Indian Journal of Clinical Anaesthesia

Page No. 502-506

Authors: Anita Kumari, Lakshmi Mahajan, Deepika Madaan, Pankaj Sarangal, Ruchi Gupta.

Proseal LMA(PLMA) and LMA supreme(SLMA) are improved versions of classic LMA and offer additional safety features such as provision of better glottis seal at low mucosal pressure, presence of a drain tube which prevents gastric insufflation and thus protects against aspiration. In the present study we compared the efficacy and aspiration risk of proseal LMA and LMA supreme with LMA classic in adult anaesthetized paralysed patients. Methods: We conducted a randomised prospective study in 60 adult anaesthetized paralysed patients. The proseal LMA and LMA supreme were compared with LMA classic in terms of ease of insertion, number of attempts, insertion time & hemodynamic parameters as primary outcome. The incidence of aspiration with these LMA devices using pH paper readings from LMA tips and comparing it with gastric content pH obtained through ryle’s tube, perioperative complications and cost effectiveness of the device used were evaluated as secondary outcome. Results: Ease of insertion was although more in PLMA and SLMA than CLMA but statistically comparable in all three groups. First attempt insertion was 15/20 in group 1, 18/20 in group 2 and 3 each. Second attempt insertion was 5 patients in CLMA; 2 patients in PLMA & one patient in SLMA. Median insertion time was (22.6±3.8 sec, 20.7±3.9 and in 18.9±4.2 sec) in group 1, 2 and 3 respectively. There was no case of aspiration as evidenced by LMA tip pH which remained in the range of 6-7. The cost of SLMA was found to be more in comparison to PLMA and CLMA. Incidences of intra and post-operative complications were similar in all the three groups. Conclusion: Clinically PLMA and SLMA are easier to insert than CLMA, but overall the three groups were comparable with respect to insertion characteristics, airway manipulation required, hemodynamics, risk of aspiration and perioperative complications but cost effectiveness along with clinical benefit was seen more with PLMA.

page No. 512-517

Authors: Alka Kewalramani(Chhabra), Seema Partani, Nagendra Prasad Sharma, Venus Sharma.

Background and aims: During general anaesthesia, maneuver of laryngoscopy and tracheal intubation is accompanied by varying degree of sympathetic stimulation. This may prove detrimental in patients with compromised cardiac and cerebrovascular reserve and hence many approaches have been tried to prevent the potentially adverse circulatory responses. In the present study, we compared dexmedetomidine with labetalol to assess and evaluate the haemodynamic responses to laryngoscopy and endotracheal intubation during induction of general anaesthesia and during extubation. Material and methods: This study was carried out in ninety patients who were posted for various surgeries requiring general anaesthesia with orotracheal intubation. They were allocated into three groups. Group D patients received 0.5mcg/kg dexmedetomidine, diluted to 5ml of 0.9% normal saline, group L received 0.25mg/kg labetalol diluted to 5 ml normal saline and group C received 5ml 0.9%normal saline. All study drugs were administered over 5 minutes followed by induction with IV Propofol 2mg/kg and suxamethonium 1.5 mg/kg. Maintenance of anaesthesia was done with 100% oxygen, sevoflurane and IV Atracurium. Haemodynamic monitoring of systolic and diastolic blood pressure, heart rate(HR), mean arterial pressure(MAP) were done. Calculation of rate pressure product( RPP) were done and all parameters were compared at intubation(I0), 1(I1), 3(I3), 5(I5), 10(I10) and 15(I15) minutes postintubation, intraoperatively and at extubation. Results: Group D and group L showed statistically significant fall in HR,SBP, DBP, MAP RPP at induction, at intubation(I0), I1, I3, I5, I10, I15 than group C(p<0.001). There were decrease in HR, SBP, RPP in group D than in group L (p<0.001), while at I10 and I15 fall in MAP was significant in group D(p<0.001). Group C showed incidence of tachycardia and hypertension to be 83% and 77% respectively. Group D showed bradycardia in three patients and hypotension in four out of thirty patients which were statistically insignificant when compared to group L.(p>0.05). Conclusion: The haemodynamic responses to laryngoscopy, endotracheal intubation and extubation are better controlled with dexmedetomidine than labetalol.

Page No. 525-528

Authors: Bhavani Vaidiyanathan, S. Saravanakumar, Gomathi Karmegam

Background and Aim: Supraglottic airway devices (SGA) offer certain advantages over endotracheal intubation, making them appropriate for outpatient anesthesia. The I-gel® is the innovative second generation supraglottic airway device from Intersurgical. I-gel offers unique advantages of easy insertion, reduced trauma, superior sealing pressure, and gastric access. Drugs such as propofol, sevoflurane are commonly used for supraglottic device insertion. The pharmacokinetic characteristics of Propofol allows for rapid onset and offset of drug effect with better blunting of airway reflexes compared to thiopentone. Midazolam is a well-established anaesthetic pre-medicant for short surgical procedures. There are innumerable studies on insertion of classic LMA with propofol but only few with I-gel. This prompted us to inspect the efficacy of propofol, and propofol–midazolam co-induction for I-gel insertion in spontaneously breathing patients for elective day care procedures. The primary aim of the study is to compare propofol and propofol-midazolam for ease of I-gel insertion. Methods: Eighty patients, aged 18-45, were divided into two groups group P and Group PM. They received anaesthesia induction with propofol and propofol –midazolam after pre-medicating with Inj.Fentanyl 2micrograms/kg respectively. Patients in (group P) received IV normal saline 2ml followed by Propofol 2.5mg/kg for induction. Patients in (group PM) received IV Midazolam 0.04mg/kg three minutes before induction with propofol. The following conditions were assessed for ease of I-gel insertion such as number of insertion attempts, Jaw relaxation, coughing and gagging. The total dose of propofol, hemodynamic changes during induction were the other parameters recorded. Results: I-gel was successfully inserted at first attempt in 33 patient’s(80%) in group PM and 24 patients(60%) group P and it was statistically significant(p ≤0.03). The total dose of propofol consumed in group P(45.5±8.165) was more compared to group PM(44.65±6.483)(p≤0.002). Conclusion: I-gel insertion was swifter with better hemodynamic stability in propofol-midazolam than propofol alone for day care surgeries.

Page No. 534-539

Authors: Ilango Ganesan, R. Vasanthageethan, Arunachalam R

Background and Objectives: Supraclavicular block is one of the most common techniques of regional anaesthesia employed for upper limb surgeries. The practice of combining additives to local anaesthetics used in peripheral nerve blocks carries lot of advantages. Hence this study was designed to evaluate the effect of addition of Clonidine to Bupivacaine in Supraclavicular brachial plexus block. Materials and Methods: We studied the addition of 100 µg of Clonidine to 0.375% bupivacaine compared with saline placebo in place of clonidine for nerve locator guided supraclavicular block using sublavian perivascular technique. Forty patients fulfilling inclusion criteria were divided into two groups, group B (Bupivacaine only group) and group BC (Bupivacaine and Clonidine group) and supraclavicular block was performed in them accordingly. Results: The onset of motor and sensory blocks were quicker in group BC (4.25±0.72 min, 8.40±0.82 min respectively) compared to group B (6.40±1.14 min, 12.00±1.97 min respectively). The duration of motor and sensory block in group BC were longer (396.30±14.92 min, 466.75±13.91 min respectively) compared to group B (299.00±23.32 min, 328.95±34.13 min respectively). These were found to be statistically significant (p value < 0.05). Conclusion: Adding clonidine to bupivacaine resulted in faster onset and longer duration of sensory and motor blockade. Intensity of postoperative analgesia also improved with mild intraoperative sedation and decreased heart rate without major haemodynamic instabilities.

Page No. 546-550

Authors: Madhavi Sanjay Chaudhari, Sanket Bharat Shah, Hemlata Vithal Kamat

Introduction: Central venous cannulation is commonly performed procedure on critically ill patients. Of the two methods, landmark technique and ultrasound (USG) guided latter increases success rate and decreases complications associated with the procedure. Ultrasound guided cannulation can be done in short or long axis approach. In the short axis approach, both artery and vein can be simultaneously viewed and hence would have less chances of arterial puncture. In the long axis approach only one vessel and the entire length of the needle is visualized and therefore there would be less chances of posterior wall puncture. In this prospective randomized observational study USG guided internal jugular vein (IJV) cannulation was done by trainees (post graduate students). The aim of this study was to find the incidence of successful cannulation and incidence of complications by short and long axis approach. Materials and Method: Fifty patients were randomly allocated into two groups, short axis and long axis. All the patients were cannulated by Seldinger technique and free flow of blood was confirmed through all the ports. Results: Demographic variables were comparable between the two groups. On first attempt 92% of patients in long axis and 76% of patients in short axis were cannulated. In both the groups, remaining patients were cannulated on second attempt and large number of patients had arrhythmias. Four patients had arterial puncture in short axis group but none was seen in long axis group. Conclusion: All patients were successfully cannulated. Higher first attempt successful cannulation and overall less complication were seen in long axis approach but the difference was not statistically significant

Page No. 556-561

Authors: Namrata Ranganath, Arathi BH

Introduction: There are studies which infer that spinal anaesthesia can be prolonged after adding adjuvants to local anaesthetics or by oral premedication before the block is performed. Aim of our study: To prolong the duration of spinal anaesthesia after the block has been performed. The study was done to compare the effects of intrathecal and intravenous clonidine on duration of spinal anaesthesia and to evaluate any advantages or disadvantages of intravenous over intrathecal clonidine in terms of analgesia, sedation, post–operative shivering and hemodynamic stability. Methodology: A prospective randomized double blind controlled comparative clinical study, was conducted on 60 patients, aged 20-60 years belonging to ASA I and II scheduled for elective infraumbilical procedures. Patient were divided into three groups of 20 each randomly, Group A- intrathecal bupivacaine (0.5% heavy) 3ml (15mg) + 75mcg of intrathecal clonidine, Group B- intrathecal bupivacaine (0.5% heavy) 3ml (15mg) + 3 mcg/Kg of intravenous clonidine over 10min, Group C – (control group) - intrathecal bupivacaine (0.5% heavy) 3ml (15mg) + 0.5ml of normal saline, intrathecally in L3-L4 interspace with a 25G Quinke’s needle. Intraoperatively the parameters noted were; Sensory characteristics- Time of onset of analgesia (T10), Maximum level of analgesia achieved, Time taken for maximum level of analgesia, Time for sensory block to regress to T10, Total duration of analgesia(rescue analgesic on patient demand). Motor characteristics- Time of onset of motor blockade (grade 1 bromage), Maximum grade of motor blockage achieved, Total duration of motor blockade (regression to Bromage-I), Hemodynamic monitoring, Sedation levels (OAA/Sscale) and Shivering episodes. Statistical software: The Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables. Results: Intravenous clonidine after bupivacaine spinal anaesthesia has characterstics similar to and comparable with intrathecal clonidine with bupivacaine with an added advantage of significant. Intraoperative and post-operative sedation, Protection against postoperative shivering and Beneficial in prolonged surgeries.

