Indian Journal of Anesthesia and Analgesia

Introduction: This study was done to look for the onset of effect and hemodynamic alterations with levobupivacaine in spinal anesthesia and to compare the effect of clonidine on onset and duration of levobupivacaine when given intrathecally in two different doses. Adverse effects and complications associated with the use of above drugs were also studied. Material and Methods: 75ASA I-II patients with age group 18-60 years undergoing infraumbilical surgeries were randomized to one of the three groups. Patients in Group 1 (L) received 15 mg (3.0 ml of 0.5%) preservative free levobupivacaine with 0.4 ml normal saline. Patients in group 2 (LC1) received 15 mg (3.0 ml of 0.5%) levobupivacaine with clonidine 30 μg (0.2 ml) and 0.2 ml normal saline. Group 3 (LC2) received 15 mg (3.0 ml of 0.5%) levobupivacaine with clonidine 60 μg (0.4 ml). Onset and duration of sensory and motor block, maximum sensory level achieved, sedation levels, hemodynamic parameters and adverse effects were recorded. Results: Clonidine significantly shortened the onset of sensory and motor block and prolonged the time to two segment regression and regression of motor block to modified Bromage 0. In addition group LC2 had higher sedation scores. There was higher incidence of hypotension, bradycardia and respiratory depression in group LC2. Conclusion: Intrathecal Clonidine in a dose of 30 μg significantly prolongs the anesthetic effects of intrathecal levobupivacaine without significant side effects. So, 30 μg is the preferred dose of clonidine over 60 μg, when used as an adjuvant to levobupivacaine in spinal anesthesia.

This article reviews the WHO and CDC guidelines of oxygen therapy for COVID-19 infected patients keeping in view the resource limited constraints of a healthcare system. Early recognition of patients with worsening respiratory function while on conventional oxygen therapies,
such as simple face masks or masks with reservoir bags and referral to a tertiary care center for advanced oxygen therapy and mechanical ventilation is important to ensure the timely and safe escalation of respiratory support. Early optimisation of care and involvement of medical care Unit is suggested. In patients with COVID-19 there is the potential for a worsening of hypoxemia and an increased need for high flow oxygen and intensive care management so close monitoring is advised. The resource limitations are oxygen supply or availability of oxygen delivery devices, personal protective equipment for the staff, proper donning and doffing areas dedicated for suspected and confirmed covid positive patients. The idea of writing this review
article was to ensure safe and economical management of these patients in a resource constrained setting using minimum possible measures. In the mild and moderate stages of disease, normal oxygen supportive measures (facemask oxygen) could also be advantageous. Supplemental oxygen therapy is immediately needed for patients with respiratory distress, hypoxemia or shock with a target SpO2 >94% as recommended by the WHO. Patients may still have increased work of breathing or hypoxemia even when oxygen is delivered via a mask with reservoir bag (flow rates of 10–15 L/min, which is usually the minimum flow required to take care of bag inflation; FiO2 0.60–0.95).

Background and Objectives: Intrathecal opioids potentiate the analgesic property of local anesthetics. Among an alpha2 adrenergic agonist, Clonidine potentiates the effect of local anesthetics and allows decrease in required doses. Hence, this study was conducted to evaluate effectiveness of intrathecal bupivacaine with adjuvant fentanyl and clonidine in patient undergoing lower segment caesarean section.
Material and Method: 100 participants, aged 18 to 35 years, of ASA Physical status I and II, scheduled for lower segment caesarean section under subarachnoid block, were randomly divided into two groups (n=50
each); Group C (n=50) was given intrathecal inj. Bupivacaine 0.5% heavy 1.7 ml (8.5 mg)+ inj. Clonidine 0.2 ml (30 mcg)+inj. Normal saline 0.3 ml Total volume 2.2 ml and Group F (n=50) was given intrathecal inj.
Bupivacaine 0.5% heavy 1.7 ml (8.5 mg) + inj. Fentanyl 0.5 ml (25 mcg) Total volume 2.2 ml. Degree of sensory and motor block, quality of intraoperative anesthesia, postoperative analgesia (VAS score), time of 1st rescue analgesia effective analgesia, hemodynamic variables and side effects were evaluated and compared. At VAS ≥4, rescue analgesic Inj. Diclofenac Sodium I.V. was given. Results: The result of the present study shows that in group F there was significant reduction in the time
for onset (1.20+0.36 min), peak of sensory blockade (1.99±0.59 min) and significant prolongation in the total duration of sensory blockade (240.40±53.45 min) extending into the postoperative period as compared to group C (2.02±0.45, 2.79±0.45 and 163±22.79 min respectively with p <0.0001, hence provided effective postoperative analgesia up to 12 hours. Complete analgesia lasted longer in group F for 11.46±1.9 hrs compared with group C for 10.96±1.9 min (p 0.19). The duration of effective analgesia was significantly prolonged in
group F (14.78±2.03 min) as compared with group C (13.17±1.31 min), (p<0.0001) Conclusion: In conclusion, addition of 25 μg Fentanyl as an adjuvant with 0.5% hyperbaric Bupivacaine, in subarachnoid block for lower segment caesarean section, has faster onset and prolongs sensory block and motor blockade; also improves postoperative analgesia with minimal side effects as compared to 30 μg clonidine.

