Indian Journal of Anesthesia and Analgesia

Abstract

Introduction: Laryngoscopy gives rise to a stress response that is seen as rise in heart rate and blood pressure and as dysrhythmia. Such changes are at peak immediately after intubation and can be dangerous for those having already limited or compromised cardiovascular reserve. They can lead to increased risk of myocardial infarction (MI), stroke, congestive cardiac failure or sudden death. Aims and Objectives: To study the effect of oral Ivabradine in attenuating the hemodynamic stress response to laryngoscopy; and to endotracheal intubation and extubation. Materials and Methods: A randomized double blinded study was done. Total number of 140 patients (adult patients undergoing ENT surgery) were randomly taken into two Groups. The first group was labelled as Test Gropu (A) and the second group was called Control Group (B). Each group had 70 patients. The Test group (A) received 5 mg oral Ivabradine and the Control group (B) received placebo. Patients were monitored for hemodynamic changes as per the protocol. Result: Mean heart rate, SBP, DBP and MAP reading at intubation, post-intubation period till 10 mins, at extubation and till 10 minutes post-extubation were significantly less in test group i.e. in patients who received oral Ivabradine as compared to control group (p<0.05). Conclusion: We conclude that Ivabradine is an extremely useful drug to prevent abnormal tachycardias during the procedure of laryngoscopy and intubation. Its stabilizing effect of haemodynamics also extends up to extubation and immediate post-operative period.

We report a case of malposition of the vaporizer on the selectatec manifold of the anesthesia workstation leading to interruption in the fresh gas flow at anesthesia machine outlet. We emphasize the importance of checking the anaesthetic vaporizer after mounting it on the backbar of the anesthesia workstation.

Aim: The aim of the present study was to compare the subsequent factors that take place during laryngeal mask airway insertion and endotracheal intubation for surgical procedures under general anesthesia. The parameters compared were: Ease of insertion and number of efforts and Postoperative complications like laryngospasm, bronchospasm and sore throat. Materials and Methods: The study participants included 80 paediatric patients between the ages of 2–8 years. All the participants were schedule to experience optional surgeries under general anesthesia in the medical hospital. Results: LMA had advantages over the tracheal tube in the form of lower incidence of cough during appearance and lower occurrence of postoperative sore throat, though offered no advantage more than tracheal tube in occurrence of bronchospasm or laryngospasm during appearance. Conclusion: The LMA provides a reliable airway in children. Incidence of postoperative complications is also less with LMA than endotracheal tubes. Therefore, LMA is a appropriate option to endotracheal intubation for possible short surgical procedures in pediatric patients.

Introduction: Conventionally central venous catheter is done utilising landmark technique. With increased availability of portable USG units, USG-guided intervention is fast gaining acceptance as a valuable tool in the critical-care setting. We designed this study to compare two methods of CVC insertion in terms of time taken, number of attempts, success rate and incidence of complications. This study will help us evaluate real time ultrasound in comparison to landmark technique. Material and Methods: 100 ASA I and II patients of either sex of ≥ 18 years of age, admitted to ICU or underwent surgery, requiring CVC placement were included in the study. Patients were randomly divided into two groups. Primary outcome measures were Successful insertion of a CVC. Secondary outcomes were (a.) Number of attempts for successful insertion of CVC (b.)Time taken to insert, (c.) Failure rate in insertion (d.) Incidence of complications. Result: The study was conducted in patients with a variety of disease processes. The distribution of age and sex was comparable in both the groups. Success rate was more in case of USG guided CVC insertion than landmark technique. In landmark technique successful cannulation was done in 86% patients vs 98% in USG group. The time taken during the procedure between group A (landmark technique ) was 42.59 ± 16.54 seconds which was higher than the time taken to catheterised by ultrasound guided technique 16.69 ± 9.80 seconds. p value was found to be less than 0.001, which was statistically significant. In group A incidence of hematoma formation was 14% and intra-arterial insertion of needle was 6% out of 20% overall complications. In group B incidence of hematoma formation was 8% and intra-arterial cannulation was 2% out of overall 10% complications. It was found that overall complication was more in group A patients than group B patients. But P value was found to be 0.161, and was statistically not significant. Conclusion: Considering the findings of the study, we concluded that USG guided CVC insertion has a better success rate, less failure, required less number of attempt and time taken to insert the CVC was significantly less. However, there was less complication with USG guided CVC insertion in present study, but it did not achieve statistical significance

Objective: The etiology of postoperative pain in patients undergoing laproscopic cholecystectomy is multifactorial consisting of incisional and visceral pain from the operation itself and parietal pain from trauma and irritation to the peritoneum and diaphragm. Design: This randamozied single blind study was conducted on 60 patients of either sex undergoing laproscopic cholecystectomy under general anesthesia. Group A [n=30] received 15 ml of 0.5% ropivacaine by instillation and group B [n=30] received 15 ml of 0.5% ropivacane intraperitoneally by piston type of nebulization 10 minutes before surgery and both the groups got 5 ml [0.5%] ropivacaine at the trocar site at the end of surgery. Results: Patients in both the groups were comparable with respect to age, sex and weight [p>0.05]. VAS score for incisional pain was significantly lower in Group A at 1hour and 8 hrs postoperatively [p=0.02 and p=0.04] respectively. At all other intervals the incisional pain, Visceral pain and shoulder tip pain was comparable amongst the two groups [p>0.05]. Time to first analgesia was longer in group A [2.29 hrs] as compared to Group B [1.66 hrs] but was stastically insignifiacant [p>0.5]. Mean total number of analgesic used was 1.4 in both the groups [p=1]. Conclusion: Intraoperative subdiaphgramatic and intraperitoneal instillation of ropivacaine 0.5% is beneficial and better modality of pain relief because of ease of technique and better VAS scores as compared to intrperitoneal nebulization of ropivacaine.

Background: Interscalene brachial plexuses block is one of the delicately done widely used blocks for upper humerus and shoulder surgeries. Ropivacaine, a newer Local Anaesthetic (LA), has been increasingly used nowadays in different concentrations for peripheral nerve blocks including brachial plexux block. Dexmedetomidine, a selective α2-receptor agonist has also been reported to improve the quality of intrathecal and epidural anesthesia when used along with LA as adjuvant. In this background, this study was undertaken to observe any alteration of the quality of brachial plexus block when dexmedetomidine used as an adjuvant along with ropivacaine in interscalene approach while performing upper arm surgeries. Methods: On obtaining Institutional Ethics Committee approval, sixty patients in total were studied when equally divided into two groups, R and RD. Thirty Patients for each group (either R or RD) were studied who fulfilled inclusion protocol and underwent surgery under brachial plexus block. Patients observed in group R received 30 ml of 0.5% ropivacaine and patients observed in group RD received 30 ml of 0.5% ropivacaine with 50 μg (0.5 ml) dexmedetomidine by electrical stimulations by using peripheral nerve stimulator (PNS) for brachial plexus block. All patients were primarily assessed for 24 hours for duration postoperative pain relief using VAS pain score (0-10centimeter). Secondarily onset and duration of sensory and motor blocks were assessed as well. Patient satisfaction scores (PSS) were also recorded by a specific scoring method for 24 h postoperatively where score 5=excellent, 4=very good, 3=good, 2=fair, and 1=poor. All patients were also monitored for hemodynamic parameters, oxygen saturation, respiratory parameters, sedation and any other adverse outcome for 24 hours. Results: The independent samples t test and Chi square test procedures were used to compare means and standard deviations for two groups of cases accordingly. Parametric and nonparametric data were assessed accordingly and p value < 0.05 was considered as significant. Patients observed in both groups were comparable with respect to baseline demographic characteristics. Total duration of analgesia in patients of group R was 540.21 ± 11.54 minutes and in group RD was 630.75 ± 10.67 min. The difference was statistically significant (p value <0.0001). Onset and duration of sensory and motor blockade were also found to be shortened and prolonged respectively in patients of group RD in comparison to group R. PSS were also found to be better in group RD. Conclusion: Dexmedetomidine when added in a relatively low dose as an adjuvant to bupivacaine for interscalene brachial plexus block, it was observed to shorten the onset time and prolongs the duration of both sensory and motor blocks with significant prolongation of duration of postoperative analgesia in patients undergoing upper humerus and shoulder surgery.

Background: Among the various modalities of regional anesthesia, spinal anesthesia is widely practiced. Clonidine is of interest because it preserves cardiovascular reflexes, provides sedation, greater intra operative haemodynamic stability and a reduction in anaesthetic and postoperative analgesics requirements and also has a marked opioid sparing effect. This study was carried out to compare the hemodynamic parameters between 0.5% hyperbaric Bupivacaine with and without Clonidine at various doses. Methods: This double blind randomized controlled trial was carried out in a total of 60 patients of age group 20 to 60 years of ASA grade I and II undergoing gynaecological and other lower abdominal surgery under spinal anesthesia. The control group consisted of 15 mg 0.5% hyperbaric bupivacaine while the experimental group was further classified into three groups based on the additional dosage of Clonidine. Presence of hypotension and bradycardia was documented. Results: Bradycardia was present in 73.3% of the participants in group IV while it was nil in Group I (controls). Hypotension was present in 73.3% of the participants in group IV while it was absent in group I participants. There was a statistically significant difference in the hypotension between group I & III, I & IV and II & IV (p<0.05). Conclusion: our study demonstrates that intrathecal clonidine at the usual dose of 1μg/kg is associated with bradycardia and relative hypotension. Therefore, 0.75 μg/Kg of clonidine is the preferred dose for addition to 0.5% hyperbaric bupivacaine in patients undergoing gynaecological and lower abdominal surgeries.