Page No. 568-571

Authors: Prashant Raosaheb Ginimuge.

Background: Many techniques of pre-oxygenation have been proposed and followed world-wide. 3–5 minutes of tidal volume pre-oxygenation is the most preferred technique of choice for pre-oxygenation. This technique may not be feasible in emergency situations. Hence this study was conducted to evaluate the efficacy and utility of four vital capacity breath pre-oxygenation technique, as its less time consuming. Methods: Fifty American Society of Anesthesiologists grade I and II patients in the age group of 20–40 years were studied under two groups of 25 each. Group I did not receive any pre-oxygenation and group II received pre-oxygenation in the form of four vital capacity breaths in 30 seconds. Rescue breaths with 100% oxygen were administered to all those patients whose oxygen saturation dropped below 75%. Results: It was observed that after one minute of post induction apnea, patients in group I had a reduction in oxygen saturation to a mean of 79.92±3.328%, in comparison to 87.24±2.368% in group II. It was also observed that vital parameters at the end of 1 min of apnea were close to baseline values in group II. The results were analysed using the "Analysis of Variance" (ANOVA) method. Conclusions: Pre-oxygenation with four vital capacity breaths does prolong the onset of desaturation and thus can be useful in emergency situations where time is precious.

Page No. 576-582

Authors: Priti M. Patel, Rakesh D. Panchal, Bipin M. Patel

Background: Pre-incisional analgesia has been shown to be more effective in control of postoperative pain by protecting central nervous system from deleterious effects of noxious stimulus and resulting allodynia and increased pain. Anti-hyperalgesic and antiallodynic properties of pregabalin improve postoperative pain by preventing the development of central sensitization. This study was designed to compare the efficacy of two different doses of Pregabalin with that of placebo in reducing post-operative pain, analgesic requirement, prolongation of analgesia and side effects. Method: Ninety female patients of ASA grade Ι & ΙΙ undergoing gynaecological surgeries were randomly divided in three groups of thirty each. Patients received Pregabalin 150 mg (P1), Pregabalin 300 mg (P2) and placebo (P0) one hour before surgery. Post-operatively parameters observed were visual analogue score (VAS) and sedation score, time to first analgesic requirement, total analgesic consumption and side effects for first 24 hours. Result: VAS score were lower in the Pregabalin group as compared to placebo group. Sedation score was highest with Pregabalin 300 mg as compared to other two groups. Time to first rescue analgesia was 6.97±1.351 hours in group P1, 8.47±1.408 hours in group P2 as compared to 3.1±1.604 in placebo group. Mean number of total doses of rescue analgesics in first 24 was 1.67±0.711 hours in group P1, 1.2±0.407 in group P2 as compared to 2.97±0.668 in group P0. Side effects like visual disturbance and dizziness were higher in group P2 as compared to other two groups. Conclusion: Pre-emptive pregabalin provide batter analgesia post operatively than placebo group. While 300mg pregabalin produces longer analgesia and require less number of doses of rescue analgesics than 150 mg Pregabalin, this dose produces more side effects like dizziness, sedation, visual disturbance and headache post operatively.

Page No. 588-592

Authors: Sangeetha Balakrishnan, Kevin Koshy Jacob

Background: It is recommended to maintain endotracheal tube cuff pressure within a range of 20 to 30 cm H2O to prevent complications. Objective: To assess the ability of experienced anesthesiologists to inflate endotracheal tube cuffs to optimal range of cuff pressure by subjective assessment alone. Methodology: An observational study was conducted to assess the ability of experienced anesthesiologists to inflate endotracheal tube cuffs to optimal range of cuff pressure by subjective assessment alone. 150 adult patients of either sex posted for elective surgeries were intubated and cuffs were inflated guided by subjective assessment alone. The pressure in these cuffs were then measured using a cuff pressure manometer and recorded. Statistical analysis was done using SSPS 18 (trial version). The primary outcome studied was the distribution of cuff pressures whether it was within or out of normal range (20 to 30 cmH2O). The relation of cuff pressure with age, sex, height, weight and nutritional status was looked for using Chi-square, Fischer Exact and Correlation tests. Results: The anesthesiologists were able to inflate the cuff to an optimal cuff pressure only in 64% of cases. The cuff pressures were recorded as low in 17.3% while in 18.7% of cases the cuff pressure reached above the optimal range. No relation was established between cuff pressure and age, gender, height, weight or nutritional status. Conclusions: Even experienced anesthesiologists are not able to inflate the endotracheal tube cuff up to optimal cuff pressure by using subjective assessment alone in all cases.

Page No. 599-603

Authors: Senthil Marappan, Prabhu Thilaak, Aparna Sukumaran, Sabapathy Vadugapalayampudur Appavoo, Shankar Ra

Background: An ideal intravenous anaesthetic agent to be considered for day-care surgery should provide rapid recovery with very less side effects and available at a reasonable cost. Both ketamine & propofol has all these characteristics but however cause significantly opposing hemodynamic effects which can be detrimental in patients with high risk, if used as sole induction agent. Aim: To assess and compare the efficacy of three different proportions of intravenous propofol-ketamine combination in minor gynaecological procedures. Materials and methods: A prospective comparative study was done on 120 patients at Vinayaka Missions Medical College Hospital by the anaesthesia department among the females who had been posted for minor gynaecological procedures. The study subjects were classified into 3 groups of 40 each. The anaesthetic drug administered for each group is as follows Group I – Propofol 1.5mg/kg + Ketamine 0.5mg/kg; Group II - Propofol 1.5mg/kg + Ketamine 1.0mg/kg and Group III - Propofol 1.5mg/kg + Ketamine 1.5mg/kg. The vital parameters were measured immediately(1 min.) after the drug (Propofol-Ketamine combination) administration and then after every 5 minutes upto half an hour. Adequacy of depth of anesthesia will be analysed by using EVANs(1987) scoring system. Requirement of airway intervention by means of bag and mask ventilation were recorded. Untoward events like vomiting or emergence phenomena during recovery were carefully watched and recorded. Results: The systolic BP and the mean heart rate was much lower in group 1 and it was highest among group 3. The mean time of maintaining the adequate depth of anaesthesia without giving supplement dosage, which was assessed by using EVANS scoring had shown that among the group I patients it was much lower when compared with group II and III and the difference was found to be statistically significant (P<.05). The air way intervention in the form of bag and mask ventilation was required by 82.7% of the patients in group III when compared to 7.5% in group I and the difference was found to be statistically significant. The recovery from anaesthesia by taking into consideration of the supplemental dose, was found to be very high in group III patients than that of group I and II and the difference was found to be statistically significant. Conclusion: Of the three different doses of ketamine with a fixed dose of propofol (1.5mg/kg), ketamine 1mg/kg was found to be a better dose when compared to 0.5mg/kg and 1.5mg/kg for day care gynaecological procedures.

Page No. 607-610

Authors: Soumya Samal, Shaswat Kumar Pattnaik, Ankita Mohta, Saubhagya Kumar Jena

Introduction: Postoperative analgesia is very essential for the postpartum women as it enables faster rehabilitation and initiation of breastfeeding. Spinal anaesthesia is most commonly used anaesthetic technique. So, we tried to compare the efficacy of dexmedetomidine and morphine as adjuvant to bupivacaine in lower segment caesarean section. Methods: This prospective comparative study was conducted on sixty parturients of ASA grade I and II scheduled for elective lower segment caesarean section under spinal anaesthesia. Cases were randomly divide into two groups: Group D received 12.5 mg of 0.5% hyperbaric bupivacaine with 5 µgdexmedetomidine and Group M received 12.5 mg of 0.5% hyperbaric bupivacaine with 125 µg morphine. Parameters recorded were the duration of time to achieve T8 sensory blockade, the time to S1 level sensory regression, the time of motor regression to Bromage 0, the time to first rescue analgesia and incidence of side effects. Results: The mean time of sensory block to reach T8 dermatome was significantly faster in group D (p=0.00004). The mean time of sensory regression to S1 and motor regression to reach modified Bromage 0 was significantly longer in group D (p<0.05). Both 1 & 5 min APGAR were similar in both the groups. Although the time to first rescue analgesia was longer in group D, it was statistically not significant. Side effects were more in group M.

Page No. 616-620

Authors: Sunder Paneerselvam, MN Nandakumar

Background: The laryngeal mask airway is a popular supraglottic airway device, with intravenous propofol being the agent of choice for its insertion. Sevoflurane is a volatile anaesthetic agent, which combines rapid, smooth inhalational induction of anaesthesia with rapid recovery, making it ideal for day care anaesthesia. Objective: To compare conditions for LMA insertion following induction with intravenous propofol and inhalational induction with sevoflurane (viz., jaw opening, ease of insertion, coughing, gagging, laryngospasm and patient movement) and number of attempts for insertion of Laryngeal Mask Airway. Study design: A randomized single blinded clinical trial. Methods: After obtaining the institutional ethical committee approval, fifty adults patients were allocated randomly into two groups of 25 each; group P (Propofol group) and group S (Sevoflurane group). Patients in group P were induced with 2.5 mg/kg intravenous Propofol. In group S, after priming the Bain’s circuit with Sevoflurane 8% in 50% N2O and O2 (flow rate – 8 litre/minute) for 30 seconds, patients were asked to take vital capacity breaths via the face mask connected to primed circuit. The LMA insertion was attempted afterloss of eyelash reflex and assessing the jaw relaxation. Scoring system was used to grade the conditions for the LMA insertion. Results: The mean time required for induction with propofol was 34.08 secs and with sevoflurane it was 46.96 secs. The mean time required for LMA insertion with propofol was 63.04±3.75ssecs and in sevoflurane group it was 87.48±15.14ssecs. In both the groups excellent conditions for LMA insertion were obtained. Complications while inserting LMA were not significant in both the groups. Conclusion: The observation of this study shows that propofol produces a much faster induction and good jaw relaxation for insertion of LMA than induction with sevoflurane. The insertional characteristics like coughing, gagging, laryngospasm, ease of insertion, patient movements and haemodynamic stability are comparable between the two groups. Prolonged time to jaw relaxation with Sevoflurane when compared to Propofol may delay laryngeal mask airway insertion.