Background: Regional anesthesia is the preferred technique for most of lower abdominal and lower limb surgeries as it allows the patient to remain awake and minimizes or completely avoids the problem associated with airway management. Hyperbaric bupivacaine 0.5% is extensively used for spinal anesthesia. Fentanyl is a synthetic lipophilic opioid commonly used for postoperative analgesia. Aim: The aim of the study is to compare the following factors in two groups i.e. Hyperbaric bupivacaine 0.5% and 5 mcg Dexmedetomidine and Hyperbaric bupivacaine 0.5% and 25 mcg Fentanyl when given intrathecally.
Materials and Methods: This randomized controlled trial was designed to evaluate the onset and duration of sensory and motor block as well as operative analgesia and adverse effects of Dexmedetomidine vs
Fentanyl given intrathecally with heavy 0.5% Bupivacaine for spinal anesthesia in patients scheduled for Total Abdominal hysterectomy patients receiving 5 mcg of Dexmedetomidine and 25 mcg of Fentanyl with 3 ml of Bupivacaine intrathecally. Results: The addition of Dexmedetomidine significantly prolonged the duration of sensory and motor block, significantly prolonged the time for demand analgesia and had no effect on the onset of sensory or motor block when compared with fentanyl. The incidence of side effects was limited to the occurrence of Hypotension, Bradycardia, vomiting in the groups that received Dexmedetomidine intrathecally. The incidence of pruritus were more in the groups that received fentanyl intrathecally. The addition of Dexmedetomidine intrathecally had similar effect on sedation when compared to fentanyl.

Background: Epidural anesthesia is the most commonly used technique for providing not only peri-operative surgical anesthesia but also post-op analgesia in lower abdominal and limb surgeries. The addition of an
adjuvant not only increases the effectiveness of a local anesthetic by prolonging and intensifying the sensory blockade but also causes reduction in dose of local anesthetic agent. In comparison to bupivacaine, ropivacaine is known to have lesser cardiotoxicity and motor blockade, with similar pain relief at equivalent analgesic doses. Fentanyl is partial agonist on μ opioid receptor. Mainly acting on the substantia gelatinosa of the dorsal horn of spinal cord. Dexmedetomidine is a selective a -2 agonist which provides sedation, anxiolysis, hypnosis, analgesia and sympatholysis. To evaluate dexmedetomidine and fentanyl as adjuvant for epidural local Anesthetics, for lower limb orthopedic surgeries in term of: Comparative evaluation of sensory and moter blockadge in relation of onset, duration and intensity Duration of postoperative analgesia Hemodynamics parameter. Materials and Methods: 100 patients of either sex with ASA grade I and II, 21 to 50 yrs old, posted for elective lower limb orthopedic surgeries were randomly selected and divided into 2 groups of 50 each, Group RDgiven 15 ml of 0.75% Ropivacaine along with Dexmedetomidine 1 μg/kg, Group RF- given 15 ml of 0.75% Ropivacaine along with fentanyl 1 μg/kg. After taking all aseptic precautions, 18 G epidural catheter was placed in space L3-L4 with the help of Touhy Epidural needle with use of LOR technique and fixed at 15 cm marking. Each patient was observed for, onset of sensory and Motor block, Height and Intensity of Motor Block Duration of post operative analgesia and Level of sedation. Result: In comparison to addition of fentanyl as 1 microgram/kg (Group RF), addition of dexmedetomidine
as 1 microgram/kg in 15 ml of 0.75 percent Ropivacaine (RD Group) for epidural anesthesia has early onset of sensory and motor block (p <0.001), lesser time for achieving complete motor block (P<0.001) prolong duration of motor block and postoperative analgesia (P<0.001). Bradycardia and hypotension were found more in Group RD and nausea and vomiting were found more in Group RF but these findings in both the groups were statistically not significant. Conclusion: Addition of dexmedetomedine 1 μg/kg to ropivacaine, as comparison to addition of fentanyl, for epidural anesthesia has early onset of sensory and prolong duration of motor block and postoperative analgesia, without an increased incidence of side effects.

