Indian Journal of Anesthesia and Analgesia

The name Segmental spinal anaesthesia is often widely used synonymously with Thoracic spinal anaesthesia. But in real sense segmental spinal anaesthesia means “blocking of the required dermatomes essential for the proposed surgical procedure with very low effective local anaesthetic drug dose “. This often necessitates dural puncture at high lumber or thoracic levels apart from the conventional spinal. Segmental spinal anaesthesia has been found to be feasible, safe, and effective alternative to conventional general anaesthesia in abdominal and some thoracic surgeries. The objective of this special article is to demonstrate the safety, benefits, risks and utility of this technique as a sole anaesthetic technique or combined with epidurals.

Radiotherapy is a commonly employed and an important modality of treatment for cancer with about 50 % of the patients receiving radiotherapy during their course of treatment.1 Two major categories for the application of radiation are external beam radiation and brachytherapy.1 Brachytherapy is derived from the greek word brachys meaning “short distance”.2 Brachytherapy is administered by inserting a radiation source inside a specific cancer site which needs anesthesia, analgesia and muscle relaxation. The theory behind brachytherapy is to deliver low intensity radiation over an extended period to a relatively small volume of tissue covering the tumour area and sparing the surrounding normal tissue. The demand for anesthesia in brachytherapy is increasing nowadays. Anesthetic management is crucial because it poses a number of challenges for the anesthesiologist. Patients for brachytherapy are often elderly and are high risk patients with multiple co morbidities, brachytherapy for head and neck malignancy may pose the problem of difficult airway, to achieve a stable position of the applicators and implants immobilization is essential.3 Brachytherapy often has an unpredictable procedural duration. Transportation of the anesthetized patients to different radiological suite is a typical challenge.3 Various modalities of anesthesia employed include general, spinal, combined spinal epidural anesthesia and local anesthesia with sedation. Anesthesiologist play a major and an important role in the ongoing challenge to provide an optimal treatment conditions for brachytherapy.

Background and Objectives: Spinal anesthesia is widely used, providing a fast onset and effective sensory and motor blockade. Systemic hypotension and bradycardia are the more common side effects seen during the central neuraxial block. Levobupivacaine has been introduced into clinical practice because of its lower toxic effects for the heart and central nervous system. We, therefore, performed this prospective randomized clinical study to compare the clinical efficacy and hemodynamics of 3 ml of 0.5% intrathecal isobaric Levobupivacaine with 3 ml of 0.5% intrathecal racemic Bupivacaine for lower abdomen and lower limb surgeries. Methodology: 100 patients belonging to ASA physical status I and II scheduled for lower abdomen and lower limb surgeries were randomly selected for the study and were divided into 2 groups of 50 each. Group L (Levobupivacaine group) received 3ml of 0.5% isobaric Levobupivacaine (15mg) intrathecally Group B (Bupivacaine group) received 3ml 0.5% of racemic Bupivacaine (15mg) intrathecally. Onset and duration of sensory block, onset duration and degree of motor block, maximum dermatomal level of sensory block, hemodynamic parameters, and adverse effects if any were studied. Results: There was a statistically significant difference between both the groups with regards to mean onset of sensory and motor block which was significantly faster in group B when compared to group L. The mean time for peak sensory block was 7.44 mins with Levobupivacaine and 6.84 mins with Bupivacaine (p-value 0.02). The mean onset time for the motor block was 10.99 mins with Levobupivacaine and 10.48 mins with Bupivacaine (p-value 0.05). The maximum sensory height attained ranged between T4 and T10 in both the groups, which was clinically and statistically not significant. The mean time for 2 segment regression was 123.8 mins in group L and 126.5 mins in group B which was statistically not significant (p-value 0.23). The degree of motor block was comparable in both groups. The mean duration of sensory block was 257.4 mins in group L and 259.9 mins in group B which was clinically and statistically not significant (p-value 0.17). The mean duration of motor block was 283.2 mins in group L and the group was 286.3 mins with a p-value of 0.31 which clinically and statistically was not significant. Hypotension and bradycardia were less common in group L than group B which was clinically and statistically significant. 52% of patients in group B and 16% of patients in group L required the use of vasopressor with a statistically significant p-value of <0.001. 30% of patients in group B had bradycardia compared to 8% in group L with a p-value of 0.002. The incidences of other side effects were comparable in both the groups. Conclusion: Levobupivacaine 15 mg (3ml of 0.5% Isobaric) has significantly a late onset of sensory and motor block but had a similar duration of sensory and motor block compared to Bupivacaine 15 mg (3ml). However, Bupivacaine required more often the use of a vasopressor and sympathomimetic drug compared to Levobupivacaine. So Levobupivacaine could be advisable inpatient whose clinical history demandsthe cardiovascular impact of spinal anesthesia to be minimized.

Keywords: Levobupivacaine; Bupivacaine; Intrathecal; Isobaric.

The anesthetist is held responsible for ensuring a stable and safe operative and post-operative environment so as to aid in the faster and uneventful recovery of the patient. Spinal anesthesia in obstetric surgeries has been gaining rapid acceptance as a choice method but the agent of choice for anesthesia must be such that it can provide a stable state for both the mother and child. The present study was done to ascertain the comparative efficacy of two agents levobupivacaine and bupivacaine in elective cesarian surgery cases. The results showed that levobupivacaine had a shorter duration of sensory and motor block as well as statistically significant lower levels of side effects as compared to bupivacaine. The authors concluded that levobupivacaine may be a more feasible alternative in such surgeries as compared to bupivacaine.

Introduction: The most common distressing symptom following surgery and anaesthesia are nausea and vomiting with an incidence of up to 20 to 30% despite newer medications like Ondansetron and steroids in our armamentarium.

