Indian Journal of Anesthesia and Analgesia

Background: Supraclavicular and infraclavicular both approaches have identical distributions of anesthesia. Proximal blocks generally have rapid onset than blocks which are distal. Objective: To compare the clinical effect of supraclavicular perivascular technique and infraclavicular brachial plexus block for upper limb surgery. Methods: A prospective randomized clinical trial was performed among hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block. The infraclavicular brachial
plexus block was achieved by using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The pain related to block administration was evaluated. The sensory and motor block extent as well as the complications were assessed. Results: No significant differences were observed in the block administration related pain, evolution of sensory and motor block quality, or the success of the block. There was significant differences in the patient’s satisfaction. Conclusions: Both infraclavicular and supraclavicular block had effects which were similar. When considering the complications, the infraclavicular approach may be preferred to the supraclavicular approach.

Background: Endotracheal intubation done with succinylcholine raises intraocular pressure which can be of significance in cases of traumatic open globe injury. Aims: The study was done to compare the efficacy of oral Ivabradine and Clonidine in lowering the intraocular pressure rise following intubation using succinylcholine. Methods: A total of 105 patients were enrolled. Three groups having 35 patients each were formed. Group I: Received oral Ivabradine 5 mg, Group II: Received oral Clonidine 0.1 mg & Group III received placebo one hour before intubation. Intraocular Pressure (IOP) was measured with schiotz tonometer preoperatively & at various intervals to assess the effect of clonidine and Ivabradine on IOP. Results: A total of 105 pateints were
enrolled. Three groups having 35 patients each were formed. The mean IOP of the patients from 3 groups were comparable initially (p - 0.082). At all later time points, the mean IOP of patients from 3 groups was
statistically different (p < 0.001). The mean IOP in patients who received clonidine was significantly lesser as compared to control group at all time points except at the baseline (p < 0.001). However, among patients
who received Ivabradine, the mean IOP was significantly less than the control group only at T1, and T7.Conclusions: Oral Clonidine can be  recommended as premedicant for obtunding the rise in IOP following
endotracheal intubation using succinylcholine. Oral Ivabradine showed no effect on IOP during endotracheal intubation using succinylcholine.

Context: When we never induce anesthesia in a struggling adult patient, fearing hypertensive response, we never bother to properly sedate the pediatric patient before bringing the child to operation theatre. Aims: To
Compare combination of midazolam and ketamine with midazolam or ketamine alone as oral preanesthetic medication in children undergoing elective surgeries. Settings and Designs: Hospital based comparative study was carried out at Department of Anesthesiology, SVS Medical College, Mahabubnagar Methods: 150 children of ASA Grade I and II in the age group of 2–10 years were included in the study and were randomly divided into three groups of 50 each. Group A received 0.5 mg/kg Midazolam in 5 ml orange syrup, Group B received Ketamine 6 mg/kg while Group C received a combination of oral Midazolam 0.5 mg/kg and oral Ketamine 3 mg/kg in 5 ml orange syrup. Statistical Analysis: The statistical analysis done by Chi-square test. Results: In
Group A, 58% children were adequately sedated and 72% children were having an acceptable anxiolysis and\ parental separation scores. In Group B, acceptable sedation, anxiolysis and behavior at parental separation was obtained in 52% children. Group C shows an acceptable sedation in 68% children. Acceptable anxiolysis was observed in 82% of children. 80% children were calm with parental separation. Side effects were mainly seen in Ketamine group with 14% children showing nystagmus and 10% of children had excessive salivation. 8% children in Ketamine Group also developed hallucination. Conclusion: The present study showed that oral premedication with Midazolam 0.5 mg/kg alone produces as good results as the combination of Midazolam 0.5 mg/kg and Ketamine 3 mg/kg in children.

Background: Infraclavicular (IC) approach for Subclavian Vein (SCV) catheterization is widely used compared to Supraclavicular (SC) approach. Recently, SC approach for SCV catheterization has gained prominence because of its well-defined landmarks with more success and less complication rate. The primary aim of this study is to determine whether US guided SC approach or IC, provides the best SCV catheterization and the complications related to either approach. Methodology: A total of 110 patients were randomly divided into
two groups of 55 patients each, the SC group (Group S) and IC group (Group I). All SCV catheterization were done by single trained anesthesiologist. The parameters recorded were access time, successful catheterization, number of attempts, catheter insertion time, ease of guide wire insertion and complications. Results: Mean
access time in Group S was 32.4s compared to 39.24s in Group I. Successful catheterization and numbers of attempts were better in SC approach. Mean catheterization time was 55.4 ± 3.02s in Group S and 78.3 ± 8.605s in Group I and was significant (p < 0.0001). 96.4% patients in Group S and 92.7% patients in Group I was
successfully catheterized and was associated with smooth insertion of guide wire. There were two cases of arterial puncture and one case of hemotoma in Group I as compared to only one case of hemotoma in Group S. Conclusion: SVC cannulation by US guided SC approach is better with respect to IC approach in terms of time for catheterization and complications.

Introduction: Myoclonus is a common problem during induction of anesthesia with etomidate. We evaluated the effect of Lignocaine pretreatment on the incidence and severity of myoclonus in our study. Methods: This is a prospective randomized double blind study. Sample size was calculated with power of study 80% and alpha error 5%, 96 patients of ASA physical status I and II, aged 18 to 60 years scheduled for elective surgery under general anesthesia were included into three groups L1, L2, L3. Before induction, patients were pretreated with
inj. 2% lignocaine 3 ml containing 40 mg, 50 mg, 60 mg diluted with normal saline depending on the random allocation by computer generated random number table. Patients were induced with 0.3 mg/kg etomidate within 30–60 sec, one minute after pretreatment with lignocaine. Patients were observed continuously for the time of initiation, grade and severity of myoclonus for 90 sec, Results: In our study, it was found that with Injection 2% lignocaine 60 mg IV 59.3%, 50 mg Lignocaine 37.5%, 40 mg Lignocaine group 9.3% of the patients had no myoclonus which was found to be significant p < 0.001. Conclusion: Both 2% IV Lignocaine 50 mg and 60 mg were effective in reducing the severity of myoclonus induced by Etomidate without causing side effects.

Background: The conventional technique of supraclavicular brachial plexus block often requires multiple trials and error needle attempts, resulting in long procedure time, procedure related pain, discomfort and
lethal complication. Ultrasound has improved the success rate of block with excellent localization as well as improved safety rates with lower complication rates. Objectives: To compare the effects of supraclavicular
brachial plexus block using conventional blind technique and US technique in terms of success rate of technique, number of complications observed, Time taken for the procedure, Onset and duration of sensory and motor blockade, duration of postoperative analgesia. Materials and Methods: This was a prospective randomized
nonblinded comparative study in which patients of ASA Grade I and II posted for upper limb orthopedic surgeries admitted during Nov 2015 to May 2017 to the Department of Orthopedics, GMERS Medical College,
Hospital, Sola, Ahmedabad were enrolled in the study. There were total 100 patients enrolled who satisfies study selection criteria out of which 50 were randomized in Group C (Conventional) and 50 were randomized in Group US (Ultrasound Guided). Results: The block was successful in 72% of patients in Group C compared to 94% in Group US. In conventional group incidence of complications like vessel puncture 12%, pneumothorax 2% noted while in US Group vessel puncture 4% noted. Time for procedure for block in Group US is longer as compared to conventional Group C. Onset of sensory block & motor block in conventional group C is longer as compared to US Group. Conclusion: US guided supraclavicular block is more successful technique with less number of complications and longer duration of block compared to Conventional technique.

Background: Epidural anesthesia is very popular for infraumbilical surgeries. Epidural form of central neuraxial blockade techniques avoid the disadvantages associated with general anesthesia like airway
manipulations, polypharmacy and other untoward effects like postoperative nausea, vomiting and need for supplemental intravenous analgesics. Amongst different local anesthetic drugs used, Ropivacaine, being pure S-enantiomer of bupivacaine is the recently introduced long acting amide anesthetic agent is claimed to be better in its cardiovascular profile. Αlpha 2 (α2) adrenergic receptor agonists have both analgesic and sedative properties when used as an adjuvant to local anesthetic in regional anesthesia. Methodology: A double blind
prospective randomized control study conducted at tertiary health care institute to evaluate and compare the efficacy, block characteristics and postoperative analgesia of 1.5 μg/kg Dexmedetomidine in comparison to 2 μg/kg Clonidine as adjuncts to 0.75% isobaric Ropivacaine in epidural anesthesia for infraumbilical surgeries. Results: Meantime for onset of sensory and motor blockade, meantime for maximum sensory blockade and meantime for complete motor blockade was earlier with dexmedetomidine than with Clonidine as epidural adjuvant. Total duration of sensory and motor blockade was considerably longer in group receiving dexmedetomidine. Higher dermatomal level of sensory blockade, longer postoperative analgesia with better sedation was achieved by group receiving dexmedetomidine with comparative stable hemodynamics as compared to group receiving Clonidine. Conclusion: Dexmedetomidine is a better alternative to Clonidine as an adjuvant to 0.75% isobaric Ropivacaine in epidural anesthesia for providing early onset of sensory and motor blockade, desirable sedation and prolonged postoperative analgesia.

Aim: The aim of the study was to compare the postoperative analgesia provided by Clonidine and Fentanyl when given as additives with Ropivacaine for caudal block in children. Methods: After obtaining the approval of our Institutional Ethics Committee, the study was conducted in 60 pediatric patients undergoing elective infraumbilical surgeries. The patients were randomly divided into two study groups i.e. Group I and II.
After inducing general anesthesia, patients in Group I received Ropivacaine 0.2% with Clonidine 2 mcg/ kg whereas Group II received Ropivacaine 0.2% with Fentanyl 1 mcg/kg via caudal route. The parameters observed included heart rate, blood pressures, oxygen saturation, postoperative pain score, sedation score, motor blockade, time to rescue analgesia and adverse effects. Statistical analysis was done by applying Fishers exact test and unpaired t-test. Results: Demographic variables were comparable in both groups. Heart rate,
blood pressures, peripheral capillary oxygen saturation values were significantly lower in the Clonidine group compared to the Fentanyl Group. The onset of pain and time to 1st dose of rescue analgesia was lesser in the Fentanyl Group (< 3 hours) when compared to Clonidine Group (3–5 hours) was statistically significant with p - value < 0.05. Sedation scores were significantly higher for the Clonidine Group. Motor blockade was not present in any patient. Adverse effects were comparable in both the groups. Conclusion: Addition of Clonidine
to Ropivacaine in a single shot caudal block is more advantageous than Fentanyl for postoperative pain relief without increasing the incidence of adverse effects.

