Indian Journal of Anesthesia and Analgesia

Objective: Central neuraxial blockade not only provides good anaestheti Background andcand surgical conditions but it has also advantages over general anaesthesia. To compare time of onset and duration of motor and sensory blockade, duration of analgesia, hemodynamic stability, adverse effects if any and number of rescue analgesia in first 24hours after surgery. 

Materials and Methods: After ethical committee permission and patient consent, study was conducted on 90 patients aged 18 to 65 years belonging to ASA- I and II undergoing lower limb and lower abdominal surgeries, were randomly divided into 3 groups. GROUP A received epidural bupivacaine 0.5 % (17 ml) + 1ml 0.9% normal saline. GROUP B received epidural Bupivacaine 0.5 %( 17 ml) + 1ml 0.5mcg per kg dexmedetomidine. GROUP C received epidural Bupivacaine 0.5 % (17 ml) + 1ml 50mg magnesium sulphate. Exclusion criteria include patient’s with bradyarrythmias, cerebrovascular diseases, neurodegenerative diseases, renal and hepatic diseases, uncontrolled hypertension, bronchial asthma, ischemic heart disease, drug and alcohol abuse and uncontrolled diabetes mellitus.The Statistical software SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. Test of significance were ANOVA and chisquare test. P value <0.05 statistically significant. 

Results: Analgesia in postoperative period and less number of rescue analgesia was better in Group C, Duration of sensory and motor blockade was prolonged and better hemodynamic stability in Group B 

Conclusion: Hence addition of magnesium sulphate to epidural bupivacaine provides better post-operative analgesia and dexmedetomidine to epidural bupivacaine increases duration of motor and sensory blockade with better hemodynamic stability.

Key Message: Addition of magnesium sulphate and dexmedetomidine for epidural anesthesia along with bupivacaine has been observed with better hemodynamic stability, increased duration of motor and sensory blockade intraoperatively with good post-operative analgesia.
 

Introduction: Vertebral body tumors although are rare in pregnancy can cause significant problems like neurological symptoms in the mother and if progressed may cause severe side effects in the fetus. Case presentation: We present here successful anesthetic management of a 20-year-old pregnant lady with 26 weeks of gestation with a D8 vertebral body tumor posted for excision and spinal fusion in the prone position. Conclusion: Surgical intervention in pregnant ladies with spinal cord tumors depends on the neurological manifestations and early intervention may be required to prevent harmful effects to both the mother and fetus, hence a multidisciplinary approach between the surgeon, anesthetist and obstetrician is essential in such cases for a safe outcome.

Introduction: Patients posted for adrenalectomy with pheochromocytoma pose major challenge to anaesthesiologist as there may be excess catecholamine release during its removal that leads to severe hypertension and arrythmias intra operatively.

Case presentation: Here we discuss anaesthetic management of 27 year old female with right supra renal mass posted for right adrenalectomy. She came with complaints of abdominal pain and weight gain for which hormonal evaluation and CECT abdomen done and was diagnosed with pheochromocytoma of right adrenal gland. As patient was obese and venous accesibility was difficult central venous catheterisation was done prior to surgery. Case was done under combined epidural with general anaesthesia.

Conclusion: In patients with pheochromocytoma posted for adrenalectomy, pre operative hormonal evaluation, intra operative and post operative hemodynamic stability are important. Intra operative and post operative tachycardia, hypertension prevented by smooth induction, minimise the intubation and extubation response and use of other adrenergic blockade drugs during and after surgery. Effective post operative pain management is necessary.

Laryngeal cysts are relatively rare benign lesions that represent approximately 5% of benign laryngeal lesions.1 Though benign, they can present with severe respiratory obstruction. We present one such rare case in a child aged 6yrs presenting with a large epiglottic cyst highlighting the anaesthetic challenges related to management of the airway in this age group. Fiberoptic intubation was planned in our case keeping all the necessary equipments in case of airway crisis.

