Indian Journal of Anesthesia and Analgesia

The increase in geriatric population with preexisting cardiac disease presenting for non-cardiac surgery is in escalating numbers. Aortic stenosis is a significant risk factor for the development of cardiac complications after non-cardiac surgery. According to the American college of cardiology recommendations, it is advisable to postpone any elective surgery in patients with aortic stenosis without proper optimization. We report about a 79-year-old female with severe aortic stenosis with left sided fracture neck of femur for bipolar hemiarthroplasty. Procedure was done under general anesthesia with fascia iliac block and intraoperative and postoperative course was uneventful.

Rare diseases and syndromes are of special interest to pediatric anesthesiologits, as each of them has very specific anesthesia concerns. Knowledge of the pathophysiology, symptomatology, treatment options of these diseases and tailored anesthesia management forms the basis of provision of safe anesthesia care to these groups of children. Mucopolysaccharidosis are a group of lysosomal storage disorders. They are caused by the total or partial deficiency of one of the eleven enzymes involved in the metabolism of glycosaminoglycans. This deficiency leads to gradual accumulation of glycosaminoglycans in the lysosomes leading to permanent, progressive cellular damage which affects appearance, physical abilities, organ and system functioning and mental development. From the anesthesiologist point of view, these patients have problems with airway management and positioning. Few anesthesiologists get to routinely care for these patients. But individual patients undergo multiple surgical procedures for improvement in quality of life. We present a case of an 11-year-old girl with MPS posted for herniotomy.

Background: Surgical stress and pain elicit a consistent and well-defined metabolic response, involving release of neuroendocrine hormones and cytokines, which leads to a myriad of detrimental effects. Lidocaine is a local anesthetic and antiarrhythmic which has anti-inflammatory, analgesic and anti-hyperalgesic properties. There are studies comparing differentt doses of infusion for varying periods of time, our study was aimed to evaluate the efficacy of intraoperative infusion of three different doses of intravenous Lidocaine in patients undergoing Laparoscopic cholecystectomy. Methods: Forty-eight inpatients were divided into 3 groups of 16 each. All the groups received intravenous lidocaine infusion of 1.5 mg/kg bolus over 10 min, 30 min before the skin incision followed by 1 mg/kg/hr in Group A, 2 mg/kg/hr in Group B and 3 mg/kg/hr in Group C infusion throughout the surgery and continued for 1 hour after the skin closure. The outcome measures are the time at which first visual analogue scale (VAS) was more than 4 requiring rescue analgesia of Inj Tramadol, total number of doses and side effects of lignocaine in 24 hours of postoperative period. Results: Onset of breakthrough pain (VAS>4) was significantly prolonged in Group C than Group A and B. Time for first rescue analgesia was significantly prolonged in Group C than Group A and Group B. Overall Analgesic consumption was significantly lower in Group C than other groups. Conclusion: Intraoperative infusion of intravenous preservative free Lidocaine at 3 mg/kg/hour is more efficient than 2 mg/kg/hour and 1 mg/kg/hour in controlling postoperative pain and reduces the requirement of postoperative analgesics.

Background: Appropriate management of pain is needed during the postpartum hospitalization period for preventing cesarean section (CS) related complications. Gabapentin and pregabalin have been used in treatment of neuropathic pain as well as postoperative pain with good results. However, there is paucity of studies in comparison with each other. The aim of current study was to compare the analgesic efficacy with respect to increase in duration of analgesia, reduction in total postoperative requirements of analgesics and study side effects and complications. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing cesarean section who were anesthetized in a standardized fashion. Patients received 300 mg pregabalin, 600 mg gabapentin or placebo, 2 hours prior to surgery. Postoperative analgesia was given at visual analogue scale (VAS) ≥ 3. The primary outcome of present study was consumption of analgesic over 24 hours and patients were followed for time to rescue analgesia, pain scores, and side effects as secondary outcomes. Results: The consumption of diclofenac was statistically significant between both pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: Prior to CS, a single dose of 300 mg pregabalin given 2 hours is equally effective to 600 mg gabapentin but superior to placebo. Both the drugs are better than placebo.

Background: Anesthetics are the agents used to induce sedation and analgesia in patients undergoing surgery. Combination of anesthetics plays major role in the major surgery and affect the various systems in the body. The present study aimed to evaluate the sedative and cardiovascular effects of ropivacaine with dexmedetomidine and clonidine in patients undergoing surgery. Materials and Methods: A total of 70 patients were included in the study. They were divided into two groups. G-A (Ropivacaine (0.75%/15 ml) + Dexmedetomidine (1 mcg/kg) and G-B Ropivacaine (0.75%/15 ml) + Clonidine (1 mcg/kg) were administered during surgery time. Study procedure was explained to all the patients and informed consent was taken. After administration of anesthetics to respective groups sedative and cardiovascular functions were recorded and analyzed. Results: 22 patients had a sedation score of 2 in Group A, whereas 35 patients had a sedation score of 2 in Group-B, 13 in Group A had score 3 at 10 min, No patient had sedation score 3 in Group B at 10 min. No one had sedation score 4 in both the groups, (Table 1). 32 patients, showed sedation score ≥ 2 in Group A compared to Group B where only 20 patients had sedation score ≥ 2 throughout the surgery. No one had a score of 3 in both the groups at the end of the surgery. Significant difference in heart rate was observed at 50 min and 70 min which got lowered in Group B when compared to Group A. No significant difference was noted in blood pressure monitoring and use of rescue drug for hypotension in both the groups. Conclusion: Epidural dexmedetomidine cause better sedation more cardiovascular stability compared to clonidine.

Introduction: The success of sedation for MRI has typically been measured by two factors: comfortable immobility during the procedure enabling successful completion of the diagnostic examination and the safety of the sedation procedure. We have tried to assess the role of Dexmedetomidine as an adjuvant in pediatric MRI procedures. Aims and Objectives: To assess the effectiveness of intravenous dexmedetomidine as an adjuvant to the combination of Ketamine and Midazolam in pediatric patients undergoing MRI study and to compare incidence and severity of adverse effects found in the groups with and without Dexmedetomidine. Materials and Methods: After obtaining ethical committee approval and consent from the parents, 60 children posted for MRI study of duration less than 60 minutes, of age group 6 months to 5 years were selected for the study purpose and randomly divided into two groups. Children under group A received Inj. Ketamine 2 mg/kg + Inj. Midazolam 0.05 mg/kg. Children under Group B received Inj. Ketamine 0.5 mg/kg + Inj. Midazolam 0.03 mg/kg + Inj. Dexmedetomidine 2 mcg/kg. Monitoring of SpO2, RR, HR were done with the help of MRI compatible monitors. 3-point score to assess grade of immobility during the procedure was used to assess the quality of sedation. Ramsay sedation score was used to assess duration of post-procedure sedation. Incidences of adverse events were noted. Inj. Propofol 0.5 mg/kg was used as rescue sedative and Inj. Atropine 0.02 mg/kg for treatment of bradycardia if any. All the patients received nasal Oxygen at 2 lt/min. Observations and Results: Movement during MRI procedure was noted in one patient from Group B. Postoperative Ramsay sedation scores were significantly higher >3 in 12 patients (40%) from Group A vs in 5 patients (16.7%) from Group B (p < 0.05). Intraprocedural quality of sedation was better with Group B (p < 0.05). 5.5% patients from group A desaturated within 10 min of administration of drugs which recovered spontaneously within 5 min of continuation of supplemental oxygen. Conclusion: Addition of Dexmedetomidine (2 mcg/kg) reduces doses of Midazolam and Ketamine hence reducing the incidence of dose related side effects without causing compromise in efficacy. It produces stable hemodynamics, better immobility during the procedure and enables early recovery from anesthesia.

Introduction: Various attempts have been made to prolong neuraxial blockade. Calcium channel blockers have shown to inhibit pain pathway. In this study verapamil was added along with local anesthetic via epidural route. Materials and Methods: A double-blind randomized controlled study done with 40 ASA I and II patients undergoing elective lower limb orthopedic surgery by randomly allocating them into two groups each consisting of 20 patients. Under aseptic precautions epidural catheter was placed in L2–L3 interspace in all patients. Patients belonging to Group P received 12 ml of Inj. Bupivacaine 0.25% + 2 ml of normal saline and Patients belonging to Group V received 12 ml of Inj. Bupivacaine 0.25% + 5 mg of Inj.Verapamil diluted to 2 ml. And further supplementary doses were done with 6 ml of 0.25% Bupivacaine every 60 minutes. The intraoperative and postoperative vitals were monitored and intensity of pain was measured by using the verbal rating pain scale at 2, 6, 12, 24, 48 hour intervals. Results: The observations were analyzed using student t test. The postoperative pain score (verbal rating scale) was found to be low at all time intervals (2, 6, 12, 24, and 48 hrs) in Group V when compared to Group P. Significantly low-pain scores were observed at 2, 6, 12 and 48 hours intervals in patients belonging to Group V (p < 0.01 at 2, 6, and 48 hours intervals and p <0.05 at 12 hours interval) than Group P. Conclusion: Pain relief was significantly better (p < 0.05) in patients who received epidural bupivacaine with verapamil mixture than the patients who received epidural bupivacaine with placebo.

Objectives: The present study was carried out to assess the role of caudal epidural injections of steroid with local anesthtic in the management of chronic low-back pain. Materials and Methods: Fifty patients of chronic low-back pain were included in the study. Epidural injections of steroid with local anesthetic were administered to them via caudal approach. Follow up was scheduled after 1 month, 3 months, and 6 months. Assessment was done by using VAS score and ODI. Results: Fifty patients of chronic low-back pain were included in the study. 31 (62%) patients were male and 19 (38%) were female. Age of the patients ranges from 30 to 70 years with the mean age of 55.21 years. Mean VAS score of the patients before the intervention was 7.91 ± 1.60 which was reduced to 3.87 ± 1.21 at 1 month follow-up, 3.46 ± 1.32 at 3 months follow-up and 4.66 ± 1.56 at 6 months follow-up. Similarly, mean ODI of the patients before the treatment was 53.81 ± 6.12 which was reduced to 33.67 ± 4.89 at the end of 1 month, 32.65 ± 5.11 at the end of 3 month and 28.80 ± 4.71 at the end of 6 month. Conclusion: Caudal epidural injection of steroid with local anesthetic is an effective method for the management of chronic low-back pain in terms of pain relief and functional improvement in both short- and long-term results.

