Indian Journal of Clinical Anaesthesia

465-468

Authors: Rakesh Kumar,Amit Sharma*,U Naga Satish

Introduction: Warfare injuries are a special subset of trauma, involving complex injury mechanisms and extensive tissue damage. Theses mechanisms may lead to significant deterioration in lung function even in the absence of any signs of external thoracic injury due to primary or secondary insult on the lungs. The mainstay in the management of these battlefield lung injuries is by initiating mechanical ventilation which either replaces or assists the functions of the respiratory system. Materials and Methods: A retrospective analysis was done from 1st January 2016 to 31st June 2016 of the data taken from the trauma register of our hospital. Data was analysed and the need for mechanical ventilation was correlated with factors like injury severity score (ISS), injury profile and pulmonary and extrapulmonary using confidence interval and Odds ratio. Paired differences were tested using Wilcoxon signed rank test. Results: Of the 528 warfare casualties received a total of 469 patients were enrolled and 94(20.04%) required mechanical ventilation in the immediate post-operative period and another 06 patients needed ventilation in the first 24 hours due to development of fat embolism syndrome. All patients had an ISS of greater than 27(48.9±12.6) as compared to non-ventilated patients (odds 1.1, 95% CI, 0.85-1.45, P=0.42). Conclusion: Acute lung injury is a major cause of increased morbidity in patients with warfare injuries. An aggressive and proactive approach of initiating mechanical ventilation can bring down complications and ICU stays. Injury severity scoring can be used for predicting ALI in warfare casualties. Lung protective ventilatory strategies can enhance patient recovery.

473-478

Authors: Seema Meena,Archana Tripathi*,Mukesh Somvanshi,Surendra Kumar

Introduction and Aims: We compared the safety, efficacy, hemodynamic variation, recovery duration and adverse effects of propofol and etomidate, with or without fentanyl, in patients undergoing dilatation and curettage for incomplete abortions. Materials and Methods: One hundred patients, ASA status I & II, aged 20-50 years, undergoing dilatation and curettage, were randomly divided into four groups of 25 patients each. Group P received propofol 2 mg/kg + normal saline 2 ml for anesthesia induction. Group PF received propofol 2 mg/kg +fentanyl 1mcg/kg to make volume 2 ml for anesthesia induction. Group E received etomidate 0.2 mg/kg + normal saline 2 ml for anesthesia induction and Group EF received etomidate 0.2 mg/kg + fentanyl 1 mcg/kg to make volume 2 ml for anesthesia induction. Heart rate, arterial pressure and SpO2 were recorded at different time intervals. The recovery time, pain on injection, myoclonus and postoperative nausea vomiting were also recorded. Results: During induction, mean arterial pressure fall significantly in both propofol groups. Amongst four groups, there was no significant difference observed in recovery time after anesthesia. The incidence of pain on injection was lower in etomidate groups. Myoclonus and Postoperative nausea and vomiting were significantly higher in etomidate groups. Conclusion: This study demonstrates that etomidate is superior in term of hemodynamic stability and less incidence of pain on injection. Etomidate combined with low dose fentanyl is more favourable than etomidate alone for attenuating myoclonus.

486-490

Authors: Lalit Kumar Raiger,Gokulakrishnan L,Madhan Chandramohan,Apoorva Aseri,Ravindra Kumar Gehlot*

Introduction: The pressor response during laryngoscopy and intubation is part of a huge spectrum of stress response, results from the increase in sympathetic and sympatho-adrenal activity. The present study was planned to observe the attenuation of pressor response during laryngoscopy and intubation with dexmedetomidine and fentanyl; also to compare the effectiveness between these two drugs. Materials and Methods: In this study we include 128 patients, of ASA grade I- II, aged 18- 65yrs, of either gender, scheduled for elective surgery under general anaesthesia. Groups: Group D – Dexmedetomidine (0.6µg/kg) and Group F – Fentanyl (2µg/kg), these drugs diluted with NS to make 10 ml, given I.V. slow over 10 min. Vital parameters (HR, SBP, DBP and MBP) were recorded as baseline, then at 10 minutes after pre-medication and then at 1,2,3,5,7 and 10 minutes after endotracheal intubation. Results: There was significant increase in heart rate, systolic blood pressure and diastolic blood pressure during laryngoscopy and intubation in group F as compared to group D (p<0> Conclusion: Dexmedetomidine (0.6mcg/kg) is superior to fentanyl (2mcg/kg) in the attenuation of the pressor response and that the ideal time for its administration should be about 10 minutes before a laryngoscopy and intubation.

496-500

Authors: Veena Mathur,Pooran Chand Trivedi,Deepak Kumar Garg*,Arvind Khare,Surendra Sethi

Introduction: Sevoflurane, a popular inhalational anaesthetic agent for paediatric anaesthesia is associated with high incidence of emergence agitation (up to 80%). This study aims to evaluate the effects of intraoperative dexmedetomidine on incidence and severity of emergence agitation (EA) in children after tonsillectomy with or without adenoidectomy under sevoflurane anaesthesia. Materials and Methods: This prospective, randomized double blind study included 70 patients aged 2-10 years with ASA physical status I and II who were randomly allocated into two groups. Group D (n = 35) received intravenous dexmedetomidine 0.3 µg/kg and Group C (n = 35) received normal saline, both given post intubation over 10 min. After extubation, emergence agitation (EA) was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) score, the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for evaluating postoperative pain and modified Aldrete score for PACU discharge time were noted. Results: Demographic profile was comparable between two groups. Incidence of emergence agitation was significantly less in Group D than Group C (20% vs 42.86%). Postoperative pain was significantly less in Group D in comparison of Group C (14.3% vs 37.15%). Emergence time, extubation time and PACU discharge time were significantly longer in Group D in comparison to Group C (8.1 ± 1.4 vs 7.1 ± 1.4 min, 9.06 ± 1.59 vs 8.06 ± 1.39 min and 23.1 ± 7.6 vs 18.1 ± 8.2 min respectively). No complications were observed between two groups except vomiting. Conclusion: Dexmedetomidine 0.3 µg/kg) given intravenously just after intubation may be considered as an effective drug to reduce emergence agitation after sevoflurane anaesthesia in children undergoing tonsillectomy with or without adenoidectomy.

505-511

Authors: Madhu S*,Balarama Reddy P,Vikas P Savdi,Ramadas K T

Aims: Hemodynamic changes caused by laryngoscopy, endotrachial intubation and creation of pneumoperitonium in laparoscopic surgeries is deleterious to patients. This study was done to compare nalbuphine an agonist antagonist opioid with fentanyl, a gold standard opioid, when used in patients undergoing laparoscopic appendectomy under general anesthesia. Materials and Methods: This study included 60 ASA I patients who underwent elective appendectomy were randomised to receive either nalbuphine 0.1mg/kg or fentanyl 2µg/kg as analgesics 5 minutes prior to intubation. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at baseline and at every 2 minutes post intubation till the end of surgery. The time of laparoscopic port insertion and creation of pneumoperitonium was noted. Independent student‘t’ test and chi square test was used to analyse continuous variables and categorical variables respectively. Results: The changes in heart rate were comparable between both groups at all time points of observation. Nalbuphine and fentanyl group showed an increase in heart rate of 3.81% and 6.03% respectively. Mean arterial pressure was comparable at all time points of observation except at the time of insertion of second port wherein fentanyl group showed 12.70% increase as compared to 4.54% fall from baseline in nalbuphine group. Side effects were comparable between both groups except sedation which was significantly more in nalbuphine group and pruritus more in fentanyl group. Conclusion: Nalbuphine due to its availability without license is an effective alternative to fentanyl in laparoscopic surgeries.

518-522

Authors: Muni Ram Meena,Hemraj Tungria,Garima Tyagi*,Anisha Banu,Lalit Kumar Raiger

Introduction and Object: Fentanyl and clonidine mostly used as adjuvant to improve quality and duration of nerve block. In present study we compared clonidine and fentanyl perineurally and systemically in Supraclavicular Brachial plexus block. Materials and Methods: Sixty eight patients were randomly assigned into four equal groups, scheduled for upper limb surgery. They received the drugs in Supraclavicular block and intravenous route as below: Group A: 24 ml 0.75% ropivacaine + 1 ml fentanyl (50µg/ml) + 5ml normal saline in block and 1ml normal saline intravenously. Group B: 24 ml 0.75% ropivacaine + 6ml normal saline in block, and 1ml fentanyl (50µg /ml) intravenously. Group C: 24 ml 0.75% ropivacaine + 1ml clonidine (150µg/ml) + 5ml normal saline in block, and 1ml normal saline intravenously. Group D: 24ml 0.75% ropivacaine +6ml normal saline in block, and 1ml clonidine (150µg/ml) intravenously. Results: Onset of sensory and motor block was significantly earlier in Group C (12.47±2.57 min & 18.00±3.46 min) than in Group A (14.65±3.41 min & 19.94±2.61 min) respectively (p<0>0.05) between Group A (7.41±0.94hrs) and Group B (7.35±0.93hrs) while it was prolonged in Group C (8.94±0.97 hrs) than Group D (8.12±1.22 hrs) (p<0> Conclusion: Fentanyl perineurally or systemically administered have comparable results while perineural clonidine offered prolonged duration of analgesia better than when it was used intravenously suggesting its local action.

529-537

Authors: Deepak Devendran,Karthik Jain M*,Vasudeva Upadhyaya K.S

Introduction: Use of endotracheal tube (ETT) has many limitations. There is a need for an airway device with similar safety and good side effect profile. In this prospective observational study, the oxygenation and ventilation parameters between patients who were inserted Proseal laryngeal mask airway (PLMA) or ETT for laparoscopic surgeries were compared. Materials and Methods: After ethical committee approval, informed consent was obtained from sixty patients (thirty in each group) posted for elective laparoscopic surgery. Following induction of general anaesthesia and paralysis, PLMA or ETT was inserted and pressure control mode was used for ventilation. The following parameters were measured: a. Oxygen saturation and changes in FiO2 needed to ensure a target SpO2> 95%, EtCO2 and changes in respiratory rate and inspiratory pressure needed to ensure a target EtCO2 between 35-45 mmHg. b. Insertion characteristics of airway device and gastric tube, hemodynamic responses, incidence of complications. Statistical Analysis: Chi-square test was used to analyze qualitative data. Independent t test was used to assess quantitative variables. Repeated measures ANOVA was used to compare the outcome measures over time adjusted for duration of surgery and anaesthesia. P values<0> Results: Both groups were comparable with respect to age, gender and weight. Oxygenation and ventilation parameters achieved with both ETT and PLMA were comparable and satisfactory. Haemodynamic parameters increased significantly in ETT group compared to PLMA group during airway insertion and removal. Also, postoperative sore throat was comparatively less in the PLMA group. Conclusion: Hence we conclude that PLMA may be considered as an alternative to ETT in airway management of patients undergoing laparoscopic surgeries with comparable oxygenation and ventilation parameters and improved side effect profile.

