Indian Journal of Anesthesia and Analgesia

Introduction: Apical Hypertrophic Cardiomyopathy (AHCM) is a rare form of Hypertrophic Cardiomyopathy (HCM) which inherits in autosomal dominant pattern affects 1:500 individual, is localized to left ventricular apex with or without formation of apical aneurysm. Although patients are asymptomatic in resting conditions, anesthesia and surgical stress may lead to exacerbation of the left ventricular outflow tract obstruction (LVOT) obstruction and may complicate perioperative course. Case Report: A 65 years old female patient diagnosed with Apical hypertrophic cardiomyopathy presented with primary peritonitis posted for emergency exploratory laparotomy and proceed on Tab Verapamil 160 mg twice daily. We managed this case successfully considering understanding of pathophysiology, hemodynamic changes and anesthetic implications needed for successful perioperative outcome. Conclusion: Patients with apical hypertrophic cardiomyopathy undergoing noncardiac surgery require thorough understanding of hemodynamic changes, proper intraoperative vigilance, avoiding factors that may increase left ventricular outflow tract obstruction with proper medication and intravenous fluid therapy.

Background: Anaphylaxis due to a colloid plasma expander can occur peri-operatively even though it is uncommon. Case Presentation: This the case report of an intra-operative anaphylaxis due to gelofusine in a 31 year old Caucasian female who underwent emergency lower segment caesarean section. The patient was managed successfully and the procedure was completedly uneventfully. Conclusion: A high index of suspicion, immediate diagnosis and rapid institution of treatment are essential for a safe outcome of such incidents.

Introduction: Neurofibromatosis is a rare inherited autosomal dominantdisorder characterized by multiple benign tumours and spots of increased skin pigmentation. The commonest member of the group is neurofibromatosis Type-1. An estimated 5% of patients with NF1 have an intra-oral manifestation of the disease. Case Report: A 6o-year-old female patient, with neurofibromatosis Type 1 was diagnosed with normal pressure hydrocephalus. She had diffuse dermal neurofibromas, peripheral IV line access proved impossible and central venous catheter in the right subclavian vein. She also had history of previous surgery for attempted V-P shunt which was postponed due to increased scalp bleed in which tracheal narrowing was noted with co-existing cervical spondylosis and altered neck anatomy as predictors for airway difficulty. Successful intubation by flexible fiber-optic was carried out without any airway block and the surgery concluded without any difficulties. Conclusion: Flexible fiber-optic laryngoscopy is a well-established and versatile tool for managing patients with known or suspected difficult airway and Neurofibromatosis is a rare pathology in surgical centres, which requires anesthetist to know its peculiarities and give special focus.

Aims and Objectives: To compare the incidence of Postdural Puncture Headache (PDPH) with spinal anesthesia using median and paramedian approach in pregnant women undergoing elective cesarean section. Materials and Methods: One Hundred patients with American Society of Anesthesiologists Physical Status I and II scheduled for elective cesarean section under spinal anesthesia were randomly allocated into two groups with fifty patients each. Group M: Received the subarachnoid block with median approach using 25G Quinke spinal needle and 10 mg Inj Bupivacaine heavy 0.5% at L3–L4 intervertebral space. Group P: Received the subarachnoid block with paramedian approach using 25G Quinke spinal needle and 10 mg Inj Bupivacaine heavy 0.5% at L3–L4 intervertebral space. Patients were assessed for hemodynamic changes, sensory and motor block and adverse effects in the intraoperative period. Postoperatively patients were monitored for PDPH, low backache, nausea, vomiting, first attempt success rate and the need for rescue analgesia. Results: The incidence of Postdural Puncture Headache (PDPH) was 18% in Group M as compared to 4% in Group P with p - value of 0.025 which is statistically significant. While the incidence of low backache was 14% in Group M as compared to 0% in Group P with p - value of 0.006 which is also statistically significant. Conclusion: The paramedian approach of subarachnoid block has lesser tendency to cause post dural puncture headache and low backache as compared to median approach in patients undergoing elective caesarean section.

Background and Objectives: Controlled hypotension has been used to reduce bleeding and to optimize visualization of surgical field during intranasal surgeries. Dexmedetomidine, an alpha-2 agonist can be an effective agent to provide controlled hypotension and it also provides sedation and analgesia with minimal side effects. The present study was undertaken to evaluate the effect of intravenous dexmedetomidine for intranasal surgeries under general anesthesia. Materials and Methods: Sixty patients aged 20 to 60 years, belonging to ASA I & II and undergoing elective intranasal surgeries under general anesthesia were included in the study. Patients were randomly allocated to two Groups (30 each), Group D and Group P. Patients in Group D received intravenous dexmedetomidine 1 mcg/kg in 10 ml of normal saline and Group P received placebo. Data obtained were subjected to analysis using statistical software SPSS vs 24. Results: Bleeding score was significantly lower in Group D (86.7% with bleeding Score 1) vs in Group P (46.7% with bleeding Score 3 and 40% with a Score 2) with a p value < 0.001. The Mean arterial pressure was significantly lower in Group D than Group P throughout the surgery with p value 0.035. The Heart rate was also lower throughout surgery in Group D than Group P significant with p value < 0.001. Conclusion: Intravenous dexmedetomidine for intranasal surgeries under general anesthesia reduces bleeding at surgical site and provides better visibility of operative field and helps achieve controlled hypotension with minimal side effects.

Introduction: Effective pain control is the mainstay of treatment in patients who have undergone upper abdominal surgeries as pain has many adverse effects on various systems of body. Epidural analgesia provides not only pain relief but also reduces postoperative stress response, pulmonary complications and duration of hospital stay. Aims and Objectives: To assess the efficacy of epidural dexmedetomidine as an adjuvant to Ropivacaine on analgesia, perioperative hemodynamics and requirement of anesthetic agents in patients undergoing upper abdominal surgeries under general anesthesia. Materials and Methods: 70, ASA Grade I and II patients, 18–60 years of either sex planned for upper abdominal surgery were included and randomly allocated into two Groups: Group RD - Patients received 1 mcg/kg Dexmedetomidine hydrochloride with 0.25% isobaric Ropivacaine hydrochloride (total volume 20 ml). Group R - Patients received 20 ml of 0.25% isobaric Ropivacaine hydrochloride. Prior to induction of anesthesia with injection Midazolam 20 mcg/kg, injection Fentanyl citrate 2 mcg/kg, injection Propofol 2 mg/kg and injection Atracurium 0.5 mg/kg to facilitate endotracheal intubation, epidural catheterization was done. Then, the epidural study medications were injected. Anesthesia was maintained with O2:N2O 1:2, Sevoflurane upto 3% and Atracurium as necessary to achieve muscle relaxation. Pain characteristics, sedation level, intraoperative hemodynamics and requirement of sevoflurane were noted. At end of surgery, patients were extubated and shifted to PACU. Categorical (qualitative) data were presented as number (percentage) and compared using Chi-square test. Continuous variables (quantitative) were presented as mean ± SD and compared using t – test. p value < 0.05 was considered as statistically significant. Result: The duration of analgesia was prolonged in the patients who received Dexmedetomidine as an adjuvant with Ropivacaine (472.14 ± 44.90 mins v/s 309.85 ± 35.72, p – value - 0.000). Number of rescue analgesia doses needed in Group RD was less than Group R (2.11 ± 0.323 v/s 3.14 ± 0.550, p - 0.00). The mean concentration of sevoflurane in Group RD was 2.380 ± 0.22% and in Group R was 2.680 ± 0.278%, and this difference was statistically highly significant (p - 0.000). Vitals remained stable in both the Groups. Conclusion: Epidural Ropivacaine with dexmedetomidine give better and longer postoperative pain relief in upper abdominal surgeries and also reduce requirement of anesthetic agents intraoperatively.

Background: Interscalene brachial plexus block is usually associated with sparing of C8, T1 dermatomes and ulnar nerve. This study have compared the effect of adding magnesium sulphate with bupivacaine on the blockade of individual dermatomes in interscalene block. Materials and Methods: 60 patients were randomly divided into two Groups. Interscalene block was given to all the patients. Group 1 received 20 ml of 0.5% bupivacaine with 0.5 ml of 50% MgSO4 (Total volume = 20.5 ml). Group 2 received 20 ml of 0.5% bupivacaine with 0.5 ml of normal saline (Total volume = 20.5 ml). Block was evaluated every 3 minutes till 15 minutes after the injection of local anesthetic or till minimum Grade 3 sensory and motor blockade was achieved. Results: In our study, the mean time of onset of sensory and motor blockade (achievement of minimum Grade 2 blockade) was comparable between the two Groups. The mean time of onset of complete sensory blockade (achievement of minimum Grade 3 sensory blockade) was also comparable between the two Groups (p > 0.05). Grade 3 sensory blockade to C8 and T1 dermatomes was achieved in 70% of patients (n = 21) in Group I and 23.3% of patients (n = 7) in Group II at 15 minutes and the difference was significant (p = 0.001). Grade 3 motor blockade (by Modified Bromage Scale) was achieved in 70% of patients (n = 21) in Group I and 23.3% of patients (n = 7) in Group II at 15 minutes which was statistically significant (p = 0.001). Conclusion: Magnesium sulphate as an adjuvant tobupivacaine in interscalene block decreases the incidence of C8 and T1 dermatomal sparing and increases the chances of complete motor blockade.

Context: Femur fractures patients are in considerable pain on attempted hip flexion. Fascia Iliaca Compartment Block (FICB) is an effective means of providing analgesia during transit and positioning for spinal anesthesia which also persists postoperatively. Aims: To assess the preoperative and postoperative analgesic effect of Dexamethasone as adjuvant to Bupivacaine in FICB. Settings and Design: After obtaining ethical committee clearance, minimum sample size calculated from pilot studies was 64. Between Dec 2016– Feb 2017, 70 patients with proximal femur fractures posted for open reduction and internal fixation surgery were recruited for the study. Methods and Materials: Patients were randomly distributed into Control and Test Groups 35 patients received USG guided FICB with 28 ml 0.25% Bupivacaine + 2 ml Normal Saline and remaining received block with 28 ml 0.25% Bupivacaine + 2 ml (8 mg) Dexamethasone 20 minutes prior to being moved into position for spinal anesthesia. VAS score is used to assess pain during positioning, and in the postoperative period for duration of analgesia and requirement of rescue analgesics. Statistical analysis used: Paired “t” test, and ANOVA for parametric data and Fischer’s test for categorical data. Results: Patients who received Dexamethasone as an adjuvant had significant prolongation of analgesia and required fewer rescue analgesics in the first postoperative day. No significant difference noticed in analgesia while positioning for spinal anesthesia. Conclusions: This study shows that FICB (total vol; 30 ml) provides preoperative analgesia, and Dexamethasone as adjuvant significantly prolongs the duration of block reducing the need for rescue analgesics over the first postoperative day.

