Indian Journal of Anesthesia and Analgesia

Background: Cisatracurium is 3 to 4 times more potent than Atracurium and is devoid of histamine release. However 2ED 95 dose of Cistracurium does not provide satisfactory intubation conditions as compared to 2ED 95 dose of Atracurium. Aims: To compare the neuromuscular blocking characteristics of 3ED95 dose of
Cisatracurium and 2ED 95 dose of Atracurium. Material and Methods: 60 patients were divided into two groups: Group A received 0.5 mg/kg iv of Atracurium (2ED95) and Group B received 0.15 mg/kg iv of Cisatracurium (3ED95) as intubating dose. Onset time, duration of action, condition of intubation, haemodynamic effects and signs of histamine release were monitored. Results: 3ED95 dose of Cisatracurium had a faster onset time (2.96 ± 0.61 minutes ) as compared to 2ED95 dose of Atracurium (3.55 ± 0.51 minutes ; p-value 0.0134). Group B also had longer duration of action than Group A (67.16 ± 9.39 minutes vs 44.87 ± 4.94 minutes respectively; Pvalue
0.0013). Excellent intubating conditions were seen in 53.33% of patients in Group B and 46.67% of patients in Group A. 4 patients had signs of histamine release in Atracurium group and none in Cisatracurium Group. Conclusion: 3ED 9 5 dose of Cisatracurium is a more effective neuromuscular blocking agent than 2ED95 dose of Atracurium in terms of providing faster onset time, longer duration of action, excellent intubating condition and better hemodynamic stability with no histamine release.

Introduction: Transurethral resection of prostrate (Turp) and transurethral resection bladder tumour (Turbt) are major operations, subarachnoid block is a well accepted and popular technique for Turp and Turbt. Materials and method: This randomized prospective double blind study conducted at MIOT hospitals, Chennai, from October 2014 – December 2015, evaluated the effective dose of clonidine with 10mg of 0.5% heavy bupivacaine in 80 patients posted for these surgeries and also to find the effect of various doses of clonidine on various subarachnoid block characteristics. Results: The level of peak sensory block (mean ± SD) was thoracic vertebral level T9.4 ± 0.68 in group BN T8.95 ± 0.94 In group BC 15, T8.3 ± 1.41 in group BC 25 and T7.5 ±
1.19 in group BC 35. There were significant differences in the peak sensory level between the groups. The 2 segment regression time (mean ± SD) defined as the time taken for the peak sensory level to regress 2 segments was compared between the 4 groups. It was 53.65 ± 5.81 min in group BN compared to 56.15 ± 7.23 min in groupBC15, 63.60 ± 8.66 min in group BC 25 and min 65.25 ± 6.87 in group BC 35. The difference in 2 segment regression was significant between the groups. The time to first requirement of analgesia was compared the
4 groups. It was 85.95 ± 6.21 min in group BN, 89.25 ± 6.37 min in group BC 15, 95.90 ± 8.59 min in group BC 25, 99.50 ± 5.72 min in group BC 35 . The difference was significant between the groups. Conclusion: Addition of 35mcg of clonidine to bupivacaine when compared to 25mcg/15mcg clonidine significantly prolongs the duration of analgesia without affecting the onset and maximum level achieved of sensory block.

Aim: To study the haemodynamic and pharmacodynamic effects of cis-atracurium and vecuronium. Settings and Design: Prospective, Randomized, Parallel group, Double blind study Plan of Study: After
institutional review board approval and informed written consent from patients, eighty patients undergoing laparoscopic appendicectomy were randomized into two groups. Group-C n=40 received loading dose of inj.
Cis-atracurium 0.15mg/kg and maintenance doses of 0.03mg/kg while Group-V, n=40 received loading dose of inj. Vecuronium 0.10mg/kg and maintenance doses of 0.02mg/kg. As premedication Inj. Ondansetron,
Glycopyrolate, Midazolam were administered followed by Inj. Propofol + Inj. Fentanyl + loading dose of assigned drug for induction & intubation of the patient. Maintenance of general anaesthesia was done with
O 2+N2O (50:50), Sevoflurane inhalation, and intermittent doses of assigned muscle relaxant drug according to PNS. The observations as time of onset of action, intubation time, time interval between loading and first maintenance dose, time interval between maintenance doses, extubation time, total number of drug dosage requiredand haemodynamic parameters were noted. Statistical analysis: Data were analysed by using repeated measure ANOVA and by Manwitney U test. Results: Time of onset of action and intubation time in Group- V
were significantly lower as compared to Group-C.Time interval between loading & first maintenance dose was comparatively higher in Group- C than Group- V. Time intervals between maintenance doses were
comparable among both the groups. When compared with Group-V, extubation time was shorter in Group-C. Conclusion: Cis-atracurium had a longer time of onset of action, longer duration of action, hence less doses were required for maintenance of anaesthesia, faster recovery as compared to Vecuronium. Both drugs were haemodynamically stable.

Context: Spinal anaesthesia is a blind landmark based procedure, it can be challenging in some patients. The subarachnoid space should preferably be identified at the first attempt, as multiple punctures are associated with pain and patient discomfort, increase risk of postdural puncture headache, spinal hematoma formation, trauma to neural structures and permanent neurological sequalae. Predictors to assess the difficulty of spinal anaesthesia increases the chances of success with this blind technique prevent multiple attempts and add to patient comfort, thus increasing the quality of healthcare. Aims: We formulated this study to assess the ease/difficulty of spinal anaesthesia based on width of interspinous gap (ISG) and patient’s characteristics.
Settings and Design: A prospective observational study conducted in 77 ASA I and II patients of either sex and age between 18-65 years, posted for elective or emergency surgery under spinal anaesthesia. Methods
and Material: The ISG was measured using vernier caliper at L4-L5 level in optimal flexed sitting position before spinal anaesthesia. The number of attempts, redirections and requirement of another spinal level were recorded. Statistical analysis used: Mean and Standard Deviation, Chi-square test, Independent t-test and p value. Results: The demographic data like age, gender, body mass index and type/gauge of spinal needle did not have any correlation with the ease of spinal anaesthesia while ISG was found to be significantly lower (p = 0.000) in patients who required more number of redirections, attempts and levels. Conclusions: ISG is a good predictor for the ease of spinal anaesthesia.