Introduction: Patients with prosthetic valves pose a specific challenge to the anesthesiologist due to their increased predisposition to thrombo embolic events, infective endocarditis and hemolysis. Case Report: Here we describe the anaesthetic management of a 50 year old female with prosthetic mitral valve posted for wound debridement and external fixation for open type III right ankle bone fracture. She is a known case of Rheumatic heart disease and has underwent mitral valve replacement with tricuspid annuloplasty 5years back and is on oral anticoagualtion which was stopped 7days prior to surgery. Pre operative ECG showed AF with recent ECHO finding of concentric LVH with EF of 60%. Pre operative coagulation profile was normal. Antibiotic prophylaxis was given 2hours prior to incision. Case was done under general anaesthesia. Patient was induced with etomidate and maintained with intermittent doses of propofol and isoflurane with adequate analgesics. Intra operative blood loss was around 100ml.Patient was extubated and shifted to ICU for observation. Conclusion: In patients with prosthetic heart valves the most common complication is thromboembolism therefore optimising the coagulation profile before the surgery and subsequent restarting of anticoagulation therapy immediately after surgery is of utmost importance.

Background and Aim: Ultrasound guided transversus abdominis plane (TAP) block is a safe, effective analgesic technique for lower abdominal surgeries .This study is designed to compare dexamethasone and dexmedetomidine as adjuvants for TAP block in patients undergoing abdominal hysterectomy under spinal anaesthesia. Materials and methods: After ethics committee approval and informed written consent ,30 Patients were allocated into 2 groups each by randomized double-blind design using a computer generated randomization posted for abdominal hysterectomy under spinal anaesthesia . Group D1 received Inj Bupivacaine 0.25% 20ml + Inj Dexamethasone 4mg + 1ml normal saline in TAP Block on each side. Group D2 received Inj Bupivacaine 0.25% 20ml + Dexmedetomidine 25mcg+ 1ml normal saline in TAP Block on each side at the end of surgery under ultrasound guidance. Assessment parameters included hemodynamic, post operative VAS score, duration of post operative analgesia, total dose of post operative rescue analgesia and side effects. Results: There was no significant difference in Heart rate and Mean arterial blood pressure in both the groups. In the first 8 hr post operative VAS score was lower in GROUP D1compared to GROUPD2 (p < 0.05).Duration of post operative analgesia was longer in GROUP D1 compared to GROUP D2 (p<0.05).Total dose of post operative rescue analgesia consumption in 24hrs was lower in GROUP DI than in GROUP D2 (p<0.05) . No significant side effects were noted. Conclusion: Dexamethasone as an adjuvant to bupivacaine in TAP block has prolonged postoperative analgesia and has reduced requirement of rescue analgesia than dexmedetomidine following abdominal hysterectomy under spinal anesthesia

Background: Ropivacaine in epidural anaesthesia provides good analgesia, lesser motor blockade and cardiac stability. Addition of adjuvants like dexmedetomidine provides longer duration of analgesia, prolonged motor blockade with adequate sedation. Our study compares Ropivacaine alone and in combination with dexmedetomidine on block characteristics, postoperative analgesia and sedation. Methods: Following institutional ethical committee clearance and patients informed written consent Sixty patients (ASA I, II) aged 18 - 60 years of either sex posted for elective lower abdominal and lower limb surgeries were randomized into two groups, Group R and Group RD. The patients in group R received 19ml of 0.75% Ropivacaine with 1ml of normal saline and the patients in group RD received 19ml of 0.75% Ropivacaine with dexmedetomidine (1μg/kg) respectively. Both groups were compared with respect to onset and duration of sensory and motor blockade, intensity of motor blockade using modified bromage scale, maximum level of sensory blockade, sedation score, hemodynamic variations and adverse effects. Results: The mean onset of sensory and motor block in group R was 11.36±3.03& 16.63±2.70 minutes, in group RD was 6.80±1.30 & 12.10±1.63 minutes respectively. Duration of sensory and motor block in Group R was 199.60±23.4 & 150±17.64 minutes and in group RD was 296.30±21.12 & 235.00±17.64 minutes respectively. The patients in Group RD had rapid onset of action, significant prolongation of motor and sensory block, intense motor block, better sedation score and postoperative analgesia (p<0.05).No significant hemodynamic changes in either group. Conclusion: There is a clear synergism between dexmedetomidine and ropivacaine compared with ropivacaine in epidural anaesthesia 