Background: Spinal Anesthesia (SA) is the routine and safe method of administering anesthesia for performing Elective or emergency cesarean sections. SA with conventional (bolus dose) method of injection provides rapid onset of action with high spinal blockade leading to hypotension, compromised the uteroplacental circulation and fetal acid-base imbalance. Our study aimed to compare, low dose bupivacaine injection by conventional to fractionated method to achieve the desired level of anesthesia with stable hemodynamic in SA. Onset of sensory and motor blockade, and duration of analgesia were monitored in patients undergoing elective Lower Segment Cesarean Section (LSCS). Methods: Sixty pregnant women undergoing elective Lower Segment Cesarean Section (LSCS) were included in the study and they were randomly allocated into two Groups. Group C patients received bolus dose of bupivacaine (0.5%) heavy by conventional method and Group F received the same dose of Bupivacaine in fractionated manner with two third of it initially followed by remaining one third dose after 30 secs. The hemodynamic monitoring consisted of Mean Arterial Pressure (MAP), Heart Rate (HR). Other variables recorded were time of onset, duration of analgesia, and regression of sensory and motor blockade. The vasopressor required as rescue drug for hypotension when fall of MAP below 20% of the basal value were observed and noted. Results: The hemodynamics were statistically comparable in both the Groups. The onset of sensory block was slightly delayed (2.50 ± 0.68 vs 3.47 ± 1.53), duration of analgesia was prolonged (141.10 ± 24.32 vs 166.80 ± 52.11) and the vasopressor requirement was less (5.33 ± 3.93 vs 2.20 ± 4.02) in Group F as compared to Group C and these results were statistically significant. The Apgar scores between the two Groups (p > 0.05) were not significant. Conclusion: SA in pregnant women for LSCS by fractionated technique of drug injection provided slightly slower onset of only sensory blockade with prolonged duration of analgesia. The statistically significant less vasopressor requirement in the study group was observed as compared to the conventional group which in turn concludes the hemodynamics more stable in the study group.

Context Background: A Workshop was conducted on intravenous line insertion among doctors and nursing staff. Theoretical aspect was explained through standees whereas practical aspect was demonstrated through skill mannequin. Aims: It was an interventional study conducted for 3 days, where an effect of a training on IV line insertion was evaluated based on pre and post training assessment score. Settings and Design: The study population was 582 including medical and n paramedical staff. The training cum workshop was divided in two sections - theoretical part and skill oriented part, theoretical aspect was explained by expert in the field by the PowerPoint presentation then Mannequin training was given. Same training method was used for all the batches. Evaluation of training was done by asking the participants to fill a questionnaire with 10 questions, before and after training session. Statistical analysis used: The results were collected and evaluated by applying paired t - test and p - value obtained SPSS statistical software. Results: In pretest out of 582 members, only 16% secured ≥ 70% marks. But in posttest evaluation showed 94% candidates securing ≥ 70%. The difference is said to be statistically significant at 95% confidence interval when p - value is < 0.05 (0.0001) Out of 582 responders 148 were doctors 434 were paramedical staff. Conclusions: Hence, we concluded that intravenous cannulation workshop is essential to improve knowledge and skill of intravenous line insertion.

Background: Regional blocks of the anterior abdominal wall have proven to be highly effective in providing excellent postoperative analgesia, decreasing opioid requirements and facilitating early mobilization and discharge after lower abdominal surgeries. In our study, we compared Transversus Abdominis Plane (TAP) block and Ilioinguinal/iliohypogastric block (IL/IH) for postoperative analgesia in lower abdominal surgeries. Materials and Methods: After local ethical committee approval and written consent, the double blind prospective randomized study was conducted on 116 patients (Type I error of 0.05 and a power of 0.9, a sample size of 44 patients/group) of ASA Grade I-II undergoing lower abdominal surgeries under spinal anesthesia. Patients were randomly divided into two Groups through computer generated sequence: Group T: Bilateral TAP block and Group I: Bilateral IL/IH block. Patients were assessed postoperatively for tramadol requirement, first analgesic demand, postoperative pain using Verbal Analog Score (VAS), nausea, vomiting and sedation. Statistical analysis was done by SPSS software version 20 (SPSS Inc., Chicago, IL, USA) and Student’s t - test, Mann-whitney U test and Fisher’s exact test applied. (p – value < 0.05 significant). Results: Demographic data were comparable. Tramadol requirement (primary outcome) was lesser in Group T as compared to Group I (p < 0.001), time for first analgesic dose was greater in Group T. Group T expressed significantly lesser VAS scores at 4, 12, and 24 hours. Postoperative nausea & vomiting was reduced in Group T as compared to Group I but was statistically insignificant. Patient satisfaction was greater in Group T. Conclusion: Transversus Abdominis Plane block provided better pain control than ilioinguinal-iliohypogastric block in lower abdominal surgeries.

Background: Anesthesiologist often check for the ability to ventilate the patient before administering neuromuscular blocking drugs to avoid cannot intubate-cannot ventilate scenario. Aim: To compare the ease of ventilation before and after administration of Neuromuscular Blocking Drugs (NMBD) in terms of expired tidal volume as the primary aim. Materials and Methods: One hundred adult (> 18 years of age) patients of both sexes, undergoing elective surgery under general anesthesia were selected. Different predictors for difficult mask ventilation were assessed preoperatively. Peak Inspiratory Pressure (PIP) in cm H2O, expired tidal volume (TV) in ml, minute ventilation (MV) in litres and ease of ventilation of the patient were noted one minute after induction with propofol and again one minute after giving NMBD. Results: It was seen that facemask ventilation was better after administration of NMBD. The mean (SD) expired tidal volume in ml increased from 414 (110) to 442 (115) and the peak inspiratory pressure decreased from 18 (5.4) to 14 (3.5) (p < 0.001). No patient who was difficult to ventilate after induction became impossible after NMBD. Conclusion: We concluded that facemask ventilation improves after NMBD.

Background and Aims: The present clinical study was conducted to evaluate the onset of analgesia, degree of sensory and motor blockades, duration of analgesia and complications between Levobupivacaine and Levobupivacaine with Dexmeditomidine in USG guided axillary brachial plexus block. Methods: The study was conducted on 60 ASA 1 and 11 patients of either sex posted for various elective or emergency surgeries of the upper limb involving elbow, forearm and hand surgeries. The subjects were divided into two groups, Group A receiving axillary brachial plexus block with 0.5% Levobupivacaine alone and Group B receiving Levobupivacaine with Dexmeditomidine 1 μg/kg. Results: The onset of sensory and motor blockades were quicker in Group B compared to Group A. Both these findings were statistically significant. Both the duration of sensory and motor blockades were longer in Group B compared to Group A which were statistically significant. Time taken for starting of regression was more in Group B compared to Group A but this finding was not statistically different. All other parameters related to duration of anesthesia including time taken for full motor and sensory recovery were longer in Group B compared to Group A. There were statistically significant differences in the duration of complete analgesia, duration of effective analgesia and time of first pain medication were longer in Group B compared to Group A. Conclusion: The onset, quality, intensity of sensory and motor blockades and the duration of analgesia is both clinically and statistically significantly prolonged in Levobupivacaine with Dexmeditomidine group.

Introduction: As an alternative to general anesthesia, for upper limb surgeries, brachial plexus block is a popular approach. This type of block avoids the untoward effects of general anesthesia including upper airway instrumentation and thus prevents the consequences as shown by the available literatures. Aim: To compare 0.5% bupivacaine with normal saline and 0.5% bupivacaine with Dexamethasone (8 mg) in brachial plexus block by supraclavicular approach. Materials and Methods: This study was a single blinded, randomized study which was taken up among 70 patients aged between 18 to 65 years of ASA I and II posted for upper limbs. They were randomly divided into two equal groups where first group received 28 ml of Bupivacaine + 2 ml NS and second group received 28 ml of Bupivacaine + 2 ml Dexamethasone (8 mg) by supra clavicular approach. Results: Between the mean ages of two groups, there was no statistically significant difference. In Bupivacaine group, the mean time for onset of sensory block was 17.4 (± 3.5) min and in Bupivacaine dexamethasone group was 11.8 (± 2.7) min (p < 0.05). The mean time for onset of motor block in Bupivacaine group was 8.5 (± 4.4) min and in Bupivacaine dexamethasone group was 6.4 (± 1.8) min (p < 0.05). Both the differences were statistically significant (p < 0.05). The mean duration of sensory block in Bupivacaine group was 2.03 (± 1.4) hours and in Bupivacaine dexamethasone group was 5.85 (± 0.84) hours (p < 0.05). The mean duration of motor block in Bupivacaine group was 2.48 (± 0.59) hours and in Bupivacaine dexamethasone group was 6.97 (± 0.47) hours (p < 0.05). In Bupivacaine dexamethasone group patients required only 1 rescue analgesic dose. Rescue analgesic requirement in Bupivacaine group was higher (p < 0.05). No significant difference in hemodynamic variables i.e., pulse rate, systolic BP, diastolic BP and O2 saturation. Conclusion: In brachial plexus block, addition of dexamethasone to bupivacaine produced faster and longer duration of block and less number of rescue analgesics in post-op 24 hours.