Page No. 626-630

Authors: Radha Korumbil Raghavan, Ushakumary Reghunathan, Bindu Meleveethil, Anis Jassir Meleveettil

Background and Aims: Postoperative analgesia after intrathecal bupivacaine is limited to a few hours. The aim of this study was to assess the effects of intrathecal Neostigmine added to hyperbaric bupivacaine on the onset and duration of spinal anaesthesia and in prolonging postoperative analgesia. Methods: A prospective, randomized double blind study was conducted in 90 patients of ASA grades I and II, in three groups of 30 each, scheduled for lower limb surgeries under subarachnoid block. Patients in Group 1 received 0.5% hyperbaric Bupivacaine 2.5ml (12.5mg) + 0.1ml of sterile normal saline, Group 2 received 0.5% hyperbaric Bupivacaine 2.5ml (12.5mg) + 0.05ml Neostigmine (25mg) + 0.05 ml sterile normal saline and Group 3 received 0.5% hyperbaric Bupivacaine 2.5ml + 0.1ml Neostigmine (50mg). The onset and duration of sensory and motor block, time of two segment regression of sensory block, postoperative analgesia and side effects were studied. Results: The mean onset time of sensory and motor block were comparable in the three groups. The sensory and motor block were prolonged by the addition of Neostigmine, of which adding 50mg Neostigmine was found to be statistically significant (p value <0.001). The visual analog scale (VAS) scores were significantly lower compared to control group upto 4 hours postoperatively in the 50mg Neostigmine group. Conclusions: 50mg Neostigmine is needed to produce significant prolongation of analgesia without significantly increasing the adverse effects, and it reduces the VAS score and analgesic consumption postoperatively.

Page No. 635-639

Authors: Neha Sharma, Nandita Mehta, Shikha Sharma

Background: Transversus Abdomin is Plane (TAP) Block is a regional analgesic technique. It provides analgesia after abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of abdominal wall skin and muscles via local anaesthetic deposition above Transversus Abdominis muscle(TAM). We evaluated efficacy of Bupivacaine and Ropivacaine in Ultrasound guided TAP Block for post-operative analgesia in abdominal surgeries like hernia repair, open cholecystectomy in a hospital based, double blind, prospective, randomized clinical trial. Method: 60 adult patients undergoing elective abdominal surgery under general anaesthesia were included in this study and were randomly divided into two groups according to computer generated table of randomization. After induction of anaesthesia, TAP Block unilateral or bilateral(depending upon nature of incision of surgery) was performed using 15 ml of 0.5% Ropivacaine or 0.25% Bupivacaine each side. Each patient was assessed intra-operatively for haemodynamic parameters like HR, SBP, DBP, MBP and SPO2 at 0, 5, 10, 20 minutes (m) and then after every 10m till the end of surgery. Post-operatively patients were assessed for pain with VAS score at 0m, 30 m, 4, 8, 12, 18 and 24 hours (h) by a blinded investigator. Results: Intra-operatively haemodynamic parameters remained stable and comparable in both the groups. Mean duration of analgesia in Ropivacaine group and Bupivacaine group was 12.61±5.13hrs and 9.92±4.81h respectively, the difference was found to be statistically significant. Conclusion: 0.5% Ropivacaine provided longer duration of analgesia than 0.25% Bupivacaine when used in Ultrasound guided TAP Block on patients undergoing abdominal surgeries. TAP Block via lumbar approach using Ultrasonography provides better pain relief especially in lower abdominal surgeries as compared to upper abdominal surgeries. There were no complications attributable to TAP Block or drugs under study.

324-328

Authors: Alka Kewalramani (Chhabra), Savita Choudhary, Rakesh Kushwaha, Nagendra Prasad Sharma, Sourabh Bhate.

Background and Aims: Etomidate is frequently used nowadays as an inducing agent in patients with compromised cardiovascular function, but it leads to undesirable side effect like myoclonus and pain on injection during induction in unpre-medicated patients. Several drugs are considered alone and in combination, before induction to reduce the incidence of myoclonus. This prospective, randomized study was aimed to compare butorphanol and fentanyl administered before the induction of etomidate to reduce the myoclonic movements. Material and Methods: Sixty patients of ASA I-II, aged 18-50 years undergoing surgeries in general anaesthesia were divided into two groups and pretreated either with intravenous butorphanol 0.02mg/kg and iv midazolam 1mg(Group BM) or intravenous fentanyl 1mcg/kg and iv midzolam(Group FM) followed by induction with etomidate until loss of eyelash reflex. Incidence and severity of myoclonus, pain on injection, apnoea and postoperative nausea and vomiting were noted. Induction dose of etomidate and induction time were observed and compared between the two groups. Results: Study results showed the incidence of myoclonus of grade 1 were 6.7% and 10% in group BM and group FM respectively(p=1.000). The mean dose of etomidate for induction and induction time were found to be 10.00±1.5mg and 32±4.50 seconds in group BM as compared to 12.00±1.8mg and 40±5.00seconds respectively in group FM.(p<0.001) Conclusion: The incidence and severity of etomidate induced myoclonus is reduced by combination of midazolam with butorphanol or fentanyl if administered before induction. Also the dose of etomidate for induction is decreased by butorphanol in combination with midazolam.

335-341

Authors: Aparna G. Kulkarni, Omshubham Asai, Abhimanyu S. Tarkase.

Aims and Objectives: The aim of the present study was to study the effectiveness of co-loading of crystalloid over preloading of crystalloid in prevention of maternal hypotension during spinal anaesthesia for elective caesarean section. Material and Methods: Hundred parturients aged 18-35 yrs undergoing elective caesarean section were randomly allocated in two groups of fifty each. Group P received preload of 20ml/kg of ringer’s lactate solution over a period of 20 minutes before spinal anaesthesia, while Group C received co-load of 20ml/Kg of ringer’s lactate solution at the maximal possible rate by pressurized giving set at the time of administration of spinal anaesthesia. Both the groups received spinal anaesthesia using 2ml of 0.5% hyperbaric bupivacaine at L3-4 level with 23G Quinke’s spinal needle. Blood pressure measurements were recorded in both the groups at 2min interval from the start of the regional block for the first 10 min and then at 5min interval till 30min and thereafter every 15min till the end of surgery. Similarly other parameters like heart rate, SPO2, maximum level of sensory block and APGAR scores were also recorded. Statistical Analysis: Chi-square test was used to find the significance of study parameters on categorical scale between groups. Z test was used to find the significance of study parameters on continuous scale between two groups (intergroup analysis) on metric parameters. Significance was assessed at 5 % level of significance. Any p – value less than 0.05 (p<0.05) and 0.01 (p<0.01) is considered as significant and highly significant respectively. Results: Demographic data was comparable in both the groups. The baseline systolic blood pressure was comparable in both the groups and the difference was not statistically significant. The fall in blood pressure was more in Gr. P than in Gr. C at 5 to 30 min after administration of spinal anaesthesia and this difference was statistically significant. (P <0.05) Similarly the incidence of hypotension was more in Gr. P (72%) than Gr. C (23%) and this difference was also statistically significant. There was no statistically significant difference in the other parameters like heart rate, SPO2 and APGAR score in both the groups. Conclusion: Co-loading of crystalloids lowers the incidence of hypotension than preloading after spinal anaesthesia for elective caesarean section.

347-352

Authors: Jawaharlal Narayansa Irkal, Siddareddy Velayudha Reddy, Venkatayogi Harsha Vardhan, Sama Madhavi.

Context: Despite of prophylaxis, nausea or vomiting is most common in the postoperative period, may leads to unanticipated readmission, prolonged hospital stay and patient’s frustration. Earlier studies have reported conflicting results of dextrose on postoperative nausea and vomiting hence we designed this study. Aim: Testing the role of intravenous 5% dextrose on reducing the frequency of postoperative nausea and vomiting. Study design: A prospective, randomized, double-blind, placebo-controlled study. Methods: In this study, we allocated 90 healthy patients scheduled for tympanoplasty under general anesthesia. The participants were randomized into two groups (n=45) to receive either Ringer’s lactate solution (group C) or 5% dextrose in Ringer’s lactate solution (group D) intravenously following surgery. A standard technique was applied for general anesthesia in all patients and single dose of ondansetron 4 mg was given intravenously half-hour before recovery from anesthesia. Postoperative nausea and vomiting scores, antiemetic doses were recorded at 0, 30, 60, 90, 120 min and 24 hours. The duration of stay in post-anesthesia care unit was also noted. The data recorded were analyzed using student t-test and chi-square test. A value of P <0.05 was considered as significant and 0.0001 was considered as extremely significant. Results: Postoperative nausea and vomiting scores were not different between the groups and non-significant statistically (P >0.05). Conversely, patients in group D consumed less antiemetic doses (P = 0.004), and had a short duration of stay in the post-anesthesia care unit (P<0.0001) when compared with patients in group C. Conclusion: In this study, postoperative dextrose 5% intravenous infusion resulted in improved postoperative emesis management as explained by decrease in rescue antiemetic consumption and post-anesthesia care unit duration of stay.

358-363

Authors: Lalitha Jeenger, Jitendra Jeenger, Suresh Chandra Dulara, Adhokshaj Joshi.