543-548

Authors: Shibani Padhy,Kavitha Jayaram*,Sindhuja Priyanka

Introduction: Conventional laryngoscopy using the traditional Macintosh blade remains the commonest method of tracheal intubation in the routine clinical scenario. Video laryngoscopes have taken over this position in many scenarios as they have been proved successful over conventional laryngoscope. There are several types of video laryngoscopes available with multiple advantages over one another. We aimed to compare the performance of the Airtraq and McGrath when performing tracheal intubation in routine anaesthesia practice. Materials and Methods: Sixty patients posted for surgery requiring endotracheal intubation were randomized to undergo intubation using an Airtraq (n=30) or McGrath (n=30) video laryngoscope. Primary end points were total duration of intubation, overall success rate of tracheal intubation, number of optimization manoeuvres used and ease of intubation between the two groups. Results: We observed that the duration of successful intubation was shorter in Airtraq 19.18 (±2.86) secs) than in the McGrath laryngoscope.27 (±5.09) secs)* P < 0>A significantly better Cormack lehane view was obtained with the Airtraq. Grade I in 73.3% with the Airtraq group versus 50% in the McGrath group, p<0> Conclusion: We conclude that the Airtraq laryngoscope facilitates a more rapid and successful intubation as compared to McGrath in routine clinical practice.

556-560

Authors: Alpa Patel,Nitin Choudhary*,Utpala Kharod,Vikash

Introduction: Continuous femoral analgesia provides extended pain relief for surgeries over thigh. Successful continuous peripheral nerve analgesia depends on catheter proximity to the target nerve and stimulating catheters may allow more accurate placement of catheters. Hence we conducted a study to compare the efficacy of stimulating nerve catheter and non stimulating nerve catheter in femoral 3-in-1 nerve block for postoperative analgesia. Materials and Methods: 60 ASA grade I & II patients of either sex between 18 to 65 years of age posted for total knee replacement surgery were randomly allocated into two groups: Group SC (stimulating catheter) and Group NSC(non stimulating catheter). All patients received subarachnoid block and after completion of surgery femoral catheter (stimulating/non stimulating depending on the group) was placed using peripheral nerve stimulator for postoperative analgesia. When spinal level regressed to T12 dermatomal level, Inj.Bupivacaine (0.25%) 20ml with Inj.Lignocaine (1%) 10ml was given. The patients were followed for next 24 hours from the time of first bolus. After the 1st bolus when the VRS score was ?3, intermittent boluses of Inj.Bupivacaine (0.25%) 15 ml with Inj.Fentanyl 0.5µg/kg were given. All patients received Inj. Paracetamol 20 mg/kg IV 6 hourly. In case patient still had VRS score ?3 then rescue analgesia in the form of Inj.Diclofenac sodium 1 mg/kg IV was given. Two groups were observed for total duration of sensory block (time from 1st bolus dose till the time VAS score was ?3); requirement of analgesic solution; requirement of rescue analgesia; and any complication or side effects. Results: Total duration of sensory block in group SC was 9.40±0.21 hours compared to 7.10±0.23 hours in group NSC (p=0.0001). Total requirement of analgesic solution was less in SC group in comparison to NSC group. No significant complication observed in either group. Conclusion: Stimulating nerve catheter provides longer duration of sensory blockade with decreased requirement of local anaesthetic solution and opioid when compared to non stimulating nerve catheter.

566-568

Authors: Ratan Pal Singh,Megha Arora*

Introduction: Sedative protocols are a topic of current research, especially for establishment of extensive monitoring systems for sedative agents. Bispectral index (BIS) is one of the main indicators for measuring the anaesthesia depth. Hence; present study was planned to comparatively assess the dose requirement of propofol with and without bispectral monitoring in patients scheduled to undergo spinal epidural anaesthesia. Materials and Methods: We planned the present research to comparatively assess the dose requirement of propofol with and without bispectral monitoring in subjects scheduled to undergo spinal epidural anaesthesia. For the present study, we evaluated a total of 60 patients and broadly divided them into group 1 and group 2, based on the absence and presence of BIS monitoring respectively. We maintained and compiled the complete demographic, clinical and anaesthetic data of all the patients and analyzed the results by SPSS software. Results: While comparing the average time needed for reaching the adequate level of sedation in between the two study groups, significant results were obtained. We also obtained significant results while comparing the average recovery time in between subjects of both the study groups. Conclusion: For assessing the level of sedation in regional anaesthesia cases, BIS monitoring should be done.

576-581

Authors: Anil Kumar M R,Sarika M Shetty*,Meghana Marulasidappa,Prashanth Parmar,Vyshnavi S

Introduction and Aim: Supraglottic airway devices are safer alternatives to endotracheal intubation during general anaesthesia. The recently introduced Baska mask is a third generation supraglottic airway device available now in India. As there are no studies about Baska mask published in India, this study was undertaken to evaluate the efficacy and safety of using the Baska mask in patients with no predictors of difficult airway. Materials and Methods: Hundred patients belonging to American society of Anesthesiologists physical status class I and II with no predictors of difficult airway undergoing elective surgery under general anaesthesia were included for the study. The patients were classified as normal and overweight depending on the body mass index (<25>2 – normal and >25 kg/m2 - overweight). The ease of successfully securing the airway with the device was evaluated using the time, the number of attempts and ease of insertion. The correct placement was confirmed by fibre-optic assessment using the Brimacombe scoring system. The airway sealing pressure and leak fraction were estimated. Complications like airway trauma, sore throat, dysphagia and dysphonia were noted after removal. Statistical analysis was done using SPSS software version 22 and assessed by t-test and chi square test. Results: Mean time of insertion was 9.7±1.9sec. In 97% (n=97) of patients the mask was placed successfully in the first attempt. Airway sealing pressure was 42.46±19.11 cmH2O and the leak fraction was 8.81±0.03%. Effective ventilation was present in all grades of Brimacombe scoring. Minimal postoperative airway trauma and sore throat were noticed. Conclusions: Baska® mask is an effective supraglottic airway device which is easy to insert, provides good ventilation and has minimal complications.

591-595

Authors: Yogendra Singhal,Udita Naithani*,Seema Partani,,Lalit Kumar Raiger,Vikram Bedi

Introduction: To avoid adverse effects of general anaesthesia, regional anaesthesia (RA) techniques are increasingly being practiced in children for different surgeries. These RA techniques are often combined with moderate degree of sedation to remain child calm and immobile. With limited literature available, we planned a prospective study to evaluate the effectiveness of dexemedetomidine as an intraoperative sedative agent with RA considering its short term sedation and least respiratory depression property. Materials and Methods: Fifty children of 1-8 year of age, ASA grade 1&2 undergoing below umbilical surgery under RA (caudal epidural anaesthesia) were selected and studied. After giving Inj. Ketamine (1mg/kg) intravenously, RA was performed with Inj. Bupivacaine. Then inj. Dexemedetomidine (1mcg/kg) IV was administered as bolus over 10 min followed by continuous infusion (0.4 mcg/kg/hr) till completion of surgery. Perioperative sedation score, vital parameters, peripheral oxygen saturation, respiratory rate and surgeon's satisfaction were observed. The Study was considered complete till stay of patient in PACU for 2hrs. Recovery time and any complications were noted. Results: The quality of sedation and surgeon's satisfaction were good in all children except three children who needed extra dose of sedative. The only adverse effects reported were bradycardia and hypotension in 3 patients which were well managed by reducing the infusion rate. Conclusion: Dexemedetomidine offers an adequate level of sedation in most of the children without haemodynamic or respiratory side effects when used intraoperatively with RA.

603-608

Authors: Tarang Jain*,Lalit Gupta,Manoj Bhardwaj

Introduction and Aims: Airway management in a patient with cervical spine injury is considered a challenge. Minimizing neck movement and maintaining head in neutral position is essential to prevent secondary neurological injury. Flexible fibreoptic intubation causes minimal cervical spine movement. In this study, we evaluated and compared orotracheal and nasotracheal flexible fibreoptic intubation in a patient with simulated cervical spine injury (using a cervical collar), under conscious sedation. Materials and Methods: Sixty patients were randomly allocated into oral and nasal groups. After premedication and preperation with Xylometazoline nasal drops and lignocaine nebulization, bolus fentanyl and propofol infusion was started to achieve concious sedation. Flexible fibreoptic intubation was performed orally or nasally, after placement of a cervical collar. Operator ease and hemodynamics were monitered. Result: In the oral group, 86.7% and in the nasal group, 93.3% first attempts were successful. The ease of fibreoptic intubation was graded to be excellent in a significantly greater number of patients in the nasal group as compared to the oral group. Hemodynamic variability though present was not clinically relevent, this might have been secondary to use of adequate sedation. Conclusion: The ease of fibreoptic intubation in simulated cervical spine injury, under conscious sedation was found to be significantly better in the nasotracheal group. Hemodynamic stability was demonstrated in both the groups in our study.

614-619

Authors: Rakhee S,Shalini Miriam Ipe*,Saramma P. Abraham,Shaloo Ipe,Sam Philip

Introduction and Aim: Ropivacaine and bupivacaine have been found to provide adequate labor analgesia when given epidurally. The aim of this randomized double blind study was to compare the onset of sensory block in epidural ropivacaine and bupivacaine with Fentanyl for labor analgesia and to assess the maternal and fetal outcome. Materials and Methods: In this prospective double blind study, 60 ASA II parturients with singleton vertex presentation were randomly allocated to two groups of 30 each. Group R received 5 ml 0.2% ropivacaine with 50mcg Fentanyl as bolus, followed by continuous infusion of ropivacaine 0.1% with Fentanyl 1 mcg/ml at 6 ml/hr. Group B received 5 ml 0.125% bupivacaine with 50 mcg Fentanyl as bolus, followed by continuous infusion of bupivacaine 0.0625% with Fentanyl 1 mcg/ml at 6 ml/hr. Onset and regression of sensory level, degree of motor block, hemodynamic effects, mode of delivery, neonatal outcome and patient satisfaction were compared. The statistical analysis was done using the Mean, Standard Deviation and the student ‘t’ test. Results: There was a significantly faster onset of sensory block with ropivacaine (5.67±0.99min) compared to bupivacaine (6.67±1.39min) (p <0> Conclusion: Ropivacaine provides effective analgesia with faster onset of sensory block in comparison to bupivacaine and is safe for mother and fetus.

