Academia Anesthesiologica International http://aijournals.com/index.php/aan <p><strong class="pull-left">Academia Anesthesiologica International </strong>is a double-blinded peer-reviewed, open access, Bi-annual, online journal that publishes original research articles, review articles, case reports, brief communications and clinical studies in all areas/advances of anesthesia, pain and intensive care. <br><strong>Online ISSN: 2456-7388 | Print ISSN:&nbsp;2617-5479</strong></p> Society for Health Care & Research Development en-US Academia Anesthesiologica International 2617-5479 Compare the Effects of Dexmedetomidine Infusion versus Normal Saline as Placebo on Haemodynamic Response in Elective Laparoscopic Surgery Under General Anaesthesia http://aijournals.com/index.php/aan/article/view/1720 <p><strong>Background</strong>: Throughout the present medical age, laparoscopic surgery is the most effective diagnostic and therapeutic methods. But it is associated with potentially harmful neuroendocrine response. <strong>Subjects and Methods</strong>: In our study we used dexmedetomidine infusion in group D and normal saline at a rate of 0.4mcg / kg / hr as placebo in group N beginning from 10 minutes before induction before pneumoperitoneum release. Patients in both groups were alike in age, gender, BMI, grade of ASA and anaesthesia. <strong>Results</strong>: After 10 min infusion of dexmedetomidine and normal saline in group D and group N respectively, fall in HR, DBP and Mean arterial pressure was significantly increased in group D compared to group N. Difference found in both the groups was statistically significant. Group N showed significant increase in HR, SBP, DBP and MAP during laryngoscopy, intubation and at 2 min , 5 min and 10 min after creation of pneumoperitoneum. Difference found was statistically significant in both groups. Thus attenuation in HR, SBP, DBP and MAP was seen in group D as compared to group N during laryngoscopy, tracheal intubation and pneumoperitoneum which were statistically significant. Group N showed statically significant increase in HR, DBP&nbsp; and MAP during extubation compared to group D. Difference found in both the groups was statistically significant. Thus attenuation in HR, DBP and MAP was seen in group D as compared to group N during extubation which was statistically significant. Postoperative sedation score was more in group D compared to group N which was statistically significant. Post-extubation, rescue analgesia was required early in group N compared to group D. Adverse effect in form of bradycardia was seen in 2 patients in group D which did not require atropine administration. <strong>Conclusion: </strong>Dexmedetomidine infusion at a rate of 0.4 mcg / kg / hr apparently started 10 minutes before the induction of anesthesia before release of pneumoperitoneum without any bolus dose. Useful adjuvant anesthesia to diminish the response of haemodynamic stress to intubation, Pneumoperitoneum, and extubation in laparoscopic surgical patients.</p> V. Ravi Sankar T. Jamuna B. Raju Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 1 8 10.21276/aan.2020.5.2.1 Evaluation of Efficacy of Transversus Abdominis Plane Block and Systemic Analgesia for Post-Operative Pain in Total Abdominal Hysterectomy: A Comparative Study http://aijournals.com/index.php/aan/article/view/1721 <p><strong>Introduction: </strong>Management of post-operative Pain is gaining considerable attention with pain being recognized as the fifth vital sign. Post- operative pain management remains unresolved as pain is individualized and varies with surgery. The aim is to evaluate the analgesic efficacy of transverses abdominis plane block by continuous catheter technique and systemic analgesia for post-operative pain in total abdominal hysterectomy. <strong>Subjects and Methods: </strong>This randomized controlled trial was done in patients undergoing total abdominal hysterectomy via Pfannenstiel incision. Patients were assigned into 2 groups, systemic analgesics group (n=25) and TAP block group (n=25) randomly. <strong>Results: </strong>Out of 50 patients, 25 patients had systemic analgesics and 25 patients had TAP block<strong>. </strong>Demographics and surgical procedure times were comparable. Mean VAS pain score with coughing on day 1 and 2 in systemic analgesics group was 3.96 and 2.07 and in TAP block group were</p> <p>0.7 and 0.3. Meantime taken to mobilize the patient after the surgery in the systemic analgesics group was 30.7 hours and in TAP block group was 22.4 hour. 18 patients needed rescue medication in the systemic analgesics group, and 9 patients required rescue medication in the TAP block group. In group 16 patients with systemic analgesics had post-operative nausea and vomiting, and 5 patients in group block TAP. <strong>Conclusion: </strong>Continuous TAP block provides better pain relief, denoted by lower visual analogue scores and better recovery profile enhancing recovery in patients undergoing abdominal hysterectomy.</p> Menaka Viswanath Ravikrishna Kalathur K. Shanthini Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 9 13 10.21276/aan.2020.5.2.2 Effect of Dexmeditomidine on Isofluorane Consumption in Middle Ear Surgery http://aijournals.com/index.php/aan/article/view/1722 <p><strong>Background: </strong>With the introduction of intentional hypotensive anesthesia in the surgical field to achieve a relatively bloodless surgical field along with the use of the operative microscope, it has revolutionized the middle ear surgery practice. Dexmedetomidine is a relatively new and potent <em>α</em>2 agonist prototype found efficient in rendering bloodless intra-surgical field and inducing controlled hypotension during the surgeries of the middle ear. The objective is to present prospective study was aimed at evaluating with and without dexmedetomidine infusion effect on end-tidal isoflurane concentration for lowering blood pressure by 30%, awakening time and quality of bloodless surgical field during middle ear surgical procedure. <strong>Subjects and Methods:</strong>54 patients who were to undergo middle ear surgery and had ASA I and II were randomly divided into the two groups. In Group I Dexmedetomidine was used and in Group II Normal saline. Effect of Dexmedetomidine infusion on end-tidal isoflurane concentration for lowering blood pressure by 30%, awakening time, quality of bloodless surgical field during middle ear surgical procedure, heart rate was evaluated. The data collected were statistically analyzed. <strong>Results: </strong>The mean values of the heart rate were statistically non-significant between the groups when recorded at the baseline, whereas, a statistically significant difference was seen in the values for heart rate intra-operatively. The mean values for heart rates were significantly higher for the placebo group. A significant difference in Isoflurane concentration was found with dexmedetomidine requiring a percentage of 0.6 0.4 and normal saline 1.8 0.5. Less bleeding was seen with dexmedetomidine. <strong>Conclusion:&nbsp; </strong>Dexmedetomidine is a potent hypotensive agent which also reduces the requirement of Isoflurane compared&nbsp; to the normal saline placebo. The use of dexmedetomidine is relatively safe and provide a relatively bloodless surgical field, hence, increasing efficacy, and improving visibility at the surgical site.</p> Smriti Bandhu Arunabh Mukharjee Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 14 19 10.21276/aan.2020.5.2.3 Anaesthesia and Anaesthesiologist: The Perception of Attendees at a Medical College in Rural Haryana http://aijournals.com/index.php/aan/article/view/1723 <p><strong>Introduction: </strong>Anaesthesia as a specialty is reaching its zenith with multiple sub-specialties, but anaesthesiologist remains obscure personnel behind the drapes due to lack of public perception and knowledge pertaining to their role. The aim is to the study was conducted to assess the perception and knowledge of general public about the role of anaesthesia and the anaesthesiologist. <strong>Subjects and Methods : </strong>A prospective, cross-sectional study, conducted in a 500-bedded, rural medical college over a 3-month period. A total of 172 attendees accompanying their patients for surgical procedures were enrolled and assessed based on preformed, pretested questionnaire in the pre-anaesthetic clinic. The questionnaire contained 30 questions to determine their knowledge and attitude towards anaesthesia and anaesthesia provider. <strong>Results: </strong>Out&nbsp;&nbsp;&nbsp; of total 172 participants, 43.02% % recognized anaesthesiologist as specially trained doctors. Eighty two (47.67%) of the attendees knew that anesthesia is administered by an anesthesiologist but 71.5% were not aware of their role in providing peri-operative care. The attendees apprised of anesthesiologists role in labour analgesia, chronic pain management, intensive care units and emergency resuscitation was Sixty seven (39%), forty nine (28.49%), forty five (26.7%) and twenty six (15.1%) out of 172 respectively. Majority of the attendees (93.6%) were receptive to know more about anaesthesia. <strong>Conclusion</strong>: The awareness regarding role of anaesthesiologist in general public is still low and the perception of people about anaesthesia as an evolved specialty is lacking. This calls for corrective measures to be taken by the anaesthesiology fraternity for propagation of anesthesiology skills via social media and other government aided platforms.