemic bupivacaine. Various adjuvants have been added to the local anaesthetics to prolong its effect. In present study, we have studied different doses of dexmedetomidine used as an adjuvant to levobupivacaine in spinal anaesthesia. Background: This study aims to investigate the effect of intrathecal administration of different doses of dexmedetomidine on the onset and duration of sensory and motor block, haemodynamic alterations and adverse effects produced by spinal levobupivacaine. Methods: 75ASA I-II patients with age group 18-70 years (weight 50-70 kg) undergoing infraumbilical surgies were randomized to one of the three groups. Every patient received 3.3 ml of drug intrathecally that consisted of 15 mg (3 ml of 0.5%) preservative free levobupivacaine containing either 0.3 ml normal saline (Group L) as control group, dexmedetomidine 15 μg (Group LD1) or dexmedetomidine 30 μg (Group LD2). Onset and duration of sensory and motor block, maximum sensory level achieved, sedation levels, haemodynamic parameters and adverse effects were recorded. Analysis of data between groups was performed using one way analysis of variance test (ANOVA test), student t-test and chi-square test (whichever was applicable). Results: Dexmedetomidine significantly shortens the onset of sensory and motor block and prolonged the time to two segment regression and regression of motor block to modified Bromage 0. In addition group LD2 had higher sedation scores. There was higher incidence of hypotension, bradycardia and respiratory depression in group LD2. Conclusion: Intrathecaldexmedetomidine in a dose of 15 μg significantly prolongs the anaesthetic effects of intrathecallevobupivacaine without significant side effects. So, 15 μg is the preferred dose of dexmedetomidine over 30 μg, when used as an adjuvant to levobupivacaine in spinal anaesthesia.

Back ground and Aim: “Pain” is the most feared symptom of disease or post-surgery especially in children because of its difficult to differentiate restlessness or crying due to pain, from that of hunger or fear in the children. There are different techniques available for pain relief in postoperative period like Non pharmacological approach, Parenteral narcotics, NSAIDS, Caudal blocks. We carried out the present study to compare the effect of rectal diclofenac and caudal bupivacaine for postoperative analgesia in pediatric patients for genitourinary and lower limb surgeries. Methodology: Fifty pediatric patients posted for elective genitourinary and lower limb surgeries of ASA grade I & II, aged 4 to 11 years of either sex were selected for this study. They were randomly divided in two groups of 25. Group A Received Caudal bupivacaine [0.25%] 1 ml/kg and Group B received Rectal Diclofenac suppository 2 mg/kg. postoperative pain was assessed by Hannallah score and analgesia given only when the score was > 7. Results: It was Observed that mean duration of time interval for first dose of analgesic was significantly longer in group B [8.56 hrs] than group A [4.2 hrs]. There were no significant hemodynamic changes, respiratory depression in both groups. Conclusion: This study concluded that Rectal diclofenac is a useful alternative to caudal bupivacaine and may offer advantages compared to caudal bupivacaine with regard to convenience of use for postoperative pain relief in children, as it is non- invasive method of pain relief.

Introduction: Caudal anaesthesia has formed a “Corner Stone” in paediatric regional anaesthesia. Bupivacaine is commonly used for caudal analgesia. Newer drugs like Ropivacaine is more cardio-stable and produces less motor blockade hence safer in paediatric age group. Methodology: This study was conducted at a tertiary care setting on 60 ASA 1 & 2 children posted for elective sub-umbilical surgeries. After thorough pre-anaesthetic evaluation, General Anaesthesia was administered followed by Caudal procedure with administration of Ropivacaine (R) or Bupivacaine (B) 1 ml/kg of 0.25% each. Motor blockade and Pain Scores were assessed using Modified Bromage Scale and Objective Pain Score respectively. Rescue analgesics were supplemented accordingly. Results: Haemodynamic parameters, pain score and duration of caudal analgesia were comparable in the 2 groups. Motor blockade in the immediate post-recovery period had a mean value of 1.80 ± 0.66 in group R and 2.47 ± 0.51 in Group B with a p<0.01 and was statistically significant. At 4th hr post-operatively, Group R had no motor blockade whereas Group B had a score of 0.17 ± 0.38 with a p<0.019 and statistically significant. Conclusion: Caudal Ropivacaine offers less motor blockade compared to Bupivacaine and is safe for paediatric population.

Context: Since spinal anaesthesia provides analgesia for short time with local anaesthetics, many intrathecal adjuvants to local anaesthetic drugs have been addressed to augment the clinical efficiency and duration of anaesthesia intra & post operatively. Aims: To compare the efficacy of midazolam and nalbuphine as adjuvants in spinal anaesthesia in infra umbilical surgeries. Material and method: This study was conducted on 50 patients aged 18 to 55 years ASA I and II, randomly divided in 2 groups by chit method undergoing elective infra-umbilical surgeries under spinal anaesthesia. Group BM received 0.5% bupivacaine heavy 3 ml, 2 mg preservative free midazolam made 3.5 ml with 0.9% normal saline and Group BN received 0.5% bupivacaine heavy 3 ml, preservative free 1 mg nalbuphine made 3.5 ml with NS. Onset & duration of sensory and motor blockade, hemodynamic changes, sedative effect, time of two segment regression, duration of analgesia and requirement of rescue analgesia, side effects/complications, if any were observed. Statistical analysis: Unpaired t-test was used for statistical analysis on IBM Statistical Package for Social Sciences version 21. p-value significant if <0.05. Results: Group BM provided short onset of sensory and motor block, longer duration of anaesthesia & post-operative analgesia, sedative effect and longer two-segment regression time as compare to group BN when used as adjuvant to hyperbaric bupivacaine. Conclusion: Midazolam is better adjuvant compare to nalbuphine when used intrathecally with bupivacaine 0.5% heavy provides longer duration of anaesthesia, sedation and post operative analgesia.

Background: There are many advantages of ultrasound guided supraclavicular brachial plexus block over the peripheral nerve stimulator guided supraclavicular brachial plexus block. Ultrasonography allows the operator to visualize the neural structures and the surrounding structures. It also guides the needle under real time visualization and navigates the needle away from the sensitive anatomy like pleura, blood vessels etc. Objective: A Comparative Study between Ultrasound and Peripheral Nerve Stimulator Guided Supraclavicular Brachial Plexus Block in Adult Patients for Elective Upper Limb surgeries. Methodology: A prospective comparative study of 60 Patients who were undergoing upper extremity surgery was carried out in the Department of Anesthesiology, JSS Medical College and Hospital, Mysuru, India during the period of November 2016 to July 2018 to compare the ultrasound and peripheral nerve stimulator guided supraclavicular brachial plexus block in adult patients for elective upper limb orthopedic surgeries. Results: The mean time to administer block was 10.17 ± 1.58 minutes in group-US and 10.67 ± 2.58 minutes in group PNS (p=0.57). Thus, in Group US and Group PNS time taken to administer block was statistically not significant. The total duration of sensory block was 10.12 ± 1.14 hours in group-US and 7.41 ± 0.68 hours in group PNS (p<0.0001). The block was successful in 96.67% of patients in group US and 80% in group PNS, which was statistically significant (p<0.05). Conclusion: It was concluded that the ultrasound guided supraclavicular brachial plexus block is more efficient, accurate and safer than the peripheral nerve stimulator guided brachial plexus block as it is characterized by a shorter time of onset and prolonged duration of sensory and motor block.

Introduction: Spinal anaesthesia is a very popular and common regional anaesthesia technique for infra umbilical surgeries. However the short duration of action of local anaesthetic drugs used for spinal anesthesia results in early postoperative analgesic intervention. Intrathecal (I/T) administration of opioids with local anaesthetics improves quality and duration of the spinal blockade, and prolongs post-operative analgesia after surgery. Aims & objectives: To study the onset of sensory & motor block. To study and compare intra operative quality and duration of anaesthesia and level of spinal block. To study and compare perioperative hemodynamic effects by spinal block. To study the post operative analgesia. To study the occurrence of side effects and complications if any. Material and Methods: The present study is a randomized prospective comparative controlled study between age group 18–50 years of both sexes belonging to ASA grade I & II for elective infra umbilical surgeries. Written and Informed consent before participation in study will be taken from all patients. 90 patients will be divided into 3 groups (n = 30), will be schedule to undergo elective infra umbilical surgeries; Group 1: Bupivacaine heavy (0.5%) 3 ml + 0.5 ml NS Group 2: Bupivacaine (3 ml) + 0.5 ml (0.5 mg) Nalbuphine Group 3: Bupivacaine (3 ml) + 0.5 ml (0.5 mg) Butorphanol. Parameters like HR, SBP, DBP (hemodynamic variables), Respiratory rate, SpO2 will be monitor preoperatively &intraoperatively at 0, 5, 10, 15, 20 min and after that every 20 min till the end of surgery. Post operatively pain will be monitor at the end of surgery, then after every 1 hour till 1st 6 hours, then after every 6 hours till 24 hours. Sensory block level will be assess by pin prick test and motor block by Modified Bromage Scale will be use to assess the degree & duration of motor blockade. The intensity of pain will be assess by Visual analogue Scale (VAS) at the end of surgery then after every 1 hour till 1st 6 hours, then after every 6 hours till 24 hours. Patient will also be observed for any side effects and complications viz; hypotension, hypoxia, sedation, desaturation etc. These complications Sedation will be assessed by RAMSAY sedation score. Result & Conclusion: Statistical analysis was done by using SPSS. The difference in proportion was analyzed by one way ANOVA test and the inter group difference in means were analyzed by using post –hoc Tukey test. Significance level for tests was determined as p < 0.05. Onset of sensory & motor blockade remain insignificant (p > 0.05) whereas duration & quality of sensory & motor blockade and duration of analgesia remain significant (p < 0.05) in study groups. From our study we conclude that intrathecal inj. Bupivacaine combination with inj. Nalbuphine is better than inj. Bupivacaine combination with inj. Butorphanol in respect to the duration of sensory & motor blockade, quality of anaesthesia and duration of analgesia (requirement of rescue analgesia) without any significant increase in adverse effects, whereas sedation remains more with inj. Butorphanol as compare to inj. Nalbuphine.

