Academia Anesthesiologica International <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> en-US (Dr. Rohit Varshney) Fri, 22 May 2020 12:55:13 +0000 OJS 60 Anaesthetic Management of a Giant Cervico-Occipital Meningocele with Cleft Palate <p>Meningocele is herniation of meninges and CSF through the skull and vertebral defect. The major anaesthetic challenges encountered in management of cervico-occipital meningocele include difficulty in securing airway, proper positioning of the neonate without pressure on the meningocoele sac, maintaining prone position and prevention of electrolyte disturbances and hypothermia. Associated congenital anomalies also can cause anaesthesia and procedure related complications. We report a case of 25 day old neonate with giant cervico occipital meningocele with cleft palate posted for excision and repair.</p> Mansi Jain, Niti Dalal, Charu Bamba Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 A Comparative Study of Different Techniques of Brachial Plexus Block in Upper Limb Surgery <p><strong>Background: </strong>Different techniques of Brachial Plexus block in upper limb surgery depending on the site of operation the approach of the brachial plexus was chosen. For the operations around the shoulder joint interscalene approach was chosen; for the operations up to the shoulder either interscalene or supraclavicular or Infraclavicular routes were chosen and for the operations up to and around the elbow joint any one of the four approaches were tried. Objective of this study was to evaluate its clinical applications and practical utility in providing good analgesia for the upper extremity surgery in elective as well as emergency cases.Design: This was a hospital based retrospective study. Duration: One Year i.e. from June 2018 to June 2019. Participants: 80 patients.<strong>Subjects and Methods:</strong>The present study includes 80 blocks of brachial plexus by four different routes. 1. Supraclavicular approach – 20 cases. 2. Infraclavicular approach – 20 cases. 3. Axillary perivascular approach – 20 cases. 4. Interscalene – 20 cases. The cases were selected at random, who were subjected for various types of surgery of upper extremity both elective and emergency as in-patients.<strong>Results:</strong>In this series of 80 blocks, when the type of the surgery (emergency or elective) is considered, it has been that about one third of the patients underwent emergency surgery successfully with the brachial plexus block. In the remaining two-third of the patients, the surgery was planned procedure.<strong>Conclusion:</strong>Thus, our study reveals that the brachial plexus block can be equally safely employed for emergency surgery as for any elective procedure. Some-times the brachial plexus block can be the only choice with no alternatives affording a reasonable chance to a moribund patient to undergo emergency surgery. The dosage of the drug was modified according to the patient’s general condition.</p> Ahsan Mustafa, Atif Mohammed, Shaher Banu Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Comparison of Fascia Iliaca Block with Intravenous Paracetamol, as Postoperative Analgesic Method for Femur Surgery <p><strong>Background: </strong>Postoperative pain is extremely unpleasant which causes severe discomfort to the patient as well as it increases the anxiety, hospital stay so overall total burden. <strong>Objectives:</strong> Comparison of efficacy between fascia iliaca block with intravenous paracetamol, as postoperative analgesic method after femur surgery. Simultaneously requirement of other analgesics in the first 24 hours.<strong>Subjects and Methods:</strong>Prospective longitudinal study conducted in patients belonging to age group of 18 to 65 years posted for femur surgeries. All patients were received Intrathecal injection of 3.5 ml of 0.5% hyperbaric bupivacaine and divided into two groups. After completion of surgery Group I received the Fascia Iliaca block with thirty ml of 0.25% of injection bupivacaine and Group II received injection Paracetamol one gram intravenously. Duration of analgesia, time from block / iv PCM to 1st rescue analgesia, number of patients as well as total doses of required rescue analgesics in 1st 24 hours were observed postoperatively.<strong>Results:</strong>From One hour onwards at all the time interval, mean pain scores was less in FIB group as compared to PCM group(p&lt;0.001). In FIB group 15 (42%) patients had more than 24 hours and 11(32%) patients had 12-24 hours of analgesia, where as in PCM Group not a single patient had more than 12 hours of analgesia. In FIB group only 20 (57%) patients required rescue analgesic as compared to 35 (100%) patients in PCM group.<strong>Conclusion:</strong>In FIB insertion point is away from femoral vessels and can be provided without nerve stimulator. Post-operative it is extremely crucial to provide analgesia specially initial 24 hours. FIB can provide prolong duration of analgesia, so helps in early mobilization and early rehabilitation as well as it also reduces opioid requirements. Thus, Fascia iliaca block is an effective, easy and affordable method for postoperative analgesia and can be used safely as a part of multimodal approach to pain relief after femur surgery.</p> Praveen kumar Shekhrajka, Dhaval kumar C Patel Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Evaluation of the Causes of Cancellation of Cases on the Day of Surgery <p><strong>Background: </strong>Cancellation of elective operation on the day of surgery is a common phenomenon in all hospitals, which is a great concern in countries like India with limited resources. This study was aimed to assess incidence and causes for this which will help to enhance efficiency and minimize wastage of resources and manpower.<strong>Subjects and Methods:</strong>The study was carried out over six months and included all patients posted for elective surgery. The reasons for cancellation were classified into four types - anaesthesia related, patient related, surgeon related and hospital/resource related.Statistical analysis: Descriptive and basic analytical statistics were used and data is expressed as number and percentage.<strong>Results:</strong>A total of 4447 patients were posted for surgery during the study period of which 595 patients were cancelled on the day of surgery with a cancellation rate of 13.37 %. Highest cancellation rate was found in Orthopaedics (39.65%) followed by ENT (14.32%), General Surgery(10.02%) and Obstetrics and Gynaecology (8.53 %). Maximum cancellations were due to surgeon related factors (46.72%) followed by anaesthesia related (21.68%), patient related (20%) and hospital/resource related (11.6%).<strong>Conclusion:</strong>Most of the reasons for cancellation are potentially avoidable. If causes are identified and appropriately addressed to the efficiency of OT can be improved. Regular audits are regularly recommended.</p> Geeta Karki, Vishwadeep Singh, Ashita Mowar Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Comparative Study of Caudal Bupivacaine and Bupivacaine with Clonidine in Infra Umbilical Surgeries in Children <p><strong>Background: </strong>Caudal epidural analgesia is one of the most commonly performed regional blocks in paediatric anaesthesia for intra and post-operative analgesia. Addition of opioids like morphine, fentanyl is associated with side effects like respiratory depression, urinary retention, etc. Clonidine, an α2 agonist is known for its analgesic effects with lesser side effects. Hence, this study was conducted to know the efficacy and safety of addition of clonidine to bupivacaine in a single shot caudal block in children.