Background Post-operative cognitive dysfunction (POCD) is the subtle cerebral complication temporally seen following surgery. Objectives: To compare the influence of general anesthesia (GA) and of combined spinal-epidural anesthesia (CSEA) upon the early post-operative neurocognitive outcome in elderly (60-70 years) subjects undergoing hip surgery. To measure the impacts of preoperatively hospital stay on POCD. Methods: Total 60, patients were recruited in a prospective, randomized, parallel-group study. They were enrolled and randomized to receive either GA (N= 30) or CSEA (N = 30). All of them were evaluated on the Mini Mental State Examination (MMSE) for their cognitive function and Clock Drawing Test (CDT) for visuospatial function prior to the surgery. The operated patients were re-evaluated 3 days after the surgery on same scales. The data collected were analyzed to assess statistical significance. Results: We observed no statistically significant difference in cognitive and visuospatial function in both the group pre-operatively, which were comparable with respect to age, sex. We found significant cognitive impairment in patients exposed with GA postoperatively 23.33% whereas in CSEA only 6.66%. Visuospatial function was also significantly affected by GA (26.66%) in comparison to CSEA (13.33%). Duration of preoperative hospital stay didn’t affect the neurocongitive functions postoperatively. Conclusions: We observed a positive difference in cognitive outcome with CSEA as compared to GA. Certain aspects of the cognition were affected to a greater extent like visuospatial functioning with exposure to GA undergoing hip surgery.

370-375

Authors: Prashanth Gowtham Raj SK, Bhagyashree Amingad.

Background: The concept of preemptive analgesia had evolved in the recent years. Present days multimodal approach is the most preferred practice for perioperative pain relief, as no single agent is effective in inhibition of nociception without its side effects. Pregabalin originally a spasmolytic, now used as a newer anti-epileptic drug, in the management of generalized and partial epileptic seizures. Its use as a preemptive analgesic in many surgical procedures had proved promising results. Hence the aim of our study was to evaluate efficacy of preemptive pregabalin for prolonging post-operative analgesia, reducing post-operative opioid analgesic requirement and haemodynamic stability. Material and Methods: 80 patients of ASA grade I and II physical status posted for elective modified radical mastectomy were divided into 2 groups of 40 each. Group T –received pregabalin 150 mg orally 1 hour before general anaesthesia. Group C – received identical empty capsules as placebo 1 hour before general anaesthesia. Results: The postoperative VAS scores were significantly lower and duration of analgesia was longer in pregabalin group as to control group. The total analgesic consumption, PONV scores were also lower in pregabalin group. Ramsay sedation scores were slightly higher in pregabalin group but were acceptable clinically. The side effects were similar in both groups. Conclusion: Preemptive 150mg oral pregabalin reduces post-operative pain scores(VAS)significantly, provides longer duration and better quality of post-operative analgesia, reduces opioid analgesic requirement and attenuates haemodynamic response to laryngoscopy, endotracheal intubation and also extubation without increase the side effects when used in optimal doses.

389-399

Authors: Vijay Narayanan S, Mohamed Mubarack A, Iniya R, Rajalekshmi M.

Background: Hypotension after spinal anaesthesia is preventable by adequate pre-loading with colloids or crystalloids. Women posted for emergency caesarean section are more vulnerable for hypotension as they are not preloaded adequately due to time constraints. The idea of the study is to maintain haemodynamics by administering preload solution without any delay. Here 6% Hydoxyethyl starch (HES) is compared with Ringer lactate (RL) as a preloading solution. Materials and Methods: 50 pregnant women posted for emergency caesarean section were randomly allocated into 2 groups – Group H of 25 women received 500 ml of 6% HES and Group R of 25 women received 500 ml of RL intravenously as preload prior to spinal anaesthesia. The requirement of ephedrine to counter hypotension and the changes in the haemodynamic parameters were noted. Statistical analysis was done using Student’s ‘t’ test, Fisher’s test and Chi square test, and p <0.05 was considered statistically significant. Results: The requirement of ephedrine was less in 6% HES group (p <0.001). The haemodynamical parameters were more stable in 6% HES group where there was minimal fall in blood pressure (p < 0.001) and minimal rise in heart rate (p <0.01) compared to RL group. Conclusion: The administration of 6% HES as a preloading solution before spinal anaesthesia in pregnant women undergoing Emergency Caesarean section is superior to Ringer lactate as it causes less incidence of hypotension and requires less ephedrine and intra-operative intravenous fluids.

407-418

Authors: Ramakrishna Reddy Mudiganti, Swathi K, Aruna Subhash T.

Background: Spinal anaesthesia is a popular technique for lower abdominal surgeries for more than a century. Choice of local anaesthetics depends mainly onset, duration, intensity of sensory and motor block and side effects. With time newer local anaesthetics were invented and used to get better analgesia and less side effects. Aim: To study and compare the effects of 0.5% Levobupivacaine with 0.5% Bupivacaine in spinal anaesthesia. Design: Randomised Controlled study. Material & Method: The study includes 100 patients randomly divided into 2 groups of 50 each. Group L patients received 3ml of 0.5% Levobupivacaine (15mg) 5mg/ml.Group B patients received 3ml of 0.5% Bupivacaine (15mg) 5mg/ml. Statistical Analysis: by using SPSS version 20 (Statistical Package for Social Studies), Chi square test, F table, Mean and standard deviation were used. Results & Conclusion: Duration of sensory block and time for first requirement of post-operative analgesia was longer in patients who received 0.5% Levobupivacaine intrathecally when compared to 0.5% Bupivacaine intrathecally. Though there was no statistical significance in terms of onset of sensory and motor block, duration of motor block was less in Levobupivacaine group. Stable haemodynamics and less side effects were observed with Levobupicaine. Hence, Levobupivacaine is a better alternative to Bupivacaine for spinal anaesthes

427-431

Authors: Sambhunath Das, Suruchi Ladha.

Introduction: Laryngoscopy and tracheal intubation is associated with profound adverse hemodynamic changes. Coronary artery disease patients have compromised myocardial blood flow and usually have associated hypertension. If the stress response to tracheal intubation is not controlled, it may lead to severe hypertension, arrhythmias and myocardial ischemia. Dexmedetomidine is a new alpha agonist with high potency to control the stress response, pain and tachyarrhythmia. Hence, impact of dexmedetomidine on hemodynamic parameters during tracheal intubation in coronary artery bypass grafting (CABG) surgery patients was evaluated in the study. Methods: Sixty patients undergoing CABG were enrolled in the study. They were divided into 3 groups. Group 1 received thiopentone 3-5mg/kg, group 2 received thiopentone plus lignocaine 1mg/kg and group 3 received thiopentone plus dexmedetomidine 0.5µg/kg prior to laryngoscopy and tracheal intubation. Heart rate (HR), mean arterial pressure (MAP) and cardiac index (CI) were measured before induction, after anaesthetic induction, at laryngoscopy, and 1min, 3min, 6min and 10min after tracheal intubation. The extra amount of fentanyl and thiopentone required controlling hypertension to laryngoscopy and intubation was noted. The values were analyzed with SPSS 20 software with a P value of <0.05 considered as significant difference. Result: Demography variables of patients were similar among the groups. The values of MAP, HR and cardiac index were similar at base line in all three groups. The increase in the heart rate and cardiac index was less in dexmedetomidine group compared to thiopentone only group (p<0.05) at all-time points. Dexmedetomidine group also had lower rise in MAP after base line in comparison to group 1 and significantly less at laryngoscopy (p< 0.0001). Lignocaine group had better control on hemodynamic changes during intubation compared to group 1, but less attenuation compared to dexmedetomidine group. Group 3 patients required less thiopentone (23.2±27mg vs 52.5±29.1mg vs 107.5±53.8mg, p=0.0001) and fentanyl (26.2±30.8µg vs 58.7±39.9µg vs 108.7±35.6µg, p=0.0001) in comparison to group 1 and group 2. Conclusion: Dexmedetomidine is an effective drug in attenuating the hemodynamic response to tracheal intubation in patients undergoing CABG. Dexmedetomidine reduced the requirement of rescue doses of thiopentone and fentanyl.

439-441

Authors: Sanjeev Bhimashankar Birajdar, Deepa Nijalingappa Allolli, Mujahed Javed.

Introduction: Postdural puncture headache is commonly experienced by parturients especially after caesarean delivery under spinal anaesthesia. The objective of our study was to study the incidence of PDPH in pregnant women with low and high body mass index. Methods: Our study comprised of Group A and Group B of 30 patients each with BMI < 30kg/m2 and > 30kg/m2 respectively undergoing elective caesarean section under spinal anaesthesia. Results: The study was a prospective randomized study in which incidence of PDPH was higher in patients with low body mass index compared to those with high body mass index. Conclusion: Incidence of PDPH was higher in patients with low body mass index compared to high body mass index and the difference was statistically significan

447-450

Authors: K. Hemnath Babu, Shashikanth G. Somani, Sonali Somani, Venugopalan VM.

Objective: To compare efficacy of subarachnoid block with bupivacaine alone and low dose bupivacaine with fentanyl as adjuvant in terms of, onset and duration of anaesthesia and post-operative analgesia. Materials and Methods: Present prospective randomized case control study was conducted in 60 patients undergoing elective caesarean section. They were randomly divided into two groups of 30 each. Subarchnoid block was standardized. Haemodynamic parameters, onset and duration of sensory and motor blockade, post-operative analgesia and side effects (if any) were compared. Data was analysed using student’s unpaired t-test. Results: Onset of analgesia was earlier in Group BF (1.36±1.30min) compared to Group B (1.81±1.61min) which was statistically significant(p<0.05). Duration of two segment regression in Group BF (81.21±9.40min) was significantly prolonged then Group B (62.4±14.81min) which was statistically significant(p<0.05). Duration of sensory blockade in Group BF (124±9.36min) was significantly more than Group B (104.7±6.40min) which was statistically significant(p<0.05). In Group BF, onset of motor blockade was delayed and duration of motor blockade was less as compared to Group B, which was statistically not significant (p>0.05). Postoperative analgesia in Group BF (194±16.82min) was significantly prolonged then Group B (108.57±7.90 min) which was statistically significant(p<0.05). Conclusion: Addition of fentanyl to bupivacaine resulted in faster onset of action and effective spinal anaesthesia with a lower dose of bupivacaine.

455-459

Authors: Suman Chattopadhyay, Ananya Biswas, SK Samim Ferdows, Dilip Kumar Bhowmik, Swagata Dey, Biswanath Bi.