Background: Lipophilic opioids (fentanyl) and alpha-2 agonist (clonidine) are increasingly being administered intrathecally as adjuncts. They enhance the effect of spinal anaesthesia without prolonging motor recovery and discharge time. Aims and objectives: To work out the influence of intrathecal fentanyl vs intrathecal clonidine with low dose (2.5 ml) bupivacaine in urological surgeries. Materials and methods: The study was a randomized, prospective study conductedas a double blind trial at the tertiary care hospital. Total 60 patients were included in this study, after fulfilling standard criteria. The study population have patients of either sex, ASA physical status I and II in the range of 50-70 years. Patients were randomly assigned to Fentanyl (F)group and Clonidine (C) group. They were assessed for analgesia time, complications, hemodynamic changes and sensory and motor block. Statistical tests: All the data was collected and entered in Microsoft Excel sheet and transferred to SPSS software ver.17 for analysis. Chi-Square test, unpaired student ‘t’ test and paired ‘t’ test wasused. P - Value of <0.05 was considered statistically significant and that of < 0.001 was considered statistically highly significant. Results: Time of onset of motor block (min) was significantly faster in group C (2.21 ± 0.6) as compared to group F (5.4 ± 0.8). Time of onset of sensory block (min) was significantly faster in group C (2.44 ± 0.5) as compared to group F (6.12 ± 0.7). Conclusion: The onset of sensory and motor blockade was faster with clonidine. Clonidine offered good post-operative analgesia. Fentanyl may be a better choice for surgeries requiring minimal hospital stay.

Objective: In a prospective study, clinical effects of intrathecal 0.5% hyperbaric bupivacaine 15 mg with fentanyl 25µg versus 0.5% hyperbaric bupivacaine 15 mg were compared in total 60 patients of ASA grade I and II undergoing lower limb surgeries. Methods: After receiving 500 ml lactated ringers solution without any premedication spinal anaesthesia was given in sitting position with 25 gauge quincke type spinal needle at L3-L4 space. Intrathecal 0.5% hyperbaric bupivacaine 15 mg with fentanyl 25µg or 0.5% hyperbaric bupivacaine 15 mg was given. Following factors were evaluated after the administration of spinal drug. Onset, maximum level and degree of sensory analgesia; Onset and degree of motor blockade, level of alertness and anxiety, hemodynamics, sensory and motor recovery, duration of effective analgesia and complications. Results: There was excellent intraoperative and early postoperative analgesia with addition of intrathecal fentanyl to bupivacaine as compared to giving intrathecal bupivacaine only. Sedation was an advantageous side effect inspite of pruritus and there was less nausea, vomiting and shivering with intrathecal fentanyl. Hemodynamic variables were unchanged with intrathecal fentanyl except respiratory rate which decreased upto 2 hours only. Conclusion: In patients with lower limb surgeries 25µg fentanyl along with 0.5% hyperbaric bupivacaine 15 mg is recommended inspite of mild pruritus with advantage of excellent intraoperative analgesia, sedation and prolonged postoperative analgesia.

Aims: To compare the effect of addition of Dexmedetomidine (1 ug/kg) and Fentanyl (1 ug/kg) to Ropivacaine (0.2%) in femoral block for potentiation of postoperative analgesia in knee surgeries. Material and methods: After ethical committee approval study was conducted on 50 patients posted for planned knee surgeries. At the end of surgery patients were divided randomly into two groups of 25 each and PNS guided femoral nerve block was given. Group–F received 0.2% Ropivacaine (20 ml) +Inj. Dexmedetomidine 1 µg/kg+ Normal Saline. Total volume 22 ml. Group–Freceived 0.2% Ropivacaine (20 ml)+Inj. Fentanyl 1 µg/kg+ Normal saline. Total volume 22 ml. Hemodynamic monitoring, duration of postoperative analgesia, motor and sensory blockade and sedation were assessed for 24 hours. Results: Duration of sensory and motor block was significantly higher in group D compared to group F; p value <0.001. Duration of analgesic action was found to be significantly higher in patients of group D; p value <0.001. There was significantly lower mean pain score on the VAS among patients in the group D as compared to those in group F; p value < 0.001. Conclusion: The onset and duration of motor and sensory blockade among patients in the group D was significantly quicker and longer as compared to those in the group F. Analgesic duration was also more in the patients of group D and pain scores as measured by VAS were less. Thus from this study we concluded that Dexmedetomidine with Ropivacaine provided better postoperative pain relief as compared to fentanyl with Ropivacaine.

Introduction: Spinal anesthesia is performed for orthopedic lowerlimb surgeries for its dense blockade, rapid onset and pain relief in the postoperative period. femoral nerve block is performed prior to subarachnoid block helps in better positioning of the patient. Our study we had compared the effects of Ropivacaine alone and Ropivacaine with Fentanyl in blocking the femoral nerve prior to subarachnoid block. Aims & Objectives: To study the effect of fentanyl added to ropivacaine and ropivacaine alone in pain relief by blocking the femoral nerve prior to positioning the patients for sub arachnoid block. in orthopaedic above knee surgeries. Materials and Methods: Sixty ASA-PS I and II patients were posted for orthopedic above knee surgeries. Patients were distributed equally between the groups. One received 20 ml of 0.2% ropivacaine and another group received 20 ml of 0.2% ropivacaine with 50 mcg fentanyl. Results: Performing femoral nerve block provides significant improvement in pain scores, patient positioning, number of attempts in performing spinal anesthesia and hence the time taken for spinal anesthesia. Addition of 50 mcg fentanyl to ropivacaine resulted in a statistically same decrease in VAS scores, quality of patient positioning and decreased the number of attempts in performing spinal anesthesia. Patients were hemodynamically stable. Conclusion: Fentanyl added to the ropivacaine and ropivacaine alone in femoral nerve block had similar analgesic effect on positioning the patients prior to sub arachnoid.

Background and Aims: Supraclavicular brachial plexus block provides rapid onset and more consistent regional anesthesia, as compared to other approaches. We hypothesized that addition of clonidine to ropivcaine in ultrasound guided supraclavicular brachial plexus block will enhance the quality of analgesia and prolong the duration of postoperative analgesia in patients undergoing upper limb surgeries. Methods: This study included 100 patients posted for upper limb surgeries who were randomly allocated into 2 groups of 50 each. Group R patients were given 19 ml of 0.75% ropivacaine + 1 ml normal saline and Group RC were given 19 ml of 0.75% ropivacaine with 0.5 µg/kg clonidine in 1 ml NS. Chi-square test was used to analyse categorical data and student’s t-test was used to analyse quantitative data. Results: The onset of sensorimotor block was earlier in Group RC (4.03 ± 0.18 min for sensory block and 9.18 ± 0.11 min for motor block) than in Group R (5.23 ± 0.18 min for sensory block and 11.37 ± 0.44 min for motor block). Both sensory and motor block duration were significantly prolonged by clonidine (p value < 0.0001). The duration of analgesia was also prolonged in Group RC 848.31 ± 5.59 as compared to Group R 596.12 ± 3.79 (p < 0.0001). None of the patients in either group observed any adverse effects. Conclusion: Addition of Clonidine to ropivacaine in supraclavicular brachial plexus block results in faster onset and prolonged duration of sensory, motor blockade and postoperative analgesia without any significant adverse effects.