Introduction: The use of interscalene block as the primary anaesthetic technique avoids the complication associated with general anaesthesia. the present study is undertaken to study the effect of adding Dexamethasone as adjuvant to Ropivacaine. Aims: Aim is to study the comparison between ropivacaine and ropivacaine with dexamethasone in ultrasound guided brachial plexus block. Materials and methods: The present study was undertaken at Gandhi hospital, Secunderabad during the period of March 2019 to October 2019. The patients were randomised into 2 groups with 30 patients in each group. Group R – 30 ml of Ropivacaine 0.5% + 2ml Normal Saline and Group RD – 30 ml of Ropivacaine 0.5% + 2ml (8mg) dexamethasone. Results: Block was
successful in 90% patients in Ropivacaine group and 93.3% in Ropivacaine + Dexamethasone. The difference was not statistically significant (p = 0.640). There were no statistically significant differences in demographic profile of patients in either group in terms of age, body weight, or gender ratio (p >0.05). There were no statistically significant differences in patients posted for surgery in either group (P value – 0.726). There was no significant difference between 2 groups in terms of ASA grading (p = 1.000). Duration of sensory block, motor block in Ropivacaine group and Ropivacaine + Dexamethasone group is highly significant (p < 0.001). Duration of analgesia in Ropivacaine group was 628.88 ± 65.11 min whereas in Ropivacaine + Dexamethasone
it is 1051 ± 61.36 min, which is statistically highly significant (p < 0.001). The hemodynamic parameters were statistically insignificant in both the groups since (p > 0.05). Conclusion: Addition of Dexamethasone to 0.5% Ropivacaine for interscalene brachial plexus block increases duration of sensory block, motor block as well as duration of analgesia.

Introduction: Upper limb surgeries are mostly performed under anesthesia such as Supraclavicular brachial plexus block, peripheral nerve block not only provide Intraoperative anaesthesia but also ensure post operative analgesia. Materials and methods: This study was conducted on 100 patients of ASA physical status I to III in age group of 18-70 years of either sex posted for elective upper limb surgeries under Supraclavicular brachial plexus bock after taking informed consent at KVG Medical College, Sullia from January 2013 to June
2014. Patients was randomly allocated to 2 groups of 50 each by random number table prepared by another anesthetist not otherwise involved in the study outside the operating room, namely; Group C: 33 ml of 0.5% Ropivacaine plus 1 ug/kg Clonidine Group D: 33 ml of 0.5% Ropivacaine plus 1 ug/kg Dexmedetomidine Results: Onset of sensory block was faster in group D than in Group C, While onset of motor block was faster in group C than in Group D, but the difference was not statically significant (p > 0.05). Duration of sensory block and duration of motor block were significantly longer in Group D as compared to Group C (p < 0.001). There was significant increase in duration of analgesia in Group D as compared with group C. None of the patients in group D required sedation intraoperatively and they were comfortable throughout the surgery with arousable sedative effects. Significant lower heart rate was observed at 30, 45, 60, 75, 90, 105, 120 and 135 min, but not less than 60 beats/min, in Group D as compared with Group C (p < 0.001). Systolic and diastolic blood pressure were found to be significantly lower than baseline from 25 to 60 min in group D as compared
with Group C (p < 0.001). Conclusion: addition of dexmedetomidine as an adjuvant to Ropivacaine produces a significantly faster onset of sensory block and a significantly longer sensory and motor block when compared to Clonidine. Dexmedetomidine significantly reduces the number of rescue analgesia dosage requirements in postoperative 24 hrs and prolongs the duration of analgesia when compared to Clonidine. The mean arterial pressure, heart rate, blood pressure did not require any therapeutic intervention in both study groups.

Caesarian sections are mostly done under regional anaesthesia, especially spinal anaesthesia, in many places. Many of the patients develop hypotension after spinal anaesthesia. A fall in blood pressure of more than 20% from baseline value is hazardous to both mother and the baby. Various methods had been tried to alleviate this response. Preloading with crystalloid solution, maintaining a left lateral tilt, elevating the foot end, and pharmacological therapy using vasopressors are all tried. Common vasopressors used are Mephenteramine and Ephedrine. Now Phenyl ephrine is the vasopressor of choice. Here we are looking at the prophylactic effect of phenylephrine given intravenously along with spinal anaesthesia, and comparing
the property with intravenous Mephenteramine given prophylactically along with spinal anaesthesia in full term pregnant subjects. All our subjects were aged between 18 to 40 years, weighing less than 70 kg, satisfying ASA1 criteria. Development of side effects like nausea, vomiting, retrosternal discomfort was also noted. Our subjects who received prophylactic vasopressors supported haemodynamic status of the subjects effectively till the delivery of the baby. Subjects who received intravenous phenyl ephrine developed a transient fall in heart rate which got corrected by itself. None of our subjects developed any hazardous side effects.

