Academia Anesthesiologica International https://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 A Clinical Comparision between Ropivacaine-Clonidine Combination and Ropivacaine (Plain) in Brachial Plexus Block by Supraclavicular Approach https://aijournals.com/index.php/aan/article/view/454 <p><strong>Background: </strong>Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. It produces effects similar to other local anaesthetics via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Thus, ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardiotoxicity. <strong>Subjects and Methods:</strong> This study was conducted on 60 patients undergoing upper limb surgeries aged between 18 to 55 years under supraclavicular block and informed written consent was taken. Result values were recorded using a preset proforma. <strong>Results: </strong>The mean duration of motor block in group RC was 10.10+/- 0.68 hours and the group R was 6.69+/- 0.65 hours. The statistical analysis by students unpaired „t‟ test showed that the difference between duration of motor block in group RC was significantly longer when compared to group R (P &lt; 0.001). &nbsp;<strong>Conclusion: </strong>The addition of Clonidine (150µg) as an adjuvant to Ropivacaine (0.75%) has faster onset of sensory and motor block and longer duration of sensory and motor block.</p> Dr Virupakshamma Shivaraddi Bhandi ##submission.copyrightStatement## 2019-02-24 2019-02-24 4 1 1 4 The Effect of Three Different Bolus Doses of Propofol Using Total Intravenous Anaesthesia (TIVA) in Patients Undergoing Transvaginal Oocyte Retrieval with Regard to Total Propofol Consumption https://aijournals.com/index.php/aan/article/view/455 <p><strong>Background: </strong>Total intravenous anaesthesia (TIVA) using propofol is one of the commonest techniques used for TVOR as a day care procedure by virtue of its adequate sedation and speedy clear headed recovery. Monitors like BIS or entropy help us to effectively titrate the drug so as to maintain optimal depth of anaesthesia and minimise drug consumption. <strong>Subjects and Methods: </strong>After obtaining Institutional Review Board approval, this prospective randomised controlled study was conducted in the Department of Anaesthesiology and Intensive care, Medical College Hospital. All ASA Grade I and II female patients of reproductive age group coming for oocyte retrieval under general anaesthesia who can understand the informed consent form were included in the study. <strong>Results: </strong>There is a statistically significant difference observed between group P1 and P3 with regard to Proportion of patients not requiring rescue boluses. No significant difference was observed between P1 – P2 and P2-P3 groups. There was a statistically significant difference observed between groups P1 and P3 in respect to total propofol consumption. No significant difference observed between P1-P2 and P2-P3. &nbsp;<strong>Conclusion: </strong>Bolus dose of propofol can be an induction dose of choice in oocyte retrieval patients as it requires less rescue boluses compared to 1.0mg/kg and and overall propofol consumption was less than 2 mg/kg but more than1 mg/kg.</p> Yuvaraj MK Aiyappa DS ##submission.copyrightStatement## 2019-02-24 2019-02-24 4 1 5 9 Three Different Bolus Doses of Propofol Using Total Intravenous Anaesthesia (TIVA) in Patients Undergoing Transvaginal Oocyte Retrieval: on Table Recovery Time and Time to Discharge Using Post Anaesthesia Discharge Scoring System (PADSS) https://aijournals.com/index.php/aan/article/view/456 <p><strong>Background: </strong>The patients undergoing IVF treatment are thoroughly evaluated for the cause of infertility, appropriate treatment instituted and the associated co morbidity. Another major challenge for the anaesthetists is to allay the anxiety. The patients presenting in the IVF clinic are under high degree of social and psychological stress. Detailed pre anaesthetic check up was done a day prior to surgery and appropriate investigations were carried out. <strong>Subjects and Methods:</strong> The anaesthetic technique and the questionnaire were explained to the patients and an informed written consent was taken from all the patients.Patients were kept fasting overnight prior to surgery and were&nbsp; premedicated with Tab. Ranitidine 150 mg and Tab. Alprazolam 0.25 mg on the night before surgery and repeated on the