Aim and objectives: Serious drug interactions are amongst the common problems encountered by the anaesthesiologists in their practice that compells them to understand the effects of individual drugs and their combinations. One such drug interaction is the effect of sevoflurane and ondonsetron on QT interval when administered individually and also when combined together.The aim of the study is toevaluate the effects of Ondansetron and Sevoflurane and theirpossible synergistic effectson QT interval. The effects on QT interval were observed whenOndansetron was administered on patients undergoing Sevoflurane anesthesia using corrected QT interval (QTc) by Bazett’s formula.

Methodology: Our study was a prospective randomized double blinded study which was done to evaluate QTc interval in 150 patients, aged between 20-60 years. QT interval was corrected by using Bazett’s formulato the heart rateand are noted at various interval period such as base line(Preoperative period), 10min, 15min, and 20 mins after the administration of ondansetron using 5 lead ECG in Lead II.

Results: There was significant prolongation of QTc interval in Sevoflurane + ondansetron group (477.92 ± 11.44) when compared with placebo (448.93 ± 8.21) with p value of <0.00001.

Conclusion: Ondansetron when administered with sevoflurane significantly prolonged theQTc intervalthat was not significant enough to produce arrhythmias. Though this combination seems to be safe, one must consider caution when administering these drugs to patients with long QT syndrome or any arrhythmia along with continuous ECG monitoring

Background: Percutaneous Nephrolithotomy is most advanced and preferred technique for Renal calculi but associated with pain and discomfort in postoperative period. Aim of our study is to compare analgesic efficacy of peritubular infiltration with paravertebral block under Ultrasound guidance for postoperative pain relief.

Methods: In this prospective randomised study total 60 adult patients were allocated in two equal groups (A, B). After undergoing surgery under general anaesthesia group A patients received peritubular infiltration of 15ml of 0.25% inj.bupivacaine with inj. Dexmeditomidine 1ug/kg and group B patients received 15ml of 0.25% inj.bupivacaine with inj. Dexmeditomidine 1ug/kg in Paravertebral space T11, T12, L1 under ultrasound guidance. Postoperatively hemodynamic variables, VAS, Dynamic VAS, mean time for 1st demand of analgesia and total consumption of inj.tramadol were noted in both groups.

Results: At 4, 8, 12 hrs VAS, Dynamic VAS scores were lower in group B compared to group A(p<0.005). Hemodynamic variables were comparable between groupsand demand for first rescue analgesia time were higher in paravertebral block group compared to peritubular infiltration group and total consumption of tramadol were low in paravertebral block.

Conclusion: Paravertebral block under ultrasound guidance is an effective analgesia for
PCNL in postoperative period compared to peritubular infiltration.

Background: Perianal surgeries can be conveniently performed under saddle block . We intended to compare intrathecal low dose isobaric and hyperbaric levobupivacaine and study their efficacy in perianal surgeries under saddle block on ambulatory basis.

Methods: In this prospective, randomised controlled, double blind trial involving 20 patients in each group were randomised into two groups, Group I and Group H. Group I received 1ml of 0.5% levobupivacaine(5 mg) + 0.16 ml of Normal Saline ( total volume-1.16 ml) and Group H : 1 ml of 0.5% levobupivacaine (5 mg) + 0.16 ml of 50% dextrose (total volume-1.16 ml). Duration for ambulation being the primary criteria, we also noted maximum cephalic spread, time to reach maximum height of sensory blockade, 2 segment regression, duration of motor and sensory blockade, time for voiding and time for rescue analgesia . Appropriate statistical tests were used for final analysis. P value less than 0.05 was considered statistically significant.