The aim of this study was to evaluate the efficacy, potency and side effects of clonidine and nalbuphinen in postspinal anesthesia shivering. In this prospective double-blind randomized controlled clinical trial, 60
American Society of ASA Grade I and II patients aged between 18 and 60 years scheduled for various surgical procedures under spinal anesthesia, who developed shivering were selected. The patients were divided into Two Groups: Group C (n = 30) comprised of patients who received clonidine 1 mcg/kg intravenously (IV) and Group N patients who received nalbuphine 0.05 mg/kg IV. Grade of shivering, disappearance of shivering, hemodynamic and side effects were observed at scheduled intervals. Disappearance of shivering
was significantly earlier in Group C (2.75 ± 1.35) than in Group N (3.58 ± 1.19) (p = 0.01704). Bradycardia is seen more in Group C than Group N (p = < 0.001). Whereas, sedation is seen in Group N after drug administration but patient remain hemodynamically stable in Group N. We conclude that both the drugs are effective but nalbuphine controls shivering with more hemodynamic stability.
 

Introduction: Major responsibility of anesthesiologist is to provide adequate ventilation to the patient. Supraglottic airway device is a novel device that fills the gap in airway management between tracheal
intubation and the use of face mask. In this study, we aim to compare supraglottic airway devices I-Gel with Classic LMA in relation to time for insertion, success rate of insertion in first attempt, hemodynamic changes and complications. Materials and Methods: The present study, was a prospective, randomized and comparative study, which included 50 patients of age between 18 and 55 years, belonging to ASA I and II, scheduled for elective short surgical procedures under general anesthesia. Patients were divided into Two Groups: Group I (I-Gel) and Group II (Classic LMA). After induction of anesthesia, proper sized supraglottic airway was inserted according to weight of the patient. Results: The success rate of insertion in first attempt in Group
I and Group II was 96% and 88% respectively, meantime taken for insertion in Group I and Group II was 12.92 ± 1.41 sec and 18.56 ± 1.23 sec respectively, sore throat seen in Group I and Group II was in 1 (4%) and 3 (12%) patients respectively. Conclusion: I-Gel have higher success rate of insertion in first attempt and shorter time of insertion in comparison to Classic LMA. Lower incidence of blood staining of device and postoperative sore throat was seen in I-Gel as compared to Classic LMA. Hence, I-Gel is a better alternative to existing Classic LMA.

Aims and Objectives: The aim of the study is to compare and study the efficacy of dexamethasone versus tramadol when added as adjuvant to 0.5% ropivacaine in supraclavicular brachial plexus block for upper
extremity surgeries. To compare the duration of postoperative analgesia with dexamethasone and tramadol added as an adjuvant to 0.5% Ropivacaine in supraclavicular brachial plexus block. To observe the side effects of the above two groups. Materials and Methods: All the patients were randomly allocated into two groups so that, each group consists of 30 patients of either sex in a given age range posted for elective upper extremity surgeries after obtaining consent from each of them. Group - RD: Injection Ropivacaine 0.5% (29 ml) + Injection dexamethasone 8 mg (2 ml) Group - RT: Injection Ropivacaine 0.5% (29 ml) + Injection tramadol 2 mg/kg. Hemodynamic variables and Visual Analog Scale (VAS) score was significantly were noted at regular
intervals until the end of the surgery. Results: Onset of motor block was earlier in Group RD: (21.8 ± 1.57 min) as compared to Group RT: (25.1 ± 2.41 min). Onset of sensory block was earlier in Group RD: (16.63 ± 0.88 min) as compared to Group RT (17.43 ± 0.97 min). Total Duration of sensory block was lesser in Group RT (475.99 ± 31.24 mins) as compared to Group RD (580.00 ± 40.42 mins) p - value < 0.001. Total duration of motor block was lesser in Group RT(415.99 ± 31.24 mins) as compared to Group D (520.00 ± 40.42 mins) p - value < 0.001. Time to rescue analgesia was earlier in Group RT (580 mins) than in Group RD (816 mins). Duration of analgesia was longer in Group RD, as compared to Group RT. Conclusion: We observed that Group RD (Inj.
0.5% Ropivacaine + Inj. Dexamethasone 8 mg) has faster onset of sensory and motor blockade than RT (Inj. 0.5% Ropivacaine + Inj. Tramadol 2 mg/kg) when used in supraclavicular block in upper extremity surgeries. Duration of analgesia was greater with Dexamethasone when added as an adjuvant as compared to Tramadol and also Dexamethasone reduces the requirement of postoperative analgesia.

Background: A number of adjuvants in the form of opioids analgesics were routinely used intrathecally to prolong the analgesia effect both in the intraoperative and postoperative period. Clonidine and tramadol were the common agents used intrathecally along with bupivacaine for increasing the duration of analgesia. Aim: To assess and compare the neuraxial blockade analgesic effect between intrathecal clonidine and intrathecal tramadol along with 0.5% hyperbaric bupivacaine for lower limb surgeries. Methodology: A prospective double blinded randomized study was conducted for a period of one year at Dhanalakshmi Srinivasan Medical College and Hospital. A total of 100 patients who had been posted for elective lower limb surgery were included
in our study and they were randomized into two groups of 50 each. Group A patients received clonidine hydrochloride 37.5 mcg (0.25 ml) and Group B patients received tramadol 25 mg (0.5 ml) and both the groups received 0.5% hyperbaric bupivacaine hydrochloride (3 ml) along with normal saline. Assessment of pain score was done using VAS scale and the motor blockade was assessed using Bromage motor blockade score and the vital parameters were also assessed along with it. Results: The onset of sensory analgesia was found to be much faster and the duration of sensory analgesia was found to be more prolonged among the group which received clonidine and the pain score which was measured using VAS was higher among the patients who received tramadol and the difference was found to be statistically significant (p < .05). The duration of motor function recovery was almost similar in both the groups and no significant side effects reported between the two groups. Conclusion: Both the groups were effective in producing adequate surgical anesthesia with hemodynamic stability without causing serious adverse events but clonidine group was found to have a faster onset of action with prolonged duration of analgesia.

Aims: Comparing Propofol and Dexmedetomidine to assess the relative safety and efficacy in achieving adequate intraoperative sedation (Ramsay Sedation Score of 3–4) and cardiorespiratory safety in patients
undergoing abdominal hysterectomy under subarachnoid block. Setting and Design: Department of Anesthesiology pain & Palliative Medicine, ESI PGISMR and Hospital, Manicktala (Tertiary Care Government
Hospital located in Kolkata, WB, India) Operation theatres, Postanesthesia Care Unit, Gynecology & Maternity Ward. Study Design: Uni-centric prospective double blinded comparative Statistical analysis used: With ShapiroWilk test and Chi-square test Materials and Methods: Forty female participants between 18 and 65 years of age
were divided into two groups via systematic random sampling. After administering subarachnoid block with 15 milligrams of 0.5% hyperbaric bupivacaine, bolus IV Dexmedetomidine (Group D, n = 20) or Propofol
(Group P, n = 20) was started. All patients were monitored. Dexmedetomidine and Propofol infusions were discontinued at the end of surgery and the patients were transferred to the Postanesthasia Care Unit (PACU). The modified Aldrete scoring system was used to assess the readiness for shifting the patients to the postsurgical wards. Results: Both the groups had comparable demographics and basal values of heart rate, blood pressure, respiratory rate, ASA physical status, duration of infusion, depth of sedation, incidence of hypotension, bradycardia, over-sedation, but Group P had higher incidence of transient respiratory depression which were easily manageable.

Introduction: Acute hyperglycemia is known to occur during major surgeries, its occurrence even for a brief period may lead to immune suppression. Surgeries which require general anesthesia are more susceptible for stress mediated immune response and intraop rise in blood glucose levels. Drugs used during induction and maintenance of anesthesia are also known to cause plasma glucose derangement along with surgical stress response, which can lead to adverse postoperative morbidity. Aim: To study the effect of blood glucose level at specified time intervals with intravenous Propofol and Etomidate. Materials and Methods: Sixty cases requiring general anesthesia, belonging to class 1 and 2 of American Society of Anesthesiology were selected. Patients were preoxygenated and premedication drugs were given and induced with either Propofol 2 mg/kg or Etomidate 0.3 mg/kg. Blood glucose was measured before premedication, at 5th minute and at 15th minute respectively. Statistical analysis done using Student t-test for parameters on continuous scale and Chi-square test for parameters on categorical scale. p - value of less than 0.05 was considered statistically significant. Results: The blood glucose in Etomidate Group increased compared to premedication value (84.7 ± 15.37 to 92.5 ± 17.09) and was statistically significant (p - value 0.0167). In Propofol Group, variation in blood glucose level was not significant (88.26 ± 15.47 to 87.0.5 ± 12.84). There was no significant increase in Heart rate, SBP, DBP & MAP at T5 & T15 in both the groups. Conclusion: In the current study, increase in blood glucose in nondiabetic patients following induction was found to be significantly high with Etomidate when compared with Propofol.

Background: The LMA has revolutionized airway management and its use are now standard practice in General Anesthesia. The rationale behind the study was to compare three techniques of Proseal Laryngeal Mask Airway (PLMA) insertion. Objectives: To assess the superiority of placement with three techniques of Proseal Laryngeal Mask Airway insertion with respect to 1. Number of attempts to successful placement 2. Insertion time 3. Oropharyngeal leak pressure 4. Fiber Optic Bronchoscopy (FOB) Grading. Materials and Methods: A randomized prospective comparative study was done for a period of 1 year. The study was carried out at Saveetha Medical College and Hospital. The study was conducted on 90 adult patients of either sex, in the age of 18–65years, belonging to ASA I and II with Modified Mallampati Score I & II posted for elective surgeries. Systemic sampling was used. All patients were kept on fasting for 8 hrs. SPSS version 20 was used for analysis. One-way ANOVA and Chi-square test was used for analysis. p - value of < 0.05 is considered statistically significant. Results: There was no significant difference between the three groups in terms of age, weight, ASA, MMS. The insertion time for Group-G was 22.5 ± 5.0 sec and Group-IT was 14.2 ± 3.3 sec which were significantly higher than Group D (11.37 ± 2.7 sec). GEB guided PLMA insertion was successful in 30/30 (100%) and IT guided insertion was also successful in 30/30 (100%) in the first attempt. Oropharyngeal leak pressure in Group IT (26 ± 3.3) and Group G (27.8 ± 2.3) was significantly higher when compared to Group D. Conclusion: We conclude that GEB-guided insertion and Introducer technique is comparable to digital technique in successful placement of PLMA. However, GEB and IT technique provides better airway seal compared to digital technique.