Introduction: Extreme pain in hip fractures does not allow ideal positioning for spinal anesthesia. Adequate pain relief before spinal anesthesia will enhance patient’s cooperation. We evaluated the analgesic efficacy of ultrasound guided PENG block and FIB for positioning and post operative pain relief in hip surgeries. Methods: This was a prospective, randomized, double blind study that included 60 patients aged 18-80 years of either sex belonging to ASA I to III undergoing hip surgeries. Group P [n=30] [USG guided Peng Block] - 25ml of 0.25% Ropivacaine Group F [n=30] [USG guided Fascia Iliaca Block} - 25ml of 0.25% Ropivacaine. Pain scores after the block, during positioning and post-operative period, opioid consumption and side effects if any were recorded. Statistical analysis done using student t test, chi-square test. Pvalue of < 0.05 was considered significant. Results: In Group P, mean VAS before block was 7.8 ± 0.47 which reduced to 0.6 ± 0.4 during positioning which is statistically significant (P<0.001), whereas in Group F, mean VAS before block was 7.6
± 0.4 which reduced to 2.6 ±- 1.2 during positioning. Duration of postoperative analgesia was comparable between the two groups. (490.4 ± 40.8 minutes in group P and 470 ± 40.48 minutes in group F) Conclusion: In Hip fractures, PENG block produces more effective analgesia for positioning and postoperative pain than Fascia iliaca block without any significant side effects.

Aims: Use of adjuvant drug along with inj. Bupivacaine for spinal anaesthesia is a well know modality & is being practiced to increase duration of anaesthesia & postoperative analgesia. The present study is carried out to study Clonidine + Fentanyl vs. only Clonidine when used as adjuvant to Bupivacaine increases the duration of spinal analgesia. Also the study was conducted to note the side effects of the adjuvant drugs when used for spinal anaesthesia Methods: It was a prospective, randomized, double-blind study, 60 ASA grade I-II patients
(30 in each group), who were scheduled for elective infra-umbilical surgery under spinal anesthesia were recruited. Group- M patients received hyperbaric Bupivacaine (2.5ml) + Clonidine 30μg for spinal anaesthesia. Group- C patients received Bupivacaine (0.5%) 2.5ml + fentanyl (15μg) + Clonidine (15μg). The total volume of intra-thecal drug along with adjuvant drugs was constant (i.e. 3 ml, by adding normal saline) in both the groups. Onset and duration of sensory, motor block, effective analgesia, hemodynamic profile, post-operative pain score and side effects if any were recorded. Results: Duration of analgesia and duration of sensory and motor block were significantly longer in Group- C (165.02 ± 12.72 min) as compared to Group- M (130.78 ± 5.95 min). Haemodynamic profile showed significant low HR and MAP at certain time intervals in the GroupM as compared to Group- C. Patients of Group- M showed a significantly (p < 0.05) higher level of VAS as
compared to Group- C at 60 min, 90 min and 120 min interval time. Conclusion: Low dose of Clonidine (15mcg) + Fentanyl (15mcg) as an adjuvant to intra-thecal %0.5 Bupivacaine for spinal anaesthesia produced prolonged post-operative analgesia in patients undergoing infra-umbilical surgeries with stable haemodynmics.

Context: LMA is devised as a substitute for the face mask and an alternative for endotracheal Intubation. Aims: The objective of the study is to compare I-Gel and Proseal LMA. Settings and Design: Randomise prospective comparative study. Methods and Material: a study was conducted on 72 patients of age group 18-60 years with ASA I /II of either sex, admitted for elective surgery done under GA. All patients were pre-medicated with i.v Glycopyrrolate and Fentanyl. Preoxygenated for 3 mins.Induced with i.v Propofol and Scoline. Group
A- Proseal LMA Group B- I-Gel was inserted Statistical analysis used: The collected data was coded in an Excel spreadsheet. Demographic data was analyzed with a paired independent student’s T-test. p values < 0.05 is considered statistically significant. Fisher’s exact test or Chi-square was used to compare categorical data. Results: The mean airway leak pressure of the Proseal group was 30 cm H2O and significantly higher than I-Gel 23 cm H2O. There was no statistical difference in the ease of insertion in both devices. The overall
success rate was 100%. The mean insertion time was significantly less for I-Gel (14s) when compared to Proseal (24s). The gastric tube could be inserted easily in all the cases The hemodynamic response was comparable between the two groups. Conclusions: We conclude that Proseal has a higher airway leak pressure of 30cm H20 compared to I-Gel (23cm H2O) enabling positive pressure ventilation at higher pressures and therefore for a wider spectrum of patients. However, I-Gel is better than Proseal in terms of faster and easier insertion.

Regional anaesthesia is the preferred technique over general anaesthesia due to its overall fewer side effects. Cervical Epidural Anaesthesia (CEA) has been an upcoming technique for the past few years which provides safe and reliable anaesthesia for upper limb surgery. Objective: To compare the efficacy and safety of cervical epidural blockade with 0.5% Ropivacaine and 0.5% Levobupivacaine in upper extremity surgeries. Methods and Material: 50 patients were divided into two groups:- Group R: CEA block will be given with an Injection of Ropivacaine 10 ml (0.5%). Group L: CEA block will be given with an Injection of Levobupivacaine 10 ml (0.5%). Assessment of sensory and motor blockade was done in terms of onset and duration. Perioperative complications were recorded and managed accordingly. Results: The onset of sensory block with levobupivacaine was (6.28 ± 1.75min) and with ropivacaine was (5.56 ± 1.62 min) (p>0.05). The mean duration of sensory blockade was longer with levobupivacaine (296 ± 31.46 min) than with ropivacaine (192 ± 21.07 min). The mean time of onset of motor blockade(9.52±2.04 min) was shorter and duration (219 ± 31.74 min) was longer with Levobupivacaine than Ropivacaine (14.2 ± 3.75 min) and (165 ± 25.45 min) respectively. Postoperative Visual Analogue Score was higher in Ropivacaine. The mean time of duration of analgesia was longer in Levobupivacaine (315.6 ± 48.08 min). Conclusions: In an equal dose, Levobupivacaine has a faster onset (sensory and motor block) and longer duration (motor block and analgesia) as compared to Ropivacaine.