Results: There were no significant differences between the two groups in terms of the maximum height of sensory blockade and 2 segment regression that was achieved and request for first rescue analgesic. Duration of motor blockade, time to full recovery of sensory block and first voiding were all statistically significantly shorter in group H than group I.

Conclusions: We conclude  that hyperbaric levobupivacaine is superior to isobaric form while being closer to ideal choice of anaesthetic agent on ambulatory basis required for perianal anaesthesia while both the concentrations are similar in their safety profile.

Background and Aim: Laryngoscopy and endotracheal intubation cause increase in heart rate and blood pressure as well as abnormalities of cardiac rhythm due to reflex sympathetic discharge which is caused by epipharyngealand laryngo-pharyngeal stimulation. The aim is to study the changes in following parameters during laryngoscopyand endotracheal intubation up to 10 min with tab melatonin administration.

Material and Methods: The present study was carried out in the Department of Anaesthesiology, Government Medical College and S.S.G. Hospital, Vadodara, from November 2017 to October 2018. Randomisation was done according to computer generated list into two equal groups. Group C (Control group) - Patients received two tablets of vitamin D3 (placebo) 120 min before induction of anaesthesia.. Group M (Melatonin group) received oral melatonin tablets of 6mg (two tablets of 3mg each) 120 min before induction of anaesthesia. Vitamin D3 was used as placebo drug. Haemodynamic parameters such as heart rate: systolic, diastolic and mean blood pressures were recorded before the administration of drug (baseline), 120 min after administration of study drug, immediately after induction, at laryngoscopy and intubation, just after laryngoscopy and intubation and at 1, 3, 5 and 10 min thereafter.

Results: The mean pre operative pulse rate, the Systolic blood pressure(SBP), the Diastolic blood pressure(DBP), Mean arterial pressure(MAP) and the SpO2 were comparable in both groups but not significant statistically (p>0.05). At baseline and just before intubation, pulse rate was comparable in both groups. Nausea & vomiting was seen in one patient from study group & was treated with inj.Ondansetroniv. Hypotension was observed in 1 patient from the study group.

Conclusion: Administration of oral melatonin premedication 120 minutes before surgery results in Significant attenuation of the rise in systolic, diastolic and mean arterial blood pressure at the time of laryngoscopy & intubation and Transient increase in pulse rate which settled down within 1 minute after intubation and remained stable throughout the study period.

Background: Spinal anesthesia (SA) onset induces maternal hypotension, which can be managed by vasopressors like phenylephrine (PE). However, PE (α-adrenergic agonist) tends to reflexively decrease the heart rate (HR) and cardiac output (CO). Norepinephrine (NE), being an α-agonist with weak β-adrenergic activity, maintains the blood pressure (BP) with less tendency to decrease the HR and CO, and hence, may be a more useful alternative to PE.

Objectives: To compare the effects of prophylactic boluses of NE and PE on SA-induced hypotension during elective cesarean section, as well as assess the neonatal outcomes and adverse reactions.

Methods: Sixty parturient belonging to ASA class I and II, scheduled for elective cesarean section, were randomly allocated between 2 groups: (i) Group NE (n=30) which received 5 µg intravenous (IV) NE, and (ii) Group PE (n=30) which received 50 µg IV PE as prophylactic boluses immediately after patient repositioning. Rescue bolus interventions using 5 µg NE or 25 µg PE were given for hypotension, respectively. Maternal hemodynamic variables were measured non-invasively. Neonatal outcomes and adverse effects, if any, were also noted and compared.