Background: Great auricular nerve block provides better postoperative analgesia than systemic analgesics in tympanomastoid surgery, henceforth reduces chances of systemic side effects like nausea and vomiting as systemic analgesics used being minimized. This prospective randomized clinical study was carried out to evaluate the efficacy of great auricular nerve block, to compare the total number of analgesics required in 24 hours period postoperatively and to look for complications if any. Methods: In this prospective randomized clinical study, 60 patients of ASA Grade I or II, aged 18 to 65 years, undergoing tympanomastoid surgery were randomly allocated in Two groups. Group G (n = 30) patients received great auricular nerve block, and Group C (n = 30) as control Group. All patients were premedicated with Inj. Nalbuphine (0.15 mg/kg), and general anesthesia was given using conventional method. In Group G great auricular nerve block was given using 0.25% Inj. bupivacaine 7 ml with Injection Epinephrine 5 μg/ml 1:200000 prior to reversal of general anesthesia.and Group C (Control Group) didn’t receive the block. Results: Duration of postoperative analgesia was 20.67 ± 4.54 hours in Group G and 2.13 ± 4.18 hours in Group C (p < 0.001). Total number of rescue analgesics required in 24 hours in postoperative period less in Group G compared to Group C. Conclusions: The Great auricular nerve block provides prolonged duration of action and decreased number of rescue analgesic in postoperative period for patients posted for mastoidectomy.

Background: The brachial plexus block can be performed by the landmark nerve technique, nerve stimulator guided (NS) or (ultrasound (US)-guided technique. A patient need not be subjected to the discomfort of paresthesia when the nerve is stimulated to produce a motor twitch, because motor fibers have a lower electrical threshold than sensory fibers. The use of the NS technique, however, did not reduce the complication rates. Therefore, the combined nerve stimulator and ultrasound-guided approach are much preferred. For supraclavicular brachial plexus block. Aim of the Study: Targeting the individual nerve bundles using a nerve stimulator would obtain a higher success rate for ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: 66 patients presenting for upper limb surgeries under USG guided Supraclavicular brachial plexus block were randomly assigned into 2 Groups. Group USG NS– Ultrasound-guided, nerve stimulated Supraclavicular block group USG – Ultrasound-guided Supraclavicular block patients received a mixture of 23 ml of a local anesthetic containing 2% Lignocaine 11.5 ml and 0.75% Ropivacaine 11.5 ml. Group USG NS– (n = 33) – half the volume of drug is injected into ‘corner pocket’ guided by USG, confirmed by nerve stimulation and remaining half the volume is injected into main neural cluster under USG guidance, confirmed by nerve stimulation. Group USG – Under USG guidance half the volume was deposited in ‘corner pocket’ and half the volume was injected in the main neural cluster. Sensory and motor blockade of ulnar nerve, median nerve, musculocutaneous nerve, and radial nerve was recorded at different time intervals. Surgical anesthesia, number of needles passes, performance time and complications were also recorded. Results: Compared with Group USG, Group USG NS had higher success rate of combined sensory-motor block within 15 min (79% vs 52%, p < 0.001). The success rate of sensory block of 4 nerves within 15 min is higher in Group USG NS (Ulnar nerve-91 vs 70%, Median nerve – 91 vs 73%, radial nerve-88 vs 67%, Musculocutaneous nerve 88 vs 64%, p < 0.001). The performance time is increased by 4 min in USG NS Group (14.3 ± 2.88 vs 10.33 ± 5.69 min, p < 0.001). Conclusion: USG guided nerve stimulated supraclavicular brachial plexus block provides higher success rate and complete sensory-motor blockade of all four nerves within 15 minutes of local anesthetic injection.

Aims: To study and compare the efficacy of intrathecal dexmedetomidine 5 μg versus intrathecal clonidine 50 μg as an adjuvant to 0.5% bupivacaine heavy 12.5 mg for spinal anesthesia. Materials and Methods: The present study is prospective, controlled double blind comparative clinical study on spinal block characteristics in patients scheduled for elective lower abdominal surgeries was undertaken to evaluate the efficacy and the safety of dexmedetomidine or clonidine as adjuvant to intrathecal hyperbaric 0.5% bupivacaine. Ninety patients were randomly divided into three groups, each group consisting of thirty patients (n = 30). Results: Dexmedetomidine group and clonidine group there is an early onset of both sensory and motor blockade and a higher level of sensory blockade compared to control group and duration of sensory, motor blockade and duration of analgesia are significantly prolonged in the dexmedetomidine group and clonidine group compared to the control group. There was a small percentage of patients who developed significant fall n blood pressure and heart rate which were easily managed without any deleterious effect. Seven patients each in dexmedetomidine group and clonidine group and two patients in control group developed hypotension requiring treatment. Five patients in dexmedetomidine group, four patients in clonidine group and one patient in control group developed bradycardia requiring treatment. More number of patients in the dexmedetomidine group and clonidine group were sedated and easily arousable. Conclusion: Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory and motor blockade, adequate sedation and prolonged postoperative analgesia.

Background: Spine surgeries require reduced intraoperative blood pressures to make better visualization of surgical site. Deliberate hypotension or controlled hypotension have been preferred technique used for many surgical procedures to attain clear surgical fields. Aim: The aim of our study is to evaluate the efficacy and hemodynamic response to IV Dexmedetomidine and placebo [Normal saline] as hypotensive agent in elective spine surgeries. Methods: Sixty patients between age group of 18–60 years were selected who were posted for elective spine surgeries. They were divided into two groups of 30 each i.e. Dexmedetomidine Group and Normal Saline Group and were be given their respective drug. Group D: Inj. Dexmedetomidine 100 mcg [diluted in 50 ml of 0.9% Normal saline]. Group N: 50 ml of 0.9% of normal saline. Patients in the D Group received 1 mcg/kg infusion (diluted in 50 ml of 0.9% normal saline) over a period of 10 min prior to premedication. After induction of anesthesia, patients in the D Group received a continuous infusion of Dexmedetomidine at 0.2 mcg/kg/h, whereas patients in the N Group received infusion of Normal saline at same dose as dexmedetomidine. The hemodynamic parameters Pulse Rate (PR), Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Blood Pressure (SBP, DBP, MAP), Respiratory Rate (RR), SpO2 were studied in all the groups at baseline, after giving drug, after intubation, 15 minutes, 30 minutes and 45 minutes, 60 minutes, 75 minutes, 90 minutes, 105 minutes, 120 minutes, after stopping drug and after extubation. Postoperative sedation score was also measured. Patient were shifted to postanesthesia care unit and monitored for hemodynamic parameters, Ramsay sedation score and adverse effects if any. The statistical analysis was done based on Student’s t-test for continuous variables and Chi-square test for categorical variables. Final interpretation will be based on Z-test with 95% level of significance. Results: Patients in D Group achieved desired MAP as compared to normal saline (placebo) group with good control over heart rate. With no significant difference in postoperative sedation score was found in patients with Dexmedetomidine group as compared to normal saline (placebo). Conclusion: Dexmedetomidine is an effective drug for achieving controlled hypotension and thus, can be used as hypotensive agent in spine surgery to maintain clear surgical field.

Introduction: Direct laryngoscopy and endotracheal intubation induces cardiovascular stress response which in turn leads to increase in plasma catecholamine concentration and rise in blood pressure and heart rate. Fentanyl is a popular opioid used to attenuate a presser response to laryngoscopy and intubation. In this study, we compared two different doses of fentanyl 2 mcg/kg and 4 mcg/kg to asses maximum effectiveness and safety to prevent stress response during laryngoscopy and intubation. Methods: In this prospective comparative clinical study, 30 patients aged 18 to 50 years of ASA physical status I and II, scheduled for elective surgery under general anesthesia requiring endo tracheal intubation. Patients were randomized into two groups of 15 patients each: Group A: Received 2 μg/kg of fentanyl IV 5 minutes before induction. Group B: Received 4 μg/kg of fentanyl IV 5 minutes before induction. All groups were assessed for hemodynamic changes after premedication, during laryngoscopy and intubation, after intubation at 1, 3, 5 and 10 minutes, postoperative sedation and postoperative side effects. Results: Fentanyl in doses of 4 mcg/kg was effective in complete prevention of hemodynamic stress response during laryngoscopy and intubation. However, 4 mcg/kg of fentanyl produced a 15–20% decrease in hemodynamic variables from baseline compared to 5–10% with 2 mcg/kg of fentanyl. Conclusion: Fentanyl in dose of 4 μg/kg five minutes before induction is the most appropriate dose in terms of efficacy and safety for preventing hemodynamic stress response during laryngoscopy and intubation.

Introduction: Patient’s safety is the most important aspect of patient management in general anesthesia. Stress response during laryngoscopy and intubation leads to hemodynamic changes. In all the methods used for induction of anesthesia, it is aimed to preserve the hemodynamic balance and to provide optimal conditions by reducing the side effects. The purpose of this study was to compare hemodynamic response during induction with propofol, etomidate or combination of propofol and etomidate with special reference to pain on injection and myoclonus in patients requiring endotracheal intubation in elective surgeries. Materials and Methods: It is a prospective randomized comparative study. After getting ethical committee clearance, a group of ninety patients aged 18 to 65 years of either sex and ASA physical status I or II scheduled for elective surgery under general anesthesia were assigned randomly to Three Groups Group (P) was induced with Injection. Propofol (2 mg/kg) intravenously Group (E) with Injection. Etomidate (0.3 mg/kg) intravenously and Group (P + E) with Injection. Propofol (1 mg/kg) plus Injection. Etomidate (0.15 mg/kg) intravenously. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Blood Pressure (MAP) and Oxygen Saturation (SpO2) were noted at different time intervals. Presence of pain on injection and myoclonus were also observed. Statistical Analysis: Data will be analyzed by descriptive Statistics. Student’s t-test was used to compare the significant difference between two means. ANOVA for three groups. The Chisquare test was used for categorical data such as gender, American Society of Anesthesiologist physical status, injection pain and myoclonus. A value of p <0.05 is considered as statistically significant. Results: There was significant difference in mean HR (p < 0.001) between the 3 groups within 1–5 minutes of induction. MAP among all three groups decreases after induction and it was more in Group P than in Group E and Group P + E. The incidence of myoclonus in Group E was 80% while in Group P + E was 1.3% and none in Group P. The incidence of pain on injection in Group P was 86.7%, Group E was 10% and none in Group P + E. Conclusion: The incidence of hemodynamic instability, pain on injection, myoclonus is less with E + P group. Therefore, we concluded that combination of etomidate & propofol can be considered as valuable alternative as an induction agent.