Background: Transversus Abdominis Plane (TAP) block is a simple and unique method for regional analgesia, especially for lower abdominal surgeries. The aim of this study was to compare the analgesic efficacy of TAP block on addition of 0.5 mcg/kg Dexmedetomidine to 0.2% Ropivacaine and 0.2% Ropivacaine alone in lower abdominal gynecological surgeries. Patients and Methods: Total of 60 female patients, scheduled for open lower abdominal surgery under general anesthesia, were recruited into two Groups: Ropivacaine (R) and Ropivacaine and Dexmedetomidine (RD). Group R received USG-guided TAP block with 30 ml of 0.2% Ropivacaine and saline. Group RD received USG-guided TAP block with 30 ml of 0.2% Ropivacaine and 0.5 mcg/kg of Dexmedetomidine. Post-operative pain scores, sedation score, time to first rescue analgesic, and total opioid requirement in first 24 hours, were calculated. Results: The difference between the duration of time to first rescue analgesic, between two groups, was statistically significant (p = 0.018). Further, it was observed that the VAS scoring was lower in group RD as compared to Group R, at al. the time intervals. The RD Group showed a significant difference between Modified Wilsons sedation score at first hour in both the groups, p < 0.001. All the patients in both the groups were oriented without sedation and with statistical significance (p < 0.05). Conclusion: The analgesic efficacy of Dexmedetomidine with 0.2% Ropivacaine in TAP block showed a positive result when compared to 0.2% Ropivacaine alone. The analgesic efficacy of Dexmedetomidine with 0.2% Ropivacaine was more pronounced when compared to the 0.2% Ropivacaine individually in TAP block procedure during Lower Abdominal Gynecological Surgeries.

Background: I-gel is being commonly used for safe day care surgeries in today’s fast pace world. Muscle relaxants even in low-doses are superior to other agents in facilitating smooth I-gel insertion. Aims and Objectives: The present study, aims to compare I-gel insertion conditions with low-dose succinylcholine and low-dose atracurium by assessing jaw relaxation, ease of insertion, hemodynamic changes and complications. Materials and Methods: Randomised comparative study conducted on 86 patients of ASA physical status I and II divided into 2 Groups of 43 each by random number tables. Group S received 0.2 mg/kg of succinylcholine and Group A received 0.1 mg/kg of atracurium. I-gel was inserted by a single investigator and jaw relaxation, insertion conditions and complications were observed. Results: Jaw relaxation was comparable in 2 Groups (93.0% had full jaw relaxation in Group A while 97.7% had full jaw relaxation in Group S) with no statistically significant difference. Group A had better ease of insertion than Group S, although difference was not statistically significant (p = 1.00). Hemodynamic response was similar in both the Groups. Post-operative myalgia was seen in 1 subject in Group S (2.3%), and sore throat in 1 subject in Group A (2.3%), statistically being insignificant. Conclusion: Both low-dose succinylcholine and low-dose atracurium provide good insertion conditions for I-gel. Low-dose atracurium (0.1 mg/kg) is equally effective as low-dose succinylcholine (0.2 mg/kg) for I-gel insertion.

Background: The Combined Spinal Epidural (CSE) technique is used with increasing frequency in labor analgesia, because of its rapid onset of excellent analgesia. Aim: Aim of the present research was to study the effect of combined spinal epidural analgesia on the progress of labor and its outcome. Material and Methods: Present study was performed in the Department of Anesthesia and Gynecology at tertiary care institute of Gujarat. History taking and clinical examination was done. A total of 100 parturients receiving combined spinal epidural analgesia was compared with 100 parturient receiving the usual anesthetic used in our labor ward that is tramadol. Progress of labor was recorded in a partogram. The outcome of labor in the form of normal vaginal delivery, instrumental delivery or cesarean section was noted. The indications for cesarean section or instrumental delivery were noted. Neonatal outcome in the form of Apgar scores at 1 minute and 5 minutes and need for intensive care facilities was noted. Results: In cases in nulliparas the mean duration of first stage of labor was significantly reduced in the combined spinal epidural group (339.58 + 70.11 minutes) as compared to controls (400.01 + 109.12 minutes). (p - value 0.011). There was no significant difference in the duration of first stage of labor in multiparous parturients. 92.0% of parturients had a pain score of < 10 in the group receiving combined spinal epidural analgesia and the remaining 8.0% had scores between 11 and 40. In the control group none of the parturients had a pain score of < 70. Conclusion: Labor pain is associated with biochemical and physiological changes that may have adverse effects on both the mothers and the fetus. Combined spinal epidural analgesia is an excellent method of relieving labor pain.

Introduction: A number of clinical studies suggest that spinal anesthesia may be superior to general anesthesia for certain surgical procedures. Aim: To compare the duration, density of motor blockade, cephalad spread of sensory anesthesia and intra-operative hemodynamic instability between the both Groups. Method: This prospective, randomised, double blind study was conducted in 60 ASA Grades I & II patients of either sex in the age range of 20–60 years undergoing elective lower abdominal and lower limb surgery. The patients were randomly divided into two equal Groups. The hemodynamic parameters like ECG, NIBP, SpO2, adverse effects and duration of surgery were monitored and recorded. Anesthesia assessed by Modified Bromage scale and bilateral loss of sensation to pin prick. The data was analysed using SPSS 20. Results: The maximum cephalad spread of sensory level was significantly lower in Ropivacaine Group (T 5.70 ± 1.055) than Bupivacaine Group (T 4.93 ± 0.828). The Grade IV motor block by Bromage scale after 3 minutes of intra-thecal injection was seen in 24 (80%) of bupivacaine group compared to 4 patients (13.7%) in ropivacaine group with statistical significance (X2 = 26.786). There were highly significant incidence of intra-operative hypotension in bupivacaine group (17) than ropivacaine (7 patients ). No significant differences in hemodynamic variables like bradycardia and arrhythmia. Conclusion: Isobaric ropivacaine as mean of providing less motor block, early ambulation and causes less hypotension when compared with bupivacaine.

Study Objective: Primary aim was to compare and study the efficacy of intravenous dexmedetomidine (1 μg/kg) and tramadol (1 mg/kg) when used for the control of post-spinal anesthesia shivering. We also compared and studied the hemodynamic changes, complications and adverse effects, in both study groups. Design: Prospective randomised double blind study. Setting: Operating room. Patients: Sixty American Society of Anesthesiologists Grade I and II patients of either gender, aged between 18 and 60 years, scheduled for various surgical procedures under sub-arachnoid block. Interventions: The patients were randomised in two Groups of 30 patients each to receive either 1 μg/kg dexmedetomidine (Group D) or 1 mg/kg tramadol (Group T) as a slow intravenous bolus over 10 minutes, once shivering commenced. Measurements: Grade of shivering, onset of shivering, time for cessation of shivering, recurrence, response rate (complete. Incomplete or failure to control shivering), duration of surgery and spinal anesthesia, axillary temperature, hemodynamic parameters (heart rate, systolic, diastolic and mean arterial pressure, ECG) and adverse effects were observed at scheduled intervals. Results: The mean time taken for cessation of shivering in Group D was 2.55 ± 1.06 minutes, whereas that in Group T was 4.15 ± 1.68 minutes. The difference between the two Groups was analyzed quantitatively and found to be highly significant (p < 0.001). In dexmedetomidine Group, 2 patients had recurrence; whereas, in tramadol Group, 5 patients had recurrence. Conclusion: Both dexmedetomidine (1 mg/kg) and tramadol (1 mg/kg) are effective in treating patients with post-spinal anesthesia shivering. However, dexmedetomidine is more effective as time taken for complete cessation of shivering is shorter with dexmedetomidine as compared to tramadol and incidence of recurrence of shivering is also lower. Furthermore, dexmedetomidine does not cause adverse effects like nausea and vomiting as are seen with tramadol. Sedation caused by dexmedetomidine provides additional comfort to the patient.

Background: Present study was undertaken to see the pre-emptive efficacy of IV paracetamol and reduction in the use of opioid for post-operative pain management. Aim and Objective: To study pre-emptive analgesic effects of 1 gm paracetamol infusion on the total requirement of tramadol in the post-operative period including rescue analgesia. Methods: After ethical approval present study was carried out NSCB Medical College, Jabalpur from October 2009 to September 2010, 90 patients of ASA class I and II between the age group of 20–60 years undergoing elective abdominal surgery were included in the study. Patients were divided into 3 Groups of 30 patients each. Group I was given IV paracetamol infusion 1gm for 15–20 minutes, 30 minutes prior to induction. Group II was IV paracetamol infusion 1 gm for 15–20 minutes prior to skin closure, and Group III received normal saline as placebo. Post-operatively pain (VAS) scores, sedation scores, postoperative tramadol doses, side effects were recorded. Results: Group III, VAS score was significantly higher (p < 0.01) as compare to Group I. Consumption of tramadol in Group III was significantly higher (p < 0.01) compared to Groups I and II. Conclusion: IV paracetamol infusion pre-emptive ensure effective analgesia and decreases tramadol consumption and side effects.

Introduction: Propofol is the widely used induction agent for smooth insertion of laryngeal mask in children who require a larger dose compared to adults1–3 and hemodynamic and respiratory effects like hypotension,2,4 bradycardia, apnoea, hypoventilation4 may be exaggerated. The present study was undertaken with the objectives to assess (i) effectiveness of ketamine as a co-induction agent in lowering the induction dose of propofol while producing favorable insertion characteristics for Laryngeal Mask Airway insertion in children (ii) safety in producing hemodynamic stability (iii) recovery of the patient. Methods: ASA I and II, aged 3–10 years children posted for elective short surgical procedures were allocated randomly into two groups of 30 each. Patients in Group P received propofol 3.5 mg.kg-1 and Group KP received intravenous ketamine 0.5 mg. kg-1 two minutes prior to propofol 2.5 mg.kg-1. LMA insertion characteristics assessed in the next 30s using (1) “mouth opening” graded on a three-point scale-full, partial and impossible (2) “the ease of LMA insertion” graded on a four-point scale-easy, some difficulty, difficult and impossible. The hemodynamic parameters recorded immediately after ketamine, propofol (0 min), thereafter at 1 minute interval for 5 minutes. At the end of surgery, LMA removed once the child was adequately recovered. Statistical evaluation done using Frequencies and Crosstabs, Paired Sample t - test and Repeated measure ANOVA. Results: Ketamine as a co-induction agent with propofol produced favorable conditions for smooth insertion of laryngeal mask in children while providing greater hemodynamic stability.