Aims: To determine the efficacy of combination therapy with Ondansetron and Dexamethasone and each drug alone in prevention of Postoperative nausea and vomiting (PONV) post laparoscopic cholecystectomy.Also to assess adverse effects if any.

Methods: 105 patients aged between 18 and 55 years belonging to ASA status 1 and 2, electively posted for lap cholecystectomy were randomly divided into three groups of 35 each. Gp A received 4mg Inj Ondansetron, Gp B received Inj Dexamethasone 8mg and Gp C received both drugs together. Similar anaesthesia and surgery techniques were used. Upto 24 h period was assessed for incidence of nausea and vomiting and need for rescue antiemetic. Statistical analysis: Chi square test and Student t test were used.

Results and Discussion: Overall cumulative incidence of PONV was 54.2% in A Gp, 25.7% in B Gp and 14.2% in Gp C. Complete response, that is no nausea and vomiting was seen in 85.7%in Gp C, 74.2% in Gp B and 45.82%in Gp A which was statistically significant. Ondansetron, a selective 5HT3 receptor antagonist is a good drug for PONV in gynaecological laparoscopy. Dexamethasone is effective against onco and chemotherapy related nausea and vomiting. Combination therapy of the 2 showed good results and reduction in incidence of PONV in lapchole cystectomy.

Introduction: Recent research has focused on the addition of the glucocorticoid dexamethasone as an adjuvant to local anesthetics in regional anesthesia.8 Although the exact mechanism of action is unknown, preliminary studies suggest its addition can impressively prolong the duration of analgesia with minimal adverse effects.

Methodology: 60 children between the age group 1-5 years of ASA-PS I and II posted for elective infraumbilical surgeries were randomly grouped into two equal groups using shuffled sealed opaque envelope technique. Pre anesthetic evaluation was done and informed consent was obtained from the parents after explaining about the procedure and the drugs being used.

Results: The number of rescue analgesics required by patients receiving only ropivacaine in their caudal block was compared to in patients receiving Dexamethasone as adjuvant with ropivacaine and was found to be statistically highly significant with a p value of 0.001.

Conclusion: The mean pain scores at different time intervals in between 2 groups were compared using Independent t test and was found to be statistically highly significant with a p value of <0.0001.

Background: Till recently Bupivacaine 0.5% Heavy was the only drug used for spinal anesthesia after the discontinuation of Lidocaine’s intrathecal use. The last few years, its pure S (-) enantiomers, ropivacaine and levobupivacaine, have been introduced into clinical practice because of their lower cardiac and central nervous system toxic effects. This study was performed to compare the anesthetic efficacy and safety of the ropivacaine and levobupivacaine, in patients undergoing lower abdominal and lower limb surgery.

Methods: 60 patients of ASA physical status I–II between the ages of 20–60 years, scheduled for spinal anesthesia were prospectively enrolled in our randomized controlled trial. They were divided into 2 groups, R and L, of 30 pts each. 3.0ml (15mg) of 0.5% isobaric ropivacaine in study group R and 3.0ml (15mg) of 0.5% isobaric levobupivacaine in study group L was given.

Results: The mean Time of onset sensory blockade and Time of onset of Motor Blockade was significantly high in Group R as compare to Group L, whereas mean Duration of sensory blockade, mean Duration of motor blockade and mean Duration of analgesia were significantly less in Group R as compare to Group L (P<0.001).

Conclusion: Intrathecal administration of either 15 mg ropivacaine or 15 mg levobupivacaine was well-tolerated and provided similar, effective anesthesia for lower limb and lower abdominal surgery. Intrathecal ropivacaine may prove useful when surgical anesthesia of a similar quality but of a shorter duration is desired.

Carbondioxide pneumoperitoneum in laparoscopic appendicectomy is associated with adverse hemodynamic effects like increases in blood pressure, heart rate and systemic vascular resistance. These adverse effects are due to release of catecholamine and vasopressin. We conducted this randomized double blinded study to assess the effect of magnesium sulphate on attenuating these adverse hemodynamic responses. Materials and Methods: Sixty ASA I and II patients of either sex aged 20–60 years posted for elective laparoscopic appendicectomy were randomized into two groups of thirty patients each. Group M received magnesium sulphate 20 mg / kg intravenously before creating pneumoperitoneum. Group C received same volume of 0.9 % saline. Results: Systolic blood pressure, diastolic blood pressure and heart rate were significantly less in patients of Group M when compared to the placebo group. Conclusion: Magnesium sulphate given at a dose of 20 mg / kg before pneumoperitoneum attenuates adverse hemodynamic responses and ensures better hemodynamic stability during pneumoperitoneum created for laparoscopic surgery.

Introduction: Magnesium is an antagonist of NMDA receptors and associated ion channels. It is found in very small concentrations in the plasma and is chiefly an intracellular ion. It is suggested that magnesium has many important roles to play in nociception. An inverse relationship has been documented between the severity of pain with different painful medical and surgical conditions and the serum magnesium levels. Methodology: Patients were monitored for postoperative pain and any analgesic requirement for a periodof24hours.AnypatientcomplainingofpainorreportingVAS≥4atanytimewasadministeredInj tramadol 100 mg IV slowly over 2-3 minutes. If pain was not relieved after 30 minutes and patients still complained of pain, additional doses of Inj tramadol 50mg IV was given and this dose could be repeated every 30 minutes upto a total dose of 250 mg in 6 hourly and maximum of 400mg of Inj tramadol over 24 hours. Results: The number of patients who were administered 2nd, 3rd and 4th doses of rescue analgesics was significantly greater in group A as compared to group B. None of the patients in group B needed more than 4 doses of rescue analgesia while in group A, 5 patients were administered a rescue analgesic for 5th time. The study suggests that local infiltration of local anaesthetic agent alone or in conjunction with magnesium is safe. Conclusion: The addition of magnesium to local anaesthetics potentiates the effect of local anaesthetics and reduces the postoperative opioid requirement.