Background: The delivery of the infant into the arms of a conscious and pain free mother is one of the most exciting and rewarding moments in medicine. To compare the efficacy of vasopressors by measuring Systolic and Diastolic blood pressure, Heart rate, Nausea and Vomiting, Neonatal APGAR scores in all Three Groups. Methods: A Prospective comparative clinical study was conducted in 30 patients coming for elective lower segment Cesarean section. Parturients were divided into 3 Groups (P, E, M) of 30 each as per the study drugs. Patients meeting the criteria were incorporated into the study. Randomization achieved by sealed envelope technique. Patient’s height and weight were measured during the preanesthetic visit. Baseline values for maternal systolic blood pressure, diastolic blood pressure and heart rate were recorded. Epi-info 7 was used for analysis. Results: No statistically significant differences were found in all the 3 Groups with regards to baseline heart rate, baseline systolic blood pressure and baseline diastolic blood pressure. There was significant statistical difference in the total dose of Phenylephrine, Ephedrine and Mephentermine used (p < 0.05). No Significant differences were observed between heart rate changes in Ephedrine and Mephentermine group. Conclusion: Phenylephrine, Mephentermine and Ephedrine effectively maintained arterial blood pressure during spinal anesthesia for cesarean section. Phenylephrine has quicker onset and peak effect in comparison to ephedrine and mephentermine and its predictable carotid sinus reflex effect causes reduction in heart rate, which may be advantageous in cardiac patients and patients in whom tachycardia is undesirable.

Background: Laparoscopic surgeries are known to cause hemodynamic repercussions due to pneumoperitoneum despite being minimally invasive surgeries. Various studies have been conducted to minimize hemodynamic alterations in laparoscopic surgeries. Aim: The aim was to compare the efficacy of intrathecal clonidine versus intrathecal clonidine with fentanyl in maintaining hemodynamic stability and to assess postoperative analgesia in patients undergoing laparoscopic surgeries under general anesthesia. Materials and Methods: A randomized double-blind study was done in 60 patients of either sex, with American Society of Anesthesiologists Grade I and II, aged between 18 and 55, posted for laparoscopic surgeries. Group CL (n = 30) received intrathecal clonidine 150 micrograms and Group CF (n = 30) received intrathecal clonidine 75 micrograms followed by intrathecal fentanyl 25 micrograms before general anesthesia. Assessment parameters included hemodynamics, postoperative analgesia and sedation scores. Results: Intraoperative heart rate, systolic, diastolic and mean arterial blood pressures at intubation, pneumoperitoneum and extubation were significantly reduced in Group CL (p < 0.05) when compared to Group CF. Mean duration of postoperative analgesia was significantly prolonged in Group CL (10.30 ± 1.24 hours, p < 0.001) when compared to Group CF (5.53 ± 1.11 hours). Mean sedation score was significantly higher in Group CL (2.07 ± 0.25 versus 1.90 ± 0.31; p = 0.025). No adverse effects were recorded during study. Conclusions: Intrathecal clonidine 150 micrograms is highly effective in maintaining intraoperative hemodynamic stability during laparoscopic surgeries under general anesthesia along with prolonged postoperative analgesia in comparison to combination of intrathecal clonidine 75 micrograms with fentanyl 25 micrograms.

Background: Total Intravenous Anesthesia (TIVA) can be defined as a technique of general anesthesia using a combination of agents given solely by the intravenous route and in the absence of all inhalational agents including nitrous oxide (Gas Anesthesia). Total intravenous anesthesia, based on the administration of Propofol combined with an opioid, has become a popular anesthetic technique. This study is to compare the analgesic effects of nalbuphine with fentanyl as well as associated side effects as adjuncts in TIVA along with propofol. Aim: To study the effect of nalbuphine and fentanyl when used as analgesic in total intravenous anesthesia along with propofol. Methods: This study was conducted on 60 adult patients belonging to American association of anesthesiologists (ASA) Grade I/II and posted for short minor surgical and gynecological procedures. They were divided into two equal groups of 30 each, using statistical table of random number: Group N: Preinduction medication with Inj. Nalbuphine 0.05 mg/kg; Group F: Preinduction medication with Inj. Fentanyl 1 mcg/kg. HR, BP, SPO2, just before induction, immediately after induction and then at every 5 minute-intervals till 2 hours were recorded. Additionally, VAS scoring, Modified Aldrete scoring, Time for rescue analgesia, Respiratory rate were noted after 30 minutes. Results: Hemodynamic parameters like heart rate, systolic blood pressure, mean arterial pressure were controlled better in the fentanyl group at 5 min, 10 min, 15 min intraoperatively. Postoperative analgesia was better with nalbuphine group with reduced visual analogue scale with reduced respiratory depression. Conclusions: Fentanyl provided better intraoperative hemodynamic stability whereas, nalbuphine provided better postoperative analgesia with lesser respiratory depression.

The aim of this study was to compare the efficacy of intravenous granisetron and intravenous ondansetron for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under general anesthesia. In this prospective double-blind randomized controlled clinical trial, 60 American Society of ASA Grade I and II patients aged between 18 and 60 years scheduled for elective total abdominal hysterectomy under general anesthesia were selected. The patients were divided in the following Groups of 30 patients each: Group 1 (Granisetron): 30 patients were given 1 mg of Granisetron was diluted in NS to make upto 10 ml; Group 2 (Ondansetron): 30 patients were given 4 mg of Ondansetron was diluted in NS to make upto 10 ml. Postoperative Nausea and Vomiting (PONV), hemodynamic and side effects were observed at scheduled intervals. The incidence of PONV was significantly lower in Group 1 (Granisetron) than in Group 2 (Ondansetron). Requirement of rescue antiemetic was significantly lower in Group 1 (Granisetron) 6.7% as compared to Group 2 (Ondansetron) 33.3%. . At all times the changes in the vital parameters like pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and SpO2 were within the normal physiological limits. There was no statistical significant difference between the groups. It was observed that there was no significant difference in adverse effects amongst the groups as well. We conclude that granisetron is more effective, potent and longer acting antiemetic as compared to ondansetron for reducing PONV in patients undergoing Total Abdominal Hysterectomy under general anesthesia.

Introduction: Cholecystectomy is surgical removal of the gall bladder. Intraperitoneal administration of other drugs along with the local anesthetics will reduce the consumption of supplementary postoperative analgesic medication. Aims: To compare between MgSO4 and Tramadol when used along with Intraperitoneal Local Anesthetics (IPLA) by instillation of drug for postoperative pain relief in terms of Visual Analog Scores. Materials and Methods: Prospective analytical study in Sixty adult patients of Class I and Class II as per American Society of Anesthesiology (ASA) of either sex were posted for elective laparoscopic cholecystectomy. These patients participated in prospective open randomized study for postoperative pain relief after laparoscopic cholecystectomy. Results: Bupivacaine along with Magnesium sulphate instillation significantly reduced VAS pain scores over 24 hrs. Prolonged duration of analgesia was noted with Magnesium sulphate. Total analgesic required over 24 hrs was less with Magnesium use. No signs of drug allergy and toxicity were observed. Conclusions: Bupivacaine and Magnesium sulphate are safe and efficacious in reducing postoperative pain following intraperitoneal instillation in laparoscopic surgeries. Thus, the intraperitoneal instillation of Bupivacaine-MgSO4 combination provides good analgesia in first 24 hours after surgery, with longer duration of pain free period.

Aims: Cardiovascular response was increase by direct laryngoscopy and endotracheal intubation. The aims of this study the hemodynamic change and compare the best among the two drugs in prevention of cardiovascular response to direct laryngoscopy and Endotracheal intubation. Background: This study also evaluates the efficacy of intravenous Esmolol (1 mg/kg) and intravenous Lidocaine (1.5 mg/kg) in attenuating cardiovascular stress response during direct laryngoscopy and endotracheal intubation in normotensive patients undergoing plan routine surgeries. Materials and Methods: This prospective study was conducted from June 2017 to May 2019 after informed consent was obtained from 120 patients. The study population consisted of ASA physical status I or II, and Mallampatti Score 1 or 2. All patients had enrolled our study are between the age of 20 years and 65 years and are scheduled for various elective surgical procedures. This study was a prospective, randomized, and clinical comparison study in rural tertiary referral health center. The Sample size for the study was 120 generated using a sample size calculator. The study participants were divided into Three Groups. A study patient (Group A) who was received intravenous esmolol 1 mg/kg two minutes before intubation. In Group B, who was received intravenous Lidocaine 1.5 mg/kg, two minutes before intubation and Group C, who received only prescribed premedication and listed in Control Group. All drugs were diluted in 10 milliliters of distilled water. All patients were monitored Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) with respect to time. All patients were kept unaware of the drug injected to enable double-blinding. Results: Group C had statistically highly significant (p ≤ 0.0001) value of HR, SBP, DBP, and MAP at all time interval after intubation when compared to Group B and Group C had statistically significant (p ≤ 0.05) higher values of hemodynamic variable at all time interval when compared to Group A. Conclusions: Intravenous lidocaine (1.5 mg/kg) and esmolol (1 mg/kg) are effective agents in suppressing the hemodynamic response to laryngoscopy and intubation without any deleterious effect. Esmolol 1 mg/kg appears to be very effective and should be viewed as potential treatment strategy for attenuating hemodynamic changes during induction of anesthesia.