Background: Factors affecting spread of local anaesthetic are baricity, position, volume injected, level of injection, concentration of local anesthetic, speed of injection, abdominal pressure (ascites, pregnancy) and other factors are density, viscosity and temperature of the local anaesthetics injected. Our study compares the effects on sensory and motor blockade when 0.5% hyperbaric bupivacaine is administered at various temperatures viz., 24°C, 37°C and 40°C intrathecally in patients coming for infraumbilical surgeries. Methods: In this study 90 patients, 30 in each group undergoing surgery below the umbilicus were randomly administered spinal anesthesia at 24°C (Group A), 37°C (Group B) and 40°C (Group C). Sensory blockade and two segment regression were assessed by pinprick and motor blockade with Bromage scale. Results: Study showed with increased temperature the cephalad spread of sensory dermatome was rapid and high. Drugs injected at room temperature (24°C) had slow onset of sensory and motor blockade (p<0.001). Two segment regression achieved from the maximum level also was rapid with increased temperature of the local anesthetic administered. Conclusion: The sensory and motor blockade is influenced by the temperature of the local anaesthetic that is administered following subarachnoid injection.

Background and Aims: Laparoscopic cholecystectomy is being preferred surgery for gall bladder diseases under general anesthesia in the present era. This study was designed to compare oral pregabalin versus intravenous dexmedetomidine as premedication in attenuating the hemodynamic responses in laparoscopic cholecystectomy. Material and Method: This prospective randomized double blind study was conducted in 90 patients (ASA) grade I or II, divided into two groups of 45 each. Group P- received oral pregabalin 150 mg 1 hr prior to surgery and intravenous normal saline (0.9%). Group D- received oral placebo tab 1 hr prior to surgery and IV dexmedetomidine 1 µg/kg with normal saline. Demographic data and haemodynamic parameter like heart rate, systolic, diastolic and mean blood pressure along with oxygen saturation and end tidal CO2 were noted. Assessment of pain by visual analogue pain score (VAS) and sedation by Ramsay Sedation Scale (RSS) was done. The time to first rescue analgesic and total dose of analgesics in 24 hrs were noted. Statistical analysis was done using SPSS software (version 17, SPSS, Chicago, IL). Result: In group P significant haemodynamic response was observed at laryngoscopy, after intubation and during pneumoperitonium while in group D it was significantly attenuated (p<0.05). In group D VAS score was lower and RSS score was more as compare to group P which was statistically significant (p< 0.05). The time for first resque analgesic was earlier in group P (37.5 ± 9.30) than group D (58.06 ± 11.62) (p<0.001). Conclusion: Dexmedetomidine was found to be more effective than pregabalin in maintaining hemodynamic responses along with better postoperative analgesia and more sedation than pregabalin group.

Tracheal intubation using a laryngoscope is considered as a gold standard 1 of airway management during administration of general anesthesia and also in critical care settings because of its several advantages including 2,3- Isolation of respiratory tract from Gastro intestinal system and hence minimal risk of aspiration. Allows delivery of oxygen and anaesthetic gases via positive pressure ventilation without inflation of stomach. Access to tracheobronchial tree for pulmonary lavage and drug administration (e.g. inhaled bronchodilators). Improved access to head and neck surgeries. Airway management is important for anesthesia because adverse respiratory events are responsible for 75% of ASA closed claims. Of these failed ventilation is the main culprit (38%), followed by faulty placement of endotracheal tube in esophagus (17%) and difficult intubation (18%). Approximately 600 patients die each year in the developed world from complications due to airway management and also in the underdeveloped world is much grimmer.4,5,6 Context: We compared tracheal intubation using airtraq optical laryngoscope with macintosh laryngoscope in adult patients undergoing elective procedures under general anesthesia Aims: This study is to compare the intubating conditions in adult surgical patients using airtraq optical laryngoscope with macintosh laryngoscope with respect to ease of intubation, time taken for intubation, airway trauma and hemodynamic response to laryngoscopy. Settings and Design: Prospective randomised interventional study. Materials and Methods: This study was done in Sree Balaji Medical College and Hospital, Chennai at Department of Anaesthesiology and Critical Care from August 2016 to February 2018. It was a Single centre, prospective, randomized, parallel group, open label, interventional controlled study. After obtaining institutional ethical committee approval. 60 patients (sample size) who were posted for elective surgery requiring general anesthesia (Recruitment) with satisfying inclusion criteria were enrolled in the study after obtaining informed consent from the patients and relatives. 2 groups by random number allotted by computer based randomization Statistical Analysis: Descriptive and inferential statistical methods were used. Results: Mean duration of intubation with the Airtraq group was 15.93 secs whereas in the Macintosh group it was found to be 38.70 secs. It was computed using Levene’s T test and was found to be statistically significant. In the Macintosh group, 4 patients had an Total IDS of 5 or greater, indicating moderate to severe intubation difficulty, whereas no patient in the Airtraq group had an Total IDS of more than 3 and was found to be statistically significant. Conclusion: Our study concludes that endotracheal intubation is easier with Airtraq compared to Macintosh laryngoscope as it provides good glottis view. In addition to that Airtraq have less intubation duration, less hemodynamic response for intubation and less Airway trauma compared to Macintosh.

Introduction: Sevoflurane is widely used in paediatric anesthesia. It has a rapid induction and rapid recovery profile. It is pleasant, non-pungent and non irritant to the respiratory airways. Emergence agitation (EA) in children early after sevoflurane anesthesia is a common postoperative problem, with incidence up to 80%. Fentanyl and α2-agonists like Dexmedetomidine have been shown to be effective measures in decreasing the incidence of EA. Aims and Objectives: To compare the incidence of intravenous dexmedetomidine and fentanyl to decrease the post operative agitation after sevoflurane anesthesia in paediatric patients undergoing lower abdominal surgery. Material and methods: Sixty ASA physical status I and II children aged 2–9 years were included in this study. After inhalation induction with sevoflurane, patients were randomly assigned to receive either Saline (group N, n=20), fentanyl 1 mic/kg IV (group F, n=20) or dexmedetomidine 0.3 mic/kg IV (group D, n=20) 10 minutes before discontinuation of anesthesia. Results: The incidence of agitation was significantly higher in group N compared with other two groups, the incidence of agitation was 60% in Group N, 45% in Group F and 20% in Group D. There was no significant difference (p > 0.05) between the three groups in modified Aldrete recovery scores, but emergence time was more in dexmedetomidine when compared with other groups which was statistically significant. Conclusion: Fentanyl 1 mic/kg iv or dexmedetomidine 0.3 mic/kg iv that is administered 10 minutes before the termination of anesthesia reduces the postoperative agitation in children.

Introduction: Osteoarthritis of the knee joint is a widely prevalent problem and leads to decrease in physical function through pain and reduced range of motion. Since there is no cure for the disease, the main aim of treatment if to reduce pain and preserve function. While early osteoarthritis is treated with exercise and lifestyle modifications only, measures like intra-articular ozone administration and platelet rich plasma therapy reduce pain, restore function and enable patients to exercise more effectively. We studied the effectiveness of ozone administration in patients with knee osteoarthritis. Materials and Methods: Thirty patients with KellgrenLawrence grade 2-3 osteoarthritis of both knees were recruited and administered intra-articular ozone. Pain and patient global assessment scores were recorded on the visual analogue scale at baseline and at 6 months. Results: All patients experienced improvement with an improvement of mean pain VAS from 6.9 at baseline to 2.9 at 6 months. Patient global assessment also improved from 5.1 to 1.3. Conclusion: Intra-articular ozone administration is effective in reducing pain in patients with osteoarthritis of the knees.

Background and Aim: Spinal anesthesia is a preferred technique of anesthesia for pregnant women undergoing caesarean section. The major disadvantage with this technique is maternal hypotension which carries the greatest risk to mother and foetus. This study was designed to analyse various advantages and disadvantages associated with crystalloid preloading and co-loading during spinal anesthesia. Methods: Hundred parturients aged 20 to 40 years of physical status ASA I and II undergoing elective caesarean section under SAB were divided into two groups with 50 patients in each group. In Crystalloid Preload group, 15 ml/kg of Ringer lactate (RL) was preloaded 20 minutes before spinal anesthesia. In Co-load group, 15 ml/kg of RL was coloaded 20 minutes just after lumbar puncture. Vital parameters were noted before and after giving spinal anesthesia. Results: The occurence of hypotension (SBP < 100 mmHg) in Group P is 30% and 20% in Group C which is statistically insignificant (p = 0.35). The incidence of nausea is 8% & 6% in group P & group C respectively (p = 0.69). The incidence of vomiting is 2% in group P & 4% in group C (p = 0.55). Mephentermine was used in 19 patients in Group P & 13 patients in Group C which is statistically insignificant. Conclusion: Both preloading and co-loading with RL have similar effect on occurence of hypotension in pregnant women receiving spinal anesthesia. Precious time need not be wasted in preloading. Periodic measurement of BP in parturients for early detection of hypotension and administration of vasopressors for maintaining BP close to baseline can ensure better outcome.

Introduction: Thyroid surgeries are usually performed under general anesthesia as it involves manipulation of the trachea.Studies comparing bilateral superficial cervical plexus block and incision line infiltration for postoperative analgesia in thyroid surgeries are sparse. Hence, we decided to evaluate the effect of BSCPB and incision line infiltration of local anaesthetic on post-operative VAS and analgesic requirements. Methods: After obtaining ethical clearance from the institutional ethical committee, 70 patients were randomly assigned to 2 groups of 35 patients each. Patient’s in group were administered BSCPB with 20 ml of 0.125% bupivacaine and 10 ml of normal saline along the line of incision. Patient’s in group I were administered BSCPB with 20 ml of normal saline and 10 ml of 0.25% bupivacaine along the line of incision. Intra-operatively requirement for analgesics were recorded. Results on continuous measurements are presented on Mean ± SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance was assessed at 5% level of significance. Student t test (two tailed, independent) was used to find the significance of study parameters on continuous scale between two groups (Inter group analysis) on metric parameters. Results: Mean VAS scores obtained postoperatively to assess postoperative pain were slightly lower statistically significant in the 2nd, 12th and 24th hour. Requirement of inj paracetamol ande inj tramadol was not significantly different between the two groups. Vocal cord movement and the incidence of sore throat was comparable between the two groups. None of the patients in both the two groups had any episode of nausea or vomiting. Conclusion: We found that both BSCPB and incision line infiltration are effective methods for providing analgesia for thyroid surgeries. There is no difference between the requirement of analgesics or postoperative pain scores over a 24 hr period.