Introduction: From its humble beginnings, ultrasound guided regional anaesthesia has evolved over the years, with the development of newer blocks and alternative approaches to existing peripheral nerve blocks. Therefore it finds application in not only the anaesthesia set-up but also in critical care and trauma triages, as a modality to provide anaesthesia and analgesia to patients. It is currently the standard of care for administering regional anaesthesia.

Methodology: The patients were selected by convenience sampling and those who matched the selection criterion, were briefed about the nature of the study and the procedures involved, in a language understood by them and written informed consent was taken. Descriptive data of the patient such as name, age, sex and detailed medical history, was collected.

Results: In our study it was observed that some patients in both Groups S and T experienced mild sedation (Ramsay Sedation Score 3) when assessed for the same at the 2 hour and 4 hour interval. The number of patients experiencing mild sedation at these intervals, were more in Group T as compared to Group S.

Conclusion: But this difference in Sedation scores between the two groups was not found to be statistically significant (p value> 0.05). At the subsequent intervals of 6, 12 and 24 hours, there was no difference in the incidence of sedation between the two groups.

Introduction: Local anaesthesia have been employed during the operation as an adjuvant to anaesthesia or to alleviate postoperative pain. Local anaesthetic is injected to block the nerves before cutting the skin at the beginning of the operation, or after closing the skin at the end. Subcutaneous infiltration of bupivacaine microcapsules prolongs analgesia in humans for up to 96 h, and pre surgical infiltration of levobupivacaine significantly decreases the intensity of postsurgical pain, especially for the first 12 h, thereby reducing analgesic consumption.

Methodology: The minimum samplesize required for the study per group is 23. We have considered 30 patients per group for better statistical representation. A total of 60 patients were included in the study.

Results: None of the patients suffered from bradycardia, hypoxaemia, respiratory depression, skin rash or incision site excessive redness nor was there any evidence of infection. The incidence of sedation and pruritis was similar in both groups with no statistically significant difference.

Conclusion: The incidence of nausea and vomiting was infact lower in group B as compared to group A. This could be explained by the lesser use of rescue analgesic agent in group B since Inj tramadol itself is associated with increased incidence of nausea and vomiting.

Objectives: To compare the effectiveness of inj. Dexamethasone 4mg added to 1.5% lignocaine with adrenaline with inj Dexamethasone 8mg added to 1.5% lignocaine with adrenaline in Supraclavicular Brachial Plexus Block in terms of onset of sensory and motor blockade andduration of sensory and motor blockade.

Materials and Methods: The study was carried out as a Prospective, randomized clinical trial among 150 patients who underwent different surgical procedures under supraclavicular brachial plexus block. They were randomized into three groups. GROUP A: Patients belonging to this group are given supraclavicular brachial plexus block with 4 mg dexamethasone as adjuvant to 1.5 %lignocaine with adrenaline (7mg/kg). GROUP B: Patients belonging to this group received supraclavicular brachial plexus block with 8 mg dexamethasone as adjuvant to 1.5 % lignocaine with adrenaline (7mg/kg). GROUP C: Patients belonging to this group received supraclavicular brachial plexus block with 2ml of normal saline added to 1.5 % lignocaine with adrenaline (7mg/kg). The three groups were compared with regard to onset of sensory and motor blockade andduration of sensory and motor blockade.

Results: No statistically significant difference was reported between the three groups in demographic variables. The mean time required for onset of sensory block in Group A and Group B is 11.2 minutes and in Group–C is 14.26, onset of motor block Group A and Group B is 13.0 minutes and in Group–C is 17.0 min. The average duration of sensory block in Group B>A>C. The average duration of Motor block in Group B is 242min, and in Group A with 192 min and with Group C is 153min.

Conclusion: In conclusion, addition of dexamethasone to local anaesthetics in supraclavicular brachial plexus block results in a faster onset and prolonged duration of sensory and motor blockade. Higher dose (8mg) of dexamethasone is more efficacious than lower dose (4mg) of dexamethasone as an adjuvant with local anaesthetics in terms of duration of sensory block, motor block and analgesia but equally efficacious in onset of sensory and motor blockade.

Introduction: A recent development in the treatment of post-operative pain is the use of peripheral nerve blocks. The technique involves blocking the conduction of nerve impulses by deposition of local anaesthetic around the nerve or nerves supplying the area of interest. Consequently, the sensory and/ or motor supply to the area supplied by the nerves, are effectively abolished, thus helping to achieve anaesthesia and analgesia.

Methodology: The patients were selected by convenience sampling and those who matched the selection criterion, were briefed about the nature of the study and the procedures involved, in a language understood by them and written informed consent was taken. Descriptive data of the patient such as name, age, sex and detailed medical history, was collected. They were randomized into two groups with the help of computerized randomization software.

Results: In our study it was noted that the mean total rescue analgesic consumption in patients belonging to Group S (over a period of 24 hours) was 73.3 mg. Whereas the mean total rescue analgesic consumption in Group T was only 35 mg. This difference in the mean total rescue analgesic consumption between the two groups was found to be statistically significant (p value < 0.001).

Conclusion: Patients in both Group T and Group S experienced some degree of nausea at the 2, 4 and 6 hour intervals, but the PONV scores of both the groups were comparable. Thereafter, patients in both the groups were asymptomatic.

Aim: To compare the effects of propofol, sevoflurane and desflurane in patients undergoing supratentorial craniotomies under general anaesthesia with regard to, perioperative haemodynamic stability, emergence and recovery characteristics.