Context: To assess the safety and efficacy of tramadol and dexamethasone as an adjuvant in enhancing post-operative analgesic effect of local anaesthetic in supraclavicular brachial plexus block (SCBPB). Aims: To compare the efficacy of tramadol and dexamethasone as adjuvants in SCBPB. Material and method: 40 patients belonging to ASA Class I and II, planned for elective upper limb surgery were randomly allocated in 2 groups of 20 each. They received SCBPB. Group T received 20 ml of 0.5% bupivacaine + 15 ml of 2% lignocaine + tramadol 100 mg while Group D received 20 ml of 0.5% bupivacaine + 15 ml of 2% lignocaine + dexamethasone 8 mg. Onset and duration of sensory and motor block, as well as duration of analgesia was observed. Statistical analysis: Unpaired t-test was used for statistical analysis on IBM Statistical Package for Social Sciences version 21. P-value significant if <0.05. Results: The onset of sensory & motor block was shorter, while duration was significantly prolonged in Group D than Group T. The duration of analgesia in group T was 502.5 ± 49.82 minutes and 989.75 ± 126.2 minutes in group D which was statistically highly significant (p<0.0001). Conclusion: It is concluded that dexamethasone when added to local anaesthetic in SCBPB enhances the onset of sensory, prolongs the duration of sensory and motor block and gives extensive duration of analgesia in the postoperative period with steady haemodynamics.

Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epiduraly administered butorphanol and nalbuphine combined with ropivacaine. Materials and Methods: A total of 60 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 18-60 years, undergoing lower limb orthopaedic surgeries under combined spinal epidural anaesthesia were enrolled into the study. Patients were randomly divided into three groups of 20 each: 0.2% Ropivacaine (group 1), 0.2% ropivacaine + 2 mg butorphanol (group 2), 0.2% ropivacaine + 10 mg Nalbuphine (group 3). The hemodynamic parameters as well as onset of pain relief and duration of analgesia were noted. Adverse events and sedation scores were also noted. Results: We found that haemodynamics were comparable in all the three groups. Onset of analgesia was earliest in Nalbuphine group (group 3) 1.45±0.51 min) followed by butorphanol group - group 2 (4.45±0.61 min) and maximum in ropivacaine plain group 1(8.30±0.97 min. The duration of analgesia was significantly prolonged in group 3 (6.40±0.821 hr) followed by butorphanol group - group 2 (4.45±0.605 hr) and shortest in plain group - group 1 (2.30±0.470 hr). Sedation was observed markedly in butorphanol group. No serious cardio respiratory side effects were observed in any group. Conclusions: Butorphanol and Nalbuphine as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory anesthesia. Nalbuphine provides a significantly prolonged post-operative analgesia.

Background: Smooth and rapid induction, optimal operating conditions, and rapid recovery with minimal side effects such as nausea, vomiting, bleeding, and postoperative pain are the characteristics of ideal anesthetic. Objectives: To compare the effect of sub-arachnoid fentanyl and clonidine on onset & duration of sensory & motor block, post-operative pain relief, complications, side effects and hemodynamic status. Materials and Methods: This was a randomize controlled study conducted from July to November 2018. A total of 60 adult patients of American Society of Anaesthesiologists (ASA) physical status grade I or II, aged between 20-50 years, of either sex, posted for lower limb orthopedic surgery included after informed consent. All the patients were randomly allocated into one of the two groups using computer generated random number table. Group BF received induction with Fentanyl while group BC was induced Clonidine. Results: The baseline demographic analysis showed that the two groups did not differ significantly in age, weight, sex, ASA grade and operative times. Duration of motor, sensory & analgesia was higher in BC group. During the course of surgery, Heart Rate (HR) & Blood Pressure (BP) was significantly low in group BC at 15,30,40 & 45 minutes than in group BF and RR was also low in BF group at 30 minutes of post-operative period. Adverse effects and VAS score was low in BC group than BF group. Conclusion: Clonidine has significantly better hemodynamic stability, post-operative recovery and less post-operative complications compared to fentanyl.

Backgound and Aim: Foreign body lodgement in aero-digestive tract is a common surgical emergency presenting to the department which contributes to high morbidity and occasional mortality. Severity of symptoms depends upon the site, size, composition, and the period for which the foreign body has been present. Aim of our study was to analyze the event following foreign body aspiration in aero-digestive tract regarding-demographic characterstics of patients, history of event, type and site of foreign body, anaesthetic management and complications. Method: 65 cases of foreign body in aero-digestive tract (50 in food passage and 15 in airway), treated over one year period (prospectively) were reviewed. Foreign body retrieval was done by invasive procedures like laryngoscopy assisted / rigid endoscopy assisted under general anaesthesia. All the cases were done under controlled ventilation with muscle relaxant. In trachea-bronchial cases intermittent positive pressure ventilation via jet ventilation most commonly used technique. Results: The incidence of foreign body ingestion - in food passage 56% of patients were below 6 year of age, 30% between 3-6 years of age followed by 20% between 1-3 years. While in case of airway 53.33% were between the age group of 1-3 years. Most common site of lodgement of foreign body was cricopharynx (44%) in food passage and right main bronchus (53.33%) in airway. Most common foreign body found was coin (56%) in digestive tract, while vegetative foreign body (73.33%) in airway. In food passage most common symptom was dysphagia (82%) while in airway cough (66.66%) and difficulty in breathing (80%) were common findings. Conclusion: Foreign bodies in aero-digestive tract constitute a serious and potentially fatal situation usually occurring in pediatric population. Controlled ventilation with muscle relaxant is the preferred anaesthetic technique.

Introduction: Lower limb orthopedic interventions such as total hip arthroplasty (THA) and total knee arthroplasty (TKA) present a challenge to the anesthetist, as these procedures typically involve elderly patients often suffer from multiple co-morbid conditions. In addition, these procedures generate significant postoperative pain. The psoas compartment block (PCB) is an alternative approach that may circumvent many of the side effects associated with central neuraxial blockade. Combined with a sciatic nerve block, unilateral anesthesia of the lower limb may be induced (‘Psoas compartment sciatic nerve block or PCSNB’). Aim and Objective of the Study: This study aimed at evaluating the analgesic effect of combined psoas compartment block and sciatic nerve block in elective lower limb surgeries intra and post-operatively. Primary Objective: To assess the effectiveness of the lower limb block based on 1) Sensory block and 2) Motor block. Secondary Objective: time to request rescue analgesia. Material and Method: Design of the Study:  Randomized controlled trial. Selection of Subjects: • Study involves adult patients of age 18 to 60 years of ASAps I - II posted for elective lower limb surgeries. • Sample size 60 •Randomization – computer-generated random numbers • Monitors – NIBP, ECG, and SpO2 • Anaesthesia: Combined psoas compartment block and sciatic nerve block. Sixty patients were subjected to psoas compartment block and sciatic nerve block using a nerve stimulator 30 ml of 0.25% of bupivacaine for psoas compartment block + and 20 ml of 0.25% of bupivacaine for sciatic nerve block. Under strict aseptic precautions, psoas compartment block was performed by posterior approach and sciatic nerve block by label’s approach using a peripheral nerve stimulator after obtaining a twitch of quadriceps and calf muscle contraction and dorsiflexion of the foot. • Assessment: Time of onset of analgesia and motor blockade, sensory blockade, total duration of analgesia and the time taken for 1st dose of rescue analgesia noted. Results: Sensory blockade by visual analog scale reveals no pain up to 8 hours and almost complete block up to 6 hours in 73.3% of patients and good analgesic effect up to 9 to 10 hours in 48.3% (29 out of 60 patients) and at 10 to 11 hours is 51.7% (31 out of 60 patients) Motor blockade assessed by modified bromage scale at 2 hours revealed a score of 1 (complete block – unable to move feet or knee) in 60 out of 60 patients (100%), at 6 hours revealed a score of 2 (almost complete block – unable to move feet only) in 44 out of 60 patients (73.3%) and 3 (partial block – able to move knees) in 16 out of 60 patients (26.7%) and at 8 hours revealed a score of 3 (partial block – able to move knees) in 29 out of 60 patients (48.3%) and 4 (detectable weakness of hip flexion while supine, full flexion of knees) in 31 out of 60 patients (51.7%). The incidence of the first dose of rescue analgesia (in. Tramadol 50 mg iv) at 9 to 10 hours is 48.3%(29 out of 60 patients) and at 10 to 11 hours is 51.7% (31 out of 60 patients). The mean Total rescue analgesic dosage was 120 mg of in. Tramadol and mean number of doses required was 2.2. One patient had a seizure following the block and one patient developed a hematoma at the injection site postoperatively both were treated conservatively. Five patients had nausea and vomiting treated within. ondansetron 0.15 mg/kg i.v. Conclusion: This study concluded that skillful application of psoas compartment block by posterior approach and proximal sciatic nerve block provides adequate intraoperative analgesia for major lower extremity procedures.

Background: Epidural anesthesia has become an integral part of today’s anesthesia practice. There are various techniques to identify epidural space like, LOR (Loss of resistance) with saline or air, Hanging drop method, MDM (Modified running drip method) and balloon method. Aims and objectives: To compare time taken to locate epidural space and ease of epidural catheter insertion among LOR with saline and MDM. Methods: 60 healthy patients of either sex, ASA-I or II physical status, between aged 20 to 60 years, scheduled to undergo lower abdominal and lower limb surgeries were randomly assigned to one of the two groups. (30 each). In LOR group (Group A): the lumbar epidural space was identified by using the LOR technique with saline. MDM Group (Group B): the lumbar epidural space was identified by using the modified drip method (MDM). Time taken to locate epidural space (T1), time taken to thread epidural catheter (T2) and quality of block were recorded. Results: The mean time taken to localize the epidural space was less in MDM than LOR but the difference was found statistically insignificant. (p=0.59).) Mean time taken to thread epidural catheter T2 was more in LOR than MDM which is also statistically not significant (p=0.76). Accidental dural puncture was seen in one patient in MDM and four patients in LOR. 3 cases of incomplete block were found in LOR while 1 case in MDM group which is not statistically significant. Conclusion: We believe that MDM is one of the most accurate visual method of identifying epidural space and useful for teaching the epidural blockade to students and residents.