<strong>Subjects and Methods:</strong>This study was conducted among 60 children in the age group of 5 – 10 years coming for various elective infraumbilical surgical procedures. They were divided into two groups of 30 each. Group A received caudal 0.25% bupivacaine (1ml/kg) and group B received caudal 0.25% bupivacaine (1ml/kg) with clonidine (1.5µg/kg). The various parameters studied were hemodynamic changes, duration of analgesia and incidence of side effects.<strong>Results:</strong>The groups were similar in age, sex and weight. The hemodynamic parameters like heart rate, blood pressure, respiratory rate were also similar between the two groups after administering caudal block. The mean duration of analgesia in group B (433.5 ± 60 min) was significantly longer (p&lt; 0.05) than group A (250.33 ±41 min).<strong> Conclusion:</strong>This study showed that the addition of clonidine in the dose of 1.5µg/kg to 0.25% bupivacaine (1ml/kg) improved the analgesic duration and efficacy after a single shot caudal block with minimal side effects in children.</p> Swetha J Gouda, P.V. Margi Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 A Prospective Study of Single Breath Vital Capacity Inhalation Induction with High Concentration of Sevoflurane (Sbvc-Hc) for LMA Insertion in Adults for Short Surgical Cases <p><strong>Background: </strong>Sevoflurane is a new volatile anesthetic agent with rapid induction and recovery. A randomized study was carried to access conditions for LMA insertion using Sevoflurane in 25 ASA I &amp; II patients undergoing short duration surgeries.<strong>Subjects and Methods:</strong>This prospective study was conducted at Department of Anesthesiology and Critical Care, SVS Medical College and Hospital, Mahabubnagar, Telangana, India. After obtaining the institutional ethics committee and written informed consent from the patients, 25 subjects of either sex were included in this study. Age of the subjects was 18 to 60 years. Patients received injection Fentanyl 1 – 2mcg/kg prior to induction. All patients were pre-oxygenated for 3 min with 100% oxygen using a fresh gas flow of 81/min. All patients received inhalational induction with 8% Sevoflurane and O2 flow at 8 L/min with single vital capacity breathe technique. Loss of verbal contact was considered as the desired endpoint for induction, which was assessed by the response to calling out the patient’s name. Then the time of loss of eyelash reflex and jaw relaxation was assessed by anesthesiologist. After adequate jaw relaxation, LMA insertion was attempted.<strong>Results:</strong>The mean loss of verbal contact was 65.40±9.67second, while the mean for time for loss of eyelash reflex and jaw relaxation were found to be 81.20±9.39 seconds and 103.20 ±12.07 seconds respectively. The mean time for LMA insertion was 122.00±15.61 and the mean attempts for successful LMA insertion was 1.12±0.33. LMA insertion was easy in 23 cases as against difficult in 2 cases. In 2 cases transient cough and biting were recorded. LMA insertion was excellent and satisfactory in 88.0 and 12 percent. However, the mean heart rate at 5 minute after induction showed a significant fall at 5 minutes after induction. The mean values of SBP, DBP and MAP did not differ significantly at pre and induction. However, a significant decrease in SBP was noticed at 1, 2 and at 5 minutes.<strong>Conclusion:</strong>Sevoflurane is an smooth inhalation anesthesia with rapid onset with adequate jaw relaxation for insertion of LMA in Adults for short duration surgeries. Sevoflurane has got good hemodynamic profile with lesser complications owing to choice of inhalation agent for insertion of LMA.</p> Kailash Prabhudev, Naveen Kumar K Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Prospective Clinical Comparative Assessment of Intubating Conditions and Neuromuscular Blocking Effects of Two Different Doses of Cisatracurium. <p><strong>Background: </strong>To study the effects of two different doses of cisatracurium 0.15mg/kg and 0.2mg/kg regarding intubating conditions, duration of action, hemodynamic stability and allergic reactions.<strong>Subjects and Methods:</strong>60 patients posted for elective surgical procedures under general anaesthesia in various surgical disciplines were enrolled into the study and alternatively allocated patients into one of the two study groups of 30 each to receive either 0.15mg/kg or 0.2mg/kg of cisatracurium. Intubating conditions assessed as excellent, good, poor or not possible and duration of action assessed and noted. PR and BP monitored at regular timed intervals following muscle relaxant and allergic reactions evaluated clinically.<strong>Results:</strong>4×ED 95 dose of cisatracurium had statistically significantly longer duration of action and had produced proportionately excellent intubating conditions as compared to its 3×ED 95 dose. The mean duration of action after 4×ED 95 loading dose was 53.03±5.75 minutes and 45.16±4.41 minutes after 3×ED 95 dose and the difference was statistically and clinically significant. Proportionately 4×ED 95 dose of Cisatracurium had produced excellent intubating conditions as compared to its 3×ED 95 dose (90% vs 70%). Differences in hemodynamic changes (pulse rate and blood pressure) after the above doses were clinically insignificant. And none of the patients after either dose showed allergic reactions.<strong>Conclusion:</strong>Cisatracurium at a higher dose 0.2mg/kg (4×ED 95) as compared to its lower dose 0.15mg/kg (3×ED 95) provides longer duration of action and proportionately excellent intubating conditions. Both doses produced stable hemodynamic status without clinically significant changes in PR and BP. No allergic reactions were noted at both the doses.</p> Kailash Prabhudev, Channagouda Hadimani Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Assessment of Transversus Abdominis Plane Block in Abdominal Surgery by Total Requirement of Diclofenac as a Post-Operative Analgesia Drug <p><strong>Background: </strong>Amongst various techniques of TAP block, landmark technique via the triangle of Petit seems to hold considerable promise for patients undergoing surgical procedures involving abdominal wall incisions. The aim of this study is to evaluate transversus abdominis plane [TAP] block in abdominal surgery by total requirement of diclofenac as postoperative analgesia drug.<strong>Subjects and Methods:</strong>Present study was carried out at Department of Anesthesia, GMERS medical college, Sola, Ahmedabad, Gujarat, India from May 2014 to May 2015. According to formula based nomogram, sample size for proposed study would be: Study group (n=30): patient received TAP block with injection bupivacaine (0.25%) 20 ml. Control group (n=30): patient not received TAP block and was given injection diclofenac on demand for post-operative analgesia as per institute protocol for routine surgery. Sensory block was assessed by sterile pin prick method in the midaxillary line on both sides of chest. Postoperative pain was assessed by using the visual analogue scale.<strong>Results:</strong>Majority of the patient were in age group of 30 to 50 in both group. VAS score was significantly higher in control group as compared to the study group at all the time. First dose of rescue analgesia required in study group was at 669.66± 346 min and in control group was 220.33 ± 139.24 min which was statistically significant. Diclofenac requirement in study group was one time in 22 patient and two time in 8 patient which was significantly less as compare to control group in which diclofenac requirement was one time in 2 patient and two time in 5 patient and three time in 23 patient in 24 hour.<strong>Conclusion:</strong>TAP block is a promising new technique for postoperative pain management in surgery involving the anterior abdominal wall as a part of multimodal analgesia. Further studies are warranted to support this finding before establishing it in routine clinical practice in different type of surgical procedures.