625-626

Authors: Karen Ruby Lionel,Ajay Prasad Hrishi*

High airway pressure’s post intubation is a critical event which requires the urgent intervention of the attending anesthesiologist. We report a case of high peak pressure and plateau pressure after intubation which was actually due to the kinked scavenging tubing of anesthesia workstation. Many a times this may happen, but is missed by even the experienced anesthesiologist who attribute the high airway pressures to change in the lung compliance of the patient or faulty equipment and will immediately respond with therapeutic intervention or replace the workstation/ventilator. A systematic evaluation of the lungs as well as the function of the ventilator along with the scavenging tubing’s, a commonly missed entity is mandatory in each case.

306-310

Authors: Harpreet Kaur,Veena Shukla*,Ranjana Khetarpal,Magila Muthuramalinga Pandian

Modern medicine involves highly specific and sophisticated techniques and equipments. However, human errors as well as equipment failure may lead to fatal accidents an increase in the cost of health care. Using checklist as tool for surgical safety involves safe anaesthesia, maintenance of open airway, correct surgical site, infection control and efficient communications and team work. Although no checklist is universal or guarantees absolute safety, an effective checklist has a patient centered approach and keeps patient safety and comfort a priority.

321-326

Authors: R Anitha Preethi,A Pushparani*

Introduction: Hemodynamic instability during pregnancy may compromise the blood flow to the uteroplacental bed which may lead fetal acidosis. We compared ephedrine and phenylephrine on fetal outcome and hypotension during elective cesarean section. Aim: To compare the effectiveness of ephedrine versus phenylephrine in fetal outcome and the treatment of fall in blood pressure during subarachnoid block for elective cesarean section. Materials and Methods: Study Design: Prospective, randomized, double blind. Based on inclusion and exclusion criteria 50 patients were selected and divided into two equal groups. All patients were done under subarachnoid block as per routine in our hospital. Group E received Ephedrine 6mg if >20% fall in the heart rate and systolic blood pressure from the baseline. Group P received phenylephrine 20mcg as increments if>20% fall in the heart rate and systolic blood pressure from the baseline. Results: Both the groups were comparable with regard to the fetal outcome (Apgar score and fetal umbilical vein ABG). Nylephrine group showed statistically significant fall in heart rate and systolic blood pressure when compared to the Ephedrine group during the first 20minutes. After 25th minute both the drugs were comparable. Conclusion: Both the drugs were comparable with respect to the fetal outcome and maternal hemodynamics in patients undergoing elective cesarean section under subarachnoid block.

327-333

Authors: Chhaya M Suryawanshi,Rajan Kumar*,Rachna Wadhwa

Introduction: Laryngoscopy and endotracheal intubation are noxious stimuli capable of producing tachycardia, arrhythmias and hypertension. This study was being done to compare the effectiveness of a pre-induction dose of clonidine with dexmedetomidine administered by intravenous infusion inattenuating the haemodynamic stress responses resulting from laryngoscopy and endotracheal intubation. Materials and Methods: Sixty adult patients included in this study were randomly divided into two groups, namely, Group A (Clonidine 4 mcg/kg) & Group B (Dexmedetomidine 1 mcg/kg) using computer generated random allocation chart and haemodynamic parameters were analyzed and recorded quantitatively from preoperative period to 30 mins post – intubation period. In the immediate post operative period and 2 hours after surgery, patient’s recovery was assessed with ALDRETE recovery score and BRUSSEL’S sedation score. Results: Mean heart rate showed fall following dexmedetomidine or clonidine infusion (19% and 23% respectively from the baseline) which was clinically significant in clonidine group but was statistically not significant in both the groups (p>0.05), while the increase in Mean heart rate following intubation was 8% and 10% respectively. In the current study, there was fall in blood pressure following infusion of study drug which was clinically not significant.Following tracheal intubation, maximal average increase was 5% in systolic and 3% in diastolic blood pressure in dexmedetomidine group, as compared to clonidine group in which, it was 6% and 4%, respectively. Isoflurane consumption, propofol requirement and opioid requirement throughout the intraoperative period was reduced in both the Groups. Aldrete recovery score and Brussels sedation score were calculated and found better in group B as compared to group A. Patients were sedated but arousable. Conclusion: Based on our study we conclude that both clonidine and dexmedetomidine are equally effective in attenuating the pressor response caused by laryngoscopy and tracheal intubation.q

341-347

Authors: Ashwini H,Seema Kumari K*,Lavanya R

Introduction: Post-operative sore throat is one of the most common complications following endotracheal intubation. Though considered minor complication, it may cause significant patient dis-satisfaction. Various non-pharmacological and pharmacological trials have been used with variable results. Objectives: To compare the efficacy of nebulised dexamethasone with that of nebulised magnesium sulphate in decreasing the incidence and severity of postoperative sore throat (POST). Materials and Methods: In this prospective double blind study 90 patients undergoing surgery under general anaesthesia with endotracheal intubation lasting <3hr> Results: Compared to group M, significantly lesser number of patients in group D had post-operative sore throat at 0hr (p= 0.0262), 4th hr (p=0.00022), 8th hr (p=0.00039) and 12hr (p=0.000657). None of the patients in group D had any hoarseness of voice at 0hr, 4th hr, 8th hr of assessment (p= <0> Conclusion: Preoperative dexamethasone nebulisation just before induction of anaesthesia is an effective method of reducing the incidence and severity of POST following endotracheal intubation. Dexamethasone nebulisation reduces the severity of sore throat more effectively than magnesium sulphate nebulisation.

354-360

Authors: Soma Ganesh Raja*,Gowri Shankar Sarate

Use of an effective sedative premedicant significantly minimizes the emotional trauma associated with perioperative anxiety and its sequelae. Currently, oral midazolam is the most commonly used premedicant in most of the countries followed by oral ketamine. Aims and Objectives: To compare the efficacy and safety of oral ketamine and oral midazolam as premedicant for paediatric cardiac catheterization. Materials and Methods: This study was carried out in the tertiary care centre in sixty patients randomly assigned into two groups of thirty patients each, to compare the efficacy of oral ketamine and oral midazolam pre medication as sedative for paediatric patients undergoing cardiac catheterization using various parametes and observation scale of response and Visual Analogue scale. Data collected was analysed and the statistical significance of these intra-group and inter-group observations thus made was determined using either a ‘Chi Square test’ or an ‘Unpaired T-test’ or Mann whitney test. Results: The demographic trends in all the groups were comparable. The type of procedure performed were also comparable in both the groups. The mean heart rate, mean systolic and diastolic blood pressures, mean arterial blood pressure were higher in the ketamine group than in the midazolam group. Though there was fall in oxygen saturation in both the groups the ketamine group required oxygen supplementation more than midazolam group though it was statistically insignificant. The mean onset of sedation was earlier for midazolam than for ketamine. Also the parental separation was smoother and calmer in patients who had oral midazolam than oral ketamine. Similarly while positioning the children for cath study also patients medicated with midazolam showed better response than those medicated with ketamine. The response to local anaesthetic injection during femoral vessels cannulation also showed midazolam with better results. The adverse effects such as secretions, nystagmus, nausea, vomiting, delirium were more common with ketamine. The mean time spent in recovery was 53.33 minutes with ketamine group and also parental satisfaction in terms of VAS score is better and favours midazolam than ketamine. Conclusions: Oral midazolam is a better premedication of choice than ketamine for paediatric patients undergoing cardiac catheterization.

368-372

Authors: Rashmi H D,Hanumanthappa V. Airani*

Introduction: Among the depolarizing muscle relaxants, Succinylcholine is the widely used depolarizing agent until today in anaesthesia practice. Side effects like hyperkalemia, fasciculations, myalgia, increased intracranial pressure and intraocular pressure are common with the use of this drug. Pretreatment with various drugs have been proven to lessen these side effects. In our study, low dose of oral pregabalin was used as a premedication to assess its effects on the incidence and severity of fasciculations and postoperative myalgia caused by Succinylcholine administration. Materials and Methods: 60 patients of either gender undergoing elective ENT surgeries under general anaesthesia were randomly allocated to two groups of 30 each. Patients in Group PG (pregabalin group) received 75 mg of pregabalin orally 1 h prior to surgery and patients in Group CG (control group) received matching placebo. Fasciculations and myalgia grading was done by a blinded observer. Haemodynamic variables were measured at regular intervals. Results: Both groups were comparable in regard to Demographic data (p > 0.05). We didn’t find any significant difference in the fasciculations incidence (p=0.702) and myalgia incidence (p=0.081) between the two groups. But the severity of fasciculations is statistically significant between the groups (< 0>P < 0> Conclusion: Low dose oral pregabalin- 75 mg decreases the severity of succinylcholine-induced fasciculations and myalgia. There is not much effect on the incidence of fasciculations and myalgia in patients undergoing elective ENT surgeries.

378-382

Authors: Shipra Singh,Suruchi Ambasta*

Introduction: Critically ill patients are prone to develop malnutrition which is a major contributory factor to the already existing burden of morbidity and mortality. Early nutrition support is an effective therapy to prevent malnutrition when patients are unable to take oral nutrition. Aim: To determine the effectiveness of a nutrition support protocol versus non-protocol management on initiating nutrition support in ICU patients. Materials and Methods: This randomized controlled study was conducted on fifty critically ill patients on mechanical ventilation with twenty five patients in each group. Nutrition protocols were followed in Group I patients and group II comprised of nonprotocolised patients. Results: Hospital stay for group I patients was 22.7 days while group II patients stayed for 31.9 days (p-value <0> Conclusion: Patients in whom nutrition support protocols were followed received enteral nutrition earlier, had early weaning from ventilator, spent less time in ICU as well as hospital and had lesser complications with low mortality.