Context: Laryngoscopes are most commonly used for endotracheal intubation. It plays an important role in securing airway in emergency conditions and in administration of general anesthesia. They range from simple rigid scopes with a light bulb to complex fiber optic video devices.
Objectives: The purpose of the study was tocompare laryngoscopy and intubating conditions in three groups of patients using Macintosh, McCoy and Airtraq laryngoscope:Visualisation of pharyngeal structures
and larynx as per Modified Cormack and Lehane grading; Hemodynamics; Adverse effects, if any. Settings and Design: Randomised prospective comparative study. Methods and Material: after obtaining ethical committee approval, 90 adult patients of either sex, aged between 18 to 60 years, of physical status ASA Grade I and Grade II undergoing elective surgeries under general anesthesia after obtaining written informed consent were included. Divided into 3 groups of 30 each and randomly allocated. Group I -Patients intubated with Macintosh laryngoscope (n-30); Group II - Patients intubated with Airtraq optical laryngoscope (n-30); Group III -Patients intubated with McCoy laryngoscope (n-30). The laryngoscopy view obtained was compared according to Cormack and Lehane grading. The change in
systolic, diastolic, mean arterial pressure, pulse rate and SpO2 will be recorded at pre-induction, pre-intubation and post intubation at 1, 3 and 5 minutes. Statistical analysis used: The demographic data was analysed using descriptive statistics and expressed as mean ± standard deviation. Categorical data was analyzed by chi square test. P value of 0.05 or less was considered statistically significant. Results: Airtraq laryngoscope improved the Cormack and Lehane glottic view compared with the McCoy and Macintosh laryngoscopes. The maximum change in HR was 24% in the Macintosh, 2.27% in the Airtraq and 11.9% in the McCoy group, and increase mean arterial pressure was 20.63% in the Macintosh, 4.37% in the Airtraq and 7.37% in the McCoy group. This difference between the three groups was significant (P <0.0001). Conclusions: From the present study, it is concluded that Airtraq optical laryngoscope provides a better glottic exposure and triggers minimal hemodynamic response to laryngoscopy and intubation when compared
to Macintosh and McCoy.

Introduction: Clonidine has been used by anesthesiologists as an anesthetic adjunct to provide increased perioperative cardiovascular and sympathoadrenal stability, to enhance general and regional anesthesia, as well as sedation and analgesia. 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 10 mg 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. Patients of either physical status ASA 1 or ASA 2 admitted for elective TURP and TURBT. Results: There were statistically significant differences in the heart rate between the groups from 30 min onwards but none of the patients in any group needed atropine to treat bradycardia (ie., heart rate did not fall below 60 beats per minute). There was a significant fall in MAP (mean arterial pressure) at 10-20 minutes in all the 4 groups following the subarachnoid block. The mean dose of ephedrine given was 10 mg in group NS, 10 mg in group BC25, 15 mg in group BC35 which was significant. Conclusion: Addition of 35 mcg of clonidine to bupivacaine when compared to 25 mcg/15 mcg clonidine significantly prolongs the duration of analgesia without affecting the onset and maximum level achieved of sensory block.

Context: The search of a drug which can give the perfect balance of sensory and motor block with minimal side effects has always missed researchers. We have conducted a study to study the efficacy of adding dextrose to levobupivacaine and try to find an alternate to the routinely used bupivacaine. Aims: Evaluation of effect of adding dextrose to levobupivacaine, compared to levobupivacaine plain in terms of onset and duration of sensory and Motor blockade; Quality of analgesia.(VAS score). Settings and Design: Open Labelled Study Methods and Material: 140 patients admitted for elective surgeries, during the period of January 2017 to December 2017. Group L: Hyperbaric Levobupivacaine with 150 mg dextrose.(0.3 ml of 50% dextrose), volume is 3.3 ml; Group p: Plain levo Bupivacaine. (volume is 3.3 ml).
Statistical analysis used: Student t test (two tailed, independent),. Chi-square/Fisher Exact test. Results: In Group II Time to two segmentsensory level regression was significantly more (188.89±22.32)
compared to Group I (118.96±33.69); duration of analgesia and motor block was also more. VAS scores in Group II were less compared to Group I. Rescue doses required in Group II were less compared to Group I. Conclusions: Addition of dextrose have proved to be effective in quick onset of sensory, motor blockade and longer duration of blockade and prolonged two segment regression time with no adverse side effects.

Background and Objectives: Dexamethasone, a synthetic corticosteroid has been found to prolong local anesthetic block duration. Clonidine, an Alpha-2-receptor agonist, has been used as an additive to local anesthetics for various regional anesthetic techniques. We compared Dexamethasone and Clonidine as an adjuvant to local anesthetic agent in supraclavicular brachial plexus block with respect to onset of sensory and motor block and duration of post-operative analgesia. Methodology: A prospective, randomized, controlled, double blind study carried out at Bangalore Medical College and Research Institute, Bengaluru. ASA I and II patients aged 18 to 60 years of either sex were included in the study. We compared the anesthetic and analgesic effects of adding dexamethasone and clonidine to 30 ml 0.5% Bupivacaine and injecting into brachial plexus sheath in 60 patients undergoing upper extremity
surgeries. Patients were randomized into 2 groups of 30 each. Group D received Dexamethasone 8 mg and Group C received clonidine 75 mcg as an adjuvant to 0.5% bupivacaine. Results: There was a significant difference in onset of sensory and motor blockade and postoperative analgesia between two groups. Mean onset of sensory block and motor block was 5.9±0.8 minutes and 8.4±0.9 minutes in dexamethasone group and 8.7±0.9 minutes and 11.7±1.5 minutes in clonidine group. Mean duration of postoperative analgesia was 7.3±0.7 hours in dexamethasone group and 5.9±0.5 hours in clonidine group. There was significant difference in mean HR, SBP and DBP between two groups from 0 min to 12 hours. Mean heart rate, SBP and DBP was higher in dexamethasone group at all intervals compared to clonidine group.
Conclusion: Our study demonstrates that, dexamethasone provides faster onset of sensory block and motor block, longer duration of post-operative analgesia, less number of rescue analgesics in post-operative 12 hours with cost-effectiveness. Hence, dexamethasone can be an alternative to clonidine in brachia plexus block.