Background and Aims: To evaluate the safety and efficacy of marketed heparin sodium topical solution (1000 IU/ml) compared to no heparin topical treatment group for prevention of infusion associated thrombophlebitis. Methods: A prospective, randomized, parallel group, comparative, single centre, clinical study. A total 100 patients undergoing intravenous cannulation that has been planned to remain in situ for at least 48 hours indoor period were enrolled. Patients were randomized in Group A (Heparin Topical solution) vs Group B (No Heparin Topical solution). Investigational product was applied on skin around dressing covering intravenous cannulation site approximately every 8 hours for the treatment period of 48 hours. Patients were evaluated for incidences of infusion phlebitis, first signs of phlebitis and treatment emergent application site reactions and were statistically analyzed for statistical significance, p - value below 0.05 levels was considered to be significant. Results: Incidences of infusion phlebitis Grade 2 was found to be higher in “no treatment group” than in “Topical Heparin Group” (20 vs 6 patients; p = 0.00205). Incidences of first sign of phlebitis grade was found to be higher in “no treatment group” than in “Topical Heparin Group” (48 vs 25 patients; p = 0.000). Time to develop first sign of phlebitis was lesser in “No Treatment Group” than in Topical Heparin Group (26 hr vs 36 hr; p = 0.0023). Also, none of the patient in the Heparin Group develop the thrombophlebitis (Grade IV- advance stage of phlebitis). Conclusions: Topical solution of Heparin Sodium 1000 IU/ml was found to be effective and safe in preventing infusion related phlebitis.

Introduction: To date various modalities of treatment are available ranging from opiods, multimodal therapy and Non-steroidal Anti-inflammatory Drugs (NSAIDs). Still NSAIDs are popular choice as they are easy to administer and their effects can easily be monitored. Aims: The aim of the present study is to “Compare intramuscular administration of Injectable Aceclofenac with Injectable Diclofenac in Post-operative Analgesia in patients undergoing Laparoscopic Abdominal Surgeries the efficacy and duration of action. Materials and Methods: It is a double blind prospective randomized study was conducted on 50 patients divided into two Groups of 25 each. Group I aceclofenac, Group II Diclofenac. Study done to compare the relative efficacy of injection aceclofenac and injection Diclofenac by intramuscular route for post-operative analgesia in patients undergoing laparoscopic abdominal surgeries. Results: The quality of analgesia with injection aceclofenac is better than that of injection Diclofenac post-operatively. Both the Groups exhibited hemodynamic stability. Incidence of rise inpulse rate and MAP in the post-operative period was higher with injection Diclofenac than Injection Aceclofenac. Injection aceclofenac in our study scores over injection Diclofenac in providing better quality of analgesia injection consistent with the pharmacokinetic profile of all the patients in Group II Diclofenac required for an additional dose of analgesic after 8 hours. Early ambulation was possible in both the Groups. The analgesia with injection aceclofenac is sustained over longer periods of time upto 24 hours. A single dose is required. Conclusion: We conclude that there is definite place for long acting NSAIDs like Injection Aceclofenac 150 mg/3 ml in the post-operative analgesia for patients undergoing laparoscopic abdominal surgeries in view of its good quality of analgesia, sustained and prolonged duration action upto 24 hours and better gastrointestinal tolerance.

Introduction: Difficult airway remains a frequent cause of anesthesia related morbidity and mortality due to difficulty with tracheal intubation. Around 30% of deaths attributable to anesthesia is mainly due to inability to manage difficult airways. For intubation in cases of difficult direct laryngoscopy many alternatives have been developed such as video laryngoscopes. Objectives: To Compare the ease of intubation by direct laryngoscopy and video laryngoscopy in patients with difficult airway. Outcome variables: Time taken for intubation, Number of Attempts of laryngoscopy for intubation and Cormack Lehane view. Methodology: 100 patients with difficult airway (Mallampatti class III, Upper lip bite test Score II and III, Neck mobility Score III) are divided into two groups of 50 each: Group A - Video Laryngoscopy group; Group B - Direct Laryngoscopy group. Time taken for intubation, number of attempts of laryngoscopy for intubation and glottic view were assessed in both Groups. Results: The time taken for tracheal intubation was shorter with Direct Laryngoscopy compared with Video Laryngoscopy. Number of attempts for tracheal intubation and laryngoscopic views were better with Video Laryngoscopy than with Direct Laryngoscopy. Conclusion: Video Laryngoscopy eases tracheal intubations in patients with difficult intubating conditions. The glottic view for guiding endotracheal tube is significantly improved, with a decreased number of optimizing manoeuvres resulting in a significantly higher success rate of tracheal intubations.

Post-operative Sore Throat (POST), is unavoidable following endotracheal intubation. In our study, we compared the efficacy of 2% viscous lignocaine gargle over 5% ketamine gargle for the prevention of Post-operative Sore Throat (POST) in patients undergoing general anesthesia with endotracheal intubation. Methodology: 80 patients undergoing general anesthesia with endotracheal intubation were allocated into two groups lignocaine (Group L) and ketamine (Group K). Both the Groups were made to gargle five minutes with respective solutions before pre-medication. Group K were made to gargle 50 mg ketamine with 29 ml normal saline and in Group L gargling was done with 30 ml of 2% viscous lignocaine undiluted. The primary objective was to assess the incidence and severity of POST. Secondary objectives were, response to intubation every three minutes for initial 15 minutes, and cough in the post-operative period. Results: Incidence and severity of POST was signifiacantly high at the end of 2nd, 4th, 6th, 12th in Group L. (p = < .07) ( < .001) (< .001) (< .04). There was a significant increase in heart rate and mean arterial pressure in group at the end of 1st, 3rd and 6th minute after intubation in Group K. 4% in Group K and 12% in Group L had post-operative cough of Score 1.

Pre-medications are frequently administered in children to alleviate the stress and fear of treatment as well as to ease child-parent separation and promote a smooth induction of anesthesia. Various drugs have been tried ranging from midazolam, ketamine, fentanyl, promethazine, and triclorfos. Of late alpha-2 agonists like Dexmedetomidine are being used, it has both sedative and analgesic properties and is devoid of respiratory depressant effect. These properties render it potentially useful for anesthesia pre-medication. Aim is to compare the effects of midazolam and dexmedetomidine when administered orally as pre-anesthetic medication for children. Materials and Methods: Children are randomised into Group M receiving midazolam 0.5 mg/kg and Group D receiving dexmedetomidine 2 mcg/kg orally. Results: Demographic and hemodynamic parameters are comparable between two drugs. Child separation Score 1 in Group D is 29 out of 35 (83%) and in Group M is 16 out of 35 (45.7%) with p value of < 0.05. Mask acceptance Score 1 and 2 in Group D is 34 out of 35 (97.2%) where as in Group M is 22 out of 35 (62.8%) with p-value of < 0.05. Sedation score of 2 and 3 in Group D is 29 out of 35 (82.9%) and Group M is 32 out of 35 (91%) with p value of > 0.05. Dexmedetomidine is a better drug in terms of child parent separation and mask acceptance score than midazolam. However, sedation scores were comparable. To conclude Dexmedetomidine is a superior pre-medication compared to Midazolam when given by oral route. Dexmedetomidine may find a regular place for pre-medication in children pre-operatively.

Background: As inguinal hernia is usually seen in elderly age group, so as to avoid or reduce the complications which could occur in the conventional dosages this clinical study of segmental epidural anesthesia was undertaken where the extent of block is limited to only few segments involved in the field of surgery. Materials and Methods: Study was conducted on 200 patients of ASA I and II posted for elective inguinal hernia repair. Segmental epidural block was performed with Ing. Bupivacaine 0.5% 5–6 ml. Result: In the present study, the mean onset of analgesia was 10.53 minutes. The quality of analgesia was excellent in 106 cases, good in 68 cases, fair in 20 cases and poor in 6 cases. Conclusion: Segmental epidural block with 5–6 ml of 0.5% Bupivacaine is found to be safe and fulfils the surgical requirement. Could be successfully employed for inguinal hernia repair with limited spread of analgesia involving only few segments.

Introduction: Intravenous use of dexmedetomidine in the peri-operative period had been found to decrease serum catecholamine levels by 90%, to blunt the hemodynamic response to laryngoscopy, tracheal intubation, pneumoperitoneum and extubation, to provide sedation without respiratory depression and to decrease post-operative analgesic requirements. Aims: We aimed primarily to evaluate the effects of two different doses dexmedetomidine infusion on hemodynamic response to critical incidences such as laryngoscopy, endotracheal intubation, creation of pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. The secondary aims were to study the dose sparing effect of dexmedetomidine on anesthetic drugs used. Methods: Hundred patients of American Society of Anesthesiologists (ASA) physical Grades I and II undergoing laparoscopic cholecystectomy were randomly allocated into two Groups of 50 patients each. Group A patients received dexmedetomidine infusion at 1 μg/kg and Group B patients received dexmedetomidine infusion at 0.6 μg/kg both over twenty minutes, starting 20 min before induction and thereafter, dexmedetomedine infusion continued at 0.2 µ/kg/hr in both the Groups till end of surgery. Parameters noted were pulse rate, mean arterial pressure, oxygen saturation, post-operative sedation and anesthetic drugs requirements. Chi-square test was used for qualitative data were applied. Results: Dexmedetomidine 1 μg/kg is more effective compared to Dexmedetomidine at 0.6 μ/kg in attenuating the tachycardia response to laryngoscopy, intubation and pneumoperitonem. Also, Dexmedetomidine at 1 μg/kg has a better dose sparing effect on anesthetic drugs used intra-operatively than Dexmedetomidine at 0.6 μg/kg. Both the Dexmedetomidine Groups provide light and arousable sedation post-operatively without respiratory depression. Conclusion: Dexmedetomidine infusion in the dose of 1 μg/kg effectively attenuates hemodynamic stress response during laparoscopic surgery with reduction in post-operative analgesic requirements.