Background and Aims: Since femoral sciatic block is not as famous as brachial plexus block for upper limb, and postoperative pain management in lower limb surgeries is limited to adjuvant in subarachnoid block or epidural analgesia. We intended to study the efficacy of ultrasound guided femorosciatic block in providing adequate postoperative analgesia, in patients undergoing below knee orthopedic surgeries. Also dexamethasone has been proved to be a useful adjuvant with local anesthetics in upper limb blocks, we considered to be studied in this block too. Methods and Materials: After approval of the institutional ethics committee, 65 patients planned for elective below knee orthopedic surgeries were enrolled in the study. Patients were randomly allocated to two groups: Group L and Group D. All the patients received subarachnoid block with 15 mg (3 ml) of 0.5% heavy bupivacaine for the surgery. In postoperative recovery room, when the level regressed to T10 level, ultrasound guided femorosciatic block was given. Group L received 20 ml of 0.25% levobupivacaine + 1 ml NS in femoral nerve block and 20 ml of 0.25% levobupivacaine + 1 ml NS in sciatic nerve block. The Group D received 20 ml of 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone in femoral nerve block and 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone in sciatic nerve block. In the postoperative period analgesia was given only on demand. The time of receiving first rescue analgesia was recorded along with the total number of rescue analgesics required in the 24 hours. The postoperative adductor muscle weakness and day of ambulation was also noted. Results: The demographic profiles of all the patients were similar. The postoperative analgesia was longer in Group D and also the number of rescue analgesics required in 24 hours was lesser in Group D. No patient had any block related or drug related side effects. Conclusion: Ultrasound guided femorosciatic block provides propitious postoperative analgesia in below knee orthopedic surgeries and can be used for providing postoperative analgesia in below knee orthopedic surgeries, without any side effects. Furthermore, adding dexamethasone to the block helps in prolonging the efficacy of the block by increasing the duration of analgesia provided and reducing the number of rescue analgesics required.

Background and Aim: Succinylcholine is the gold standard for rapid sequence induction of anesthesia. An alternative neuromuscular blocker (NMB) with comparable quick onset and short duration is desirable in situations where its use is contraindicated. Rocuronium offers promise especially after the introduction of sugammadex. There is still some concern regarding the quality of intubating conditions provided at 60 seconds. Methods and Materials: Forty patients undergoing elective surgery under general anesthesia were randomly divided into two groups. For intubation Group R received i.v. rocuronium bromide 0.6 mg/kg and Group S received succinylcholine 1 mg/kg. Rapid sequence induction was performed with injection thiopentone 5 mg/kg followed immediately by the NMB according to the assigned group. Intubation was performed one minute after the NMB and intubating conditions assessed and graded on a four-point scale: Excellent = jaw relaxed, vocal cords apart and immobile, no diaphragmatic movement; Good = jaw relaxed, vocal cords apart and immobile, some diaphragmatic movement; Poor = jaw relaxed, vocal cords moving, bucking; Inadequate = jaw not relaxed, vocal cords adducted, uncontrolled cough/bucking. Good and excellent conditions were together taken as clinically acceptable. Results: All the 20 intubations performed in group S and only 11 in Group R were rated as excellent one minute after the injection of muscle relaxant (p < 0.001). They were rated clinically acceptable in 18 patients in Group R compared to 20 patients in Group S (p > 0.05). Conclusions: Rocuronium provides clinically acceptable intubating conditions similiar to succinylcholine at 60 seconds and can be considered a safe alternative for rapid tracheal intubation in select situations where succinylcholine is contraindicated.

Background: For regional nerve blocks, a combination of dexmedetomidine with local anesthetic like levobupivacaine has shown improved effectiveness by extending the duration of analgesia and reduction in postoperative analgesic requirement. This study was undertaken to evaluate the effectiveness and efficacy of levobupivacaine alone and levobupivacaine with dexmedetomidine in axillary brachial plexus block. Materials and Methods: We included 70 patients of ASA category I, II, and III, posted for elective hand and forearm surgeries and randomly assigned them into two groups to receive either 24 ml 0.5% Inj.levobupivacaine and 1 ml normal saline (Group L) or 24 ml of 0.5% Inj.levobupivacaine and 1 mcg/kg of Inj.dexmedetomidine diluted to 1 ml with normal saline (Group LD). Results: In Group LD the onset of sensory block (16.13 ± 4.001 min) and motor block (18 ± 3.889 min) was significantly shorter compared to that of Group L. Duration of sensory block in Group LD was 677.25 ± 99.54 min and in Group L was 494.38 ± 70.64 min and the difference was clinically significant (p < 0.001). Duration of motor block in Group LD was 710.88 ± 87.32 min and in Group L was 526.25 ± 70.229 min and was clinically significant. Duration of analgesia in Group L was 576.88 ± 76.306 min and that in Group LD was 764.38 ± 110.275 min. There was a significant change in hemodynamics in Group LD as compared to that in Group L. Conclusion: Levobupivacaine along with sdexmedetomidine provides faster onset of anesthesia with extended duration of analgesia. It offers efficacious and trouble-free method of anesthesia and better analgesia in postoperative period for hand and forearm surgeries.

Context: Temperature is a vital parameter for monitoring under anesthesia. Induction of anesthesia leads to impairment of thermoregulatory center and results in redistribution of body heat from core to periphery. Hypothermia especially in children may results in increased morbidity and mortality. Sites of measurement of core body temperature are invasive and are not easily accesible. The purpose of this study is to evaluate the performance of skin temperature probe applied over the carotid artery in comparison to the nasopharyngeal, axillary, forehead temperature recordings. So that a better, safe and appropriate alternative to invasive temperature monitoring in pediatric age group can be used. Aim: To compare core temperature measured with invasive nasopharyngeal probe and noninvasive surface temperature measured with probe over axilla, forehead and skin over carotid artery. Settings and Design: The present study was a prospective, randomized and comparative study. We included 150 patients of age between 1 month and 60 months of ASA Grade 1 and 2, posted for elective abdominal and inguinoscrotal surgeries lasting more than 1 hour. Methods and Materials: Patients were randomly divided in 3 groups with 50 patients in each group. Group 1: Axillary vs nasopharyngeal temperature. Group 2: Forehead vs nasopharyngeal temperature. Group 3: Skin over carotid artery vs nasopharyngeal temperature. Standard General Anesthesia protocol was followed in all patients. We evaluated differences by monitoring and comparing invasive and noninvasive methods of temperature monitoring at above sites. Statistical analysis used: Software named statistical package for the social sciences (SPSS version 21.0, IBM Corporation, USA) for MS Windows. Results: Temperature noted throughout the surgery in Group 1 i.e. Axillary temperature v/s nasopharynx, temperature and we found that axillary temperature was lower by 1–1.5°C than nasopharynx temperature which was statistically significant (p-value being <0.05). Whereas in Group 2 i.e. Forehead temperature was lower by 2–3°C than nasopharynx temperature which was also statistically significant (p-value being < 0.05). However, in Group 3 we found that the temperature at skin over carotid artery (noninvasive) was almost equivalent to temperature at nasopharynx (invasive) with minimum difference of 0.2–0.3°C (p-value being >0.05), which was statistically not significant. This shows that temperature on skin over carotid artery almost equals to core, i.e. nasopharyngeal temperature in paediatric patients. Conclusions: We conclude that instead of using conventional invasive method of temperature monitoring, we can use equally reliable method of monitoring i.e. skin over carotid which is noninvasive, easily accessible with higher accuracy of estimating near core temperature.

Aims and objectives: To evaluate efficacy of dexmedetomidine in the dose of 0.5 ug/kg as a single bolus dose in attenuating hemodynamic response to laryngoscopy and tracheal intubation in adult patients. Materials and Methods: We conducted a prospective, randomized, double-blind study, in which 60 patients scheduled for elective surgery under general anesthesia were enrolled for the study. Patients were randomly distributed in two groups (30 in each group). Group D received a bolus dose of 0.5 ug/kg dexmedetomidine group and Group C received 10 ml of normal saline (control group). Results: There was significant decrease in heart rate in Group D as compared to Group C from 1 minute after induction till 80 minutes (p < 0.05). There was significant decrease in SBP, DBP and MAP in Group D as compared to Group C from laryngoscopy till postextubation (p < 0.05). Complications like hypotension, hypertension, bradycardia, tachycardia, agitation and coughing was observed in 0%, 80%, 0%, 83.33%, 23.33% and 40% of Group C patients respectively while it was present in 10%, 0%, 10%, 0%, 0% and 13.33% of Group D patients respectively. Conclusion: Single bolus dose of dexmedetomidine 0.5 μg/kg prior to laryngoscopy and endotracheal intubation attenuates the airway reflexes and hemodynamic responses effectively during induction of anesthesia providing smooth intubation and provides adequate sedation and delays the need for analgesia in the postoperative period.

Background: Premedication with oral melatonin and clonidine reduces anxiety and prolongs the postoperative analgesia. But there are few studies that have observed the isoflurane consumption when they are given as premedication, hence this study was conducted to compare the isoflurane consumption and duration of analgesia when oral melatonin and clonidine is given as premedication. Methods: Eighty-four patients whose aged between 18 and 60 years of American Society of Anesthesiologists one and two, undergoing surgery under general anesthesia were randomly allocated into three groups of 28 each. Group C received placebo (sugar pellet), Group M melatonin 3 mg orally and Group Cl clonidine 100 μg orally 60 min before surgery. Results: The end tidal isoflurane concentration at 30 min [Group C 0.78 (0.21), Group M 0.48 (0.15), Group Cl 0.64 (0.16) (p < 0.001)], at 60 min [Group C 0.75 (0.16), Group M 0.53 (0.2), Group Cl 0.64 (0.12) (p < 0.001 )] was lower in Group M compared to Group Cl and C. Isoflurane consumption at 30 min [Group C 6.24 (1.3), Group M 3.84 (0.75), Group Cl 4.96 (0.98) (p < 0.001)] and at 60 min [Group C 10.8 (2.18), Group M 7.65 (1.11), Group Cl 9 (2.45) (p < 0.001)] was lower in Group M compared to Group Cl and C. Duration of analgesia was 267.60 ± 81.66 min in Group C, 507.00 ± 136.11 min in group M and 438.60 ± 111.01 min in Group Cl (p < 0.001). Conclusion: Premedication with oral melatonin resulted in lower end tidal isoflurane concentration and isoflurane consumption, however it did not prolong the duration of analgesia when compared with oral clonidine.