next day one hour prior to surgery with sip of water. <strong>Results: </strong>On table recovery time was found to be 6.12 minutes in group P1 (2mg/kg), 5.32 minutes in group P2 (1.5mg/kg) and 5.32 minutes in group P3 (1mg/kg). No statistical difference observed between the 3 groups. Time to discharge was found to be 37.08 minutes in group P1 (2mg/kg), 33.48minutes in group P2 (1.5mg/kg) and 28.88minutes in group P3 (1mg/kg). <strong>Conclusion: </strong>On table recovery time was found to be 6.12 minutes in group P1 (2mg/kg), 5.32 minutes in group P2 (1.5mg/kg) and 5.32 minutes in group P3 (1mg/kg). No statistical significant difference was observed between the three groups.</p> Yuvaraj MK Aiyappa DS ##submission.copyrightStatement## 2019-02-24 2019-02-24 4 1 10 14 Adding Clonidine to Ropivacaine in Brachial Plexus Block for Upper Limb Surgeries: Study of Hemodynamic Variables https://aijournals.com/index.php/aan/article/view/468 <p><strong>Background: </strong>Ropivacaine is a long acting amide local anaesthetic agent. It was first synthesized in 1957 along with bupivacaine and mepivacaine. It is a pure S-enantiomer while bupivacaine is a racemic mixture. Ropivacaine causes reversible inhibition of sodium ion influx, and thereby blocks impulse conduction in nerve fibres. This action is potentiated by dose-dependent inhibition of potassium channels. <strong>Subjects and Methods: </strong>This study was conducted on 60 patients undergoing upper limb surgeries aged between 18 to 55 years under supraclavicular block. Informed written consent was taken. Result values were recorded using a preset proforma. <strong>Results: </strong>There were 24 patients in Group R and 23 patients in Group RC belonging to ASA Grade I, and 6 patients in Group R and 7 patients in Group RC belonging to ASA Grade II which was considered statistically not significant. <strong>Conclusion: </strong>The combination produces improved analgesia, resulting in a prolonged effect and stable hemodynamics.</p> Dr Virupakshamma Ajay Basarigidad ##submission.copyrightStatement## 2019-02-24 2019-02-24 4 1 15 18 Effect of Intravenous Bolus Infusion of Dexmedetomidine on the Duration of Epidural Analgesia with Ropivacaine for Below Umbilical Surgeries in Adult Patients https://aijournals.com/index.php/aan/article/view/533 <p><strong>Background: </strong>Epidural anaesthesia is one of the most popular, reliable, safe and easy neuraxial technique to administer and widely used procedure for operative anaesthesia, obstetric analgesia, postoperative pain control and chronic pain management. Epidural anaesthesia is obtained by blocking the spinal nerves in epidural space as the nerves emerge from the dura and pass in to the intervertebral foramina. Duration of epidural anaesthesia may be prolonged by addition of opioids, clonidine, neostigmine, or vasoconstrictor agents to the local anesthetic drug for better post operative pain relief. This study is designed to investigate the effect of intravenous bolus infusion of dexmedetomidine on the duration of epidural analgesia with ropivacaine for below umbilical surgeries in adult patients and its associated adverse events. <strong>Aims of study:</strong> To determine the effect of intravenous bolus infusion of dexmedetomidine on the duration of epidural analgesia with ropivacaine for below umbilical surgeries in adult patients and to assess the incidence of intra operative side-effects. <strong>Subjects and Methods:</strong> A double blind prospective randomised control study was done. Patients were allocated in to two study groups, named A and B using computer generated randomization. <strong>Results: </strong>The duration of analgesia of epidural block with isobaric 0.5% ropivacaine with intravenous infusion of saline and dexmedetomidine were compared. Post-operative pain was evaluated by Visual Analogue Scale. Duration of analgesia is the time taken from the administration of the drug to the time when the patient complains of pain of &gt; 50 in Visual Analogue Scale. The duration of analgesia was longest in patients received intravenous dexmedetomidine along with epidural ropivacaine. <strong>Conclusion: </strong>In conclusion, Intravenous infusion of dexmedetomidine added to epidural block with ropivacaine offered prolonged analgesia in below umbilical Surgeries in adult patients without increasing the incidence of adverse effects.