Background and Aims: Patients undergoing breast cancer surgeries face significant postoperative pain. We aimed to compare the analgesic efficacy of plain bupivacaine and plain bupivacaine with magnesium sulphate and dexamethasone in pectoral nerve block (PECS). Methods: Sixty ASA status I and II female patients between age 18 to 60 years scheduled for unilateral modified radical mastectomy (MRM) under general anaesthesia, were enrolled in this prospective randomised double blind controlled study. All patients received USG guided
PECS block. Patients in group C were given a total of 30 cc 0.25% bupivacaine while group D received total of 30 cc 0.25% bupivacaine with 4 mg dexamethasone and group M received 150 mg of magnesium sulphate with 0.25% of bupivacaine 30cc in total. General anaesthesia was administered in a standardised manner to all three groups before giving block. The various parameters observed included duration of analgesia, VAS score, number of rescue analgesics required and any adverse effects. The primary outcome was to compare total duration of analgesia between the three groups.

Results: The mean duration of analgesia was 778.95 ± 94.735 min (13 hrs) in group D, 519.90 ± 66.607 min (9.3 hrs) in group M and 384.30 ± 49.558 min (6.4 hrs) in group C. At 12 and 24 hrs, VAS scores were significantly lower in group D as compared to group M and group C (p > 0.001). The difference in VAS scores between group M and group C at 12 and 24 hrs was not statistically significant. At 48 hrs VAS scores among the three groups were comparable.

Conclusion: In the postoperative period, the use of dexamethasone and magnesium sulphate as adjuncts to bupivacaine in PECS block results in lower VAS scores, decreased demands for rescue analgesia and prolonged duration of analgesia. The use of these adjuvants provides better patient satisfaction without causing any noticeable side effects.

Introduction: Dexmedetomidine is a highly selective α2 adrenoceptor agonist recently introduced to anesthesia. It produces dose dependent sedation and analgesia without respiratory depression. The purpose
of this study was to compare the effect of intravenous versus intrathecal low dose dexmedetomidine on bupivacaine spinal block in patients undergoing lower abdomen and lower limb surgeries.

Methodology: This prospective randomized clinical study was conducted on 60 patients of age 20 to 60 years posted for elective lower abdomen and lower limb surgeries. All patients were divided into 3 groups of 20 each.

Results: Three groups were demographically comparable. Onset of sensoryblockade was statistically not significant between the three groups. Onset of motor blockade was not statistically significant between group A and B but statistically significant when compared with group C. Duration of sensory blockade, duration of analgesia and
two segment regression time were significantly prolonged in group A followed by group B when compared with group C. Duration of motor blockadewas significantly prolonged in group Awhen compared with
group B and group C.

Conclusion: Dexmedetomidinewhen administered intravenously or intrathecally along with intrathecal hyperbaric bupivacaine produced a significant prolongation in the duration of sensory and motor block, but that administered intrathecally produced more significant prolongation of an effect than that administered intravenously, with preserved hemodynamic stability and satisfactory arousable sedation.

Context: Spinal anaesthesia remains one of the basic and important technique in the modern period, but associated with adverse effects like hypotension, bradycardia, post-spinal headache. Several options have been tried to prevent spinal induced hypotension but the problem continues. Therefore this study was conducted to see the efficacy of prophylactic intramuscular ephedrine in reducing the incidence of spinal induced hypotension.

Aims: To observe the outcome of prophylactic IM ephedrine on intraoperative hemodynamic changes after spinal anaesthesia and also to see the incidence of hypotension after spinal anaesthesia

Settings and Design: Prospective Randomised Controlled study Methods and Material: Study was conducted on 108
patients posted for elective lower abdominal and lower limb surgeries under spinal anaesthesia. Group A received intramuscular ephedrine 30mg (1ml), group B received intramuscular normal saline (1ml) as placebo 10 minutes before spinal anesthesia. Patients were monitored for intraoperative hemodynamics, to see the incidence of hypotension and also to see any adverse side effects during intraoperative period. Statistical analysis used: To find the significance on continuous scale between two groups, Student t test was used. Leven`s test used to find the homogeneity of variance. Chi-square/Fisher Exact test: used for significance of categorical scale study parameters between the groups, Fisher exact test is applied when samples are very small.

Results: Incidence of hypotension was more in group B and proven to be statistically significant when compared to ephedrine group from 2 – 20 minutes. The numbers of patients receiving the rescue vasopressor
therapy was higher among in group B. There was no side effects observed in both the groups.

Conclusions: Intramuscular ephedrine when given prophylactically 30mg, 10 minutes before spinal anaesthesia provides better haemodynamic stability during intraoperative period without any side effects.

Background: Laryngoscopy and intubation produce an exaggerated and unpredictable stress response in hypertensive patients which may lead to the development of life-threatening complications such as pulmonary edema, cerebrovascular hemorrhage and myocardial infarction. It is possible to reduce these harmful and undesirable hemodynamic responses to intubation by using different intubation techniques. The objective of this study was to compare the hemodynamic response to laryngoscopy and endotracheal intubation in hypertensive patients aged 40 years to 60 years using Macintosh, McCoy and Tru View Video laryngoscopes.

Materials and Methods: We studied the hemodynamic response to laryngoscopy and intubation in 90 hypertensive patients posted for elective surgeries requiring general anesthesia, with ASA grading 2 or 3 aged between 40 and 60 years and Mallampati grade 1 and 2 using Macintosh, McCoy and Truview video laryngoscope. The changes in
heart rate, systolic and diastolic blood pressure were observed in the post intubation period, every minute for the  rst 10 minutes.