Results: Pre-operative and post-operative hemodynamic parameters (HR, SBP, DBP, MAP, SpO2), adverse incidences (of hypotension, bradycardia, and nausea) as well as neonatal outcomes were comparable between the two groups (P>0.05). However, the number of patients who required additional rescue vasopressor boluses was significantly greater in Group PE than in Group NE (OR for 2 vs 0 bolus = 9.75; OR for 2 vs. 1 bolus = 11.1428).

Conclusion: NE was more efficacious in preventing SA-induced hypotension with better preservation of maternal HR than PE, and hence, can be considered as an alternative to PE.

Aim: To compare the analgesic effects of caudal block using 1ml/kg of 0.25% bupivacine to a combination of local infiltration with 0.5ml/kg of 0.25% bupivacaine with rectal diclofenac suppository 2mg/kg in the management of postoperative pain following below umbilical surgeries in pediatric patients of age group 2-7 years.

Materials and Methods: 100 patients belonging to both sexes, aged between 2-7 years, with ASA Status I, II who were posted for below umbilical surgeries under general anaesthesia were included in the study The patients were randomly allocated into two groups. Group A : Patients received caudal block with 1ml/kg of 0.25% Bupivacaine Group B : Patients received local wound infiltration with 0.25% Bupivacaine 0.5ml/kg and rectal diclofenac suppository 2mg/kg .

Observation and Results: The pain scores, total duration of analgesia, number of rescue analgesics required, time for micturition and postoperative complications,if any were compared in both the groups.

Conclusion: We conclude that both caudal block and local infiltration with reactal diclofenac suppository are equ ally effective for postoperative analgesia in below umbilical surgeries.

Background and Aims: Laryngeal mask airway is a novel device that bridges the gap in airway management between endotracheal intubation and face mask. In this study we wanted to determine the optimal insertion technique of LMA in children. The aim of this study is to compare the position of LMA in relation to laryngeal inlet between the two insertion techniques - the standard brain technique and rotational technique by using fibre optic bronchoscopy in children.

Methods: This is a randomised controlled study which included 60 patients divided in two groups of 30 each based on technique of insertion of LMA. After successful insertion, position of LMA is graded using fibre optic bronchoscope.

Results: In patients belonging to rotational technique group the incidence of FOB grade 1 is 96.67%and FOB grade 3 is 0%. Similarly, in standard technique group the incidence of FOB grade 1is 60% and FOB grade 3 is 3.33%.

Conclusion: Rotational technique of LMA insertion is associated with better positioning in relation to laryngeal inlet compared to standard technique as well as lesser attempts and decreased complications.

Context: The procedures like laryngoscopy and intubation evoke stress response in patients undergoing elective surgeries under general anaesthesia

Aims: To compare and evaluate dexmedetomidine and fentanyl on hemodynamic response like Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) in patients during intubation and extubation.

Settingsand Design: Doubleblinded Randomised Control prospective Study

Materials and Methods: AAfterobtainingethical clearance, 90 patients belonging to American Society of Anaesthesiologists class I/II, Scheduled for surgeries with duration of approx. 90mins were randomly divided into two groups. Group A received dexmedetomidine 1µg/ kg as loading dose over 10mns prior to induction followed by infusion at 0.5µg/kg/hr until 10mins prior to extubation. Group B received IV Fentanyl 1µg/kg as loading dose over 10mins prior to induction followed by infusion at 0.5 µg/kg/hr until 10mins prior to extubation.

Exclusion criteria included cardiovascular disease, Obesity >30kg/m2, patients with anticipated difficult airway, on sedatives, hypnotics and who have allergy to the study drug. Statistical analysis used: Data analyzed- SPSS22.0 software. Test of significance: Chi-squaretest. Continuousdata: Mean standard deviation. Testof significance:Independentttest p value:

<0.05- statistically significant.>

Results: With respect to hemodynamic response during intubation and extubation, Group A has shown significantly lower HR, SBP, DBP and MAP in comparison to Group B. Postoperative Visual Analogue Score for first 24hrs was significantly less in Group A compared to Group B.