Background and Aim: Though rocuronium has a rapid onset of neuromuscular blockade like succinylcholine without the latter's adverse effects, its use is limited due to its prolonged action. Present study was performed with an aim to compare the outcome of using Rocuronium and Succinylcholie as muscle relaxant (MR). Material and Methods: A single-center, prospective-randomized, blinded study of 60 patients, divided into 2 groups and intubation conditions were evaluated. Results: The intubating conditions were scored as excellent in 29 and 26, and Good intubating conditions were observed in 1 and 4 Patients of group I and 2 respectively. Conclusion: We conclude that rocuronium, an innovative nondepolarizing MR with a succinct onset of action and transitional duration, but lack of the unpleasant reactions connected with succinylcholine may be a appropriate alternative to succinylcholine for tracheal intubation.

Background: To see effect of low dose fentanyl vs low dose dexamethasone in ultrasound guided supraclavicular block via multipoint injection technique. Methods: This double blinded randomized controlled study was carried out on 60 patients belonging to ASA grade I and II, undergoing surgeries of the upper limb under USG guided supraclavicular block via multipoint injection technique. Group I (NS) received 20 ml 0.5% bupivacaine with 1 ml normal saline. Group II (Fenta) received 20 ml 0.5% bupivacaine with 10 µg (1 ml) fentanyl. Group III (Dexa) received 20 ml 0.5% bupivacaine with 4 mg (1 ml) dexamethasone. Results: The onset of sensory blockade in group 1 (NS) was 9.6430 ± 1.19025 min, in group 2 (Fenta) it was 10.3395 ± 0.59338 min, whereas in group 3 (Dexa) it was 3.9735 ± 0.41802 min. The onset of motor blockade was 17.9025 ± 1.13816 min in group 1 (NS), 17.9530 ± 0.85577 min in group 2 (Fenta), 8.6145 ± 1.15154 min in group 3 (Dexa). The mean duration of sensory blockade in group 1 (NS) was 259.200 ± 36.3544 min, in group 2 (Fenta) it was 406.350 ± 20.1240 min, whereas in group 3 (Dexa) it was 1031.500 ± 173.8676 min. The mean duration of motor block in minutes was 197.900 ± 31.8878 in group 1 (NS), 339.250 ± 26.2616 in group 2 (Fenta) and 934.950 ± 168.9181 min in group 3 (Dexa). Conclusion: The dosage of fentanyl and dexamethasone do not linearly correlate to the degree of blockade. Dexamethasone is superior to fentanyl as an adjuvant in supraclavicular block.

Modified electroconvulsive therapy (ECT) under anesthesia is an important in the treatment of severe, persistent depression; bipolar disorder and schizophrenia; especially resistant cases. However, it is commonly associated with acute hyper dynamic responses. Aims: To compare the effects of dexmedetomidine and esmolol on patients’ haemodynamics, motor seizure duration, and recovery times following ECT. Study Design: Randomised Prospective Double Blinded Study. Materials and Methods: 90 cases aged between 18 to 50 years belonging to ASA grade I and II were randomly divided into three groups with 30 each. Group A received normal saline (placebo), Group B received dexmedetomidine 1 μg/kg, and Group C received esmolol 1 mg/kg; before induction with thiopentone sodium 2 mg/kg and muscle relaxation with succinylcholine 0.75 mg/kg. Hemodynamic parameters were recorded at different time intervals. The seizure duration using arm isolation method and recovery times using post-anesthesia discharge scoring system (PADSS) were noted. Analysis: Data analysis was done using SPSS (Statistical product and service solutions) software trial version 21 for windows. Results were expressed as mean ±SD, proportions and percentages. One way ANOVA test was used to assess the significant differences between groups. Results: PostECT rise in hemodynamic parameters was significantly less in dexmedetomidine group as compared to esmolol and control group at 2, 4, 6, and 8 min using ANOVA test. There was no significant difference in seizure duration, emergence, and recovery among the three groups. Conclusions: Both drugs reduce the hyperdynamic response to ECT without affecting the seizure duration, but dexmedetomidine has more favourable response in view of stable vitals, smooth emergence and no adverse effect on recovery duration.

Introduction: Flupirtine is non-opioid, non-NSAID, centrally acting indirect NMDA receptor antagonist. It's analgesic effect is equivalent to NSAIDs and opioids with devoid of their side effects. Abdominal surgeries are the most painful surgeries amongst the surgical procedures. Aim: To evaluate the pre-emptive analgesic effect of flupirtine for postoperative pain relief in patients undergoing abdominal surgeries. Methods: 60 patients of either sex posted for elective abdominal surgeries were included in this study. These patients were aged between 18 and 60 years with ASA physical status I and II. They were randomly divided into two groups, named group A and group B. Patients in group A received 2 oral placebo capsules and group B patients received 2 flupirtine 100 mg capsules orally. Both drugs were administered two hours before the surgery. All patients underwent abdominal surgeries under general anesthesia. In the postoperative period patients were assessed for the intensity of pain using Numerical rating scale, Time to first rescue analgesia, Ramsay sedation score and side effects in the first 24 hours postoperative period. If NRS score ≥ 4, rescue analgesic tramadol 50 mg iv was given at 6 hours interval. Results: The mean NRS score was significantly decreased (p = 0.00) in group B patients for the first 3 hours. The time to first rescue analgesia was significantly high (p = 0.00) in group B patients. 60% of patients in group A received rescue analgesia in the first hour of the postoperative period. The mean RSS score was high in group B patients in the first 3 to 5 hours. The side effects were less in both groups. Conclusion: This study concludes that pre-emptive administration of oral flupirtine 200 mg provides effective analgesia in the first 2 to 3 hours of the postoperative period in patients undergoing abdominal surgeries with mild to moderate sedation.

Regional anesthesia has some advantages over general anesthesia such as it can be used in outpatient anesthesia, for patients with full stomach, for diabetic patients, associated cardiac, pulmonary, hepatic or renal damage and poly-trauma. Alpha-2 agonists added to local anaesthetic drugs increases the duration of painless period during and after surgery. Here we elicit the clinical Performance of this two drugs dexmedetomidine and clonidine as an additive agent to local anaesthetics like ropivacaine in blocking the brachial plexus by supraclavicular method. The clinical parameters we study here are onset, duration of Duration of blockade (both S and M) and analgesia time and hemodynamic stability. Material and Methods: Prospective study was done on patients undergoing upper arm surgeries under brachial block were split into two equivalent groups. D-group received 0.375% ropivacaine (30 ml) plus one mcg/kg dexmedetomidine, C- group received 0.375% ropivacaine (30 ml) plus one mcg/kg clonidine. Results: Statistical analysis shows significant difference in onset of sensory (S) and motor (M) blockade, highly significance in duration of sensory and motor blockade between D and C groups (p=0.0001). High Statistical significance was seen analgesia duration (p=0.0001) and number of rescue analgesics used (p=0.0001) among D and C groups. Conclusion: Dexmedetomidine has more additive benefits than clonidine when combined with ropivacaine by making the onset of clinical effect earlier, prolonging the blockade extent (both S and M) and painless period during post surgery with fewer requirements of rescue analgesics after arm, forearm and hand surgeries.

Context: Propofol is a sedative-hypnotic intravenous anaesthetic agent. It causes a high incidence of pain during intravenous injection which leads to patient dissatisfaction. Aim: The aim of this study was to determine whether pre-treatment with intravenous lignocaine, ondensetron and fentanyl was effective in reducing propofol induced pain. Settings and Design: In a prospective, randomized, double blind study 150 ASA physical status I and II patients, aged 20-60 years, undergoing elective surgery under general anesthesia, were allocated randomly into three groups. Methods and Material: Group A received IV lignocaine 42 mg (2 ml), Group B received IV ondansetron 4mg and Group C received IV fentanyl 100 mcg. Mid-arm was occluded before drug injection then released after 1 min followed by propofol injection. Patients were assessed according to Mc Crirrick and Hunter pain scoring system at 0, 5, 10, 15 and 20 seconds. Statistical analysis: ANOVA with Dunnett’s post hoc test and chi-square test were used to analyze results. Results: Two patients in Group A and one patient in Group B had ‘no pain’ during the observation period. Group B and Group C have more ‘mild pain’ than Group A while it is comparable in Group B and C. ‘Moderate pain’ is comparable between Group A and B while Group A has more ‘moderate pain’ than Group C and Group B has more ‘moderate pain’ than Group C. Only one patient in Group A had ‘severe pain’. Conclusion: Pre-treatment with lignocaine, ondensetron and fentanyl was effective in reducing pain on propofol injection but the superiority of one drug over the other cannot be commented.

Background: The popular techniques of regional anesthesia used for surgeries of lower limbs are Subarachnoid block is better term anesthesia and epidural anesthesia. Limitations of intrathecal anesthesia are short duration of analgesia, onset of sympathetic blockade rapidly and brief postoperative analgesia duration. Aim: To evaluate the synergistic effect of addition of dexmedetomidine to ropivacaine 0.75% and fentanyl to ropivacaine .75% in epidural anesthesia for surgeries of lower limbs. Materials and Methods: The study conducted in Gandhi hospital during period between December 2016 to November 2017. Institutional ethical committee clearance as well as informed consent from all patients was obtained from all patients. One hundred patients, who had various elective lower limb surgical procedures belonging to ASA class I and II were included in the study. Group RD (n = 50)–15 ml of 0.75% ropivacaine + 1.0 µg/kg of dexmedetomidine, Group RF (n=50) 15 ml of 0.75% ropivacaine and Fentanyl 1 µg/kg. Results: The mean time of onset of sensory blockade in group RD is 5.26 ± 1.49 mins and in RF 10.04 ± 2.5 mins. There is highly statistical significant difference between the groups (p = 0.000). The mean time taken for the onset of motor blockade is 11.22 ± 2.61 mins in group RD and 15.36 ± 3.28 mins in group RF There is statistical significant difference between the groups (p = 0.000). There is no statistically significant difference in the mean heart rate, mean systolic blood pressure, diastolic blood pressure and mean arterial pressure between groups at various intervals. Bradycardia and dry mouth seen only in the RD group none was in RF group. Hypotension, nausea and vomiting, tremors observed in both groups on comparision were stastically insignificant. Conclusion: Dexmedetomidine can be used as a more potent and safer alternative to Fentanyl in epidural anesthesia as a adjuvant to ropivacaine.