</p> Meenu Agrawal Meena Singh Pranav Bansal Tushar Jindal Ishrat Yousuf Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 20 25 10.21276/aan.2020.5.2.4 Betamethasone Versus Ketamine for Attenuation of POST in Patients Undergoing Surgeries Under GA with Endotracheal Intubation- A Clinical Study http://aijournals.com/index.php/aan/article/view/1724 <p><strong>Background: </strong>Postoperative sore throat is one of the most common complications after endotracheal intubation. The present study was conducted to assess the role of betamethasone gel applied over the endotracheal tube cuff for attenuation of POST in patients undergoing surgeries under GA with endotracheal intubation and compare it with ketamine nebulization. <strong>Subjects and Methods : </strong>This is a randomized controlled prospective study conducted in 90 patients of either sex between 18-70 years of age divided into three groups. Group I patients received ketamine 50 mg, group II received 3 ml of water soluble 0.05% betamethasone gel, group III received 3 ml of water soluble 2% lignocaine. POST was graded on a four-point scale (0–3); 0 = no sore throat; 1 = mild sore throat (complains of sore throat only on questioning); 2 = moderate sore throat (complains of sore throat on his/her own); 3 = severe sore throat (change of voice or hoarseness, associated with severe throat pain). <strong>Results: </strong>The mean duration of surgery in group I was 128.5 minutes, in group II was 131 minutes and in group III was 134.5 minutes. There were 6 (20%), 7 (23.3) and 14 (46.6%) cases in group I, II and III respectively. The difference was significant (P&lt; 0.05). At 0 hour there were 3 cases in group I, II and 10 in group III, at 2 hours was 3, 5 and 12 in group I, II and III respectively, at 6 hours was 5,4 and 14 cases in group I, II and III respectively, at 12 hours was 3, 3 and 12 cases in group I, II and III respectively and at 24 hours was 2, 2 and 12 cases in group I, II and III respectively. <strong>Conclusion: </strong>Authors found that POST can be equally managed with nebulisation with ketamine preoperatively and application of betamethasone gel over endotracheal tube cuff.</p> S. Ankalagowri Sankardevar N R Arjun Uthkala B Hegde Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 26 29 10.21276/aan.2020.5.2.5 Usefulness of 0.5% Hyperbaric Bupivacaine with Dexmedetomidine on Spinal Anaesthesia in Lower Limb Orthopaedic Patients http://aijournals.com/index.php/aan/article/view/1725 <p><strong>Background: </strong>The present study was conducted to assess the usefulness of 0.5% hyperbaric bupivacaine with dexmedetomidine on spinal anesthesia in lower limb orthopedic patients. <strong>Subjects and Methods: </strong>This study involved 50 patients with ASA Grade I and II of both genders. Patients were randomly allocated into group I (n=25) Patients received Dexmedetomidine 0.5 <em>µ </em>g/kg over 15 minutes using an infusion pump 20 minutes prior to SAB and group II (n=25) Intraoperatively HR, BP and SpO2 were measured and noted. <strong>Results: </strong>The mean heart rate at baseline was 80.00 8.49 in group I and 81.80 8.74 in group II. The mean heart rate at 5 minutes was 73.80 13.38 in group I which was significantly higher (p=0.02) compared to 65.63 12.45 in group II. The mean arterial pressure at baseline was 97.64&nbsp; 5.24 in group I and 97.73&nbsp; 6.96 in&nbsp; group II suggesting MAP in both groups was comparable. The MAP at 5 minutes was 90.73 14.65 in group I which was significantly higher (p=0.01) compared to 81.22 11.64 in group II, suggesting a greater fall from the baseline in group II compared to group I. The MAP in both groups was found to be comparable at 15, 30, 45, 60, 75, 90, 105, 120 minutes (p&gt;0.05). The oxygen saturation in both groups was found&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; to be comparable at all time intervals. The duration of onset of sensory blockade (Time is taken to reach T10 level) in 53.33% of patients in Group I is between 1 to 2 minutes (60 to 120 seconds) and less than 1 minute (60 seconds) in 46.67% of patients. The average mean time and standard deviation of onset of sensory blockade in Group I is 66 44.14 seconds. <strong>Conclusion: </strong>Authors found that dexmedetomidine was given intravenously as premedication before spinal anaesthesia using injection bupivacaine results in a quicker onset of analgesia, prolonged duration of sensory, motor block and well balanced hemodynamic parameters.</p> N R Arjun Nischala Reddy G K. Narayana Prasad Uthkala B Hegde Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 30 34 10.21276/aan.2020.5.2.6 Epidural Fentanyl and Fentanyl Plus Magnesium for Post-Operative Analgesia in Lower Extremity Surgery http://aijournals.com/index.php/aan/article/view/1726 <p><strong>Background: </strong>The present study was conducted to assess the efficacy of epidural fentanyl with a combination of epidural fentanyl and magnesium in lower extremity surgery. <strong>Subjects and Methods : </strong>This study was conducted on 100 ASA I/II patients scheduled to undergo elective lower limb orthopedic surgeries. Group I patients received epidural fentanyl 50 <em>µ</em>g (1cc) diluted and made up to 6cc with normal saline. Group II patients received epidural fentanyl 50 <em>µ</em>g (1cc)+ Magnesium sulphate 50mg (4 units in insulin syringe of 50% solution) diluted and made up to 6cc with normal saline. Patient data such as indication for surgery, the anesthetic details, intraoperative monitoring, post-operative follow-up, etc was recorded. <strong>Results: </strong>Each group had 36 males and 14 females. Time is taken for the highest sensory level in group I was 13.92 4.50 minutes and 12.24&nbsp; 3.43 minutes in groups I and II respectively. The mean duration of surgery was 99.00&nbsp; 13.31 minutes in group I and 92.20&nbsp;&nbsp; 15.21&nbsp;&nbsp; in group II. Time for Regression to L1 was 118.80 13.41 and 119.60 17.85 minutes in group I and II respectively. The duration of analgesia (min) was 107.00 25.82 and 143.40 39.57 minutes in group I and II respectively. Common adverse events were nausea/ vomiting seen 2 in group I and 4 in group II and urinary retention seen 0 in group I and 2 in group II. The difference was non- significant (P&gt; 0.05). <strong>Conclusion: </strong>Authors found that the addition of magnesium sulfate to epidural fentanyl for elective lower limb orthopedic surgeries has prolonged the duration of fentanyl analgesia without any significant side effects.</p> Ajay Babu Ramakrishnan S. Ankalagowri Sankardevar Nischala Reddy G Uthkala B Hegde Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 35 38 10.21276/aan.2020.5.2.7 Efficacy of Intrathecal Neostigmine with Intrathecal Dexmedetomidine in Postoperative Analgesia http://aijournals.com/index.php/aan/article/view/1727 <p><strong>Background: </strong>The present study was conducted to compare the efficacy of intrathecal neostigmine with intrathecal dexmedetomidine in postop- erative analgesia. <strong>Subjects and Methods: </strong>The present study was conducted in the department of Anesthesia involving 100 patients belonging to ASA grade I and II, posted for elective Sub umbilical surgeries, under spinal anaesthesia. Group I patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 50mcg (0.5ml) of Neostigmine. Group II patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 10mcg (0.5ml) of dexmedetomidine. <strong>Results: </strong>The maximum patients were seen in age group 18-30 years ie 10 in group I and 16 in group II and minimum in 41-50 years ie 6 in group I and 4 in group II. The mean time for onset of sensory block in group I was 1.43 0.53 min and in group II was 2.319&nbsp;&nbsp; 0.44 min. The mean time for onset of peak sensory block in group I was 5.48&nbsp;&nbsp;&nbsp; 0.43 min and Group II was 7.31&nbsp;&nbsp;&nbsp; 0.44 min.&nbsp; Time for two segment regression was significantly higher in dexmedetomidine group as compared to neostigmine group, the mean time for two segment regression in group I was 124.98 21.48 min and group II was 165.24 14.45 min. The mean time for onset of motor block was 3.079 0.44 min in group I and 4.0454&nbsp; 0.38 min in group II. The mean duration of motor block in group I was 191.58&nbsp; 26.81 min and 324&nbsp; &nbsp;36.8 min in group II. The difference was significant (P&lt; 0.05). The mean sedation score in group I was 1.03 and in group II was 2.07. The difference was significant (P&lt; 0.05). <strong>Conclusion: </strong>Authors recommend the use of dexmedetomidine as an adjuvant to bupivacaine in subarachnoid block</p> Nischala Reddy G Ajay Babu Ramakrishnan S. Ankalagowri Sankardevar Uthkala B Hegde Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 39 42 10.21276/aan.2020.5.2.8 Study of Comparison of Dexmedetomidine Added to Levobupivacaine versus Alone Levobupivacaine in Supraclavicular Brachial Plexus Blockade http://aijournals.com/index.php/aan/article/view/1728 <p><strong>Background: </strong>The aim is the current research is the comparison of Dexmedetomidine added to Levobupivacaine versus alone Levobupivacaine in supraclavicular brachial plexus blockade. <strong>Subjects and Methods : </strong>The current research was performed in the Department of Aneshtesia, Gov- ernment Medical College and SSG Hospital, Vadodara, from October 2014tooctober to 2015. Subjects were separated into 2 groups: Group LD: receives Inj. Levobupivacaine 0.5 %(35ml)+inj.Dexmedetomidine (0.5 l)+Inj.NS(0.5ml)=total 36 ml. Group L: receives Inj.Levobupivacaine0.5</p> <p>%( 35ml) + inj. Normal saline(1ml) = 36 ml. Pulse rate, Blood pressure, Respiratory rate and Oxygen saturation (SpO<sub>2</sub>), Ramsay sedation score</p> <p>were monitored before giving the block, immediately after giving the block, each 5 minutes till fifteen minutes, every fifteen minutes thereafter for one hour and each thirty minutes afterward until the conclusion of surgery. <strong>Results: </strong>Total duration of sensory block was significantly extended in group LD as a contrast to group L. Total duration of motor block was significantly longer in group LD as a contrast to group L. Patients receiving Dexmedetomidine had long-lasting postoperative analgesia as compared to the control group. Thus, the total duration of analgesia was considerably extended in group LD patients as a contrast to group L patients and the dissimilarity was statistically highly significant. <strong>Conclusion: </strong>Dexmedetomidine can be utilized as a secure and useful aid to local anesthetics in supraclavicular brachial plexus block to give outstanding perioperative analgesia with negligible consequences.