Introduction: Laparoscopic cholecystectomy is associated with an appreciably high rate of postoperative nausea & vomiting (PONV) which is considered as a reason of patient’s delay in discharge and disability aggravation. This study was designed to compare the effectiveness of Ondansetron, Dexamethason and Ondansetron plus Dexamethasone as an antiemetic prophylaxis for preventing PONV in patients after laparoscopic cholecystectomy. Methods: In this randomised double blind study, 153 patients of both sexes of ASA I and II aged between 16 to 60 yrs received 4 mg Ondansetron (Group O, n = 50), 8 mg Dexamethason (Group D, n =51) or Ondansetron 4 mg plus Dexamethasone 8 mg (Group OD, n=52) intravenously immediately before induction of anaesthesia. Perioperative care was standardised in all patients. Patient was then observed for 24 hours postoperatively for any episode of PONV and any adverse effects of the study drugs. Results: A complete response (defined as no PONV and no need for another antiemetic) was achieved in 62% of the patients receiving Ondansetron, 64.7% of the patient receiving Dexamethasone and in 84.6% of patients receiving Ondansetron plus Dexamethasone (P<0.05). The overall cumulative incidences (0-24 hrs) of PONV were 40% in Ondansetron group, 37.3% in the Dexamethasone group and 15.4% in combination group (P<0.05). No difference in adverse events was observed in between group. Conclusion: We concluded that combination of Ondansetron plus Dexamethasone is better than each drug alone as an antiemetic prophylaxis against PONV following laparoscopic cholecystectomy.

468-473

Authors: Swarnalingam Thangavelu, Shankar Anand Radhakrishnan, Nazir Ahmed Mallick.

Background: The pain experienced after upper abdominal surgery leads to a reduction in 70-75% of vital capacity which leads to postoperative pulmonary complications. The ideal adjuvant for epidural analgesia in patients undergoing upper abdominal surgery seems to be every effective for better outcome and early immobilization in the immediate postoperative period. With this background we planned to conduct a study on epidural analgesia by comparing two alpha 2 agonists. Methods: 50 patients who have planned for elective upper abdominal surgery under general anaesthesia were enrolled in our study. Before induction of general anaesthesia, epidural catheterization was done. The surgical procedure was carried out under routine general anaesthesia with endotracheal controlled ventilation. The patients were given either Dexmedetomidine or Clonidine in the dosage of 2mcg/Kg with 0.125% Bupivacaine via epidural catheter after extubation. Patients were shifted to Post Anaesthesia Care Unit for observation. Sedation and pain were assessed with monitoring of vital parameters. The side effects were also noted. Results: Statistical analysis showed that the duration of analgesia was prolonged in the patients who received Dexmedetomidine as an adjuvant with local anaesthetic agent (417.32±67.36 minutes, p value < 0.05). The time to first rescue analgesia was comparatively delayed in Dexmedetomidine group while comparing with Clonidine group (425.6±64.27 minutes, p value < 0.05). The incidence of hypotension and bradycardia was greater in Clonidine group. There was no significant statistical difference with respect to side effects in both groups. Conclusion: From our study we concluded that Dexmedetomidine provides both analgesia and sedation with better hemodynamic status while compared to Clonidine used as adjuvants in epidural analgesia. But needs further study to optimize the dosage of these two adjuvants while giving via epidural route along with local anaesthetic agen

488-491

Authors: Madhuri S. Kurdi, Ashwini H. Ramaswamy.

Research is essential for the growth and development of any medical science. The status of research in developing nations is very primitive mainly because of lack of funds and lack of motivation. India is doing good academic progress and the situation of clinical research in India is nowadays improving rapidly. Training programmes on research methodology are being conducted and multidisciplinary research units are being set up in several medical colleges in India. Several organizations have sponsored the development of short duration modules of mobile research workshops in India. Research publications are a desirable qualification nowadays, for promotion amongst faculty members. This has led to a great enthusiasm amongst faculty members to get their research studies published. This article describes the current status of clinical research in developing nations and discusses the measures undertaken to improve research activities in India.

144-147

Authors: Anil Shetty, Vinaybabu Kurian, Anand Bangera, Nikil M.P.

Background & Objectives: Drugs administered before anaesthesia to decrease anxiety and to obtain a smoother induction, maintenance and emergence from anaesthesia is a part of preanaesthetic medication. Clonidine, a central α2 agonist and Midazolam, a benzodiazepine, are among drugs used as preanaesthetic medication which plays a vital role in producing sedation and reducing anxiety especially in children. Hence, the aim of this study was to evaluate the role of oral Clonidine and oral Midazolam as an ideal preanaesthetic medication in children to produce sedation and reduce anxiety. Methods: A prospective randomised double blind study was done involving 70 children (2-10) years scheduled for elective surgery between the period of January 2014 to July 2015 in Department of Anaesthesia, K.S. Hegde Medical College and Hospital, K.S.Hegde Medical (Affiliated to NITTE university), Deralakatte, Mangalore, Karnataka, India. They were randomly divided in to two groups as group A (Oral Midazolam, 0.5mg/kg) and group B (Oral Clonidine, 4mcg/kg). The drugs were administered to the subjects 45 minutes before induction of anaesthesia and evaluated for sedation and anxiety based on scores as per protocol. Results: Anxiety scores showed a decrease in both Midazolam and Clonidine group with a value of 3.35(p<0.001) and 4.12(p<0.00) respectively. Similarly, sedation scores showed an increase in both Midazolam and Clonidine group with a value of 4.25(p<0.001) and 5.51(p<0.000) respectively. Interpretation & conclusions: Oral Clonidine (4mcg/kg) is a potent and efficacious preanaesthetic medication in children when juxtaposed with oral Midazolam (0.5mg/kg) in producing sedation and reducing anxiety along with analgesic sparing effect.

155-159

Authors: Debaprasad Mohanty, Mahendra Kumar Nayak, Sidharth Sraban Routray, Debasis Mishra.

Postoperative cognitive dysfunction (POCD) is one of the major complications after operation in elderly patients. In various studies it was shown that perioperative blood transfusion was an independent risk factor for development of POCD in aged patients. So, the current study was a comparative study to assess and analyze the effect of liberal transfusion and restrictive transfusion in orthopedic surgery patients. Material & Methods: In a prospective randomized study 80 patients with the age more than 65 years undergoing lower limb orthopedic surgery from November 2013 to October 2015 were included. After all investigations the patients were given combined spinal and epidural anaesthesia. They were divided into two groups – Restrictive group and Liberal group and were given blood transfusion accordingly. The incident of POCD, MMSE score were noted and compared. Observation: We observed that no statistical difference was observed in the groups with respect to age, sex, body weight, ASA grade, level of education, preoperative MMSE scores, length of surgery, preoperative haemoglobin levels, intraoperative blood loss. There was no significant difference for MMSE score at preoperative examination. 17.5% patients in restrictive transfusion group and 20% patients in liberal transfusion group developed POCD. Conclusion: Lliberal transfusion strategy was not superior to restrictive transfusion strategy in terms of a better postoperative cognitive functioning.

165-169

Authors: Dnyaneshwar Ramaji Fating, Ashwini K. Dandekar, N.G. Tirpude.

Background: Laryngoscopy and endotracheal intubation evoke a haemodynamic response leading to increased heart rate and blood pressure. Purpose of present study was to evaluate the efficacy of Nalbuphine for attenuation of haemodynamic response to laryngoscopy and intubation. Methods: 120 patients belonging to ASA Grade I and II, posted for elective laparoscopic surgery under general anaesthesia were included in this double blind prospective randomised study. Patients were randomly allocated in two groups to receive either injection Nalbuphine IV 0.2mg/kg diluted to 5 ml with normal saline (Group N) or 5 ml normal saline (Group C), five minutes before induction. Monitoring of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure was done at laryngoscopy and endotracheal intubation and 1, 3, 5, 7 and 10 minutes after laryngoscopy and endotracheal intubation. Results: Increase in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure in Group N was lower than in Group C. Conclusion: Intravenous Nalbuphine in the dose of 0.2 mg/kg appears to be a promising drug which can be used to attenuate the haemodynamic response to laryngoscopy and intubation.

179-183

Authors: Leena Goel, Megha Goel.

Introduction: Monitored Anesthesia Care (MAC) is proposed to be a suitable technique for middle ear surgery. Aim: In present study we compared the efficiency of dexmedetomidine and propofol as an adjunct to local anesthesia for in producing analgesia, sedation, variation in respiratory and hemodynamic responses, along with patients and surgeons satisfaction. Materials and Methods: Fifty patients were enrolled in this prospective, single blinded, randomized study. The patients were allotted randomly into two groups: dexmedetomidine (Group D) or propofol (Group D). Sedation was assessed with Ramsay Sedation Scale (RSS) value of 3. Different parameters observed included changes in hemodynamic and respiratory values, post-surgical recovery time, sedation analgesia, surgeons’ and patients’ satisfaction about quality of anaesthesia. Results: Both the drugs i.e. dexmedetomidine and propofol were found to be providing adequate sedation but propofol was related with increased need for rescue analgesia and less patient satisfaction. These results propose that dexmedetomidine provide sufficient sedation with analgesia with good surgeon and patient ease without any adverse effect for patients being operated for middle ear surgery under local anesthesia.

191-195

Authors: “Light wand- guided nasotracheal intubation in patients with limited mouth opening: a comparison with blind nasal intubation”

Background and objectives: Approximately 1–3% of surgical patients have difficult airways, which accounts for the most important cause of anaesthesia-related morbidity and mortality. The fibreoptic bronchoscope is considered the gold standard for the management of difficult airways. However, blind nasal intubation remains a basic technique in developing countries, especially in remote areas where a Fiberoptic bronchoscope is not always available. The light wand is a simple, cost effective device, and has become a tool widely accepted in airway management under various clinical scenarios, including difficult airways. The study was conducted to evaluate the efficacy of light wand-guided nasotracheal intubation over blind nasal intubation. Methods: A total of 60 ASA Grade I & II patients of age 18-60 yrs of Body mass index between 18-25 kg/m2 with limited mouth opening (distance between upper and lower central incisors < 3.0 cm) posted for elective surgeries were divided into two equal groups in a randomized, double-blind fashion. Blind nasal group 30 patients Light wand Group: 30 patients Results: The first attempt and overall success rate of light wand guided nasotracheal intubation was 80% and 90% respectively, significantly higher than blind nasal intubation i.e. 50% and 66.66% respectively (p<0.05). The mean intubation time in light wand group was 103±61 seconds and was 155±73 seconds in blind nasal group (p<0.05). There was significantly better haemodynamic stability and a lower incidence of pharyngalgia in lightwand group. Interpretation & Conclusions: The study shows nasotracheal intubation using the light wand to be a more effective and simple approach than blind nasal intubation, with a higher success rate, better haemodynamic stability, and fewer postoperative complications in patients with a known or anticipated difficult airway.