389-393

Authors: B Sanjeev Kumar,Pratheeba N*,Remadevi R,Ravindra Bhat R,Senthilnathan M

Introduction: The potential long-term complication of intraoperative awareness needs to be addressed. These complications range from mild auditory perceptions to being fully awake. Studies with prospective patient interviews that specifically inquire about awareness have noted an incidence of 0.1 to 0.2 percent in the general population and approximately 1 percent in high-risk populations. Aims and Objectives: Comparative evaluation of two dose regimens of propofol to assess the depth of anesthesia during total intravenou anesthesia using Bispectral index monitor. The objectives were to find the average Bispectral index during propofol anaesthesia, compare and determine, in two groups, the amount of additional bolus or reduction in the infusion rates of propofol in two dose regimens and to correlate the Bispectral indices with hemodynamic monitoring and to assess incidence of postoperative awareness in the two groups. Materials and Methods: This study was conducted as a prospective randomized double-blind study in a teaching hospital. After the approval from the Ethics committee of the institution, 50 ASA I-II patients were randomly divided into two groups (GI and GII). The patients were induced with a standard regimen of 2 mg kg-1 of propofol and 0.1 mg kg-1 of vecuronium and intubated using appropriate sized endotracheal tube. Following intubation, propofol was infused according to the group the patients was allotted. GI received propofol infusion maintenance dose of 10 mg kg-1 hour for the first 10 minutes following intubation, 8 mg. kg-1 hour for the next 10 minutes and thereafter 6 mg kg-1 hour for the entire length of the surgery. GII received propofol infusion maintenance dose of 8 mg kg -1hour for the first 10 minutes following intubation, 6 mg kg -1hour for the next 10 minutes and thereafter 4 mg kg-1 hour for the entire length of the surgery. The Bispectral index, blood pressure and heart rate were monitored during intubation and thereafter every five minutes for the entire length of the surgery. And the propofol dose was adjusted to maintain the Bispectral index between 40 and 60. Results: Additional doses of propofol were required in the GII 8/6/4 mg kg-1 hour regimen when compared to GI 10/8/6 mg kg-1 hour dose regimen. The average Bispectral index was comparable in the two groups. Conclusion: Patients were hemodynamically stable when the Bispectral index was maintained between 40 and 60. Intraoperative awareness was not detected during this study.

399-402

Authors: Shivanand L. Karigar*,D G. Talikoti,Basavaraj Patil

Introduction: After the birth of the baby if the placenta is not expulsed within 30 minutes of the delivery, it is termed as retained placenta. The incidence of retained placenta is 2% of deliveries world-wide and is an important cause for maternal mortality and morbidity. Nitroglycerine (NTG) is an organic nitrate that relaxes smooth muscles and produces a generalized vasodilatation. As it relaxes the smooth muscle, it is also used as a uterine relaxant for manual placental removal. Aims and Objectives: To know the efficacy and safety of intravenous NTG in manual removal of placenta and to know the hemodynamic effects during the procedure. Materials and Methods: Total number of patients included in this study were 40. Patients were divided in two groups, each group having 20 patients each. Group 1 patients were administered with 100 microgm of NTG and group 2 patients with 150 microgm of NTG. Clinical parameters and complications were studied and compared between the two groups. Placenta was observed for separation and graded as easily separated, separated with assistance, difficult to separate, failed to separate. The clinical parameters like hypotension, tachycardia, headache after awakening, palpitation after awakening were compared between the two groups. Results: In group 1, we observed that placenta was easily separatedin 12 patients (60%), separated with assistance in 3 patients (15%), difficult to separate in 3 patients (15%) and in 2 patients (10%) placenta was not separated. In group 2, we observed that, placenta was easily separated in 14 patients (70%), separated with assistance in 2 patients (10%), difficult to separate in 2 patients (10%) and in 2 patients (10%) placenta was not separated. Conclusion: Intravenous NTG is an effective and safe method for manual removal of placenta with a dose of 100 microgram.

407-414

Authors: Pradeep Hosagoudar*,K R Vimala,Uday Bhaskar,Vallur Swetha Redd,L Krishna,Pradeep Hosagoudar*,K R Vimala,Obstetrics and Gynecology Obstetrics and Gynecology,Vallur Swetha Reddy,L Krishna

Introduction: Labor pain is the most severe pain a women would experience and several treatment modalities have been adopted since decades. Labor analgesia using epidural technique is considered as the efficient and effective treatment options available. Parturients in India especially rural areas are less aware regarding labor analgesia using epidural technique. Aim: To study the effects of labor analgesia using epidural technique in nulliparous women. Materials and Methods: Sixty full term nulliparous women with singleton vertex pregnancy were made aware of labor analgesia using epidural technique and included, those willing were grouped epidural(n=30), those not keen were grouped control(n=30). In 1st stage labor, parturients in epidural group received bupivacaine and fentanyl, whereas in control group received intramuscular Inj. tramadol, and Inj. pethidine if needed. Duration of 1st and 2nd stage labor, pain relief, maternal satisfaction, adverse effects, instrumental deliveries, 1st and 5th minute Apgar score and NICU admission were recorded. Results: The mean duration of first stage labor was shorter (p=0.071) in epidural group (250.17±106.33 minutes) compared with control group (302.0±111.99 minutes) and statistically insignificant prolongation (p=0.892) (18.73±6.82 minutes) of 2nd stage labor as compared to control (18.33±14.53 minutes). Pain relief in epidural group was statistically significant (p<0 p=1.00).>st (p=0.306) and 5th minutes (p=1.00), NICU admission rate were statistically insignificant (p=0.143) between groups. Conclusion: Labor epidural analgesia using Inj.bupivacaine and Inj.fentanyl provides good pain relief, safe for mother and baby. It does not affect labor duration, instrumental delivery rate or neonatal outcome.

423-430

Authors: Ruma Thakuria,Tridip Jyoti Borah*,Jaideep Sonowal,Dipika Choudhury

Introduction and Aim: Dexmedetomidine, a neuraxial adjuvant, when given intrathecally with hyperbaric bupivacaine provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects. When intravenous dexmedetomidine is used in conjunction with neuraxial anesthesia, few studies have shown that it prolongs the sensory-motor blockade and provides better intraoperative and postoperative analgesia. We formulated this hypothesis that intravenous (IV) dexmedetomidine bolus followed by infusion would prolong the duration of subarachnoid block (SAB) with 0.5% heavy bupivacaine. Our aim was to assess the onset and duration of sensory and motor blockade following IV dexmedetomidine supplementation after SAB. Materials and Methods: Sixty American Society of Anesthesiologists Grade I and II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 30 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group II received a loading dose of 1 µg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 µg/kg/hr till the end of surgery, whereas patients in group I received an equivalent quantity of normal saline. The time to reach peak sensory block level, time taken for two segment regression and maximum motor block, total duration of sensory and motor blockade, Ramsay sedation score and modified Bromage score were statistically analyzed using Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) Windows-based version 16.0. Results: Two segment regression time of sensory blockade was more in the dexmedetomidine group (130.33±14.49 mins) as compared to the normal saline group (94.67±15.02 mins) which was statistically significant (P< 0> Conclusion: The results of the present study shows that, intravenous dexmedetomidine given as a loading dose followed by maintenance dose prolonged the duration of sensory and motor blockade of bupivacaine-induced spinal anesthesia. It also provided conscious sedation without respiratory depression while maintaining good hemodynamic stability.

437-439

Authors: Gunaseelan S,Arun Kumar. J*

Introduction: Axillary block with Bupivacaine mixed with adjuvants like dexmedetomidine, a more selectivealpha2 adrenoreceptor agonist, induces faster onset of blockade, delays the absorption of local anaesthetic and prolongs its action. Steroid adjuvants like dexamethasone can decrease inflammation at the same time demonstrated prolonged analgesic effect. The study aimed at comparing the efficacy of these adjuvants in affecting regional block onset and duration. Materials and Methods: This Randomized, uncontrolled, single blinded, two-arm, concurrent parallel trial was conducted during January to March 2017 among 60 participants posted for forearm and hand surgeries randomly allocated into two groups viz: Group A: 30 subjects given a mixture (30ml) of Bupivacaine (0.25%) and Dexamethasone (8mg) and Group B: 30 subjects given 30ml a mixture (30ml) of Bupivacaine (0.25%) and 1 ml of dexmedotomidine (100µg). The intra and post-operative outcomes of the two groups were compared statistically. Results: The onset of motor and sensory blockade was significantly (p<0> Conclusion: Dexmedotomidine when compared with Dexamethasone used as an adjuvant to Bupivacaine in axillary block for forearm and hand surgeries showed marked efficacy in terms of earlier onset of action, prolonged blockade and longer duration of post-operative analgesia.

445-450

Authors: Viji S Pillai*,Bhagyalakshmi Ramesh,Silvy Anna Varughese

This study compares the safety and efficacy of multiple level thoracic paravertebral block and modified Pecs block for postoperative pain relief after Modified Radical Mastectomies. After Institutional Review Board [IRB] and Human Ethics Committee [HEC approval, the study was conducted on 41 patients who were scheduled to undergo modified radical mastectomy. Written informed consent was taken. Female patients in the age group of 18-75 years who were ASA grade I and II were randomly allocated to two groups to either receive Ultrasound guided Thoracic paravertebral block TPVB at T2 and T4 levels (Group 2) or an ultrasound guided modified PECS block (Group 1) preoperatively in the block room. Paravertebral block was given at two vertebral levels T2 (10 ml) and T4 level (10 ml) under ultrasound guidance utilising the parasagital in-plane technique. Modified PEC block was administered to patients in the PEC group.10 ml of 0.5% Ropivacaine for Pec1 and 20ml for Pec 2. In all patients surgery was done under GA. Pain was assessed with Numerical Rating Scale (NRS) on a 0 to 10 scale, for 24 hours after surgery, at 0,0.5,1,1.5,2,4,6,12 and 24 hours after surgery by a blinded observer. Rescue opioid and Paracetamol requirement was recorded. The patients were also monitored for any specific block related complications. Primary outcome measures were the numerical rating scores for pain and rescue analgesic requirement. Secondary outcome measures was looking for any block related complications. Demographic categorical variables were expressed in frequency and percentage, and the continuous variables were reported in terms of mean and standard deviation. The comparison of pain scores between the thoracic paravertebral nerve block and modified pectoral nerve block was done using Mann-Whitney U test. Mean duration of analgesia and mean 24 hour Morphine, Paracetamol consumption was compared using Student's t test. There was no statistically significant difference between the two groups with respect to the pain scores at 0,0.5,1,1.5,2,4,6,12,and 24 hours at rest or with movement of the ipsilateral arm. The 24 hour Morphine consumption was not also statistically significant. [pec gp,mean 2.17, SD 1.09, tpvb gp mean 2 SD 0.77, p value 0.752.] Paracetamol consumption in the initial 24 hours after surgery was also not statistically significant between the two groups (pec gp. 36.8% and tpvb gp. 50% patients received paracetamol with a p value of 0.523). We found both the blocks, modified Pecs and multiple level paravertebral block were equally effective in treating postoperative pain.