</p> Jigna R Shah, Apoorva Moghe, Maulik Humbal Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Comparative Evaluation of Ropivacaine versus Levobupivacaine for Postoperative Epidural Analgesia in Geriatric Patients Posted for Orthopedic Surgeries <p><strong>Background: </strong>With increasing life expectancy, improved healthcare and increasing prosperity, the proportion of elderly population is increasing throughout the world. Post-operative pain management among elderly patients&nbsp; is a challenging and daunting task for anaesthesiologists. Altered redistribution kinetics as well as compromised drug clearance capacity render geriatric patients particularly vulnerable to drug-induced complications. Regional anaesthesia is preferred for the older patients because this form of anaesthesia causes the least interference with the metabolic functions.<strong>Subjects and Methods:</strong>56 elderly patients&nbsp; scheduled for elective orthopaedic lower limb surgery under epidural anaesthesia with continuous post-operative epidural analgesia were enrolled in this prospective randomised study and were randomly allocated to two groups&nbsp; consisting 28 patients each as under: Group I : Epidural analgesia Ropivacaine 0.2% @ 6ml/hr. Group II: Epidural analgesia Levobupivacaine 0.2% @ 6ml/hr. Statistical evaluation: Hemodynamic profiles, Onset of analgesia, extent of sensory and motor block&nbsp; were recorded.&nbsp; To compare the change in a parameter at two different time intervals paired "t" test was used. Block characteristics were analysed using Mann Whitney U test.<strong>Results:</strong>Both Ropivacaine and levobupivacaine provided excellent analgesic effect, a good hemodynamic stability and complication free infusion. As compared to levobupivacaine, ropivacaine had an early motor block recovery, early achievement of VAS score 0, ability to achieve higher levels of block and finally prolongation of analgesic effect even after the infusion was stopped.<strong>Conclusion:</strong>As compared to levobupivacaine, ropivacaine seems to be a better option for continuous epidural infusion owing to early motor block recovery and prolonged analgesia&nbsp;&nbsp; after the infusion was stopped.</p> Shilpi Misra, Furkan Akhtar Ansari Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Comparison of Hypobaric Bupivacaine, With and Without Fentanyl for Patients Undergoing Surgeries around Hip: A Randomized Double Blind Study from North India <p><strong>Background: </strong>Hip surgeries are frequently performed using single shot spinal anesthesia with 15-17.5 mg plain bupivacaine 0.5% which provides surgical anesthesia for 3-4 hours but is difficult to make the patients with hip fractures to lie in lateral decubitus position with the operating side dependent and to make them sit also. Using hypobaric local anesthetic for surgeries around hip, preparation time may be reduced for performing spinal anesthesia and surgery in the same position without waiting for establishment of spinal anesthesia in the supine position. Furthermore, hypobaric local anesthetics can produce more selective block on the operating side and avoid unnecessary paralysis of the nonoperating side potentially resulting in hemodynamic stability and better mobilization of patients during recovery period.<strong>Subjects and Methods:</strong>In the present study, we compared the anesthetic and hemodynamic effects of hypobaric bupivacaine with and without fentanyl in 100 ASA physical status I and II patients undergoing surgeries around hip. Patients received spinal injection of either 2.5ml (12.5mg) of isobaric bupivacaine with 1.5ml of distilled water (total 4ml) making it hypobaric or 2.5 ml (12.5mg) of isobaric bupivacaine with 1ml of distilled water and 0.5ml(25 µg) of fentanyl (total 4ml) with operative side up, in a double blinded manner. Sensory level and motor block were evaluated on the operative and non-operative sides until regression to L2 and full motor recovery. Hemodynamic changes after spinal injection and the first analgesic request for VAS &gt;3 were noted.<strong>Results:</strong>Demographic characteristics of both the groups were comparable. Time to maximal fall in MAP and patients requiring vasopressor were similar in both the groups. None of the patients in any of the two group required atropine for bradycardia. Co-administration of fentanyl in hypobaric bupivacaine hastened the onset of sensory block (12±3 vs. 20±9.0, p value &lt;0.001) and the time required was less on the operative side than on the contralateral (non-operative) side in both the groups. The median upper level of block was higher on the operative than on the contralateral side in both the groups. Co-administration of fentanyl in hypobaric bupivacaine prolonged the sensory regression to L2 (298±40 vs. 256±35, p value &lt;0.001). Co-administration of fentanyl had no effect on the time to complete motor recovery as at the end of surgery, all the patients had complete motor recovery on the contralateral (non-operative) side, while none of the patient in any of the two groups had complete motor recovery on the operative side. Time to first analgesic requirement was significantly higher (318±27 vs. 288±28, p value &lt;0.001) with the addition of fentanyl to the hypobaric bupivacaine.<strong>Conclusion:</strong>So we conclude that the use of hypobaric bupivacaine produces spinal anesthesia with a faster sensory motor recovery on the contralateral (non-operative) side. Co-administration of fentanyl further prolongs the sensory block on the operative side without significantly affecting the motor block, so delays the use of first analgesic without further compromising the systemic hemodynamics.</p> Anshuman Shukla, Sumita Kumari, Vinita Singh, Satyajeet Verma, Sujeet Rai Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Role of Intravenous Dexmedetomidine as an Adjuvant in Labour Analgesia in Pre-eclampsia: A Prospective Study <p><strong>Background: </strong>Dexmedetomidine is a highly selective α-2 adrenergic receptor agonist with several diverse actions like sedation, anxiolysis, sympatholysis, analgesia, and decreased intraoperative anesthetic requirements (narcotic, inhalational). Intravenous (IV) dexmedetomidine can be used as an adjuvant in labour analgesia in preeclampsia patients as onset is faster and duration of analgesia is longer. Aim of the study: The aim of the study was to determine the role of intravenous Dexmedetomidine as an adjuvant in Labour analgesia in PIH.<strong>Subjects and Methods:</strong>This was a prospective study and was done in the department of Anaesthesia at Maheshwara Medical College. Our study included 60 full term pregnant women with preeclampsia, within 25 to 45 years age range. They were divided into two groups, as Test group and Control group of 30 patients each. Test group received IV Dexmedetomidine and Control group received IV Fentanyl.<strong>Results:</strong>Maximum number of cases 15/30 (50%) were in the age group 31-35 years, Majority were primigravida ie, 60% ( 36/60). Onset of analgesia was faster, duration of analgesia was longer and uterine contraction was greater with IV Dexmedetomidine as compared to IV fentanyl.<strong>Conclusion:</strong>From the present study we conclude that IV Dexmedetomidine can be used for labour analgesia in pregnant women with preecampsia and observed that onset and duration of analgesia are better and also it gives stable maternal parameters of maternal heart rate and mean blood pressure.