Back ground and Aims: This study aims to evaluate the effectiveness of intra-articular injection of platelet rich plasma (PRP)in reducing pain and improving physical function, in osteoarthritis. Method: Prospective longitudinal study comprising of 100 patient& divided into 3groups according to Kallgren & Lawrence grading of osteoarthritis of knee and followed up for period of 1 year (january18 to October 19). All patients were treated with intraarticular PRP injection (C-arm guided) in affected knee at 4weeks apart. VAS (Visual analog scale), KOOS (knee injury osteoarthritis outcome score) used for clinical evaluation. Data analyzed using SPSS software 22.0. Result: Outcome were almost similar for grade 1&2 though intensity of pain showed significant improvement
even in grade3(p<0.05). on the basis of VAS SCORE Highly significant improvement in pain in Grade1 and Grade2 osteoarthritis having p value<0.0001 and significant improvement in Grade3 osteoarthritis having p value=0.003(<0.05). On the basis of KOOS SCORE all the parameter like pain symptom, functional daily activity, sport & recreational activity and quality of life highly significant improve in Grade1&2 pvalue<0.0001 and for Grade3 significant improvement in all parameter having p value<0.05. Conclusion: PRP injection is a cost effective, reliable, minimal invasive, no side effect, good efficacy & used
in less equipped setting. And showed clinical as well as functional improvement in VAS score and KOOS score. It is highly significant for grade 1 and 2 and significant for grade 3 osteoarthritis.

Context: Central venous pressures along with other dynamic and static variables are used to guide fluid therapy in patients with sepsis admitted to ICU. However, insertion of central venous catheter is associated with serious complications. We, therefore measured external jugular venous pressure (EJVP), peripheral venous pressure (PVP) and correlated with central venous pressure (CVP) measured by conventional technique and thus technical difficulty and complications can be avoided. Aims: To evaluate the correlation between conventional CVP with EJVP and PVP values in patients with sepsis. Settings and Design: Prospective observational study. Methods and Material: Study done on 54 patients admitted with sepsis requiring fluid resuscitation. CVP, EJVP and PVP measurements were taken using a water column manometer in cm H2O. All the three venous pressures were repeated 3 times following every fluid challenge of 250 ml. Statistical analysis used: Pearson's correlation and Bland–Altman's analysis. Results: The observations were analyzed by dividing the patients into 2 groups on the basis of CVP measurements Group A (CVP ≤ 10) Mean difference between CVP with PVP and EJVP is >2 cm H2O and p value is insignificant. Group B (CVP >10) Mean difference between CVP with PVP and EJVP is <2 cm H2O and p value (p<0.001) is strongly significant. Conclusions: The present study concludes that, there is definite correlation between CVP, EJVP and PVP in a given patient. Further concludes the difference between CVP and EJVP/PVP was minimum (<2 cm H2O) when the CVP was >10 cm H 2O.

Introduction: Total knee arthroplasty is associated with moderate to severe pain and effective analgesia is essential to facilitate post operative recovery. This non randomised case series examined the analgesic effect of adductor canal block as a central tool in an integrated multi modal analgesia. Material and Methods: We used adductor block to manage postoperative pain in 43 patients presenting to our service for unilateral primary total knee arthroplasty. We recorded pain scores, opioid usage and any adverse side effect. Result: Pain control was generally satisfactory. Very few patients required fentanyl infusion as a rescue analgesia. Vomiting was reported but other side effects such as hypotension, itching, fall etc were unremarkable. Conclusion: Adductor block was practical, safe and effective method of analgesia for pain relief in patients who have undergone unilateral total knee replacement.