Background: Spinal anesthesia with bupivacaine is administered routinely for lower limb surgeries along with additives for better hemodynamics, prolonged sensory and motor blockade. Most commonly used additives being opiods. In the present study non-opiod like dexmedetomidine is compared with buprenorphine as an adjuvant for bupivacaine in patients undergoing femur interlocking nailing surgeries. Materials and Methods: In the present randomized controlled prospective double-blinded study a total of 90 patients from either gender, aged 20–60 years of ASA I and II undergoing femur interlocking nailing surgeries under spinal anesthesia were included. The patients were randomly divided into two groups (n = 45 each) by closed envelope technique. Patients in Group B received 15 mg of 0.5% hyperbaric bupivacaine with 45 μg of buprenorphine, and Group D received 15 mg of 0.5% hyperbaric bupivacaine with 5 μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade, time to first analgesic requirement and any adverse events were recorded. Data were analyzed using Fisher’s exact test or Chi-square test for categorical data and analysis of variance for continuous data. The value of p < 0.05 was considered statistically significant. Results: In our study the subjects in Group D (dexmedetomidine) group had significantly longer period of motor blockade (190 ± 18.2 min) and sensory blockade (145 ± 20.2 min) compared to Group B (120 ± 17.2, 102 ± 13.5) respectively, which is statistically significant (p < 0.05 and p < 0.05* respectively). The time to first request of analgesic in the postoperative period was also longer (200 ± 21.9 min) in dexmedetomidine group when compared with Group B (130 ± 20), (p < 0.05*). There were no untoward complications (hypotension, sedation) in any groups. Conclusion: Intrathecal dexmedetomidine (5 μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade than intrathecal buprenorphine (45 μg) with bupivacaine for spinal anesthesia.

Background: Pulmonary artery catheter and central venous catheter are an important and integral part of hemodynamic monitoring during coronary artery bypass grafting. Methods: In our prospective randomized survey, 180 patients received either pulmonary artery or central venous catheter after induction of anesthesia. Patients between 35 and 75 years with ejection fraction between 35 and 60% undergoing elective off pump coronary artery bypass grafting surgery were included. Both groups were compared regarding heart rate, mean arterial pressures, serum lactate and central venous saturation, need for inotropes, fluid challenge, blood and blood products use, postoperative complications and ICU stay. Results: There is no statistical difference in heart rate and mean arterial pressure in intra- and postoperative period in both CVC and PA group except in PA group where heart rate was significantly lower after grafting and mean arterial pressure was higher at T6 and T12 hrs. After 48 hours blood lactate level was significant lower in PA catheter groups. Both groups were similar in terms of central venous saturation, intraoperative fluid bolus use, blood, blood products use and output both intraoperative and postoperatively. Use of inotropes particularly noradrenaline and levosemandan was more in PA group. There was no statistically significant difference in respiratory, CNS and Renal complications (p value >0.05), ICU stays >48 hr and mortality in both groups. Conclusion: We can conclude from our study that PAC definitely provides additional information regarding cardiac output and cardiac index in comparisons with CVC but clearly it does not result in significant difference in postoperative ICU stay and outcome of patient in form of morbidity and mortality in coronary artery bypass patients with preserved LV function.

Pain is the commonest and most troubling impact of sickness and medical procedure. It has been an extraordinary test and worry to analysts. Entirely torment is an unmeasurable substance and any plan for its evaluation in man must be available to both subjects and spectator mistake. Aim of our study was to study on Bupivacaine and Bupivacaine plus Midazolam for caudal analgesia in children’s. Materials and Methods: The examination was embraced in 60 patients between the age gathering of 3 months and 12 years, and weighing between 4.5 kg and 25 kg, experiencing the elective medical procedures performed beneath the umbilical region. Conclusion: Caudal additional dural course has been favored in youngsters for its higher consistency, as respects to specialized parts of area of room and viability of relief from discomfort with medications regulated by this course.

Background: Conventional cardiac surgery involving cardiac arrest and cardiopulmonary bypass (CPB) is well known to be associated with postoperative myocardial dysfunction and low cardiac output syndrome (LCOS). The aim of this study is to compare the effect of prophylactically administered levosimendan and milrinone on postoperative parameters and outcomes in neonates and infants after corrective open-heart surgery and comparing postoperative parameters like heart rate, mean arterial pressure, arterial and venous blood gasses at certain particular points of time. Method: We performed a prospective observational study at our institute. Total 100 pediatric patients undergoing complex congenital cardiac surgeries to evaluate the efficacy of milrinone and levosimendan on intraoperative and postoperative outcomes. Result: In the postoperative period heart rate and mean arterial pressure at three different time periods (T1, T2 and T3) did not show any statistically significant difference in both the groups. The VIS score after 48 hours was less in Group L (p = 0.0005). Serum creatinine estimated at T2 and T3 showed a statistically significant difference. (p value at T2 = <0.001, p value at T3 = 0.002). Duration of ventilation was less in Group L (p = 0.0297). Conclusion: In our prospective observational study of 100 infants undergoing surgery for complex congenital cardiac conditions, postoperative hemodynamic parameters and markers of tissue perfusion overtime were similar in infants with administration of either levosimendan or milrinone. Our results might be the basis of future controlled trials of levosimendan in children with a special focus on duration of mechanical ventilation and the incidence of renal complications.

Context: Securing the airway to ensure alveolar ventilation and prevent pulmonary aspiration constitutes a crucial component in the practice of clinical anesthesia. Unanticipated difficult intubation still occur despite adoption of various clinical predictors. Ultrasound imagimg technique has emerged as new tool for various aspects in anesthesia practice. Aims: We have evaluated the feasibility of ultrasonography as an imaging tool in identifying important airway anatomical structures on the anterior aspect of the neck and correlated the ultrasound-guided measurements of the airway parameters with the modified Cormack-Lehane grading of the direct laryngoscopy for prediction of the difficult airway. Settings and Design: For this prospective observational study, 100 patients above the age of 18, ASA I to III grades, scheduled for elective surgery, requiring general anesthesia and endotracheal intubation were included. Methods and Materials: Modified Mallampati score, Body Mass Index, distance between the anterior commissure to epiglottis (DACE) and distance from epiglottis to midpoint of maximum distance between vocal cords (DEM) using the USG machine followed by MCLS grade on laryngoscopy were noted. Statistical analysis used: Software named Statistical package for the social sciences (SPSS version 21.0, IBM Corporation, USA) for MS Windows. Results: On data analysis mean of DACE in Easy MCLS group was 0.46 ± 0.19 while in Difficult MCLS group was 0.91 ± 0.23 and the difference was statistically significant. Similarly mean of DEM in Easy MCLS group was 0.66 ± 0.21 while in Difficult MCLS group was 0.59 ± 0.23. The Mean of Ratio of DACE to DEM in Easy MCLS group was 0.71 ± 0.19 while in Difficult MCLS group was 1.67 ± 0.23 and this difference was also statistically significant. From Receiver operating characteristic (ROC) analyses distribution of area under the curve for DACE/DEM ratio was 0.96 which was significantly higher for prediction of difficult laryngoscopy. Conclusions: We as anesthesiologists can use USG as a clinical tool for assessing airway in order to rule out difficult airway and prepare the anesthesia workstation for the benefit of the patient.

Background: The local anesthetics are associated with relatively short duration of action which limit the technique for comparatively long duration surgery and also analgesic intervention is needed in postoperative period. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this study was to evaluate the onset and duration of sensory and motor block hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine given intrathecally with hyperbaric 0.5% bupivacaine. Materials and Methods: The study was carried out on 60 patients of both the sexes of ASA Grade I and II physical status scheduled for lower abdominal and lower limb surgeries. Patients were allocated into two groups. Group I (Control): 15 mg hyperbaric bupivacaine + 0.5 ml saline (preservative free). Group II (Dexmedetomidine): 15 mg hyperbaric bupivacaine + 10 μg Dexmedetomidine. Results: Patients in dexmedetomidine group (II) had a significantly longer sensory and motor block time than patients in control Group (I). The mean time of sensory regression to S1 was 367 ± 32 min in group II and 204 ± 21 min in Group I. The regression time of motor block to reach modified Bromage 0 was 325 ± 21 min in group II and 138 ± 15 min in Group I. Conclusions: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics.