Results: Patients intubated using Macintosh or McCoy laryngoscope showed signi cantly greater (p < 0.05) rise in heart rate, systolic and diastolic blood pressure during  rst ten minutes in post-intubation period as compared to patients intubated using TruView video laryngoscope. Changes in SpO2 were statistically insigni cant and ECG remained within normal limits. Although time taken to intubate was longer with TruviewVideoaryngoscope.

Conclusions: We conclude that Truview Video laryngoscope provides a better laryngeal view while producing the least hemodynamic response during laryngoscopy and intubation in hypertensive patients as compared to McCoy and Macintosh blades.

Context: Preoperative period exposes to anxiety and stress to children and their parents resulting in emotional and psychological disturbances. To alleviate this midazolam has been found to be effective
premedication. The purpose of this study is to compare the efficacy of oral versus nasal route and acceptance by children.

Aims: To compare efficacy of oral and intranasal midazolam as premedication in children.

Settings and Design: comparartive study, observational study in tertiary health care set up.

Methods and Material: Fifty patients of age 2-5years of either gender of ASA I and II were assigned to two groups of 25 each undergoing
elective surgeries of 1.5-2 hours under general anaesthesia. In Oral group - midazolam formulation 0.5 mg/kg (preservative free plus sweetener) and in intranasal group - midazolam nasal spray as 0.2 mg/kg with half the dose in each nostril was administered 30minutes prior to surgery and were assessed for acceptance of drug, level of sedation 30minutes after premedication, behaviour at time of separation from parents and behaviour during mask acceptance at the time of induction which was by a standard intravenous technique. Intraoperatively children were monitored for heart rate and SpO2. Statistical analysis used: unpaired student t test and p value < 0.05 is significant, Statistical Package for the Social Sciences SPSS Statistics for Windows, Version 20.0 software (IBM, Bengaluru, India), Microsoft word and excel have been used to generate graphs and tables. Mean, median and standard deviation have also been used.

Results: Two routes were statistically insignificant regarding acceptance of drug, sedation after 30min and behavior during parental separation, though oral was slightly better than nasal clinically. Mask acceptance of oral midazolam was better than nasal and significant.

Conclusions: Both are safe with oral is better than nasal route for premedication in children due to significant mask acceptance.

Aims: To Investigate the efficacy and safety profile of Fentanyl when added to Chloroprocaine for outpatient spinal anesthesia in terms of quality and duration of sensory and motor blockade and effective
analgesia.

Settings and Design: prospective, randomized, double-blind study Methods and Material: After institutional review board approval and informed written consent from patients,100 participants, aged 18 to
60 years, of ASA Physical status I, II, or III scheduled for lower limb ambulatory surgery under a subarachnoid block, were randomly divided into two groups (n = 50 each); Group C received 4.0ml (40 mg) 1% isobaric Chloroprocaine + 0.4ml Normal Saline (0.9%) and Group F received 4.0ml (40mg) 1% isobaric Chloroprocaine + 0.4ml Fentanyl (20μg). Degree of sensory and motor block, postoperative analgesia (VAS score), time of 1st rescue analgesia (effective analgesia), time of ambulation, voiding of spontaneous urine, hemodynamic variables, and side effects were evaluated and compared. At VAS ≥ 4, rescue analgesic Inj. Diclofenac Sodium I.V. was given.

Results: Participants in Group F had prolonged onset (3.91 ± 1.09 min), peak (7.54 ± 1.30 min), and duration (110.74 ± 9.78 min) of a sensory block than Group C (3.02 ± 0.97 min), (6.53 ± 1.34 min), (104.64 ±
10.83 min) respectively. Motor characteristics were comparable in both groups with onset, peak, and duration respectively in group C was (4.01 ± 1.42 min),(7.48 ± 1.89 min) and(79.6 ± 8.42 min) and in group F was (4.52 ± 0.83 min), (9.05 ± 0.52 min),(90.76 ± 5.59 min). Duration of analgesia was longer in Group F (148.36 ± 2.84 min) than in Group C (145.12 ± 2.78 min). Time of ambulation was earlier in group C (110.62 ± 5.25) than in group F (115.42 ± 5.8 9min). Voiding of spontaneous urine was earlier in group C (112.8 ± 4.69) than in group F (115.76 ± 5.92 min). The incidence of side effects was comparable in both groups.

Introduction: perineural dexamethasone prolongs the duration of a single injection peripheral nerve block when added to the local anesthetic solution while perineural use of dexamethasone remains off-label. Postulated systemic mechanisms of action along with safety concerns have prompted the investigation of intravenous dexamethasone as an alternative.

Aim: We aimed to confirm that the addition of intravenous dexamethasone will prolong the duration of analgesia after a single-shot axillary brachial plexus block compared to conventional long-acting local anesthetic alone.

Material And Method: 46 Asa I to III adult patients scheduled for elective forearm and hand surgeries were randomly allocated to 2 groups of 23 patients each. Patients in group D received axillary brachial plexus block with an injection of 30 ml bupivacaine 0.5% and 2 ml of dexamethasone (8mg) IV and Patients in control group A received axillary brachial plexus block with an injection of 30 ml of bupivacaine 0.5% and 2ml of 0.9% saline IV prior to surgery.

Results: There was a statistically significant difference in the duration of post-operative analgesia, duration of motor and sensory blockade, and better overall patient satisfaction in group D when compared to group A.

Conclusion: We concluded that a Single axillary brachial plexus block with 0.5% bupivacaine and intravenous dexamethasone resulted in prolonged duration of postoperative analgesia, sensory and motor blockade, and better patient satisfaction

Aims: The study was designed to compare the effect of IVFentanyl vs. IV Paracetamol on consumption of
Sevoflurane and the recovery characteristics.