Materials and Methods: A prospective randomized study of 150 adult patients belonging to both sexes undergoing elective supratentorial craniotomies under general anaesthesia were takenup for study and divided into three groups of 50 each. Group P : Anaesthesia was induced with Inj. Thiopentone sodium and maintained with 66% nitrous oxide (N20), in 33% oxygen (02) and Propofol (3-6mg/kg/hr) Group S: Anaesthesia was induced with Inj.Thiopentone sodium and maintained with 66% nitrous oxide (N2O) in 33% oxygen (O2) and Sevoflurane. (1-2%) Group D: Anaesthesia was induced with Inj. Thiopentone sodium and maintained with 66% N 2O and 33% O2 and Desflurane. (4-6%). The effects of Propofol, Desflurane and Sevoflurane on haemodynamics and recovery characteristics were observed.

Results: In Desflurane Group the mean time taken for response to verbal commands was 4.61±0.47 min, spontaneous eye opening was 5.3±0.49 min,to squeezing fingers and lift limb was 6.17 ± 0.31 min. While the mean time taken for extubation was 7.72±0.53 min and time taken to orientation to place, name was 9.38±0.52min. These desflurane values are very much lower than the other two groups.

Conclusion: We conclude that Desflurane as the inhalational agent ensures faster recovery in the early postoperative period as evident from significant decrease in the time required for extubation and the time requiredtoachieveamodifiedAldretescoreof≥9whencomparedtopatientsreceivingSevofluraneand Propofol.

Introduction: Supra Glottic Airway devices have set a new trend in airway maintenance since their invention. Availability of these devices in the paediatric sizes has revolutionized their use. Endo Tracheal Tubes have always been considered “Gold Standard” owing to their ability of maintaining stable respiratory parameters and in prevention of aspiration. We have compared the repiratory parameters achieved with Paediatric I-Gel, Proseal -LMA and Endo Tracheal Tube. Description: 120 children aged 2 to 12 years, both sex, ASA 1 and 2, posted for elective surgery were included in the study. They were divided into 3 groups of 40 each - Endo Tracheal Tube (E), Proseal LMA (P-LMA) and I-GEL respectively. The device was inserted after induction of anaesthesia and the respiratory parameters namely SpO2 and EtCO2 were recorded at various time intervals. Result: All values were analysed and expressed as mean +/– SD. Statistical comparison was done by unpaired student “t”- test and chi square test. The values obtained for various time intervals were found to be statistically insignificant for all the three devices. Conclusion: PaediatricProseal LMA (P-LMA) and I-GEL are very much comparable with Endo Tracheal Tube (E) with regard to respiratory parameters and hence can be safely used as an alternative airway in the paediatric population.

Introduction: With the availability of supraglottic devices in providing effective seal even in conditions of raised airway pressures, use of these devices in laparoscopic surgeries has become popular. Of the various supraglottic devices being used in laparoscopic surgery LMA ProSealTM and i-gelTM airway are commonly used with efficacy. The aim of this study was to compare the use of i-gelTM and LMA ProSealTM in patients undergoing Laparoscopic cholecystectomy.

Methodology: This was a prospective randomized, hospital based study conducted at a tertiary care hospital. Adult inpatients of either gender posted for elective laparoscopic surgery were recruited in the study. A total of 100 patients were included out of which 50 each were randomly allocated to either i-gelTM group (Group I) or LMA ProSealTM group (Group P). After randomization, the chosen supraglottic airway device (i-gel/Proseal LMA) was inserted. Airway insertion attempts, time to successful ventilation, Gastric tube placement, Airway sealing quality, Numbers of attempts required for correct placement and complications were recorded and the data was assessed.

Results: Demographic data were comparable in the two groups. The Ventilation time was found to be significantly faster with PLMA as compared to i-gel. I-gel and Proseal showed no significant differences in the airway and gastric tube insertion attempts, ventilation success rate, airway sealing pressures, SpO2, EtCO 2, airway sealing quality score and intra abdominal pressures.

Conclusion: Both i-gel and Proseal both provide adequate ventilation in laparoscopic cholecystectomy surgeries. Complications such as airway injury and bleeding with Proseal LMA are significantly more as compared to i-gel.

Introduction: Laryngoscopy and endotracheal intubation is invariably associated with haemodynamic stress response which may have severe consequences in patients with comorbidities. Various drugs have been tried to attenuate this response. Ease of use, cost effectiveness and minimal side effects are some important considerations while choosing an agent. In this study we have compared the efficacy of oral clonidine with IV fentanyl and IV butorphanol in attenuating the stress response to laryngoscopy and intubation.

Materials and Methods: This is a prospective, randomised, comparative study carried out on 75 patients aged 20–60 years, ASA I/II physical status, scheduled for elective surgery. These patients were randomly allocated into three groups- GROUP A received IV Fentanyl 2mcg/kg and GROUP B received IV Butorphanol 40 mcg/kg five mins prior to induction respectively. GROUP C received Oral Clonidine 4 mcg/kg 90 mins prior to induction. All thepatients were assessed for heart rate, systolic blood pressure and diastolic blood pressure before induction, during laryngoscopy, after intubation at 1 min, 2 min, 3 min and 5 minrespectively. Statistical analysis: The data was compared and analysed using Kruskal-Wallis test.

Results: There was an increase in the hemodynamic parameters post laryngoscopy and intubation in all the groups.Astatistically significant difference in the mean heart rate, systolic blood pressure and diastolic blood pressure was observed; the increase being significantly lower and short-lived in the oral clonidine group compared to the other two groups. Although all the three drugs were effective in attenuating the pressor response, oral clonidine was moreeffective and consistent compared to IV fentanyl and IV butorphanol.