Context: The addition of adjuvant like midazolam or fentanyl has further expanded the advantage of spinal anesthesia. Aims: The aim of the present study is to compare the efficacy of intrathecally administered midazolam and fentanyl in combination with hyperbaric bupivacaine with respect to the time of onset of sensory block; Duration of sensory block; Quality of intraoperative anesthesia; Duration of effective postoperative analgesia; Incidence of side effects. Settings and design: A comparative study. Methods and materials: The study was conducted in 120 ASA Grade I-II patients between age group 20–55 years posted for elective lower abdominal surgeries and gynecological surgeries. We have divided these patients into three groups. Group B — 40 patients received 3 ml (15 mg) intrathecal hyperbaric bupivacaine 0.5% and 0.5 ml of 0.9% normal saline. Group M — 40 patients received 3 ml (15 mg) intrathecal hyperbaric bupivacaine 0.5% and preservative free midazolam 1 mg (0.2 ml) and 0.3 ml of 0.9% normal saline. Group F - 40 patients received 3 ml (15 mg) intrathecal hyperbaric bupivacaine 0.5% and fentanyl 25 micrograms (0.5 ml). Statistical analysis used: t-test. Results: The patients studied across the groups did not vary much with respect to age, sex. The onset of sensory block was shortened in Group F (4.02 min)when compared to Group M (4.55 min) the two segment regression time was delayed in Group F (190.75 min) when compared to Group M (141.63 min). The addition of fentanyl 25 micrograms and midazolam 1 mg to hyperbaric bupivacaine gives better intraoperative comfort and postoperative analgesia than bupivacaine alone. The Group F (253.63 min) has more comfort and prolonged duration of analgesia than Group M (195.08 min). The Group M has more hemodynamic stability than Group F by fewer incidences of side effects like respiratory depression, hypotension, and bradycardia. The intraoperative comfort without significant hemodynamic changes is a welcome effect in immediate postoperative period in Group M. Conclusions: The addition of fentanyl and midazolam to bupivacaine gives better intraoperative comfort and postoperative analgesia than local anesthetic bupivacaine alone.

Background: Postoperative pain relief is a growing concern for an anesthesiologist as an uneventful postoperative period makes surgery a comfortable proposition for surgical patients. Objectives: To assess the duration of effective analgesia. To assess hemodynamic parameters during the surgery and to determine any adverse effects if any. Methods: A prospective randomized controlled trial was done in patients posted for elective lower abdominal and lower limb surgeries for 2 years. Two groups were decided Group M (n=35), received 3 ml of 0.5% hyperbaric bupivacaine, preservative free magnesium sulfate 50%, 0.1 ml (50 mg) and preservative free normal saline 0.5 ml. Group CM (n=35), received 3 ml of 0.5% hyperbaric bupivacaine, preservative free magnesium sulfate 50%, 0.1 ml (50 mg) and clonidine 0.5 ml (75 μg). SPSS (version 22.0) was used for analysis. Results: Most of the patients belonged to age group between 41–50 years in both the groups. The duration (minutes) of analgesia was prolonged in Group CM compared to group M. By using unpaired t-tests, p-value was < 0.0001. The total dose of diclofenac given was less in Group CM compared to Group M. Pulse rate and Mean arterial pressure were not significant. No significant difference with respect to hypotension and bradycardia (p-value > 0.05). Conclusion: The duration of postoperative analgesia seems to be augmented by the combination since these are more prolonged than what is expected with either of the drugs used alone as adjuvants.

Aims and objectives: To compare hemodynamic responses and side effects while induction and intubation with intravenous etomidate and propofol. Material and Methods: We conducted a prospective, randomized, double-blind study, in which 100 patients undergoing elective surgery under general anesthesia were enrolled for the study. Patients were randomly distributed in two groups (50 in each group). Group P received propofol at 2 mg/kg and Group E received etomidate at 0.2 mg/kg. Results: When both the groups were compared it was found out there was statistically significant difference in Group P as compared to Group E in terms of decrease in HR , SBP , DBP, MAP, incidence of myoclonic movements and incidence of pain on injection. There was no overall complication in both groups. Conclusion: Induction of anesthesia with etomidate had more stable hemodynamic conditions as compared to propofol. There was significant reduction in heart rate and blood pressure leading to hypotension in propofol group while etomidate group had stable hemodynamics. Incidence and severity of pain on injection was more with propofol while incidence of myoclonus was more with etomidate. Overall, it was concluded that etomidate was a better choice for induction of anesthesia, only drawback being higher incidence of myoclonus.

Background: In 1940, Reid and Brace first described the hemodynamic response to laryngoscopy and intubation due to noxious stimuli of the upper airway. To minimize this various drugs have been used. Newer opioids like butorphanol, and dexmedetomidine have significant role to suppress hemodynamic changes during laryngoscopy, intubation and pneumoperitoneum. So we have compared the intravenous butorphanol and dexmedetomidine to reduce stress response during laryngoscopy in laparoscopic cholecystectomy. Materials and Methods: The study was carried on 100 patients of both sex with comparable characteristics and of ASA Grade I and II physical status. Patients were allocated into two groups: Group B inj. Butorphanol 30 μg/kg was given 5 minutes before induction and Group D inj. Dexmedetomidine 1 μg/kg diluted in 10 ml normal saline, was given in 10 minutes by infusion pump. Results: The rise in heart rate and blood pressure was less in Dexmedetomidine group as compared to Butorphanol. Conclusions: Dexmedetomidine is better in attenuating the stress response during laryngoscopy, intubation and pneumoperitoneum as compared to butorphanol.

Introduction: Middle ear surgeries as such are associated with PONV and when inhaled anesthetics are used in these surgeries, the incidence of PONV might vary. Achieving a more effective outcome with respect to PONV will become increasingly important in the future as a result of increasing pressure to decrease discharge times. Aims: To compare the intra-operative hemodynamic parameters along with postoperative nausea and vomiting with Desflurane and Sevoflurane in Middle Ear Surgeries. Materials and methods: The present study was a prospective, randomized, comparative clinical study, was conducted in patients scheduled to undergo elective middle ear surgeries in 60 patients, planned for elective middle ear surgeries under general anesthesia. Patients between the age of 12 and 60 are selected for the study comprising of both sexes. They are divided into 2 groups randomly, Group S (Sevoflurane) and Group D (Desflurane); 30 patients in each group. Results: The difference in average preoperative systolic, diastolic blood pressure, heart rate was statistically not significant when compared in both groups. There was no statistically significant difference (p > 0.05) between the two groups with respect to PONV as Fisher's exact test statistic value is 1. Conclusion: No significant difference was found in terms of intra-operative hemodynamics and postoperative nausea and vomiting in patients receiving general anesthesia with sevoflurane and desflurane as inhalational agents for Middle ear surgeries.

Context: Pectoral nerve blocks (PECS) is a novel technique introduced to provide analgesia for anterior and lateral chest wall surgeries. Aims: The present study was planned to evaluate the efficacy and safety of ultrasound-guided PECS 1 and 2 block for postoperative analgesia after breast surgeries. Settings and Design: Prospective, randomized, placebo controlled clinical study. Methods and Material: Forty female patients of ASA I/II, undergoing breast surgeries were recruited and randomly allocated into two groups. Group P patients were subjected to ultrasound-guided PECS block with 0.375% Inj. Ropivacaine (10 ml at PECS 1 and 20 ml at PECS 2) and Group C patients were injected with 0.9% saline at PECS I and II sites before reversal from anesthesia. Post operatively VAS scores, time of administration of the first rescue analgesic, number of rescue analgesics, level of blockade were recorded and rescue analgesia with Inj. Fentanyl 1 mcg/kg was given when the VAS score was 4 or more. Statistical analysis used: Data collected were tested for normalcy using the Shapiro Wilk test and compared using the Mann Whitney U test, Student T test and Pearson’s chi-square test using the SPSS software version 23. p-values less than 0.05 was considered statistically significant. Results: The VAS scores, total Fentanyl consumption at 24 hours in Group P was less than that of Group C (p < 0.05). Conclusion: PECS provides effective postoperative analgesia for more than 12 hours from T2 to T5 dermatomal levels with opioid sparing effects after breast surgeries with no adverse effects.

Introduction: Upper limb surgeries can be done under general anesthesia. However, using Brachial plexus block is a better alternative. This method provides good muscular relaxation and also maintains intraoperative hemodynamics at a stable level. Aim of the study: To study the effect of Midazolam added to brachial plexus block by supraclavicular approach. Materials and methods: This was a prospective, randomized, single blinded study. A total of 100ASA Grade I or II adult patients who underwent upper limb surgeries under supraclavicular brachial plexus block were studied. Patients were randomly allocated to two groups of 50 each. Patients in Group B received 30 mL of 0.375% Bupivacaine and Group BM received 30 mL of 0.375% Bupivacaine with preservative free Midazolam 0.05 mg/kg. The onset time and duration of sensory and motor blockade were noted. The patients were observed for 24 hours postoperatively for hemodynamic variables, sedation scores and rescue analgesic requirements. Results: Group BM showed significantly quicker onset of sensory and motor block than Group B (p < 0.05). Group BM also had significantly longer duration of sensory and motor block (p < 0.05). Group BM had significantly less requirements for rescue analgesia (p < 0.05). Both groups showed similar hemodynamics and sedation scores postoperatively. Conclusion: Midazolam (0.05 mg/kg) in combination with 30 mL of Bupivacaine (0.375%) hastened onset of sensory and motor block, and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events.

Introduction: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Spinal anesthesia using local anesthetics like hyperbaric bupivacaine is one of the most popular techniques for both elective and emergency surgical procedures. One disadvantage with spinal anesthesia is relatively short duration of action. Postoperative pain relief provides comfort to the anxious patients and improve their morale and mobility there by contributing to a rapid and complete recovery. Aims: Study done on IV. Magnesium Sulfate, in patients given spinal anesthesia, for postoperative analgesia. Materials and Methods: This prospective study was conducted on 50 adult patients of ASA physical status 1 & 2 in the 18–60 age group, of either sex, posted for elective lower limb orthopedic surgeries under spinal anesthesia over a period of 12 months. Patients were randomly divided on an alternative basis into groups of 25 each. GroupM-Patients receiving IV MgSO4/infusion, Group -S-Patients receiving isotonic saline. Results: The mean height and mean weight in either group were identical. The type of surgeries performed were almost identical. There was no significant difference in hemodynamic variables (mean arterial pressure and heart rate) during the intra-or-postoperative period. Perioperative mean arterial pressure. Time of first pain medication in Group M was 334 min whereas in Group S was 227 min. This was statistically significant (p < 0.001). VAS was statistically significant at the end of 3 and 6 hours (p < 0.001), but it was insignificant at the end of 12 hours (p > 0.05). The cumulative requirement in 24 hrs of both tramadol and diclofenac was statistically significantly less for group M vs. S (p = <0.05). Postoperative serum Mg concentrations in Group M were significantly higher than those in Group S (p < 0.001 immediately after surgery, and at 1 and 24h after surgery. However, all patients in Group M had a serum Mg concentration in the normal range 24h after surgery. Conclusion: IV Magnesium sulfate infusion in spinal anesthesia decreases intra-operative hemodynamic variabilities, prolongs duration of analgesia and improves the quality of analgesia in the early postoperative period with better hemodynamic stability. It also decreases the postoperative analgesic requirements, thus it can be used as a beneficial additive for prolonging spinal anesthesia.