Introduction: Subarachnoid block is the most common technique amongst regional anesthesia for lower abdomen and lower limb surgeries. Dexmedetomidine, a new highly selective α2-agonist, is under evaluation as a neuraxial adjuvant as it provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects. In this study we want to compare efficacy of Epidural Dexmeditomidine with Intravenous Dexmeditomidine in subarachnoid block with Inj. Bupivacaine. Aims and objectives: Primary objective of this study is to compare the duration of post-operative analgesia of IV Dexmeditomidine with epidural Dexmeditomidine in subarachnoid block given for lower limb surgeries.
Our secondary objective is to compare the onset of sensory blockade, onset of motor blockade, sedation Score and any complications like bradycardia, hypotension in both groups. Methodology: Sixty patients posted for lower limb surgeries were included in this study. In Group I Inj
Dexmeditomidine 0.5 ug/kg diluted in 100 ml NS was given as infusion over 15 minutes and Group E received, 100 ml NS as infusion over 15 minutes. Epidural space was identified with Tuohy needle by LOR resistance and 10 ml NS was given epidurally in Group I and 0.5 ug/kg of Inj dexmedetomidine in 9.5 ml of NS was given epidurally in Group E. Subarachnoid block was given by 25G spinal needle in L3-L4 space in sitting position using all aseptic precautions in both the groups with 3.5 ml 0.5% hyperbaric Bupivacaine. Onset of sensory and motor blockade, pulse rate, MAP, sedation score, time for two segment regression and the time when patients request first analgesic were noted and analysed.
Result: The mean time of onset of sensory blockade and mean time of onset of motor blockade were comparable between the groups, in Group I onset of sensory blockade was 7.27±2.75 min while in Group E
8.17±2.03 min with P >0.05 while onset of motor blockade was 11.33±3.45 min in Group I and 12.03±2.07 min in Group E with p >0.05. The time taken for two-segment regression was significantly earlier in Group I 157.5 ±22.35 min than in Group E 171.03±13.01 min. with P <0.006. The mean duration of post-operative analgesia was significantly longer in Group E 447.33±41.78 while in Group I 425.5±27.16 min with P <0.02. The mean of RSS (Ramsay sedation score) in Group I was 3±0.12 and in Group E was 2±0.24, the difference was clinically
significant with P = 0.036. Conclusion: Administration of Epidural Dexmeditomidine 0.5 ug/kg leads to prolongation of sensory blockade after intrathecal Bupivacaine and prolongs postoperative analgesia than Intravenous Dexmeditomidine.

Background: Sore throat is a common problem following general anesthesia and intubation. It has been found to correlate with increased endotracheal tube (ETT) cuff pressure. In this study, we assessed the incidence and severity of sore throat in patients who had their ETT cuff pressure monitored and compared them with patients in whom the adequacy of cuff inflation was assessed only by clinical methods. Material and Methods: Forty-eight ASA I and II patients in the age group of 18-60 years, posted for faciomaxillary surgeries were randomly divided into two groups. In Group 1, the adequacy of inflation of
ETT cuff was checked by palpating the sternal notch and auscultating with a stethoscope to rule out leak. In Group 2, ETT cuff pressure was adjusted to 25 cm H2O using a cuff manometer. Postoperatively, sore throat was assessed using a 10 point scale at 1 hour, 6 hours and 24 hours of surgery. Results: There was no statistically significant difference in the incidence of sore throat between the groups. The sore throat scores recorded after one hour of surgery were significantly higher in Group 1 compared to Group 2 (median score 4 in Group 1 vs 2 in Group 2, P=0.008). There was no statistically significant difference
in the sore throat scores recorded after 6 and 24 hours of surgery in both the groups. Conclusion: Endotracheal tube cuff pressure has to be routinely monitored and kept in the optimal range of 20-30 cm H 2O to minimize postoperative complications like sore throat.

Background and Objective: The prevalence of preoperative anxiety has varied widely, from 11% to 80%, depending on the methods used to assess it. Patients with increased anxiety may carry greater risk of
experiencing pain and complications during noxious medical procedures and interventional pain management. Aim of our study is to compare anxiety and expected pain before procedure and pain experienced during procedure in first timer patients and experienced patients undergoing interventional pain management. Material and Methods: The 400 participating patients were divided into two groups. Group 1 (First timer) and Group 2 (Experienced). Pre-procedural anxiety and expected procedural pain were assessed 1 hr before procedure. After half an hour post procedure, patient was given same Proforma for scoring of experienced procedural pain. Data was analyzed by using SPSS 20.0 (SPSS Inc., Chicago, IL, USA). Mann Whitney U test and Wilcoxon Signed Rank test were used for statistical analysis. Results: Preoperative anxiety is significantly higher in first timer patients than that in experienced patients. [Median- first timer patients = 8 (7-8), experienced patient = 4(3-5)], (P value= <0.001). Expected pain before procedure is seen higher in first timer patient than that in experienced patients. [Median- first timer patients=8(7-8), experienced patients=4(3-5)], (P value <0.001). Procedure pain experienced by first timer patients is significantly higher than that in experienced patients. [Median- first timer patients=6(5-7), experienced patients= 4(3-4)], (P value <0.001).
Conclusion: We concluded that lower level of anxiety in experienced group was associated with lower level of preprocedural expected pain and pain experienced during procedure. While in first timer, higher level of preprocedural anxiety was associated with higher level of preprocedural expected pain and pain experienced during procedure.

Context: Labor pain is characterized by regular, painful uterine contractions that increase in frequency and intensity in three stages of labor. Women’s experience of pain during labor greatly varies from feeling of little pain to extremely distressing pain. Therefore, we have conducted a questionnaire based study in the primary caregivers like paramedical staff to assess their knowledge about labor pain and the methods to counteract like labor analgesia. Aims: To check awareness about labour analgesia and anesthesia among paramedical staff and To provide the knowledge regarding labour analgesia. Settings and Design: Questionnaire based study Methods and Material: After obtaining institutional ethical committee approval, this study is conducted between January - February 2020 among the paramedical staff. The members included were belonging to age group 20-45 years. Statistical analysis used: Data entered to Microsoft Excel and presented in %. Results: Out of the total population, only 7.5% had the awareness about labour analgesia and 92.5% didn’t have awareness about labour analgesia. Out of 15 members have who had knowledge about labour analgesia,
12 members gained this through doctors and 03 members through their friends or relatives. Conclusions: Our study revealed that most of the paramedical staff still have that fear of labour pains and still suffer from the agony of labor pains due to lack of awareness, or knowledge about availability of labor analgesia service.