Context: Persistent vomiting leads to poor patient satisfaction, delayed wound healing, dehydration and electrolyte disturbances. In addition, vomiting or retching can sometimes result in more serious complications like aspiration, wound dehiscence, increased intracranial pressure, oesophageal rupture and pneumothorax. The expanding number of procedures performed as daycare surgeries has led to the increasing use of dexamethasone for PONV. Aims: The present study is to evaluate the optimum dose of dexamethasone for prevention of PONV and to measure the extent of the hyperglycemic side effects post-operatively in non-diabetics. Settings and Design: Prospective randomized controlled comparative study. Methods and Materials: After approval from the Institutional Ethics Committee, study was conducted on 135 patients of the American Society of Anesthesiologists (ASA) Grade I, II and III, aged between 20 to 60 years and included both genders that underwent elective surgeries under general anesthesia. Patients were randomized into 3 Groups to assess the efficacy of different doses of dexamethasone for prevention of PONV. All post-operative cases were followed up at 0, 12 and 24 hours, PONV and blood sugar levels were measured. PONV was being evaluated on a five-point ordinal scale. Statistical analysis used: Percentage analysis was used for categorical variables and the mean and SD was used for continuous variables. ANOVA with Tukey's Post-hoc test was used for the significant difference and for the repeated measures of ANOVA was used with Bonferroni correction to control the Type I error on multiple comparisons. The collected data were analysed with IBM® SPSS statistics software 23.0 Version. Results: Among categorical variables, p values for age (p - 0.611), gender (p - 0.533), ASA status (p - 0.234) with Chi-square testing were not significant. It is interesting to note that only 1 (2.2%) patient had nausea and vomiting in Group C compared to 5 (11.1%) in Group A and 3 (6.7%) in Group B in the immediate post-operative period. Post-operative blood glucose levels varied significantly in different Groups. In Group A blood sugar levels were 106.93 ± 14.426 mg/dl, Group B 117.31 ± 11.791 mg/dl and Group C 129.49 ± 16.170 mg/dl respectively in the immediate post-operative period. Conclusions: The benefits of administering higher doses of IV Dexamethasone should be weighed against the potential side-effects of short-lasting hyperglycemia.

Background and Aims: The alpha-2-adrenergic agonist drugs are now widely used in anesthesiology for multiple purposes and are not limited only to intraoperative and postoperative analgesia. Clonidine, an imidazoline derivative belongs to this class and has selectivity ratio of 200:1 for alpha-2: alpha-1 receptors. Contents: Apart from its antihypertensive and anti-adrenergic effects, recent studies have established clonidine as a wonder drug to be an effective analgesic, sedative and has an opioid sparing effect with decreased anesthetic requirements intraoperatively. Therefore, a detailed analysis and discussion for possible new role of clonidine in anesthetic armamentarium seems to be need of the hour. This review highlights pharmacological aspects, mechanisms of action, opioid sparing effect, potential indications and adverse effects. Conclusion: Although Clonidine reduces post-operative pain intensity and nausea apart from some other uses like alcohol withdrawal, acute hypertension, smoking cessation, cancer pain management and adjuvant to local anesthetics. However, one should be vigilant while using it for high risk of perioperative low blood pressure and bradycardia.

Introduction: The stress response to laryngoscopy and endotracheal intubation activates the sympathetic nervous system, which may increase myocardial oxygen demand by increasing heart rate and arterial blood pressure. Activation of the sympathetic nervous system may also cause coronary artery vasoconstriction reducing the supply of oxygen to the myocardium, which in turn would pre-dispose to myocardial ischemia. Aims: To study the effectiveness of Lignocaine 2 mg/kg and Esmolol 200 mg and to ascertain the superiority of Esmolol over lignocaine or vice versa in suppressing sympathetic response. Materials and Methods: A clinical comparative study of attenuation of sympathetic response to laryngoscopy and intubation was done in 150 patients posted for elective surgeries under general anesthesia with endotracheal intubation for all the patients. Patients were allocated randomly to the Three Groups, Group 1 (Control), Group II (Lignocaine) and Group III (Esmolol) 50 patients in each group. Results: In patients with no drugs to attenuate the sympathetic responses to laryngoscopy and intubation the maximum rises in heart rate, systolic, diastolic and mean arterial blood pressures were statistically and clinically very highly significant and can be detrimental in high risk patients. Lignocaine significantly attenuates the sympathetic responses to laryngoscopy and tracheal intubation. Esmolol also very significantly attenuates the sympathetic responses. Conclusion: Esmolol is more efficient than lignocaine in attenuating the sympathetic responses to laryngoscopy and intubation. Esmolol at a bolus dose of 200 mg I.V. administered. 3 minutes before laryngoscopy and intubation can be recommended to attenuate the sympathetic responses due to laryngoscopy and intubation.

Introduction: Laryngoscopy and endotracheal intubation are routine procedures of modern balanced general anesthesia technique. Endotracheal intubation has become an integral part of the anesthetic management and critical care of the patient and has been practiced following its description by Rowbotham and Magill in 1921. Materials and Methods: Present clinical study was conducted in Department of Anesthesiology, Subbaiah Institute of Medical Science and Research Centre, Purle, Shivamogga. After approval from the hospital ethics committee, study was conducted during the period between October 2016 and September 2018. It was a prospective study. A total of 60 patients undergoing elective surgery were selected. Patients in each group received respective drugs as per timing and dose mentioned earlier. On arrival in the operating room, patient’s basal parameters-Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MBP), Rate Pressure Product (RPP) and Electrocardiography are monitored using, pulse oximetry, Non-invasive Blood Pressure (NIBP), and ECG monitor. Intravenous access using 18 G cannula was established and an I.V. infusion of ringer lactate was started. All patients were pre-oxygenated with 100% oxygen for 3 minutes before induction with a tight fitting face mask. Results: All the patients received Tab. Alprazolam for night sedation, day before. One hour before the expected time of induction, Group P received tab. Pregabalin 150 mg orally with sips of water and Group C received 0.3 mg orally with sips of water. Base line parameters, after pre-medication, after induction and subsequently at 1 minute, 3 minutes, 5 minutes, and 10 minutes post-intubation were recorded. Data was tabulated and analyzed using Microsoft Office version 2010. The demographic profile (age wise, gender wise and weight wise distribution) was comparable in all the groups. Laryngoscopy and endotracheal intubation resulted in increased heart rate and blood pressure (SBP, DBP and MAP) in all the groups with maximum values at 1 minute. The percentage rise in hemodynamic parameters was as given below Heart Rate: 10% rise above the baseline in Pregabalin Group 7.8% fall from the baseline in Clonidine Group Systolic blood pressure: 9.65% rise above the baseline in Pregabalin Group 4.67% rise from the baseline in Clonidine Group, Diastolic blood pressure: 11.91% rise above the baseline in Pregabalin Group 7.91% rise from the baseline in Clonidine Group, Mean arterial pressure: 11.16% rise above the baseline in Pregabalin Group, 7.72% rise from the baseline in Clonidine group. Conclusion: Both oral Clonidine 0.3 mg and Oral Pregabalin 150 mg effectively attenuates the hemodynamic response to laryngoscopy and endotracheal intubation. Clonidine was found to be more effective than Pregabalin in lowering of blood pressure and heart rate changes associated with laryngoscopy and endotracheal intubation. Pregabalin gives better post-operative analgesia, more sedation and less bradycardia as compared to Clonidine.

Aims and objectives: To compare addition of dexmedetomidine as an adjuvant to local anesthetic agent in intravenous regional anesthesia. Materials and Methods: We conducted a prospective, randomized, double blind study, in which 50 patients undergoing posted for hand and forearm surgeries were enrolled for the study. Patients were randomly distributed in two Groups (25 in each Group). Group I - 25 patients were administered lignocaine (3 mg/kg) to total volume without adjuvant in IVRA. Group II - 25 patients were administered (1 mcg/kg) dexmedetomidine as an adjuvant to lignocaine (3 mg/kg) to total volume in IVRA. Results: Onset of sensory and motor block was hastened by the addition of Dexmedetomidine to local anesthetic agent.The mean time taken to achieve complete sensory block and motor block was maximum in control group as compared to Study Group. All patients in both the groups had excellent quality of surgical anesthesia, and duration of sensory and motor block was prolonged with the addition of Dexmedetomidine (1 mcg/kg) as compared to Control Group. The total duration of post-operative analgesia was highly significant with addition of Dexmedetomidine as compared to control group. Conclusion: All patients in both the Groups had excellent quality of surgical anesthesia, and duration of sensory and motor block was prolonged with the addition of Dexmedetomidine (1 mcg/kg) as compared to control group. The total duration of post-operative analgesia was highly significant with addition of Dexmedetomidine as compared to control group. Addition of Dexmedetomidine (1 mcg/kg) to lidocaine (3 mg/kg) as an adjuvant can be used safely.

Context: Several studies addressing Intrathecal Morphine (ITM) use following spine surgery have been published using low to high-dose of ITM. But the optimal dose of ITM with maximal analgesic property and minimal complication and side effects is yet to be decided. Aims: We aimed to compare the analgesic efficacy of two low doses of ITM, 0.3 mg and 0.4 mg in patients undergoing lumbar spine decompression, with or without instrumentation surgery. Materials and Methods: Fifty patients were enrolled in a double-blinded randomised controlled trial, and received either 0.3 mg or 0.4 mg of ITM. Post-operatively, all patients were given a Patient Controlled Analgesia (PCA) pump and observed for the first 24h in a step-down unit. Measurement of: Total fentanyl used during intra-operative period; Total PCA morphine consumed in first 24h; Intensity of pain; Sedation score; nausea; Vomiting; Pruritus; and occurrence of respiratory depression were recorded. Statistical Analysis Used: Statistical analysis was performed using Graph Pad Prism 6.0, La Jolla, CA, USA. Statistical significance of categorical variables between the groups was compared by Chi-square test and that of quantitative variables were compared using Student’s t-test. Results: The total intra-operative fentanyl consumption and total PCA morphine use and the overall pain score over the first 24 h in the post-operative period was significantly low in 0.4 ITM Group. There was no difference in terms of sedation, nausea, vomiting and pruritus. There was no case of respiratory depression in either Group. Conclusions: 0.4 mg ITM provided superior analgesia in the post-operative period compared to 0.3 mg with no significant increase in the incidence of side effects.