Conclusion: Dexmedetomidine is better and safe alternative to fentanyl in attenuating hemodynamic response during both intubation and extubation.

Introduction: General anaesthesia is the gold standard anaesthetic technique for laproscopic appendicitis. However, this procedure is not risk free. Carbon dioxide is used to create pneumoperitoneum in laproscopic surgeries causes various hemodynamic changes such as abrupt elevation of arterial pressure, systemic vascular resistance and decreased cardiac output. These changes are well tolerated in healthy patients. There is also an increase in circulatory catecholamines during laryngoscopy and intubation. Many pharmacological techniques were evaluated either in the premedication or during the induction to attenuate the hemodynamic response to pneumoperitoneum such as – deepening the anaesthesia, pretreatment with vasodilators, adrenoceptor blockers, calcium channel blockers and opiods. This study is designed to evaluate the hemodynamic changes associated by laryngoscopy, tracheal intubation and pneumoperitoneum in laparoscopic appendicectomy by premedicating the patients with Gabapentin (900mg) and Pregabalin (150mg).

Materials and Methods: The study was carried out as a hospital based double blinded randomized prospective comparative study after obtaining institutional ethics committee approval in the Department of Anaesthesiology, SMVMCH Puducherry. The sample size was calculated as 72 with 36 in each group. Patients scheduled for elective laparoscopic appendicectomy were selected for the study based on predetermined inclusion and exclusion criteria. The study drug, Gabapentin 900mg or Pregabalin 150mg, was sealed in a black covered envelope and was given to the patient with sips of water 1 hour before the induction of anaesthesia by an anaesthetist not involved in study. Anaesthetic and surgical techniques were standardized for all patients. HR, SBP, DBP, MAP, SpO2 were recorded at the following points of time:(i) Prior to induction, (ii) 2-3 minutes after intubation, (iii) Before creating pneumoperitoneum, (iv) After creating pneumoperitoneum, (v) 2 minutes after extubation, (vi) Intra op,every 5 mins till the end of surgery, (vii) Post op, every 10 mins for the 1st 30 minutes and then every 30 minutes till 3 hours, along with Ramsay sedation score.

Introduction: Since the introduction of spinal anaesthesia in 1898 by Dr. August Bier, who described the intrathecal administration of cocaine, spinal anaesthesia is preferred over general anaesthesia, particularly in surgical procedures of lower abdomen and lower limbs1 (D C Simon et al 2008). The aim of intrathecal local anaesthetic is to provide adequate sensory and motor block necessary for all below umbilical surgeries. Hyperbaric Bupivacaine is the most commonly used intrathecal local anaesthetic. Various adjuvants have been added to Bupivacaine to shorten the onset of block and prolong the duration of block. A number of adjuvants such as clonidine, Midazolam, opioids have been studied to prolong the effect of spinal anaesthesia3,4 (Elia N.et al 2008, Boussofara et al 2006). Clonidine has side effects like bradycardia, hypotension, dryness of mouth, nausea, respiratory depression, itching, and neurological toxicity. Dexmedetomidine is a new highly selective α2 agonist. It is α2 agonist drug, when given intrathecally, significantly prolongs the duration of spinal block. Intrathecal α2 receptor agonists have been found to have antinociceptive action for both somatic and visceral pain5 (Al Ghanem SM et al 2009). It is hypothesized that intrathecal 5 µg Dexmedetomidine would produce more postoperative analgesic effect with hyperbaric Bupivacaine in spinal anaesthesia with minimal side effects5-7 (Al Ghanem, Al Mustafa et al 2009 & Kanazi GE). To see whether the Dexmedetomidine alleviates the side effects of clonidine & Midazolam, we decided to study the efficacy and safety profile of Dexmedetomidine in combination with local anaesthetic in subarachnoid block for below umbilical surgeries.