453-456

Authors: Nitin Choudhary*,Abhijit Kumar,Sonia Wadhawan,Poonam Bhadoria,Vishnu Panwar

Large retrosternal goitre is a challenge to the anaesthesiologist and the surgeon. We describe the successful anaesthetic management of a 44 year old male patient with extensive retrosternal goitre with severe tracheal compression, operated for total thyroidectomy under general anaesthesia by combined cervical approach and sternotomy. A multidisciplinary team approach with surgical colleagues allowed successful management of the patient.

459-460

Authors: Rashmi Patil,*,Madhuri Kurdi

Tonsillectomy is a commonly performed procedure in children. Disseminated sepsis is a rare complication of tonsillectomy. Patients usually present with hypotension, reduced oxygen saturation, tachycardia with high total count and reduced urine output. Our patient also required NIV (non-invasive ventilation), ionotropes and antibiotics with serial blood examinations. Early diagnosis and prompt treatment will help in better outcome. The tonsils contain T lymphocytes and macrophages as they serve immune defense mechanisms. Tonsillitis is most commonly caused by viral infection, 40% of cases are caused by bacterial infection. Immunological functions like antigen transport and antibody production are altered in diseased tonsils. The presence of various micro organisms in the open tonsillar bed during and after tonsillectomy acts as foci of infection. The tissue reaction and presence of micro-organisms is also due to different surgical techniques involved.

170-174

Authors: Yamini Taloh, Nongthombam Ratan Singh, Mumtak Borang, Praneshwari Sinam, J. F. Pyngrope

Introduction: One of the most important disadvantages of propofol injection is intense burning pain. The present study was conducted with the aim to assess the effect of low dose Ketamine (100 µg/kg) in the alleviation of pain on propofol injection. Materials and Methods: Patients who underwent surgical procedures under general anaesthesia were allocated into two groups viz. Group K (n=35) - pre-treatment with ketamine 100µg/kg (1ml) and Group S (n=35)- pre-treatment with 0.9% normal saline (1ml) in this double-blinded, randomized study. After venous occlusion, ketamine was injected over 10 seconds, after which the occlusion was removed and over 20 seconds, the first 25% of the calculated dose of propofol was injected. The evaluation of the severity of pain was done by the verbal rating scale (VRS) during the injection of the induction agent for every 5 seconds and graded as 0 to 3.The data were recorded and analysedusing unpaired‘t’ test and chi-square test as and where appropriate. Results: The demographic profiles were comparable between the two groups. It was observed that 42.9% of patients in normal saline and 80% in ketamine groups experienced no pain (p<0>0.05). Conclusion: It may be concluded that pre-treatment with low dose ketamine with a tourniquet just before propofol injection, significantly reduced the incidence and degree of propofol induced pain without significant adverse hemodynamic effects.

182-184

Authors: Krishna Murthy TK., Vinay Kumar PV.

Introduction: In India incidence of obesity is in increasing trend. Anaesthetising morbidly obese patients is challenge to anaesthesiologist. Due to alteration in pharmacokinetics and pharmacodynamics in obese patients, drug dosing in these patients is different from patients with normal body mass index. This has led to lot of confusion in titration of anaesthetic drugs perioperatively. Any method which helps in perioperative drug titration may help in optimal intraoperative maintenance of anaesthesia, early awakening at the end of surgery and early postoperative recovery. We hypothesize that intraoperative Bispectral index (BIS) monitoring allows optimal titration of anaesthetic drugs intraoperatively and decrease awakening time, early postoperative recovery from general anaesthesia in morbidly obese patients undergoing laparoscopic laparoscopic sleeve gastrectomy surgery. Materials and Methods: Two groups of 40 patients each were anaesthetized with the use of BIS monitoring in BIS- GROUP and in NON-BIS GROUP patients were anaesthetized without the using BIS monitoring. The heamodynamic parameters heart rate (HR) and mean arterial pressure (MAP) were recorded before induction, after induction at 1 minute (min), 3min, and 5min, after incision at 1min, 5min, 10min, 15min, 30min, 45min, 60min, and 70min were recorded. Awakening time (time to eye opening to verbal command) recorded every minute, time to extubation at 1min, 5 min, 15 min were recorded and time to achieve Modified Aldrete score ?9 were recorded. Results: Mean awakening time, time to extubate and Modified Aldrete score ?9 were significantly shorter in the BIS group as compared to the NON-BIS group (P < 0>0.05). Conclusion: Without compromising the hemodynamic stability BIS monitoring was effective in early awakening, associated with early postoperative recovery in morbidly obese patients undergoing laparoscopic laparoscopic sleeve gastrectomy surgery.

190-194

Authors: Sujith Alexander Kurian, Jayakumar P

Introduction: One lung ventilation (OLV) is required for most of the lung surgeries and one of the common problem which we encounter during this surgical procedure is hypoxia. Our prospective study evaluates the effectiveness of a low tidal volume ventilation to the operated, non- dependent lung (NDL) in improving the oxygenation during OLV. Materials and Methods: 40 ASA I, II and III patients posted for elective open thoracotomy was studied. After standard induction of anesthesia, lung separation was achieved with left sided DLT. ABG was taken on two lung ventilation (TLV) before thoracotomy and lung separation and that value was taken as base line. After thoracotomy the dependent lung alone (OLV) was ventilated for 15 mins and ABG was repeated. Then the NDL was ventilated with another ventilator with a low tidal volume and limited airway pressure and sample ABG were taken at 5 minutes and 20 minutes of NDL ventilation. Results: ABG values of PaO2 suggested that thought the values decreased during OLV compared to base line values with TLV, PaO2 had a significant increase after instituting NDL ventilation. Conclusion: NDL ventilation with low tidal volume and limited peak pressure is an effective method to avoid hypoxia and improve oxygenation during OLV requiring lung surgeries.

199-204

Authors: Skull pins, Labetalol, fentanyl, Hemodynamic changes, Pressure response.

Introduction: Laryngoscopy and intubation as well as application of skull pin in neurosurgical procedure is a highly noxious stimulus which causes hemodynamic changes and can be detrimental in patients with raised intracranial pressure. We studied the effect of addition of intravenous labetalol with fentanyl to attenuate the pressure response to intubation and skull pin insertion in neurosurgery. Materials and Methods: Fifty patients undergoing elective neurosurgical procedure were randomised into two groups as group LF and group F. Patients of group LF received intravenous Labetalol 0.25mg/kg 5 minutes prior and intravenous fentanyl 2µg/kg 3 minutes prior to intubation. Patients of group F received intravenous saline 5 minutes prior and intravenous Fentanyl 2µg/kg 3 minutes prior to intubation. Heart rate (HR) systolic and diastolic blood pressure (SBP and DBP) and mean arterial pressure (MAP) were noted at baseline, after study drug administration, after induction, immediately after intubation, immediately after skull pin insertion, 5 minutes interval till 20 minutes after that. Results: Immediately after intubation HR was 82.60+5.0 per minute in LF group and 97.64 + 4.71 per minute in group F (p=0.01). MAP was higher in group F than group LF (106.84+3.89 mm of Hg, 83.02+3.75 mm of Hg respectively p=0.001). Immediately after skull pin insertion rise in HR (group LF 79.76+5.07 per minute, group F 97.84+4.40 per minute respectively p=0.001) and MAP ( group LF 80.28+5.32 mm of Hg, group F 103.17+7.66 mm of Hg respectively p=0.001) was at lesser extent in group LF. Conclusion: Addition of single dose intravenous labetalol to fentanyl gives better haemodynamic stability to laryngoscopy and intubation as well as skull pin insertion than fentanyl alone.

210-215

Authors: Neeraj Kumar, Amarjeet Kumar, Ashish Kumar, Mumtaz Hussain, Anil Kumar

Introduction: Major complex intraabdominal surgeries which have prolonged intraoperative surgical duration and wide hemodynamic fluctuations so they required an elective mechanical ventilation in view of large fluid shift and massive blood loss. So such large group of patients for providing conscious sedation two most popular agents dexmedetomidine and propofol are being used because their mechanisms of action and pharmacokinetic properties are different. Aims and Objectives: Primary aim of our study is to assess the duration of mechanical ventilation in both study group (D or P) following major intraabdominal surgery. The secondary aim was to evaluate total duration of intensive care unit as well as hospital stay, incidence of delirium and any additional sedative agent. Materials and Methods: All patients on arrival to the ICU and after fulfilling the inclusion and exclusion criteria following completion of major intraabdominal surgeries they were allocated, randomly using sealed envelopes techniques into two groups each comprising of 15 patients, to receive intravenous infusions of either dexmedetomidine or propofol and plan for elective mechanical ventilation. Statistical analysis: All data’s was statistically analysed using Minitab® 16 (Minitab, Inc., State College, PA) software. Results: In our study variables like demographic profile, baseline hemodynamics and ASA status were comparable in both the study groups. Our study results showed that total duration of mechanical ventilation was much earlier in the dexmedetomidine group compared to propofol (7.62 hours vs. 11.23 hours, P <0> 0.05). The incidence of delirium were more in patient receiving propofol group (6.6% vs. 20%, P = 0.346). Conclusion: This study concluded that for any complex major intraabdominal surgeries dexmedetomidine has significant reduction in time on mechanical ventilation but no significant difference was seen in terms of incidence of delirium, duration of ICU or hospital stay and mortality.

222-227

Authors: Amit Vadhel, Devyani Desai, M R Upadhyay

Background and Aims: Conventional technique of supraclavicular block is associated with direct injury to the vessels, nerves and pleura, which can be minimized with lateral approach. Here, we compared lateral with conventional approach supraclavicular block given for forearm surgeries. Materials and Methods: After getting approval from ethical scientific committee, SSG hospital, Vadodara, this randomized prospective single blinded study was conducted from October 2014 to October 2015. 60 patients of either gender between 18 to 60 years, of ASA grade I and II undergoing forearm surgeries were enrolled. Those who refused, having anatomical distortion or infection of local site and pregnant patients were excluded. After doing randomization by computer method, Group C (n=30) received conventional and Group L (n= 30) received lateral approach supraclavicular block using nerve locator and total 35 ml of Inj. Lignocaine with adrenaline (1:200000)7mg/kg, Inj. Bupivacaine 2 mg/kg with Inj. Sterile water was injected. Patients were evaluated for technical difficulty, characteristics of sensory and motor blockade, duration of postoperative analgesia and complications. Results: Statistical analysis was done using student ‘t’ test with Medcalc software. P<0> Conclusion: Lateral approach of supraclavicular block is a safe alternative to conventional approach.