Background and Aims: Awake fiberoptic intubation (AFOI) is considered the gold standard for anticipated difficult intubation in maxillofacial surgery. Regional anaesthesia of the airway is essential for awake fiberoptic intubation. The aim of this study was to compare the efficacy of two different techniques of local anaesthetic administration namely; nebulization and transtracheal injection for AFOI. Materials and Method: This prospective randomised double blind study was conducted on 60 patients of age more than 18 years, ASA grade I-III undergoing maxillofacial surgery who had anticipated difficult intubation. Patients were divided into two group; Group T received transtracheal injection with 4 ml of 4% lignocaine and Group N received ultrasonic nebulization with 4 ml of 4% lignocaine before performing AFOI. All patients received procedural sedation with fentanyl and dexmedetomidine. Time taken to intubate the patient, ease of intubation assessed by cough severity score, patient comfort score, the quality assessment of the entire procedure with post-intubation patient satisfaction and hemodynamic changes were recorded and compared. The data were presented as mean ± SD, median and range. Statistical analysis was done by student t-test for quantitative variables and chi-square test for categorical variables. p value < 0.05 was considered statistically significant. Result: Time taken to intubate the patient was significantly less in Group T 131.27 ± 71.81 sec vs 220.97 ± 102.45 sec in Group N; (p=0.0002). Cough severity, patient comfort and quality of procedure with post-intubation patient satisfaction score were also significantly better in Group T (p=0.0023, 0.0018, 0.0001) while haemodynamic variables were comparable in both the groups. Conclusion: Transtracheal technique provided better quality of anaesthesia with shorter intubation time as compared to the nebulization technique for AFOI in patients undergoing maxillofacial surgery.

Background: Post dural puncture headache (PDPH) is a common and incapacitating complication of spinal anesthesia, with higher incidence in obstetric patients, affects postoperative wellbeing of mother as well as child. The study was undertaken to compare incidence and severity of post dural puncture headache in caesarean section after spinal anesthesia using 23G, 25G and 27G quincke needle. Methodology: 150 patients of ASA grade I or II undergoing emergency or elective caesarean section were selected and randomly divided in to 3 equal (50 in each) groups; A, B and C and received spinal anesthesia with 23G, 25G and 27G spinal needle respectively. No. of trials, time to get successful puncture and time to achieve T6 block recorded. Incidence, onset, severity and duration of PDPH recorded postoperatively. Results: Incidence of PDPH was 20%, 6% and 0% in group A, B and C respectively. Onset and duration of PDPH were 34.60 (+ 4.427) hrs and 5.90 (+ 0.876) days in group A and 39.33 (+ 3.055) hrs and 4.67 (+0.577) days in group B respectively. 2 patients in group A had moderate and rest had mild PDPH. 6 patients in group A, 10 patients in group B and 14 patients in group C required >1 trial. Time taken for successful puncture was 21.8 (+9.833), 44.08 (+14.251) and 92.72 (+12.420) sec in groups A, B and C respectively. Time to achieve T6 level was 4.08 (+1.226), 6.22 (+1.112) and 7.14 (+1.16) min in group A, B and C respectively. Conclusion: Incidence of PDPH was significantly lower with 27G and 25G than in 23G spinal needles.

Present study designed to evaluate and compare the role of 25 gauge Quincke and Whitacre spinal needles on technical difficulties and incidence of Post dural puncture headache in 18 to 65 years of age group patients, undergoing surgeries under spinal anesthesia. One hundred and fifty patients of American Society of Anesthesiology physical status grade I, II and III, aged between 18-65 years of either sex, undergoing elective surgical procedures under spinal anesthesia, were enrolled for the study period. In group Q 75 patients received spinal anesthesia through a Quincke needle. Whereas, in group W, 75 patients received spinal anesthesia through a Whitacre needle. PDPH was assessed in all patients including associated symptoms and numeric Pain Rating Scale. It was concluded that shape of the tip of the needle has no effect either on the number of attempts for a successful intrathecal anesthesia or on the incidence and severity of postdural puncture headache. The overall incidence of post dural puncture headache is 2.7% and we did not observe any difference between 25G Quincke and 25G Whitacre needle on the incidence of PDPH (2.7% in both groups).

Introduction: Bupivacaine (0.5% heavy) is used to administer subarachnoid block but carries an increased risk of cardiac and central nervous system toxicity if inadvertently injected intravascularly. Levobupivacaine is S-enantiomer of racemic bupivacaine with lesser systemic toxicity. A study was done to compare isobaric levobupivacaine and hyperbaric bupivacaine for spinal anaesthesia in patients undergoing elective lower abdominal surgeries to study hemodynamic variations, sensory and motor blocking properties of these. Methods: A prospective randomized controlled double blind study was conducted in 100 patients of ASA I and II physical status posted for elective lower abdominal surgeries under subarachnoid block, randomized into 2 groups with 50 patients each, received either 3 ml of 0.5% isobaric levobupivacaine (group L) or 3 ml of 0.5% hyperbaric Bupivacaine (group B). Hemodynamic parameters, time for onset of sensory and motor blockade, maximum height of sensory block and total duration of sensory and motor blockade were recorded. Intraoperative or postoperative side effects were noted. Results: The incidence of hypotension and bradycardia were comparable between the two groups. Onset of sensory and motor block (L-2.88 ± 1.81, B-2.12 ± 0.47, p value 0.005, L-3.12 ± 1.62, B-2.28 ± 0.81, p value 0.001, respectively) were significantly delayed in levobupivacaine group. The total duration of sensory block (L- 190.04 ± 35.19, B- 204.02 ± 30.06, p value 0.035) and motor block (L-176.65 ± 40.64, B 204.46 ± 29.8, p value<0.001) were higher in bupivacaine group. Conclusion: 0.5% isobaric levobupivacaine could be an alternative to 0.5% hyperbaric bupivacaine for spinal anaesthesia with similar hemodynamic changes, side effects and shorter durations of sensory and motor blockade.

Backround: The main objective of this study is to compare the efficacy of two newer supraglottic airway devices LMA Supreme and I GEL in patients undergoing laparoscopic surgeries with positive pressure ventilation. Materials and methods: A total of 50 patients with 25 in each group (‘LMA Supreme’ or ‘I GEL) undergoing laparoscopic surgery at SMVMCH from October 2014 to May 2016 were included in the study. Based on the score given by the inserting anaesthetist, parameters like ease of insertion, number of insertion attempts, ease of insertion of Ryles tube, airway seal by the device before and after creating pneumoperitoneum and any complications arising after removing the device were assessed. Results: LMA Supreme and I GEL have an equally high successful rate in terms of ease of insertion and both devices have a similar number of attempts for insertion. In terms of ease of insertion of ryles tube, all patients in LMA supreme group were successfully inserted with a ryles tube (Insertion score 1), where as there was some difficulty encountered in inserting the ryles tube in I GEL group. There was no audible leak throughout the period before creating pneumoperitoneum and after creating pneumoperitoneum showing that both devices are equally effective in providing an adequate airway seal with positive pressure ventilation. Both the devices were equally effective in providing airway seal with a minimal increased requirement of tidal volume in I GEL group. Thus inferring both the devices are equally effective in working performance as an effective airway device in laparoscopic surgeries with positive pressure ventilation. Conclusion: Both LMA Supreme and I GEL are equally effective in maintaining adequate airway seal in laparoscopic surgeries with positive pressure ventilation. LMA Supreme is superior over I GEL in terms of ease of insertion of Ryles tube and increased tidal volume requirement in I GEL group for maintaining the ventilation when compared to LMA supreme.

Context: The primary goals of premedication in children are to facilitate a smooth separation from the parents and to ease the induction of anesthesia. Aims: To compare the efficacy of midazolam and triclofos when given orally as premedicants in children. Material and methods: 50 patients aged 2-6 years of ASA I & II were divided randomly into two groups equally. Group M received syrup midazolam, 0.5 mg kg-1 and group T received syrup triclofos 75 mg kg-1, orally as premedication. Level of sedation and behavior [1,3] at the time of separation from parents and during mask acceptance [1,3]. Statistical analysis: Unpaired t-test was used for statistical analysis. p-value <0.05 is significant. Results: In group-M 56% and 40% patients while in group-T 24% and 8% patients achieved a sedation score of 4 and 5 respectively (p<0.05). In group-T 64% and 24% while in group-M 8% and 12% patients achieved a behavior score of 1 and 2 respectively at the time of separation from parents (p<0.05). In group-M 68% and in group-T 24% patients achieved a mask acceptance score of 4 (p<0.05). Conclusion: Oral midazolam 0.5 mg kg-1 was better in terms of level of sedation and behavior at the time of mask acceptance whereas, triclofos 75 mg kg-1 was better in terms of behavior at the time of separation from parents in paediatric age group 2 to 6 years. Hence, midazolam was found to be superior to triclofos.