</p> Nimisha Brahmbhatt Swati Mehta Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 43 48 10.21276/aan.2020.5.2.9 A Comparative Study of Dexmedetomidine and Clonidine for Attenuation of Hemodynamic Response during Laryngoscopy and Intubation http://aijournals.com/index.php/aan/article/view/1729 <p><strong>Background: </strong>The present study was conducted to compare dexmedetomidine and clonidine for attenuation of hemodynamic response during laryngoscopy and intubation. <strong>Subjects and Methods: </strong>Group I patients received 0.9% normal saline (placebo), group II patients received 0.5 <em>µ</em>g/kg of dexmedetomidine and group III patients received 3 <em>µ</em>g/kg of or clonidine. Each group had 15 patients. <strong>Results: </strong>The mean age in group I was 28.2 years, in group II was 32.1 years and in group III was 33.2 years, mean weight was 61.2 years, in group II was 60.4 years and in group III was 62.1 years, height was 156.2 cm, in group II was 157.1 cm and in group III was 152.8 cm. There were 8 males and 7 females in group I, 6 males and 9 females in group II and 7 males and 8 females in group III. The mean SBP (mm Hg) in group I was 121.4 and in group II was 122.6, and in group III was 127.4, DBP (mm Hg) was 76.2 in group I, 78.4 in group II and 78.2 in group III. MAP (mm Hg) was 86.7 in group I, 93.2 in group II and 92.5 in group III. HR (bpm) was 74.2 in group I, 78.4 in group II and 77.3 in group III. % oxygen saturation was 98.2in group I, 98.5 in group II and 97.9 in group III. The difference was non- significant (P&gt; 0.05). <strong>Conclusion: </strong>Authors found that both groups were equally effective in causing attenuation of hemodynamic response to endotracheal intubation.</p> Sanjay Kumar Gupta Saurabh Singhal Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 49 52 10.21276/aan.2020.5.2.10 Abnormal Central Venous Oxygen Saturation as a Predictor of Mortality in Patients with Sepsis and Polytrauma in the Surgical Intensive Care Unit http://aijournals.com/index.php/aan/article/view/1730 <p><strong>Background</strong>: In postoperative heart surgery patients and patients with sepsis, pathological (low and supranormal) central venous oxygen satura- tion (ScvO2) was shown to be associated with lower mortality. The objective is we want to examine the effect of sepsis and polytrauma infection on our surgical ICU and the incidence of morbidity and death in the population. <strong>Subjects and Methods: </strong>In such patients who met the qualifying criteria and had a history of scepticism and multi-trauma, a retrospective observational review was conducted. We investigated and evaluated the association between SCV02 and mortality and other variables, such as lactate and baseline excess and period of the ICU stay and inotropic assistance within the first 6 hours, using a multivariate model review. Their entry was measured and 6 hours later. <strong>Result: </strong>The incidence of deaths in the hyperoxia group was 2.4 times higher in comparison to the general population, and the death rate in the hypoxia category was 1.25 times higher. The risk of death for the hyperoxic population was 2.4 times higher. There was no statistically relevant discrepancy of ICU, inotropic treatment, coagulopathy, dialysis, apache-11 score, baseline excess and lactate between the three levels of Scv02. <strong>Conclusion</strong>: The base excess and Scv02 were not significant when the lactates were calculated to a mortality point, but the j curve revealed that both the hypoxia group and the hyperoxia mortality had improved in contrast with the normal oxy group. Since the small sample size was sufficient to predict a trend, secondary targets were not</p> T Vijaya Kumar Srinivas A. V. Mahesh Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 53 56 10.21276/aan.2020.5.2.11 Evaluation of the True View PCD Video Laryngoscope for Oral Endotracheal Intubation http://aijournals.com/index.php/aan/article/view/1731 <p><strong>Background: </strong>Truview PCD video laryngoscope is particularly planned to assist in locating the endotracheal tube in addition to observe the admission of the tube into the glottis. The present study was performed to assess the outlook of glottic opening and relief of intubation between the Truview PCD laryngoscope and Macintosh laryngoscope in patients undergoes general anaesthesia. <strong>Subjects and Methods: </strong>Ninety patients of ASA grade 1 and 2 aged 18-60 years, posted for elective surgery under general anaesthesia needing endotracheal intubation were arbitrarily allocated into group 1 (Truview PCD laryngoscope n=45) and group 2 (Macintosh laryngoscope n=45). The two groups were compared for demographic data, intubation difficulty score, Cormack-Lehane grade, time to intubate, number of intubation attempts and hemodynamic parameters. <strong>Conclusion: </strong>Truview PCD can be measured as an alternate intubation device, especially in difficult intubation conditions.</p> Neha Agrawal Alks Shah Balraj Joshi Pinal Vasani Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 57 61 10.21276/aan.2020.5.2.12 Comparison of Various Techniques of Anesthesia for Surgical Management of Diabetic Foot http://aijournals.com/index.php/aan/article/view/1732 <p><strong>Background: </strong>Diabetes mellitus is a multisystem disease caused by an absolute or relative deficiency of insulin secretion or resistance or a combination of both. Anesthesia in them is of special concern because of complex polypharmacy, an inappropriate dose of oral hypoglycemic agents or insulin and errors in converting IV insulin to usual medication. The objective is to compare the various techniques of anesthesia for surgical management of diabetic foot in terms of intraoperative hemodynamic stability, perioperative problems related to anesthesia techniques, postoperative analgesia. <strong>Subjects and Methods</strong>: Sixty adult diabetic patients of both gender of ASA grade II-III, aged 35years undergoing surgical management of diabetic foot were elected and separated into three groups, Group A: general anesthesia with tracheal intubation, Group B: unilateral spinal anesthesia with injection 0.5% bupivacaine heavy 1.5ml (7.5mg), Group C: popliteal nerve block via lateral approach by injecting 30 ml 0.5% bupivacaine. Parameters like pulse rate, mean arterial blood pressure, respiratory rate and SpO2 were recorded at regular intervals. Postoperative pain, perioperative side effects, complications and problems related to anesthetic techniques were noted. The analysis is done by unpaired t-test and chi-square test. <strong>Results: </strong>Group C patients were hemodynamic stable than Group A and B. Post-op analgesia was prolonged in Group C. Perioperative side effects were more found in Group A. <strong>Conclusion</strong>: Popliteal nerve block and unilateral spinal anesthesia provide better hemodynamic stability and postoperative analgesia with negligible side effects as compared to general anesthesia for surgical management of diabetic foot.</p> Kapil S. Divekar Karishma D. Mehta Pancham Mehta Payal P. Prajapati Kamla H. Mehta Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 62 65 10.21276/aan.2020.5.2.13 Comparison of efficacy of Ondansetron and Metoclopramide in reducing Postoperative Nausea and Vomiting http://aijournals.com/index.php/aan/article/view/1733 <p><strong>Background: </strong>Post-operative vomiting and nausea are common conditions faced by cases undergoing surgery under general anesthesia. Ondansetron and metoclopramide are the widely used drug which was proved to reduce the post-operative vomiting and nausea but among metoclopramide and ondansetron, the one drug with better efficacy remains a question and hence this study was conducted to assess the same. <strong>Subjects and Methods : </strong>This randomized controlled trial was conducted in the department of anesthesiology among the patients who underwent surgery in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai from August 2019 to March 2020. A total of eighty cases were included and the study participants were randomized and divided into two groups with forty cases in each group. Patients in group A received the drug Metoclopramide (10 mg) and group B received Ondansetron (4 mg). Outcome assessed were the incidence of nausea and vomiting and the number of doses of additional antiemetics needed. Data was analyzed using SPSS -17. <strong>Results: </strong>There was no statistically significant difference noted between the two groups for age, gender, weight and duration of surgery whereas vomiting and nausea were found to be significantly low in the ondansetron group compared to the metoclopramide group which in turn results in significantly more doses of antiemetics were needed in the metoclopramide group than the ondansetron group during the post-operative period. <strong>Conclusion: </strong>Single dose of preoperative ondansetron helps to significantly reduce postoperative nausea and vomiting compared to metoclopramide.