Background: Adequate pre-operative anxiolysis and sedation are important in patients undergoing surgery. Agomelatine and Ramelteon are analogues of melatonin and have been used routinely to induce sleep in insomnia patients. Aims: To compare the effects of Tab. agomelatine and Tab. ramelteon on pre-operative anxiety, sedation and orientation. Subjects and Methods: This was a prospective, randomized, comparative study conducted after institutional ethics committee approval on 60 ASA I adult patients undergoing elective surgeries under general anesthesia. After obtaining written and informed consent, the patients were randomly allocated into two equal groups: Group A (n = 30) received Tab. agomelatine 10 mg and Group R (n = 30) received Tab. ramelteon 8 mg orally, 1 hour before induction of anesthesia. Patient’s anxiety, sedation and orientation were assessed at 0, 15, 30, 45, 60 minutes and before induction of anesthesia. Statistical Analysis: Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver. 2.11 were used for analysis of data. Data was expressed as mean ± standard deviation or absolute values. Qualitative data were compared with the Chi-square test and fisher's exact test. Quantitative variables were compared with the student 't' test. The level of statistical significance was set at p < 0.05. Results: Decrease in anxiety levels from baseline in both the groups and greatest reduction was at 15 minutes. In both the groups, increasing sedation score was noted after 15 minutes and greatest sedation around 60 minutes. Orientation score between the two groups was unchanged from baseline and between the two groups as well and hence no p-value. Conclusion: Tab. agomelatine 10 mg and Tab. Ramelteon 8 mg administered orally, 60 minutes before induction of anesthesia provided comparable anxiolysis and sedation but did not affect orientation of the patient.

Context: Management of post-operative pain in children is challenging due to the side effects of the drugs like opioids and pain during intramuscular administration. Aims: To compare the quality of post-operative analgesia between rectally administered paracetamol and diclofenac as Assessed by Pain Discomfort Scale (APDS). Settings and Design: We compared the efficacy of pre-operatively administered rectal paracetamol 40 mg/kg and diclofenac 1 mg/kg. in 60 randomised children undergoing elective inguinal hernia surgeries. Materials and Methods: The patients were given general anesthesia with fentanyl for intra-operative pain relief. Post-operative pain was assessed using AIIMS Pain and Discomfort Scoring system (APDS) and the duration of analgesia was noted. Statistical analysis used: The difference between the Paracetamol and Diclofenac Group with respect to duration of analgesia, intra-operative fentanyl use and heart rate at awakening was compared using independent t-test. APDS score was compared using Mann Whitney’s test. A p-value < 0.05 was considered significant. Results: Intra-operative fentanyl requirement was similar in both the Groups. Post-operative pain scores were lower in Diclofenac Group. Duration of analgesia was longer in Diclofenac Group compared to Paracetamol Group (12.5 hrs vs 7.6 hrs). Three patients in Diclofenac Group had vomiting and gastritis. Conclusions: Better post-operative pain relief of 1 mg/kg of rectal diclofenac without significant bleeding makes it an attractive option for management of post-operative pain in children. However, anti-gastritis prophylaxis may be desirable to prevent the complications.

Introduction: In airway management, comparison of laryngeal mask airway is a new concept. It avoids the hazards of tracheal intubation and at the same time has many advantages over the traditional face mask. Aims: The present study was performed to evaluate to laryngeal mask insertion using thiopental sodium and low dose atracurium is comparison with propofol. Materials and Methods: A total number of seventy (70) cases ASA I and ASA II Grade were considered in the study and patients were divided into two Groups. Thirty five (35) of them induced with thiopental sodium and low dose of atracurium and the other thirty five (35) patients were induced with propofol for comparison of insertion conditions of LMA. Results: Between the Groups, there was no statistical difference with respect to age, weight and sex. Jaw relaxation, insertion conditions are same in both Groups. But incidence of coughing gauging is more in Group I compared with Group II. Total score is good in group compared with Group I. All these parameters are statistically not significant. Conclusion: A significantly greater ease of insertion of the LMA was observed and significantly lesser time taken for insertion was observed in patients induced with propofol as compared to thiopental sodium and low dose atracurium.

Background: Parecoxib has been previously evaluated in various doses to reduce post-operative pain relief. Aim of the Study: Parecoxib was evaluated as a pre-emptive agent in patients undergoing surgery under general anesthesia and hemodynamic effects and side effects. Settings and Design: This study design was a double blind prospective randomized controlled trial. Patients and Methods: 100 patients in age group 20–45 years undergoing surgery under general anesthesia were randomly divided into two Groups. Group I received 40 mg of Parecoxib I.V. 1 hour before induction of anesthesia and 2 ml normal saline I.V. at the end of surgery and Group II was given the same vice versa. Hemodynamic parameters i.e., blood pressure and pulse rate, intensity of pain and number of patients requiring rescue analgesia in two groups at baseline and post-operatively at the end of surgery and henceforth at 30 minutes, 1, 2, 4, 6, 8, 12 hours were noted in addition to adverse effects in two Groups. Results: Demographic profile and hemodynamic parameters were comparable at baseline in two Groups. The mean time weighted score of pain intensity was significantly higher in Group II (1.92 ± 0.10) as compared to Group I (1.61 ± 0.34). Pain relief score was significantly lower in Group II (1.13 ± 0.18) as compared to one (1.72 ± 0.56). They demanded rescue analgesia at a relatively early time 125.40 ± 111.87 min as compared to Group I patients 357.24 ± 231.37 min ( t:6.379, p:0.000). Post-operatively the mean of hemodynamic parameters over varied time intervals was slightly higher in Group II as compared to Group I. Conclusion: Pre-operative parecoxib has an effective pre-emptive analgesic effect by decreasing the post-operative pain and delaying the time to demand of rescue analgesia as compared to its use post-operatively.

Background: Difficult airway leading to failed intubation are the foremost causes of anesthesia related morbidity and mortality. Newer developments in airway management has resulted in the pioneering of various optical and vedio laryngoscopes. In anticipated difficult airway patients, awake intubation using flexible fiber optic bronchoscope is the method of choice. Truview PCDTM laryngoscope is designed to help positioning of the endotracheal tube and also to record entry of the tube into glottis. Aims: To study and compare the effectiveness of fiber optic bronchoscope and Trueview PCDTM video laryngoscope in patients undergoing awake oral tracheal intubation in difficult airway situations. Study design: This was a prospective randomized study. Methodology: Sixty patients with ASA physical status classification I and II undergoing elective surgery under general anesthesia were randomized into two Groups; Group I (Trueview PCDTM video laryngoscope) and Group II (fiber optic bronchoscope). Intubation time, intubation attempts, Cormack and Lehane Grade (CLG), hemodynamic response, complications, were recorded. Results: Group II (88.10 ± 4.20 seconds) has significantly longer intubation time compared to Group I (58.00 ± 11.49 seconds). Intubation on first attempt observed in 76.7% patients in Group I compared to Group II (70%). CLG Grade I observed in 73.3% patients in Group I compared to Group II (80%). Better glottis visualization seen in Group II than Group I which is not significant. Hemodynamic parameters did not show significant difference among the two Groups. Conclusion: Trueview PCDTM video laryngoscope could be a suitable auxiliary to flexible fiber optic bronchoscope in difficult airway situations.

Background: Effective post-operative analgesia is obtained by Tranversus Abdominis Plane Block and it decreases consumption of post-operative opioids significantly after abdominal surgeries. Aims: To evaluate which period is more effective for Tranversus Abdominis Plane (TAP) Block administration using Ultra sound guidance for post-operative analgesia in patients undergoing total abdominal hysterectomy. Materials and Methods: This was a prospective randomized, double blind study conducted on 70 patients between ages of 19 and 66 years, with ASA class I-II. The subjects were divided into two Groups. The TAP block was given pre-operatively to Group I patients and was given post-operatively to the Group II patients. These patients were scheduled to undergo open total abdominal hysterectomy. Both the groups received standard general anesthetic technique. In the post-operative period tramadol (20 mg/2 ml bolus intravenous and then 10 mg/ml I.V. with a five minute lock out period) was given that was controlled by the patient. Metoclopramide 10 mg I.V. 8 hourly was given as per PONV score. The Numerical Rating Scale was used to assess pain. The NRS scores were recorded at 2, 4, 6, 12 and 24 hours post-operatively. The NRS at rest, the NRS on movement and sedation score were recorded. Tramadol consumption in both groups was compared. Results: When both the groups were compared it was observed that the NRS scores at rest were significantly lower in Group 2 at 2 and 4 hours post-operatively (p < 0.05). In Group 2, the 24 hour tramadol consumption was significantly lower than that of Group 1 (p < 0.05). Conclusion: Post-operative ultrasound guided TAP Block confers significantly reduced pain scores in the early post-operative periods of TAH cases as compared to pre-operative TAP block.

Introduction: The success of Functional Endoscopic Sinus Surgery (FESS) depends on the visual clarity of the surgical field, through the endoscope. Aims: The objective of this double-blind, randomized, controlled study was to determine if a pre-operative dose of Bisoprolol (2.5 mg) would reduce the bleeding during FESS and improve the visualization of the operative field. Methods: Sixty ASA I or II patients, scheduled for FESS were randomized to receive either a Placebo (Group A) or 2.5 mg of Bisoprolol (Group B) 90 min prior to the surgery. All the patients received standard anesthesia and monitoring. The aim was to maintain the mean arterial pressure (MAP) of 60–70 mm Hg, by titrating the dose of Sevoflurane and Fentanyl. Results: The blood loss in Control group was (97 ± 16.75 ml) and in Bisoprolol group was (58.3 ± 13.9 ml). The volume percent of Sevoflurane and the dose of Fentanyl used was significantly lower in those who received Bisoprolol. During the operative period, the MAPs were 92.87 ± 6.39 (Group A) and 78.25 ± 3.5 mm Hg (Group B) and the heart rate was 94.75 ± 3.14 min (Group A) and 67.97 ± 1.84 min (Group B). Conclusion: This clinical trial has demonstrated that administration of a single pre-operative dose of bisoprolol (2.5 mg) can significantly reduce the blood loss during FESS and improve the visualization of the operating field.

We conducted a study, in a prospective, randomized, comparative study, we compared the ultrasound guided technique with conventional technique for brachial plexus block by the infraclavicular approach. Brachial plexus block by infraclavicular approach was performed in 60 patients of ASA Grade I and II posted for upper limb surgeries below the mid arm. The patients were randomly allocated into two Groups. In Group USG, block was performed under ultrasound real time image guidance and in Group CT, block was performed by manual conventional technique. Aim of the study was to compare the performance time, number of attempts, onset of sensory anesthesia and motor block, success rate, duration of action (post-operative first analgesia required), complications and patient compliance during procedure with ultrasound (USG) guided and conventional technique (CT) brachial plexus block by infraclavicular approach1,2,3.