Background: The sensation of pain is a mechanism to protect an organism from injury. However pain is also an unpleasant experience. The conquest of pain has been considered as a path-breaking achievement in the history of medicine. Lignocaine has been considered as one of the time-tested drug used in regional anesthesia, which helped in the alleviation of pain. The duration and quality of sensory and motor blockade with lignocaine are variable. Several innovations are being tried to overcome this drawback. Therefore, there is a need to evaluate the effect of alkalinizing lignocaine in terms of, time for onset of action, degree and duration of blockade. Methods: This double blind, randomized controlled trial was carried out among 60 patients, aged between 18 and 60 years, of ASA Grade I and II, who underwent surgery of the upper limb over a period of six months. The participants were randomly allocated into control group who received 25 ml of 1% plain lignocaine and study group who received 25 ml of 1% alkalinized lignocaine. Onset time of analgesia and paralysis (complete motor block) were recorded. Duration and quality of sensory and motor blockade were also recorded. Results: The onset of sensory and motor blockade was earlier in study group than the control group (p = 0.001). Similarly the duration of sensory and motor block was significantly increased in the study group when compared to the control group (p = 0.001). The number of participants who had complete analgesia and complete paralysis was significantly higher in study group in comparison to the control group. Conclusion: In this modern era of anesthesia which demands higher degree of comfort, stress-free anesthetic and surgical techniques, alkalinized lignocaine solution goes a long way in advancement of anesthetic care.

Abstract

Background and Aims: Laryngoscopy and endotracheal intubation violate the patients’ airway reflexes and cause intense sympathetic activity. Literature suggests that this deleterious response may be blunted by drugs. Opioids are most commonly used for this purpose. However, there is no consensus regarding the best drug and best route of administration. Therefore, there has been a growing trend to find an effective substitute to lower these side effects as much as possible. Paracetamol is a non-opioid analgesic with COX-2 selective inhibiting property. The main purpose of our study was to evaluate the effect of pre-operative intravenous paracetamol on hemodynamic response to laryngoscopy and endotracheal intubation. Methods: After Institutional Ethical Committee clearance, 160 patients of American Society of Anesthesiologists (ASA) Physical Status I and II were enrolled in the study and divided into two groups. Group A received 1 gm paracetamol infusion (Labelled A1) in 100 ml volume whereas Group B received 0.9% normal saline infusion (B1) in 100 ml volume Intravenously (I.V.) thirty minutes prior to induction over fifteen minutes. Standard general anesthesia techniques were used for both groups. The hemodynamics were recorded at baseline, before induction, after induction, before laryngoscopy, immediately after intubation and thereafter 1, 3, 5, 7 and 10 inutes following intubation. After 10 minutes of intubation, Group A received the infusion labeled A2 (0.9% Normal saline in 100 ml volume) whereas Group B received the infusion labeled B2 (paracetamol 1 gm in 100 ml volume) over 15 minutes. Results: Both groups were similar in terms of age, sex, height, weight, Mallampati scores and American Society of Anesthesiologists (ASA) physical status. After 1 minute of laryngoscopy and intubation, significant increase in the heart rate was seen in both the groups. (p ≤ 0.05) in Group A, the increase in mean heart rate produced by laryngoscopy and intubation was not statistically significant at 3 mins (p ≥ 0.05) and remained insignificant at 5, 7 and 10 minutes after intubation. However, in Group B the increase in mean heart rate produced by laryngoscopy and intubation was significantly high at 3 min (p ≤ 0.0001) and remained significant at 5, 7 and 10 minutes after intubation. There was significant fall in SBP, DBP and MAP (p ≤ 0.05) from baseline after induction, laryngoscopy and after 1 minute of intubation in both Group A and Group B but inter group comparisons at these time points were statistically insignificant (p ≥ 0.05). Conclusion: Administration of paracetamol (1 gram), thirty minutes prior to induction of anesthesia could not totally blunt all the cardiovascular responses to laryngoscopy and intubation, but it did show better control of heart rate after intubation.

Background: Supraclavicular brachial plexus block is a commonly employed regional nerve block technique for upper extremity surgery. Various adjuvants were added tolocal anesthetics in brachial plexus block to achieve rapid onset and prolonged block. Objective: To compare dexamethasone and dexmedetomidine as an adjuvant to local anesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block. Methods: Forty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a double-blinded fashion. Group one was given 0.25% Bupivacaine 2 milligram/kg aslocal anesthetic and Dexmedetomidine 1 microgram/kg as adjuvant. Group two was given 0.25% Bupivacaine 2 milligram/kg and Dexamethasone 100 microgram/kg as adjuvant. Onset and duration of sensory and motor blockade and hemodynamic stability were recorded. All patients were observed for any side effects and complications. All data were recorded, and statistical analysis was done. Results: Sensory block and motor block onset was earlier in dexmedetomidine group. The duration of blockade was also prolonged in dexmedetomidine group when compared with dexamethasone group and is not associated with any major side-effect. Conclusion: Dexmedetomidine is a better adjuvant than dexamethasone in supraclavicular brachial plexus block.

Background: Overview of post-operative pain control strategies lacks high quality effectiveness of the commonly used analgesics. Restricted use of strong systemic analgesics borne out of the fear of respiratory depression and other opoids related complications like nausea, vomiting, constipation, urinary retention etc. that results in failure to provide continuous analgesia of good quality in post-operative period. Therapeutic transdermal fentanyl (TTF) is a unique & innovative way of administering strong analgesic fentanyl transcutenously. Pharmacokinetic studies provides sufficient evidences that with TTF plateau analgesic concentration of fentanyl are attained after 8–12 hours and are maintained over prolonged period of 72 hours or more as the drug remains in circulation even after removal of patch. Therefore, TTF is expected to provide continuous analgesia of superior quality in post,operative period. Materials and Methods: 25 patients included in the study underwent major surgeries under uniform method of general anesthesia with gas, oxygen, relaxant and analgesic technique with controlled ventilation on Bain circuit. On these patients fentanyl transdermal patch releasing 50 mcg/hour fentanyl was applied to the hair free skin on lateral chest wall and secured in place just before induction of anesthesia. We assessed the quality, duration and intensity of pain; patient’s comfort score, requirements of rescue analgesics, efficacy & safety in its use, patient’s satisfaction. We vigilantly observed them for any adverse cardiovascular, respiratory and local complications. Results: 68% (17/25) patients did not demand rescue analgesic dose during entire post-operative period and mean VAS score was less than 1 after 12 hours post-operatively till the observation period of 72 hours. Only 32% (8/25) of the patients required supplement analgesic with one/two dose of 75 mg diclofenac sodium by intramuscular route. All patients expressed satisfaction with the analgesia provided; some had local complications like erythema at patch application site. The patients under study neither showed incidences of severe respiratory depression nor acute changes in cardiovascular parameter (HR, ECG and SBP, DBP) measurement throughout study period. The changes observed in cardiovascular and respiratory parameter were in-significant and did not require specific treatment. Conclusion: Therapeutic Transdermal Fentanyl releasing 50 mcg/hr fentanyl can be safely used to control post-operative pain and is effective after 8–12 hours of application with fewer side effects at patch application site.

Purpose: The purpose of this study is to analyse the safety and success of combined interscalene-cervical plexus block as a sole anesthesia method for Acromioclavicular joint fixation retrospectively. Methodology: We retrospectively analysed and present a case series of acromioclavicular joint fixation surgery that were operated under combined interscalene-cervical plexus blockbetween Jan 2017 and Dec 2018 in our institute. Block success, any complications as inadvertent arterial puncture, hematoma formation, respiratory distress, Horner’s syndrome, pneumothorax, and signs of local anesthetic toxicity from the records were evaluated. Any conversion to general anesthesia, intra-operative anesthetic supplementation and time to receive first dose of analgesics also analysed from the records. Results: After exclusion 32 patients were analysed and found 100% block success rate. None of them required conversion to general anesthesia. In our study, four patients developed hoarseness of voice (12.50%), and three patients complained of breathing difficulty (9.38%). No other major complications. Conclusion: The ultrasound guided combined interscalene and cervical plexus block able to provide a successful, safe and effective sole anesthesia technique for acromioclavicular reconstruction surgeries without major complications. Prospective comparative study would prove that it can be an alternate method over general anesthesia.

Background: Pre-emptive analgesia is defined as an anti-nociceptive treatment that prevents the establishment of altered central processing of afferent input, which amplifies post-operative pain. Objective: To evaluate the role of gabapentin as pre-emptive analgesic in patients undergoing total abdominal hysterectomy. Methods: Aprospective, randomized clinical study was conducted and the patients were randomly allocated to two groups of 15 each with ASA Grade I and II. Patients in Group A were given oral gabapentin 1200 mg 1 hour before surgery whereas placebo was given to patients belonging to Group B. Epidural block is achieved in both groups with a bolus dose of 0.5% bupivacaine (maximum allowable dose–2 mg/kg) prior to surgery. After skin closure, the infusion dose is reduced to a lower concentration of Bupivacaine (0.0625% ) at the rate of 2 ml/hr and the patient will be shifted to HDU (high dependency unit). Data collected includes patients age, body weight, post-operative VAS scores, and tramadol 50 mg I.V. doses given at 1, 4, 8, 12, 16, 20, 24 hours. Results: Study revealed that the mean VAS score in the post-operative period is lower in group A (Gabapentin) as compared to group B (placebo). Mean number of total top ups with tramadol is lower in Group A (Gabapentin) as compared to Group B (Placebo). Conclusion: Pre-emptive use of gabapentin 1200 mg orally significantly reduces the number of post-operative analgesic dose requirements and post-operative pain in patients undergoing total abdominal hysterectomy under epidural anesthesia.