</p> M. Kawin Kumar Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 66 70 10.21276/aan.2020.5.2.14 Hemodynamic Profile of Laryngeal Mask Airway Insertion Compared to Laryngoscopy and Tracheal Intubation http://aijournals.com/index.php/aan/article/view/1734 <p><strong>Background: </strong>Endotracheal intubation by laryngoscopy is one of the most famous and frequent methods for securing the airway. This study compares the modifications in hemodynamic parameters in hypertensive patients following laryngoscopic endotracheal intubation or laryngeal mask airway insertion. <strong>Subjects and Methods : </strong>Fifty patients between the ages of 35-70 years of either gender with a history of Hypertension of ASA grade II planned for elective surgery were selected. They were separated into 2 groups: group LMA and group ET. LMA insertion or tracheal intubation was executed following the induction of anesthesia with Propofol and succinylcholine. The heart rate, mean arterial pressure and rate pressure product were calculated after induction and instantly following insertion /intubation and then after 1, 3, 5 minutes. <strong>Results: </strong>The heart rate was augmented after induction and continued to be high for more than 3 minutes after LMA insertion and tracheal intubation. The increase in Heart rate was more in the ET group than the LMA group. The values remained high for 5 minutes in Group ET and only for&nbsp;&nbsp; 3 minutes in Group LMA. Group LMA had lower values at all times when compared to Group ET. <strong>Conclusion: </strong>Our study concludes that the insertion of the laryngeal mask airway grounds a lesser hemodynamic reaction than tracheal intubation in hypertensive patients.</p> Ram Nandan Prasad Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 71 74 10.21276/aan.2020.5.2.15 Attenuation of Hemodynamic Pressor Response during Laryngoscopy and Intubation: A Clinical Study of Premedication with Different Doses of Oral Melatonin http://aijournals.com/index.php/aan/article/view/1737 <p><strong>Objectives: </strong>To assess the effect of two different doses of oral melatonin premedication on the hemodynamic parameters. <strong>Subjects and Methods: </strong>Ninety patients aged between 20 to 45 years of either sex belonging to ASA grade I and II were randomly divided into three groups. This randomized prospective study was conducted on patients undergoing elective surgeries on general anesthesia. In Group-C oral Placebo was given 120 minutes before surgery, in Group M6- Tab. Melatonin 6mg and in Group M9- Tab. Melatonin 9mg was given 120 minutes before surgery. Patients were assessed for intraoperative and post-operative hemodynamic parameters at different time intervals. <strong>Results :&nbsp;&nbsp; </strong>The&nbsp;&nbsp; mean heart rate in Group M6 and group M9 was significantly decreased from baseline (83.63&nbsp; 6.7) to (81.96&nbsp; 6.1) and from (82.82&nbsp; .09) to&nbsp; (77.4&nbsp; 5.25) respectively, (P&lt;0.001) while in Group C it was increased from baseline (81.2&nbsp; 5.33) to (92.0&nbsp; 4.64). Systolic blood pressure&nbsp;&nbsp; (SBP) was increased from baseline (123.56 3.25) to (132.76 3.77) in Group C, while in Group M6 and M9 it was significantly decreased from (121.13 3.82) to (118.13 31.3) and from (122.79&nbsp; 3.33) to (115.96&nbsp; 3.44) respectively. (P&lt;0.001) Diastolic blood pressure (DBP) in Group C was increased from baseline (80.23 2.11) to (87.70 3.48). In Group M6 and M9, it was significantly decreased from baseline (78.03 5.15) to (73.56 3.77) and from (77.51 3.87) to (71.55 3.14) respectively. (P&lt;0.001). <strong>Conclusion: </strong>Oral melatonin in a dose of 6mg and 9mg was more effective compared to placebo but 9mg attenuated the hemodynamic response asoociated with laryngoscopy and endotracheal intubation better as compared to 6mg melatonin.</p> <p><strong>Objectives: </strong>To assess the effect of two different doses of oral melatonin premedication on the hemodynamic parameters. <strong>Subjects and Methods: </strong>Ninety patients aged between 20 to 45 years of either sex belonging to ASA grade I and II were randomly divided into three groups. This randomized prospective study was conducted on patients undergoing elective surgeries on general anesthesia. In Group-C oral Placebo was given 120 minutes before surgery, in Group M6- Tab. Melatonin 6mg and in Group M9- Tab. Melatonin 9mg was given 120 minutes before surgery. Patients were assessed for intraoperative and post-operative hemodynamic parameters at different time intervals. <strong>Results :&nbsp;&nbsp; </strong>The&nbsp;&nbsp; mean heart rate in Group M6 and group M9 was significantly decreased from baseline (83.63&nbsp; 6.7) to (81.96&nbsp; 6.1) and from (82.82&nbsp; .09) to&nbsp; (77.4&nbsp; 5.25) respectively, (P&lt;0.001) while in Group C it was increased from baseline (81.2&nbsp; 5.33) to (92.0&nbsp; 4.64). Systolic blood pressure&nbsp;&nbsp; (SBP) was increased from baseline (123.56 3.25) to (132.76 3.77) in Group C, while in Group M6 and M9 it was significantly decreased from (121.13 3.82) to (118.13 31.3) and from (122.79&nbsp; 3.33) to (115.96&nbsp; 3.44) respectively. (P&lt;0.001) Diastolic blood pressure (DBP) in Group C was increased from baseline (80.23 2.11) to (87.70 3.48). In Group M6 and M9, it was significantly decreased from baseline (78.03 5.15) to (73.56 3.77) and from (77.51 3.87) to (71.55 3.14) respectively. (P&lt;0.001). <strong>Conclusion: </strong>Oral melatonin in a dose of 6mg and 9mg was more effective compared to placebo but 9mg attenuated the hemodynamic response asoociated with laryngoscopy and endotracheal intubation better as compared to 6mg melatonin.</p> Archana Devtara Ankur Gandhi Maya Damor Sadhana Jain Aditya Sharma Aradhaya Verma Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 75 79 10.21276/aan.2020.5.2.16 Choice for Post-Operative Pain – Fentanyl or Acetaminophen? A Randomized Control Study http://aijournals.com/index.php/aan/article/view/1738 <p><strong>Background: </strong>Pain a common complaint often reported by post-operative cases. Fentanyl is one of the widely used short-term and rapid-response opioid drugs with addictive nature. Acetaminophen and another widely used pain killer without addictive property. Hence, this study was planned to compare the efficacy of fentanyl and acetaminophen in terms of reducing post-operative pain. <strong>Subjects and Methods : </strong>This randomized controlled trial was carried out in the department of anesthesiology among the surgical patients admitted in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai from January 2019 to June 2019. A total of eighty cases were included and they were randomized&nbsp; and divided into two groups with forty cases in each group where group A received the drug fentanyl 1mcg/kg and group B received drug acetaminophen 1 gm intravenously during the second hour of their post-operative period. The pain was assessed using the VAS score. Results were analyzed using the Statistical Package for Social Sciences (SPSS) version 17. <strong>Results: </strong>Both fentanyl and acetaminophen groups were similar in terms of age, gender, different surgical procedures and complaints with no statistically significant difference, noted. However, postoperative pain scores were comparatively less in the fentanly group compared to the acetaminophen group during the sixth and twelfth postoperative hour but the pain scores were similar in both the groups at the twenty-fourth postoperative hour. <strong>Conclusion: </strong>Fentanyl can be used for the management of postoperative pain compared to acetaminophen, which reported comparatively fewer complaints.</p> M. Kawin Kumar Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 80 83 10.21276/aan.2020.5.2.17 Prospective Study of Efficacy of Intracuff Dexamethasone, Lignocaine and Normal Saline on Post Extubation Response http://aijournals.com/index.php/aan/article/view/1739 <p><strong>Background: </strong>Post-surgical throat pain is the most common symptom after endotracheal intubation and is seen in up to 90 percent of patients. It can be considered along with the appearance of the endotracheal tube with laryngeal edema and ischemia. Chemical and mechanical tracheal mucosal inflammation affects the occurrence of cough from general anesthesia at the time of emergence, possibly leading to severe postoperative complications. During the emergence of a sore throat in a lighter plane of anesthesia, adverse hemodynamic changes can result. These changes are especially undesirable in patients undergoing neurosurgery, ophthalmic surgery or those with an increased risk of adverse cardiovascular incidents. The aims is to the purpose of this research is to determine and compare the effectiveness of intra-cuff dexamethasone and lignocaine in reducing the adverse effects of the post-extubation airway as a control group with normal saline. <strong>Subjects and Methods</strong>: Prospective study was performed on 90 patients admitted to general anaesthesia for separate operations. After having received approval from the institutional ethics committee and written informed consent, they were randomly divided into 3 groups of 30 patients each. <strong>Results</strong>: Among the three classes of surgical, anaesthetic, and baseline characteristics, there were no statistically significant differences. In terms of cough, the three groups differed significantly (p = 0.02). In other words, while lignocaine was more beneficial for the occurrence of cough after extubation, dexamethasone affected the severity of post-extubation cough more than the other 2 medications. In comparison with the dexamethasone and standard saline groups, spontaneous ventilation time and time to extubation (increase in endotracheal tolerance) were also extended in the lignocaine community. The three classes did not vary substantially in terms of patient satisfaction after 24 hours. <strong>Conclusions</strong>: When Dexamethasone is inflated with the endotracheal tube cuff, the incidence of postoperative sore throat and cough, but not speech hoarseness, is decreased.