Background: Delivery by cesarean section is one of the commonest major operative procedure in obstetrics worldwide. Pain has been a major concern of mankind since the very beginning and according to Association for the Study of Pain, pain is “sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Pain is inevitable after every surgery; hence, management of post-operative pain is of utmost importance. Methods: This was a single blind randomized controlled study in which 100 parturient who were undergoing cesarean delivery under spinal anesthesia in district hospital, Ballari from July 2018 to Dec 2018 were taken for the study. Patients were divided into two equal groups using computer generated randomization with 50 women in each group. Results: Paracetamol is better than Tramadol for post-operative acute pain relief in cesarean patients owing to its comparable analgesic efficacy and also Paracetamol is considered to be more safe, effective and requires no special monitoring.

Keywords: Paracetamol; Tramadol; Cesarian section.

Background: Spinal anesthesia induced hypotension is common and dangerous especially in the elderly, as they have diminished physiological reserve and compromised blood supply to the vital organs. Aim: To compare the heart rate, systolic and diastolic blood pressure after spinal anesthesia with prophylactic use of atropine and ephedrine. Materials and Methods: This was a prospective study in which sixty ASA I and II patients undergoing urological surgeries were assigned to receive I.V. atropine 0.6 mg or I.V. ephedrine 12 mg one minute after spinal anesthesia induction. Heart Rate (HR), systolic and diastolic blood pressure, requirement of mephentermine and phenylephrine and side effects were studied. Hemodynamic parameters were compared with baseline values among the groups. Results: The patients with demographic data, baseline hemodynamic parameters and duration of surgery were comparable in both groups. Compared to baseline, trend of mean HR, systolic and diastolic BP were significantly less in Group E (ephedrine) than Group A (atropine). Conclusion: Administration of intravenous atropine 0.6 mg one min after induction of spinal anesthesia in elderly patients is safe and effective in the prevention of spinal anesthesia induced hypotension and bradycardia. Also, the requirement of vasopressors decreases without clinically significant side effects.

We conducted a comparative study, and compared the arterial blood gas valves with respect to time 0, 5, 10, 15, 20 mins after sample collection and temperature at 0 oc and 22 0c degree arterial blood gas sample was collected from dorasalis pedis artery before induction of general anesthesia in 100 patients of ASA Grade I and II posted for all type of elective surgeries. The samples were randomly allocated into two groups. In Group A at 0 degree Celsius, and in Group B, 22 degree Celsius. parameter noted pH, pCO2, pO2, standard bicarbonate, base excess, O2 and CO2 at 0, 5, 10 , 15 and 20 minutes. Statistical analysis was done with t-test.

Background: Effective post-operative pain control is an essential component of the care of the surgical patient. Certain patient population are at risk of in-adequate pain control and requires special attention, including pediatric patients, geriatric patients and patients with difficulty in communication. Objectives: To compare quality and duration of analgesia, motor and sensory block after caudal block with either Bupivacaine or Ropivacaine in pediatric cases aged 2–6 years. Materials and Methods: An observational study with consecutive sampling technique getting either of two interventions are recruited till the sample size is attained. 74 pediatric patients planned for circumcision with ASA1 allocated in two different groups, to receive either 0.375% ropivacaine or 0.375% bupivacaine. Onset of action and return of motor movements assessed based on Bromage scale. Mean duration of onset of anesthesia, duration of motor blockade and post-operative analgesia among two groups are compared using t-test. Proportions of children with adverse effect among two groups are compared using Chi-square test. Results: Both the groups were comparable regarding age, weight, onset of action and post-operative analgesia but significant difference was noted in return of motor movements in both groups. Conclusion: Not much significant difference observed in the post-operative analgesia among the study groups. As regard to the motor function recovery is much faster with ropivacaine than with bupivacaine.

Background: This prospective randomised study was done to compare iPACK (local anesthetic infiltration in the interspace between Popliteal Artery and Capsule of Knee) versus LIA (Local Infiltration Analgesia), in combination with ACB (Adductor canal block) for post-operative pain managment in patients undergoing TKR (Total Knee Replacement) surgeries. Methods: 120 patients in the age group of 50 to 70 yrs belonging to ASA I & II posted for TKR were divided into two equal Groups and studied. Both the groups received subarachnoid block as the anesthetic technique followed by Adductor canal block. Group A received iPACK and Group B received LIA. Post-operatively parameters like VAS (Visual Analogue Scale), distance walked and opioid consumption were studied. Results: Demographic profile was comparable in both the groups. Both the groups had optimal post-operative analgesia which was evident with respect to VAS, distance walked and opioid consumption. The mean VAS scores at 24 hrs was 2.85 ± 1.45 and 3.14 ± 1.12 in Group A and Group B respectively. The mean VAS scores at 48 hrs was 3.22 ± 2.32 and 3.8 ± 2.91 in Group A and Group B respectively. The distance walked and opioid consumption were comparable in both the Groups. Conclusion: It is concluded that both iPACK and LIA, in combination with Adductor canal block were equally effective in providing post-operative analgesia in TKR patients.

Background: The transversus abdominis plane (TAP) block is a regional analgesia technique that forms part of the multimodal approach to post-operative pain management for abdominal surgeries. Local anesthetics like Bupivacaine with longer duration are preferred for TAP block. Objectives: To evaluate if Fentanyl as an adjuvant to bupivacaine in ultrasound guided TAP block improve the duration and quality of post-operative analgesia following abdominal hysterectomy. Methods: Forty four patients, aged 18–60 years of American Society of Anesthesiologist (ASA) Physical status I or II, posted for elective open abdominal hysterectomy under general anesthesia were recruited by convenience sampling technique, to receive TAP block using 19.5 ml of bupivacaine hydrochloride 0.25% + 0.5 ml saline 0.9% (Group B, n = 22) or 19.5 ml of bupivacaine hydrochloride 0.25% + 0.5 ml Fentanyl. (25 micrograms) (Group BF, n = 22), after the completion of surgery but prior to extubation. Visual analog scale (VAS) scores at rest and movement were assessed on the emergence, at 0, 2, 4, 6, 12 and 24 hours (h). Results: VAS score was significantly lower in study group, at rest at 2h (14.68 vs 20.63, p = 0.006), 4h (24.46 vs 24.77, p = 0.02), 6h (22.27 vs 28.45, p = 0.002) and 12h (18.90 vs 21.00, p = 0.043) and that with movement, at 2h (20.45 vs 25.86, p = 0.006), 4h (25.23 vs 30.95, p = 0.001) and 6h (29.14 vs 33.90, p = 0.006). Sedation score in study group was relatively significant at 4h (1.77 vs 1.27, p = 0.01) but clinically in-significant to cause major adverse effects. Conclusion: Fentanyl as an adjuvant to bupivacaine in ultrasound guided transversus abdominis plane block, following abdominal hysterectomy under general anesthesia improves the quality and duration of post-operative analgesia without any major adverse effects.

Introduction: Pediatric patients, because of their anatomical differences in airway compared to adult pose many challenges during endotracheal intubation during general anesthesia. One such challenge is selecting the proper size of endotracheal tube for intubation. Objective: To assess the subglottic diameter by ultrasonography and compare with age based formula for selection of the appropriate size endotracheal tube in pediatric patients. Materials and Methods: 60 pediatric patients aged 5 to 15 years of both gender with normal airway, scheduled for surgery under general anesthesia and intubation, were included for this prospective clinical randomised study. Patients were divided randomly into Two groups of 30 each. In Group A (n = 30) estimation of endotracheal tube size was done by ultrasonography and patients were intubated by that size of tube. In Group B (n = 30) estimation of endotracheal tube size was done by age based Motoyama formula and patients were intubated by that size of tube. Time required for intubation, leak test for appropriate size endotracheal tube, hemodynamic parameters and peri-operative complications were studied. Results: In our study, in Group A 26 of 30 (86.66%) patients and in Group B 19 of 30 (63.33%) patients had appropriate size of tube as checked with the leak test, the P value (< 0.05) was significant. Conclusion: Ultrasound guided assessment of subglottic region is more reliable method to estimate appropriate size of endotracheal tube in pediatric patients.

Pre-emptive analgesia aims at preventing central nervous system from reaching the hyper excitable state known as central sensitization, in which it responds excessively to afferent inputs. The effective pain management pre-operatively can reduce the post-operative pain and analgesic requirement in pediatric age group. Inguinal hernia repair and penile surgeries are one of the most common and painful ambulatory surgeries with 40–50% patients reporting moderate to severe pain within 24 hours. Hence it is the prime concern of anesthesiologist for post-operative pain relief. Our study was conducted in 60 patients of ASA Grade I/II aged between 2–8 years, who were randomly divided into two Groups, Group K and Group T. We used intravenous ketorolac 1 mg/kg body weight and tramadol 1 mg/kg body weight as pre-emptive analgesics and compared intra-operative parameters like mean heart rate, mean arterial pressure, post-operative pain with FLACC score (face, legs, activity, cry, consolability) and time for first rescue analgesia. The study results showed that both the groups were comparable in various demographic data. In our study, intra-operative mean heart rate and mean arterial pressure were significantly higher in case of ketorolac as compared to tramadol. Our results showed that FLACC score is significantly higher and time for first rescue analgesia is significantly earlier in ketorolac group compared with tramadol group. The mean time for first rescue in Group T and Group K was 5.50 ± 0.68 (hours) and 2.33 ± 0.76 (hours) respectively.

Aim: Our aim was to comparatively evaluate the post-operative neurocognitive dysfunction following general and regional anesthesia in pregnant patients with cardiac disease undergoing elective cesarean section. Materials and Methods: Sixty pregnant patients with congenital or rheumatic heart disease undergoing elective cesarean section were divided into two groups, General anesthesia group (Group G, n = 30) and Regional Anesthesia Group (Group R, n = 30). Neuro-Cognitive Tests - Trail Making test A & B, Digit symbol substitution test, Benton visual retention test and Benton visual recognition test were performed one day prior to surgery and at 6h, on day 1 and day 3 post-operatively. Results: Neuro-cognitive tests when compared from their preoperative values to 6h, day 1 and day 3 post-operatively, there was a significant increase (p <-0.001) in both Groups G and Group R. Whereas when compared between the Group G and Group R at pre-operative, 6h, day 1 and day 3 post-operatively there was no significant difference between them (p > 0.05). Cognitive dysfunction occurred in both the groups but it was short lasting in Group R. Post-operative cognitive dysfunction incidence in Group G was 23% as compared to 10% in Group R on day 3. Conclusion: Neurocognitive functions are affected in post-operative pregnant patients with cardiac disease irrespective of the technique of anesthesia. However, recovery is delayed in patients receiving general anesthesia.  