Context: Advantages of Epidural anesthesia over spinal anesthesia like lesser incidence of hemodynamic instability and postdural puncture headache are offset by delayed onset time and unreliable motor blockade. Clonidine has been used as an additive in epidural and spinal anesthesia to prolong the duration of action. Aims: To compare the effect of Clonidine as an Additive in Epidural and Spinal Anesthesia. Settings and Designs: We designed this study to compare the effect of clonidine in epidural and spinal anesthesia in 75 adult patients scheduled for lower abdominal surgeries. Materials and Methods: Seventy five adult patients were randomized to receive intrathecal 0.5% hyperbaric Bupivacaine, 3 ml (Group ITB), 0.5% hyperbaric Bupivacaine + 30 μg clonidine, 3 ml (Group ITBC) or 16 ml 0.5% Bupivacaine with 75 μg clonidine at L3-L4 inter vertebral space, 16 ml (Group EDBC). Onset time of sensory blockade, duration and degree of sensory and motor blockade, heart rate, blood pressure and sedation were noted periodically. Statistical Analysis: Analysis was done by one way ANOVA (variables over time), Turkey’s posttest (parametric variables), Kruskal-Wallis test (Nonparametric variables). Results: Group EDBC had similar onset time of Group ITB. Sensory blockade was increased by 37% in EDBC and 27% in ITBC compared to ITB (212.2 ± 12.4 min, 230.4 ± 13.6 min and 166.8 ± 8.5 min respectively). EDBC had motor blockade similar to that of ITB. Hypotension and bradycardia were more severe in ITBC. Conclusions: Epidural bupivacaine with clonidine has better hemodynamic stability compared to intrathecal bupivacaine with similar sensory and motor blockade characteristics.

Background: The geriatric population faces serious problems. When combined with the tendency for older population to have more unsteady balance and vision problems, it becomes a recipe for increased risk of fracture. Aims: Hemodynamic stability during perioperative period is of paramount importance in such scenario and hence the technique of choice becomes neuraxial block. The anesthetist’s traditional approach to provide anesthesia for geriatric population has been the emphasis on maintaining hemodynamic stability by maintaining heart rate, saturation, blood pressure and by avoiding hypotension, bradycardia etc. This study aimed to compare the efficacy of intrathecal 0.5% Bupivacaine and 0.5% Levobupivacaine in geriatric patients. Methods: After ethical committee permission, a comparative study was conducted in the department of Anesthesia at BLDE (DU’s) Shri BM Patil Medical College, Hospital and Research Center, Vijayapur. With prior informed written consent, study was conducted on total of 120 geriatric patients above 60 years of age with American society of anesthesiologist (ASA) Grade II–III scheduled for lower limb surgeries under spinal anesthesia. The patients either received 0.5 % hyperbaric Inj. Bupivacaine 3 ml (60 patients) Group B (Bupivacaine) or 0.5 % hyperbaric Inj. Levobupivacaine 3 ml (60 patients) Group L (Levobupivacaine) The time for onset of sensory block between the two groups was the primary endpoint. Other measurements included were time to Grade 4 motor blockade and time to 2 segment regression, Hemodynamic changes (RR, SpO2, MAP, HR), Time to rescue analgesia and side effects if any. Results: Statistical analysis was done using Chi-square test and Unpaired t-test. Time to onset of sensory blockade was significantly faster (p – value < 0.001) in Levobupivacaine Group compared to Bupivacaine Group. Also, there was a significant increase in heart rate, respiratory rate in patients of Group L with p < 0.001. Time to Grade 4 motor blockade, time to 2-segment regression and time to rescue analgesia were also increased in Group L patients with p = 0.872, p < 0.046 and p < 0.002 respectively. Mean arterial pressure was increased in Group B patients with p < 0.02. Side effects like hypotension was significantly less (p - value < 0.001) with Group Levobupivacaine compared to Group Bupivacaine. Conclusions: Increased incidence of intraoperative hypotension with Bupivacaine suggests that L evobupivacaine is a better drug in maintaining perioperative hemodynamics in a geriatric patient undergoing lower limb orthopedic surgery.

A 44 years old female patient with primary sjogren’s syndrome presented for surgical repair of third degree uterovaginal prolapse with cystocele and rectocele. Other associated medical problems included hypertension, Type II diabetes mellitus and hypothyroidism. Vaginal hysterectomy with colpoperineorrhaphy and levataroplasty was done under lumbar subarachnoid block and the perioperative course was uneventful. Herein, we describe our experience of anesthetic management of a case of primary sjogren’s syndrome for an elective surgical procedure.

Introduction: Panfacial fractures are the biggest challenge for anesthesiologist because of its difficulty in airway management. Different airway securing devices have been used. Case Report: A 28 Years old male patient with pan facial fracture posted for open reduction and internal fixation of mandible and left zygomatic arch with a closed reduction of nasal bone fracture. Airway examination showed decreased mouth opening of 1 finger indicating difficulty in mask ventilation and intubation. He was successfully intubated with the help of truview laryngoscope. Conclusion: Careful evaluation of fracture, difficult airway predictors are useful in intubating patient with decreased mouth opening in panfacial trauma with the help of truview laryngoscope.

A 55 year old, diabetic, hypertensive female patient diagnosed with rheumatic heart disease and severe mitral stenosis was posted for mitral valve repair surgery. She was a known case of hypothyroidism with seizure disorder. On 2D echo, she had a severely dilated left atrium and a moderate degree of pulmonary hypertension (RVSP 48 mm Hg) She was found to have a left atrial clot on the Trans Esophageal Echocardiography (TEE) performed prior to surgery. On clinical examination, the patient was obese and a candidate for difficult airway. Her pulse was irregularly irregular suggestive of atrial fibrillation which was confirmed on ECG. Patient was taken up for surgery under high-risk with all surgical and anesthetic concerns explained to the family. Although there were no events intraoperatively, patient was difficult to wean off the ventilator postoperatively with one episode of cardiac arrest during a weaning trial. Patient was successfully revived after CPCR as per AHA guidelines. After an elective tracheostomy was performed, various causes of the sudden ventilator dependency that were ruled out included cor pulmonale owing to pulmonary hypertension, an undetected preoperative obstructive sleep apnoea, embolization of the clot to the brain, and chronic hypothyroidism leading to respiratory muscle weakness.

Background: Laryngoscopy and intubation in the lightly anesthetized patient is associated with significant increase in blood pressure and heart rate. These changes occur from reflex sympathetic discharge resulting from pharyngeal and laryngotracheal stimulation with increases in plasma concentration of epinephrine and norepinephrine. This reaction is not prevented by regular premedication. This study was designed to compare the two different doses of fentanyl citrate that is 2 mcg/kg and 4 mcg/kg in attenuation of hemodynamic effects during laryngoscopy and intubation. Methods: 80 adult patients 40 in each group ranging from 18–60 years of age and from both sexes undergoing modified radical mastectomy and total and subtotal thyroidectomy and surgeries which include oral intubation were selected for the study. Only patients belonging to ASA 1 and 2 were selected for the study. Group 1: Receives Inj. Fentanyl Citrate 2 mcg/kg. Group 2: Receives Inj, Fentanyl Citrate 4 mc/kg. All the parameters including heart rate, systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were recorded at the time of intubation and sequencially 1 min, 3 min, 5 min, and 10 minutes after intubation. Results: We studied all 4 parameters in both the Groups in all the patients and found out that the heart rate slightly increased during intubation in the Group 1 patients while it was either remained stable or decreased in Group 2 patients. There is consistent decrease in SBP, DBP and MBP in both the Groups from the baseline throughout the study period, and maximum decrease in all the pressures found at 10 minutes interval in Group 2 patients. Conclusion: Fentanyl citrate given 5 minutes before intubation produces most attenuation of the hemodynamic effects of stress response. Pretreatment with fentanyl citrate in every normal case would cause attenuation of hemodynamic effects of laryngoscopy and intubation. It will cause minimal change in heart rate, SBP, DBP, MAP, RPP during the first 10 minutes after intubation. Fentanyl citrate in 2 mcg/kg significantly attenuate but fentanyl 4 mcg/kg completely attenuates the hemodynamic responses during laryngoscopy and intubation.

Introduction: The Laryngeal Mask Airway (LMA) was designed to facilitate separation of the gastrointestinal and respiratory tracts, improve the airway seal, enable controlled ventilation and diagnose mask misplacement. A Drain Tube (DT) enables diagnosis of mask misplacement and also aims to attenuate risks of gastric inflation, regurgitation and aspiration of gastric contents. Aims and Objectives: Our objective is to compare digital insertion and bougie guided insertion of the ProSeal LMA with respect to the oropharyngeal leak pressure, number of attempts to successful placement, effective airway time, airway trauma insertion, postoperative airway morbidity and hemodynamic response to insertion. Materials and Methods: In our study, compared ProSeal LMA insertions using the digital and bougie guided techniques in 40 adult ASA I & II patients randomized into Two Groups of 20 patients. Results: The study finds that effective airway time (37.3 ± 3.7 seconds vs 20.8 ± 3.0 seconds) and oropharyngeal leak pressure (31.8 ± 1.7 cm H2O vs 24.2 ± 3.2 cm H2O) are higher in the bougie guided group as compared to the digitally inserted group and that this association is statistically significant. The two techniques are comparable with respect to other parameters. Conclusion: The bougie guided technique of insertion of ProSeal LMA is an acceptable alternative to the digital technique. It has advantages of having a higher leak pressure and lesser chance if malposition. The disadvantages include a higher effective airway time and the potential for stimulation and trauma.