Objectives: Owing to safety of Modified Pectoralis block and limited studies available our study will compare the analgesic efficacy of Modified Pectoralis block with the combination of local and pocket infiltration after MRM. Design Open label randomized trial. Setting: Indira Gandhi Medical College, Shimla, HP, India. Participants 60 ASA physical status I-II patients (aged 25-65 years), scheduled for elective MRM procedures were recruited for the study. Intervention Group I (PEC 30 patients) received ultrasound guided PEC block preoperatively and Group II (local infiltration 30 patients) received local anaesthetic infiltration at surgical incision and pocket infiltration postoperatively. Patients were induced with standard general anaesthesia and then after reversal and shifted to recovery room. Main Outcome and Measure Post-operative pain assessment was done using Visual Analogue Score at O hour (Time taken as patient is shifted to PACU), 30 min, 1, 2, 4, 6, 12 and 24 hours. Results: In the PACU, the mean for rescue analgesia required in group 1 was 30.07 (SD = 3.473) and in group 2 was 8.13 (SD = 1.196) and this was statistically significant. The difference in mean of VAS score in group 2 at 6 hrs was (3.00) and in group 1 was (1.73) and this score increased significantly in next hours. The mean of total analgesic required in first 24 hrs in group1 was 0.00 (SD = 0.000) and in group 2 was 2.63 (SD = 556). Conclusion: Ultrasound guided PEC block had prolong post-operative analgesia as compare to local anaesthesia infilteration at surgical incision with pocket infilteration post-operatively.

Post-operative pain is common after abdominal surgery and is a major cause of patient dissatisfaction in post-operative period. Various drugs like opioids, nonsteroidal anti-inflammatory drugs, dexamethasone has been used to control post-operative pain but efficacy is variable. Wound infiltration is being used nowa-days to provide analgesia in immediate post-operative period. Ropivacaine, a newer longer acting local anesthetic, is used due to its less side effects. Tramadol can be used to as an adjuvant to ropivacaine in wound infiltration. A total of 75 patients, posted for open cholecystectomy, were randomly divided into three groups. Group C – inj. normal saline 22 ml, Group R- 0.375% ropivacaine 20 ml + inj. normal saline 2 ml. Group RT- 0.375% ropivacaine 20 ml + inj. tramadol 2 mg/kg in 2 ml. A total volume of 22 ml was infiltrated. Local wound infiltration was done at time of closure according to study groups.VAS score in post-operative period, time for first rescue analgesic, number of rescue doses in first 24 hrs, PONV and patient satisfaction were noted. There was higher VAS score and early requirement of rescue dose in control group compared to group R and RT (p < 0.001). There was also longer duration of analgesia in group RT compared to group R (p < 0.05). Incidences of PONV were comparable in all three groups. Ropivacaine and ropivacaine-tramodol were effective in wound infiltration for post-operative analgesia but later was preferred due to longer duration of action and better patient satisfaction without increased incidence of PONV.

Background: A painful stimulus can produce vasoconstriction and a decrease in perfusion index (PI). The visual analog scale (VAS) is the most common pain assessment scale. However, it is affected by psychometric instability. This study was designed to evaluate the correlation between VAS as a subjective indicator of pain and PI as an objective indicator of pain. Materials and Methods: At the post-anesthesia care unit, the perfusion index was checked to 50 adult patients of ASA-I who underwent laparoscopic surgery. At the time of the first request for analgesia (T1) VAS was recorded together with the PI, heart rate (HR), Mean Arterial Blood Pressure (MAP), peripheral oxygen saturation and following which analgesia was given. Thirty minutes thereafter, (T2) second measurements for the mentioned parameters were taken. Results: The PI was significantly higher at T2 than at T1 (mean increase % = 90% vs 81.4%). This increase was associated with a statistically significant decrease in VAS, HR, and MAP. This means that the PI increases with adequate relief from pain, as indicated by a decrease in VAS, HR, and MAP. A decrease in VAS was associated with an increase in PI, but the correlation was not statistically significant as the degree of the increase in PI in relation to the decrease in VAS was variable among patients. Conclusion: PI can be added to other indicators of pain assessment in the post-anesthesia care unit.

Bupivacaine is the most common drug used in spinal anesthesia in vaginal hysterectomy which gives adequate anesthesia for the procedure. Clonidine is α2 agonist used to prolong the duration of intrathecally administered local anesthetic and has potent antinociceptive properties. Fentanyl not only improves the quality of intra-operative analgesia but also reduces the need of supplemental sedation. In the present study, we tried to find out whether quality of of anesthesia is better with low dose bupivacaine and clonidine or with low dose bupivacaine and fentanyl. Methods: Prospective, randomised double-blind, controlled study was conducted in a tertiary care institution. 80 patients ASA Grade I and II scheduled for vaginal hysterectomy were randomly allocated into two groups by using computer generated random numbers. Group BC (n = 40) received 0.5% Hyperbaric bupivacaine 2.8 ml (14 mg) + 25 mcg Clonidine and Group BF (n = 40) received 0.5% hyperbaric bupivacaine 2.8 ml (14 mg) + 30 mcg Fentanyl intrathecally. Time for onset of sensory and motor blockade, time to achieve maximum sensory and motor blockade, time for segment regression up to L1, side effects, perioperative and post-operative analgesic requirements were assessed. Results: Mean duration of onset to peak sensory block (5.45 ± 0.50 min), onset to peak motor block (7.05 ± 0.22 min) was significantly higher in group BC as compared to group BF (6.90 ± 0.38 min) and (8.67 ± 0.47 min) respectively. Significant difference in mean duration of sensory block and motor block (189.80 ± 6.49 min, 247.28 ± 8.42 min) in group BC and group BF (150.23 ± 4.23, 197.08 ± 6.25 min) were noted. Duration of post-operative analgesia was significantly higher in group BC (495.93 ± 22.43 min) as compared to group BF (269.33 ± 17.98 min). There was significant difference between VAS score in group BC and group BF except 4th hr and 18th hr. All patients were hemodynamically stable and no significant difference in post-operative sedation and adverse effects was observed. Conclusion: Clonidine and fentanyl are good adjuvant drugs and their use intrathecally as an additive to bupivacaine extends the duration of spinal anesthesia significantly, lowering the need to administer general anesthesia if duration of surgery is prolonged. Further they also provides excellent post-operative analgesia. Clonidine is better adjuvant with bupivacaine in view of better sensory and motor blockade, prolonged post-operative analgesia.

Background: Post-operative nausea and vomiting (PONV) is a frequent complication associated with laparoscopic cholecystectomy. In this randomized double-blind placebo controlled prospective study, we compared the efficacy of intravenous metoclopramide and ondansetron for prevention of PONV following laparoscopic cholecystectomy in patients. Materials and Methods: A total of 75 patients (20–60 years of age) undergoing elective laparascopic cholecysetectomy were randomly allocated to one of the three groups of 25 patients each. Group A received metoclopramide 10 mg, Group B received ondansetron and group C received normal saline 10 ml after induction. All episodes of PONV within 24 hrs. after induction of anesthesia were recorded. Results: The overall incidence of post-operative emesis was 44% in control group, 16% in Metoclopramide group and 12% in Ondansetron group.The decrease in incidence of emesis in Metoclopramide and Ondansetron group was significant as compared to control group whereas there was no statistical difference between Metoclopramide and Ondansetron groups. Conclusion: For prevention of PONV after laparoscopic cholecystectomy, both metoclopramide and ondansetron are equally effective in comparison to placebo group.

Background: The present study was designed to check the vasoconstrictive effects of bronchodilator and adrenergic in bettering cardiovascular disease in elective cesarean receiving crystalloid coloading throughout intrathecal bupivacaine injection. Material and Methods: 30 patients were selected in present study. Once pre-anesthetic analysis and investigations, the patients were explained regarding the procedure. Cluster E were received blood vessel (IV) bronchodilator five mg and cluster P were received blood vessel (IV) adrenergic a hundred weight unit once there'll be fall in maternal pulse force per unit area (SBP) > 20% from the bottom line. Results: The two teams, i.e., cluster one and cluster a pair of matched with relation to their age, weight and height. Overall, 7/15 (46.66%) patients within the adrenergic cluster and 7/15 (46.66%) patients within the bronchodilator cluster had one or additional episode of cardiovascular disease and needed one or additional bolus of vasoconstrictive. Compared with the baseline values, the amendment in mean rate among completely different intervals were found to be non-vital at any given time interval (p > 0.05). Conclusion: We conclude from the current study that bronchodilator five mg and adrenergic a hundred µg square measure equally economical in managing cardiovascular disease throughout spinal for cesarean.

Background: The objective of the study was to compare the study on the endotracheal tube cuff pressure changes between supine and prone in patients undergoing prone position surgeries. Materials and Methods: After obtaining approval from institutional ethics committee, this study was conducted in Department of Anesthesiology at Sri Manakula Vinayagar Medical College and Hospital, Puducherry between November 2015 and August 2017. A total of 60 patients who met the inclusion criteria were enrolled into study and prepared for General Anesthesia in prone position. After induction, the cuff pressure was recorded with head in neutral, flexed and extended position; these parameters were noted with patient in supine position and then in prone position. Results: There was no significant difference in mean cuff pressure at neutral posture between supine and prone position. Mean cuff pressure was increased after flexion and extension from neutral posture in both supine and prone position. At flexed posture mean cuff pressure was higher in supine position and at extended posture mean cuff pressure was higher in prone position. Conclusion: With this study we concluded that the supine or prone position has no influence on the cuff pressure when the head is in neutral position. In the supine position flexion of the head should be avoided because it leads to higher cuff pressure than with the head flexed in prone position. Similarly extension of the head should be avoided in the prone position.