Background: Arterial hypotension is a potential hazard associated with spinal anesthesia. Routinely, crystalloids and colloids are used for managing hypotension. While crystalloids easily move out of the intravascular space, colloids are confined to the intravascular space, thereby minimizing the risk of hypotension. This study was carried out to compare the efficacy of 10% Hydroxyethyl starch with Ringer’s lactate solution. Methods: This double blind randomized controlled trial was carried out on 100 patients who underwent spinal anesthesia during the study period. The study participants were randomized into experimental group (6% Hydroxyethyl starch, 10 ml/Kg) and control group (Ringer’s lactate, 20 ml/Kg). Blood pressure and heart rate were recorded periodically up to 60 minutes. Sensory level of blockade was checked after 5 minutes. Results: It was observed that as the surgery prolonged, the incidence of hypotension increased among the controls compared to the experimental group. While the initial incidence was higher among the experimental group (24%), the incidence was greater for the controls beyond 25 minutes (42%). The difference in the incidence was statistically significant (p<0.05). Conclusion: Hydroxyethyl starch is superior to Ringer’s lactate solution in prevention of Hypotension following spinal anesthesia. Incidence of hypotension is reduced but not completely eliminated. Hydroxyethyl starch also has several other advantages such as prophylaxis against venous thrombosis and decreased allergic potential.

Brain dead patients are potential organ donors but the pathological changes associated with braindeath can affect graft survival. Among various effects of braindeath endocrine and autonomic changes are noteworthy. Central diabetes insipidus characterized by reduced level of anti-diuretic hormone in brain dead patients can result in hypernatremia which inturn may affect the survival of the transplanted liver graft. Managing hypernatremia with exogenous vasopressin replacement improves the liver graft function.Vasopressin also maintains haemodynamic stability and reduce excessive free water loss as urine. It is given as intravenous infusion at 0.01-0.04 U/min or maximum 2.4U/hour.

Background: Even though various peripheral nerve blocks are used for analgesia in clavicular fractures. The use of ultrasound guided combined superficial cervical plexus block and interscalene blocks as a sole anaesthetic technique for surgical fixation of clavicular fractures are not well, established. Materials and Methods: A retrospective chart review of patient undergoing clavicular fracture surgeries was performed. Patients received combined superficial cervical plexus block and interscalene block were included in the study. Block success and complication rate were evaluated. Results: Of the 20 patients underwent clavicular fracture surgery, 12 of them received ultrasound guided combined superficial cervical plexus block and interscalene block. Block success rate was found to be 100%. Time for rescue analgesia found to be 6.66 ± 0.84 hours. And there were no occurence of any Complications. Conclusion: We concluded that ultrasound guided combined superficial cervical plexus block and interscalene block can be used as a sole anaesthetic technique in clavicular fracture repair.

Aim: To assess the effect of oral Gabapentin and oral Clonidine used as Preemptive analgesia to attenuate postoperative pain in patients undergoing elective Abdomino-Pelvic surgeries under Spinal Anesthesia. Objective: To assess postoperative analgesic benefit, their postoperative efficacy with respect to duration of analgesia and total postoperative requirement and side effects if any of both the groups. Material and Method: 60 patients of either sex of age between 18-65 years, ASA grade I & II, patient admitted to Khaja banda nawaz teaching and general hospital for elective abdominal surgeries under spinal anesthesia were included in the study. The patients were randomly allocated into two groups of 30 each, group G received Gabapentin 300 mg tablet orally 90 min before surgery, group C received clonidine 100 μg tablet orally 90 min before surgery. Duration of postoperative analgesia, Degree of postoperative pain (VAS score) and added rescue analgesia required in 24 hrs were recorded postoperatively. Result: Analysis revealed the postoperative analgesic efficacy of oral Gabapentin showed better pain tolerance compared to that of oral Clonidine. The Ramsay sedation score showed a significant sedative effect by Gabapentin than in Clonidine at 90 mins, haemodynamic parameters changes suggested Gabapentin to be haemodynamically stable than clonidine, Morphine consumption in 24 hrs was significantly high in Clonidine group with increased incidence of nausea and vomiting. Conclusion: Oral Gabapentin 300 mg given before 90 minutes as preemptive analgesia was more effective in reducing postoperative pain and morphine consumption, also providing better anxiolysis in patients undergoing abdomino-pelvic Surgeries under spinal anesthesia compared to Oral Clonidine 100 μg.

Background: Clonidine is one of the drugs that have been extensively studied by administering through oral, intravenous and intrathecal routes to prolong the spinal anesthesia. A lot of studies have shown oral clonidine premedication to prolong duration of sensory block and motor block. This study is undertaken to evaluate the effect of oral clonidine as premedicant on spinal anesthesia with 0.5% hyperbaric bupivacaine. Methods: A double blind randomized controlled study was carried out on 100 participants who underwent elective surgeries under spinal anesthesia. The participants were allocated into experimental (oral Clonidine) and control group (50 each) equally. Heart rate, level and duration of sensory and motor blockades were observed. Results: The mean time to highest sensory blockade was lower in experimental group (5.28 min) when compared to control group (7.76 min). The observed difference was statistically significant (p<0.001). Similarly, there was a statistically significant difference in the mean duration of motor blockade between the groups, wherein the experimental group had a longer duration (264 min) compared to the control group (208.50 min) (Table 4). Conclusion: Premedication with oral clonidine 150μg, 1 hour prior to spinal anesthesia is adequate to provide clinically useful prolongation of sensory blockade without significant adverse effects.

Background: Proseal LMA (PLMA), is the latest entrant in the family of LMA designed for positive pressure ventilation and protection against aspiration. These features of PLMA are especially useful in laparoscopy surgeries, which are widely preferred these days and can act as an alternative to the Endotracheal tube (ETT). Rigid laryngoscopy during endotracheal intubation (the gold standard for safe glottic seal) causes hemodynamic responses which add to the stress of pneumoperitoneum in laparoscopic surgeries, unlike Proseal LMA which is a supraglottic device and less invasive. Aim: To compare the efficacy and safety of the Proseal Laryngeal Mask Airway with Portex endotracheal intubation in gynecological laparoscopic surgeries under general anesthesia. Setting and Design: A prospective, randomized study was conducted on 60 females, ASA-I & ASA-II patients undergoing laparoscopic gynecological surgery under general anesthesia. Ethical clearance and written consent were obtained before the study. Patients were randomly divided into two groups-PLMA (P) and Endotracheal tube (E) depending on the device used to secure the airway. Ease, attempt of of insertion, hemodynamic parameters, and postoperative complications were studied. Results: The insertion rate was 100% in both groups. Vital parameters like heart rate, systolic bp, diastolic bp and mean arterial pressure were relatively lower with Proseal LMA at 1 min, 3 min, and 5 min and after removal as compared to ETT. The difference was statistically significant. There was no significant difference in End-tidal CO2, SpO2, during baseline, insertion, and removal of the device, before and after pneumoperitoneum, and also in airway pressure during insertion, before and after pneumoperitoneum. Perioperative complications were higher with the endotracheal tube. Conclusion: The Proseal LMA offers a safe and effective alternative for airway management in patients undergoing gynecological laparoscopic procedures under general anesthesia.

Introduction: The assessment of pain in small children is often difficult to interpret as the most common sign of pain is crying which is also seen in a myriad of non pain full conditions. Epidural space in children favours rapid longitudinal spread of drugs and makes it effective in treating postoperative pain. Aim: The aim of this study was to evaluate the efficacy of caudal bupivacaine alone or in combination with butorphanol for postoperative analgesia in children undergoing infra-umbilical surgeries. Materials and Methods: A Simple Randamoized which includes 50 patients posted for urogenital operations such as herniotomy, orchidopexy, urethroplasty and CTEV Correction divided into two groups of 25 each. Group B received 0.25% plain bupivacaine and Group BB received 0.25% Bupivacaine with Butorphanol adjuvant. The effect of recovery from caudal blockade and duration of analgesia was compared and contrasted. Results: There were no significant changes in heart rate, blood pressure and oxygen saturation between two groups. Postoperative pain score was comparable in two groups in first eight hours, but it is significantly less in bupivacaine with butorphanol group which is statistically significant. There is a significant difference between the groups in the mean duration of analgesia with Group BB having a much longer duration compared to Group B. 3 patient in Group B and 5 patient in Group BB had nausea in postoperative period, which is statistically insignificant (p>0.05). No episodes of any other clinically significant postoperative complications were recorded. Conclusion: Butorphanol is considered to be a safe and effective adjuvant to Bupivacaine for caudal analgesia in children undergoing surgery below umbilicus.

Abstract: Laryngoscopy and intubation can result in significant haemodynamic response which is even more exaggerated in hypertensive patients. The magnitude of cardiovascular response is directly related to the force applied and duration of laryngoscopy. Various airway devices and drugs have been tried to limit this pressure response. We conducted a prospective, randomized study to compare the haemodynamic response to intubation using McCoy laryngoscope, Intubating Laryngeal Mask Airway (ILMA) and VividTrac® video laryngoscope in patients with controlled hypertension requiring general anaesthesia for various surgeries. Methods: The study included 90 controlled hypertensive patients of either sex, belonging to ASA grade II, between the age group of 40-60 years, requiring general anaesthesia were divided into three groups. In group M, patients were intubated with a McCoy laryngoscope. In group L, patients were intubated with intubating LMA. In group V, patients were intubated using a VividTrac® video laryngoscope. The haemodynamic response following intubation was compared among all three groups. Intubation time, the success rate of intubation and complications, if any, were also compared in all three groups. Results: It was observed that the VividTrac® video laryngoscope produced significantly less haemodynamic response compared to intubation with ILMA and McCoy laryngoscope. Intubation using McCoy laryngoscope was found to be comparatively a faster method to secure tracheal intubation when compared to ILMA and video laryngoscope. Complications, like oesophageal intubation and sore throat, were more with intubating LMA, whereas injury to oropharyngeal mucosa was found to be observed with VividTrac® video laryngoscope. Conclusion: VividTrac® video laryngoscopy and intubation cause fewer haemodynamic changes compared to Intubating LMA and McCoy laryngoscopy.