</p> Jyothsna C, Roopa Kotha Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Incidence of Bacteremia at the Time of ICU Admission and its Impact on Outcome <p><strong>Background: </strong>For patients admitted in ICU, if they are suspected with infection, at admission time, blood culture is taken. Aim: This study aimed to evaluate the bacteraemia incidence at the ICU admission time, and assess its impact on the outcome.<strong>Subjects and Methods:</strong>This is a retrospective study which was conducted in a tertiary hospital. At time of admission, data from all the ICU admissions with suspected sepsis were analysed over a period of July 2016 to June 2018. The positive blood culture group (Group A) consisted of patients with clinically significant BSI.<strong>Results:</strong>600 patients were selected in the study. 250 patients out of 600 patients (42%) were on antibiotics. 380 patients out of 600 patients (63%) were direct ICU admission from casualty, 70 patients from hospital wards (11%), 45 patients from other ICU’s in the hospital (8%) and 105 patients from other hospitals (18%). Blood cultures were positive only in 70 patients (11.6%) with significant BSI. ICU mortality was significantly higher in positive blood culture group (i.e. 30/70), when compared with negative blood culture group (i.e. 68/530). Mortality was higher in patients with pseudomonas aeruginosa (75%) though it was not statistically significant.<strong>Conclusion:</strong>In the ICU, only in minority of patients with suspected infection, blood cultures may be positive. Even though the patients are administered with antibiotics, prognosis of the patients with positive blood culture is worse.</p> Jose B Cherayath, Jitin George Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Study of Efficacy of Sevoflurane with Rocuronium during Induction in Neurosurgical Patients <p><strong>Background: </strong>Rocuronium provides good intubating conditions but large doses causes prolongation of its duration of action, making it unsuitable for short surgical procedures. Aims: We assessed the efficacy of sevoflurane with rocuronium during induction in terms of reducing the onset time for intubation, evaluating intubating conditions and haemodynamic responses during intubation.<strong>Subjects and Methods:</strong>This prospective, randomised, double-blind study was conducted in 40 adult patients undergoing lumbar disc operations under general anaesthesia were randomly allocated into two equal groups namely Group R (received 0.8 mg/kg of rocuronium) and Group RS (received 0.8 mg/kg of rocuronium and 2% sevoflurane during induction).<strong>Results:</strong>The two groups were comparable with respect to age, sex, weight and ASA grade. The time for loss of thumb adduction was 101.4 ± 11.2 s in Group R compared with 61.04 ± 5.4 s in Group RS&nbsp; P &lt; 0.001]. The onset time of intubation was significant P &lt; 0.001]. Significant differences in heart rate and mean arterial pressure were seen immediately after intubation, at 1 and 3 min after intubation (P &lt; 0.05) between the two groups. The mean intubation score was comparable in both the groups is insignificant[P = 0.11].<strong>Conclusion:</strong>Rocuronium 0.8 mg/kg along with 2% sevoflurane provides rapid sequence intubation during anaesthesia in neurosurgical patients.</p> Jose B Cherayath, Jitin George Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Comparison of Continuous Epidural Blockade and Continuous Femoral Nerve Block on Postoperative Pain in Total Knee Replacement Surgeries: A Prospective Randomised Controlled Study <p><strong>Background: </strong>The use of epidural analgesia in the management of postoperative pain following orthopedic surgeries has evolved as a critical component of a multimodal approach to achieve the goal of pain relief, early mobilization, and improved compliance with physiotherapy resulting in overall improved outcomes. <strong>Aim:</strong> The aim of this study is to compare continuous femoral nerve block with continuous epidural block technique for postoperative analgesia in patients undergoing elective total knee replacement surgery.<strong>Subjects and Methods:</strong>The patients belonging to the ASA I to III scheduled for various knee surgeries under spinal anesthesia were enrolled in this study. They were randomly divided into two equal groups of thirty-three patients each. The Group F patients received continuous femoral nerve blockade and in the Group E patients continuous epidural blocked preoperatively.<strong>Results:</strong>The analgesic efficacy of both continuous femoral nerve block and continuous epidural nerve block was equal as measured by the visual analogue scores. The incidence of Hypotension was more in the Epidural group. The adverse effects due to the Continuous Femoral Nerve block were lower in comparison with the Continuous Epidural block technique.<strong>Conclusion:</strong>Continuous femoral nerve blockade provides postoperative analgesia equivalent to that obtained with a continuous epidural blocked but with lesser side effects.</p> K. Shanthini, Nishkala Chandra Sekar, Kusuma Mathai Copyright (c) 2020 Academia Anesthesiologica International Fri, 22 May 2020 00:00:00 +0000 Effect of Addition of Dexamethasone or Clonidine to Ropivacaine on Postoperative Analgesia in Ultrasonography Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair: A Prospective Double Blind Randomized Control Trial <p><strong>Background: </strong>A hernia repair surgery commonly induces moderate to severe postoperative pain for 48 hours. Aim of the study was to compare 0.5% Ropivacaine with dexamethasone and 0.5% Ropivacaine with clonidine for ultrasonography guided transversus abdominis plane (TAP) block as post-operative analgesia in patients undergoing Inguinal hernia repair surgery.<strong>Subjects and Methods:</strong>A randomized prospective controlled clinical study was conducted in 64 patients undergoing Inguinal Herneoplasty. Participants were divided into two groups in which group RD (n=32) received 0.5% Ropivavacaine with Dexamethasone 8mg and those in group RC (n=32) received 0.5% Ropivacaine with Clonidine 75mcg as USG guided TAP block at the end of surgery. The postoperative pain was evaluated by visual analog scale (VAS) for pain scoring at every 2 hours for 24 hours postoperatively. Subjective assessment of duration of analgesia was done.<strong>Results:</strong>Time to first rescue analgesia was significantly less in group RC (424.53±34.13) compared to group RD (616.09±31.36min) (P &lt; 0.001). Total tramadol consumed in 24 h was significantly higher in group RC than group RD (P &lt; 0.001). Visual analog scale scores for both somatic and visceral pain were significantly higher in group RC than group RD at 6h, 8 h and 12 h postoperatively.<strong>Conclusion:</strong>TAP block is a safe and effective way of relieving postoperative pain in inguinal herneoplasty patients. Addition of dexamethasone to Ropivacaine significantly enhances its effect in terms of block quality and analgesia duration as compared to clonidine addition.</p> Sweta Bharadiya, Neelam Meena, Ram Nivas, R.K. Solanki Copyright (c) 2020 Academia Anesthesiologica International Tue, 26 May 2020 00:00:00 +0000 Comparative Efficacy of Intrathecal Pethidine with Lignocaine 5% (Heavy) as Sole Anaesthetic Agent for Perineal Operations <p><strong>Background: </strong>The discovery of opioid receptors and ligand in the brain and spinal cord lead to the feasibility of their use intrathecally. Pethidine is the only narcotic that has been shown to be effective intrathecally for surgery. This is probably because it as a phenyl-piperidine derivative and has a structure and action similar to that of local anaesthetic.