</p> P. Rajeswar Suresh Kumar Esampalli Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-16 2020-12-16 5 2 84 88 10.21276/aan.2020.5.2.18 To Determine the Incidence of Difficult Intubation http://aijournals.com/index.php/aan/article/view/1754 <p><strong>Introduction: </strong>To determine the incidence of difficult intubation among patients scheduled for surgery under general anesthesia. <strong>Subjects and Methods: </strong>Prospective Observational study conducted on 410 patients. Anesthesia induced &amp; laryngoscopy performed. Difficulty in intubation graded according to Intubation Difficulty Scale (IDS). <strong>Results</strong>: Based on IDS score, the incidence of difficult intubation found to be 22.5%.&nbsp;&nbsp;&nbsp; A slight difficulty in 22% (IDS = 1-5) &amp; moderate to major difficulty (IDS &gt;5) in 0.5% cases. Intubation done successfully in all patients. Conclusion: The incidence of difficult intubation among patients scheduled for surgery under general anesthesia observed to be 22.5%</p> Ruchi Garg Narendra Tajne Neeraj Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-22 2020-12-22 5 2 89 92 10.21276/aan.2020.5.2.19 To Find Optimal Time for Intravenous Fentanyl (1.5µg/Kg) to Attenuate Hemodynamic Response to Laryngoscopy and Intubation http://aijournals.com/index.php/aan/article/view/1765 <p><strong>Background: </strong>Laryngoscopy is often accompanied with a haemodynamic pressor response, which could be hazardous and needs to be suppressed. The aim is to find optimal timing for intravenous low dose Fentanyl (1.5<em>µ</em>g/Kg) to attenuate hemodynamic response to laryngoscopy and intu- bation. <strong>Subjects and Methods: </strong>The study was conducted on 100 adult patients for elective surgery under general anaesthesia and endotracheal intubation. The haemodynamic changes (Heart rate and Blood Pressure) were noted after administering intravenous Fentanyl at 3 (Group I) or 5 minutes (Group II). <strong>Results: </strong>Changes in haemodynamic parameters were more significant in Group I as compared to Group II. <strong>Conclusion: </strong>Fentanyl when given 5 minutes before intubation effectively attenuates the haemodynamic response to laryngoscopy and endotracheal intubation.</p> Ruchi Garg Narendra Tajne Esther Zeliang Neeraj Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-22 2020-12-22 5 2 93 99 10.21276/aan.2020.5.2.20 A Comparitive Study of Sugammadex Vs Neostigmine, Reversal of Residual Neuro-Muscular Blockade http://aijournals.com/index.php/aan/article/view/1766 <p><strong>Background: </strong>In postoperative re-curarization, The use of standard neuromuscular blockers remains a significant problem. Furthermore, deep blockages cannot be reversed efficiently by traditional reverse agents, including neostigmines or edrophonium. Incomplete neuromuscular therapy can be considered an objectively regulated neuromuscular process. Sometimes there is a link to residual fatigue, residual curarization, and neuromuscular obstruction. Indeed, the recent opinion reveals that the notion of an incomplete four-way recovery train is below 0.9 (TOF&lt;0.9). The objective is to compare sugammadex vs Neostigmine and Reversal of Neuro Muscular blockade. <strong>Subjects and Methods: </strong>A general procedure of anesthesia requiring reversal of pharmacological obstructions and admission for 1 night, in 189 adult patients were enrolled for the study. <strong>Results: </strong>In comparison, the clinical signs of medium-block recovery were reported in the sugammadex group and 69 percent in the neostigmine-glycopyrrolate groups before being moved to the recovery room. In both procedures, most patients have reported that they felt positive, were able to lift their heads for 5 seconds, and had no muscle weakness before and after discharge. <strong>Conclusion: </strong>Sugammadex can revert mild or deep NMB caused by rocuronium in contrast to neostigmine/glycopyrrolate, and further studies are required for evaluating sugammadex effect on patient welfare, prospects for NMB recovery, and the optimum use of resources.</p> Ahsan Mustafa Atif Mohammed Shaher Banu Rana Khatoon Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-22 2020-12-22 5 2 100 103 10.21276/aan.2020.5.2.21 Effects of Perineural Dexmedetomidine Added to 0.75% Ropivacaine in Peripheral Nerve Stimulator Guided Supraclavicular Brachial Plexus Block - A Prospective Randomized Double-Blind Study http://aijournals.com/index.php/aan/article/view/1767 <p><strong>Background: </strong>Regional anaesthesia for the upper limb is being widely used as it not only evades the necessity of general anaesthesia but also provides an excellent postoperative period devoid of nausea, vomiting, and early postoperative pain. The objective is to study the effects of perineural dexmedetomidine 75<em>µ</em>g added to 0.75% ropivacaine in supraclavicular brachial plexus block (SCB). The primary objective was analgesia duration. Secondary objectives include various block (sensory and motor) characteristics, sedation, adverse effects if any. <strong>Subjects and Methods: </strong>Eightyfour patients undergoing forearm and wrist surgeries under peripheral nerve stimulator (PNS) guided SCB were randomized into two groups of 42 each. Group R received 24mL 0.75% ropivacaine + 1 mL normal saline (NS), and Group D received 24 mL 0.75% ropivacaine + 75<em>µ</em>g dexmedetomidine in 1ml NS. Analgesia duration (the time when the first rescue analgesia was given), sensory and motor block characteristics, sedation and side effects in both groups were analysed using appropriate statistical tests. <strong>Results : </strong>Analgesia duration was significantly increased in group D (780&nbsp; 101.59 min) compared to Group R (475.25&nbsp; 81.42 min), P 0.000. The sensory and motor block&nbsp; duration was significantly increased in the group D (606.37 74.33 min and 516 49.70 min) compared to group R (411.87 62.90 min and 365.75 51.74 min), P 0.000. <strong>Conclusion</strong>: Perineural dexmedetomidine with ropivacaine in SCB prolongs the analgesia duration, increase the sensory and motor block duration devoid of any significant side effects.</p> Raja Poovathai Sathis C. Sundararaju Kanagaraj Murugesan BK Mohamed Haaris Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-22 2020-12-22 5 2 104 109 10.21276/aan.2020.5.2.22 Analysis Impact of two Different Temperatures of 0.5% Heavy Bupivacaine on the Incidence of Shivering in Spinal Anaesthesia: A Comparative Study http://aijournals.com/index.php/aan/article/view/1768 <p><strong>Background: </strong>In spinal anaesthesia profound nerve block can be produced in a large part of the body by injecting small amount of drug in subarachnoid space therefore less chances of drug toxicity by local anaesthetic. Injection of ice-cold epidural local anaesthetic increases shivering compared with epidural solutions that are pre-warmed to 30<em><sup>◦</sup> </em>C. The present study was undertaken for assessing whether there is any effect of two different temperatures (4 <em><sup>◦</sup></em>C and 37<em><sup>◦</sup></em>C) of 0.5% heavy bupivacaine on the incidence of shivering in spinal anaesthesia. <strong>Subjects and Methods: </strong>A total of 70 subjects were included in the study having two groups of 35 parturients in each group. Group T<sub>4</sub> (n=35)–Hyperbaric bupivacaine (0.5%) 2.4ml cooled to the temperature of 4<em><sup>◦</sup></em>C, and Group T<sub>37</sub> (n=35) – Hyperbaric bupivacaine (0.5%) 2.4ml warmed to the temperature of 37 <em><sup>◦</sup></em>C. The anaesthesiologist performed the spinal block after thorough hand washing and preparing the back of the patient under all aseptic precautions as per the hospital protocol. Subarachnoid block was given with the patient in sitting position after infiltration at local area with 2% lignocaine. The patient was placed in supine position. Oxygen at a flow rate of 5L/min was given via simple face mask. Intraoperative fluid management was done with warm fluid. Heart rate, NIBP, SpO<sub>2</sub> and temperature was monitored and noted. The core temperature was measured using a rectal thermometer with cover. All the results were analysed by SPSS software. <strong>Results: </strong>Mean time of onset of sensory block among the patients of the T4 and T37 group was 73.05 seconds and 64.88 seconds respectively. Non-significant results were obtained while comparing the onset time of sensory block among the two study groups. Non-significant results were obtained while comparing the shivering onset and core body temperature at different time intervals, non-significant result were obtained. <strong>Conclusion: </strong>Injection of cold or warm bupivacaine has no effect on the incidence of shivering.