Arthroscopic knee surgery is routinely performed these days for various indications none the less with pain in post operative period requiring analgesic cover. Pain is mediated through Opiate receptors in intraarticular tissue. Dexmedetomidine, a alpha (α) 2 adrenergic agonist whose administration Intra articularly along with Inj. Ropivacaine (local anesthetic) does helps in providing good analgesia postoperatively. With this background this comparative we planned study between inj. ropivacaine and ropivacaine with dexmedetomidine deposited intra articularly for post operative analgesia in arthroscopic knee surgery. Duration of analgesia, efficacy of drugs and any side effects between both groups were compared. Fifty patients undergoing elective arthroscopy surgery of knee joint of ASA grade II & III; 18-65 years of age of either sex were included and after the surgery was over, they were randomly divided in two groups of 25; Group A (n=25) to receive Inj. Ropivacaine 0.25% and Group B (n=25) to receive Inj. Ropivacaine (0.25%) + Inj. Dexmedetomidine (1 µg/kg) making final volume 20 ml pushed intra-articularly under aseptic precautions by the operating surgeon. Patients were observed postoperatively for Pulse, RR, Temp, BP, Sedation using Modified Wilson Score and Pain assesment at rest using VAS every 2 hourly for first postoperative day. Rescue analgesic using Inj. Diclofenac sodium 75 mg IV was given at VAS score was ≥ 4. The duration (in hours) for first dose of analgesic was considerably more in group B [2.68 ± 0.48] than group A [1.88 ± 0.34]. There were no significant postoperative complications in both groups. So mixing of Intraarticular Dexmedetomidine with Ropivacaine provides longer duration of analgesia and reduced pain scores as compared to Intraarticular Ropivacaine alone safely.

Backround and Aims: Effectiveness of Ropivacaine in spinal anaesthesia for hemodyanamic stability and anaesthesia quality for lower limb orthopaedic surgeries when used with adjuvants also improves the quality of anaesthesia & analgesia. Methods: Seventy patients ASA I or II received intrathecal injection isobaric ropivacaine (0.5%) with adjuvant. Group RC (n=35) received 15 mg isobaric ropivacaine (0.5%) with 60 mcg clonidine. Group RF (n=35) received 15 mg isobaric ropivacaine (0.5%) with 25 mcg fentanyl. The onset and duration of sensory & motor block, hemodyanamic parameters were recorded. Statistical analysis was done using Statistical Package of Social Science (SPSS Version 20; Chicago Inc., USA). Results: Sensory block duration (in seconds) in RC (329.42 ± 33.86) RF(226 ± 46.98) and motor block in RC (248.51 ± 55) RF (212.60 ± 43.52) out lasted duration of surgery (125.61 + 64.46). In clonidine group, there was significant prolongation of sensory block (p < 0.001), motor block (p < 0.01) and the total analgesia time (p < 0.001). Hypotension and bradycardia occurred in 8.6% patients in clonidine group, whereas pruritus was experienced by 8.6% patients in fentanyl group. Conclusion: clonidine or fentanyl when added to ropivacaine provided adequate subarachnoid block for lower limb orthopaedic surgeries, where clonidine was better than fentanyl, in terms of duration of subarachnoid block and postoperative analgesia.

Studies done on internal jugular venous valve (IJVV) competence shows that structural and functional integrity of the IJV valve may be compromised when the IJV is cannulated for insertion of a central venous catheter. USG guided IJV cannulation distal and proximal from anatomical location of IJVV was carried out to study the incidence of IJVV incompetence. Methods: Sixty patients undergoing elective major surgery, without pre-existing incompetence of IJV valve were randomly divided in two groups high (distal) and low (proximal) to undergo IJV catheterisation (>1 cm above or below the cricoid level, respectively) under USG guidance. USG confirmation of IJVV status both, anatomical and physiological in normal respiration and with Valsalva manoeuvre was done. Color Doppler ultrasound was used to study the incidence of valvular incompetence at different intervals i.e. at (T1) preoperative, (T2) one week after catheter insertion and (T3) one month after catheter removal, both, during normal respiration and during Valsalva manoeuvres and were compared with baseline T1. Results: Incidence of IJVVI, with catheter in IJV (T2) was higher with lower approach than with higher approach (30% vs. 20%; p < 0.01) and tended to be so after removal of the catheter (T3) (20% vs. 13%; p =0.04). With Valsalva Manoeuvre, IJV diameter was significantly high in lower group at (T2), with catheter in IJV (H/L) (1.9+0.7/2.3+0.7*) and at (T3), after catheter removal (H/L) (1.9+0.8/2.3+0.9*). p <0.001. Conclusions: Cannulation and catheterization of the IJV may cause long lasting functional impairment of the IJV valve. IJV cannulation above the level of cricoid cartilage, under USG guidance helps to some extent in lowering the incidence of IJV valve incompetence.

Background: Laparotomies requires a good amount of pain relief postoperatively to avoid delay in recovery and reduce the duration of stay in the hospital. Among multiple modalities of pain relief postoperative wound infiltration is simple, easy to administer and it has minimal systemic side effects. In our study, we are going to compare the efficacy of 5% magnesium sulfate with 1.5 µg/kg dexmedetomidine along with 0.75% ropivacaine. It's the effect on the postoperative opioid requirement. Material and Methods: 60 ASA I and II patients who are posted for elective laparotomies were randomized to receive one of two treatments: Group RM: 30 ml of drug (0.75% Ropivacaine 3 mg/kg with 5% Magnesium sulfate). Group RD: 30 ml of drug (0.75% Ropivacaine 3 mg/kg with 1.5 µg/kg Dexmedetomidine). Postoperative VAS scoring, time for first rescue analgesia, total tramadol requirement in first 24 hours, patient satisfaction and complications like nausea, vomiting, bradycardia, hypotension, respiratory depression were noted and expressed as mean and standard deviation. Data analyzed with SPSS software version 16.0. p < 0.05 considered statistically significant. Results: Time for first rescue analgesia was earlier in the RM group when compared to the RD group (p>0.05). the total dose of tramadol requirement significantly less with RD group 421.02 ± 21.2 when compared to RM group 221.08 ± 12.6 (p<0.005), sedation score (Grade 2 level sedation) and patient satisfaction scores were significantly higher with RD group (p<0.05). Conclusion: Results of our study concludes that 0.75% Ropivacaine with 1.5 µg/kg Dexmedetomidine provides better postoperative analgesia by reducing the dose of tramadol requirement with good sedation and excellent patient satisfaction than 0.75% Ropivacaine with 5% Magnesium Sulphate in patients undergoing elective laparotomies.

Background: Management of postoperative pain is essential for the smooth recovery of the patients. Intrathecal opioids are commonly used adjuvants to bupivacaine heavy for improving the quality of spinal anaesthesia. There are less number of studies comparing intrathecal butorphanol and pethidine. Aims: To compare the effects of intrathecal butorphanol versus pethidine on spinal anaesthesia produced by bupivacaine heavy.Settings and design: A prospective randomized double blind study. Materials and methods: 100 patients of ASA 1 & 2 undergoing spinal anaesthesia were randomly allotted to group A or B. Group A received intrathecal 0.5 mg butorphanol + 2.5 ml 0.5% bupivacaine heavy. Group B received intrathecal 25 mg pethidine + 2.5 ml 0.5% bupivacaine heavy. All patients were monitored for sensory and motor blockade, and occurrence of any side effects. Statistical analysis used: SPSS statistical software version 21.0. The mean and standard deviation computed for quantitative data. Proportions calculated for qualitative data. Appropriate test of significance used and a P value < 0.05 considered significant. Results: Mean time of duration of sensory blockade was 161.40 ± 12.291 minutes in group A and 147.10 ± 8.087 minutes in group B, which is statistically significant (p<0.001). Mean time of duration of analgesia was 304.70 ± 22.484 minutes in group A and 215.26 ± 16.359 minutes in group B, which is statistically significant (p<0.001). Neither of the groups had prolonged motor blockade or adverse effects. Conclusion: Intrathecal butorphanol and pethidine work synergistically with bupivacaine heavy to prolong the duration of sensory blockade and analgesia without prolonging the motor blockade and without causing any significant side effects. The effect is more pronounced with butorphanol compared to pethidine.