<strong>Subjects and Methods:</strong>50 patients belonging to ASA grade 1 and 2 physical status were randomly assigned to two groups A and B. Patients in group A received 1 ml of 5% lignocaine (heavy) intrathecally and those in group B gained intrathecal Pethidine (preservative-free) 0.5mg/kg body weight. The time for onset and level of sensory blockade, onset and degree of motor blockade, hemodynamic parameters, time for regression of sensory and motor blockade, duration of postoperative analgesia and side effects were noted and compared in both the groups.<strong>Results:</strong>Two groups were comparable with respect to age, sex, height and weight. The onset of sensory and motor blockade in-group A was 2.00±1.06min and 2.56±0.88 and in-group B it was 3.56±1.64 min and 7.22±1.11 min respectively, which was statistically significant. Grade I motor paralysis was seen in 2 cases (10%) in group A and 15 cases (75%) in groupB. Grade II motor paralysis was seen in 6 cases (30%) in group A and 5 cases (25%) in group B. Grade III motor paralysis was viewed in 12 cases (60%) in group A and 0 cases(0%) in group B. Grade I and III motor paralysis in the groups were statistically significant (p&lt;0.05). Time for sensory regression at L1 was 65.12±4.83 min in-group A and 94.60±6.88 min in-group B that was statistically very significant (p&lt;0.05). The time for regression of motor blockade was 60.40±3.85 in-group A and 60.20±5.02 in group B, which was statistically not significant (p&gt;0.05). The duration of postoperative analgesia was 122.84±9.37 min in-group A and 320.60±23.02 in group B, which was statistically very significant. The incidence of side effects was comparable in both groups.<strong>Conclusion:</strong>Pethidine (preservative-free) 0.5mg/kg body weight can be used intrathecally as a sole anaesthetic agent to provide prolonged postoperative analgesia associated with hemodynamic stability and early ambulation in patients undergoing perineal surgeries.</p> Jitta Sudershan Reddy Copyright (c) 2020 Academia Anesthesiologica International Tue, 26 May 2020 00:00:00 +0000 A Comparative Study of Isobaric Levobupivacaine 0.5% versus Isobaric Levobupivacaine 0.5% with 3µg Dexmeditomidine in Spinal Anaesthesia in Patients Undergoing Effective Lower Limb Surgeries <p><strong>Background: </strong>Intrathecal apha-2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is a 2 receptor agonist and its 2/1selectivity is 8 times higher than that of clonidine. Aim: In this study, we aimed to investigate the effect of adding 3µg dexmedetomidine to Intrathecal Isobariclevobupivacaine0.5% on the onset time and duration of motor and Sensory blocks.Study design: Randomized controlled study.<strong>Subjects and Methods:</strong>Patients were randomly assigned into two groups. Group L (n=30) patients received 3 mL (15mg) of 0.5% levobupivacaine+0.3mL normal saline and Group LD(n=30) patients received 3mL(15mg)of0.5%levobupivacaine+0.3mL (3mcg dexmedetomidine). Sensory block onset time, block reaching time to T10dermatome, the most elevated dermatome level, two dermatome regression time, sensory block complete regression time as well as motor block on a set time, reaching Bromage3and regressing to Bromage 0 were recorded.<strong>Results:</strong>Sensory and motor block onset times were shorter in Group LD than in Group L (p&lt;0.001).The regression of the sensory block to S1dermatome andBromage0 was Longer in Group LD than Group L (p&lt;0.001).The two dermatome regression time was Longer in Group LD than Group L (p&lt;0.001). There were no statistically significant Differences between groups in blood pressure and hear trate.There was no statistically Significant difference between groups when adverse effects were compared.<strong>Conclusion:</strong>We conclude that intrathecal dexmedetomidine addition to Isobaric levobupivacaine 0.5%for spinal anaesthesia shortens sensory and motor block onset time and prolongs Block duration without any significant adverse effects.</p> Spoorthy Uppuleti, Kuppannagari Subba Reddy Copyright (c) 2020 Academia Anesthesiologica International Tue, 26 May 2020 00:00:00 +0000 Clinical Comparison of Epidural Clonidine and Verapamil with Ropivacaine in Abdominal Hysterectomy; A Prospective, Randomized, Controlled Study. <p><strong>Background: </strong>Adjuvants, when combined with local anaesthetics, increase duration of block, improve quality of blockade and accelerate onset of block. The aim of this study is to assess the analgesic properties and postoperative analgesia of Clonidine and verapamil in the epidural block for abdominal hysterectomy.<strong>Subjects and Methods:</strong>Ninety patients were divided into three groups Group l- patient were given ropivacaine (0.75%) in the dose of 20 ml, Group II -0.75% ropivacaine 20 ml with verapamil in the dose of 2.5 ml, Group III -0.75% ropivacaine 20 ml with Clonidine in the dose of 1mcg/kg body weight. Patients were assessed for onset, degree, level, duration of sensory and motor block, duration of complete analgesia and postoperative analgesia, rescue analgesic requirement, sedation score and adverse effects.<strong>Results:</strong>When groups I and II were compared, onset of sensory and motor block was found to be statistically insignificant (p&gt;0.05), while it was early in group III in comparison to groups I and II and statistically significant ( p&lt;0.05). The duration of sensory block in group III was more in comparison to groups I and II&nbsp; and were statistically significant ( p&lt;0.05). The mean duration of analgesia in group I was 184.03 + 5.20 mins, in group II was 300.46 + 5.80 mins and in groups, III was 538 + 12.80 mins.<strong>Conclusion:</strong>Verapamil does not enhance the onset, duration of the sensory and motor block, though Clonidine in the dose of 1ug/kg enhances the onset of sensory block. The duration of postoperative analgesia with verapamil was more and much higher compared to Clonidine.</p> Suraj Kumar, Manoj Tripathi, Deepak Malviya, Sujeet Rai, Sumit Kumar, Manoj Kumar Giri Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 Comparison of Pethidine and Dexmedetomidine for the Control of Intraoperative Shivering Under Spinal Anesthesia <p><strong>Background: </strong>Spinal anesthesia significantly impairs the thermoregulation system by inhibiting tonic vasoconstriction, which plays a significant role in temperature regulation. Various non-pharmacological and pharmacological methods are available for the control of shivering during anesthesia. The present study was done with an aim to compare the two drugs Pethidine and Dexmedetomidine for the control of intraoperative shivering under spinal anesthesia.<strong>Subjects and Methods:</strong>A prospective randomized study was carried out in the Department of Anaesthesiology, on 100 patients who developed intra-operative shivering following spinal anesthesia for numerous surgical procedures. When patients developed shivering of higher than mentioned grades, they were randomly assigned to one of the 2 study groups: Group D- Dexmedetomidine group receiving single intravenous bolus dose of 0.5mcg/kg over 5 min.&nbsp; Group P: Pethidine group patients receiving 0.5mg/kg Pethidine IV over 5 min. Patients were intently monitored for the failure of the drug, Recurrence of shivering and side effects like nausea, vomiting, bradycardia (&lt; 50/min), hypotension (&gt;20% of baseline), giddiness and sedation score were recorded.<strong>Results:</strong>We found the Pethidine group had 62.5% and Dexmedetomidine had 67.5% of grade 3 shivering. The grades of shivering were comparable between the two groups with no statistical difference. We found the dexmedetomidine group had a significant reduction in time required to control shivering and vanishing of shivering after drug.<strong>Conclusion:</strong>Both dexmedetomidine (0.5mcg/kg) and Pethidine (0.5mg/kg) are effective in treating patients with post-spinal anesthesia shivering but the time taken for control of shivering was shorter with Dexmedetomidine as compared to Pethidine.