</p> Nand Kishore Yashwant Singh Payal Nidhi Kumar Nidhi Chauhan Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 110 113 10.21276/aan.2020.5.2.23 Anesthetic Management of a 4 Days Old Sub-Acute Puerperal Uterine Inversion with General Anesthesia http://aijournals.com/index.php/aan/article/view/1769 <p>Uterus inversion is one of the rare and potentially life-threatening uncommon complications of the puerperium and subacute type is even rarer. A case is hereby reported of a 24-year-old primipara who was referred to our institute from a peripheral hospital with 4 days old uterine inversion. Inversion of the uterus was corrected under general anesthesia with halothane and maintained in anatomical position with the help of uterotonic drugs.</p> Ajay Wahi Sapna Bansal Ritu Gupta S.S. Bajwa Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 114 116 10.21276/aan.2020.5.2.24 Preoperative Hypertension: Incidence, Effect on Perioperative Risks and Outcome http://aijournals.com/index.php/aan/article/view/1770 <p><strong>Background: </strong>Hypertension (HTN) is the most frequent preoperative abnormality detected in surgical patients. Its high prevalence necessitates an analysis of its severity and the associated perioperative risks. There is always a controversy about whether to postpone elective surgery given poorly controlled HTN or not. The present study aimed to observe the incidence of HTN in pre-surgical patients, associated co-morbidities&nbsp;&nbsp; and end-organ damage, perioperative risks and outcome. <strong>Subjects and Methods: </strong>After approval from ethical committee, in this prospective observational study 1180 adult surgical patients were assessed for HTN. Patients found to be hypertensive were then categorized as known hypertensive, HTN detected at PAC clinic and hypertensive on day of operation. These patients were further investigated for end-organ damage. Hemodynamic changes at the time of intubation, any intraoperative complications and post-operative morbidity and mortality were also observed. <strong>Results: </strong>The incidence of HTN was 9.2%, out of these 47.7% were known hypertensive, 27.5% had raised blood pressure on admission and 24.7% were detected for the first time in the preoperative room. In hypertensive patients, haemodynamic fluctuations were more during the intraoperative period. Eight patients (7.4%) had fresh, transient (lasted&lt;10minutes) ECG changes (five had ischemic changes and three had arrhythmias) that required no treatment. Five (4.6%) patients were postponed due to hypertension. <strong>Conclusion: </strong>HTN is a frequently encountered abnormality seen among presurgical patients and many patients remain undetected till the time of surgery. During surgery, these preoperatively detected hypertensive patients have more swings in BP as compared to known hypertensive patients who are on regular treatment. However, stage 1 &amp; 2 HTN alone is not found to be associated with increased risk and data from the present study indicates that stage 3 HTN without end-organ damage can undergo minor surgeries safely.</p> Mamta Jain Anish Kumar Singh Vandna Arora Sanjay Johar Jatin Lal Teena Bansal Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 117 124 10.21276/aan.2020.5.2.25 A Comparative Study on Effects of Bupivacaine- Lignocaine and Bupivacaine- Lignocaine with Dexmedetomidine Combination in Ultrasound Guided Supraclavicular Brachial Plexus Block http://aijournals.com/index.php/aan/article/view/1771 <p><strong>Background: </strong>To compare the effects of Bupivacaine Lignocaine and Bupivacaine Lignocaine in the ultrasound-guided Supraclavicular brachial plexus block with a mixture of Dexmedetomidine. <strong>Subjects and Methods: </strong>It is an interventional study undertaken over a course of 9 months in 60 patients undergoing elective upper limb surgery in the anaesthesia clinic of the Tertiary Centre. Sixty patients were allocated randomly to 2 groups, group I and group II. Effects on the onset and length of sensory and motor blockade and on the extent of postoperative analgesia may be studied. <strong>Results: </strong>Demographic data are equivalent in all grades. There is no significant change in hemodynamic parameters in comparison to the 2 groups. The onset of the sensory blockade and motor blockade in Group B was much smaller. With additional time in Group-B, the length of the sensory blockade and the motor blockade is statistically significant. Compared to A, the duration of complete sensory recovery and full motor recovery time forecast was longer in category B. In group-B at 0 and 4, the duration of complete analgesia at VAS is considerably long. Among the research classes, the length of maximal analgesia and the time of first rescue pain relief are statistically important. In the study, no complications were found. <strong>Conclusion: </strong>As an adjuvant to bupivacaine in the USG supraclavicular plexus block, dexmedetomidine shortens the onset and prolongs the sensory and motor block length.</p> P. Rajeswar MN Girish Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 125 130 10.21276/aan.2020.5.2.26 A Comparative Study of Atracurium and Cisatracurium for Assessment of Intubating Conditions http://aijournals.com/index.php/aan/article/view/1772 <p><strong>Background: </strong>The present study was conducted to compare atracurium and cisatracurium for the assessment of intubating conditions. <strong>Subjects and Methods: </strong>60 patients of the American Society of anaesthesiology (ASA) class I and II between the age group of 20-60 years were randomly divided into 2 groups of 30 each. Group I received atracurium in the dose of 0.5 mg/kg body weight and group II patients received cis-atracurium in the dose of 0.2 mg/kg body weight. Parameters such as arterial blood pressure, heart rate and onset time and duration of action were recorded. <strong>Results: </strong>The mean onset of action in group I was 3.4 minutes and in group II was 2.6 minutes. The mean duration of action in group I was 36.2 minutes and in group, II was 64.1 minutes. The mean heart rate was 98.2 beats/min, 96.1 beats/mins and 109.3 beats/mins at baseline, after injection of muscle relaxant and after the attempt of intubation respectively in group I. In group II was 93.5 beats/min, 98.5 beats/min and 97.4 beats/min respectively in group II. The mean arterial pressure was 89.6 mmHg, 93.7 mmHg and 98.5 mmHg at baseline, after injection of muscle relaxant and after the attempt of intubation respectively in group I. In group II was 90.4 mmHg, 92.5 mmHg and 94.1 mmHg respectively in group II. The difference was significant (P&lt; 0.05). <strong>Conclusion: </strong>Cisatracurium is more efficacious as compared to atracurium with respect to intubating conditions.</p> Pooja Shah Rahul Chalekar Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 131 134 10.21276/aan.2020.5.2.27 Comparison of Sensory Effects of Ropivacaine Alone and Ropivacaine Along with Dexamethasone in Adductor Block for Post-Operative Analgesia After Lower Limb Surgeries http://aijournals.com/index.php/aan/article/view/1773 <p><strong>Background: </strong>The present study was undertaken to study the effect of adding dexamethasone to 0.2% ropivacaine in the adductor canal block. <strong>Subjects and Methods: </strong>52 patients for lower limb surgery were divided into 2 groups. Group R received 20 ml of 0.2% ropivacaine + 2 ml&nbsp;&nbsp; of normal saline and group RD received 20ml of 0.2% ropivacaine with 8 mg of 2 ml dexamethasone. The patient was evaluated for the onset of sensory block and duration of analgesia, side effects and complications. <strong>Results: </strong>The average age was 61.23&nbsp;&nbsp; 8.16 years in the R group&nbsp;&nbsp; and 61.77&nbsp;&nbsp; 7.55 years in RD group. The average body weight 64.63&nbsp;&nbsp; 7.08 kg in the R group and 66.9&nbsp;&nbsp; 6.77 kg in RD group. Both groups&nbsp;&nbsp;&nbsp;&nbsp; had predominantly male patients. There was no significant difference between the 2 groups in terms of ASA grading (P=1.000). The onset of sensory block in group R was 12&nbsp; 1.70 min whereas in group RD it was 11.53&nbsp;&nbsp; 1.66 min, which was not statistically significant (P &gt; 0.05).&nbsp;&nbsp; The duration of analgesia in group R was 507.96 149.32 min whereas in group RD it was 1082.63 195.11 min, which was statistically highly significant (P&lt;0.0001). <strong>Conclusion: </strong>The Addition of dexamethasone to 0.2% ropivacaine for the adductor canal block increases the duration of analgesia significantly. But there was no difference in the onset of analgesia.</p> K Girish Reddy M Adithya Reddy Ram Babu Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 135 138 10.21276/aan.2020.5.2.28 Efficacy of Lignocaine and Esmolol in Attenuating the Cardiovascular Responses to Laryngoscopy and Endotracheal Intubation http://aijournals.com/index.php/aan/article/view/1774 <p><strong>Background: </strong>The present study was undertaken to compare the efficacy of lignocaine and esmolol in attenuating the cardiovascular responses to laryngoscopy and endotracheal intubation. <strong>Subjects and Methods: </strong>60 patients undergoing elective surgery were divided into two groups of 30 each, group L (Lignocaine) and group E (Esmolol). Baseline hemodynamic parameters - heart rate (HR), systolic blood pressure (SBP), diastolic blood pressures (DBP), mean arterial pressure (MAP) and rate-pressure product (RPP) were recorded. <strong>Results: </strong>There was no statistically significant difference in heart rate among the groups before and after premedication and after induction (P value &gt;0.05). After intubation,&nbsp;&nbsp; there was rise in heart rate in both the groups. The rise was significantly less in esmolol group as compared lignocaine groups (p value &lt;0.05) till 5 minutes of study period. There was no statistically significant difference in systolic blood pressure among the groups before and after premedication. After induction and intubation, there was no statistically significant difference in systolic blood pressure among the groups (p value &gt;0.05). <strong>Conclusion: </strong>Esmolol hydrochloride 1mg/kg IV bolus dose is superior to lignocaine hydrochloride 1.5mg/kg IV bolus to attenuate the haemodynamic responses to laryngoscopy and endotracheal intubation.