207-213

Authors: Prashanth Kumar C, Chaitra U, Sathyajith Karanth A.

Background: Prolonged post-operative analgesic effect of intrathecal morphine is often limited by its adverse effects. This study was conducted to know the effect of three different doses of intrathecal nalbuphine in reducing adverse effects related with intrathecal morphine. Methods: The study was performed in a prospective, randomized, observer-blind manner. Total of 120 patients were divided randomly into four groups (n=30) to receive 100 micrograms of morphine alone (Group A), 0.5mg(Group B), 1.0mg(Group C), 1.5mg(Group D) of nalbuphine with 100 micrograms morphine. Post operatively patients were monitored for vital signs, SpO2, sedation, pain (VAS), presence of pruritus, nausea and vomiting, respiratory depression and urinary retention for 24 hours. Results: Addition of nalbuphine decreases pruritus, nausea and vomiting in dose dependent manner with maximum effect at 1.5mg. No significant differences observed in vital signs, SpO2, sedation score, pain (VAS) score, duration of analgesia and total dose of analgesia required. None of the patients developed respiratory depression and urinary retention. Conclusion: Present study provides evidence that addition of 1.5mg of intrathecal nalbuphine with 100micrograms of intrathecal morphine completely abolishes opioid induced pruritus and significantly reduces nausea and vomiting without reducing analgesic effect of morphine.

219-223

Authors: Rajneendra Sharma, Seema Partani, Saurabh Bhateja.

Background: Intrathecal neostigmine produces analgesia but its utility is limited by increased incidences of nausea and vomiting. However, epidural neostigmine has been investigated to produce postoperative analgesia without nausea and vomiting. The purpose of the current study was to define the dose range for analgesic effectiveness of epidural neostigmine co-administered with levobupivacaine and side effects in patients after lower limb orthopedic procedures. Patients & Methods: After Institutional Ethical committee approval and informed written consent, 120 patients (n = 30) undergoing lower limb orthopedic surgery were randomly allocated to one of four groups and studied in a prospective way. Patients were randomized to receive either saline or 50, 100, or 150 µg neostigmine in 1ml as adjuvant to Levobupivacaine 0.5%, 20 ml (n = 30 per group), epidurally. Onset and duration of analgesia and motor block was assessed using pin prick, visual analogue scale (VAS) and bromage scale for 22 hrs. peri-operatively. Any side effects were also observed. Results: Groups were demographically the same and did not differ in intraoperative vital characteristics (heart rate and respiratory rate), however there was some protection from hypotension observed in neostigmine 100 and 150 µg group. Addition of neostigmine resulted in significant longer duration of analgesia in group III (490±105.2 mins) and group IV (542±133.6 mins) than control group I (335±101.3 mins). The time of onset of analgesia (7.2 mins versus 9.2 mins in control) and motor block (12.4 and 11.5 mins versus 17 mins in control) was also decreased significantly. Two patients in control and one patient in group III developed nausea/vomiting which was statistically insignificant. There was no other incidence of increased side effects in any group. Conclusion: Co-administration of epidural neostigmine and levobupivacaine appears to be a useful technique for perioperative analgesia as it increases duration of analgesia without increasing side effects.

233-237

Authors: Rakesh Kushwala, Savita Choudhary, Shashank Gupta.

Background: Post-operative pain poses special problems in children. The use of caudal epidural analgesia for post-operative pain relief, either completely eliminates or appreciably reduces the hazards of narcotic analgesics. So, this study was planned to clinically evaluate the efficacy, safety and duration of pain relief following caudal epidural analgesia in children. Materials & Methods: This prospective study was conducted in children from age group 0 to 12 years undergoing perianal and genital surgery after taking permission from institutional ethics committee. Patients with sacral anomalies, skin infection, poor bony land marks, movements and previous operation were not included in study. 1% lignocaine hydrochloride was used with adrenaline in concentration of 1:2000000 for caudal analgesia Children were observed for pain as well as for any untoward effects in post-operative period. Results: In this study caudal block was successful in 48 (96%) cases out of total 50 surgical patients who were recruited during the study period. The duration of pain relief ranged from 265 minutes to 500 minutes. The average duration was 394 minutes. Haematoma and Blood in epidural tap were observed in 4% and 8% cases respectively. Retention of urine was recorded in 4% cases. Pain at injection site was complained by 12% cases. Nausea and vomiting was recorded in 20% cases. Conclusion: It is concluded that caudal block is an efficient and safe method for achieving pain relief of reasonable duration during post-operative period in children.

243-250

Authors: Venkatesan K, Vijay Narayanan S, Iniya R, Rajalekshmi M.

Background: Adequate analgesia following caesarean section decreases morbidity, ambulation, improves patient outcome and facilitates care of the newborn baby. Intrathecal Magnesium, an NMDA antagonist has been shown to prolong analgesia without significant side effect in healthy parturients. We therefore studied the effect of adding intrathecal Magnesium sulphate to Bupivacaine, Fentanyl in patient with mild pregnancy induced hypertension undergoing caesarean section. Aim: To study and compare the effect of added Fentanyl 0.5cc (25 mcg) & Magnesium sulphate 0.1cc 50% (50mg) to 0.5% 2cc (10mg) Bupivacaine, in patients with pregnancy induced hypertension (PIH) undergoing elective Caesarean section under spinal anesthesia. Materials and Methods: 60 patients undergoing elective caesarean section under spinal anaesthesia were randomly divided into three groups. Control group (N=20) received 0.5% 2cc (10mg) Inj.bupivacaine+0.6cc normal saline. Fentanyl group (N=20) received 0.5% 2cc (10mg) Inj.bupivacaine+0.5cc (25micgm) Inj.fentanyl+0.1cc normal saline. Magnesium sulphate group (N=20) received 0.5% 2cc (10mg) Inj.bupivacaine+0.5cc (25mcg) Inj.fentanyl+0.1cc 50% (50mg) magnesium sulphate. Onset, duration and recovery of sensory and motor block, duration of spinal anaesthesia, APGAR score and post operative analgesia duration were studied. Statistical analysis was done using univariate analysis, ANOVA and two group ‘T’ test. p<0.05 was taken as statistically signicant. Results: Onset of sensory and motor blockade were delayed in the magnesium sulphate group which was significant. Duration of spinal anesthesia, motor block duration and post-operative analgesia were also significantly prolonged in Magnesium sulphate group. Conclusion: Addition of magnesium sulphate to intrathecal bupivacaine is beneficial in antenatal women undergoing caesarean section, as it prolongs the motor blockade and duration of analgesia.

257-260

Authors: Rajkumar Ahirwal, Yashwant Dhayjale.

Background: Caesarean deliveries done under spinal anesthesia are associated with higher incidence of post-operative nausea and vomiting (PONV). Aims and Objectives: Present study was performed to find the efficacy of subhypnotic dose of propofol compared to ondansetron and placebo in controlling nausea and vomiting during caesarean delivery under spinal anesthesia. Material and Methods: A randomized placebo controlled study was done on 90 parturient patients at GMC and Hamidia Hospital, Bhopal between May 2013 and December 2013. All the study patients were randomly divided into three groups: Group I (Placebo treated), Group II (1 mg/kg/hr infusion of propofol) and Group III (4 mg of Ondansetron). Emetic episodes (nausea and vomiting) were evaluated using linear numerical scale ranging from 0 (No nausea and vomiting) to 2 (Vomiting). Results: In present study we found that on administration of study drugs incidence of PONV was low (13.33%) in propofol group as compared to ondansetron group (16.66%) (p >0.05). Incidence of PONV was significantly more in placebo treated group (53.33%). Conclusion: Propofol and ondansetron, both were highly effective as compared to placebo in preventing the emetic episodes during caesarean delivery under spinal anesthesia. Moreover subhypnotic dose of propofol was more effective than ondansetron in the prevention of PONV

271-277

Authors: Manoj Kumar N. Gajbhare, Neha P. Kamble.

Background: Spinal anaesthesia for cesarean section has been the preferred technique for majority of anaesthesiologist. Maternal hypotension following spinal anaesthesia remains common place in cesarean delivery. The combination of reduced dose of local anaesthetics with intrathecal opioids makes it possible to achieve adequate spinal anaesthesia with minimum hypotension. Objectives: The aim of our study was to compare the effectiveness of plain bupivacaine with low dose bupivacaine plus fentanyl with respect to sensory and motor blockade, hemodynamic changes, side effect profile and post-operative analgesia after spinal anaesthesia. Material and methods: 60 patients undergoing elective cesarean section under spinal anaesthesia were randomly allocated to two equal groups; Group B patients received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine and Group B + F received 8mg (1.6 mL) of 0.5% hyperbaric bupivacaine plus 20 ug (0.4 mL) preservative free fentanyl. The clinical profile of subarachnoid block in two groups and its effect on maternal and neonatal outcome was studied. Results: The mean time required to reach peak sensory level was earlier in Group B + F. Mean time of two segment regression of sensory analgesia and complete sensory recovery was significantly earlier in Group B. Duration of motor recovery was earlier in Group B +F. Mean maximal heart rate was significantly more in Group B. Mean minimal systolic arterial pressure was significantly less in Group B compared to Group B + F. The duration of effective analgesia was significantly more in Group B + F (235.33+29.15) compared to Group B (120.33+10.98). The incidence of side effects was less in Group B + F than Group B. Conclusion: We can conclude that the addition of low dose fentanyl to 0.5% hyperbaric bupivacaine for spinal anaesthesia in cesarean section provides satisfactory sensory and motor blockade, better hemodynamic stability, less side effects and effective post-operative analgesia.

283-286

Authors: Seema Partani, Rakesh Kushwaha, Rajnindra Sharma.

In this era of modern scientific advancement where automobile industries are reaching new heights and roads are jammed-up with all types of vehicles; accidents form a bulk of cases admitted to trauma ward. Majority of these cases have fascio-maxillary injuries where a proper airway assessment is the most important part of treatment. In this content a retrospective study was done analyzing the case records of sixty patient with fascio-maxillary injuries admitted to our institute over a period of six months. The aim of this study was to find out the difficulties found during management. Majority of patients were in age group of 20-30 yrs and ten patients had some degree of airway compromised and five had associated head injuries. Out of these ten compromised airway, five were managed with change of position, oral suction & use of oropharyngeal airway; while four needed endotracheal intubation in casualty (Fig. 1) and only one required tracheostomy in casualty. 20 patients were intubated via nasal route. Blood transfusion was done for three patients.