Gout is a chronic metabolic, inflammatory disease causing hyperuricemia with formation and deposition of monosodium urate crystals in joints, tissues and involving multiple systems. It has important anaesthetic and critical care implications. This review article aims to present an overview of gout and the effects of hyperuricemia along with its important peri-operative implications. The literature is sparse regarding its anaesthetic considerations.

Introduction: Dexmedetomidine is a potent and highly selective alpha (2)-adrenoreceptor agonist. It has sympatholytic and antinociceptive effects which allow hemodynamic stability during stressful condition e.g. Laryngoscopy and surgical stimulation. This study has been done to assess the efficacy of nebulization of Dexmedetomidine to obtund the sympathetic response of laryngoscopy and tracheal intubation. Material and Methods: The present study was conducted on 70 patients of ASA physical status I and II, aged between 18 and 50 years of either sex, scheduled for elective surgeries under general anaesthesia. The preoperative vitals of each patient [HR, SBP, DBP and MAP] was recorded in waiting room of operation theatre. The patients were randomly divided into two groups. In preoperative room/ waiting area, Group-N (Normal saline group) patients were nebulized with normal saline (5 ml) and in Group-D (Dexmedetomidine group) patients were nebulized with Dexmedetomidine solution (2 mcg/kg) 30 minutes prior the induction of anaesthesia. All patients were induced with Inj. Fentanyl 2 mcg/kg, Inj. Propofol 2 mg/kg and paralyzed with Inj. Vecuronium 0.1 mg/kg. After confirming adequate neuromuscular blockade HR, SBP, DBP and MAP were recorded; Laryngoscopy was done [keeping laryngoscopy timing < 15 seconds] & patients were intubated with standard/ adequate size endotracheal tube. Heart rate and blood pressure were recorded after intubation at 1minute interval for 5 minutes. During this time no other stimuli were given to the patient (e.g. surgical drape, catheterization, Ryle’s tube etc.). The comparison was made between hemodynamic parameters obtained at pre-laryngoscopy and post laryngoscopy time period. Result: We found that in Group- D, the parameters were lower than the baseline value at 3 min time after intubation. However, hemodynamic variables never reached the baseline by 5 minutes time in case of Group- N. Neither bradycardia nor hypotension was observed in any of the patients. The sedation score was more in Group- D when compared to Group- N. This indicates that nebulization with Dexmedetomidine in a dose of 2 mcg/kg is effective and safe in attenuating the laryngoscopy & tracheal intubation sympathetic response. 

Aim: The primary objective of the study was to compare the early post-operative recovery profile of Sevoflurane with Desflurane in adult patients undergoing elective neurosurgical procedures, with respect to emergence time, extubation time and the time taken to reach Aldrete score of 9. The secondary objectives were comparison of intra-operative hemodynamics, brain swelling, post-operative nausea and vomiting (PONV) and shivering. Methodology: After obtaining Institutional Ethical Committee (IEC) approval, 50 consenting adult patients posted for elective craniotomies were randomly allocated by computer generated random number technique into two groups, Group S (Sevoflurane) and Group D (Desflurane). Patients were preoxygenated and induced as per institution protocol. Patients were intubated with appropriate size endotracheal tube and anaesthesia was maintained with O 2: Air at 50%, chosen volatile anaesthetic that was age adjusted to obtain 1 MAC. Tidal volume and respiratory rate were adjusted to obtain an End tidal CO2 (EtCO2) of 30-35 mmHg. Normothermia was maintained with forced air warmer. When the duramater was opened, subjective assessment of brain swelling was done by the neurosurgeon, who was blinded to the study group. Infusions were stopped once the bone flap was secured and the volatile agent was discontinued after skin closure and detachment of Mayfield head holder. Patients were reversed and extubated after TOF ratio was > 0.9 and hemodyamics were stable. Intra-operative hemodynamics, brain swelling, emergence time, extubation time, time to reach Aldrete score of 9, PONV and shivering were recorded and patients were shifted to PostAnaesthesia Care Unit (PACU) for monitoring. Results: Statistical analysis was done using SPSS software. Descriptive statistics of mean and standard deviation were arrived for the variables wherever appropriate and Paired ‘t’ test, Chi-square test or Fischer’s test were used wherever appropriate to compare the mean difference between the variables to derive the p-value. A p-value of <0.05 was considered statistically significant. The Emergence time (Group S 8.28 ± 3.75 minutes vs. Group D 8.44 ± 3.98 minutes; p-value 0.885), Extubation time (Group S 11.84 ± 4.13 minutes vs. Group D 11.92 ± 5.01 minutes: p-value 0.959), time to reach Aldrete score of 9 (Group S 7.72 ± 4.2 minutes vs. Group D 6.2 ± 3.74 minutes: p-value 0.618) were statistically and clinically comparable. The secondary objectives of the study like intra-operative hemodynamics (MAP with p-value 0.977, HR with p-value 0.431), brain swelling (p-value 1.00), PONV (p-value 0.307) and shivering (p-value 1.00) were also comparable between two groups. Conclusion: We conclude that there was no statistically significant difference in early recovery profile between Sevoflurane and Desflurane in neurosurgical procedures with respect to emergence time, extubation time and time to reach Aldrete score of 9. There was no significant difference in intra-operative hemodynamics, incidence of postoperative nausea and vomiting, shivering and brain swelling between both the groups.

Background and Objectives: Post-operative mechanically ventilated patient in the intensive care unit (ICU) frequently need sedation and analgesia to facilitate care. Inadequate Sedation in patients admitted to the ICU after surgery leads to patient discomfort, ventilator asynchrony, accidental device removal, and increase metabolic demands during respiration. Careful drug selection for sedation by the ICU team is essential so that patients can be easily weaned from mechanical ventilation after stopping sedation to achieve lesser duration of mechanical ventilation and to decrease ICU stay. Dexmedetomidine, a short-acting alpha-2-agonist, has anxiolytic, anesthetic, hypnotic, and analgesic properties.Propofol is recommended for the short-term (<24 h) treatment of anxiety in post-operative mechanically ventilated patients. The objective of this study was to compare the efficacy and safety of dexmedetomidine versus propofol for post-operative mechanically ventilated patients in ICU before weaning from mechanical ventilation. Methodology: Thirty patients aged above 20 years after major abdominal or pelvic surgeries requiring at least 6 hrs artificial ventilation admitted to ICU were included as subjects and they were randomly divided into two groups of fifteen each. Group D received Dexmedetomidine, a loading dose of 2.5 μg/kg and a maintenance dose of 0.5 μg/kg/hr and Group P received Propofol, a loading dose of 1 mg/kg and a maintenance dose of 0.5 mg/kg/hr. Both the groups were compared for level of sedation using Ramsay sedation score, hemodynamic variables, safety profile and fentanyl requirement to achieve adequate analgesia. Results: Ramsay sedation score was within the desired level (2-4) in both Dexmedetomidine and Propofol groups (p>0.05). Patients who received Dexmedetomidine infusion had significantly decreased heart rates when compared to patients who received Propofol infusion (p<0.00). Total Fentanyl dose requirement was significant in Propofol group (66.3 ± 10.1 μg) when compared to Dexmedetomidine group. (31.0 ± 9.5 μg; p=0.001). Conclusion: Dexmedetomidine and Propofol are safe sedative drugs for post-operative mechanically ventilated patients.To compare with Propofol, Dexmetomidine induces less sedation level with the same duration of mechanical ventilation and has its own analgesic effect and shortens the length of patient's stay in ICU. Bradycardia was noted more frequently in Dexmedetomidine while arterial hypotension, general malaise and delirium in Propofol group.Fentanyl requirement was more with Propofol group.

Background: We evaluated usefulness of Mallampati test, Inter incisor distance, Thyromental distance and Sternomental distance in predicting difficult intubation in oral cancer surgery patients. Methods: Preoperatively, assessment of airway predictors was done in 111 patients undergoing oral cancer surgery. Difficult intubation was defined as Cormark and Lehane grading of grade 3 & 4. Results: Incidence of difficult intubation was found to be 18% patients. By using Receiver operating characteristic analysis, Inter incisor distance < 2.55 cm, Thyromental distance < 8.75 cm were found to be the cut off points of difficult intubation. Sensitivity and specificity for predicting difficult intubation by Interincisor distance was 60% and 78% respectively with a positive predictive value of 39% and with higher negative predictive value of 89%. AUC (area under curve) with 95% confident interval showed 0.69% for Inter incisor distance, 0.64% for Thyromental distance and 0.57% with Sternomental distance. Conclusions: Inter incisor distance and Mallampati grading was a better predictor compared to other parameters and Sternomental distance showed the least significance in predicting a difficult airway in oral cancer surgery patients.

Context: Bupivacaine is a commonly used local anesthetic in peripheral nerve blocks. Ropivacaine is a newer local anesthetic and has better safety profile. The study was done to compare the two drugs. Aims: To compare the effects of Inj. Bupivacaine 0.5% and Inj. Ropivacaine 0.5% as local anesthetic for supraclavicular brachial plexus block in upper limb orthopedic surgeries. Study design: Randomized comparative study. Methods: The study was done at a medical college hospital. The patients included in the study were randomized into two groups (Bupivacaine and Ropivacaine) and were given 30 ml of respective drug under ultrasound guidance. The drugs were compared in terms of time taken for onset of action, duration of sensory and motor block, side effects. Statistical analysis used: Chi-square test and student’s t-test. Results: The time taken for onset of sensory block was less with Bupivacaine (16.6 + 3.2 min) than with Ropivacaine (19.9 + 4.0 min) (p=0.0001). The onset of motor block was earlier with Bupivacaine (21.4 + 2.6 min) in contrast to Ropivacaine (25.9 + 2.4 min) (p=0.001). The duration of sensory blockade (Bupivacaine– 343.8 + 44.4 min; Ropivacaine– 317.9 + 29.1 min) and motor blockade (Bupivacaine– 387.4 + 36.0 min; Ropivacaine– 368.7 + 33.1 min) was longer with Bupivacaine (p=0.003; p=0.019 respectively). There were no adverse effects in both the groups. Conclusion: At equal volumes, Bupivacaine has advantage over Ropivacaine for supraclavicular brachial plexus block.