</p> K Girish Reddy M Adithya Reddy Ram Babu Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 139 144 10.21276/aan.2020.5.2.29 The i-viewT M Video Laryngoscope - the Most Recent of all Video Laryngoscopes: An Observational study Analysing Performance http://aijournals.com/index.php/aan/article/view/1775 <p><strong>Background: </strong>The spectrum of video laryngoscopes appears ever-expanding with the advent of newer and newer devices. In a span of fewer than 20 years, beginning with the first device, the Glidescope in 2001, plenty of devices are now at our disposal. The i-view<em><sup>T</sup> <sup>M</sup> </em>video laryngoscope, the most recent introduction to the family in 2018, has not reportedly been evaluated yet for its performance. The <strong>o</strong>bjective is to evaluate&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; the performance of the i-view video laryngoscope in terms of intubation characteristics, a prospective observational study. <strong>Subjects and Methods: </strong>The study included 60 patients undergoing laryngoscopy and intubation using the i-view video laryngoscope for nonemergency surgery requiring general anaesthesia. The primary outcome was intubation time. Modified Cormack-Lehane (CL) view, adjustment maneuvers and hemodynamic responses were also noted as secondary outcome measures. <strong>Results: </strong>Sixty patients were enrolled in the study. After exclusions, 56 patients underwent video laryngoscopy with the device. The mean intubation time was 30.3 5.1 seconds. Thirty-seven patients (66.07%)&nbsp; had a CL view 1, and 17 patients (30.35%) 2a. Forty patients were intubated without any adjustment maneuver, 12 needed one adjustment and 2 patients needed 2 maneuvers. There were 2 cases of failed intubation even in three attempts. The variations in haemodynamic parameters were found to be statistically insignificant. No complication related to the device could be documented. <strong>Conclusions: </strong>The new video laryngoscope, i-view is found to be at least at par with its older congeners, if not better. Larger, multicentric, comparative trials may be needed to establish the same.</p> S Kamran Habib Nazia Tauheed S. Zafer Hashmi Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-24 2020-12-24 5 2 145 150 10.21276/aan.2020.5.2.30 Comparison of Intraoperative Hemodynamic and Postoperative Cognitive Recovery Characteristics of Desflurane with Sevoflurane in General Anesthesia http://aijournals.com/index.php/aan/article/view/1786 <p><strong>Background: </strong>Present study was done with an aim of Desflurane versus Sevoflurane on intraoperative hemodynamic and postoperative cognitive revival distinctiveness in general anesthesia. <strong>Subjects and Methods: </strong>60 ASA I &amp; II subjects were arbitrarily separated into 2 categories. The following parameters were observed: Time in use for (1) primary reply to authority by inquiring subjects to open eyes and press finger. (2) Extubation. (3) direction to time, place and person. Bring out through inquiring subjects to remember his forename, area etc. (4) Attain modified Aldrete score &gt;=9. <strong>Results: </strong>Subjects in the group D improved considerably quicker as designated through the instance to primary rejoinder to authority. Direction to time, place and person were statistically significant between both groups. Instance to attain modified Aldrete score 9 was quicker with group D than group S. <strong>Conclusion: </strong>Desflurane provides improved intra-operative hemodynamic variables, a premature revival from anesthesia and premature postoperative cognitive revival contrast to Sevoflurane.</p> Shilpinkumar Kamlesh Solanki Manthan Purshottam Parmar Hardik G Patel Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-26 2020-12-26 5 2 151 154 10.21276/aan.2020.5.2.31 Comparison of Low Dose Intrathecal Buprenorphine and Clonidine as an Adjuvant to Bupivacaine in Spinal Anesthesia for Post-Operative Analgesia in Lower Limb and Lower Abdominal Surgeries http://aijournals.com/index.php/aan/article/view/1787 <p><strong>Background: </strong>Management of postoperative pain is an important part of post-operative care. Spinal anesthesia when used with adjuvants can prolong analgesia well into the early postoperative period and is one of the commonly used methods in most lower abdominal and lower limb surgeries. Various studies have been done using higher doses of adjuvants. However, relatively fewer studies have been done using lower doses of these drugs. In this study, low doses of intrathecal buprenorphine and clonidine used as an adjuvant in spinal anaesthesia were compared&nbsp;&nbsp;&nbsp;&nbsp; in providing effective postoperative analgesia. <strong>Subjects &amp; Methods: </strong>100 ASA 1 and 2 patients who were planned for lower abdominal and lower limb surgeries were enrolled in our study and were randomly divided into 2 groups of 50 each- Group X and Y. Patients with a known allergy, on <em>β </em>blockers, <em>α</em>2 agonists, basal heart rate 50/min, pregnant and lactating women, obesity- BMI&nbsp; 30 were excluded from the study. The patients in group X received 15mg (3 ml) of 0.5% hyperbaric bupivacaine with 45<em>µ</em>g (0.15 ml) of buprenorphine and patients in group Y received 15 mg (3 ml) of 0.5% hyperbaric bupivacaine with 22.5<em>µ</em>g (0.15 ml) of clonidine. The duration of analgesia- the time to request for first rescue analgesic and the number of doses of systemic analgesics in the first 24 hrs postoperatively was noted. <strong>Results: </strong>The time to request for the first rescue analgesic was significantly longer in group X(buprenorphine) when compared to group Y(clonidine) with a p-value &lt;0.001. Also, the mean requirement of the total number of analgesics was less in group X when compared to group Y and was statistically significant with a p-value &lt;0.001. <strong>Conclusion: </strong>We conclude that intrathecal adjuvants buprenorphine and clonidine, even in low doses, provide effective postoperative analgesia and buprenorphine has a longer analgesic effect when compared to clonidine.</p> Ramya DM R Vinay KN Vikas Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-26 2020-12-26 5 2 155 161 10.21276/aan.2020.5.2.32 Effects of Preloading with Isotonically Balanced Tetra Hydroxyethyl Starch Versus Preloading with Gelufusine On Blood Glucose Level in Diabetic Patients http://aijournals.com/index.php/aan/article/view/1796 <p><strong>Background: </strong>The present study was conducted to study the effects of preloading with isotonically balanced tetra hydroxyethyl starch versus preloading with Gelufusine on blood glucose levels in diabetic patients. <strong>Subjects and Methods: </strong>50 patients were diabetic categorized as&nbsp;&nbsp; study group (Group S) and 50 patients were nondiabetic categorized as a control group (Group C). Group C1 was non-diabetic patients who received gelofusine 10 ml/kg as preloading fluid 30 minutes prior to general anaesthesia, group C2 was non-diabetic patients who received 6% Hydroxyethyl starch 10 ml/kg as preloading fluid 30 minutes prior to general anaesthesia, group S1 was controlled diabetic patients who received gelofusine 10 ml/kg as preloading fluid 30 minutes prior to general anaesthesia and group S2 was controlled diabetic patients who received&nbsp;&nbsp; 6% Hydroxyethyl starch 10 ml/kg as preloading fluid 30 minutes prior to general anaesthesia. <strong>Results: </strong>There was no statistically significant difference in age, weight, height and the duration of surgery of patients between four groups (p&gt;0.05). In the four groups of patients included in the study, female patients outnumbered the male patients but the difference was not statistically significant (p&gt;0.05). There was no statistically significant difference in the baseline blood glucose values between all four groups. The blood glucose level in group C1 and S1 recorded a maximum decrease at 60 minutes. In group C2 and S2, there was the increase in blood glucose level at 60 minutes. <strong>Conclusion: </strong>Gelofusine fluid preloading produces a better outcome in diabetic patients as compared to preloading with hydroxyethyl starch fluid.</p> Amit Prakash Chandra Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-26 2020-12-26 5 2 162 167 10.21276/aan.2020.5.2.33 Role of Topical Heparin in the prevention of Superficial Thrombophlebitis http://aijournals.com/index.php/aan/article/view/1810 <p><strong>Background: </strong>Sometimes the use of an intravenous (IV) catheter is associated with superficial thrombophlebitis. The efficacy of the topical Heparin solution was compared with placebo for the prevention of thrombophlebitis related to IV catheter. <strong>Subjects and Methods : </strong>Patients who were 18-45 years of age with an intravenous catheter for at least 72 h were registered and randomized to receive 3-6 drops of topical solution of heparin (Group H) over the 18G catheterized vein every 8<em><sup>th</sup> </em>hourly for a total of 6 doses and another group (Group N) did not receive any topical solution over 18G catheterisation. Patients enrolled were examined every 12 h for phlebitis using the phlebitis visual infusion scale. <strong>Result: </strong>Usage of the phlebitis visual infusion scale to examine phlebitis every 12 hours. In group H mean Phlebitic scale was 0.08 0.27, 0.12 0.33, 0.24&nbsp;&nbsp;&nbsp; 0.43, 0.28&nbsp;&nbsp;&nbsp;&nbsp; 0.45, 0.36&nbsp;&nbsp;&nbsp;&nbsp; 0.56 and 0.52&nbsp;&nbsp;&nbsp;&nbsp; 0.77 at 12, 24, 36, 48, 60 and 72 hours respectively. The mean phlebitic scale in group N&nbsp;&nbsp; was 0.60&nbsp;&nbsp;&nbsp; 0.50, 0.72&nbsp;&nbsp;&nbsp; 0.61, 1.04&nbsp;&nbsp;&nbsp; 0.67, 1.08&nbsp;&nbsp;&nbsp;&nbsp; 0.64, 1.16&nbsp;&nbsp;&nbsp;&nbsp; 0.55 and 1.72&nbsp;&nbsp;&nbsp;&nbsp; 0.89 respectively at 12, 24, 36, 48, 60 and 72 hours. In group&nbsp;&nbsp; H mean phlebitic scale was significantly lesser as compare to group N. <strong>Conclusion: </strong>After peripheral intravenous catheterisation, prophylactic topical application of heparin was effective in preventing the development of superficial thrombophlebitis.