Plan of study: Patients scheduled for elective surgeries under
general Anaesthesia are randomly allocated with 50 patients in each group. Group- F received Fentanyl
1mcg/kg per min as bolus 5min before infusion immediately after intubation. Group- P received Paracetamol
1gm in 100ml for a period of 15min and twenty five minutes before intubation. Intra-operatively Sevoflurane
concentration was titrated to maintain entropy value of 40-60. Total volume of Sevoflurane consumed
is obtained from GE/Datex-Omeda S/5 advance monitor and average Sevoflurane consumed in ml/hr is
calculated.

Results: Consumption of Sevoflurane in Group- F was 16.01 ± 0.95ml/hr as compared to 16.9 ± 2.2
ml/hr in Group- P which was statistically significant. Post extubation at the end of fifth minute all patients in
Group- P attained score of 12 as compared to only 56% patients of Group- F and it was is statistica lly significant
(p <0.001).

Conclusion: Consumption of Sevoflurane & post-operative pain was less in Fentanyl group when
compared to paracetamol group. However recovery characteristics are better in paracetamol group.

Background: Brachial plexus block (BPB) is a well accepted technique to provide anaesthesia and analgesia for upper limb surgeries. Usage of ultrasound (USG) guided BPB technique has overcome the disadvantages caused by traditional landmark technique. Objective: To determine the block performance time, onset time, success rate, and any complications with the USG guided technique in both Axillary and Infraclavicular BPB
Methods: For an ultrasound guided brachial plexus block 80 patients undergoing elective upper limb surgeries were randomly allocated into 2 groups group AX (axillary), Group IC (infraclavicular) to receive Ropivacaine 0.75% 25 ml. Block performance time, onset and duration of sensory and motor block and success rate were
assessed.

Results: The mean block performance time of Group IC (6.43 ± 0.38) was significantly shorter compared to Group AX (8.46 ± 0.43). The mean onset time of sensory block (5.33 ± 1.67 vs 7.03 ± 2.01) and
motor block (9.23 ± 3.01 vs 17.53 ± 4.10) were significantly faster in Group IC compared to Group AX. Duration of sensory block (290.38 ± 78.65 vs 295.25 ± 35.86) and motor block (356 ± 97.99 vs 357.8 ± 108.13). Success rate was (95%) in group IC and (85%) in group AX. Conclusion: Ultrasound guided BPB through infraclavicular
approach has shorter performance time, higher success rate and faster onset of sensory and motor block when compared to axillary approach. There was no statistically significant difference in duration of sensory and motor block in both approaches.

Introduction: Postdural puncture headache is a common complication following dural puncture for spinal anesthesia. The objective was to study the relationship between body mass index and incidence of
postdural puncture headache in female patients undergoing infraumbilical surgeries under spinal anesthesia.
Methodology: After institutional ethical committee cleareance and written informed consent, a prospective observational study was conducted in 70 female patients undergoing infraumbilical surgeries under spinal anesthesia. Body mass index was calculated and they were grouped into 2groups, one with BMI < 25kg/m2 and another with BMI ≥ 25kg/m2. Incidence of PDPH was assessed in both the groups. Results: Postdural puncture headache was reported in 5 patients in the group with BMI < 25kg/m2 and in one patient in the higher BMI group. The overall incidence of PDPH was 8.57% following spinal anesthesia. But the incidence of PDPH was higher in the low BMI group compared to the high BMI group and the results showed a statistical significance with a p value <0.04. Gauge of the needle and number of attempts showed no correlation with the incidence of PDPH and results had a p value >0.05.

Conclusion: The findings of our study was consistent with
the previous studies that showed a inverse relationship between body mass index and incidence of postdural
puncture headache.

Background: Moyamoya disease is a progressive occlusive cereberovascular disorder that usually presents as recurrent strokes in pediatric population. There is paucity of literature on anesthetic management of pediatric patients in the Indian subcontinent. The main objective of our study was to evaluate the perioperative course and outcome of children undergoing revascularization surgery of Moyamoya disease.

Methodology: A series of 11 patients aged between 5 months-10 years age group were analyzed overa period of one year.

Conclusion:– Anaesthetic management involves maintainence of cerebral blood flow and cerebral perfusion pressure and
normothermia to avoid perioperative ischemic complications.

Context: The study was conducted to establish a co-relation between Sonoclot parameters and blood and blood product during on-pump cardiac surgeries.

Aims: To estimate the amount of blood and blood
product transfusion and post-operative drain are affected by Sonoclot-guided transfusion therapy.

Settings
and Design: Randomised controlled Study

Methods and Material: Total of 120 patients were randomly assigned
by computer generation to either Sonoclot guided therapy or routine hospital therapy. Patients of either sex undergoing on-pump complex cardiac surgical procedures. Patients having pre-existing hepatic disorders, a renal disease requiring dialysis, and those who received anticoagulant or antiplatelet drugs within one week of surgery were excluded.

Statistical analysis used: Data were analyzed using descriptive statistics to get the frequency distribution & the Independent Sample T-test was used for inter-group Comparison. p-value of <0.05 is considered as statistically significant. SPSS (Statistical Software for Social Sciences) version 20 was used.

Results: The whole blood transfusion in the two groups was non-significant both intra-operative and post-operative period. While a comparison of FFP transfusion during an intra-operative period in Sonoclot group was significant. Platelets were administered in the post-operative period and comparison in the two groups was not significant. A comparison of 24 hr drain output in two groups of patients was non-significant.
Conclusions: It allows the diagnosis of an exact cause of hemostatic abnormality i.e. deficiency of coagulation factors or fibrinogen or platelet function.