Introduction: There has been an increasing need to find an easily available, effective and feasible method of reducing the incidence of myalgia. Hence, the purpose of the present study is to evaluate and compare the effect of pretreatment with intravenous lidocaine and intramuscular diclofenac in succinylcholine induced post operative myalgia. Materials & Methods: Patients were divided into three groups of 50 each, based on random number generated by computer software and as per the group pretreatment was given. Pain related to the surgical procedure was treated with IV pethidine in a dose of 1 mg/kg. Severity and intensity of post operative myalgia was assessed by the investigator with a standardized questionnaire 1 hour, 24 hours and 48 hours after surgery. Results: There is no significant difference (p > 0.016) between efficacy of intramuscular diclofenac and the control in reducing the intensity of pain at any of the three time points. There is a significant difference (p < 0.016) between efficacy of intravenous lidocaine and the control in reducing the intensity of pain at all of the three time points. There is a significant difference (p < 0.016) between efficacy of intravenous lidocaine and efficacy of intramuscular diclofenac in reducing the intensity of pain at all of the three time points. Discussion & Conclusion: Intravenous lidocaine is effective in reducing the incidence and intensity of succinycholine induced myalgia. Intramuscular diclofenac compares poorly to lidocaine in reducing the incidence and intensity of succinycholine induced myalgia.

It is reported that, peripherally administered NDMA receptor antagonists are involved in anti-nocieption 15 and anti-inflammatory action [16]. The present study was undertaken to evaluate the ketamine hydrochloride gargling NDMA receptor antagonist to attenuate post operative sore throat response after endotracheal intubation in elective operative procedures under general anaesthesia. In the present study, 100 patients of either sex, ASA grade I and II, 20-45 years age range posted for elective operative procedures under general anaesthesia with endotracheal intubation were studied. These patients were divided into 2 equal groups where group I (control) received 30 ml normal saline gargles 40 seconds 5 minutes prior to induction of anaesthesia and group II received 29 ml normal saline with 1 ml Ketamine hydrochloride 50 mg gargles for 40 seconds 5 minutes prior to induction of anaesthesia. Induction of anaesthesia was carried out with IN. Thiopentone 5 mg/kg and IV Suxamethonium 1 mg/kg for felicitation of intubation. With gentle laryngoscopy endotracheal intubation was done with appropriate size red rubber cuff endotracheal tube after lubrication with normal saline. All patients were monitored intraoperatively as well as postoperatively at regular intervals for haemodynamic changes. Postoperative sore throat was assessed at 0, 4 8, and 24 hours in both groups. It was observed that, at 0 hours (immediate postoperative in recovery), the incidence of postoperative sore throat was about 60% in ketamine group as compared to 90% in control group. Out of 60%, 50% of patients had very mild sore throat and 10% moderate sore throat in ketamine group. At 4 and 8 hours, there were maximum patients with no sore throat and mild sore throat in ketamine group as compared to control group. At 24 hours, the incidence of sore throat was very minimum in ketamine group. In control group, the incidence of mild to moderate was 70-90% far more than ketamine group.

Background: No anesthesia is safe or satisfactory unless diligent efforts are made toward the maintenance of a functioning, unobstructed airway. LMA & COPA both devices can be used to establish an airway for spontaneously breathing anesthetized patients with little difficulty or trauma. Hence an attempt was made to organize a randomized clinical comparative study with regard to the usefulness & complications of LMA & COPA. Method: A total of 60 patients of ASA Grade I and Grade II undergoing elective surgical procedures with both sexes, ranging in age from 18 to 55 years were included. Informed written consent was obtained from each patient and the procedure was explained to the patient. A thorough pre-operative examination and detailed history were completed according to the proforma. The patients were randomly assigned to either LMA or COPA placement. Result: The demographic data of all patients were comparable in both groups (p>0.05). The first-time successful insertion rate was higher in the LMA group (93.33%) than in the COPA group (83.33%). Airway interventions were required more often with COPA & “hands-free” ventilation was better with LMA than with COPA. With respect to hemodynamic variables, LMA & COPA are equivalents. Conclusion: Considering technical aspects of airway management, LMA is better than COPA with respect higher first-time success rate of LMA. More airway manipulation is required with COPA. With respect to hemodynamic stability, LMA & COPA are equivalent. LMA is associated with more incidences of sore throat in the immediate postoperative period than COPA. Postoperative late sore throat incidences are similar to LMA & COPA.

Context: Magnesium prolongs analgesia in humans when given intrathecally. Fentanyl being highly lipid soluble diffuses into spinal cord and binds to dorsal horn receptors rapidly when administered intrathecally.Aims: To compare the effects of magnesium sulphate and fentanyl with bupivacaine for post operative analgesia in perianal surgeries. Material and methods: 42 patients aged 18-65 years of ASA Grade I and II scheduled for perianal elective surgeries under spinal anaesthesia were allocated equally in two groups according to chit system randomly. Group BF- Inj. bupivacaine 0.5% 1 ml+25 µg fentanyl (preservative free) 0.5 ml. Group BM- Inj. bupivacaine 0.5% 1 ml+100 mg magnesium sulfate (preservative free) diluted to 0.5 ml with normal saline. Patients were observed for onset and duration of sensory and motor blockade, duration of postoperative analgesia and analgesic requirement in first 24 hours. Statistical analysis: The statistical analysis was assessed by unpaired t-test on Microsoft excel and IBM SPSS version 21. Results: Duration of sensory block, motor block and postoperative analgesia was significantly more in BM group than in BF group (p<0.001). Time to rescue analgesia in group BF was significantly less than that in group BM (p<0.001). Conclusion: Though the onset of motor and sensory block is delayed with intrathecal magnesium sulfate, duration of analgesia is prolonged as compared to intrathecal fentanyl. Total analgesic requirement is significantly more with fentanyl as compared to magnesium.

Background and aims: Pain on injection of propofol is a well-known side effect faced by all anesthesiologists in their day to day practice. The aim of the study was to assess the efficacy of low dose ketamine in the prevention of pain on injection of propofol. Materials and methods: A prospective, randomized, and double-blind study was conducted on 100 patients, from either gender, aged 20-50 years, of the American Society of Anaesthesiologists Grade I or II, scheduled for various surgeries under general anesthesia. The patients were randomly divided into two groups of 50 each to receive either ketamine 0.5 mg/kg (Group K) or saline (Group S) infusion over 10 min. Venous drainage was occluded manually for one minute. This was followed by an injection of propofol 2 mg/kg IV over 25s. The patients were asked for pain on injection every 5s until the loss of consciousness. The pain scoring was done using McCririck and Hunter scale. The primary outcome of the study was the incidence of pain on propofol injection. Secondary outcomes such as increased secretions, emergence agitation were recorded. Results: Nine patients in group K (18%) and 42 patients in group S (84%) developed pain on injection of propofol. The incidence of pain was statistically significant between the two groups (p = < 0.001). Three patients in group K (6%) and 23 (46%) patients in group S had severe pain (p = < 0.001). Three patients in group K experienced increased secretions, which was not significant in comparison with the other group (6% vs 0%, p = 0.242). Four patients in group K had emergence agitation, but this was again not statistically significant when compared to group S (8% vs 0%, p = 0.117). Conclusion: We conclude that pretreatment of a smaller dose of ketamine was effective in the prevention of pain on injection of propofol without major side effects.

Background: It is very important to see complete recovery from regional anaesthesia before ambulation and discharge of the patient. Bromage score or the Formal motor power test system are the conventional methods which have been used to see recovery from epidural block. Material and Methods: A total of fifty patients of ASA grade I and II, presenting for surgeries below the umbilicus under epidural anesthesia were taken up for the study. The block recovery was compared with the use of a 128-Hz tuning fork with the conventional tests. Conventional block recovery testing included Bromage score, Formal muscle power testing according to the British Medical Research Council, pinprick testing, and warm/cold testing. After obtaining base line values, an epidural block was performed and patients were tested every 15 minutes after surgery, till the vibration score of one less than the baseline was achieved. The results of the different methods to the time at which baseline values of vibration sense were reached were compared. Results: At the end of surgery, normal baseline power, foot flexion and foot extension strength was attained in all the 50(100%) patients at 90-100 minutes where as complete recovery of quadriceps strength was seen in 45 (90%) patients, rest of the patients with residual muscle weakness had motor power of grade IV and normal motor power Grade V was achieved in the next 10 minutes. Conclusion: Recovery of vibration sense corresponds with recovery of motor block after epidural anesthesia and may serve as an easy means of documenting recovery with a single test before discharge.

Introduction: Middle ear surgeries require hypotensive anaesthesia to improve quality of surgical field. Dexmedetomidine is α2 agonist which provides desired surgical field, sedation and analgesia. Aim: The present study was aimed to evaluate the effects of dexmedetomidine infusion on requirement of halothane to provide oligaemic surgical field during middle ear surgery using operating microscope. Materials and Method: 90 patients of either sex between age group of 18-60 years, ASA grade I and II were randomly divided into two equal group scheduled for Middle Ear Surgery were included in this observational study. Patients of group I were given placebo infusion of normal saline and group II given inj.dexmedetomidine at rate of 1 µ g/kg i.v over 10 min 15 min before induction followed by infusion at 0.4 µ g/kg/hr i.v till 10 min prior to end of surgery. General anaesthesia given with standard anaesthetic technique. Halothane concentration was titrated to achieve mean arterial pressure 30% below baseline value. All patients assessed intra‑operatively for bleeding at surgical field, haemodynamic changes and awakening time. Result: Mean percentage of halothane requirement to maintain mean arterial blood pressure below 30% of baseline value was significantly reduced in patients receiving dexmedetomidine infusion (0.34±0.2%) when compared to those receiving placebo infusion (0.54±0.3%). Quality of surgical field was better and mean awakening time was significantly reduced in Group II than Group I (<0.001). Conclusion: Dexmedetomidine infusion maintains hemodynamic stability and was safe to provide oligaemic surgical field for better visualisation under operating microscope for middle ear microsurgery.