</p> Viral Prakashkumar Patel, Shital Hardik Halvadia Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 A Comparative Evaluation of Dexamethasone and Tramadol as Adjuvant to Levobupivacaine in Supraclavicular Block <p><strong>Background: </strong>The present study was conducted to evaluate and compare dexamethasone and tramadol as adjuvant to levobupivacaine in supraclavicular block. <strong>Subjects and Methods: </strong>The present study was conducted on 50 patients of American Society of Anesthesiologists (ASA) grade I and II. Patients were divided in to two groups of 25 each. In group I, 30 ml of 0.5% levobupivacaine hydrochloride plus 2 ml tramadol (100 mg) was used. In group II, 30 ml of 0.5% levobupivacaine hydrochloride plus 2 ml dexamethasone (8 mg) was used. Visual Analogue Scale was used. The onset of sensory and motor block was evaluated.<strong>Results: </strong>The mean onset of sensory block in group I was 5.41 minutes and in group II was 3.86 minutes, motor onset was 9.12 minutes in group I and 7.25 minutes in group II, duration of sensory block in group I was 12.14 hours and in group II was 15.34 hours, duration of motor block in group I was 14.34 hours and I group II was 16.23 hours, duration of analgesia in group I was 16.1 hour and in group II was 18.4 hours. The difference was significant difference (P&lt;0.05). The mean VAS score in group II was better as compared to group I (P &lt;0.05). <strong>Conclusion:</strong>Authors found that dexamethasone is a better adjuvant than tramadol when added to levobupivacaine in supraclavicular brachial plexus block.</p> Rangit Priyakar Pandey, Richa Chandra Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 A Comparative Study of Effectiveness of Ultrasound-Guided Transversus Abdominis Plane (TAP) Block vs Epidural Analgesia for Post-Operative Pain Relief in Lower Abdominal Surgeries <p><strong>Background: </strong>An increase in the use of regional anesthesia techniques for postoperative pain relief for analgesia following lower abdominal surgeries. Epidural anesthesia considered as the "gold standard" has been established to provide excellent analgesia as well as attenuation of neurogenic contribution to inflammation. The TAP block provides reliable somatic analgesia in lower abdominal incision surgeries. Use of ultrasound helps incorrect localization of the plane and accurate placement of the needle and catheter.<strong>Subjects and Methods:</strong>In TAP group under USG guidance 20 ml 0.2% Inj. Ropivacaine was deposited on each side of the abdominal wall. In Epidural group 10 ml of 0.2% Inj. Ropivacaine was administered at skin closure.<strong>Results:</strong>Systolic and diastolic blood pressure levels were significantly lower in group B as compared to group A (p&lt;0.05). . VAS score was significantly higher in group B as compared to group A (P&lt;0.05). It was observed that a significantly higher number of patients in epidural group required rescue analgesia and at higher dosages (p&lt;0.05).<strong>Conclusion:</strong>TAP block has almost no complications, keeps the patient hemodynamically stable and offers a good early postoperative analgesia (till 24 hours) when compared to a more accepted modality like epidural analgesia.</p> Santosh Bhagasra, Neelam Meena, Vikas Rajpurohit Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 Comparison of Intra-Articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for Post-Operative Analgesia in Arthroscopic Knee Surgeries <p><strong>Background: </strong>The post-operative pain in knee arthroscopy procedures can be attributed to irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection1.&nbsp; In the recent years, new interest has focused on the cholinergic system that modulates pain perception and transmission. The present study is designed to compare the efficacy of intra- articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for pain relief following arthroscopic surgeries.<strong>Subjects and Methods:</strong>Prospective, Interventional, Randomised study was conducted over 90 patients scheduled for elective arthroscopic knee surgery, who were randomly allocated into three equal groups of 30 patients each. Group I-Bupivacaine with Neostigmine, Group II-Bupivacaine with Fentanyl and Group III-Bupivacaine alone. The study drug combinations were administered Intra-articularly at the conclusion of surgery. Hemodynamic variables and Pain were observed immediately after completion of surgery (Baseline) and thereafter at fixed intervals. The duration of effective analgesia was measured from the “baseline” until the first use of rescue analgesic. The number of rescue analgesics given in 24 hours were also recorded. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software.<strong>Results:</strong>Requirement for first analgesia was significantly earlier in Group III (146.00±71.66 minutes) as compared to Group II (236.00±111.34 minutes) and Group I (648.00±228.55 minutes). Majority of patients of Group I (90.0%) required rescue analgesia only once while in was twice in Group II (90.00%) and thrice in Group III (86.67%).<strong>Conclusion:</strong>Intra-articular administration of Neostigmine in combination with Bupivacaine provided a better post-operative analgesic effect with a lower incidence of side effects and lesser requirement of rescue analgesia.</p> Prachi Singh, Sandeep Kumar Yadav, Sumit Kumar, Manoj Tripathi, Deepak Malviya Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 Dexmedetomidine as an Adjuvant in Sciatic Nerve Block for Lower Limb Surgeries: An Observational Study <p><strong>Background: </strong>In recent anesthetic practice, peripheral nerve blocks (PNB) are used extensively for surgical anesthesia and non-surgical postop analgesia. PNBs offer many benefits over other anesthetic techniques in a certain population of patients and in some specific clinical setting that may contribute to faster and safer pain relief, increased patient satisfaction, reduced hospital stay, and decreased overall healthcare cost. However, the use of a single PNB is not sufficient enough to block the pain for longer durations. Hence, to prolong the effect of anesthesia without causing any adverse event, adjuvants are injected perineurally along with local anesthetic agents. <strong>Aim:</strong> The present study was aimed to evaluate the anesthetic efficacy of dexmedetomidine as an adjuvant in sciatic nerve block in lower limb surgery patients.<strong>Subjects and Methods:</strong>This observational non-randomized study involved 50 patients who were undergoing lower limb surgeries in the study period. The heart rate, blood pressure (both SBP and DBP), and peripheral oxygen saturation were recorded. A VAS score of more than 5 was considered significant and these patients received tramadol injection (75 mg) i.v. As rescue analgesia in the postop period. To prolong the effect of sciatic nerve block, dexmedetomidine (0.5 mcg/kg) was used.<strong>Results:</strong>In the maximum number of the patient,the complete block was achieved. Only 6 patients required tramadol injection as the rescue analgesia. No significant post and intraoperative complications were reported after the procedure.<strong>Conclusion:</strong>It is concluded from the study that the inclusion of dexmedetomidine (0.5 mcg/kg) in lower limb surgeries was associated with a prolonged duration of analgesia.