233-236

Authors: Dhanashree H. Dongare, Girish Y. Saundattikar

Functional endoscopic sinus surgery (FESS) requires good intraoperative surgical field visualization for better identification of structures. Among the many modalities for improving visibility, antifibrinolytic agent like Tranexamic acid has shown good results in many other surgeries. In this study, we have evaluated the effect of a single bolus dose of 15mg/kg intravenous Tranexamic acid when used as an adjunct. Materials and Methods: We have studied group T (n=30), who received Inj. Tranexamic acid against group C (n=30) i.e. control group. They were compared for surgical field using Boezaart scale, surgical duration and blood loss. Statistical analysis was done by unpaired t test and chi square test as was appropriate. Results: T group showed significantly lower values of Boezaart scale score i.e. better visualisation for surgical field (p<0> Conclusion: We found that Tranexamic acid has a beneficial role in functional endoscopic sinus surgeries by improving the quality of surgical field when used as an adjunct.

244-248

Authors: Ganesh Nikam, Madhukrishna N

Aims: 1.To study and compare efficiency of clonidine and dexmedetomidine to reduce haemodynamic response i.e. attenuation of pressor response to laryngoscopy and tracheal intubation with single premedication dose. 2. To evaluate dose sparing effect of clonidine and dexmedetomidine on induction agent. Materials and Methods: 60 patients physical status ASA grade I and II were randomized into two groups: C and D (n = 30 in each group). Group C received 1µg/kg of clonidine while group D received 1µg/kg of dexmedetomidine preoperatively over 10 minutes before induction through syringe infusion pump. Each patient was induced with injection Thiopentone sodium until loss of eyelash reflex. After check ventilation succinylcholine 2 mg/kg was given followed by tracheal intubation. Anaesthesia was maintained with O2+ N2O(50:50) and Vecuronium supplemented with isoflurane. Hemodynamic parameters were recorded. Results: We observed no statistical difference in heart rate, blood pressure (systolic, diastolic and mean arterial pressure) between the two groups from baseline up to induction between two groups. Group C had higher readings of HR, SBP, DBP and MAP compared to group D after intubation upto 3 min which was statistically significant. Induction dose of thiopentone was lower in dexmedetomidine group and was statistically significant. Conclusion: Dexmedetomidine attenuated the hemodynamic pressor response and also reduces the dose requirement of thiopentone sodium and was superior to clonidine.

255-260

Authors: Aparna Abhijit Bagle, Priyanka Gulia, Sneha Sheelvanth, Anagha Patil, Tripti Nagdev

Introduction: Post-operative analgesia in patients undergoing lower abdominal surgery is very essential for immediate postoperative pain relief which can be provided by oral or parenteral medication, epidural analgesia, local blocks etc. The combined spinal–epidural technique (CSE) has become increasingly popular in recent years. The study was designed to evaluate the efficacy of epidural butorphanol and tramadol for postoperative pain relief. After the surgical procedure and regression of spinal analgesia, the epidural catheter can be used to provide postoperative pain relief. Materials and Methods: After permission from hospital ethics committee, study was conducted on 60 patients undergoing lower abdominal surgeries. Combined spinal epidural anaesthesia was planned in all these 60 patients using two segment technique.18 G epidural catheter was placed in L2-L3 space and spinal anaesthesia was given at L3-L4 space using 26 G Quincke’s needle and 0.5% bupivacaine 3ml.Sensory, motor block and hemodynamic parameters were monitored intraoperatively. Postoperatively along with hemodynamic parameters visual analogue score (VAS) was observed and at VAS > 4, study drug (either butorphanol 1mg or tramadol 50mg) was given through epidural catheter. Onset of analgesia, quality of analgesia, duration of analgesia, cardio-respiratory parameters and any side effects were monitored and documented. Statistical Analysis: Data analysis was done using the SPSS (Statistical Package for the Social Science) Version 17 for window. Discussion: Mean onset of analgesia in Butorphanol group (10.03 ± 1.85 min) was significantly faster than Tramadol group (12.17 ± 2.19 min) [Z = 4.07, p<0 Z=23.06,> Conclusion: Epidural butorphanol provides a rapid, excellent but shorter duration of analgesia when compared to epidural tramadol.

266-271

Authors: Neeta S., Sunil B. V., Sonal Bhat, Shaila Kamath, Madhusudan U.

Introduction: The sitting position is often used for patients undergoing spinal anesthesia especially when lower lumbar and sacral levels of sensory anesthesia are required. An advantage of this position is that the complications associated with it can be reduced. The present study assess the relation between saddle block anesthesia and the duration spent in sitting posture. Materials and Methods: Sixty ASA I and II patients were included in this study. In this randomized controlled study, patients planned to undergo perineal procedures were selected. Spinal anesthesia was given with 2.2 ml of 0.5 % hyperbaric bupivacaine and the patients were made to sit for one, six, twelve and twenty minutes before making them supine for the procedure. The data were analyzed using students ‘t’ test and .Chi - Square test . Results: Better hemodynamic stability was achieved by increasing the duration of sitting posture after spinal anesthesia. Also duration of motor /sensory blockade was decreased by increasing the duration of sitting position. Conclusion: The study shows that the duration of sitting position is inversely related to the duration and extent of sensory and motor blockade. .Also better hemodynamic stability can be achieved with saddle block anesthesia.

277-281

Authors: Yogesh Kumar Manik, Vipin Kumar Dhama, Subhash, Navab Singh, Sudhir Kumar

Introduction: Previous studies have shown stable cardiovascular parameters and minimal airway irritation with sevoflurane induction in adults. Also, time taken for induction is comparable to intravenous drugs. The authors planned to conduct a randomized, control study to compare the effect of continuous tidal volume breaths versus three vital capacity breaths for sevoflurane induction on time taken for induction, haemodynamic parameters and intubating conditions in adult patients undergoing elective surgery under general anaesthesia. Materials and Methods: Sixty patients planned to undergo elective surgical procedures under general anaesthesia were included in study. Patients were divided randomly using sealed opaque envelope method in group 1 and group 2 of thirty patients each. Group 1 patients received continuous tidal volume breath and group 2 patients received three vital capacity breaths. The statistical analysis was done using IBM SPSS Statistics Software Version 15.0. The independent samples Student t-test was used to determine the differences in basic clinical characteristics, mean Arterial Pressure, heart Rate, and intubation time between the two groups. Quantitative data were evaluated by chi square test. Any p value less than 0.05 was considered as significant. Result: Variation in heart rate between two groups was statistically significant at 1 min. (p=0.04), 2 min. (p=0.01) and 3 min. (p=0.004) after start of induction. The time taken for loss of consciousness was significantly less in vital capacity induction group. (p <0> Conclusion: Heart rate and mean arterial pressure remain stable during sevoflurane induction in adult patients using three vital capacity breath or tidal volume breath technique. Intubating conditions are better and time taken to lose consciousness is less with vital capacity breaths.

287-288

Authors: Kriti Nagar, Shirin Parveen

Cardiac patient for non cardiac surgery has since forever been a topic of interest for the anaesthesiologist. Few cases have only been reported with their own suitable line of management, however the simultaneous use of combined epidural spinal anaesthesia and Dexmedetomidine, an ?2 agonist has been studied by only a handful. Use of epidural for incremental doses of local anaesthetic for allaying the postoperative pain and thereby reducing the occurrence of ischemic events is also being described.

292-293

Authors: Pankaj Kumar Gupta, Neha Shrivastava

Endotracheal tube is a device commonly used in patients requiring general anaesthesia and mechanical ventilation. It becomes very important to ascertain its quality so that patient’s health is not compromised and he or she is not exposed to undue risks. We hereby describe an incidence of manufacturing defect in endotracheal tube leading to compromised patient ventilation and the steps to recognize and rectify it.

297-298

Authors: Shilpa H. L., Shwetha Odeyar S., Adarsh E. S.

Prader willi syndrome (PWS) is a complex multisystem disorder. PWS mainly affects central nervous system and often involves the hypothalamus. Its major clinical features include neonatal hypotonia, developmental delay, short stature, behavior abnormalities, childhood onset obesity, hypothalamic hypogonadism and characteristic appearance. Anaesthetic management with general or regional anaesthesia for these patients is difficult mainly due to morbid obesity. The importance of PWS for anesthesiologist and primary physician is estimated by the circumstances as the prevalence of PWS is nearly as frequent as trisomy -21. We report the anaesthetic management of a 22 year old male patient with genetically proven PWS (small stature, obesity with characteristic behaviour problem) who presented with chronic fissure in ano. Though the clinical course of the patient was uneventful under saddle block. In this case report we discuss our strategy for the prevention of perioperative complications for PWS patients.

9-12

Authors: Anuja Agrawal, Mridul M. Panditrao, Smita Joshi.

Introduction: The recommended approach for postoperative pain management is to initiate the treatment with analgesics such as paracetamol, NSAIDS, and aspirin followed by adjunctive use of opioids to treat more acute pain symptoms. However, the adverse effects associated with opioids and NSAIDS are well established. Aim: To study the efficacy of paracetamol in comparison to Tramadol when used as analgesic component of balanced anesthesia, pre-emptively for intraoperative and postoperative purpose. To study their side effects. To find out which of these two drugs is better in providing intraoperative and postoperative analgesia with minimum side effects. Materials and Methods: 60 patients of either sex, divided using computer generated random number table into 2 equal groups. Group T: (n 30): Tramadol hydrochloride group, Group P: (n 30): Paracetamol group. The dose of paracetamol and tramadol hydrochloride was 15mg/kg and 2mg/ kg body weight respectively. Statistical analysis: analysis was done by SPSS software version 11 by using Z test, chi-square test, proportion test (Z). P value less than 0.05 was considered as significant and less than 0.0001 as highly significant. Results: Both the groups were comparable with respect to their demographic profile, ASA status, and surgical procedures. Both paracetamol and tramadol have a good analgesic action and fewer side effects. The mean score of VAS Scale in group P (1.86  2.40) and group T (3.03  2.42) was similar and difference was not statistically significant. Also the side effects were comparable in both groups. Total number of rescue analgesics required by the group P (1.6) was significantly less as compared to the group T (3.7) with Z value = 4.00, p < 0.0001. Conclusion: Paracetamol has a better efficacy than tramadol hydrochloride in providing intra-operative and post-operative analgesia, when used pre-emptively with reduced number of doses of analgesic and almost no side effects.