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Authors: "Preanaesthetic sedation with intranasal midazolam atomizer versus oral midazolam in paediatric patients” – a randomized comparative study

Background: Separation from the parents and unfamiliar operation theatre environment adds severe anxiety and apprehension to children. Therefore, an effective preanaesthetic medication for use in children undergoing surgery is required. In spite of plethora of research activities, premedication in children remains a controversial subject as various premedication and delivery systems have developed using different routes of administration. Aims and objectives: To compare the safety, efficacy, ease of administration, acceptability, degree of sedation, anxiolysis and parental separation of midazolam by oral and intranasal spray for preanaesthetic sedation. Materials and Methods: Sixty six ASA-I and ASA-II paediatric patients of age group one to ten years, scheduled for elective surgical procedures were divided into Nasal(N) group and Oral(O) who were randomised to receive either intranasal midazolam atomizer spray (0.4mg/kg) or oral midazolam syrup (0.5mg/kg). The demographic details, vital parameters, sedation score, anxiolytic score, separation score and drug acceptability were noted before administering the drug and at 10,20,30 minutes interval till parenteral separation was done. Results: There was statistically significant increase in mean pulse rate at 10 minutes interval in group-N (P< 0.05). Though statistically significant increase in systolic blood pressure(SBP) was noted at all 3 intervals(P<0.05)in group O, statistically significant increase in diastolic blood pressure(DBP) was noted in group O only at 10 minutes of interval (P-value<0.05). Drug acceptability was good in group-O which was statistically significant(P- value <0.001). Sedation and anxiolysis were good in group-N compared to group-O but statistically significant scores were noted at 20 minutes interval (P<0.001, P<0.01 respectively). Parental separation in group-N was better compared to group-O which was not statistically significant. Conclusion: Both the oral and nasal routes were equally safe. The transnasal route achieved faster sedation, anxiolytic and separation scores, virtually complete absorption as compared to oral syrup. Hence it may be preferred as a good alternative to oral midazolam. The oral route was better accepted by children.

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Authors: R. Venkatraman, C.R. Saravanan, P. Ayyanar Sakthivel, Ajay Haridas Poonath.

Background: The cataract surgeries are usually done in elderly patients under monitored anaesthesia care with or without sedation. Dexmedetomidine is a non-opioid sedative and analgesic and is devoid of respiratory depression. The objective of this present study is to evaluate the sedative effects of low dose dexmedetomidine infusion for unilateral cataract surgery. The patient and surgeon satisfaction scores were also recorded. Methods: Sixty patients scheduled for unilateral cataract surgery were randomly assigned to two groups: Group 1 receiving dexmedetomidine 0.5mcg/kg diluted in 100ml normal saline infusion over 15min while group 2 received normal saline. The patients in both the groups received premedication with alprazolam 0.5mg two hours prior to surgery. The hemodynamics, sedation score, patient and surgeon satisfaction scores and any adverse effects were recorded. Ramsay sedation score (RSS) of 3 was kept as a satisfactory sedation for the patient. Results: All the patients in group 1 achieved RSS of 3 while in group 2 only 47% of patients reached the target score. The patient and surgeon satisfaction scores were better with group 1. There was a significant fall in heart rate and blood pressure between 15 and 25 min after dexmedetomidine infusion. In group 1, two patients had bradycardia and four patients developed hypotension which was easily manageable. Conclusion: Dexmedetomidine, when administered as a low dose infusion provides reliable sedation and is a useful anaesthetic adjuvant for monitored anaesthesia care in cataract surgery. The patient and surgeon satisfaction scores were also better with dexmedetomidine infusion.

4-11

Authors: Abhishek Bhuava, Akshaya N Shetti, Vinod Kharde, VK Badhe, Das Divekar

Introduction: Preanesthetic medication forms an integral part of anaesthetic management. Pharmacological and non-pharmacological techniques are tried to achieve anxiolysis and better hemodynamic stability. Clonidine is alpha 2 agonist and acts on central nervous sytem. It is adminstered in various route and oral route is one of them. This study has been designed to study the effect of oral clonidine on perioperative hemodynamics. Aims: To evaluate beneficial effects of oral clonidine in attenuating the haemodynamic responses and comparing with placebo in patients undergoing surgeries under general anaesthesia. Settings and Design: Randomized double blind study. Methods and Material: Two hundred patients were enrolled in this study and studied for 2 years. Randomization was carried out. Four groups, including 50 patients per group were created. Group I (Placebo) received oral tablet ranitidine 150 mg, Group II C2, C3 and C4received oral clonidine 2 µg/kg, 3µg/kg and 4µg/kg body weight respectively. Sedation, anxiolysis and hemodynamic changes were recorded. Statistical analysis used: The statistical significance for categorical variables was determined by chi-square test. For continuous variables two sample t-test was applied. For intra group comparison paired t- test and for inter group comparison unpaired t-test was used. Results were expressed as Mean ± SD (standard deviation). A P value < 0.05 was considered statistically significant. Results: No statistically significant differences concerning demographic data between the groups of patients computed. A significant difference observed with respect to sedation and anxiolysis between all the four groups. The HR response between clonidine (2 µg/kg, 3µg/kg and 4µg/kg) and placebo was very significant at all times (p<0.001) showing a favorable response towards attenuation of HR. The SBP, MAP and DBP response between clonidine and placebo is significant at all times. When compared to clonidine (2 µg/kg, 3µg/kg and 4µg/kg) group the requirement of MAC of Isoflurane in placebo group is higher. Conclusion: Administration of oral clonidine preferably 4µg/kg, as pre-medicant results in improved perioperative haemodynamic stability and Isoflurane sparing effect.

16-19

Authors: Madhavi Ravindra Nishtala, Bhargavi Sanket, Chandrika Yabagodu Ramavakoda

Anaesthesia for laparoscopic pyloromyotomy poses multiple challenges. We have analysed our experience of anaesthetizing these infants by describing the perioperative events statistically in order to improve our anaesthetic technique. Pre-operative records, demographic details, intraoperative and post operative records of all cases of laparoscopic pyloromyotomy performed over a period of 5 years in a tertiary care unit were collected and reviewed. A statistical analysis of demographic details, preoperative clinical features with emphasis on metabolic derangements, adverse events during surgery and in the post operative period was done. We observed a combined intraoperative and post operative complication rate of 20% with no occurrence of mortality. Maximum morbidity post operatively was due to the development of emesis seen in 8 children (7.3%).

27-32

Authors: Sidharth Sraban Routray, Deba Prasad Mohanty, Laxmidhar Dash, Debasis Mishra, Avijit Prusty

Background: There are various ICU scoring systems like APACHE and SAPS II to predict mortality which are done at 24 hours of admission during which precious time is lost in administering therapy. In various studies microalbuminuria has shown promise not only as a predictor of organ failure and vasopressor requirement but also of mortality. Aim: To evaluate the relation between microalbuminuria (urine micro albumin creatinine ratio) and SAPS II score in patients with sepsis and whether it could predict mortality in critically ill patients and the risk of developing multiorgan failure. Methods: In was a prospective, non-interventional study conducted on 64 patients admitted to ICU. Spot urine samples were collected at 6 and 24 hours of admission and were tested for urine microalbumin by immunoturbidometric method and for urine creatinine by Jaffe method and urine microalbumin: creatinine (Urine ACR) ratio was calculated. The urine ACR was co-related with SAPS II score and mortality of the patients. Results: SAPS II score ranged from 13 to 87. Median SAPS II score among survivors were 42.0 and among non survivors were 63.5. Non survivors had a higher SAPS II score compared to survivors (P value=0.0001).Urine ACR 1(urine micro albumin creatinine ratio at 6 hour) was 66.4 μg/mg among survivors and 166.5 μg/mg among non survivors and ACR 2 (urine micro albumin creatinine ratio at 24 hour) was 34.6 among survivors and 151.4 among non survivors (p value = 0.0001). Urine ACR 1 and Urine ACR 2 were correlated with SAPS II score and found statistically significance. Conclusion: The degree of microalbuminuria was more among patients with organ dysfunction than among patients with no organ dysfunction. Significant microalbuminuria is also predictive of organ dysfunction.

36-38

Authors: Vibhuti A. Shah, Vidhi A. Gujjar

Objective: Purpose of the study, is to find out if Non Invasive Ventilation (NIV) failure can be predicted, on the basis of the information available at initial point of a contact with patient. Methods: This is the retrospective study of patients which were admitted to AMC MET Medical College, ShethL.G.General Hospital, Ahmedabad during the years 2014-2015.Patients were assign, to one of the two groups covering the successful NIV treatment & NIV failure. Results: 90 patients were incorporated in the study& two groups were compare on the variables accessible at initial point of contact with patient. Patients in which NIV treatment failed did had elevated levels of the C-reactive protein (p=0.04). Multivariate analysis showed that an odds ratio, of 1.13 for NIV failure; associated with increased respiratory rate. NIV was less likely to fall short in patients with the recognized Chronic Obstructive Pulmonary Disease (p=0.05). Conclusion: In this current study NIV failure, was found to be associated with the elevated levels of the C-reactive protein tended to have the elevated respiratory rates.

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Authors: Manjula Sarkar, Pushkar Desai, Shantaram Pawaskar, Shubhra Sarkar

Background: Acute pain in the perioperative setting is detrimental to post operative outcome and adequate analgesia leads to better outcome. Methods: Sixty ASA I/II patients between 18- 65 years undergoing laparoscopic cholecystectomy and appendicectomy were included and randomly divided into 2 groups. ASA III/IV patients, previous opioid and alpha 2 agonist treatment and patients requiring extensive surgical dissection were excluded. Group D received IV Dexmedetomidine 1μg/kg over 10 min followed by 0.2-0.7 μg /kg/hr and Group P received IV Paracetamol 15 mg/kg prior to extubation. Patients were monitored for hemodynamics and VAS score was assessed after extubation till 24 hours. Rescue analgesia (IV tramadol 1 mg/kg) was given and the time interval till the requirement of first dose of rescue analgesia was recorded. Results: In group D, 12 patients required rescue analgesia as compared to 4 Patients in group P (40% vs13.3%; P=0.02). VAS scores were similar in both groups with group P showing trend towards low score. Median time at which the first dose of rescue analgesia was administered in group P was longer (134.42 + 12.67 vs 82.76 + 9.38 min; P=0.001). Incidence of bradycardia and hypotension was higher in group D (20% vs 3.3%; P=0.04). Conclusion: Paracetamol is a superior to Dexmedetomidine for analgesia in short surgical procedures and should form a part of multimodal analgesia.