Background: Coronary revascularization surgery is a procedure associated with higher rate of transfusion. Approximately 20% of all cardiac surgeries require allogeneic blood transfusions. The Red Blood Cells (RBCs) transfusion increases the morbidity and mortality in any surgery. The understanding of preoperative variables pertinent with the Red Blood Cells (RBCs) transfusion will authenticate the risks of transfusion and thus cede the need for productive blood conservancy methods. The intention of this study was to regulate the clinical and demographic variables associated with blood product transfusion in patients undergoing elective off pump coronary revascularization surgery. Materials and Methods: This was a single-center retrospective study conducted on 142 patients who had undergone elective off pump coronary revascularization surgery Patients’ preoperative clinical and demographic data, were analyzed. The preoperative lab analysis like hemoglobin, hematocrit, renal functions and coagulation profile were cataloged. The primary endpoints of interest was packed red blood cell transfusion. Secondary outcomes analyzes were reoperation rate for bleeding or cardiac tamponed and total postoperative chest tube drainage. Only intraoperative and postoperative (6 days) homologous packed RBC transfusions were recorded. Results: A total of 142 patients who underwent isolated off pump coronary revascularization surgery were studied. Blood transfusions were given to 23 of 142 patients (16.19%). Eleven of 41 women (26.8%) needed transfusion, compared with 12 of 101 men (11.9%) (p < 0.028). Conclusion: In the present study, we conclude preoperative anemia, low hematocrit and female gender were certainly associated with perioperative allogeneic red blood cells transfusion in patients undergoing off pump coronary revascularization surgery.

Context: Ideal drugs used for anesthesia for induction should counter the response to stress at the same time not affecting the changes in the hemodynamics of the patient. This is required because induction is an important part in anesthesia.

Aim: To compare hemodynamic response to induction of anesthesia with thiopentone or etomidate in adult treated hypertensive patients. Settings and Design: Present hospital based comparative study was carried out at Adichunchanagiri Institute of Medical Sciences, BG Nagar, Bellur.

Methods: 60 adult treated hypertensive patients of either sex, aged between 29 and 61 years, belonging to ASA I and II who were randomly allotted to Two Groups of 30 each. Group T received 5 mg/kg of thiopentone sodium and Group E received Etomidate 0.3 mg/kg. Pulse rate, systolic, diastolic and mean arterial pressures both after premedication (level 0) and at every minute for five minutes (levels 1–5) postinduction with both drugs were recorded. Statistical Analysis: The data was analyzed using t-test for comparing mean values between Two Groups.

Results: SBP fell to 120 ± 28.8 from 131.70 ± 16.03 (level 0) in Group T and fell to 120.80 ± 20.05 from 131.23 ± 16.03 (level 0) in Group E. DBP had a slight fall to 77.73 ± 17.00 at 4 minutes in Group T. MAP fell from 94.52 ± 12.10 (level 0) to 91.72 ± 21.34 in Group T and fell from 96.96 ± 12.96 (level 0) to 90.37 ± 17.51 in Group E. Comparison of variations in heart rate, SBP, DBP and map from level 0 to postinduction recordings at 1–5 levels between Two Groups was insignificant (p > 0.05). Patients in both Groups did not have any side effects.

Conclusion: Both drugs are comparable in efficacy and safety. Thiopentone comparatively has better cost effectiveness and ease of availability.

Background: Spinal anesthesia is easy to perform and provides a rapid-onset, dense surgical block. It is associated with hypotension and bradycardia, which may be deleterious to both mother and baby1. Various preventive methods are used to prevent or minimize hypotension including uterine displacement, fluid preloading, and compression stocking the lower extremities.2This study compares the effectiveness of Granisetron and Ondansetron on the spinal anesthesia induced hypotension, bradycardia after intrathecal hyperbaric Bupivacaine in patients undergoing cesarean sections.

Materials and Methods: Sixty full-term patients posted for cesarean section belonging to ASA I or II were randomly assigned to Two Groups each containing 30 patients. Group G received 1 mg Granisetron and Group O received 4mg Ondansetron. Hemodynamic were noted at regularly along with APGAR score.

Results: Trend observed in heart rate following the administration of the test drugs in both the groups and was not significant. The baseline hemodynamic of the patients were insignificant in both the Groups. This continued to be the case for up to 5 minutes after delivery of the drugs. At 10, 20, 30 and 45 minutes however, all three parameters were higher in Group O than Group G. At 60 mins however, no significant difference is seen between the groups. Similar trend was observed in APGAR score in neonates of both the Groups.

Conclusion: Ondansetron was more effective in attenuation of spinal anesthesia induced hypotension than in Granisetron. Both the Groups had no significant difference in prevention of bradycardia oxygen saturation and foetal outcome.

Introduction: The continuous epidural infusion of local anesthetic and fentanyl using a multirate elastomeric infusion pump provides the good analgesic option to treat the postoperative pain following the major abdominal surgery. The aim of the present study is to compare the different infusion rates of 0.1% bupivacaine with fentanyl as continuous epidural infusion using Baxter’s multirate elastomeric infusion pump in patients undergoing laparotomy under general anesthesia.

Materials and Methods: Seventy five patients, in age group of 25–60 year with ASA Grade I and II undergoing intraabdominal surgery under general anesthesia were randomly divided into three groups. The epidural catheter was placed in L1–2 interspace with six cm of catheter length in epidural space before induction of GA. At the time of closure of peritoneum a bolus of 8 ml of 0.1% bupivacaine with fentanyl 2 mcg/ml was given in epidural space and the continuous infusion was started at specified rate depending upon the group. In Gp I the infusion was @ 5 ml/hr while in Gp II and Gp III infusion rate was 7 ml/hr and 12 ml/hr respectively. An independent observer visited the patient at regular intervals to enquire about VAS score in postoperative period, extending up to 48 hours. Statistical Analysis: Parametric and nonparametric data were collected and relevant data of each patient was entered in Microsoft Excel Worksheet© and were analyzed statistically by using IBM SPSS© software. p - value < 0.05 was taken statistically significant.

Results: Analysis of postoperative VAS score showed that all the patients have 0 VAS at the time of extubation. Gp I showed higher VAS scores while Gp II and Gp III had a comparable VAS scores. Mean morphine consumption in Gp I was 0.96 ± 1.136 (total 5.7 mg), in Gp II was 0.48 ± 0.714 (total 2.88 mg) and in Gp III was 0.24 ± 0.663 (total 1.44 mg). All groups demonstrated the height of sensory block at T5 dermatome level in immediate postoperative period and the regression was faster in Gp I and II. The mean height of sensory blockade was much higher in Gp III (T7 dermatome) as compared to Gp I & II (T 9 dermatome). Gp III had mild weakness in hip flexion after 20 hrs of continuous infusion. Statistically higher sedation scores were noted in Gp III, but all patients were responsive to commands at all times. Gp III had higher incidence of bradycardia and hypotension (5/25, 20 %), shivering (13/25, 52%), pruritus (14/25, 56%), nausea and vomiting. The mean hospital stay was 5.106 ± 1.203 days.

Conclusion: For adequate postoperative pain relief following laparotomy under general anesthesia, the administration of bupivacaine 0.1% with fentanyl 2 mcg/ml @7 ml/hr is ideal rate for continuous epidural infusion. The multi rate elastomeric pump used in the study performed satisfactorily and no mal function was reported.

Introduction: General anesthesia is an integral part of anesthesia and intubation is a necessary step to protect the airway from regurgitation and aspiration. Postoperative sore throat, hoarseness of voice, cough are common sequelae after endotracheal intubation. The present study was conducted to compare the efficiency of preoperative nebulization of lignocaine hydrochloride and magnesium sulphate for reducing the incidence of POST in patients undergoing surgeries in general anesthesia.

Aims and Objective: The purpose and aim of the study was to compare the efficiency of preoperative nebulization of lignocaine hydrochloride and magnesium sulphate in reducing the incidence of POST following GA with regards to- Postoperative Sore Throat (POST), Cough hoarseness of voice, dysphagia and dysphonia and Complications from possible systemic effects, because of absorption from mucosal surfaces.

Materials and Methods: 100 patients of Government Medical College, Kota, and attached group of hospitals, scheduled to undergo elective surgery lasting more than 1 hour but less than three hours under GA requiring tracheal intubation within the age group 40–70 years, of both sexes were randomly allocated in two groups by simple randomization using computer generated numbers. Group A: 50 patients received nebulized magnesium sulphate 4 ml. (6.25%). Group B: 50 patients received nebulized lignocaine 4 ml. (2%).

Results: On Intergroup comparison incidence of sore throat was more common in Lignocaine Group as compared to Magnesium Group but there was no significant difference in both Groups with respect to sore throat at rest (p > 0.05). On Intragroup comparison incidence of hoarseness of voice decrease with time in both groups but more faster recovery in Magnesium Group. In Magnesium Group no incidence of hoarseness of voice found at 24 hr after extubation. In Lignocaine group no incidence of hoarseness of voice found at 48 hr after extubation.

Introduction: Hypotension following Spinal Anesthesia (SA) is a common and troublesome Complication. Prophylactic fluid preloading with crystalloids is traditional practice to prevent hypotension. Timing of the infusion of the crystalloid is more important as its shorter intravascular stay. We hypothesized that crystalloid loading just after intrathecal injection compared to preload is more effective.

Methods: 100 healthy adult patients of ASA 1 & 2, scheduled to undergo lower limb and abdominal surgery under spinal anesthesia, were studied. Patients in preload Group (A) were preloaded with RL at 15 ml/kg over 20 min periods prior to spinal anesthesia while in coload Group (B) received Ringer lactate 15 ml/kg as soon as spinal block is performed over 10 to 15 min.

Results: The incidence of hypotension was low in coload group than compared to preload group. Mean arterial pressure at before spinal anesthesia was 100 mm Hg and 101 mm Hg, following subarachnoid block at 3 minutes dropped up to 85 mm Hg and 92 mm Hg, after 5 minutes 80 mm Hg and 88 mm Hg after 10 minutes 78 mm Hg and 90 mm Hg in preload and coload group respectively.

Conclusions: In our study, we found that coload is more effective, than preload solution in prevention of hypotension in patients undergoing elective surgeries for abdomen and lower limb surgery under spinal anesthesia. So, it is unnecessary to spend time to deliver preload and delay surgery for the prevention of SA induced hypotension.

Context: Posttraumatic intracranial hypertension might be detrimental. Bedside ultrasound measurement of optic nerve sheath diameter helps in early diagnosis of increased intracranial pressure.

Aims: To determine the accuracy of detecting the raised intracranial pressure by ultrasonographic measurement of Optic Nerve Sheath Diameter (ONSD). To correlate ONSD with the Computer Tomography (CT) findings of increased intracranial pressure and the average time taken to measure ONSD with ultrasound.

Settings and Design: A Prospective, double blinded Observational Study.