Background: Ropivacaine and Levobupivacaine are newer local anesthetic agents in obstetric practice for labor epidural analgesia which have got advantages of less motor blockade and systemic toxicity compared to Bupivacaine. Objective: To compare the efficacy of equipotent doses of Ropivacaine 0.1% and Levobupivacaine 0.0625% with fentanyl as continuous infusion for labor epidural analgesia. Study Design: A Prospective randomized control trial. Methods: After obtaining the institutional ethics committee approval, Patients who met the inclusion criteria were randomly allocated to group B and group R (20 patients in each group) by computer generated random numbers. Patients were randomly assigned to receive either 10 ml of 0.2% ropivacaine or 10 ml of 0.125% levobupivacaine followed by infusion of 0.1% ropivacaine with fentanyl 2 mcg/ml or 0.0625% levobupivacaine with fentanyl 2 mcg/ml at 8 ml/hr continuous epidural infusion. Visual analogue scale (VAS) before epidural bolus dose and throughout the labor were recorded. Maternal heart rate, blood pressure, oxygen saturation, fetal heart rate, maximum sensory level achieved and degree of motor blockade were recorded every fifteen minutes. Results: The demographic variables were comparable between the two groups. There was no significant difference in the onset of pain relief, VAS scores during the infusion and level of Sensory block. There was no difference found in the hemodynamic parameters, delivery outcome, patient satisfaction and neonatal outcome. Conclusion: Epidural Levobupivacaine provides good and effective analgesia as Ropivacaine for labor pain and hence, a good alternate local anesthetic in labor epidural analgesia with cost limitations.

High sensitivity C-reactive protein is inflammatory marker having predictive value in both stable and unstable angina as well as in the acute phase after coronary artery bypass grafting. Many studies have evaluated the prognostic value of CRP for predicting post-operative outcome, most have focused on pre-operative CRP levels, which cannot reflect the inflammatory reactions induced by surgery itself. Here author hypothesized that post-operative CRP elevation, reflecting surgery-induced inflammatory reactions, is related to the occurrence of post-operative major adverse cardiovascular and cerebral events (MACCE) in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Objective: To better understand the current state and application of high sensitivity C-reactive protein (hs-CRP) in clinical practice. To establish excellence of hs-CRP level as a prognostic marker in low EF heart patients. We have done prospective observational study in peri-operative period of 100 patients with stable ischemic heart disease and left ventricular dysfunction (EF < 35%) who underwent off pump CABG to ascertain whether an activation of the inflammatory system during surgery, detected by elevated serum hs-CRP, has any association with prognosis. Result: In patients with pre-operative hs-CRP ≥ 1.0 mg/dl, the cumulative event incidence was 38% compared to 15% in patients with levels pre-operatively of hs-CRP less than 1.0 mg/dl. Post-operative hs-CRP has no significant difference. Conclusion: Author conclude that increased pre-operative hs-CRP > 1.0 mg/dl predict in hospital cardiac and cerebrovascular morbidity and mortality. There is increase in post-operative hs-CRP but it is not statistically significant to conclude it as prognostic marker for predicting post-operative morbidity.

Context: Bleeding during the nasal and middle ear surgeries can impair the visibility of the surgical field. Controlled hypotension is a technique used to bring down the Mean Arterial Pressure (MAP) and reduce the bleeding in the surgical field. Aims: To evaluate the effectiveness of dexmedetomidine, a selective α2-adrenoceptor agonist, on reducing the intra-operative bleeding and duration of surgery. Settings and Designs: Randomized, double blind, control study. Materials and Methods: We included sixty patients who were posted for tympanoplasty and FESS under general anesthesia and divided randomly to Group D where dexmedetomidine 1 μg/kg loading dose plus a maintenance of 0.5 to 0.8 μg/kg/hr and Group P in whom normal saline 1 ml/kg loading dose and 1 ml/kg/hr maintenance was administered. Heart rate and MAP was measured at 15,30,45,60 minutes and at extubation. Bleeding severity score and the duration of surgery were noted. Student t-test and chi-square test were used for data analysis, p - value < 0.05 was considered statistically significant. Results: The fall in heart rate, MAP was more in the Group D than in Group P and was significantstatistically (p < 0.05). Bleeding severity score was lower in the Group D than in Group P. (none of the patients had a score of 3 in Group D and in Group P 10 patients had a score of 3). The mean duration of surgery was also less in the Group D (55.55 min ± 2.34) when compared to Group P (68.39 min ± 4.38) which was statistically significant (p < 0.01). Conclusion: Dexmedetomidine infusion started as loading dose along with intra-operative maintenance results in a decrease in the MAP, reduced bleeding and shorter surgical duration.

Dexmedetomidine is a selective α2 agonist with sedative, analgesic and sympatholytic properties and hence, it can be used as an anesthetic adjuvant. Aims: We aimed primarily to evaluate the effects of low dose Dexmedetomidine infusion on hemodynamic response to critical incidences such as laryngoscopy, endotracheal intubation, creation of pneumoperitoneum and extubation in patients undergoing laparoscopic cholecystectomy. The secondary aims were to observe the effects on sedation levels, post-operative analgesia requirements and occurrence of adverse effects. Methods: Ninety patients of American Society of Anesthesiologists [ASA] physical grades I and II undergoing laparoscopic cholecystectomy were randomly allocated into three groups of 30 patients each as follows: Group NS: [Saline group; n = 30] – Received 0.9% normal saline infusion; Group DEX: 0.2-Patients received Dexmedetomidine infusion 0.2 mcg/kg/hr; Group DEX: 0.4-Patients received Dexmedetomidine infusion 0.4 mcg/kg/hr. Infusions were started 15 min before induction and continued till end of surgery. Parameters noted were pulse rate, mean arterial pressure, post-operative sedation and analgesia requirements. SPSS 15.0 version software was used for statistical analysis and Continuous data were analyzed by ANOVA test. Results: In Group NS, significant hemodynamic stress response was seen following laryngoscopy, tracheal intubation, creation of pneumoperitoneum and extubation. In Dexmedetomidine groups, the hemodynamic response was significantly attenuated. The results, however, were statistically better in Dex 0.4 group compared with Dex 0.2 group. Post-operative 24 hour analgesic requirements were much less in Dexmedetomidine groups. No significant side effects were noted. Conclusion: Low dose Dexmedetomidine infusion in the dose of 0.4 mcg/kg/h effectively attenuates hemodynamic stress response during laparoscopic surgery with reduction in post-operative analgesic requirements.

Introduction: Propofol has become the most widely used I.V. hypnotic agent. It provides rapid induction but the major disadvantages are cardiovascular and respiratory dysfunction hence, the concept of “Auto-coinduction” and “Co-induction” has come forward. The current study, has been designed to evaluate reduction in induction doses of propofol and alteration in peri-intubation hemodynamic in propofol auto-co-induction and midazolam propofol co-induction groups along with propofol group. Materials and Methods: The present study, is a prospective, observational and non-interventional study, which includes 75 patients of age between 20 and 50 years with ASA grade I. All the patients were divided into three groups and each group have 25 patients Group I (PP), Group II (MP), Group III (P). Two minutes prior to induction agent Group I received 0.5 mg/kg propofol, Group II received 0.05 mg/kg midazolam. Induction dose of propofol and hemodynamic parameters during various interval were measured. Results: Propofol induction dose in Group I,II,III, was 74.4 mg, 66.36 mg and 136.4 mg respectively which was statically significant (p < 0.05) when group Iand II compare with group III. Hemodynamic stability in peri-intubation period was better in group I that mean auto-co-induction. Conclusion: We conclude that midazolam co-induction and propofol auto-co-induction significantly reduce the induction dose of propofol, propofol auto-co-induction provides better hemodynamic stability in peri-intubation period. The priming appears to be cost effective by significantly reducing the total dose of propofol required and no significant adverse intra-operative or post-operative effects were observed in all groups.

Background: Adjuvants like fentanyl and clonidine have found to prolong the duration of analgesia when used along with local anesthetic in the paravertebral space for breast surgery. This study was planned to study the effect of addition of ketamine to bupivacaine for paravertebral block on intra-operative and post-operative analgesia in patient undergoing modified radical mastectomy under general anesthesia. Materials and Methods: This prospective, randomized, controlled double blind study was conducted in 60 women of ASA grade I–III age between 18 to 70 years who underwent modified radical mastectomy. Group A consisted of 30 patients receiving PVB with 0.3 ml/kg of 0.25% bupivacaine and 1 ml normal saline prior to GA and Group B consisted of 30 patients receiving PVB with 0.5 mg/kg ketamine along with 0.3 ml/kg of 0.25% bupivacaine in normal saline prior to GA. Intra-operative supplemental fentanyl consumption, hemodynamic parameter, pain score and post-operative morphine consumption were compared. Results: The mean intra-operative fentanyl consumption requirement in group A was 21.95 ± 21.58 μg, and 12.83 ± 19.93 μg in group B. (p = 0.828) 60% of the patients in group A did not require any analgesic supplementation which was comparable to that in group B (63.33%). First requirement of rescue analgesia in post-operative period was after 3.63 ± 2.55 hr in group A and 3.13 ± 2.84 hr in group B, (p = 0.480). The mean VAS values in both the groups were statistically comparable at rest and as well as on movement. (p > 0.05). Conclusion: The present study, showed that the addition of ketamine to bupivacaine did not improve the efficacy or duration of paravertebral analgesia in the post-operative and intra-operative period in patients undergoing modified radical mastectomy.

Introduction: The study based on that midazolam pre-medication reduces the induction dose and cost of propofol. Aims: To study effect of midazolam pre-medication on induction dose of propofol in adult patients. Methods: A prospective randomized, double blind control study was conducted. Total 60 patients (16–45 years) were divided into 2 groups. Group 1 received 0.05 mg/kg of Midazolam and Group 2 received Normal Saline. We compared the induction dose of propofol in both groups, taking loss of verbal contact as the end point. Additionally, changes in hemodynamic status like blood pressure and heart rate and induction time were studied and compared in both groups. Results: The dose of Propofol required to induce anesthesia in Midazolam group was 1.32 mg/kg and 2.27 mg/kg in the control group. The hemodynamic changes in Midazolam group compared to NS were non-significant. Conclusion: We recommend midazolam when used in combination with propofol reduces the dose of propofol and the time required for induction.