Background: Climatic change is the biggest global health threat of the 21st century. It is widely recognized that extreme climatic conditions during summer months may constitute public health threat. Elderly persons, children & patients with chronic medical problems or poor physical reserves are particularly susceptible to heat related illness. Trauma is the overall leading cause of death in younger age group. Persons who are working outside in the fields are exposed to direct atmospheric heat via radiations from sun. The industrial workers get exposed to industrial pollution and high humidity levels which interfere with evaporation. Aims and Objectives: We aimed to compare the incidence of complications and hospital stay in polytrauma patients during hot climate with comfortable temperature. Material and Methods: A prospective study was undertaken to study the impact of hot climate on 100 polytrauma patients of age 20-70 yrs of either sex with moderate trauma (Trauma index score >8). Patients were grouped on the basis of peak outdoor temperature. Group I included the polytrauma patients when peak outdoor temperature ranged between 20-29°C (comfortable zone) and Group II included the polytrauma patients when peak outdoor temperature was >40°C. Fifty patients were enrolled in each group. To reduce the bias, inclusion and exclusion criterion were defined. Meteorological factors, patient characteristics, surgical procedures undertaken and other related data were noted. Results: There was no statistically significant difference in relation to duration of hospital stay and complications among both groups. Mean duration of hospital stays (days) was 15.11±5.78 in group I and 17.14±7.61 in group II with p-value of 0.161. In group I, only 19 patients (38%) whereas in group II, 22(44%)
patients had complications (p-value 0.271). Conclusion: We did not find any statistically significant difference on hot climate as compared to comfortable temperature in 100 polytrauma adult patients. Four patients died during study period, one in group I and three in group II. All patients who died were high risk as per Shoe Maker’s Risk Score and ASA physical status.

Spinal anesthesia is unparalleled in the way a small dose of local anesthetic, virtually devoid of systemic pharmacologic effect, can produce profound surgical anesthesia. The quality and duration of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Here we evaluate the clinical effects of the adjuvants, α2 agonists-dexmedetomidine 5 mcg and clonidine 15 mcg in conjunction with intrathecal isobaric ropivacaine 0.75% for lower limb surgeries and assessing 1. The onset and duration of sensory block 2. The onset and duration of motor block 3. The duration of analgesia 4. Hemodynamic changes. Material and Methods: Prospective study was done on patients undergoing lower limb surgeries under neuraxial block were split into three equivalent groups. Group RR: subjects received 3 ml of isobaric Ropivacaine 0.75% with sterile water 0.1 ml (total=3.1 ml), Group RC: subjects 3 ml isobaric Ropivacaine 0.75% with clonidine 15 mcg (total=3.1 ml), Group RD: subjects 3 ml isobaric Ropivacaine 0.75% with dexmedetomidine 5 mcg (total=3.1 ml). Result: Statistical analysis shows significant difference in onset, duration of sensory and motor block and duration of analgesia among three Groups, Group RD, RC and RR. The time of onset of sensory, motor block was earlier and duration of sensory, motor block was longer and duration of analgesia (time to requirement of first rescue analgesic) prolonged in Group RD as compared to Group RC and Group RR. Conclusion: Dexmedetomidine with isobaric ropivacaine 0.75% produces more rapid onset of sensory and motor block, prolonged duration of sensory and motor block and longer duration of analgesia than clonidine with isobaric ropivacaine 0.75% and isobaric ropivacaine 0.75% alone intrathecally.

In the present study, 100 patients of ASA Grade I and II between age group of 20-65 years of weight range 40-70 kg were included. These 100 patients were divided into 2 equal groups of 50 patients each according to the drugs administered for brachial plexus block. Group A control group received 30 ml of Ropivacaine 0.5% with 0.5 ml of normal saline and Group B patients received 30 ml Ropivacaine 0.5% with Dexmedetomidine 50 μgm 0.5 ml for brachial plexus block. Intravenous infusion line was set up and all patients were monitored throughout intraoperative period and observed for changes in pulse rate, blood pressure, respiration and any untoward effects. It was observed that, the onset of motor and sensory block was significantly quicker in Group B (study group) as compared to Group A (control group). The duration of motor blockade and sensory blockade was significantly longer in Group B patients as compared to Group A patients. The quality of sensory blockade was excellent in Group B patients and satisfactory in Group A patients. The duration of postoperative analgesia was significantly more prolonged in Group B patients as compared to Group A patients. There were no significant changes in mean pulse rate and mean arterial pressure at various time intervals in both groups during intraoperative and postoperative period. There were no dreadful complications in any patients during intraoperative and postoperative period in both groups.