52-55

Authors: GV Rao, Jyothsna M

Introduction: Organophosphorus compounds are anti acetylcholinesterases which exert their toxicity by interfering with the normal function of zetylcholine, an essential neuro - transmitter throughout the autonomic and central nervous system. Methodology: The study was conducted at the Respiratory Intensive Care Unit of Department of Anaesthesiology. Prior approval for the study and the protocol was obtained from the institution ethical committee. After explaining the possible prognosis in the course of organophosphorus poisoning, consent from a responsible attendant / informant of the patient was obtained before the actual study was initiated. Results: It’s evident from the above table that maximum number of patients presented with mild poisoning based on the SCE levels (77%) and about 23% had moderate to severe poisoning levels. Conclusion: There was a significant correlation between SCH levels and duration of consumption of OP.

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Authors: Anuradha Ganigara, Chandrika Y Ramavakoda, Bindu, Bhargavi Sanket, Vinay Jadhav, Jayalaxmi Sripathi

Background: Biliary atresia (BA) is a progressive and fatal obliterative cholangiopathy affecting 1 in 10,000 infants resulting in biliary cirrhosis and eventually death within the first two years of life. The first line of treatment is a surgical procedure known as Kasai’s portoenterostomy which aims to restore the forward flow of bile into the intestines. There is paucity of literature regarding perioperative anesthetic management of BA and its outcome. This review was thus specifically done to fill in the dearth with regard to anesthetic challenges and complications met during management of infants with BA undergoing Kasai’s procedure. Materials and methods: Retrospective data of all infants diagnosed and operated for EHBA in our institute from 2011 to 2014 was collected. Perioperative data, anesthetic and surgical details including post operative course of these children were collected and analyzed. Results: The highlights of our series were the delayed presentation of infants with BA at an average age of 85 days which indirectly prolonged the operative time. These infants in early stages of cirrhosis had higher requirements of crystalloid and blood component therapy. Intraoperatively, a decrease in blood pressure was also reflected in the R wave amplitude of ECG which signals further research in the direction of non invasive hemodynamic monitoring in infants. Of significance was the finding of normal intraoperative blood glucose values in infants with EHBA and thus inadvertent dextrose supplementation in all infants with liver dysfunction needs to be avoided. Multimodal analgesia in the form of intravenous opioids, paracetamol, tramadol and judicious local anesthetic infiltration can be used to tackle perioperative pain. Conclusions: In conclusion, when faced with anesthetizing infants with EHBA, the anesthesiologist needs to pay attention to the preoperative assessment like age of presentation, severity of the liver dysfunction and associated congenital and co morbid conditions like anemia and coagulopathy. Goals of anesthetic management would include meticulous maintenance of euvolemia, euthermia, euglycemia and provision of adequate perioperative analgesia and anesthesia.

74-79

Authors: Rajesh Subhedar, Shakuntala Shelke, Rupali Patil, Ajay Subhedar, Vishal Ambre

Introduction: Up till now almost all studies used either single intravenous dose of dexamethasone in perioperative period for post operative pain relief or perineurally in regional anesthesia along with local anesthetic agent to prolong the regional anesthesia. The recent animal studies shown the neurotoxicity of perineurally used injection dexamethasone. This study was planned to evaluate the effect of single dose of dexamethasone in infiltration with local anesthetic agent in day care surgical procedure. Methodology: Cases selection is from ASA – grade I & II patients posted for day care surgical procedure be done under local infiltration anesthesia. The patients are randomly allocated into two groups. Dexamethasone group-GD —25 patients. Control group- GC -26 patients patients were observed for symptoms of perineal itching, effect at the site of local infiltration and PONV. Post operative pain was evaluated half hourly after end of surgical procedure. Pain score is noted by numeric rating scale (NRS) at first pain, after one hour of analgesic and at the time of discharge from the hospital. They were followed up to 7 to 8 days for wound healing and stitch removal. Observation: The average time of first pain was 259.1 min and 120 min in Group D & C respectively. NRS pain score after rescue analgesic in group D was significantly lower than Group C. Amongst Group D four patients did not required any analgesic till the time of discharge on the same day. From Group C four patients needed additional analgesic Itching at the site of local infiltration perineal itching and PONV was not significant. Conclusion-We conclude that addition of injection dexamethasone with injection lignocaine for local infiltration anesthesia delays the requirement of first analgesic significantly. In addition to this the analgesic effect of injection dexamethasone along with injection diclofinac is highly promising.

85-95

Authors: Vijayanand kannabiran, Pushpa rani anand

Introduction: Ropivacaine has a reduced risk of cardiotoxicity, neurotoxicity, and rapid recovery of motor function. Postoperative pain relief is an important issue with Ropivacaine. Dexmedetomidine which is a highly selective α-2 adrenergic agonist with eight times greater affinity for receptors than clonidine decrease the requirements of analgesics and augment the effects of local anaesthetics. Aim and Objective: Compare the analgesic efficacy of intrathecal isobaric 0.75% Ropivacaine with the combination of isobaric 0.75% Ropivacaine and Dexmedetomidine. Study design: A prospective randomized double-blinded study. Sample size: 100 patients were selected and allocated in two groups randomly. Inclusion criteria · ASAI & II · Either sex · 18-60 years for lower limb Orthopaedic surgery Exclusion criteria: · Patient refusal · Patients who had contraindications for spinal anaesthesia · Allergy to local anaesthetics · Cardiac disease · Hypertension Patients were divided into two following groups randomly by lot method. · Group R: Received 3ml volume of 0.75% isobaric ropivacaine and 0.5ml normal saline. · Group D: Received 3ml volume of 0.75% isobaric ropivacaine and 5µg dexmedetomidine in 0.5ml normal saline Observations: Ropivacaine vs. plain 0.75% isobaric Ropivacaine given intrathecally in patients who underwent lower limb orthopedic surgeries.The following observations were made: 1. The addition of 5ug Dexmedetomidine to 0.75% Ropivacaine significantly prolonged the duration of analgesia and the time to demand analgesia. 2. The addition of dexmedetomidine intrathecally produced sedation that was arousable for many hours compared to plain ropivacaine group 3. The incidence of side effects such as hypotension and bradycardia were more in patients who received dexmedetomidine But shivering was greatly reduced in dexmedetomidine. 4. No episode of respiratory depression was noted in both the study groups which are more common with opioids.

102-107

Authors: Megha G H, Kamala G R, Sanjeev G M

Introduction: Alpha-2 agonists are mixed with local anaesthetic agents to extend the duration of spinal, extradural and peripheral nerve blocks. We studied the effect of dexmeditomidine as an adjuvant to bupivacaine in brachial plexus block on onset and duration of sensory and motor block, duration of analgesia, level of sedation, perioperative hemodynamic parameters and complications. Methods: Forty patients of ASA Ι and ASA ΙΙ scheduled for upper limb surgery were included in double blind randomised comparison of inj. Dexmeditomidine and inj. Normal saline. We divided patients in two groups. Group A patients were given inj dexmeditomidine 50 microgm (0.5ml) and group B patients were given inj normal saline in brachial plexus block as adjuvant to 30 ml of local anaesthesic solution containing 14 ml of lidocaine with adrenaline and 16ml bupivacaine. We recorded time of onset and duration of sensory and motor block, level of sedation, duration of analgesia, hemodynamic changes and side effects in both groups. Results: mean time to onset of sensory block was 5.42±1.39 min in group A and 8.34± 1.35 min group B and that of motor block was 11.1± 2.6min in group A and 18.0± 2.9min in group B. Total duration of sensory block was 730.15±78.27min in group A and 360.62±61.7min in group B and that of motor block was 616.2± 54.46min in group A and 288.4± 54.26min in group B. Duration of analgesia was 970.36 ± 80.7 min in group A and 300±40.31 min in group B. Conclusion: addition of 50 microgm of inj dexmeditomidine to bupivacaine in brachial plexus block shortens onset and prolongs duration of sensory and motor block, prolongs duration of analgesia and decreases intraoperative requirement of sedatives.

115-120

Authors: Khaja Ali Hassan, Ahsan Mustafa

Introduction: The descriptive study is to compare this new device, the Laryngeal tube airway with the Laryngeal mask airway in securing the upper airway during short surgical procedures under general anesthesia. Methodology: After obtaining Institutional approval and written informed consent from all patients, 60 patients ASA I/II, aged 20-50 in this study. They were randomly classified into two groups, Group I (LT) and Group II (LMA). Results: The first attempt success rate in securing the airway with LT was 80.0% and the success rate with LMA was 86.6%. The time taken for securing the airway with LT was 37.76 + 5.27 and with LMA was 29.26 + 4.22 sec. Conclusion: Laryngeal tube is superior to LMA in providing a better airway seal.

129-130

Authors: M.P. Nath, Tejwant Rajkhowa, R.K. Bhattacharyya

During general anesthesia polypharmacy is used and all drugs have the tendency to produce allergic reactions leading to anaphylaxis, although rare. Sometimes typical clinical picture of anaphylaxis may not be manifested producing the scenario complicated and if not timely intervened, may be lethal. Propofol (2, 6 di-isopropyl phenol) is commonly used as induction agent in modern anesthesia practice and its anaphylactic incidences being reported1. Here we report a case of Propofol anaphylaxis who underwent functional endoscopic sinus surgery (FESS) didn’t show typical features of anaphylaxis and timely resuscitation lead to complete recovery.

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Authors: Mrunalini Parasa,, Nagendranath Vemuri, Shaik Mastan Saheb, Divya Nayak L, Vidyasagar Ramakrishnan

Temporo mandibular joint ankylosis is an anticipated difficult intubation scenario. Awake fibre optic intubation is the safest approach to secure the airway. Availability of an adequate sized flexible fibreoptic bronchoscope is a prerequisite for successful endotracheal intubation. We report the use of a flexible urethroscope to facilitate nasotracheal intubation in a four years child.