Background: Caesarean delivery requires significant traction of peritoneum and intra-abdominal organs. Intra operative visceral pain is sometimes a problem during spinal anaesthesia. Increasing the dose of local anaesthestic is associated with less intra operative visceral pain. Objective: To evaluate the quality of intra operative analgesia and post-operative analgesia when fentanyl is added to intrathecal bupivacaine for caesarean section. Methods: Double blind, randomized controlled trial was conducted among 80 patients aged between 18-35 years from February 2007 to January 2008. 80 patients of the age group 18-35 years undergoing cesarean section, belonging to ASA Grade 1 were considered for this study. The patients were randomly divided into two groups of 40 patients each. Epi info 7 was used for analysis. Results: age and anthropometric characters (height and weight) were calculated in terms of mean and Standard deviation. As seen no significant difference was seen either in age, height or weight (p>0.05). For Mean BP at the time of arrival and during positioning for intrathecal injection: p > 0.05- not significant. After intrathecal injection: p < 0.01- highly significant. 1 min, 2 min, 3 min, 4 min, 5 min, 6 min, 7 min after intrathecal injection: p > 0.05 – not significant. Conclusion: Addition of fentanyl (12.5 µg) to 0.5% hyperbaric Bupivacaine (10 mg) provides early onset of sensory blockade, improvement in intraoperative analgesia and significant increase in the duration of postoperative analgesia.

Introduction: Carbon dioxide insufflation for pneumoperitoneum causes increase plasma levels of catecholamines and vasopressin which leads to hemodynamic disturbances. These effects are exaggerated by the trendelenburg position and long duration of surgery in robot assisted surgeries. This study was designed to evaluate the effect of Dexmedetomidine and fentanyl on hemodynamics in robot assisted surgeries in trendlenberg position. Methods: After obtaining Ethical committee clearance and patients consent, randomised comparative study on 40 ASA I and II patients, who were randomly allocated to receive either dexmedetomedine or fentanyl intravenous infusion was done. Patients with ASA III & IV, on β blockers, HR<55 bpmin were excluded. Intraoperative Hemodynamics, recovery and emergence was assessed. Students ‘t’ test was used. Results: The study included 40 patients undergoing robotic lower abdominal surgeries requiring steep trendlenberg positions. Dexmedetomedine group of patients showed better intra operative hemodynamics at various time intervals as compared to Fentanyl group of patients.

Introduction: Several modalities have been used to alleviate pain after laparoscopic abdominal surgeries – like nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (both intravenous and patient controlled analgesia, infiltration of local anaesthetic, thoracic epidural block and multimodal analgesia. Apart from providing post operative pain relief, regional anaesthetic techniques improve patient recovery by preventing the neuroendocrine responses to surgery and reducing the postoperative opioid requirements. Aim: To compare the efficacy of 0.2% ropivacaine and 0.25% bupivacaine when used in USG guided Transversus abdominus plane block for post operative analgesia in abdominal surgeries. Material and Methods: 50 patients scheduled for elective lower abdominal surgeries. The patients were randomly divided into two groups of 25 each- Group B receiving 0.25% bupivacaine, group R receiving 0.2% ropivacaine. Conducted in Department of Anesthesiology, Great Eastern Medical School & Hospital, Srikakulam. Result: Results showed no significant differences between the study groups in terms of age, weight and gender distributions. VAS showed significant difference between the study groups at 6 hrs and 12 hrs. The mean postoperative VAS in group B (0.25% bupivacaine) was maximum at the end of 6 hrs (4.08) whereas the mean postoperative VAS in group R (0.2% ropivacaine) was maximum at the end 12 hrs (4.0). Conclusions: Ropivacaine can be used as a safe alternative to Bupivacaine, routinely for TAP block for patients undergoing abdominal surgeries.

Introduction: Etomidate a GABA receptor stimulating hypnotic agent is short-acting, has minimal residual sedation and a favourable haemodynamic profile and is thus a common choice for short term procedures especially in the haemodynamically compromised patients. But it has undesirable side effects of pain on injection and myoclonus. The problem of pain on injection has been solved by a new lipid formulation for etomidate. Myoclonus is seen in up to 50 to 80% of patients during induction of anaesthesia with etomidate if no supplemental agents are used. A number of drugs have been investigated for the suppression of etomidate-induced myoclonus. Ideally a pre-treatment drug for preventing myoclonic movements should be short acting, not have significant effects on respiration and haemodynamics and not prolong recovery from anaesthesia. Etomidate has a less inhibitory effect on the pharyngo-laryngeal reflex, hence blunting the responses to laryngoscopy and endotracheal intubation is also necessary. Materials and Methods: This study was conducted to study the effect of pre-treatment with midazolam on etomidate induced myoclonus.We studied 30 patients who were given Midazolam pre-treatment before administration of Etomidate. Results: 23.33% (7/30) patients developed myoclonus and none of them had severe myoclonus. Vital were not significantly affected. Conclusion: Midazolam is a good pre-treatment option before etomidate as it reduces incidence and severity of etomidate induced myoclonus without significant adverse effects.

Background: Brachial plexus block achieves ideal operating conditions by producing complete muscle relaxation, maintaining stable intra-operative hemodynamics and associated sympathetic block. Usage of adjuvant drugs along with local anesthetic, to lower the dose of each agent and enhance analgesic efficacy and thereby reducing the incidence of adverse events is a routine practice in regional anesthesia. Aim: To assess the anesthetic and analgesic effect of adding clonidine with bupivacaine as a regional anesthetic agent for brachial plexus block during upper limb surgeries. Methodology: A prospective longitudinal study was conducted for a period of one year from the anesthesiology department of Vinayaka Missions Medical College Hospital Salem. A total of 60 patients were included for the study and it was divided into two groups. Group A patients received 25 ml of 0.5% bupivacaine and group B patients received 25 ml of 0.5% bupivacaine along with 0.2 ml (30 mcg) clonidine. Onsite time and the duration of sensory and motor block was recorded along with the duration of analgesia and the maximum number of doses of analgesics required were also noted. Vitals were recorded at intervals of 5 min for first 30 min, then after every 10 min till end of surgery, and then hourly after surgery. Results: The onset of sensory and motor block was found to be much quicker and prolonged for a longer duration among the patients who received bupivacaine along with clonidine and the difference in time duration was found to be statistically significant. Similarly, the post-operative analgesia effect was found to be longer (487.9 mins)among the group received bupivacaine with clonidine with a less number of additional requirement of analgesia dose (1.1 dose) whereas the analgesia effect among the group received bupivacaine alone was 303.6 mins with mean additional dose of analgesia of 2.4 and the difference was found to be statistically significant. Vital parameters were normal and were almost similar among both the groups. Conclusion: Thus, our study had demonstrated that addition of clonidine as an adjuvant drug along with bupivacaine as a regional anesthetic agent in supraclavicular brachial plexus block had significatly prolonged the duration of analgesia and improved the quality of anesthesia.

Study Objective: To compare intravenous dexmedetomidine in combination with midazolam and dexmedetomidineas premedication in patients receiving spinal anaesthesia. Design: Prospective randomized controlled double blind study. Methodology: 60 patients belonging to ASA physical status I and II scheduled for surgery under spinal anaesthesia were randomly selected for the study and were randomly divided into two groups of 30 each. Group DM patients received intravenous dexmedetomidine 1 μg/kg in combination with midazolam 0.025 mg/kg (bolus) and group D patients received intravenous dexmedetomidine1 μg/kg (bolus) as premedication before receiving 3 ml (15 mg) of intrathecal hyperbaric bupivacaine (spinal anaesthesia). Hemodynamic changes, to note down the level of sedation, additional analgesic requirements preoperatively, and complication if any were studied. Results: Ramsay sedation score was statistically significant in the dexmedetomidine in combination with midazolam group (DM) for 20 minutes in comparison with Dexmedetomidine (D) group, and there after the sedation scores were similar in both the groups (sedation score of 2-3) without any respiratory depression. The time request for analgesia, hemodynamic parameters and side effects were similar in either of the groups. Conclusion: Intravenous bolus of dexmedetomidine (D) is sufficient to provide adequate sedation with good hemodynamic stability and without respiratory depression in patients who receive spinalanesthesia.

Background: Spinal anesthesia is the most commonly used anesthesia for orthopedic surgery. Despite of using long acting local anesthetic like Bupivacaine, the duration of anesthesia is short. Therefore, various drug combinations like Clonidine, Ketamine, Opioids etc. have been tried to prolong duration of analgesia. Methodology: This study was conducted among 60 participants GMERS Hospital, Valsad. Patients were randomly allocated to 2 groups. Thirty subjects were in each group who received either 0.5% heavy Bupivacaine 3 ml (15 mg) + Clonidine 0.3 ml (45 µg) (Group A) or 0.5% heavy Bupivacaine 3 ml (15 mg) + Midazolam 0.2 ml (1 mg) + 0.9% normal saline 0.1 ml (Group B). Time required for sensory block, motor blockade, level of sedation and post operatively pain measurement was assessed. Result: The present study showed that significant decrease in mean arterial pressure and heart rate at 30, 45 and 60 min in patients with adjuvant clonidine as compared to midazolam. Mean time for sensory onset, sensory regression to S2 from highest sensory level, two segment sensory regression, total duration of motor blockade and onset of grade-3 motor blockade in patient with adjuvant Clonidine was significantly higher as compared to adjuvant Midazolam. Post operatively there was no significant difference in mean postoperative systolic blood pressure, diastolic blood pressure, pulse rate, saturation and respiratory rate. Sedation score was also higher in patients with adjuvant Clonidine group. Most common reported adverse events with Clonidine was hypotension and bradycardia. Conclusion: Adjuvant Clonidine 45 μg intrathecal hyperbaric Bupivacaine (0.5%) significantly prolongs duration of motor and sensory block. It provides adequate hemodynamic stability, prolongs postoperative analgesia without any significant side effects.