Introduction: The cardiovascular response to tracheal intubation, although transient, may be harmful to some patients, mainly those with myocardial or cerebrovascular disease. So we have conducted a study
to find out hemodynamic effect of intubation using FOB. Aim and Objectives: To observe haemodynamic response to nasotracheal intubation under general anaesthesia using fiberoptic bronchoscopy with respect to :Haemodynamic changes during intubation,at the time of & after intubation; Time required for intubation; Saturation; Post extubation epistaxis.

Methodology: 50 ASA grade I and II patients of both sexes in the age
group of 18 - 60 years scheduled for an elective surgery under general anesthesia were sleeted for nasotracheal intubation with FOB. A uniform protocol of anesthesia was used. Measurements: Heart Rate [HR], Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP] & Mean Arterial Pressure [MAP] were noted at their baseline, post-induction values, at the time of insertion of the scope, immediately after intubation & at 3, 5 and 10 minutes after intubation.

Result: Haemodynamic response in the form tachycardia, increase in SBP, DBP & MAP occurred in nasotracheal intubations with the fiberoptic bronchoscope. SpO2 was continuously monitored and patients maintained 100% saturation during induction, at the time of insertion of FOB, at 3min, 5min and 10 min. 8 patients had lower reading immediately after intubation with mean Spo2 of 98.72%. Mean
time for intubation using FOB was 69.52 sec.

Conclusion: Fiberoptic bronchoscope under general anesthesia causes signicant increases in blood pressure and heart rate

Introduction: Laryngoscopy and intubation are noxious stimuli and are associated with haemodynamic responses in the form of laryngo-sympathetic stimulation which is manifested as hypertension, tachycardia. The magnitude of haemodynamic changes observed may be dependent on various factors such as the depth of anaesthesia, whether any measures are taken prior to airway manipulation, the anaesthetic agent used, the duration of laryngoscopy and intubation.

Aims: The present study is aimed to comparing the effectiveness
of two different doses of intravenous Dexmedetomidine, 0.6 μg/kg body weight and 1μg/kg body weight for attenuating haemodynamic response to laryngoscopy and endotracheal intubation and also to find out
any adverse effects.

Materials and methods : A Randomized, controlled study between 2 doses of intravenous dexmedetomidine–0.6 μg/kg body weight and 1 μg/kg body weight for attenuation of haemodynamic response to laryngoscopy and endotracheal intubation. was undertaken in 60 patients of either sex between 18 to and 55 yrs of age belonging to ASA-I undergoing elective general endotracheal anesthesia were selected for the study.

Results: There was marked decrease in HR after dexmedetomidine administration. In group D-0.6 and group D-1 HR, SBP, DBP and MAP markedly increased at 1 minute following laryngoscopy and
intubation in the control group where as in dexmedetomidine group there was a fall in HR, SBP, DBP and MAP at various intervals following intubation which was statistically significant. There was no statistical difference between the group D-0.6 and group D-1 with regard to haemodynamic parameters after laryngoscopy and endotracheal intubation. There was increased incidence of sedation in patients belonging to group D-1 when compared to group D-0.6 which was statistically significant. Incidence of bradycardia and hypotension was
higher in group D-1 when compared to group D-0.6 which were managed easily.

Conclusion: It is concluded that Dexmedetomidine obtunds the haemodynamic responses to laryngoscopy and endotracheal intubation
and 0.6 μg/kg body weight is the ideal dose for the same.

Introduction: Tracheal extubation is almost always associated with hemodynamic changes due to reflex sympathetic discharge caused by epipharyngeal and laryngo-pharyngeal stimulation. This increase in
sympatho–adrenal activity may result in hypertension, tachycardia and arrhythmias.

Aims: The purpose of the study is to compare the effect of intravenous Fentanyl 1μg/kg with dexmedetomidine 0.7μg/kg on the hemodynamic and recovery responses during extubation.

Materials and methods: Prospective, randomized, double blind, controlled study was conducted in 60 patients of either sex between 20 and 50 yrs of age belonging to ASA-I and II, undergoing general procedures and urological procedures were selected for the
study.

Results: The heart rate increased in both the groups during extubation but the increase was more in Group-F patients. The MAP increased for the initial 1min after drug administration in Group-D. However,
dexmedetomidine attenuated the increase in blood pressure to a greater degree than lignocaine. The airway response (coughing) was better attenuated in Group-D than Group-F. The patients in Group-D were drowsy but responding to verbal commands when compared to Group-F.The incidence of bradycardia and hypotension though minimally present in Group-D, which was easily managed.

Conclusion: Compared to Fentanyl 1μg/ kg, dexmedetomidine 0.7μg/kg administered I.V. before extubation attenuates airway and hemodynamic reflexes to a greater extent allowing smooth and easy tracheal extubation, thereby providing comfortable recovery

Background and Aim: Various studies have been done on addition of various adjuncts to spinal local anaesthetics to improve as well as to increase the time of spinal anesthesia and analgesia, so that the total dose of local anaesthetics could be decreased. Present study was done with an aim to evaluate the relative efficacy of dexmedetomidine and
fentanyl with 0.5% hyperbaric bupivacaine intrathecally in Endo-urological procedures.

Material and Methods: Total 80 patients of ASA grade I and II, between 18 to 70 years were scheduled for different Endo-urological surgeries including Turp, Turbt, End To End Urethroplasy,Suprapubic Cystolithotrity/Suprapubic Cystolithotomy And Urs (Lower ureteric stone) and RIRS were included in the study. Patients were allocated into 2 groups, each of 40 patients, each received a total volume of 3.5ml which contained dose of 15mg (i.e. 3ml) 0.5% hyperbaric bupivacaine
combined either Dexmedetomidinne or Fentanyl. After noting baseline parameters the patients were monitored using continuous electrocardiography (lead II), heart rate, non-invasive blood pressure, and continuous pulse oximetry.