Conclusion: Oral clonidine 4mcg/kg given 90 mins prior to induction is more effective than IV fentanyl and IV butorphanol in blunting the hemodynamic response to direct laryngoscopy and intubation without causing any significant side effects.

Introduction: Shivering is a frequent complication reported in 30 to 40% of patients undergoing surgery under regional anaesthesia. It increases oxygen consumption, hypercarbia and minute ventilation. It induces arterial hypoxemia, lactic acidosis, increased intra-ocular pressure, and interferes with patient monitoring and comfort. Most of the studies done in the past have been in the treatment of shivering rather than prevention. This study compared intravenous dexmedetomidine versus intravenous tramadol for prevention of shivering in patients who received spinal anaesthesia for various surgical procedures.

Aims and objectives: The aim of this study was to study and compare the efficacy of intravenous infusion of low dose dexmedetomidine (0.25mcg/kg) vs Tramadol (0.5mg/kg) in the prevention of postoperative shivering. Primary objective was prevention of shivering and Secondary objectives were sedation, hemodynamic changes and nausea and vomiting.

Materials and Methods: Prospective randomised double blinded comparative study was done on patients scheduled for elective surgery during June 2018-March 2019 in GKNM Hospital, Coimbatore. Patients were included as per criteria. Informed and written consent was obtained and randomized by computer. Group D received IV Dexmedetomidine of 0.25mcg/Kg dose and Group T received IV Tramadol of 0.5mg/kg. Data was collected and analyzed. Patients were evaluated post operatively by the investigator who was blinded to the group assigned.

Results: The mean age of the total population was 39.55 ± 11.73 years with male predominance in tramadol group. Dexmedetomedine was more effective in preventing shivering, 16 patients (40%) of group D had shivering compared to 24 patients (60%) of tramadol group. This difference though was not statistically significant, numerically showed that dexmedetomedine was better in prevention of shivering. The tramadol group had early onset of shivering in comparison to Dexmedetomedine group (p<0.05). Dexmedetomedine group had higher grades of sedation and incidence of nausea and vomiting was higher in tramadol group.

Conclusion: Dexmedetomedine even at a lower dose is comparatively a more effective drug for prevention of shivering with fewer side effects than tramadol in patients undergoing surgery under spinal anaesthesia.

Postoperative pain and discomfort are the major concerns in all patients undergoing any surgery. Delay of discharge is mainly due postoperative pain. So, postoperative pain relief becomes very important. Epidural anal gesiaisone of many recent evidence-base dregimens for postoperative pain relief after surgeries particularly surgeries of abdomen. The objective of this study is to compare the efficacy, onset and duration of epidural analgesia of Bupivacaine - Clonidinecombination Vs. Bupivacaine-Fentanyl combination for post-operative analgesia in lower abdominal and lower limb surgeries. Materials and Methods: 50 patients belonging to ASA 1 and 2 were assigned into two groups (25 each). Group F received epidural Fentanyl with 0. 25% Bupivacaine and Group C received epidural Clonidine with 0.25% Bupivacaine. Results: With regard to anxiolysis, increased sedative property with easy arousal, longer and better quality analgesia and patient comfort, epidural clonidine and Bupivacaine combination was found to be superior to epidural Fentanyl and Bupivacaine. Various parameters like HR, Blood pressure (both systolic and diastolic), SPo2, Visual Analogue Scale (VAS) and Ram say Sedation Score (RSS) were observed for 24 hours post operatively. It was follow edup at 15 minutes, 30 min, 120 min, 240 min, 360 min, 480 min, 600 min, 720 min, 840 min, 960 min, 1080 min, 1200 min, 1320 min and 1440 min. Incidencesof side effects were also noted. Conclusion: Clonidine has proved to be very efficient compared to Fentanyl in postoperative analgesia.

Introduction: The efficacy of dexamethasone in prolonging the effect of local anesthetic has not been extensively studied when compared to other adjuvants. So, in our study we evaluated the analgesic efficacy of caudally administered dexamethasone along with dilute concentration of local anesthetics in children undergoing infra umbilical surgeries.

Methodology: 60 children between the age group 1–5 years of ASA-PS I and II posted for elective infraumbilical surgeries were randomly grouped into two equal groups using shuffled sealed opaque envelope technique. Pre anesthetic evaluation was done and informed consent was obtained from the parents after explaining about the procedure and the drugs being used.The two groups were Group R (control group) and Group D (study group). Group R received 1 ml/kg of 0.15% ropivacaine with normal saline (1ml) and Group D received 1 ml/kg of 0.15% ropivacaine with dexamethasone 0.1 mg/kg in saline to make a total volume 1ml in the caudal epidural space.

Results: No significant variation was noticed in either of the groups with respect to heart rate. The p values at all the various time intervals was >0.05.

Conclusion: There is no difference which is statistically significant between the diastolic blood pressures of the two groups.

Background: Absent gastric bubble was an X-ray chest finding preoperatively of a 68 year old gentleman posted for CABG. Apart from symptoms of unstable angina consistent with his angiographic findings, he complained of chest pain at night and lump in throat which we could attribute to gastroesophageal reflux disease. The aim of this study was to find the causes of absent gastric air bubble, so as to understand its implications and prevent the possible complications in patients undergoing CABG.

Methods: All patients undergoing cardiac surgery underwent prescribed blood investigation, ECG, X-ray chest (PAview ) PFT, carotid doppler, 2D ECHO and coronary angiography. Over a period of 6 months we had 5 patients whose X-ray chest showed absent gastric air bubble. All of the 5 patients were evaluated and managed preoperative,intra and postoperative keeping in mind the possible complications.