Background: Spinal anaesthesia is the most common anaesthesia techniques used for Caesarean surgeries, median and paramedian approaches are two common techniques used for spinal anaesthesia. The present study was conducted to compare both median and paramedian approach in spinal anaesthesia in pregnant patients undergoing caesarean surgery in terms of incidence of PDPH, ease of each approach and skin to subarachnoid distance in both the approaches.

Materials and Methods: A total of 100 obstetric patients, undergoing cesarean surgery were included in the study. Patients were randomly allocated into two groups. Group M (n=50)- median approach and Group PM (n=50)- Paramedian approach.

Results: Mean number of attempts for successful spinal anesthesia were higher in Group PM (paramedian 1.90+0.65) as compared to Group M (median 1.54+0.68). Mean skin to subarachnoid distance was higher in Group PM (5.97 ± 0.13cms) as compared to Group M (5.05 ±0.19cms). Nine patients presented with Post dural puncture headache out of total 100 patients. In Group M, six patients (12%) developed PDPH out of 50 patients while in group PM, three patients (6%) developed PDPH, however, the difference was not statistically significant.

Conclusion: Paramedian approach is better than median approach in terms of reduction in the frequency of PDPH, though the results were statistically insignificant. Skin to subarachnoid distance (SSD) is significantly higher in paramedian approach as compared to median group.

Background: Successful conduct of anaesthesia in children depends on adequate premedication which comforts the anxious child. Children are vulnerable to stress response because of limited energy reserves, larger brain masses and obligatory glucose requirements. This feeling of worry and nervousness is also seen in the parents of the children undergoing
the surgery. Hence premedication becomes important in children in order to avoid anxiety in both children and parents. Methods: A prospective observational study was conducted in 78 pediatric patients aged between 2 to 10 years of age in our institution. One group received atomized intranasal midazolam 0.3mg/kg (Group M) and the other group received intranasal dexmedetomidine 1mcg/kg (Group D) 30 minutes before the surgery. Results: Mean sedation score was higher in Group M (1.58 ± 0.55) than in Group D (1.15 ± 0.36) with P value 0.002 at 5 minutes. Similarly the mean sedation score at 10 minutes for Group M was 2.34 ± 0.97 and Group D was 1.75 ± 0.71 with P-value 0.008. Separation score and mask acceptance were better with Group M compared to Group D. Conclusion: We conclude that in children, atomized intranasal midazolam produces better sedation levels, child parent separation and mask acceptance compared to intranasal dexmedetomidine.

Background: Brachial Plexus block is the easiest and simplest form of providing anesthesia for upper limb surgeries. It is known that potassium added to local anesthetics can increase the extracellular concentration, time of depolarization and prolongation of action of the local anesthetics. With this in background, this study was designed to observe the effect of potassium chloride as adjuvant to local anesthetics on onset of sensory and motor blockade and qualitative block for analgesia.

Materials and Methods: Forty patients of ASA I and II of either sex, aged 17 to 61 years posted for upper limb orthopaedic surgeries received either plain Inj. Xylocaine 1.5% (A1), Inj. Xylocaine 1.5% with Inj. Potassium Chloride 0.2 mmol (A2), plain Inj. Bupivacaine 0.375% (B1) or Inj. Bupivacaine 0.375% with Inj. Potassium Chloride 0.2 mmol (B2) in Brachial Plexus block through Supraclavicular approach. Patients were assessed for the onset of sensory and motor blockade, duration of anaesthesia and post-operative analgesia.

Result: Groups A2 and B2 (potassium added groups) had faster onset of sensory and motor blockade, and prolonged duration of action than A1 and B1 (plain Xylocaine and Bupivacaine) groups. The quality of blockade was better in groups with added potassium, more so with Bupivacaine than with Xylocaine.

Conclusion: Addition of Potassium chloride to Xylocaine and Bupivacaine had significant clinical advantage over Plain drugs specially Bupivacaine on onset time, duration and quality of sensory and motor blockade in Brachial Plexus block.