Results: The changes in mean heart rate between two groups were significant statistically after 60 minutes of spinal anaesthesia, which showed more fall in heart rate in patients of group-D than group-F. The changes in mean arterial pressure were also statistically significant between the two groups after 75 minutes of spinal anaesthesia, which showed more fall in patients of group-D. Intra–operative hypotension requiring treatment was also observed more in group-D patients (12.5%) compared to group-F (2.5%).

Conclusion: Dexmedetomidine is a good option to fentanyl in spinal anesthesia as it significantly prolongs duration of sensory and motor block and increase the duration of analgesia, it causes hypotension and bradycardia which are easily reversible and without any untoward adverse events.

Introduction: Popliteal nerve block is a useful technique for ankle and foot surgeries as it avoids complications in elderly who are prone for hemodynamic changes leading to increased morbidity and mortality. There is advantage of early post operative mobility which is essential in orthopaedic surgeries and absence of post dural puncture headache. Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist action.The primary aim of study is to evaluate effect of adding Nalbuphine to Bupivacaine in popliteal nerve block in terms of onset and duration of sensory and motor blockade and duration of analgesia.

Study Design: A prospective randomised comparative clinical study.

Materials and Methods: After obtaining institutional ethical committee clearance. Sixty patients between 18 -70 years of either sex with ASA status I, II, III posted for ankle and foot surgeries were grouped randomly into two groups using simple sealed envelope method with 30 in each group. After getting informed consent from patients detailed
pre anaesthetic evaluation was done on previous day of surgery. Group A received 20ml of Bupivacaine with 1ml of normal saline and group BN received 20ml of Bupivacaine with 1ml of 10mg Nalbuphine. Data
presented as mean and standard deviation. The t-test was used to examine the differences between means. Statistical significance was accepted for a p < 0.05.

Results: Sensory blockade: In our study we found that Group BN patients who received Nalbuphine as additive provided faster onset of sensory level blockage with mean time of onset value being 11.8 ± 2.4 (in mins) compared to Group A where mean value was 15.20 ± 1.80 (in
mins) . The results were statistically signicant with a p value of <0.001**. The duration of sensory level block in Group BN who received Nalbuphine as additive was 760 ± 23.3 compared to Group A where mean value was 552 ± 19 with statistically signicant p value of <0.001**. Motor blockade: In our study we found that Group BN patients who received Nalbuphine as additive provided faster onset of motor level blockage with mean time of onset value being 14.7 ± 1.5 (in mins) compared to Group A where mean value was17.6 ± 1.1(in mins) .
The results were statistically signicant with a p value of <0.001**. The duration of motor level block in Group BN was 573 ± 20.6 compared to Group A where mean value was 438 ± 18.4 with statistically signicant p value of <0.001**.

Conclusion: This study demonstrates that addition of 10 mg nalbuphine to bupivacaine in popliteal nerve block in patients undergoing ankle and foot surgeries decreases time of onset of anaesthesia, shows signicant increase in duration of sensory and motor blockade and also increases the post operative analgesia.

Introduction: Pain is an unpleasant subjective sensation which can only be experienced though not fully expressed especially in children.The regional anaesthetic techniques significantly decrease post operative pain and systemic analgesic requirements. Caudal route was chosen for this study as it is one of the simplest and
safest techniques in paediatric anaesthesia with a high success rate. Aim: Aim of the study is to compare between 0.25% bupivacaine and 0.2% ropivacaine in caudal block in paediatric age group (0 to 8 years) in unilateral groin surgeries.

Materials and Methods: It is a randomized controlled study comparing bupivacaine and ropivacaine in caudal epidural analgesia for lower abdominal and genital surgeries. Patients were allocated by random number table in two groups of 30 patients each to receive 0.25% Bupivacaine ( Group B) 1ml/kg or 0.2% Ropivacaine (Group R) 1ml/kg for caudal block.

Results: No significant differences were observed among haemodynamic parameters throughout intraoperative period. Mean pain scores were more in Bupivacaine group however the difference was not statistically significant. Motor power was low in both the groups in first hr postoperatively and significantly low in Bupivacaine group in second hour, low but comparable in 3rd hr i.e. Ropivacaine group attained full motor power by 3rd hr and Bupivacaine group by 4th hr. Mean duration of sensory block in Ropivacaine group was 86.6 ± 10.2 min and in Bupivacaine group was 90.96 ± 7.29 min-not statistically significant. Mean duration of analgesia in Ropivacaine group was 5.38 ± 0.71 hrs and Bupivacaine group was 5.01 ± 0.8 hrs –not statistically significant.

Conclusion: Local anaesthetic Ropivacaine may prove to be a better alternative to Bupivacaine via caudal epidural route in Paediatric patients in urogenital surgeries.

.Pulmonary aspiration is the inhalation of the oropharyngeal or gastric contents into the larynx and the respiratory tract. Mendelson described the potential consequences of abolished airwayexes underanaesthesiaandthesubsequentaspirationof gastric contents,knownasMendelson’ssyndrome. Pulmonary aspiration occurs1in900 to1in10000 cases of general anesthesia administered.Mortality rateofpatientswhohadaspirationrangesfrom0to 4.6%.Theincidenceofaspirationunderanaesthesia isgreaterwithhigherASA status and emergency surgery. Prevention of pulmonary aspiration is one of the main goals of anesthetic practice. Problems associated with extubation are often more common than those occurring at intubation. Aspiration of solid matter can cause hypoxia by physical obstruction, whereas aspiration of acidic gastriccauses pneumonitis with progressive dyspnoea, hypoxia, wheeze, and patchy collapse with consolidation in the chest radiograph. The risk of morbidity and mortality increases with bronchial exposure to greater volumes and acidity of the aspirated material.