</p> Lata D Shetty Bhagyashree C Bagodi Bahubali Gane Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-29 2020-12-29 5 2 168 171 10.21276/aan.2020.5.2.34 Gabapentin as Pre-Emptive Analgesic Agent Given To Abdominal Hysterectomy Patients for Post-Operative Analgesia http://aijournals.com/index.php/aan/article/view/1836 <p><strong>Background: </strong>Pain after hysterectomy is often multifactorial from various causes. Pain occurs from the incision site, deeper visceral systems, and pain in action, such as through straining, coughing, or mobilisation, which can be serious. The objective is to evaluate whether Gabapentin when given orally preoperatively at a dose of 300 mg affects postoperative pain and analgesic requirements in patients undergoing total abdominal hysterectomy under spinal anaesthesia. <strong>Subjects and Methods: </strong>This is a prospective, randomised, double-blind, placebo-controlled sample. This research was performed on a total of 60 patients who underwent an elective abdominal hysterectomy at our institute. Patients were randomly assigned to two groups: Group G (Gabapentin Group) and Group P (Placebo Group). Group G patients received Gabapentin 300 mg orally&nbsp;&nbsp; and Group P patients received placebo capsules with sips of water two hours before the operation. Period from spinal anaesthesia to the first analgesic (T) requirement, a complete analgesic requirement in the first 24 hours, visual analogue scale (VAS) rest and activity ratings, Ramsay sedation score, drug side effects such as somnolence, dizziness, confusion, nausea, vomiting were reported in 0,2,4,6,12 hours postoperatively. <strong>Results: </strong>When administered preoperatively, a single oral dose of Gabapentin 300 mg lowers postoperative pain and overall tramadol intake&nbsp;&nbsp;&nbsp; in the abdominal anaesthesia patients. For Gabapentin usage, sedation was the most important side effect. Gabapentin should also be used as&nbsp;&nbsp;&nbsp; a supplement for the management of postoperative pain. <strong>Conclusion: </strong>This study shows that a single oral dosage of 300mg of gabapentin as pre-operatively administered decreases the post-operative discomfort and overall utilisation of tramadol in abdominal hysterectomy patients with spinal anaesthesia.</p> Mohd. Abdul Moiz Sunil Bablu Pulla Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-30 2020-12-30 5 2 172 177 10.21276/aan.2020.5.2.35 Comparison of the Coracoid and Retroclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block http://aijournals.com/index.php/aan/article/view/1837 <p><strong>Background: </strong>The infrastructural brachial plexus block has a less possible risk of tourniquet pain during the surgery and a greater blocking&nbsp;&nbsp;&nbsp;&nbsp; of musculocutaneous and axillary nerves than the axillary block with one injection. If enough time is given for block start, the efficacy of the infra-clavicular brachial block can be increased. The objective is to Comparing the coracoid and retro clavicular approaches with an ultrasound brachial plexus block. <strong>Subjects and Methods : </strong>A total of One Hundred patients receiving IBPB block were randomly assigned into two groups, Coracoid-based group C and retro clavicular-based Group R. <strong>Results: </strong>Group R has greatly increased visibility of the needle tip compared with group C. Group R had a better view of the needle shaft than group C. In group R, block output time (2.8 1.48 minutes) was statistically lower than in group C (5.7 1.19 minutes). Anesthesia duration in group R (17.6 1.3) vs (21.2&nbsp; 2.0) was statistically shorter. The needle passes in&nbsp; group R were much less. <strong>Conclusion: </strong>The results of this study indicate that the ultrasound-guided ICB approach correlates with a higher needle tip and shaft vision, shorter periods of time and anesthesia, and with fewer needle passes than the coracoid approach. But in terms of success rates and patient satisfaction, the retro clavicular approach was identical to the coracoid technique.</p> Sunil Bablu Pulla Mohd. Abdul Moiz Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-30 2020-12-30 5 2 178 182 10.21276/aan.2020.5.2.36 Epidural Ropivacaine versus Ropivacaine with Fentanyl for Analgesia in Paediatric Laparoscopic Surgeries: A Double-Blind Randomized Comparative Study http://aijournals.com/index.php/aan/article/view/1844 <p><strong>Background: </strong>Laparoscopic surgery in children has beneficial outcomes like decreased pain and less tissue manipulation. That is why we&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; get better outcomes and better healing. In abdominal surgeries, local anaesthesia and opioid by epidural route prove to have a significant analgesic effect. The aims is to compare the hemodynamic effects, use of rescue analgesia after adding fentanyl to ropivacaine in single bolus epidurals in laparoscopic surgeries of paediatric patients. Settings and Design is Randomized double-blind study. <strong>Subjects and Methods: </strong>We conducted a study in 1 to 5 years age group patients undergoing laparoscopic procedures under general anaesthesia, divided into two groups after randomization, Group I has been given single bolus dose epidural ropivacaine (0.2%) and Group II has been given single bolus dose epidural ropivacaine (0.2%) with fentanyl (1mg ml<em><sup>−</sup></em><sup>1</sup>). Hemodynamic stability, Intra and postoperative analgesic needs were compared. Statistical analysis used: We have used paired ”t” test for comparison of continuous data at different time intervals in a group and unpaired “t” test for comparison between two groups. We have used chi-square (<em>χ</em><sup>2</sup>) for comparison of discrete (categorical) variables. <strong>Results: </strong>We have found a significant rise in heart rate and mean arterial pressure at all-time intervals (p&lt;0.001) except just after induction (5 min), but the rise was more significant in Group I. Intraoperative fentanyl requirement was significantly higher (15.54&nbsp; 3.77<em>µ</em>g vs 0.74&nbsp; 1.91<em>µ</em>g) in Group I. Similarly in&nbsp; the postoperative period the rescue analgesic was also required early (2.27 0.50hrs vs 7.13 0.81 hrs) and more (412 32mg vs 284 27 mg) in Group I. <strong>Conclusions: </strong>It was concluded that single-dose epidural ropivacaine with fentanyl provides more hemodynamic stability with less need of intra and postoperative rescue analgesics.</p> Sumita Kumari Manoj Tripathi Samiksha Parashar Sujeet Rai Deepak Malviya Virendra Kumar Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-30 2020-12-30 5 2 183 188 10.21276/aan.2020.5.2.37 A Prospective, Randomized Study to Compare Open Surgical Tracheostomy and Modified Griggs Percutaneous Tracheostomy in Patients of Traumatic Brain Injury http://aijournals.com/index.php/aan/article/view/1845 <p><strong>Background : </strong>Traumatic brain injury (TBI) patients with poor GCS usually require airway protection. Tracheostomy provides many benefits as compared to endotracheal tube. Percutaneous tracheostomy (PCT) performed by a trained professional dedicated to neurosurgical ICU may have advantages over open surgical tracheostomy. We conducted a prospective randomised study to compare both these procedures in patients of TBI. The aim is to compare open surgical tracheostomy (ST) and modified Griggs percutaneous tracheostomy (PCT) in patients of traumatic brain injury. <strong>Subjects and Methods: </strong>TBI patients in neurosurgical ICU were randomly allotted one of the two methods of tracheostomy that were being compared. Demographic profile of patients was recorded. Total duration of the procedure, length of incision, number of sutures used, days taken in wound healing after decannulation and complications were studied. Chi square and student’s t-test were applied for statistical analysis. <strong>Results: </strong>Demographic profile of both groups was comparable. Total duration of the procedure, length of incision, number of sutures used and days taken to heal after decannulation were significantly lesser in PCT group as compared to ST group. Overall rate of complicated procedures was similar in PCT group as compared to ST group. There was no incident of raised intracranial pressure requiring treatment. Complications were mostly minor in nature and there was no mortality reported in any group. <strong>Conclusion: </strong>Both PCT and ST have lesser rate of major complications. PCT will be beneficial for TBI patients when it is performed by a trained intensivist.</p> Ajay Wahi Sapna Bansal Ritu Gupta Parmal Singh Saini S.S. Bajwa Copyright (c) 2020 Author https://creativecommons.org/licenses/by/4.0/ 2020-12-30 2020-12-30 5 2 189 195 10.21276/aan.2020.5.2.38