</p> Krishna Prasad GV, Vipin Sharma Jaishree Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 Utilities of Peripheral Nerve Blocks beyond the Operating Room: A Narrative Review <p>Intravenous analgesia has been the standard method employed to alleviate pain. However, intravenous analgesia cause higher rate of systemic side-effects, patient discomfort and longer hospital stays. In recent times, peripheral nerve blocks (PNB) have become the most preferred choice for a variety of procedures in operating room. PNBs lower the risks of peri-operative challenges, they involve in lowering the number of opioid-related complications, and they mitigate the need for general anaesthesia. Further, peripheral nerve blocks with the assistance from ultrasound technology provide superior choices over traditional pain-relieving methods practiced in the operating room.&nbsp; Objective of the current review article is to throw light on the peripheral nerve blocks and their utilities other than operation theatres. Also, this review article throws light on the several utilities of peripheral nerve blocks in trauma cases, block on arrival, upper limb, lower limb, chest and abdomen, head injury, maxillofacial injuries, uses in central vein canulations, recurrent ventricular tachycardia, interventional radiology, chronic pains with acute presentation and gangrene of limbs.</p> Krishna Prasad GV Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 Clinical Comparative Study between Fentanyl and Dexmedetomidine with Bupivacaine for Lower Limb Surgery in Spinal Anaesthesia <p><strong>Background: </strong>Spinal anesthesia is a preferred technique of choice in infraumbilical surgeries. The spinal anesthesia effect can be improved by adding various adjuvant like Fentanyl, clonidine, dexmedetomidine. Dexmedetomidine is a highly selective alpha 2 adrenergic agonists. The aim of study to compare efficacy and safety between Dexmedetomidine and Fentanyl with Bupivacaine.<strong>Subjects and Methods:</strong>A prospective randomized, double-blind study was conducted on 100 patient by dividing them into two groups. Group D: 2.5ml (12.5mg) of 0.5% hyperbaric bupivacaine with 5mcg (0.5ml) dexmedetomidine and Group F : 2.5ml(12.5mg) of 0.5% hyperbaric bupivacaine with 2 5mcg(0.5ml)&nbsp; fentanyl. The total volume injected intrathecally was 3.0ml in ASA I and II grade patient undergoing lower limb surgery.<strong>Results:</strong>Patients in dexmedetomidine groupD had a significantly longer sensory and motor block time than patients in fentanyl group F.The mean time of sensory regression to level S1 was 306.00 ± 13 .32 in group D and 206.14± 16.69 in group F(P&lt;0.001). The regression time of motor block to reach modified Bromage 0 was 257.70±14.61 in group D and 178.54±14.23 in group F(P&lt;0.001).<strong>Conclusion:</strong>Intrathecal Dexmedetomidine is associated with prolonging motor and sensory block as compare to Fentanyl.</p> Tuhin Vashishth, Sangeeta Varun Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 A Comparative Study of Hemodynamic Effects of Levosimendan and Milrinone in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting <p><strong>Background: </strong>Off-Pump CABG or “beating heart” surgery possess a challenge to the anesthesiologist. Main goals are provision of safe anesthesia with maximum myocardial protection and maintenance of hemodynamics with various manipulation of heart during in order to visualize and graft the coronary arteries. Anesthetic regimen and ionotropic support influences postoperative myocardial function and outcome in coronary bypass surgery patients.Objective:&nbsp; To compare and assess haemodynamic effects of&nbsp; Levosimendan and Milrinone in patient undergoing off pump coronary artery bypass grafting with compromised cardiac function (NYHA III,IV) and pre-operative, left ventricular ejection fraction (LVEF) &lt; 45%.<strong>Subjects and Methods:</strong>Patients were randomly allocated to 2 groups (64 patients in each group). Levosimendan Group (Group A) received infusion of Inj. Levosimendan 0.1µg/kg/min after loading dose of 12μg/kg over 10 mins. While Milrinone Group (Group B) received infusion of inj. Milrinone 0.5µg/kg/min after loading dose of 50 μg/kg over 10 mins. HR, MAP, CVP, CI, SVRI, lactate levels were&nbsp; monitored at baseline, after induction, after sternotomy, at 30mins ,thereafter&nbsp; 6, 12, and 24 hours using Flo-Trac sensor (Edwards Life sciences).<strong>Results:</strong>Heart Rate, CI was significantly higher in Levosimendan group while MAP, SVRI and lactate levels were lower in Levosimendan group as compared to Milrinone group. Need of other inotropic support is more in Milrinone group.<strong>Conclusion:</strong>Levosimendan maintained the haemodynamic parameters better as compared to Milrinone in off pump CABG patients with low preoperative ejection fraction and also better end organ perfusion represented by lower lactate levels.</p> Chand Kishan Vyas, Ramesh Kumar, Neelu Sharma, Indu Verma, Anjum Saiyed Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 Comparison of Sevoflurane and Propofol for Laryngeal Mask Airway Insertion in Adults <p><strong>Background: </strong>A randomized comparative study titled “Comparison of sevoflurane and propofol for insertion of laryngeal mask airway insertion in adults.” was done on 50 patients in the department of anesthesiology, at Pratima Medical College, Karimnagar, Telangana, India.<strong>Subjects and Methods:</strong>The conditions and hemodynamic changes for insertion of LMA were assessed in ASA grade I and II patients age 18 – 60 years while inserting LMA insertion. Patients were randomized into two groups. Inj Fentanyl 1.5 - 2µg/kg was given to both groupsof patients. Propofol 2 – 2.5 mg/kg was given in group P. Group S patients were induced with 8% sevoflurane. Hemodynamic parameters and quality of insertion of LMA were assessed. Time taken for insertion of LMA in both groups was compared.<strong>Results:</strong>There was no significant difference in adverse response to LMA insertion. The quality of insertion with propofol was excellent in all patients. With sevoflurane quality of insertion ranged from excellent to satisfactory. But the airway related incidents in our study were more in the sevoflurane group when compared to the propofol group but are not of any statistical significance. Induction of anesthesia with sevoflurane was associated with the advantage that means arterial pressure was better maintained with sevoflurane compared with propofol.<strong>Conclusion:</strong>Thus, sevoflurane is associated with good hemodynamic stability,but the quality of anesthesia provided with propofol is higher. Prolonged jaw relaxation with sevoflurane compared to propofol may delay laryngeal mask airway insertion.</p> Jitta Sudershan Reddy Copyright (c) 2020 Academia Anesthesiologica International Sat, 30 May 2020 00:00:00 +0000 A Comparative Study of Dexmedetomidine and Fentanyl on Airway Reflexes and Hemodynamic Responses to Tracheal Extubation in Nasal Surgeries <p><strong>Background: </strong>Extubation at light levels of anesthesia or sedation can stimulate reflex responses via tracheal and laryngeal irritation. The present study was conducted to compare dexmedetomidine and fentanyl on airway reflexes and hemodynamic responses to tracheal extubation in nasal surgeries.<strong>Subjects and Methods:</strong>The present study was conducted on 60 patients of ASA grade I and Grade II of both genders. Patients were divided into 2 groups of 30 each. Group I were dexmedetomidine 0.5 μg/kg in 100 mL of isotonic saline and group II patients received fentanyl 1 μg/kg in 100 mL of isotonic saline intravenously. Parameters such as duration of surgery and duration of anesthesia (minutes) were recorded. Extubation time, awakening time and orientation time was recorded.<strong>Results:</strong>The ASA grade I was seen in 20 in group I and 14 in group II, ASA grade II was seen in 10 in group I and 16 I group II. Group I comprised of 14 males and 16 females, group II had 17 males and 13 females. Mean duration of surgery in group I was 172.4 minutes and in group II was 174.6 minutes in group II. Mean duration of anesthesia was 194.2 minutes in group I and 198.6 minutes in group II. The difference was non- significant (P&gt; 0.05). The mean extubation time in group I was 7.2 minutes and 5.6 minutes in group II, awakening time was 10.2 minutes in group I and 10.8 minutes in group II and orientation time was 14.3 minutes in group I and 15.2 minutes in group II.