17-24

Authors: Avinash Prakash, Anita Yadav, Habib Md. Reazaul Karim, Anil Kumar Narayan, Kumar Aman.

Introduction and Aim: Anaesthesia as speciality has evolved very much but the services are yet very much under recognized. This may be partly because of low knowledge of anaesthesia and anaesthesiologists. School education level of patients may also affect this. This study was conducted to assess the patient’s knowledge and perception about the role of anaesthesiologists, anaesthesia and their relationship with different educational level of patients and previous anaesthesia exposure Materials and Methods: The present cross sectional study was conducted with 150 participants aged > 15 years of either sex posted for elective surgery. A questionnaire was used as data collection tool. Data of entire cohort as well as in different subgroups based on education level and previous exposure were calculated and compared using INSTAT software and p < 0.05 was considered significant. Results: All the participants (56.67% female; mean age 39.36 + 12.63 years) completed the questionnaire. Their knowledge and awareness of anaesthesia and anaesthesiologists was very poor. Even patients with previous anaesthesia exposure were having poor knowledge (3 to 41 % in different aspects). No difference in knowledge and awareness was noted with different educational level (p > 0.05). Previously exposed patients had significantly more knowledge regarding ‘who makes you unconscious’, ‘types of anaesthesia’ and routes of ‘general anaesthesia administration’ but it failed to show difference in other aspects. Conclusion: Knowledge about anaesthesia and anaesthesiologists are still very poor. School education has no positive impact and previous anaesthesia exposure increases the knowledge in limited aspects.

30-33

Authors: Karthik Jain M., Bindu George, Fonseca Alex Jude, Deleema D., Ann Mary.

Introduction: Postoperative visual loss (POVL) after posterior approach to spine surgeries is a devastating complication necessitating a prospective study. The primary aim was to identify ophthalmological changes contributing to POVL (visual acuity, anterior segment, intraocular pressure (IOP), fundus, field of vision, external ocular examination). Secondary objectives was to evaluate the relationship between ophthalmological changes and various perioperative data including patient comorbidities, positioning and other intraoperative details. Materials and Methods: After getting necessary approvals and consent, thirty patients posted for the posterior spine surgeries were assessed preoperatively. Ophthalmological examination was conducted preoperatively, the day before surgery and postoperatively twice (first within an hour of completion of surgery and second at twenty four hours). Perioperatively, data including type of surgical frame, headrest used, duration of prone positioning, total blood loss, total intravenous fluids administered, lowest mean arterial pressure for more than ten minutes, blood transfusion details and use of hypotensive anaesthesia were noted. Data were analyzed using chi-square test, paired t test, and correlation coefficient. Results: There were no changes in visual acuity, anterior segment, fundus and field of vision postoperatively. But 12 patients had a rise in IOP and six developed lid edema and chemosis. There was a minimal increase in IOP at one hour post operatively (right eye- 2.8 mm Hg (p=0.001, and left eye- 3 mmHg(p<0.001). The analysis of perioperative data revealed no relationship with ophthalmological changes noted. Conclusion: There were no clinically significant ophthalmological changes contributing to POVL in spine surgeries in prone position. Observed ophthalmological changes did not have any correlation with patient comorbidities, positioning and other intraoperative details.

43-49

Authors: Ravindra Kumar Gehlot, Shekhar Suman Saxena, Lalit Kumar Raiger.

Introduction: The major responsibility of the anesthesiologist is to provide adequate ventilation to the patient because airway related problems are still the most common cause of anaesthesia related morbidity and mortality. The use of I-gel has been reported in laparoscopic surgeries and was found equally effective ventilatory device as PLMA. Therefore, we planned this study to compare I-gel and PLMA with ET tube in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This prospective study was conducted on 90 patients of both sex, 18-60 years age, ASA grade I-II, scheduled for elective laproscopic surgery under general anaesthesia. All patients were randomised into three groups of 30 patients each; Group I (I-gel), Group P (PLMA), Group E (ET Tube). Attempts of insertion of devices, effective airway time and easiness of gastric tube; hemodynamic parameters (HR, MAP, SpO2 and EtCO2) were recorded. Results: There was significantly less 2nd attempt required in I-gel group(10%) as compared with ET tube (36.7%) and PLMA (13.3%),(p=0.019). Laryngopharyngeal morbidity were significantly more in Group E as compared to Group P and I (p<0.05). Hemodynamic changes were significantly higher in Group E immediately after intubation which persisted for 3 minutes and immediately after extubation (p= 0.00). Conclusion: Supraglottic Airway Devices (PLMA and I-gel) were as effective as ET tube in establishing airway and the haemodynamic stability is better then ET tube in laparoscopic cholecystectomy.

56-61

Authors: Shivanand Y. Hulakund, Archana R. Endigeri, Navya C. N., Prakashappa D. S..

Introduction and Aim: The cardiovascular changes to airway manipulation like tachycardia and hypertension occur secondary to catecholamine secretion. These changes make less effects on normal patients but can be hazardous in cardiac compromised patients. Various pharmacological measures are tried to lessen these ill effects. As a result we made an effort to compare the usefulness of two drugs, highly specific α2 agonist Dexmedetomidine at a dosage of 1µg/kg versus Esmolol 1mg/kg; in reducing these effects during induction of G.A. Materials and Methods: In this randomized clinical trial 102 patients, of age group 18-65 years and American Society of Anesthesiology classification I/ II, undergoing various surgeries under G.A. requiring intubation were distributed into 2 groups of 51 patients each. Group D patients were given Dexmeditomedine1µg/kg in diluted form over a time period of 10 minutes and Group E patients were given Esmolol 1mg/kg diluted to 10 ml and given over 1 min .Induction of anesthesia was done with volatile agent sevoflurane. Maintenance was done with O2 and N2O 30:60 along with vecuronium. Monitoring was done and hemodynamic parameters were recorded at particular intervals during laryngoscopy and intubation of trachea. Results: All observations were expressed as mean and standard deviation. Based on statistical analysis the Baseline heart rate, and baseline mean arterial pressure were comparable in both the groups. The decrease in mean HR observed at, 3, 5 and 10minutes after intubation in Group D was statistically highly significant compared to mean HR in group E (p<0.000).(table 2). The mean fall in SBP in group D at 1, 3, 5 and 10 minutes after intubation was statistically highly significant (p=0.000) compared to the Esmolol group E The fall in mean DBP value at 1,3, 5 and 10 minutes of intubation were statistically highly significant (p=0.000)in group D compared to the latter group. The mean basal MAP, 2min after drug administration and 1min after induction are comparable in both groups (p>0.05).The fall in mean MAP values in group D at 1, 3, 5 and 10 minutes of intubation were statistically highly significant (p<0.0000001) compared to group E. 1min after induction fall in mean RPP value in D group is statistically higher than in E Group (P=0.0243). We also noticed hypotension in 5 patients and a fall in heart rate in 3 patients of study group in group D which did not need any medication. However no patients in the latter group had these side effects, we attribute this to the lesser dosage of esmolol used. Conclusion: This study shows that dexmeditomedine 1µg/kg is better than esmolol 1mg/kg for lessening the stress response to airway manipulation.

68-74

Authors: Selvakumar Rajasekaran, Suresh Murugaih, Asha Anandan, Ayshvarya Ramalingam.

Introduction: Spinal anaesthesia is the most commonly employed technique for Caesarean section. Many drugs such as opioids as intrathecal additives such have been widely studied found to be associated with respiratory depression, pruritis, etc. Upcoming studies on alpha-2 agonists as intrathecal additives have been found promising and will replace opioids soon. Knowledge on the efficacy of the individual a2 agonists over one another is lacking. So the aim of the study is to compare the spinal additive effect of dexmedetomidine and clonidine in pregnant patients for caesarean section. Materials and Methods: Ninety patients belonging to ASA group I and II of age group of 20 – 40 years were included in the study. Patients with PIH, Diabetes, Body weight above 100kg, Height less than 145 cm, Post spinal surgeries, spinal deformity, and known history of Coagulopathy and allergic to study drugs, documented IUGR, intrauterine anomaly and patients those who are not willing for spinal anaesthesia were excluded from the study. They were randomly allocated into three groups of 30 patients each, Group D where the patients received dexmedetomidine 5µg with bupivacaine 10mg, Group C where the patients received clonidine 15µg with bupivacaine 10mg and Group B where the patient received bupivacaine 10mg with 0.9% saline 0.5ml. The duration of the sensory and the motor blockade, two segment regression times, duration of the postoperative analgesia, sedation and neonatal wellbeing with maternal hemodynamic changes were studied. Results: Demographic characteristics and hemodynamic parameters were comparable between the three groups. The onset and maximal sensory block was faster in Dxm and clonidine groups (162±41.40;166±37.57) than control group (254.67±28.73) which was statistically significant. The two segment regression time was significantly shorter in control group (67.53±5.94) than Dxm and clonidine group (103.47±8.08;108±6.90). Dxm and clonidine group showed shorter time (3.40±0.84; 3.13±0.50) to reach Bromage grade 3 motor block than control group (4.52±1.78). The maximum sedation score recorded in both Dxm and clonidine group was 2.The time of onset (minutes) of sedation between Dxm and clonidine groups which was (8.9±2.85;7.43±2.27 ) were statistically insignificant. Conclusion: Addition of intrathecal clonidine 15µg/ dexmedetomidine 5µg to 10mg of bupivacaine in LSCS patients increase the duration of motor and sensory blockade, with little changes in maternal hemodynamics without any changes in neonatal outcome.

80-85

Authors: Shubhendu Bajpal, Nanda Upadhyaya, Rina Gadhavi.

Introduction: Regional anesthesia has lots of advantages compared to general anesthesia for Vaginal hysterectomy. Intrathecal anesthesia and Epidural anaesthesia are regional anaesthesia techniques used for Vaginal Hysterectomy. Aim and Objectives: 1.To study the adjuvant effect of alpha 2 agonist DEXMEDETOMIDINE with local anesthetic (ROPIVACAINE 0.75%) in lumbar epidural anesthesia in form of onset and lasting period of sensory and motor blockade, variation in hemodynamic parameter, post-operative analgesia. Materials and Methods: The study population was randomly divided into, 25 patients in each group. 1. Group R (n=25) -20ml of 0.75% ropivacaine; 2. Group RD (n=25) -20ml of 0.75% ropivacaine + 1µg/kg of dexmedetomidine. With the patients in sitting position, epidural space was identified by hanging drop method and confirmed by loss of resistance technique to air using 18G Tuohy needle via the midline approach at either L2-3 or L3-4 inter spinous space. An epidural catheter was fixed at 3 cms inside the epidural space. Result and Interpretation: result shows the prolonged sensory and motor blockage in RD group. Onset of sensory and motor blockade is stastaticaly significant. Sedation score is higher in RD group. Difference in heamodynamic parameters were statistically not significant. Parameters and side effects between two groups. Conclusion: Dexmedetomidine given epidurally with ropivacaine produces synergistic effect of profound and prolonged motor blockade and sensory blockade with better sedation and hemodynamic stability. Ropivacaine and dexmedetomidine can be a safe and effective alternate for epidural blockade in vaginal hysterectomies.