Background: Airway management is very essential in medical speciality, difficulty in airway access can lead to hypoxic brain damage, cardiac arrest and even death or morbidity. A difficult airway in pediatric airway
examination can be stressful condition for all involved. Hence in order to avoid the morbidity and mortality it is essential to evaluate airway in preoperative examination and identify potentially difficult airway. In
order to find the predictors of difficult airway we conducted a study in 200 patients with age limit of 3-6 years scheduled for elective surgeries under general anesthesia. We studied the following tests: Interincisor distance (IID), MMC (Modified Mallampati classification), Thyromental distance (TMD) and CLG (Cormack Lehane Grade). We correlated EVL (easy visualization of larynx) CLG I, IIa, IIb and DVL (difficult visualization) CLG III, IV with above parameters. It was observed that there was no such difference in EVL and DVL with IID, MMC and TMD. While MMC-I showed statistically significant difference between EVL and DVL. Sensitivity of TMD was 84.69% and specificity was 98.5%. with MMC. Conclusion: Thyromental distance was good predictor for difficult laryngoscopy and intubation.

An observational & comparative study was designed to compare the efficacy, safety of RopivacaineFentanyl versus Bupivacaine-Fentanyl intra-thecally for lower abdominal and lower limb surgeries not
exceeding 2 hours. 70 patients of either gender with ASA I & II aged between 18 to 55 years were randomized into two groups, n = 35 each. Group R received 3 ml of (0.75%) Ropivacaine+ Fentanyl 25 μg (0.5 ml) and Group B received 3 ml of (0.5%) Bupivacaine+ Fentanyl 25 μg (0.5 ml). Spinal anesthesia procedure was standardized. Hemodynamic parameters, onset and duration of sensory & motor blockade, level achieved, duration of analgesia, regression and side effects were checked. Onset and Regression of sensory blockade in ropivacaine group was faster with a P <0.001 which was statistically significant. Onset of motor blockade was rapid in both the groups, but duration of motor blockade was significantly shorter in ropivacaine group. Ropivacaine group were recorded with excellent analgesia and stable hemodynamics with no side effects. From the present study we concluded that with addition of fentanyl to local anesthetics there is prolongation of analgesic effect. The hemodynamic parameters and SpO2 are comparable in both the groups. Postoperative analgesic consumption is less in both groups. When bupivacaine-fentanyl combination was introduced intrathecally, they produced a significantly longer duration of analgesia. Their sensory block and motor block were
also longer than ropivacaine-fentanyl combination. Shorter duration of motor block with ropivacaine allows for early ambulation, voiding and physiotherapy, therefore it is preferred in day care surgeries.

Background: Efficient prevention and management of postoperative nausea and vomiting [PONV] continues to be a concern that needs to be addressed. Objective: The aim of this study is to evaluate the effectiveness of the single dose dexamethasone [I.V. 8 mg] in preventing post operative nausea and vomiting in patients undergoing laparoscopic surgery under general anesthesia. Design: This was a hospital based Retro prospective Study. Duration: One Year December 2019 to November 2019. Setting: Department of Surgery, Owaisi Hospital and Research Centre. Participants: 50 patients undergoing laparoscopic surgery. Materials and Methods: A randomized, placebo-controlled study was conducted on 50 patients undergoing elective laparoscopic surgery under general anesthesia. The patients were allocated randomly to one of the two groups Group A - Dexamethasone I.V 8 mg, Group B - I.V saline The anesthetic was standardized. The
patients were premedicated with glycopyrrolate 0.2 mg i.v., ranitidine 50 mg i.v., midazolam 0.05 mg/kg and fentanyl 1.5 mg/kg i.v. Vomiting was treated with metoclopromide 10 mg i.v. repeated if necessary. Results: The total incidence of nausea and vomiting was 28% in the dexamethasone group compared with 68% in the saline group. Dexamethasone is shown to be more effective in reducing nausea than vomiting. Conclusion: Prophylactic administration of single dose of dexamethasone 8 mg, IV resulted in prevention of post operative nausea and vomiting. Dexamethasone is more useful either alone or in combination with other antiemetics in prevention and treatment of postoperative nausea and vomiting, especially when it is severe
andfrequent.

Background and Aims: We compared the block characteristics between dexmedetomidine versus buprenorphine as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block. Duration of sensory and motor block along with duration of analgesia were the primary endpoints. Materials and Methods: A comparative two group randomized clinical study was designed in which sixty ASA 1 and ASA 2 patients who were scheduled for elective upper limb surgeries under ultrasound guided supraclavicular brachial plexus block were randomly divided into two equal groups. Group D (n=30), received 24 ml 0.5% bupivacaine + 1 ml (50 μg) dexmedetomidine and Group B (n=30), received 24 ml 0.5% bupivacaine + 1 ml (100 μg) buprenorphine. Duration of sensory, motor blockade and analgesia were assessed along with onset of sensory and motor blockade, sedation, and side effects among the two groups. Results: Duration of sensory and motor block in Group D (588.7±38.2 & 481.7±16.8) was longer than Group B
(395.7±15.5 & 334.3±23.8; p <0.001). Duration of analgesia in Group D (805.7±54.1) was longer than Group B (579.0±41.4). There was no significant difference among the groups with respect to onset of sensory and motor blockade. Bradycardia was observed in one patient in Group D and vomiting was seen in two patients in Group B, no other adverse effects were observed. Conclusion: Dexmedetomidine prolongs the duration of sensory and motor blockade and duration of analgesia as compared with buprenorphine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus block, with no adverse side effects.