Context: It’s important to prevent shivering in parturient undergoing caesarean surgery under spinal anaesthesia as shivering results in increased metabolic rate, CO2 and oxygen consumption. Aims: Intrathecal tramadol as an adjuvant to bupivacaine, to assess incidence and grading of post spinal shivering, onset and duration of sensory and motor block, haemodynamic changes and APGAR score of the new born. Material and methods: Thirty patients aged 21-35 years of ASA I & II posted for elective or emergency caesarean section were randomly allocated into two groups. Group B (n=15) received inj. bupivacaine 0.5% heavy 2 ml+0.2 ml 0.9% normal saline and group T (n=15) received inj. bupivacaine 0.5% heavy 2 ml+inj. tramadol 0.2 ml (10 mg) preservative free intrathecally. Statistical analysis: The statistical analysis was assessed by unpaired students t-test and Chi square test. Results: Intra-operatively, shivering in 66.67% compared to 13.3% and post-operatively in 80% compared to 6.67% was seen, in group B & group T respectively. Onset of sensory blockade was 8.33 ± 0.90 minutes versus 9.20±0.68 minutes and motor blockade was 11.13 ± 0.834 minutes versus 12.00 ± 0.756 minutes, in group T and group B respectively whereas, duration of sensory and motor blockade were prolonged in group T (p<0.05). No differences in APGAR score, hemodynamic parameters and incidence of complication between both groups. Conclusion: Intrathecal tramadol significantly reduces the incidence of shivering in parturient undergoing caesarean surgery without significant adverse effect on mother and neonates while having early onset of both motor and sensory components in subarachnoid block.

Background and Aims: Different additives have been used to prolong Brachial plexus block. We evaluated the effect of adding Dexamethasone to Ropivacaine for Ultrasound guided Supraclavicular Brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. Materials and Methods: A total of 60 patients (18-60 years) satisfying inclusion and exclusion criteria posted for elective upper limb surgeries under supraclavicular Brachial plexus block were divided into two equal groups (Group R and RD) in a randomized, double-blind fashion. In group RD (n= 30) 30 ml 0.5% Ropivacaine plus 8 mg (2 ml) of Dexamethasone and group R (n = 30) 30 ml 0.5% Ropivacaine plus 2 ml normal saline were administered in Ultrasound guided supraclavicular block. Sensory and motor block onset times and block durations, duration of analgesia, and side effects if any were recorded for each patient. Results: Demographic parameters were comparable in both groups. Onset time of sensory and motor block were shorter in Group RD (10.15 + 1.14 min and 14.95 ± 0.83 min respectively) than in Group R (12.45 + 2.76 min and 16.05 ± 1.96 min respectively) (p = 0.001). Duration of sensory and motor blockade were longer in Group RD (909 ± 22.10 min and 878 ± 19.47 min respectively) than in Group R (450 ± 27.74 min and 420 ± 23.17 min) (p = 0.001). Duration of analgesia was longer in Group RD (1004 ± 25.49 min) than in Group R (498 ± 35.43 min) (p = 0.001). Intra-operative hemodynamic parameters were comparable in both the groups without any adverse effects. Conclusions: Dexamethasone when added to Ropivacaine for Brachial plexus block shortens the onset time and prolongs the duration of the block and the duration of post-operative analgesia.

Context: Not many studies have compared the new laryngeal mask airway (LMA) devices with pre-existing ones. We compared ambu auragain LMA with LMA supreme in this study for controlled ventilation under general anaesthesia. Aims: The main aim of this study was to the compare ambu auragain LMA with the LMA supreme for controlled ventilation during general anaesthesia. Material and Methods: 50 patients aged 18 to 50 years of American society of Anaesthesiologists (ASA) grade I and II of either gender, weight 30 to 70 kilogram, with Mallampatti grade -I/II posted for elective surgeries in supine position under general anaesthesia were randomly allocated into two equal groups. Group A (ambu auragain) and group S (LMA supreme). Both groups were compared for numbers of attempts and time taken for insertion of device, ease of insertion of nasogastric tube (NGT), oropharyngeal leak pressure, hemodynamic stability and any side effects or complications. Statistical analysis: The statistical analysis was assessed by unpaired student’s t-test. p<0.05 was considered significant. Result: Both groups were statistically comparable in regard to number of attempts for placement and time of insertion of device, ease of insertion of NGT and haemodynamic stability. Group A had higher oropharyngeal leak pressure 32.0 ± 1.34 compared to Group S 26.0 ± 1.21 (p=0.0001). Conclusion: Ambu auragain can be a better alternative to LMA supreme for controlled ventilation under general anaesthesia due to high oropharyngeal leak pressure.

Aim: Pain associated with Propofol injection is quite distressing. This study was aimed to compare the effectivness of ondensetron and fentanyl for alleviation of pain caused by propofol injection. Setting and design: Prospective comparative observational study. Methods and Material: A prospective observational study was conducted on 90 patients who were scheduled for the elective surgeries under general anaesthesia and received inj.propofol as an induction agent. Patients who received pretreatment with ondensetron (4 mg) before Propofol injection formed group O (n=30) while patients who received fentanyl (100 µg) as a pretreatment or nothing formed group F (n=30) and group P (n=30) respectively. The primary outcome recorded was the incidence of pain after propofol injection. We also assessed severity of pain and local reaction at the site of injection. Statistical analysis used: Purposive sampling method used for calculation of sample size. Data were analysed using SPSS softwere version 16.0. ANOVA test were used to compare quantitative data while chi-square test and fisher’s exact test were used to compare qualitative data. p value <0.05 was considered as a significant. Results: The incidence of pain was significantly low in group O (13.3%) and group F (13.3%) compared to group P (100%). Among all the patients who had pain, patients of group O and group F experienced only mild pain while patients of group P experienced moderate to severe pain. None of the patient had inflammatory reaction at local site. Conclusion: Pretreatment with Ondensetron or Fentanyl is equally effective for alleviation of pain caused by Propofol injection. 

Context: Paediatric airway is different than adult airway in terms of anatomy and physiology, therefore techniques and tools for securing the airway are different. Macintosh laryngoscope is most commonly used but, Airtraq is new tool, that allows high quality viewing of the vocal cords, without requiring a straight line of sight. Aims: To compare use of Airtraq with Macintosh laryngoscope for intubation in paediatric subject posted for elective surgeries. Materials and Methods: After written and informed consent of parents/ guardians, 50 patients of ASA 1 & 2, 2 - 6 years of age were divided into two groups (group A & M). Patients pre-medicated with ondansetron, glycopyrrolate, midazolam, paracetamol. Anaesthesia was induced with ketamine, propofol, succinylcholine and maintain on O2, N2O, sevoflurane and atracurium. Group M (n=25) were intubated with Macintosh and group A (n=25) patients with Airtraq. Intubation time, number of attempts, optimization manoeuvres were recorded. Hemodynamic changes were recorded before induction and after induction at interval of 1, 3, 5 minutes after intubation. Statistical analysis: The statistical analysis was assessed by unpaired t-test on Microsoft excel and IBM SPSS (Statistical Package for Social Sciences) version 21. P-value significant if <0.05. Results: Time taken for intubation was 33.96 + 15.7 seconds for group A and 44.80 + 16.3 seconds for group M. The calculated p value (p=0.02) showed there was statistically significance. Conclusion: Airtraq required shorter time to intubate, lesser number of attempts, lesser optimization manoeuvres’ and better laryngeal view as compared to Macintosh in paediatric patients.

Context: Dexmedetomidine, a potent α2 adrenoceptor agonist, is more selective towards the α2 adrenoceptor and have analgesic and sedative properties [3]. Levobupivacaine has been shown to be safe and effective for epidural/spinal anaesthesia and brachial plexus block [4]. Aims: To assess the safety, efficacy, onset & duration of sensory & motor block and rescue analgesia time of dexmedetomidine as an adjuvant to levobupivacaine 0.5% and levobupivacaine 0.5% alone in supraclavicular brachial plexus (SCBP) block. Material and methods: 60 patients aged 18-55 years of ASA I & II were divided randomly into two groups using chit method. Group LD (n=30) received 0.5% levobupivacaine 30 ml with inj. dexmedetomidine 1 μg kg-1 and Group L (n=30) 0.5% levobupivacaine 30 ml alone in SCBP block. Onset and duration of sensory & motor block, as well as duration of analgesia were assessed using pinprick, bromage score and visual analogue score respectively. Statistical analysis: The statistical analysis was assessed by unpaired t-test on Microsoft excel and IBM SPSS (Statistical Package for Social Sciences) version 21. P-value significant if <0.05. Results: The rescue analgesia time for Group LD was 1029.55 ± 95.87 and Group L was 657.93 ± 47.81 (p<0.0001). The onset of sensory & motor block was hastened, while duration was significantly prolonged in Group LD than Group L. Conclusion: Dexmedetomidine when added to levobupivacaine in SCBP block hastens the onset and prolongs duration of sensory & motor block and rescue analgesia time in the postoperative period with steady haemodynamics.