92-101

Authors: V. S. Senthil Kumar, V. Arun Pothan Raj.

Whenever the conventional laryngoscopy fails, insertion of supraglottic airway device may be indicated. The I-Gel and LMA-Supreme are both novel supraglottic airway devices which are disposable, cheap and aids the passage of gastric tube which helps in gastric drainage. Both the devices can be used as an adjunct to endotracheal intubation in patient with difficult airway. This prospective randomized, single blind study was designed to compare the supraglottic airway devices I-Gel and LMA-Supreme in patients undergoing general anaesthesia for elective surgeries. After obtaining the institutional ethical committee approval, 60 adult patients of ASA I and II physical status of either sex undergoing elective surgical procedures under general anaesthesia were randomly allocated into 2 groups. Group A I-Gel group (n=30) and Group B LMA-Supreme (n=30). The study showed no significant difference between the two groups based on demographic variables. The mean insertion time for LMA-Supreme is significantly lower than I-Gel (P<0.05). The airway leak pressure was comparable between the two devices. The first attempt success rate and the ease of insertion was significantly better in LMA-Supreme than I-Gel (P<0.05). There was no significant variation in the hemodynamic response in both the groups. Post-operative sore throat was noted in LMA-Supreme and blood staining was noted in I-Gel group. When compared with I-Gel LMA-Supreme has a higher first attempt success rate and also a lower insertion time.

110-113

Authors: Madhavi R. Godbole, Girish Saundattikar.

Introduction: As is well described laryngoscopy and intubation produce significant hemodynamic response. It is shown in previous studies that type of laryngoscope blade used affects the degree of hemodynamic response to endotracheal intubation. In our study we have attempted to compare hemodynamic response to laryngoscopy and intubation using Macintosh and McCoy blade. Aim: Our aim was to perform comparative study of hemodynamic response to laryngoscopy and intubation using Macintosh versus McCoy blade. Materials and Methods: A prospective randomized controlled study comparing hemodynamic response to laryngoscopy and intubation using Macintosh and McCoy blade was conducted. A total no. of Sixty patients, either male or female, between age group of 20 -50yrs, belonging to American Society of Anaesthesiology physical status I and II requiring General anaesthesia were randomly allocated to either group A (Macintosh group) or group B (McCoy group) In both the groups, standard methods were used. Comparison of hemodynamic parameters i.e. Heart rate (HR), systolic (SBP) diastolic (DBP) and mean blood pressure (MAP) was done at induction, during laryngoscopy and intubation, till 5 mins after intubation. Statistical Analysis: Hemodynamic changes in between the two groups were compared statistically using Unpaired “t” tests. Results: Significant rise in all HR, SBP, DBP, MAP was seen in both the groups after laryngoscopy and intubation. In group A the rise was found to be statistically significant as compared to group B. Conclusion: This study helped us to conclude that McCoy blade produces reduced hemodynamic response to laryngoscopy and intubation as compared to Macintosh blade

120-124

Authors: Dinesh Govindarao, Lakshmi Priya, Sunitha G. E..

Introduction and Objectives: Levobupivacaine and Ropivacaine, the two S enantiomers of Bupivacaine can be safer alternatives to racemic bupivacaine due to claims of cardiovascular safety profile. Hence, this study was conducted to assess the clinical efficacy of Levobupivacaine and Ropivacaine for spinal anaesthesia for orthopaedic surgeries of lower limbs. Methods and Materials: For this study, 60 adult ASA class I and II patients admitted for elective lower limb orthopaedic surgeries were randomised to 2 groups of n=30 each after approval from ethical committee and informed written consent. Spinal anaesthesia was given with 3ml Levobupivacaine 0.5% (15 mg) to patients in Group L and with 3ml Ropivacaine 0.5% (15 mg) to patients in Group R. Characteristics of spinal anesthesia in the two subsets like analgesia, motor blockade and hemodynamic parameters were observed and adverse effects, if any, were recorded. Data obtained were compiled and analysed with suitable statistical tests. A p-value of 0.05 was considered significant. Results: Onset of sensory and motor block were significantly faster in Group L (7 and 1.87 min) compared to Group R (9.43 min and 3.10 min). The maximum level of analgesia was attained faster in Group L (12.67 mins) compared to Group R (16.67 mins). The two segment regression time and the duration of analgesia were significantly shorter in Group R (72.63 min, 213.93 min) compared to Group L (103.6 min, 251.33 mins) Higher grade of motor blockade was achieved rapidly in Group L (9.03 mins) when compared to Group R (12.63 min). The mean duration of motor blockade was prolonged in Group L (263.67 mins) whereas recovery from motor blockade was earlier in Group R (151.17 mins). Both the groups had stable hemodynamics and adverse effects were not observed in both the groups. Conclusion: Intrathecal isobaric Levobupivacaine 15mg and Ropivacaine 15mg are effective in lower limb orthopaedic surgeries without significant haemodynamic changes. However, Levobupivacaine produced faster onset, prolonged and higher level of sensory block, prolonged motor blockade compared to Ropivacaine.

129-133

Authors: Dhaval Kumar C. Patel, Neeta Abhay Kavishvar.

Introduction: For pain relief during labor, regional analgesia is considered the most preferred technique; nevertheless the best method is yet to be determined. We carried out a randomized study to assess efficacy, safety & maternal satisfaction with standard epidural and combined spinal epidural (CSE) analgesia technique among 40 primigarvida. Materials and Methods: Healthy primigarvida in labor having cervical dilatation between 3 to 5 cm were assigned randomly to receive either epidural or CSE for labor analgesia. Analgesia was established in Epidural group with 12ml of 0.0625% bupivacaine added with 2µg/ml fentanyl & in CSE group with intrathecal injection of 2.5mg 0.5% heavy bupivacaine plus fentanyl 25µg (total 2 ml). In both groups whenever patient’s VAS>3, 2nd dose was given in form of epidural bolus 10ml 0.0625% bupivacaine + 2µg/ml fentanyl, followed by infusion of same concentration at 8 ml/h. Results: The onset of labor analgesia was significantly faster in CSE group (5.5±1.9 vs. 13±5.9 minutes, p<0.001) compared to epidural group. More than 75% patients in both groups didn’t developed any motor blockade. The total dose of bupivacaine used in Epidural group was 20.5±6.6mg whereas it was only 8.5±7.7mg in CSE group which was significant low than epidural group; same was for fentanyl (65.1±21.6µg in epidural and 44.4±24.6µg in CSE group). In CSE group 35% patients had pruritus and 10% had nausea and vomiting, but none had in epidural group. Mothers have labeled quality of analgesia comparable. Conclusions: Both techniques were equally effective in relieving the pain during labor, but the onset of analgesia with CSE technique was faster than epidural group. The LSCS rate was comparable and complications were minor. Thus CSE can be safe and effective alternative to standard epidural technique for labor analgesia.

141-146

Authors: Prerana Jogdand, Prasad M. Sule.

Aim and Objectives: Aim of the present study was to compare the efficacy of the block, hemodynamic effects, postoperative analgesia and side effects of combined psoas compartment sciatic nerve block with continuous spinal anaesthesia in adult patients undergoing lower extremity surgeries. Materials and Methods: Sixty patients of either sex, ASA grade I, II and III, age between 18-70 years, were randomly allocated into two groups. In group A, psoas compartment block was performed by posterior approach using 30cc of 0.25% bupivacaine and sciatic nerve block by classical posterior approach using the 20cc of 0.25% bupivacaine. In group B, continuous spinal anaesthesia was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 3cc (15 mg) of 0.5% heavy bupivacaine. We studied various parameters of block, hemodynamic effects, duration of postoperative analgesia and any complications. Results: Group B had earlier onset of sensory and motor block as compare to group A. The mean duration of sensory and motor block was significantly prolonged in group A than in group B. The efficacy of sensory blockade was comparable in both the groups while in group A 90% patients and in group B 97% of patients had complete motor blockade. The incidence of hypotension was more with group B as compared to group A. The duration of post-operative analgesia was longer in group A than in group B. No major complications were observed in both the groups. Conclusions: It was concluded that combined psoas compartment block and sciatic nerve block is a beneficial alternative to existing anaesthesia techniques for lower extremities surgeries.

152-155

Authors: Yi Lin. Lee, Shah Shitalkumar Sharad, Keng Tiong Jerry Tan, Kothandan Harikrishnan.

Congenital heart disease affects approximately 1% of the population and is the leading cause of birth defect associated infant illness and death. The most common cyanotic heart disease is tetralogy of Fallot (TOF) which is characterized by overriding of aorta, ventricular septal defect (VSD), pulmonary stenosis and right ventricular hypertrophy. TOF are repaired early in infancy and involves closure of the VSD and repair or replacement of the pulmonary valve to improve right ventricular outflow. A potential and significant complication is stenosis of the pulmonary homograft. We discuss a young patient with previous sternotomies for repair of TOF presenting for his 4th redo-sternotomy for an infective abscess near his old pulmonary homograft. This case presents to us multiple challenges such as a septic patient, previous sternotomies and a potential for intraoperatively massive blood loss.

159-161

Authors: Mohandeep Kaur, Michell Gulabani, Vinod Bala Dhir, Rao Pal Singh.

Subacute Sclerosing panencephalitis (SSPE), also known as Dawson’s disease or measles encephalitis, is an extremely rare and fatal subacute infection caused by a persistent defective measles virus (MV). It mostly develops 7-10 years after initial MV infection and is fatal within 3 years from onset of symptoms.1 Measles virus infection before 2 years of age has 16 times higher risk of developing SSPE as compared to infection occurring after five years of age.2 SSPE is a progressive, degenerative disease of the central nervous system that occurs several years after measles infection. Saha et al reported an annual incidence of 21 per million population in India3 as compared to 2.4 per million population in the middle east.4-5 By this case report, we aim to stress on the certitude that the only definitive prevention against SSPE is timely measles vaccination.