Introduction: Pain during labor is one of the major determinants of women’s child birth experience. Epidural labor analgesia is the gold standard method now-a-days, with no harmful effects to the neonate but, beneficial effects has been observed. High acceptance rate of labor analgesia is observed in Developed countries, therefore, their data focuses on overall birth experience. Materials and Methods: Descriptive study was carried out on 120 expectant mothers attending the antenatal OPD of MNR Medical College and Hospital, Hyderabad over a period of 6 months. After taking informed consent 120 expectant mothers were selected by convenience sampling technique. Knowledge was assessed using structured questionnaire. Attitude was assessed using 3 point Likert scale consisted of 20 statements. Results: Majority of expectant mothers, 62 (52%) belongs to age-group of 28–31 years, 38 (32%) in age-group of 24–27 years, 10 (8%) in age-group of 20–23 years and other 10 (8%) in age-group of 32–35 years. Gravida distribution of expectant mothers, 66 (55%) had gravida one, 46 (38%) had gravida second and few 8 (7%) had gravida three. Conclusion: Most of expectant mothers had average level of knowledge but majority of had positive attitude. Most of the Indian parturient still suffer from the agony of labor pains due to lack of awareness, lack of availability or knowledge of availability of labor analgesia service. The awareness level needs to be improved.

Background: Smooth functioning of countries healthcare services require balanced distribution of physicians among different specialities. Each country needs to examine the factors influencing career specialty preference which will be helpful in future recruitment process. Aims: To assess the awareness and attitude towards anesthesiology as a career option and the factors which influence in making such a choice. Methods: A crosssectional study was conducted on final year MBBS students in Navodaya Medical College, Raichur. A semistructured, self-administered questionnaire copy was distributed to a total of 113 final year MBBS students and results were analyzed using SPSS version IBM 22. Results: The most preferred specialty was General Medicine (18.45%), followed by general surgery (15.53%) and orthopedics (14.56%). Among males the most preferred specialty was general medicine (27.12%) and among females obstetrics and gynecology (27.27%) was the most preferred specialty. The most common reason for not choosing anesthesia as a career choice was lack of recognition by patients (24.71%) and the most common reason behind making a career choice was personal interest (19.42%). 30.8% students found that anesthesia as a specialty was interesting and life saving and 37.5% students found that anesthesia posting was interesting and important. Conclusion: With only 2% students choosing anesthesia, it is vital to provide adequate aids and emphasize on the positive aspects of anesthesia among the undergraduates to create interest in anesthesiology as a career choice.

This study aims to identify the predictors of mortality in Swine flu-associated deaths and to formulate protocols and guidelines for the future management of Swine flu patients in case of inter-hospital patient transfer, risk stratification, and optimization of other co-morbid conditions. Design: Retrospective Descriptive Study. Materials and Methods: Patients who were admitted to the hospital from September 2017 to March 2018 and September 2018 to March 2019 were included in the study as two separate groups. The data was retrospectively collected from the Medical Records Department (MRD). Information regarding age/ sex, clinical presentation, laboratory findings, organ failures, arterial blood gas parameters, Chest X-ray, duration of ICU stay, need for mechanical ventilation, and pre-existing co-morbidities was collected. Analysis: Categorical variables were presented in numbers. The data was entered in MS Excel spreadsheet and analysis was done using SPSS version 22.0 by calculating percentages. Conclusion: Old age, presence of co-morbidities, late admission to a tertiary care hospital, inter-hospital transfer, and low Pao2/Fio2 ratio at the time of admission were identified as the key factors for early mortality in H1N1 Influenza patients. Recommendation: Better protocols are to be formulated for the management of Swine flu-positive patients in cases of inter-hospital patient transfer, risk stratification, and optimization of other co-morbid conditions.

Introduction: The supraclavicular brachial plexus block provides anaesthesia of entire upper extremity in most consistent manner. Brachial plexus blockade for upper limb surgeries is advantageous as the effect of drug is limited to the part of the body to be operated upon. Materials and Methods: The present study titled “A comparative study of Ropivacaine + Clonidine with Bupivacaine + Clonidine in supraclavicular brachial plexus block” was carried out at Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Telangana State. It was a prospective and randomized study. Sixty patients of age group between 18 and 70 years admitted between August 2018 and November 2018 were selected for the study. These patients were undergoing elective operative procedures for upper limb surgeries (i.e., elbow, forearm and hand surgeries). Exclusion criteria included patient’s refusal, history of bleeding disorders or patients on anticoagulant therapy, peripheral neuropathy, local infection, respiratory disease, or known allergy to local anesthetic drugs. Each patient was visited pre-operatively and the procedure was explained and informed written consent was obtained. Investigations like Hemoglobin, Bleeding time, Clotting time, blood grouping, random blood sugar, blood urea, serum creatinine, bleeding time, clotting time, chest x-ray, ECG were done. Results: The present study was conducted on 60 consenting patients aged between 18 and 70 years. Group RC received 30 ml of 0.5% Ropivacaine + clonidine (30 mcg). Group BC received 30 ml of 0.5% Bupivacaine + clonidine (30 mcg) for brachial plexus block by supraclavicular approach. The minimum age in both groups was 18 years. The maximum age in both groups was 60 years and 65 years respectively. The mean age in group BC were 31.20 ± 12.59 and RC were 32.00 ± 13.17 respectively. There was no significant difference in the age of patients between the Group BC and Group RC. Both groups were similar with respect to age distribution (p > 0.05). Conclusion: From our study, we concluded that addition of Clonidine (2 µg/kg) to 0.5% Ropivacaine in supraclavicular brachial plexus block has advantages compare to bupivacaine with clonidine Faster onset of analgesia, sensory and motor blockade.

Background: Brachial plexus block is a reliable, regional anesthetic technique for upper arm surgeries. Opioid agonist-antagonists are used as adjuvant to enhance the analgesia of bupivacaine. The present study was aimed to compare the analgesic efficacy and safety of nalbuphine and tramadol as an adjuvant to 0.5% bupivacaine for brachial plexus block. Materials and Methods: Thirty adult patients of ASA I and II of both genders were randomized into two Groups of fifteen patients, Group BT receive 28 ml of 0.5% bupivacaine with 2 ml of tramadol and Group BN receive 28 ml of 0.5% bupivacaine with 2 ml of nalbuphine 20 mg for supraclavicular brachial plexus block. Patients were observed for onset and duration of sensory and motor block with duration of pain relief as primary end points while occurrence of any adverse effect due to technique or nalbuphine was noted as secondary outcome. Results: In Group BN, there was a statistically significant shorter time to onset of sensory blockade (10.46 ± 1.5 min vs 13.66 ± 2.5 min, p < 0.001), shorter onset time to achieve motor block (14.4 ± 2.5 min vs. 18.46 ± 3.5 min, p < 0.001), longer duration of motor block (291.4 min vs 363.07 min, p < 0.001), and prolonged analgesia (456 min vs 409.13 min, p = 0.003). No significant side effects were seen in any of the groups. Conclusion: Addition of nalbuphine to 0.5% bupivacaine in supraclavicular brachial plexus block significantly hastens the onset, and prolongs the duration of sensorimotor blockade and analgesia when compared with tramadol as an additive. Both the drugs were comparable in terms of safety.

Introduction: Post-operative nausea and vomiting (POVN) is a common condition and causes much discomfort to the patient. It is not only unpleasant but also can have serious consequences like that of gastric content aspiration, rupture of esophagus, opening up of wounds, subcutaneous emphysema, or pneumothorax. Aim of the Study: To compare the anti-emetic effects of intravenous granisetron, ondansetron and palonosetron for prophylaxis of post-operative nausea and vomiting after laparoscopic surgeries under general anesthesia. Materials and Methods: This was a prospective, randomized, double-blinded, comparative study. A total of 75 patients were divided randomly into three groups each having 25 subjects. Group-A received ondansetron 8 mg, Group-B received Granisetron 2.5 mg and Group-C received Palonosetron 0.75 ug. Both male and female patients, ASA I–II with age ranging from 18–65 years and who underwent elective laparoscopic surgeries under general anesthesia were selected.The incidence of post-operative; nausea, retching and vomiting were studied. Observations and Results: Age, gender and weight were insignificant in all the 3 Groups. Groups-A/C was found to be statistically significant (p < 0.05) in 24–48 and also 12–24 hours. Retchingwas significantly less in Group-C when compared to other two groups. Incidence of vomiting was significantly less in Group-C when compared to Group-A and B. The p-value between Group–A and C was found to be statistically significant (p < 0.05) in 24–48 hours. Conclusion: Prophylactic therapy with palonosetron is more effective than prophylactic therapy with ondansetron and granisetron for the long-term prevention of PONV after laparoscopic surgery.

Aims and Objectives: The aim of the study was to compare the anti-emetic efficacy, duration of action, and side effects of Palonosetron, Ondansetron, and Granisetron for anti-emetic prophylaxis of post-operative nausea and vomiting. Methodology: We conducted a prospective, randomized, double blind study on patients undergoing laparoscopic abdominal surgeries. The total 120 patients were divided into three groups of 40 patients. Patients of group A were given injection palonosetron (0.075 mg), group B were given injection ondansetron (4 mg), and group C were given injection granisetron (1 mg), intravenously along with premedication, fifteen minutes prior to induction of general anaesthesia. We analyzed the anti-emetic efficacy, duration of action, and side effects of palonosetron, ondansetron, and granisetron. Results: Total incidence of nausea and vomiting was maximum in ondansetron group with total of 74 compared to 36 in granisetron and 12 in palonosetron group, considering overalapping data in all time intervals and this difference was found to be statistically major. In ondansetron group 18 patients had complete response, while complete response was higher in granisetron group (24) and highest with 28 patients in palonosetron group and this difference was statistically substantial. (p < 0.05). Headache and sedation was found in ondansetron group in 2 and 4 patients respectively while only 1 patient had headache in palonosetron group, 7 patients complained of headache in granisetron group. Conclusion: We conclude that palonosetron is more effective in comparison to granisetron and ondansetron in the prevention of PONV in patients undergoing elective abdominal laproscopic surgeries.