Background and aim of the study: The rationale behind this study was to reduce the side effects of standard dose of tramadol by reducing the dose of tramadol and to achieve same analgesic effect by combining with diclofenac. So this study compares the analgesic efficacy and side effect profile of rectal tramadol 100 mg with combination of rectal tramadol 50 mg and rectal diclofenac 50 mg in patients undergoing lower abdominal surgeries. Materials and Methods: Two hours after the establishment of spinal anaesthesia, patient were administered either tramadol 100 mg rectally in Group T (n=50) or combination of tramadol 50 mg rectally and diclofenac 50 mg rectally in Group TD (n=50). Using 0-10 numeric rating scale (NRS), pain at the surgical site at rest during postoperative period was measured. Any side effects like nausea, vomiting, pruritus, dizziness, headache, drowsiness, gastritis, Sweating etc. for 24 h was noted. Results: The mean duration of effective postoperative analgesia was 314.5 ± 7 minutes and 318.9 ± 5 minutes in group T and TD respectively. The difference between the groups with respect to duration of effective postoperative analgesia was not statistically significant. Group T had a statistically higher incidence of nausea and vomiting than group TD. Conclusion: The combination of low dose tramadol and diclofenac may be a better alternative to standard dose tramadol as it provides same quality and duration of analgesia with fewer side effects.

Introduction: Intubation and maintenance of the airway is one of the most important steps in anaesthesia practice and a fundamental responsibility of the anaesthesiologist. Airway assessment is an integral part of pre-anaesthetic evaluation to recognize a potentially difficult airway. A range of bedside screening tests are available to predict a difficult airway but with doubtful accuracy. Hence, identifying a single reliable predictor of difficult intubation is valuable. Hence, the present study aims to evaluate the usefulness of thyromental height test alone as a single predictor of difficult laryngoscopy in our population. Methods: After ethical clearance and taking informed consent, we conducted a randomized prospective observational study on 315 adult patients posted for elective surgical procedures under general anaesthesia with endotracheal intubation. Airway was assessed and Thyromental Height (TMH) was measured on the day before surgery. Intra – operatively laryngoscopy was performed and Cormack- Lehane’sgrading noted. The preoperative assessment data and laryngoscopy findings were used together to evaluate the accuracy of TMHT in predicting difficult laryngoscopy. Results: Mean TMH observed in our study was 52.80 mm. TMHT at cut off of 50 mm had high sensitivity of 82.3% and high negative predictive value of 96.7%, but with low specificity of 63.7% (P value 0.000). When the cut off revised to 48 mm, sensitivity and specificity had best compromise, sensitivity of test decreased to 64.7% and specificity increased to 79.7% (p value 0.002). Conclusion: The present study demonstrates the practicality of TMHT. It confirms the good sensitivity of TMHT for predicting difficult intubation, but validation will require further studies in more diverse patient population.

Background: A new SADs called I-gel has several advantages such as easy insertion, stability after insertion and minimal risk of tissue compression. Incidence of postoperative complication was not differ among I- gel and c-LMA. Very few reports that have evaluated the paediatric I-gel, especially in small children. Methodology: Total 90 ASA grade I-II patients of 1-12 years age group (45 patients in Group I: I – gel, 45 patients in group L: c-LMA classic) who undergone elective urology surgery from civil hospital, Ahmedabad were included in the study. A supraglottic device was inserted after required depth of anaesthesia achieved. The ease of insertion, insertion time, attempt of insertion and sealing pressure were noted. Vital parameter during surgery and complication in post anaesthesia care unit were recorded. Result: Success rate for first attempt in I-gel group was significantly higher (85.0%) as compared to cLMA (80.0%). The insertion time was shorter with I-gel (14.64 + 16.7 sec) than with c-LMA (20.11 + 28.5 sec). Airway leak pressure of I-gel is higher (26 + 2.63 mmHg) than c-LMA (22 + 2.3 mmHg). On removal, blood stain was present in one patient in I-gel group and 3 patient in c-LMA group. There was no significant change in hemodynamic parameters before and after insertion in both the group. Conclusion: I-gel is superior than c-LMA in terms of significantly easier and more rapid insertion with high leak pressure. The hemodynamic changes after insertion and the postoperative complication are not significantly differ between c-LMA and I-gel patients.

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor in young males with potential life threatening complications. Advances in pre operative imaging, pre operative embolisation, and hypotensive anesthesia have made JNAs amenable to surgical resection with minimal complication. We present anesthetic management of JNAs that have been operated in our institute over the recent years. Method: After ethical committee approval, details of patients undergoing surgery for JNA were noted with regard to demographics, preoperative optimization and evaluation, intraoperative management and complications, and postoperative course. Twenty patients were evaluated and included in our study. Results: The age of JNA patients ranged from 9-17years. All our patients had undergone preoperative embolisation of the feeding artery. Standard anesthesia induction technique was used in all the patients. Controlled hypotension was achieved with the help of a combination of inhalational anesthetics and vasodilators. Average duration of surgery was 126.7 ± 55 minutes, and mean blood loss was 822 ± 291 ml. Seven patients were extubated in the operating room. The other 13 patients were remained intubated for 24 hours due to extensive surgery with a risk of postoperative hemorrhage, and were monitored in the postoperative intensive care unit. Conclusion: JNAs remain a challenge for anesthesiologists because of excessive intraoperative hemorrhage. Invasive monitoring, along with hypotensive anesthesia decreases bleeding and provides a clear field of vision for operating surgeon.

Introduction: An endotracheal tube always considered to be the gold standard to maintain an airway because of its inherent ability to provide positive pressure ventilation [1,2]. Haemodynamic responses, situations of failed intubation, unable to ventilate and unable to intubate are also a serious concern. With the advent of newer supraglottic airway devices, these drawbacks of tracheal tube are avoided. The Proseal laryngeal mask is a new laryngeal mask device with a cuff modified to improve the seal around glottis and a drainage tube to provide for aspiration of gastric contents. The aim of our study was to compare efficacy and safety of Proseal Laryngeal Mask Airway with portex cuffed endotracheal tube in patients undergoing surgeries under general anaesthesia. Aim and Objectives: To compare efficacy and safety of Proseal Laryngeal Mask Airway with Portex cuffed endotracheal intubation in sixty adult patients undergoing surgeries under general anaesthesia. Results: Both groups were comparable with respect to their demographic characteristics. Time taken for insertion in group P and group E was similar. The study participants where Proseal LMA was used had a statistically significant lower rates of HR, SBP, DBP and MAP, at 1, 3, 5, 10 mins and after removal of device than participants in whom endotracheal tube was used. Side effects were lower in group P than group E. Conclusion: Proseal LMA is suitable and safe alternative to endotracheal tube for airway management.

Aims: A high incidence of anxiety about anesthetic procedure is seen in patients undergoing surgical procedures, which can be related to their unawareness about anaesthesia and anaesthetist's role in perioperative care. we aimed at assessing the effectiveness of a simple informative audiovisual clip as preoperative educational tool in reducing the anxiety in patients undergoing surgical procedures under spinal anaesthesia. Methods: A prospective randomized study involving 200 patients undergoing surgery under spinal anaesthesia was conducted. 2 groups with 100 patients in each group were formed and named as group AV (those who were shown audiovisual clip) and group NV (patients in this group were not shown the audiovisual clip). Anxiety scores were assessed using the spielberger state - trait anxiety inventory at both preoperative visit and just before the surgery. Hydrodynamic parameters like Heart rate and mean arterial pressures were recorded. Appropriate statistical tests were applied for analysis of the obtained data. Results: Baseline anxiety scores and hemodynamic parameters were comparable in both the groups. Compared to AV group the patients in NV group showed statistically significant rise in anxiety scores when measured before the spinal anaesthesia (p <0.001). Hemodynamic parameters were stable in AV group when compared to NV group (p < 0.001). Patients in AV group showed statistically significant decrease in anxiety scores from baseline values, when measured just before the spinal anaesthesia. Conclusion: Preoperative education in the form of informative audiovisual clip is effective in reducing patient anxiety about spinal anaesthesia.

Background: Spinal anaesthesia is well established technique in which several local anaesthetic drugs are used. These drugs have their own advantages and disadvantages regarding safety profile, onset and duration of action. The continuous search is going on to find safer drugs with having lesser side effects. Material and Method: This study was planned with an aim to compare Ropivacaine 0.5% in 5% glucose solution with the commercially available Bupivacaine 0.5% in glucose 8% (heavy) given in spinal anaesthesia regarding stability; onset and duration of sensory block; onset and duration of motor block and associated side effects like nausea/vomiting and pruritus. This was a prospective randomized double blind clinical control trial in which total 80 patients of either sex were enrolled and divided into two groups (Group A-Ropivacaine and Group B- Bupivacaine) using envelope method. Data Analysis: Data of both the groups were recorded and compared statistically. To compare the means, independent t-test was applied and to compare categorical data chi-square test was used. Result: As a result of the study it was found that hemodynamic parameters were comparable in both the groups; Onset of sensory as well as motor block were faster in the Bupivacaine group; total duration of motor block and sensory block was shorter in Ropivacaine group; time taken for mobilization was significantly lesser in Ropivacaine group; side effects like nausea/vomiting were also less in Ropivacaine group. Conclusion: It can be concluded that Ropivacaine 0.5% in 5% glucose is a good alternate to Bupivacaine heavy in short duration lower abdominal surgeries with shorter sensory and motor block duration and lesser incidence of adverse effects.

Keyword: Hyperbaric Ropivacaine; Spinal Anesthesia; Bupivacaine; Lower abdominal surgery.

Background: Parturients are often not prepared for labour analgesia in advance. They demand it when they are already in labour with unbearable pain; many a times an hour or two before the delivery. This study was done to evaluate the efficacy of medicine in analgesia during labour. Objective: To assess the efficacy of intrathecal Buprenorphine as a sole method for analgesia in labour. Methods: Double blind, randomized controlled trial, 30 parturients in active labour were studied. Labour ward, Department of Obstetrics and Gynaecology, Dr. Balabhai Nanavati Hospital, Vile Parle, Mumbai, during 1st January 2006 to 31st December 2006. Epi-info 7 was used for analysis and student t-test was used. Results: There was no significant difference in age, weight, height and gestational age between two groups. (p > 0.05). There was significant change in duration of analgesia in both the groups (p < 0.001). Mean Pulse rate At 0 minutes and 2 minutes p value was < 0.05 – significant when compared in both groups. Conclusion: Addition of buprenorphine to intrathecal fentanyl and bupivacaine provides early onset and prolonged duration of analgesia during labour.