Results: Cause of absent gastric bubble in our patients: 1. Hiatus hernia -1 2. Achalesia cardia -1 3. Gastro-esophegael reflux disease -3 Conclusion: Absent gastric bubble is a sign which needs to be investigated pre-operatively for its cause. Gastro-esophageal reflux disease is a common disease which mimics heart attack.1. and is common in patients coming for CABG and can be a cause for concern for patient due to persistent chest pain post surgery. Adequate precautions like duration of fasting preop-operatively, prevention of micro aspiration post-operatively with head end elevation and low fat diet, abstinence from smoking, tea, coffee intake, weightloss will help in relieving symptoms of GERD and improve patient satisfaction post CABG. Confirmation and explanation of the observed relation between the presence of hiatal hernia and infarction requires further research .

Background: Lower segment caesarean section is widely performed under spinal anaesthesia and shivering is a common complication encountered. Clonidine and Dexmedetomidine are  – 2 agonists with anti-shivering property.

Aim: The aim was to compare the efficacy, hemodynamic and adverse effects of intravenous Dexmedetomidine versus Clonidine for post spinal anaesthesia shivering in LSCS.

Materials and Methods: A randomized double blind study was carried out in 70 parturients of ASA Physical Status II between 18 – 35 years who underwent LSCS under spinal anaesthesia and developed grade 2 or above level of shivering (wrench grading) in the intraoperative period. Group C (n=35) received intravenous Clonidine 1 mcg/kg and Group D (n=35) Dexmedetomidine 0.5 mcg/kg. Assessment included hemodynamics, time taken for complete cessation of shiveringand sedation scores.

Results: Mean time taken in Group D for cessation of shivering was 2.26 ± 0.44 minutes and in Group C, it was 5.48 ± 0.91min (p < 0.001). In Group C drug failed to control shivering in 17.4% and had recurrence in 20.69% while there was no failure (p < 0.001) and recurrence (p = 0.01) in Group D. Ramsay sedation scores were better with Group D when compared with Group C (p = 0.005). The incidence of hypotension and bradycardia was 22.8% in Group C and in Group D 2.86% (p = 0.012).

Conclusion: We conclude that Dexmedetomidine (0.5 mcg/kg) has early onset of action with less failure rate and recurrences with better hemodynamic stability and sedation when compared to Clonidine (1.0 mcg/kg) for post spinal shivering in LSCS

Keymessage: The study aimed to observe the efficacy of intravenous Dexmedetomidine versusClonidine for post spinal anaesthesia shivering in LSCS. The hemodynamic responses and sedationachieved by Dexmedetomidine and Clonidine when used as antishivering agent were also compared.
 

Laparoscopic surgery is associated with an elevation of cardiac parameters as well an elevation in blood pressure due to effects of catecholamine activity and vaso constriction. Due to the widespread use of laparoscopic techniques in modern day surgical practice it has become imperative for the anaesthetist to maintain a stable hemodynamic environment in the patient in the operative and post operative period. The use of dexmedetomidine and magnesium sulphate has been done with successfully in practice. The present study aimed to ascertain whether the comparative efficacy of both these drugs is equal or different. The study employed a subject pool of 60 subjects. The study found that there were no statistically significant differences between the two drugs when used in the corresponding sample population.

Background: The most important goal of anaesthesia for geriatric patients with comorbid diseases is to maintain normal homoeostasis of different systems during and after surgery. This prospective study was conducted to evaluate the success rate and associated complications of the caudal epidural block for transurethral resection of prostate in elderly patients with comorbid diseases.

Methods: This is a prospective study of a cohort of 110 elderly patients posted for transurethral resection of prostate with comorbid diseases belonging to American Society of anaesthesiologist’s physical status II, III and IV over a period of 1 year from November 2018 to November 2019. Standard recommended technique for caudal epidural block was followed. Time of onset, spread, duration of analgesia, intensity of block, complications, and unwanted effects were noted.

Results: The average age was 72. Eighty percent patients belonged to ASAIII and IV grade. The majority had excellent to a good quality of anaesthesia with no motor block. 80% of patients had the onset of analgesia between 5–15 minutes and 71% had a duration between 90–130 minutes. four patients had patchy analgesia and they were considered as a failure. No death was encountered in the study.

Conclusion: Caudal epidural block is a safe, effective anaesthetic technique for transurethral resection of the prostate in elderly with comorbid diseases of other systems.

The advent of minimally invasive surgeries has heralded a new field in surgical practice. The procedure of laparoscopy has been most beneficial to the clinician and patient alike however, it has also been responsible for newer complications. The present study was conducted with a view to ascertain if the hemodynamic instability brought about by pneumoperitoneum be effectively counteracted by using dexmedetomidine in cases of elective laparoscopic cholecystectomy. The study employed 30 subjects and who were evaluated in pre, intra and post operative stages for HR and BP. The results showed a significant difference between parameters of subjects who were administered the study drug and a corresponding control sample. The study concluded that the benefits of dexmedetomidine are accurate and the drug must be considered as a necessary adjuvant in all minimally invasive surgeries.

Introduction: Functional endoscopic sinus surgery (FESS) is a commonly performed operation. Endoscopic sinus surgery allows enhanced illumination and visualization and it has dramatically improved surgical dissection. However major complications such as excess bleeding and poor visibility can arise do to work in a confined space.Due to poor visibility longer time to perform the surgery may arise.

Material and Methods: This study was performed on randomly selected 60 patients, in a randomized placebo controlled double blind prospective study. We evaluated the hypotensive efficacy of intravenous Esmolol in FESS, reduction in blood pressure and Quality of surgical field and complications under general anaesthesia.

Conclusions: Esmolol produces a lower surgical bleeding scores and better quality of operative field for the surgeon as well as less adverse effects.