<strong>Conclusion:</strong>Authors found that dexmedetomidine 0.5 μg/kg IV, administered before extubation, was more effective in attenuating airway reflex responses to tracheal extubation as compared with fentanyl 1 μg/kg IV.</p> Saurabh Misra, Rajeev Tiwari, Shivendu Shekhar Ojha Copyright (c) 2020 Academia Anesthesiologica International Sun, 31 May 2020 00:00:00 +0000 Comparison of 0.5% Levobupivacaine Versus 0.5% Isobaric Levobupivacaine with 3mcg Dexmedetomidine in Spinal Anaesthesia- A Comparative Study <p><strong>Background: </strong>Effective postoperative pain control is an essential component of the care of the surgical patient. The present study was conducted to compare levobupivacaine 0.5% versus isobaric levobupivacaine 0.5% with 3mcg dexmedetomidine in spinal anaesthesia.<strong>Subjects and Methods:</strong>The present study was conducted on 80 patients of ASA Grade-I and Grade-II of both genders. They were divided into 2 groups of 40 each. Group I were those who received 3 ml of 0.5% isobaric levobupivacaine with 0.3 ml of normal saline and group II patients received 3 ml of 0.5% isobaric levobupivacaine with&nbsp; 3µg of dexmedetomidine. Parameters such as onset of sensory blockade at T10 dermatome and onset of motor blockade motor blockade, maximum level of sensory and motor blockade attained and the time taken for the same, total duration of sensory blockade and motor blockade were recorded.<strong>Results:</strong>Group I, ASA grade I was seen in 25 and II in 15, in group II, ASA grade I was seen in 22 and II in 18 patients. Group I comprised of 18 males and 22 females, group II had 20 males and 20 females. Mean duration of surgery in group I was 58.2 minutes in group I and 56.4 minutes in group II. Mean heart rate was 82.3 per minute in group I and 81.6 per minute in group II. The mean time required to obtained sensory block in group I was 10.4 minutes and in group II was 7.4 minutes. The mean time for motor block in group I was 8.2 minutes and in group II was 5.4 minutes. The mean time required to obtain motor block in group I was 16.5 minutes and in group II was 16.1 minutes.<strong>Conclusion:</strong>Authors found that addition of intrathecal dexmedetomidine to 0.5% isobaric levobupivacaine shortens sensory and motor block onset time and prolongs block duration.</p> Rajeev Tiwari, Saurabh Misra, Shivendu Shekhar Ojha Copyright (c) 2020 Academia Anesthesiologica International Sun, 31 May 2020 00:00:00 +0000 A Comparative Study of Laryngeal Mask Airway and Air-Q Intubating Laryngeal Airway Using Parker Flex Tip Tube <p><strong>Background: </strong>To facilitate tracheal intubation, intubating laryngeal mask airway(ILMA) was designed specifically. A relatively new supraglottic airway device, air-Q ILA is an alternative to ILMA to facilitate endotracheal intubation. Considering advantages of air-Q over ILMA are that the breathing tube of the device is shorter, wider and due to removable connector, a standard e Parker Flex Tip tracheal tube (product of Parker Medical Company) has a curved, centered, flexible and tapered distal tip that is designed to facilitate easy, rapid and non-traumatic intubation. It has double murphy eyes with an anterior curvature and a posterior opening bevel. It is designed so that the posterior bevel will decrease the incidence of the tube catching at the anterior or the lateral laryngeal structures during tracheal intubation.<strong>Subjects and Methods: </strong>This is a randomized, single-blind study. Total of 100 patients of either sex aged 18–60 years belonging to American Society of Anaesthesiologists (ASA) physical status I or II scheduled for elective surgery under general anesthesia with endotracheal intubation were included in the study and the patients with respiratory or pharyngeal pathology, mouth opening &lt; 2.5 cm, body mass index ≥35 kg/m2, pregnancy and anticipated difficult airway were excluded from the study. The duration of the study was one year. The ethical clearance was taken from the institutional ethical committee. Written informed consent from all participants was obtained for participation in the study. <strong>Results: </strong>A total of 100 patients were allocated for the study. The insertion of the airway device was successful in all the patients of group 1. So, 50&nbsp; patients were analysed for intubation in group 1. Air-Q ILA could not be inserted and resulted in failure in two cases. Hence, 48 patients were analysed statistically for intubation in group 2. The two groups were comparable with respect to age, weight and sex distribution. The mean age of patients in group 1 was 40.00 ± 10.76 years and in group 2 it was 40.56 ± 11.0 years (P = 0.651). There were 30 females and 20 males both in group 1 and group 2 (P = 1.000). The mean weight of patients in group 1 was 60.34 ± 8.06 kg and in group 2 was 60.10 ± 10.05 kg (P = 0.924). <strong>Conclusion:</strong>The &nbsp;overall success rate using Parker Flex Tip tube was more with ILMA (99%) as compared to air-Q ILA (78%). It can be further suggested that Parker Flex Tip tube can be used as an alternative to silicone tube with ILMA, but more multicentre studies are required over larger populations to evaluate the utility of Parker Flex Tip tube with air-Q ILA.</p> Sanjay Melville Masih, Rakesh Kumar Gupta Copyright (c) 2020 Academia Anesthesiologica International Thu, 25 Jun 2020 00:00:00 +0000 Assessment of Outcome of Intrathecal Analgesia in Multiparous Women Undergoing Vaginal Delivery <p><strong>Background: </strong>The present study was conducted to assess the outcome of intrathecal analgesia in multiparous women undergoing vaginal delivery. <strong>Subjects and Methods: </strong>The present study was conducted among 80 multiparous women ages ranged 18- 40 years. All patients received 0.5 ml of intrathecal injection of 2.5 mg bupivacaine 0.5% and 1 ml dexamethasone 4 mg plus a 0.5 ml adjuvant. The adjuvants in group I patients were 100 μg morphine, 25 μg fentanyl in group II, 5 μg dexmedetomidine in group III and normal saline in group IV (control group). The primary and secondary outcome was the duration of pain relief, the analgesia onset time, the maximum level of sensory block, the visual analogue scale (VAS) was recorded. <strong>Results: </strong>The mean duration of analgesia in group I was 182.4 minutes, in group II was 170.5 minutes, in group III was 200.4 minutes and in group, IV was 140.2 minutes. The onset of analgesia was 3.9 minutes, 2.8 minutes, 2.7 minutes and 4.5 minutes in group I, II, III and IV respectively. S1 sensory regression time (minutes) was 181.4, 157.4, 185.3 and 130.6 in group I, II, III and IV respectively. Modified Bromage scale 5 minutes, 15 minutes and 30 minutes after IT in all groups was 0.0. VAS was 1.3, 1.6, 1.6 and 3.1 with significant differences in all groups (P&lt; 0.05). There was non- significant difference in mean age, weight, height and gestational age between all groups (P&gt; 0.05). There was a non- significant difference in APGAR 1, 5, umbilical pH immediately after delivery, neonatal HR after 5minute, 15 minutes and 30 minutes in all groups (P&gt; 0.05). <strong>Conclusion: </strong>The authors found that dexmedetomidine is a safe and effective adjuvant to intrathecal bupivacaine-dexamethasone in multiparous women undergoing normal vaginal delivery.</p> Sanjay Melville Masih, Rakesh Kumar Gupta Copyright (c) 2020 Academia Anesthesiologica International Thu, 25 Jun 2020 00:00:00 +0000