Introduction: Labour is a highly complex and personal process for every woman. Analgesic intervention is a matter of personal choice for delivery. Local anesthesia given as an epidural injection along with an opioid gives quicker analgesia without impeding motor activity. Bupivacaine and Ropivacaine are commonly employed drugs to provide efficient epidural analgesia in labour. Aims: To compare the efficacy of ropivacaine with fentanyl and bupivacaine with fentanyl given as continuous infusion in labour epidural analgesia. Materials and Methods: This was a prospective randomized control trial wherein 70 women in labour were studied. These 70 parturients were randomly put into two groups. Group A (n=35) received 12 ml of 0.125% ropivacaine as the initial bolus followed by 8 ml/hour infusion of 0.125% ropivacaine with 2 µg/ml fentanyl. Group B (n=35) received 12 ml of 0.125% bupivacaine as initial bolus followed by 8ml/hour infusion of 0.125% bupivacaine with 2 µg/ml fentanyl. Various parameters like duration of labour, mode of delivery, neonatal outcome and complications were noted and compared for both the groups. Results: Both the groups showed minimal fluctuations in pain that were clinically and statistically insignificant. The spontaneous deliveries were similar in both groups. The rate of instrument assisted delivery and caesarean delivery was similar in both groups. No adverse neonatal outcome (because of the drugs used) in the form of low APGAR scores or admission to NICU were noticed in both the groups. Motor block was not statistically significant. The incidence of complications was minimal and comparable in both groups. Conclusion: Ropivacaine used at lower concentration (0.125%) offers good pain relief equivalent to that of bupivacaine. Both the drugs give similar results as regards the duration of labour, mode of delivery, neonatal outcome and complications. Though ropivacaine is less potent than bupivacaine, its safety and efficacy is equivalent to bupivacaine.

Objectives: The aim of this study was to determine the effect of position (Sniff / HELP) during laryngoscopy on the extent of change/ improvement in laryngoscopic view of glottis. Materials and Methods: This prospective, observational study was conducted on 245 patients who were scheduled to undergo elective surgeries, age 18-60 years, of either sex and ASA physical status I and II. Patients were positioned in HELP at first, following standard anaesthesia induction laryngoscopy was done to evaluate CL grade (HELP score). Patients were then positioned to sniff position and CL grade was reassessed (SNIFF score) and intubated. SNIFF score and HELP score were then compared. Chi-square, Fisher's exact, Student's t-test were used for analysis. Results: In 163 cases (66.5%) HELP and Sniff showed equal CL grades. In 67 cases (27.34%) HELP showed improved CL grades in comparison to Sniff. 47 cases (19.2%) of CL grade II by SNIFF position showed grade I view in HELP. Out of total 22 cases (9%) showing C & L grade III in SNIFF position, 15 cases (6.1%) showed grade I and 5 cases (2%) showed grade II in HELP. HELP provided equal/improved view in 230 cases (93.8%) of our study population which was statistically significant. Conclusion: HELP provides better glottic visualization and it should be the ideal intubating position for all patients (both obese and non obese) irrespective of age and sex. Neck circumference serves as more accurate predictor of poor glottic visualization during direct laryngoscopy as compared to BMI.

Introduction: Commonly we use 0.5% hyperbaric bupivacaine in spinal anaesthesia. Adjuvants to spinal anaesthesia have been used to improve quality of analgesia and in prolongation of anaesthetic duration. Dexmedetomidine has been studied and shown to have synergism with bupivacaine and other local anesthetics. Recently, in a few studies, intravenous (IV) dexmedetomidine has been shown to improve analgesic quality. In this study we aimed at finding the efficacy of (IV) dexmedetomidine in improving the analgesia quality and duration of subarachnoid blockade in our hospital scenario. Materials and Methods: Ninety patients were divided into two groups of 45 each. In Group A - 3.5 mL of 0.5% hyperbaric bupivacaine was used for spinal anesthesia. In Group B - 3.5 mL 0.5% hyperbaric bupivacaine used for spinal anaesthesia, thirty minutes later a loading dose of IV dexmedetomidine 1 mcg/Kg was infused over 30 min followed by maintenance dose of 0.3 mcg/kg/hr IV dexmedetomidine infused till the end of surgery. In Group A, isotonic saline was used instead of dexmedetomidine preparation. Duration of motor block, sensory block, analgesia, hemodynamic changes, sedation levels, complications and side effects were noted and compared between the study groups in patients undergoing lower abdominal surgeries. Results: The duration of motor block in Group A was 149.38 ± 21.32 minutes vs.189.13 ± 31.18 minutes in Group B (p< 0.05), duration of sensory block in Group A was 166.79 ± 33.12 minutes vs. 248.13 ± 48.32 minutes in Group B (p< 0.05), and duration of analgesia in Group A was 198.69 ± 41.38 minutes vs. 298.57 ± 34.65 minutes in Group B (p< 0.05). Conclusion: Use of IV dexmedetomidine improves analgesia quality and prolongs anaesthesia duration in subarachnoid block with 0.5% hyperbaric bupivacaine without any hemodynamic instability and with optimum sedation.

Introduction: Muscle relaxants are frequently used to facilitate endotracheal intubation during the induction of anesthesia. However, the administration of short-acting depolarizing muscle relaxants is associated with postoperative myalgias, malignant hyperthermia, hyperkalemia and increased intracranial or intraocular pressure. Aim: To compare the intubating condition and haemodynamic response to induction, laryngoscopy and intubation in patients induced with lignocaine, fentanyl and propofol or lignocaine, fentanyl and thiopentone and intubated without muscle relaxants. Methods: 40 patients were randomly allotted in P group [Propofol group] and T group [Thiopentone group]. Patients with the predicted difficulty of intubation, history of hypertension, history of asthma, drug or alcohol abuse, significant cerebrovascular disease and cardiovascular disease, BMI more than 30 kgm-2 were excluded from the study. The results were compared between both the groups. Jaw relaxation, vocal cord position, patient’s response to laryngoscopy and intubation were assessed and graded as excellent, good, and poor. Results: In this study higher incidence of ideal and acceptable intubating conditions were observed in 95% of patients in P group when compared with T group in which the acceptable intubating conditions were observed in 30% of the patients which is statistically significant (p < 0.05). The mean heart rate was decreased in both the groups after induction, but immediately after intubation, mean heart rate was high in group T, when compared with group P. Conclusion: We conclude that induction with Propofol, Fentanyl and Lignocaine provides better intubating conditions with less haemodynamic response to laryngoscopy and intubation than induction with Thiopentone, Fentanyl and Lignocaine.

Introduction: Relief of pain during operation and postoperative period is one of the main stay of balanced anaesthesia. Bupivacaine Hydrochloride is known for long procedures due to prolonged action. The addition of opioids has been opted as a method to reach these goals. Aims: To compare the intra-operative effects of a single low dose of intrathecal tramadol and fentanyl with hyperbaric bupivacaine hydrochloride. Materials and Methods: Fifty patients posted for various elective orthopedic procedures were studied in a randomized prospective double blinded manner. Patients will be randomly divided into two following groups. Group A: SAB with addition of 25 μg fentanyl to 3 ml of 0.5% Bupivacaine. Hydrochloride (hyperbaric), Group B: SAB with addition of 25 mg tramadol to 3 ml of 0.5% Bupivacaine Hydrochloride (hyperbaric). Results: During Intraoperative period no significant differences in BP, heart rate and respiratory rate were noted. There was no delay in time to full motor recovery in both the groups of patients. The mean duration of analgesia did not differ in both groups. Mean duration of analgesia in Group A was 565.4 minutes and in Group B was 551 min.Time for two segment regression did not differ in both the groups. The patients showed minimal side effects, like nausea, Vomiting, shivering and pruritis in both groups which was statistically insignificant. Conclusions: Both intrathecal tramadol and fentanyl act synergistically to potentiate bupivacaine induced sensory spinal block. Excellent surgical anaesthesia and an extended analgesia were observed in postoperative period with minimum side effects among both the groups.

Background: Post-operative nausea and vomiting is very much prevalent and unpleasant complaints with laparoscopic surgeries that leads to numerous emergencies so antiemetic prophylaxis reduced complications associated with nausea and vomiting. Aim and Objectives: To compare an efficacy of ondansetron & dexamethasone singly as well as a combination of both dexamethasone & ondansetron in the patients for those who undergoes laparoscopic surgeries and have a requirement of rescue anti-emetics. Methods: Sample size of the study was 150 patients (50 patients per group) which was between the age group of 20 years to 50 years of ASA I, II for those who chiefly requires a general anesthesia for laparoscopic surgeries in an arbitrary clinical trial. Therefore, 150 patients was divided into 3 group of 50 each of name Ondensetron group (O), Dexamethsone group (D)and OD group and respective drugs was administered 10 minutes before induction, and post-operative patients were evaluated at time interval of 0 to 6 hours (early vomiting category), 6 to 24 hours (delayed vomiting) to check the degree of nausea, vomiting along with the requirements of antiemetic drug. Results: Nausea was the bottom-most in Combination Group OD (considered as 6%) when compared to Ondansetron Group O (considered as 20%) & Dexamethasone Group D (considered as 12%). For vomiting incidence, results were opposite. It was less in OD Group (i.e. 4% only) when compared to O Group (i.e. 12%) & D Group (i.e. 16%). The requirement for antiemetic drug in the above-mentioned groups of O, D and OD was 26, 20 and 6 respectively. Last but not the least, incidence of vomiting & failure in prophylaxis was observed and analyzed in D Group during initial to 6 hours of duration. Also requirement was more for antivomiting drug of post-operation within 6 to 24 hours observed in O Group compare to OD Group. Conclusion: Combination therapy of ondansetron (Group O) & dexamethasone (Group D) shows adequate control of PONV with delayed PONV which was being better controlled than early PONV (as and when compared to ondansetron & dexamethasone one singly). The need of adjunct antiemetics was emphatic reduced in initial 24 hours of duration.