Brachial plexus block is a versatile and reliable regional anaesthesia technique. It is a block of roots, divisions and cords first performed by Halsted in 1884. It provides a useful alternative to general anaesthesia for upper limb surgery by being safe, decreasing the cost of anaesthetic agents, decrease operation theatre pollution and prolonged post-operative pain relief. Objectives: To study comparative effect of adding tramadol and butorphanol as an adjuvant with local anaesthetic (bupivacaine + xyloadrenaline ) in supraclavicular brachial plexus block in upper limb surgeries. Methods and Material: 60 patients were divided into two groups: Group A: inj. bupivacaine 0.5% (15ml)+inj xyloadrenaline (15ml) +inj tramadol(100mg) 2ml+inj ns 3 ml. Group B: inj. bupivacaine 0.5% (15ml)+inj xyloadrenaline (15)ml +inj butorphanol (1mg)1ml + inj ns 4ml. Assessment of onset of sensory and motor blockade, surgical procedure and duration of surgery. Perioperative complications were recorded and managed accordingly. Results: The onset of sensory block was rapid with Tramadol (4.2 min) as compared to Butorphanol (18.83min). The onset of motor blockade was faster with Tramadol (7.7min) as compared to Butorphanol (24.13min). Tramadol has longer duration of sensory (634.66 min) and motor (458.33 min) blockade as compared with butorphanol group (282.03min) and (350.16min) respectively (p<0.05). Duration of surgery and VAS Score was also similar in both groups and statistically not significant. Conclusion: Tramadol greatly reduce the onset time for sensory and motor block as well prolong the sensory and motor block,while Butorphanol has minimal effect on onset and duration of block but it provide post op analgesia.

Background: Laryngeal mask airway (LMA) is an excellent airway device used in day care surgeries. We aimed to compare two induction anaesthetic agents, propofol and sevoflurane for LMA insertion conditions in day care surgeries.

Patients and Methods: This prospective, randomized study was conducted on 80 adult, ASA grade I and II patients, of either gender, undergoing elective day care surgical procedures. Patients were randomly divided in two groups of 40 each. Group P received intravenous propofol infusion at the rate of 800ml/ hour for induction followed by LMA insertion. Group S received 8% sevoflurane for induction followed by LMA insertion. Both groups were compared for LMA insertion conditions in terms of time taken from the start of induction to loss of verbal contact, loss of eyelash reflex, jaw relaxation, successful LMA insertion conditions, number of attempts of LMA insertion and effective airway establishment time. Unpaired student – t test and Chi square test were used for statistical analysis.

Results: Patients in Group P achieved earlier LMA insertion conditions as compared to Group S i.e. shorter time to loss of verbal contact (33.48 ± 6.55 seconds vs 41.30 ± 4.12 seconds), loss of eye lash reflex (36.50 ± 6.67 seconds vs 44.40 ± 4.06 seconds), adequate jaw relaxation (40.35 ± 7.64 seconds vs 49.02 ± 4.45 seconds), and effective airway establishment time (44.88 ± 8.86 vs 54.65 ± 4.28 seconds) (P value <0.001).

Conclusion: We concluded that both the agents can be used for insertion of LMA however induction and insertion of LMA is faster with propofol.

Background: The Coronavirus disease (COVID-19) pandemic affected the health care personnel with the worse outcome as compared to the general population.Anaesthesiologists,being the first responders in critical care units (ICU) for aerosol-generating procedures like endotracheal intubation are at higher risk of getting infected with the virus.The updated SARS guideline (Severe Acute Respiratory Syndrome) of the 2003 epidemic in Toronto, Canada, is quite instructive for endotracheal intubation. This study was intended with the primary objective to find out the adherence of guidelines among the anaesthesiologists while doing endotracheal intubation and the secondary objective is to assess the incidence of other critical events.

Methods: This survey was conducted in a tertiary care centre among the anaesthesiologists about their first COVID-19 patient intubation,based on a 40-point questionnaire about adherence of guidelines and critical event encountered. All the responses collected in google form which was further evaluated with the help of SPSS-17.

Results: Total of 112 patients intubated in the ICU, out of which 62% were emergency intubation, aerosol boxes used while intubation in 20% cases. Hand hygiene before the procedure was not followed in 25% and no gowns used while doing the procedure was recorded in 34% respondents. Clamping ET tube and use of hydrophobic filter was missed in 15% and 22% cases. The surroundings contaminated in 51% of respondents. Hypoxia, hypotension, arrhythmia, hypertension, cardiac arrest and aspiration during intubation was observed in 58%, 62%, 29%, 21%, 22%, 11% cases respectively.

Conclusion: With the anaesthesiologists getting adapted to the new norms of intubation in COVID days, the adherence to guidelines is suboptimal, and the complication rate was high during the first intubation attempts.

Context: To evaluate intubation difficulty comparing Macintosh, Miller and Truview blades in patients with immobilized cervical spine. Aims: 1. To compare the difficulty during orotracheal intubation between Macintosh, Miller or Truview laryngoscopes utilizing the Intubation Difficulty Scale (IDS). 2. To compare the time taken for intubation. 3. Success rate of intubation in the three groups.

Settings and Designs: Prospective randomized cross sectional study.

Methods and Materials: This study was conducted in healthy Patients to evaluate the difficulty during intubation using the mentioned laryngoscopes, with the neck immobilized using Manual In-line Axial Stabilization (MIAS). Evaluation was done using intubation difficulty score (having seven parameters), success rate and duration of intubation. Intubation failure was defined as duration exceeding 120 seconds for which MIAS was relaxed and intubation was done conventionally. Statistics: One Way Analysis of Variance with Duncan’s mean test.