Methods and Materials: To determine the accuracy of detecting the raised intracranial pressure by ultrasonographic measurement of Optic Nerve Sheath Diameter (ONSD). To correlate ONSD with the Computer Tomography (CT) findings of increased intracranial pressure and the average time taken to measure ONSD with ultrasound. Statistical Analysis: Descriptive Analysis - Sensitivity, Specificity and Predictive values.

Results: The sensitivity for the mean binocular optic nerve sheath diameter ultrasonography in detecting elevated intracranial pressure was 99.42% and the specificity was 82.43% with an odds ratio of 0.3547. The positive predictive value was 92.97% and the negative predictive value was 98.39% with an p - value of < 0.0001 which was significant. The average time taken to measure the ONSD was 19.8 secs.

Conclusions: The evaluation of optic nerve sheath diameter is a simple noninvasive procedure, which is a potentially useful tool in the assessment and monitoring of raised intracranial pressure.

Context: Endotracheal intubation is the gold standard of a secure airway under general anaesthesia and extubation at the end of surgery is a norm. However this does not happen in all the patients. Delayed extubation after surgery occurs in small percentage of patients due to various reasons which would have been decided preoperatively or sometimes intraoperatively. But sometimes its unexpected due to unanticipated complications in perioperative period.

Aim: This study was conducted to analyze prevalence and causes of delayed extubation among surgical patients.

Setting and Design: It was a one year prospective observational study of patients with delayed extubation after surgical procedures.

Results: Prevalence of delayed extubation among surgical patients operated under anesthesia was 4.32%. Preoperative variable which showed higher percentage of delayed extubation were age above 40 years, male gender, ASA PS II and above. Among operative variables, delayed extubation was seen more in surgical procedures like intraabdominal surgeries and head and neck surgeries and patients under general anesthesia. Delayed extubation was planned in 70.32% of surgical patients. Intraoperative events like hypotension, blood loss, starting of inotropes and duration of surgery also has an influence on delayed extubation.

Conclusion: Delayed extubation, though not frequent, will be required in some surgical patients. It has its own morbidity and mortality. Prolonged intubation and mechanical ventilation after delayed extubation is more harmful as it is associated with complications.

Introduction: Prolongation of analgesia after single shot Brachial Plexus Block (BPB) with local anesthetic remains a challenge. Dexamethasone prolongs duration of action of local anesthetic when used as an adjuvant. We aimed to determine the efficacy of dexamethasone after addition to bupivacaine for prolongation of analgesia & motor block in BPB.

Methods: A prospective, randomized, double blind study was carried out in a tertiary care hospital during the period of May 2016 to January 2019. Patients (n = 50) between 18 and 70 years of age of either sex undergoing upper limb surgery were enrolled. Patients in Group Ι (n = 25) received 0.5% bupivacaine plus dexamethasone 8 mg and Patients in Group ΙI (n = 25) received 0.5% bupivacaine plus 0.9% normal saline. Mean duration of analgesia, mean duration of motor block, onset of sensory block & onset of motor block were recorded. ‘p’ value less than 0.05 was taken as significant.

Results: Demographic characteristics were comparable in both the study groups. The mean duration of analgesia was significantly longer in Group Ι as compared to Group II (748.5 ± 65.57 mins vs 555.4 ± 35.20 mins: p < 0.05). Group Ι showed significantly longer mean duration of motor block compared to Group II (814.3 ± 100.81 mins vs 690.3 ± 81.36 mins: p < 0.05). Similarly, the onset of motor block was significantly rapid in Group Ι as compared to Group II (13.04 ± 2.09 mins vs 14.52 ± 2.29 mins: p < 0.05).

Conclusion: Dexamethasone as an adjuvant to bupivacaine in brachial plexus block significantly prolongs the duration of analgesia and motor block in patients undergoing upper limb surgery.

Introduction: Wall of abdomen is a source of pain after abdominal surgeries. Even an operation such as inguinal herniorrhaphymay lead to chronic pain in patients. Lower abdominal surgeries are common surgical procedure with a rare postoperative morbidity. However, chronic pain and continuous neuralgia have been accepted as complications after lower abdominal surgeries. Aims: To compare Effect of 0.25% Bupivacaine and 0.5% Ropivacaine in Transversus abdominis plane block for postoperative analgesia in lower abdominal surgeries. Materials and Methods: This is was a prospective study conducted at during the period from June 2017 to May 2018. Sixty patients with ASA Grade I and II of 20 to 60 years age, undergoing inguinal hernia surgeries under spinal anesthesia were randomly alocated into Two Groups of 30 each, Group B - Bupivacaine 0.25% and Group R- Ropivacaine 0.5%. Results: Thus, the effect of Bupivacaine and Ropivacaine was comparable to each other suggesting that Bupivacaine and Ropivacaine have hemodynamic stability in TAP block. The duration of postoperative analgesia was for more than 24 hrs in Ropivacaine Group comparative to Bupivacaine has a postoperative analgesia for 8 hrs. Conclusion: TAP bock performed by landmark technique in patients undergoing lower abdominal surgeries with 0.5% ropivacainesingle injection of 0.5% ropivacaine gives prolonged postoperative analgesia, Reduces the doses of rescue analgesics in postoperative period.

Background: Different modes of mechanical ventilation such as volume controlled ventilation (VCV) and Pressure Controlled Ventilation (PCV) are deployed to balance respiratory mechanics, gas exchange and hemodynamics in patients undergoing lumbar spine surgeries in prone position.

Methods: This prospective study included 72 patients undergoing lumbar spine surgeries in prone position. They were randomized to two Groups – Group V (who received volume controlled ventilation) and Group P (who received pressure controlled ventilation). The ventilation and hemodynamic parameters were statistically analyzed at 5 min after intubation in supine (S5), 60 min after prone (P60) and 180 min after prone (P180) position. Oxygenation parameters were assessed from ABG in supine (baseline) and at the end of surgery in prone position. Chisquare, independent t-test and ANOVA were used to compare the data between the two groups.

Results: Demographics, oxygenation and hemodynamics were comparable between the two groups. P peak and P mean increased from supine to prone position in both the groups. The P peak in VCV was higher than PCV in prone position and the difference was significant at first hour [p = 0.008] . The dynamic compliance (Cdyn) decreased in both PCV and VCV from supine to prone position. There was significant increase in Cdyn in PCV at the end of first hour in prone position (p = 0.005). Vte, MV, PEEP, RR, EtCO2, and VD/VT did not show any significant difference between the groups (p > 0.05).

Conclusion: Both VCV and PCV can be safely used to ventilate patients in prone position undergoing lumbar spine surgeries.

Background: Insertion of Ryles Tube (RT) or orogastric tube and deflating the gastric contents is often required in patients of laparoscopic surgeries. Passing the RT into the stomach is always difficult in an anesthetized and intubated patients as they cannot follow the commands. Various techniques have been tried with variable success.

Aim: We describe here a simple and easy technique of RT or orogastric tube insertion in paralyzed and intubated patients and compared with the conventional method in terms of success rate, attempts, time taken for insertion and adverse effects. Patients in our study included were those coming for laparoscopic surgeries under general aesthesia.

Methods: A total of 60 patients undergoing laparoscopic surgeries, requiring RT placement of either sex, between the age group 25 and 55 yrs. were enrolled for our study. Patients were allotted into Two Groups. Group C (control) the RT was passed through the mouth, and in Group ET (study) RT was passed through the red rubber endotracheal tube. Demographic parameters, required number of attempts, placement time and adverse events were noted.

Results and Conclusions: Our method of passing RT into the stomach in anesthetized and paralyzed patients- through the endotracheal tube is very simple and easy. The attempts and the time taken for insertion of the RT was much less in our method. The adverse effects were negligible with this method as compared to the conventional method.

Context: Cisatracurium is a cis isomer of parent compound atracurium, devoid of histamine release, thus possessing hemodynamic & cardiovascular stability. Aims: We compared the intubating conditions, hemodynamic stability & recovery of atracurium & vecuronium. Settings and Design: We carried out prospective, double blind randomized study after approval of ethical committee. 100 adult patients of ASA 1 & 2 with comparable demographic data were selected. Divided in Two Groups C (Cisatracurium) & V (Vecuronium). Standard monitoring was done & following routine premedication & induction agents, patients were intubated at 2 mins after administration of cisatracurium 0.15 mg/kg & vecuronium 0.1 mg/ kg respectively, maintained on intermittent dose of cisatracurium: 0.03 mg/kg & vecuronium: 0.02 mg/kg. Intubation conditions were assessed according to Time to 25% recovery of t1/tc following initial doses, Time to 25% recovery of t1/tc following repeated boluses, Time to 25% recovery of t1/tc following last dose, Return of t4/t1 ratio 0.8 spontaneous recovery at end of operation. Statistical analysis used: The results were evaluated by applying paired t-test and p - value using SPSS Statistical Software. Results: Intubating conditions at 2 mins following administration appeared satisfactory & laryngoscopy condition was good in 98% in Group C & 97% in Group V, Time taken for 25% recovery following First Dose & Subsequent Doses was longer for Group C than Group V. Time taken to 25% recovery of t1/tc following Last Dose was shorter in Group C patients as compared to Group V, duration of action of Group C was longer than Group V, both demonstrated equal hemodynamic & cardiovascular effect. Conclusions: Cisatracurium is intermediate onset nondepolarizing muscle relaxant devoid of histamine release with longer duration of action & faster recovery.

Introduction: Postoperative Sore Throat (POST) is an undesirable common complaint following general anesthesia. The objective of this study was to compare the incidence of sore throat and hoarseness of voice following endotracheal intubation using McIntosh laryngoscope or king vision video laryngoscope.

Methodology: It was a prospective randomized control trial in which 200 ASA 1 and 2 patients, scheduled for elective surgery requiring endotracheal intubation were randomly allocated to VCL (Video laryngoscope) and MCL (McIntosh laryngoscope) Group. Endotracheal intubation was performed using McIntosh Laryngoscope in MCL Group and kingvision video laryngoscope in VCL Group. POST and hoarseness was assessed at 6, 12, 24 and 48 hours. Incidence of sore throat, hoarseness of voice, laryngoscopy time and ease of insertion was noted and compared.