Introduction: Supraclavicular brachial plexus block provides anaesthesia of the entire upper extremity in the most consistent and time-efficient manner. The present study was undertaken to evaluate the time of onset, duration of sensory and motor block along with monitoring of heart rate, non-invasive blood pressure, and sedation. The analgesic efficacy of clonidine bupivacaine combination compared to plain bupivacaine for brachial plexus block by supraclavicular approach was also studied. Material and Methods: After institutional ethical committee clearance and prior informed consent, fifty patients aged 18 to 60 years undergoing upper limb surgery were included in the study after being divided into two equal groups: one with Bupivacaine – Clonidine (BC), another with bupivacaine (B) alone. Group BC received 30 ml of Bupivacaine 0.25% plus 1 μg/kg of clonidine with Normal saline to make a total of 1 ml and Group B received 30 ml of bupivacaine 0.25% plus 1 ml of Normal saline 0.9%. The onset as well as duration of sensory and motor block along with monitoring of heart rate, NIBP, sedation score were recorded. Results: The time of onset of sensory and motor blockades was fast in clonidine group along with prolonged duration of action of the same. There was no statistically significant difference between the two groups with regards to age, gender and weight (p>0.05). The mean duration of sensory block in group BC was 500.00 ± 104.61 min and in group B was 326.00 ± 58.31 min. The mean duration of motor block in group BC was 420.60 ± 94.23 min and the group B was 283.00 ± 54.85 min. The statistical analysis by unpaired student’s ‘t’- test showed that the duration of sensory and motor block in group BC was significantly longer when compared to group B (p < 0.001). Conclusion: This study concludes that clonidine is a better adjuvant to bupicaine for supraclavicular brachial plexus block; it provides faster, longer duration of analgesia and sedation with hemodynamic stability.

Introduction: Bupivacaine is the first choice of local anaesthesia [LA] intrathecally for Caesarean Section or Labour analgesia. Aim: To assess intrathecal fentanyl (25 ugms)+2.5 mg of 0.5% bupivacaine effect during labour in second stage and its effect on mother & child. Materials and methods: This study was a prospective, observational study which was controlled and evaluated spinal analgesia efficacy in single dose in managing labour pain. 80 patients are taken for observation 40 controlled group, 40 study group. In study group intrathecal fentanyl 25 μg + hyper baric bupivacaine was given. Results: Duration of analgesia lasts up to 5 hours, patient’s satisfaction levels were good with no side effects, C/S rate was 1 and it is statistically not significant. Conclusion: Administration of narcotics intrathecallyhas an analgesia effectand is the best option in women who have labour. ITN will have particular appeal for facilities that do not have readily available 24/7 epidural services. Fentanyl + LA in low doses is effective analgesia with no significant side effects.

Background: Hypotension is one of the most common complications associated with regional anaesthetic technique for CS. Several studies have been done for methods to prevent hypotension, which have been widely discussed in past decades, without definite conclusions. Hence we designed a study as such to compare the effect of placing a Crawford wedge or giving a table tilt (left) after spinal anesthesia for caesarean section, by observing the hemodynamic changes as suggested by previous study, to determine which would be best suit for cesarean section parturients in preventing supine hypotension syndrome. Materials and Methods: A total of 120 parturients who met the inclusion criteria were enrolled into the study and were randomly allocated into either the wedge group or the table tilt group. After placing the wedge or table tilt, patient hemodynamic parameters such as Heart rate, Blood pressure, Oxygen saturation were recorded between the groups. Results: In Tilt group 50% were Primigravida and 50% were Multigravida respectively, in wedge group 45% were Primigravida and 55% were Multigravida. Mean Hear rate increased to 90.2 ± 8.7 bpm at 10 min in Tilt group and to 90.6 ± 9.1 bpm at 20 min in Wedge group. Mean SBP was higher in Wedge group after 5 min of positioning than in tilt group. Mean DBP was higher in Wedge group after 5 min of positioning than in tilt group. Mean MAP was higher in Wedge group after 5 min of positioning than in tilt group. The results show that there is no significant differences regarding Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, saturation between wedge group and table tilt group. Conclusion: We observed that there was incidence of hypotension in both the groups but the placement of Crawford wedge and execution of table tilt were equally efficient in preventing supine hypotension syndrome for patient undergoing cesarean section.

Context: Ropivacaine is a new agent introduced recently which can provide differential blockade. It has been reported to produce greater degree of analgesia at the same time producing lesser motor blockade compared to bupivacaine. Aims: To compare the postoperative analgesia between 0.2% Ropivacaine with 4 mcg/ml of Fentanyl with 0.125% Bupivacaine with 4 mcg/ml of Fentanyl in knee joint replacement surgery. Settings and design: Present study was prospective randomized study carried out at SVS Medical College, Mahabubnagar. Methods: In this double blinded prospective study, 59 patients were selected and allotted into two groups, 30 in Group R and 29 in Group B by computer based randomised selection program. Combined spinal epidural technique was performed on the patient. After the completion of the surgical procedure when the patient complained of pain; basal pulse rate, mean arterial pressure, pain scores and degree of motor blockade were noted. Statistical analysis: Data was expressed as means and standard deviation and compared by using students t test. Results: The onset of action was significantly quick with ropivacaine i.e. 5.53 min compared to 6.96 min for bupivacaine; but there was no significant difference when time and duration of peak action was studied. Modified Bromage scale was used for measuring motor blockade and it was found that motor blockade was significantly less with ropivacaine group compared to the bupivacaine group. Both the agents were found to be comparable in terms of hemodynamic parameters. Conclusion: Ropivacaine in combination with fentanyl was found to be more effective than bupivacaine in same combination.

Objectives: To evaluate the incidence of ventilator associated pneumonia (VAP) before and after implementation of VAP Care bundle and to correlate incidence of VAP with Care bundle compliance. Methods: This is a prospective study conducted in an adult intensive care unit (ICU) from August 2016 to July 2018. Active surveillance of VAP cases was carried out and incidence was calculated as per CDC definition. The VAP Care bundle with following elements was introduced after training; head end elevation by 300, Chlorhexidine mouth care 6th hourly, daily sedation vacation and assessing readiness to wean from ventilator, peptic ulcer and DVT prophylaxis. To study the effect of Care bundle on incidence of VAP, 2 year retrospective data before Care bundle implementation was collected and analyzed. Care bundle compliance was assessed using a checklist for each intubated patient. Results: The incidence of VAP was 9.87 and 2.92 per 1000 ventilator days before and after implementation of Care bundle respectively. The reduction in average incidence of VAP rate before and after implementation of Care bundle is 6.95 per 1000 ventilator days with p<0.005 which is highly significant. The overall VAP bundle compliance rate was 80.33% with significant statistical correlation between the VAP rate and its bundle compliance (p<0.005). Conclusion: Significant reduction in the incidence of VAP rate can be achieved with strict adherence to VAP Care bundle, periodic training of health care workers with regard to infection control practices and active surveillance by the infection control team.

Introduction: Ropivacaine is a new local anesthetic agent with minimal cardiovascular toxicity. Various adjuvant have been tried with local anesthetics to prolong post operative analgesia, clonidine is one such drug. The aim of our study was to evaluate the effect of adding clonidine to ropivacaine on brachial plexus block characteristics, post operative analgesia and complications. Materials and methods: A controlled prospective clinical study was carried out among 60 patients of either gender belonging to ASA I and II undergoing upper limb surgeries. Patients were randomly allocated to either of the 2 groups of 30 each. Group- R received: Inj. Ropivacaine 35 ml (0.75%) +Inj. Normal saline 1 ml. Group-RC received Inj. Ropivacaine 35 ml (0.75%) +inj. Clonidine 1 ml (150 µg). Results: The mean time for Onset of the sensory block was 10.06 ± 35.43 minutes in group-R and 11.86 ± 65.21 minutes in group-RC (P<0.05). The mean time for Onset of the motor block was 11.96 minutes in group-R and 13.93 minutes in group-RC (P >0.5). The total duration of sensory block was 10.03 ± 1.1 hours in group R and 13.96 ± 0.69 hours in group RC, the p < 0.01. The total duration of post operative analgesia was 11.62 hours in group R and 14.57 hours in group RC, the p value being < 0.001. Conclusion: Thus we conclude from our study that addition of Clonidine 150 µgm to ropivacaine in supraclavicular brachial plexus block improves post operative analgesia without any side effects.