Results: All patients in the Macintosh group , 18 (90%) in Miller group and 16 (80%) in Truview group were intubated successfully. The duration of intubation was significantly longer and IDS score, least in Truviewgroup. Truview provided better glottic view and required less optimizing maneuvers.

Conclusions: The Intubation Difficulty Scale (IDS) score in parients with cervical spine immobilization (MIAS) is significantly least with TruView laryngoscope compared to conventional laryngoscopy using Macintosh or Miller laryngoscope. The time taken for intubation was shortest with Macintosh laryngoscope. Success rate of intubation is highest with Macintosh laryngoscope while it is least with TruView laryngoscope under the stipulated time limit (120 seconds) for laryngoscopy.

Background: Intravenous regional anesthesia (IVRA) was introduced into clinical practice by August Bier in 1908. This form of analgesia is ideally suited for emergencies, where patient is with full stomach or suffering from other diseases that contraindicates general anaesthesia, moreover the feasibility and simplicity of execution of this method, its effectiveness and its lack of any side effects have been gratifying. IVRA is particularly suitable for day care surgeries as it requires minimal preparation and premedication. Dexmedetomidine, a stereoisomer of medetomidine is a highly selective alpha 2 adrenergic agonist and has been shown to decrease anesthetic requirements by upto 90% and to induce analgesia in rats, volunteers and patients. The present study was designed to evaluate the quality, onset and recovery of IVRA with 0.5mcg/kg dexmedetomidine added to 3mg/kg of 0.5% lignocaine.

Methods: After institutional approval and informed consent, 60 ASA 1 and 2 volunteers, were taken into the study. In Group A 30 patients were randomly allocated to receive IVRA for upper limb with 3mg/kg for 0.5% lignocaine; in Group B 30 patients randomly received IVRA of upper limb with 3mg/kg of 0.5% lignocaine with 0.5mcg/kg Dexmedetomidine. The onset and recovery of sensory block were tested in six sites of the forearm and hand, determined by pin prick, touch and cold. The cuff was released after 45 minutes.Theonsetofcompletemotorblockwasalsoassessedandanysymptomsaftercuffde!ationwere recorded. Usual haemodynamic monitoring was used.

Results: The speed of onset of sensory and motor block was higher in Group B than in Group A (p<0.05). The recovery of sensory and motor block was prolonged in Group B than in Group A (p<0.05). The tourniquetpainoccurredsigni#cantlylaterinGroupBascomparedtoGroupA.Therewerefewincidence of bradycardia in Group B.

Conclusion: Addition of 0.5mcg/kg of Dexmedetomidine as an adjuvant to Bier’s Block effectively enhances the anesthesia and post-operative analgesia obtained with lignocaine. The low dose of Dexmedetomidine was effective and did not cause any major side-effects.

Background: Pain management in immediate postoperative period is an extremely important but herculean task. As oral medication is not possible at this stage, it is injectable analgesia which is put to task. In countries like India, where efficacy and cost both count, intramuscular diclofenac is the most commonly employed analgesic.

Methodology: The study was cross sectional by using questionnaire in 80 healthy adult subjects of either sex undergoing Hernia correction surgery under spinal anaesthesia. The subjects were assigned into two groups (Group I and Group P) by computer generated randomization table to receive intramuscular diclofenac 75mg or transdermal diclofenac patch 100mg immediately after spinal anaesthesia. The patients were monitored for pain using Visual Analogue Scale. Duration of analgesia and request for rescue analgesic (Tramadol 2mg/kg) were noted in both the groups. The study ended when patients had a VAS > 8 or at first request for analgesic.

Result and Conclusion: It was concluded that if applied with proper planning, diclofenac patch was as effective as diclofenac injection but at the same time administration of patch is devoid of pain, local side effects, drug destruction by stomach and digestive enzymes and first pass metabolism in liver.

Introduction: Anaesthesia to a parturient is not only unique but also requires highest degree of care because the anesthesiologist has to look after two individuals, the mother and foetus. Hypotension during subarachnoid block for caesarean delivery can have detrimental effects on both mother and foetus.

Objectives: To determine the efficacy of Ephedrine and Mephentermine prophylactically in managing the hypotension for caesarean section under sub arachanoid block and their undesirable side effects.

Materials and Methods: Patients were divided randomly into 2 groups (E group and M group) of 30 each. Patients were premedicatated with inj. Pantaprazole 40mg and inj. Metoclopramide 10 mg and pre loaded with ringer’s lactate at 10ml/kg infusion in the morning of the day of surgery. Baseline pulse rate, blood pressure, and SpO2 were recorded. Subarachnoid block was performed in sitting position, under aseptic conditions with a hyperbaric Bupivacaine 0.5%, 2cc (10mg) using 25 gauge Quincke’s needle. Group E received Ephedrine 3mg and Group M received Mephentramine 3mg prophylacticaly immediately after subarachnoid block.Blood pressure and pulse rate were measured every minute until the delivery, then every 5 minutes till the end of surgery. APGAR score were noted to assess the fetal outcome. Patient were monitored for 2 hours in the post operative recovery room soon after surgery for any untoward complications.

Results: Mephentermine significantly increases the systolic blood pressure, mean arterial pressure and reduces the heart rate compared to Ephedrine.

Conclusion: Maintenance of SBP between ‘hypotension value’ and baseline value by carefully titrating the vasopressor results in a satisfactory fetal outcome. Both ephedrine and mephentermine are equally efficacious for the management of maternal hypotension in terms of frequency of usage and result in a similar neonatal outcome. Our results suggest that Mephentermine increases the systolic blood pressure and decreases heart rate compared to Ephedrine and therefore more potent for management of hypotension before delivery of the baby during spinal anaesthesia in patients undergoing elective Caesarean section.