</p> Rakeshkumar B Deepak Falgunan ##submission.copyrightStatement## 2019-03-17 2019-03-17 4 1 19 23 The Effect of Intravenous Dexmedetomidine Infusion on Subarachnoid Block with Bupivacaine in Inguinal Herniorrhaphies https://aijournals.com/index.php/aan/article/view/535 <p><strong>Background: </strong>lumbar subarachnoid block is a technique which requires a small dose of heavy bupivacaine to provide rapid and reliable surgical anaesthesia. Duration of spinal anaesthesia may be prolonged by addition of opioids, clonidine, neostigmine, or vasoconstrictor agents to the local anesthetic drug for better post-op pain relief. This study is designed to investigate the effects of intravenous dexmedetomidine on the duration of sensory and motor blockade induced by intrathecal administration of bupivacaine, and its associated adverse events. <strong>Aims and Objectives:</strong> To assess the effect of Dexmedetomidine infusion on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess the incidence of intra operative side effects, if any.<strong> Subjects and Methods:</strong> This study was done under the department of Anaesthesiology, Govt. T. D. Medical College Hospital, Alappuzha, Kerala for a period of 8 months. A double blind prospective randomized control study was done.50 adults aged 20 to 60 years scheduled for herniorrhaphies were allocated into two study groups, named A and B using computer generated randomization. <strong>Results: </strong>The duration of analgesia compared and Post-operative pain was evaluated by Visual Analogue Scale. Duration of analgesia is the time taken from the administration of the drug to the time when the patient complains of pain of &gt; 50 in Visual Analogue Scale. The duration of analgesia was longest in patients received intravenous dexmedetomidine along with spinal bupivacaine. Side effect like respiratory depression not observed in either group. <strong>Conclusion:</strong> In conclusion, intravenous infusion of dexmedetomidine added to subarachnoid block with bupivacaine offered prolonged analgesia in adult patients undergoing herniorrhaphies, without increasing the incidence of adverse effects.</p> Rakeshkumar B Dr Sunitha ##submission.copyrightStatement## 2019-03-17 2019-03-17 4 1 24 28 Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Supraclavicular Brachial Plexus Block For Upper Limb Surgery https://aijournals.com/index.php/aan/article/view/536 <p><strong>Background: </strong>Brachial plexus blocks are commonly used for forearm and hand surgeries&nbsp; but&nbsp; due to adverse effect like cardiotoxicity there is lot of research going on to find more cardiostable agent.Ropivacaine is commonly tried now&nbsp; adays in place of bupivacaine for brachial plexus block. It is new amino amide local anaesthetic having less cardiac toxicity as compared to bupivacaine. The present study was performed at our Institute to compare the Clinical characteristics of 0.5% ropivacaine and 0.5% bupivacaine when used for supraclavicular brachial plexus block in forearm and hand surgeries. <strong>Subjects and Methods:</strong> In this prospective randomised study sixty patients of ASA-I and II scheduled&nbsp; for forearm and hand surgeries under supraclavicular brachial plexus block were randomly divided into two groups of thirty each.&nbsp; Group R received Ropivacaine 0.5% 20 ml + 10ml normal saline while Group B received Bupivacaine 0.5% 20 ml + 10ml normal saline. Mean pulse, blood pressure,onset of sensory and motor blockade, duration of analgesia, and side effecs of local anaesthetic used were noted in both the groups. Statistical analysis for clinical characterstics was done&nbsp; by&nbsp;&nbsp; student t test&nbsp; and ANOVA&nbsp; was used to analyze hemodynamic variations between two groups.&nbsp; p&lt;0.05 considered as significant and p&lt;0.01 considered as highly significant. <strong>Results: </strong>Mean onset time of sensory blockade was&nbsp; 5.5 ± 0.89 mins in Group R and 6.5 ± 0.65mins in Group B and motor blockade was 14.3 ± 2.64 mins in Group R and 12.4 ± 2.06 mins in Group B. Mean duration of Analgesia in Group R was 432 ± 18.2 mins and in Group B was 492 ± 20.3 mins.