Introduction: Practice of videolaryngoscopy in anesthesia has been found to improve the ease of intubation in patients with normal and difficult airway both. Airtraq and King vision are two commonly available channelled videolaryngoscopes. Presently, very few data regarding comparison of these two videolaryngoscopes are available. Materials and Methods: After getting approval from the ethical committee, 60 ASA Grade I and II, adult patients posted for elective surgery under general anesthesia were randomly divided into two groups of 30 each. After induction with standard protocol, intubation was done using either Airtraq or King vision videolaryngoscope as per the group. The primary aim was to observe the intubation time and secondary aims included were quality of visualization of glottic aperture, number of attempts, manoeuvres required during intubation and complications. Results: The time required to intubate patients was shorter with King Vision video laryngoscope as compared to Airtraq (29.03 ± 1.84 vs 31.20 ± 4.08 seconds, p = 0.01). No difference was noted in number of attempts, quality of visualization or optimization manoeuvres during intubation for subjective device. Conclusion: Both the video laryngoscopes are suitable for intubation in routine clinical practice. Though, King vision gives faster view of glottis and rapid tube insertion into the glottis as compared to Airtraq, the clinical significance remained negligible.

Introduction: Calcium permeability is reduced by local anesthetics, and calcium ions play an important role in opioid-receptor mediated analgesia. The aim of this study is to evaluate whether addition of verapamil into local anesthetic for brachial plexus block provide additional anesthetic and analgesic effects. Methodology: Sixty patients undergoing upper extremity surgery were randomized to either Group A (20 ml of 1% lignocaine, 20 ml of 0.25% bupivacaine, 1 ml normal saline) or Group B (20 ml of 1% lignocaine, 20 ml of 0.25% bupivacaine, 1 ml 2.5 mg verapamil). Results: Baseline characteristics like age, gender distribution and body weight were similar in both the study groups. Mean duration of sensory block was found to be significantly higher in the group of patients receiving verapamil (191 ± 45.59 minutes vs 163 ± 45.72 minutes; p value < 0.01). Rest of the parameters like mean time of onset of sensory and motor block, duration of motor block and duration of analgesia were similar in both the study groups. There was no difference in the proportions of hemodynamic complications like heart rate, systolic blood pressure and oxygen saturation among the patients in the two groups as well. Conclusions: Our results show that adding verapamil to brachial plexus block can prolong sensory block. However, no change in analgesic properties or hemodynamic changes was observed.

Background: The use of neuraxial opioid has gained popularity over the last few years. The dose calculation of local anesthesia for intrathecal block is difficult due to hormonal and mechanical factors of pregnant women along with neonatal outcome. Aim: This study was undertaken to compare the effects on outcome of newborn and peri-operative maternal analgesia with intrathecal versus intravenous fentanyl in lower segment cesarean section under subarachnoid block. Materials and Methods: The ASA I and II pregnant women were randomly allocated into 2 Groups (30 patients each). Group A received 1.7 ml of 0.5% hyperbaric bupivacaine along with 25 mcg fentanyl (0.5 ml), Group B received 1.7 ml of 0.5% hyperbaric bupivacaine along with saline (0.5 ml) 1 mcg/kg body weight of intravenous fentanyl immediately after SAB. Umbilical arterial blood gas analysis was sent immediately after baby extraction and Apgar score noted. The sensory and motor level achieved, hemodynamic changes, post-operative maternal analgesia and side effects were recorded. Results: Apgar score of newborn was normal in both the groups. Patients in Group A had statistically significant prolonged maternal analgesia than a patient in Group B (p <.0001). There was statistically significant (p = 0.002) decreased incidence of nausea and vomiting in Group A. Conclusion: Intrathecal and intravenous fentanyl achieves quality anesthesia with good Apgar score of neonate, while intrathecal fentanyl has added benefit of prolonged peri-operative maternal analgesia with minimal side effects.

Context: The availabiliy of rapid, shorter acting anesthetics, analgesics and muscle relaxant drugs has faciltated the recovery process and allowed more extensive procedures to be performed on ambulatory basis.1 Dexmedetomidine is highly selective alpha 2 adrenoreceptor agonist with sympatholytic, sedative, amnestic and analgesic properties. It provides unique consious sedation where patient is easily arousable and analgesia without respiratory depression. Aims: To evaluate recovery profile with Dexmedetomidine in Ambulatory Anesthesia. Settings and Design: 60 female patients posted for Medical termination of pregnancy aged between 20 and 40 years were included in the study, and were randomly divided into two groups, Group M (Midazolam) and Group D (Dexmedetomidine) having 30 patients in each. Methods and Materials: All Group D patients received Inj. Ondansetron, Inj. Dexmedetomidine 0.25 ug/kg I.V. slowly over 10 minutes as infusion with hemodynamic monitoring, Inj. Fentanyl l ug/kg I.V. Induction was done with Inj. Propofol upto a maximum of 2 mg/kg in divided doses, titrated to effect. Dexmedetomidine infusion @ 0.25 ug/kg/hour was continued during the procedure if hemodynamic parameters were stable. Statistical Analysis: The statistical significance of difference was tested using Chi-square test, unpaired ‘t’ test, repeated measures analysis of variance (ANOVA), The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 11.5, Inc. Chicago) for MS Windows. Results: Group D had better recovery profile than Group M, with Group D having shorter awakening (p-value 0.020). Orientation times of (p - value 0.001). Faster achievement of target Aldrete D (p - value 0.001). and Fastrack scores (p - value 0.001). and a rapid home readiness compared to Group M. Conclusions: Dexmedetomidine infusion in lower doses 0.2–0.3 mcg/kg/hr for short duration procedures can be a good choice in multimodal approach in Ambulatory Anesthesia.

Introduction: Post-operative nausea and vomiting is one of the most common and distressing side effect encountered by patients following anesthetic and surgical procedures. Aims: The aim of the present study is to compare the effectiveness of intravenously administered Granisetron with Metoclopramide in the prevention of post-operative nausea and vomiting in patients undergoing major gynecological surgery under general anesthesia. Materials and Methods: This study was carried out for a period a total number of 50 cases were taken into study 25 of them received Granisetron (40 μg/kg) and the other 25 patients received Metoclopramide (0.2 mg/kg) for preventing post-operative nausea and vomiting through a period of 24 hours. Results: There were no statistically significant differences between the groups with respect to patient's characteristics, type of surgery and duration of anesthesia. There was statistically significant increase in pulse rate and systolic blood pressure in metoclopramide group while the diastolic blood pressure remained relatively constant. Granisetron group did not show significant variation in either pulse rate or blood pressure. The incidence of post-operative nausea and vomiting in 24 hours period was 12% and 48% in granisetron and metoclopramide respectively. The incidence of nausea in first 24 hours of post-operative period was 12% and 48% in granisetron and metoclopramide groups respectively. The incidence of retching/vomiting in first 24 hours post-operative period was 32% in metoclopramide group and no such episodes occurred with granisetron. Conclusion: The administration of granisetron before induction of anesthesia is superior to metoclopramide in long-term prevention of post-operative nausea and vomiting following major gynecological surgery.

Introduction: Addition of adjuvant to local anesthetic in supraclavicular brachial plexus block helps in rapid onset, increased duration of block and improved quality of analgesia. We compare clonidine and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Methods: Sixty ASA Grade I/II patients undergoing upper limb surgery under supraclavicular brachial plexus block. Two groups of 30 patients each and randomly assigned using computer generated random numbers. The patients were compared for onset as well as duration of sensory and motor blockade, duration of analgesia and hemodynamic side effects. Group C: Bupivacaine 0.25% (35 cc) + clonidine 1 μg/kg; Group D: Bupivacaine 0.25% (35 cc) + dexmedetomidine 1 μg/kg. Results: The onset of sensory block was shorter in dexmedetomidine group (statistically highly significant) as additive to bupivacaine compared to clonidine. Although no significant difference was seen in onset of motor block, the duration of sensory block and motor block was significantly prolonged in the dexmedetomidine group than in clonidine group. There was significant less rescue analgesia demanded by patients of dexmedetomidine group with no significant difference in block quality in both the groups. Conclusion: From the present study, it can be concluded that, dexmedetomidine prolongs the duration of sensory and motor block and enhances the quality of block as compared with clonidine when used as an adjuvant to in supraclavicular brachial plexus block.

Background: Caudal epidural analgesia a commonly practiced regional anesthesia in children undergoing infraumbilical surgeries but, provides short duration of action after single shot of anesthesia. Objective: To explore the effect of intranasal dexmedetomidine on the duration of anesthesia and postoperative analgesia, in pediatric patients undergoing infraumbilical surgery, under single-shotcaudal epidural block. Methodology: Pediatric patients (n = 60) were randomly assigned to two Groups—A and B, Group A received intranasal dexmedetomidine (1 μg/kg of body weight) with caudal bupivacaine (0.25%, 1 ml/kg of body weight) and Group B received same, without dexmedetomidine. Vitals were recorded at regular time intervals. Postoperative anesthesia, analgesia, and sedation levels were measured by Modified Bromage Scale, FLACC scale, and Ramsay Sedation Scale. Statistical analysis wasdone using MedCalc version 17. P - value of < 0.05 was considered statistically significant. Results: Study groups were equivalent in terms of demographics and vitals. Duration of anesthesia in Group A and B were found to be 215.83 ± 16.19 mins and 137.17 ± 15.52 min, respectively, and significant difference was identified between the groups. The time from caudal block to first rescue analgesia was 12.47 ± 2.16 hour sin Group A and 3.55 ± 1.18 hours in Group B; significant variance existed between both the groups (p < 0.001). Mean sedation scores were significantly more in Group A, compared to Group B (p < 0.001). Conclusion: Intranasal dexmedetomidine (1 μg/kg) with bupivacaine (0.25 %) via caudal epidural, lengthens the duration of anesthesia and analgesia in pediatric patients, as compared to sole administration of bupivacaine, without side effects.