Results: There was no significant difference in the incidence of sore throat and hoarseness of voice between the Two Groups . However, duration of laryngoscopy was longer in VCL Group. Conclusion: Incidence of Postoperative sore throat and hoarseness of voice does not alter when Kingvision video laryngoscope as compared to McIntosh laryngoscope is used for endotracheal intubation, however the time taken for laryngoscopy and intubation is longer with kingvision video laryngoscope

Context: Adjuncts to local anesthetics for brachial plexus block may enhance the quality and duration of analgesia. Dexmedetomidine, an α-2 adrenergic agonist is known to produce anti-nociception and enhance the effect of local anesthetics in various peripheral nerve blocks. Aims: To evaluate the effects of the addition of Dexmedetomidine (1µ/Kg) to Levobupivacaine (0.5%) for supraclavicular brachial plexus block in upper limb surgeries. Study Design: A prospective, randomized double-blinded study. Methods: The patients included in the study were randomized into two equal groups. Patients in Group L (n = 30) were administered 29 ml of 0.5% of Levobupivacaine and 1ml of normal saline and Group LD (n = 30) were given 29 ml of 0.5% Levobupivacaine with Dexmedetomidine (1µ/Kg). The onset and duration of sensory and motor block, Hemodynamic variables, Visual Analog Score (VAS), Patient Satisfaction Score (PSS) were recorded for 24 hours postoperatively. Statistical analysis used: Chi-square test and Student’s unpaired t-test. Results: Onset of sensory block and motor block in Group LD was (5.30 ± 1.02 min) and (7.87 ± 1.33 min), whereas in Group L (10.83 ± 1.05 min) and (13.87 ± 1.33 min) respectively. Duration of sensory block and motor block in Group LD was (11.42 ± 0.6 hrs) and (10.10 ± 0.68 hrs), whereas in Group L (8.01 ± 0.64 hrs) and (6.69 ± 0.65 hrs) respectively. Mean Pulse rate and mean Blood Pressure was lower in Group LD (p < 0.05). VAS was lower in Group LD (p < 0.05). PSS was higher in Group LD (p > 0.05). Conclusion: Dexmedetomidine (1 /kg) in combination with Levobupivacaine (0.5%) has early onset of sensory and motor block and prolonged duration of sensory and motor block with minimal hemodynamic variables.

Objective: A randomized, double blind study to compare the analgesic efficacy, maternal and neonatal outcome of ropivacaine 0.1% and bupivacaine 0.1% both with fentanyl for labor epidural analgesia. Methods: Sixty term parturient of ASA Grade I & II with singleton pregnancy in vertex presentation and adequate cervical dilatation requesting painless labor were divided into two groups of 30 each. Group BF parturient received bupivacaine 0.1% with fentanyl 20 g and Group RF parturient received ropivacaine 0.1% with fentanyl 20 g as intermittent bolus doses epidurally. After written informed consent, epidural catheter was placed in L3-4/4-5 space followed by study drug administration and top up doses intermittently. Maternal hemodynamics, Visual Analogue Score (VAS), Foetal heart rate, sensory analgesia, motor block, neonatal APGAR score at 1 and 5 min and labor characteristics were recorded. Results: The groups were comparable in demographic and obstetric characteristics. Two patients in Group BF developed motor block of Grade 1 while none of the patient in Group RF had motor block. VAS score and quality of analgesia was comparable in both the groups. Onset of sensory block was longer in Group RF. No significant difference was found in both groups with regards to hemodynamics. Conclusion: We conclude that ropivacaine 0.1% with fentanyl produced excellent analgesia comparable to bupivacaine 0.1% with fentanyl and can be used safely for labor epidural analgesia.

Background: Spinal anesthesia has become the choice in obstetric patients awaiting cesarean section for its characteristics in providing rapid onset of anesthesia, allowing the mother to immediately interact with her baby. We were going to investigate the effect of the sitting and the lateral decubitus positions in the performance of spinal anesthesia for elective cesarean sections. The objective was to compare the onset time of anesthesia, the total requirement of ephedrine and hemodynamic changes in the Two Groups. Materials and Methods: After ethics committee approval, this comparative observational study was conducted in the Department of Anesthesiology at Sri Manakula Vinayagar Medical College and Hospital, Puducherry. A total of 72 parturients who met the inclusion criteria were enrolled into the study and were alternatively prepared for spinal anesthesia either in the sitting or in the left lateral position. The onset time taken for anesthesia to reach T4 level, the total requirement of ephedrine and hemodynamic parameters were recorded. Results: The Two Groups were comparable with regards to age, weight, gestational period and ASA grade. The mean and SD of onset time - Sensory Blockade in minute after Injection in sitting position group was 3.833 ± 2.049. Similarly it was 4.75 ± 2.089 for the lateral position group. The mean and SD of Ephedrine requirement in milligram in sitting position group is 8.5 ± 6.313. Similarly it was 7.5 ± 6.934 for the lateral position group. There were no significant difference between the groups. Conclusion: Our results showed no significant differences between the sitting and left lateral positions regarding the time taken to achieve T4 dermatomal level of anesthesia, the incidence of hypotension depicted by the total requirement of injection ephedrine and overall hemodynamic variables. We concluded that the sitting or the left lateral decubitus position in the performance of spinal anesthesia for cesarean section does not influence on the onset time of anesthesia and incidence of hypotension.

Context: Patients without information of surgery and anesthesia are supposed to have high anxiety level in the perioperative period which may have adverse hemodynamic effects and higher incidence of postoperative pain. Overall information regarding anesthesia may attenuate the perioperative anxiety. Aims: Our aim and objective was to observe and compare the perioperative anxiety level in patients undergoing elective surgery using Beck Anxiety Inventory (BAI) scale. Materials and Methods: One hundred patients of either sex aged between 18 and 80 years conforming to ASA physical Status I to III posted for elective surgery were randomly allocated into Two Groups to receive either baseline information during preanesthetic check up according to Institutional protocol (Group A, n = 50) or additional information based on a questionnaire regarding the process of anesthesia (Group B, n = 50). The levels of anxiety were assessed using BAI score at 4 time points namely, just after PAC (reading 0), at waiting room before entry to operation theatre (reading 1), on operation table just prior to administering anesthesia (reading 2) and again at four hours after the surgery (reading 3). Results: Patients of Group A has much higher anxiety level than Group B (p < 0.05). In both the groups anxiety level was the highest just prior to anesthesia but the degree of anxiety was less in Group B (17.28 ± 4.69) than group A (25.88 ± 6.82) p value < 0.0001. Conclusion: Combination of preanesthetic check up with additional information to the patient regarding anesthesia based on a questionnaire is better than only check up to reduce perioperative anxiety.

Background: Central Venous Pressure (CVP) has been used for fluid resuscitation and to check intravascular volume status. A rapid bedside sonographic examination can be instrumental in guiding management of trauma and critically ill patients. This study evaluated the Ultrasonographic (USG) measurement of Inferior Vena Cava (IVC) diameter and caval index to identify intravascular volume status and its correlation with CVP. We also investigated the association of caval index of ≥ 50% and CVP ≤ 8 mm Hg. Aims: This study was designed to evaluate Ultrasonographic (USG) measurement of Inferior Vena Cava (IVC) diameter and caval index could identify intravascular volume status and its correlation with CVP. Also, investigating the association of caval index of ≥ 50% and CVP ≤ 8 mm Hg. Materials and Methods: A hundred patients aged 18 years and above were enrolled in this prospective, observational study. IVC inspiratory and expiratory diameters were measured by USG. The correlation of CVP and caval index was calculated. Participants were stratified by their CVP ≤ 8 mm Hg and > 8 mm Hg. Results: In 100 participants of the study, 68 had a CVP ≤ 8 mm Hg with caval index > 50%. The efficacy of caval index predicting the low CVP (CVP ≤ 8) between the Two Groups was statistically significant. The caval index ≥ 50% predicting a CVP ≤ 8 mm Hg had sensitivity, specificity, positive and negative predictive value of 97%, 96%, 99% and 93% respectively. Conclusions: Bedside USG measurement of caval index greater than or equal to 50% is strongly associated with a low CVP and caval index could be a useful tool to determine CVP.

Introduction: Endotracheal intubation is the translaryngeal placement of endotracheal tube into the trachea. Hypertension and tachycardia, usually accompany larynogoscopy and tracheal intubation. Aims: A comparative study of attenuation of hemodynamic responses to laryngoscopy and intubation with and without oral clonidine. Materials and Methods: This study was done in Fifty patients were selected for the study with the age group ranging between 20–60 years belonging to ASA Group-I. Patients undergoing elective surgical procedures were included in the study. The fifty patients were randomly divided into Two Groups: Control Group and Study Group. Each Group consisted of 25 patients. Results: Preinduction and postinduction hemodynamic values were significantly lower in study (clonidine) group, when compared with those of control (without clonidine) group. The difference was statistically significant. Conclusions: The stability of heart rate and blood pressure could be achieved by using clonidine 5 ug/kg as a premedicantly useful in management and can prevent instances of ‘alpine anesthesia’(attempt to delineate the role of intraoperative hypotension and blood pressure variability).

Background: Prediction of difficult airway is a challenging task. Commonly used airway assessment screening tests has high interobserver variability and low predictability in detecting difficult airway. Ultrasound could be a helpful tool in the prediction of these difficulties. Objectives: The purpose of this study was to evaluate the ability of preoperative ultrasound assessment of anterior neck soft tissue thickness in predicting difficult laryngoscopy in patients undergoing during elective surgery requiring tracheal intubation. Design: Prospective; Double blind; Observational study. Patients: A total of 100 patients aged more than 18 years, without neck pathologies undergoing general anesthesia and tracheal intubation were included in the study. Outcome Measures: Ultrasound distance from skin surface to anterior commissure of vocal cord (DSVC) was recorded with a linear 6 to 13 MHz ultrasound transducer preoperatively. Postoperative anesthesia record was analyzed for Cormac Lehane grades during laryngoscopy. Results: The DSVC cutoff value of 0.51 cm was the best predictor of Cormack Lehane grade more than 2 at direct laryngoscopy and of difficult intubation, (sensitivity 78.3%, specificity 74%). The mean (SD) of DSVC was 0.53 (0.12) cm in the difficult laryngoscopy group and 0.40 (0.14) cm in the easy laryngoscopy group, (p < 0.001). Conclusion: The noninvasive prediction of difficult laryngoscopy can be done by airway ultrasound. The distance of 0.51 cm or more at the level of vocal cord can predict potential difficult laryngoscopy in patients undergoing anesthesia with endotracheal intubation.