&nbsp; There was no statistical significant difference in onset of sensory block, motor block and mean duration of analagesia between two groups (p&gt;0.05). <strong>Conclusion: </strong>Supraclavicular brachial plexus block using either 0.5% Ropivacaine or 0.5% Bupivacaine have similar onset of sensory and motor blockade, duration of analgesia but due to potentially proven safety profile in the literatue compared to bupivacaine it may offer an advantage in modern clinical practice.</p> Balwinderjit Singh Iqbal Singh ##submission.copyrightStatement## 2019-03-17 2019-03-17 4 1 29 32 Evaluation of Thiopentone Sodium, Propofol and Midazolam for Modified Electro Convulsive Therapy https://aijournals.com/index.php/aan/article/view/542 <p><strong>Background: </strong>Modified Electroconvulsive therapy (MECT), is evidence based, safe and established treatment for varieties of psychiatric diseases that includes acute mania, major depressive disorder, schizophrenia, suicidal tendency and many more conditions.&nbsp; Government of India and world health organization has mandated use of sedative / anesthetic drug to make MECT acceptable method of treatment. MECT is administered under anesthesia to control acute cardiovascular, cerebrovascular and musculoskeletal changes occurring subsequent to delivery of electric current across the cerebral cortex. This also prevents respiratory and traumatic complications. <strong>Subjects and Methods: </strong>In the present clinical observational study we analyzed 113 MECT administrations for evaluating suitability of thiopentone sodium, propofol and midazolam with succinyl choline chloride; on 45 patients belonging to ASA grade II with no associated systemic diseases. <strong>Results: </strong>We observed the induction characteristics, induction and recovery time, associated changes in hemodynamic parameters during and after procedure, duration and energy required to induce muscular convulsions and changes in serum potassium level. Our observations indicates that induction&nbsp; was quicker with propofol than with thiopentone 43.67 ± 9.13v/s 61.31 ± 15.58 seconds and recovery time was also quicker with propofol than thiopentone 518.73 ± 69.67 v/s 595.25 ± 112.68 seconds . Only on one occasion in thiopentone group induction was turbulent. Acute but short lasting changes in heart rate, systolic, diastolic and mean arterial pressure was observed in both thiopentone and propofol groups. The energy requirement was less than 100 joules on 34 sittings in thiopentone group while in propofol group it was observed on 47 sittings. In thiopentone group on 17 occasion energy required were more than 100 joules and 5 sittings in propofol group.&nbsp; There was transient elevation of mean serum potassium of 0.55 mEq/lit after MECT in all patients. Midazolam did not produce satisfactory condition in dose of 5 mg and needed thiopentone supplement on 10 occasions. <strong>Conclusion: </strong>The findings allowed us to conclude that both thiopentone and propofol along with sub-paralytic dose of succinyl choline chloride produced satisfactory conditions for MECT sittings without complications. However propofol provided quick induction and recovery and lesser energy requirement.</p> Harsh Kasliwal Vipin Kumar Varshney M. M. Neema ##submission.copyrightStatement## 2019-03-21 2019-03-21 4 1 33 37 Effect of Age and Gender on Incidence of Post Spinal Headache https://aijournals.com/index.php/aan/article/view/543 <p><strong>Background: </strong>Post spinal headache is a common complication after spinal anaesthesia, lumbar puncture and myelography. The aim of study is to calculate the incidence of post dural puncture headache in non-obstetric patients coming to the GMERS Medical College and civil hospital, sola, Ahmedabad. <strong>Subjects and Methods:</strong> A prospective observational study was conducted on 150 patients of ASA grade I and II admitted in the department of general surgery, orthopedic and gynecology under spinal anaesthesia. All patients were interviewed after 12 hours, 24 hours, 36 hour, 48 hours, 60 hours and 72 hours as regard to headache, its severity, location character, duration, associated symptoms like nausea, vomiting, auditory and ocular symptoms. PDPH was treated initially conservatively with bed rest, hydration and analgesic (injection diclofenac 75 mg). If the PDPH persisted longer than 24 hour with same severity, and epidural blood patch was considered before discharged from hospital. <strong>Results &amp; Conclusion: &nbsp;</strong>The overall incidence of PDPH in Civil Hospital, Sola, and Ahmedabad was 8.06%. The incidence of PDPH in young patients was 12.12% and in old patients were 3.44%. The incidence of PDPH in female was 12.5% and in male was 4.08%. Thus female significantly have more risk of developing PDPH. The onset o PDPH after dural puncture among the patients who develop PDPH occurred within 24 hours in 33.3%, within 30 hours in 40% and within 36 hours in 26.6% of patients. PDPH was most commonly located in occipital region in 60% of patients. Severity of PDPH was mild to moderate. In 73.3% of patients the maximum severity was grade II. Nausea and vomiting was associated with severe PDPH. No patients develop any other associated symptoms.