Context: LMA secures airway better than face mask and also causes less hemodynamic stress than endotracheal tube insertion. We have done a study on, comparison of dexmedetomidine-propofol with fentanyl-propofol for laryngeal mask airway insertion. Aims: To compare efficacy of Dexmedetomidine–Propofol and Fentanyl–Propofol for LMA insertion in terms of ease of intubation using Muzi and colleagues scoring system; compare the hemodynamic responses to LMA insertion.
Settings and Design: Prospective randomized double blind study
Methods and Material: After obtaining institutional ethical committee approval, 110 ASA I and II patients were included. Group A patients were preoxygenated for 3 min, dexmedetomidine 1 mcg/kg over 2 min.
30 sec later propofol 2 mg/kg was given for induction, Group B patients were preoxygenated for 3 min, fentanyl 1 mcg/kg given over 2 min. 30 sec later propofol 2 mg/kg was given for induction. Parameters observed include HR, SBP, DBP, MAP, SpO2 and RR before insertion of LMA and after insertion of LMA. Statistical analysis used: SPSS (version 18.0) to analyze data (version 18.0), and Sigma-Stat 12.0 is used to
decide sample size. Results: Dexmedetomidine group had better LMA insertion conditions like better jaw mobility, lesser incidence of cough and fewer incidence of breath holding spells. Moreover, reduction of hemodynamic parameters like SBP, DBP and MAP was more with fentanyl group than dexmedetomidine group. Conclusions: From our study we conclude that dexmedetomidine caused less respiratory depression and more stable hemodynamic conditions, compared to fentanyl. Thus we feel that dexmedetomidine can be used as an alternative to fentanyl with an advantage for LMA insertions in short surgical procedures.

Background: The ideal anesthetic should produce a rapid and smooth onset of action, intra-operative amnesia and analgesia, good surgical conditions and a short recovery period without side-effects.
Objective: To evaluate recovery from Anesthesia with Isoflurane and Halothane in Day care surgery
Design: This was a hospital based Retro prospective Study Duration: One Year January 2019 to December 2019
Setting: Department of Surgery, Owaisi Hospital & Research Centre Participants: 60 Patients undergoing day care surgeries.
Methods: This study was conducted in sixty patients (thirty patients in Group-I and thirty patients in Group-II). Glyucopyrrolate 0.2 mg i.v was given. Patient was induced with 1% propofol 2 mg/kg; slowly i.e. every 4 ml in 10 seconds until the eyelash reflex was obtunded. On abolition of eyelash reflex patient was maintained on spontaneous ventilation by using Magill’s circuit with N20 6 Lts; 02 3 Ltrs. and Isoflurane 1.5% in Group-I or Halothane 1.5% in group-II patients.

Results: The early and intermediate recovery is faster with isoflurane than with halothane. The discharge times are also earlier with isoflurane than with halothane.
Conclusion: Isoflurane is a useful and better anesthetic even halothane and offers a clear advantage when used for maintenance of Anesthesia for operations of short duration performed on a day-care basis.

Objectives: To compare the safety and efficacy of lignocaine versus dexmedetomidine in attenuation of cardiovascular response to laryngoscopy. Study design: Randomized controlled trial. Sixtypatients of ASA I & II category posted for elective surgery under general Anesthesia were enrolled in the study. Patients were randomly divided into two Groups: Group L(Lignocaine ) and Group D (Dexmedetomidine) with 30 patients in each group.

Materials and Methods: Group L received 1.5 mg/kg of lignocaine intravenous (IV) and Group D received 1 mcg/kg of dexmedetomidine as IV infusion. Thiopentone was given until eyelash reflex was lost, and
intubation was facilitated with succinylcholine. Anesthesia was maintained with 33:66 oxygen, nitrous oxide, and titrated doses of inhalation agents and vecuronium was given. Hemodynamic parameters were recorded as baseline vitals, at preinduction, after induction, during intubation, 1 min, 3 mins, 5 mins, and 10 mins after intubation. SPSS version 16 was used for analysis.

Results: All the demographic variables were well matched between groups. There was a statistically significant difference (p <0.001) between dexmedetomidine and lignocaine in parameters like heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure at all time intervals after tracheal intubation, with dexmedetomidine being the most effective. Sedation scores were more with dexmedetomidine.No adverse effects were noticed in patients of both groups.

Conclusion: Dexmedetomidine attenuates the hemodynamic stress response to laryngoscopy and intubation more effectively when compared with lignocaine 1.5 mg/kg IV, without any adverse effects.