</p> Rachana Gandhi Alka Shah Ila Patel ##submission.copyrightStatement## 2019-03-20 2019-03-20 4 1 38 41 Effectiveness of Mixture of Xylocaine, Bupivacaine and Buprenorphine for Lumbar Blockade by Epidural Approach https://aijournals.com/index.php/aan/article/view/544 <p><strong>Background: </strong>Pain is one of the most compelling experience for human beings. Pain is the most difficult one to define and assess, as it is a purely subjective sensation experienced only by the sufferer. Present study was done in which Buprenorphine was given epidurally along with Bupivacaine and Xylocaine as a single shot technique to evaluate its potency, duration of analgesia and other side effects. <strong>Subjects and Methods:</strong> Fifty adult patients of ASA risk I/II undergoing lower abdominal surgery, lower limb - orthopaedic surgery, surgery involving perineal region and gynaecological procedures were selected for our study. The patients were divided into two groups consisting of 25 patients each.&nbsp; In group I, patients were given Inj. Bupivacaine 0.5% 20 cc + xylacaine in lumbar epidural space. In group II, patients were given Bupivacaine 0.5% 20 cc + xylacaine 0.5% 20 cc mixed with Inj. Buprenorphine 0.2 mg (2 ml) in same syringe in lumbar epidural space. Duration of total analgesia was measured with help of pain scorre, which were measured throughout operative period and in postoperative period. All the statistical tests will be performed in SPSS version 15 software. <strong>Results: &nbsp;</strong>In study group majority patients complain of pain at around 16 to 20 hours. Most of the patients in group-I are in 0-4 hours and in group – II are 20-24 hours. Maximum respiratory depression was around 12% (2/min). It was observed that hypotension was seen in 4 cases and bradycardia in 4 cases – intraoperatively and postoperatively no patient had bradycardia or hypotension in study group. <strong>Conclusion:</strong> Buprenorphine if given epidurally along with local anesthetic solution for various surgical procedures can provide excellent pain free period lasting up to 24 hours without any disturbances to normal physiology life and notable side effects.</p> Madhavi Mavani Ila Patel ##submission.copyrightStatement## 2019-03-20 2019-03-20 4 1 42 48 Transtracheal Lidocaine as an Adjunct to Intraoperative Propofol During Parotidectomy https://aijournals.com/index.php/aan/article/view/546 <p><strong>Background: </strong>Minimizing the damage to facial nerve is a matter of utmost priority for a surgeon during parotidectomy. The use of long acting muscle relaxants are avoided as it might hinder identification of the nerve.Transtracheal injection of a local anaesthetic is believed to result in a reduction in requirement of depth of anaesthesia intraoperatively. Objective: To compare the intraoperative propofol consumption, patient's immobility and haemodynamic stability during total parotidectomy under GA, with and without use of a transtracheal block using&nbsp; lidocaine. <strong>Subjects and Methods:</strong> An observational study was conducted in the Department of Anaesthesia, Amrita institute of Medical sciences and Research centre - Kochi, among 40 patients undergoing parotidectomy under GA, during the period March 2013 to September 2014,with 20 patients receiving an additional transtracheal block using lidocaine and the rest without any additional block. Heart rate, systolic, diastolic and mean arterial blood pressures were documented at various time intervals. Intraoperatively total propofol consumption (bolus and infusion) and number of patient movements, if any, were documented. The data thus collected was properly coded and entered in Microsoft Excel and analysis was done using the software SPSS version 16.0. <strong>Results: </strong>Intra operative propofol consumption and patient movements were significantly lower in group which received trans tracheal block.Mean heart rate, systolic blood pressure, diastolic blood pressure as well as mean arterial pressure at various time intervals were comparable between the two groups. <strong>Conclusion: </strong>Trans tracheal block can be practiced as a safe alternative to propofol infusion during surgeries where muscle relaxants are to be avoided.</p> Prasanth Mohan Aneesh Lakshmanan Moni Ann Thomas ##submission.copyrightStatement## 2019-03-23 2019-03-23 4 1 49 52 A Comparative Study of Intrathecal Neostigmine and Dexmedetomidine as Adjuvant to Bupivacaine Spinal Analgesia in Sub Umbilical Regional Surgeries https://aijournals.com/index.php/aan/article/view/589 <p><strong>Background: </strong>Spinal anesthesia is the most commonly used technique for lower abdominal surgeries as it is very economical and easy to administer. This study aims to determine the effect of intrathecal administration of Neostigmine and Dexmedetomidine as adjuvants on the onset and duration of sensory and motor block and postoperative analgesia produced by spinal Bupivacaine. &nbsp;<strong>Subjects and Methods:</strong> prospective randomized clinical study was carried out on 100 patients belonging to ASA grade I and II, posted for elective Sub umbilical surgeries&nbsp; under spinal anaesthesia, The study was designed to compare neostigmine 50mcg and Dexmedetomidine 10mcg along with 15mg 0.5% bupivacaine, in subarachnoid block. 100 patients were divided into two groups using randomized double blind method with 50 patients in each group. <strong>Results: </strong>The time of onset of peak sensory block is higher in Group D as compared to Group N. Mean Time for onset of peak sensory block in Group N was 5.48 ± 0.43 min and Group D was 7.31 ± 0.44 min. p value is &lt; 0.01( statistically significant). Time for two segment regression was significantly higher in Dexmedetomidine group as compared to Neostigmine group. The onset of motor block in group N is earlier as compared to group D. The duration of analgesia is significantly higher in group D as compared to group N. <strong>Conclusion: </strong>Our study concludes that the use of intrathecal Neostigmine 50 mcg added to 15mg hyperbaric bupivacaine significantly hastens the onset of sensory and motor block. Dexmedetomidine(10mcg) when used intrathecally along with Bupivacaine significantly prolongs the duration of motor blockade, two segment regression and duration of effective post-operative analgesia.</p> Hegde Uthkala Bhaskar Sumanth Kankanala G Nischala Reddy ##submission.copyrightStatement## 2019-04-12 2019-04-12 4 1 53 56 A Study to Evaluate the Effects of Intrathecal Nalbuphine Hydrochloride with Bupivacaine and Bupivacaine Alone on Post-Operative Analgesia in Lower Abdominal Surgeries https://aijournals.com/index.php/aan/article/view/590 <p><strong>Background: </strong>A pain-free and stress-free post-operative period helps in early mobilization and recovery, thereby reducing morbidity and mortality. Accomplishing the subarachnoid block with local anaesthetic alone has a drawback of analgesia of shorter duration in postoperative period. Addition of opioids to local anaesthetic solution used for conduct of&nbsp; has subarachnoid block been found safe, devoid of any nerve toxicity and in addition it increases the quality as well as the duration of the block. Nalbuphine is a semisynthetic opioid having agonist and antagonist effects on opioid receptors and devoid of other opioid like side effects. <strong>Aim:</strong> The purpose of our study was to establish the effectiveness of intrathecal nalbuphine as an adjuvant and also the efficacy of nalbuphine for post-operative analgesia and its side effects if any. &nbsp;<strong>Subjects and Methods:</strong> The study conducted on 60 patients of ASA grade I and II, age group between 18-60 years, scheduled for elective lower abdominal, perineal and lower limb surgeries. Patients were randomised into two equal groups of 30 each, group I (Nalbuphine group) received 3cc of hyperbaric bupivacaine 0.5% + 0.8 cc injection nalbuphine preservative free (0.8mg) intrathecally, Group II(controlled group) received 3cc of hyperbaric bupivacaine 0.5% + 0.8 cc of injection normal saline intrathecally. Statistical analysis was done using appropriate tests. <strong>Results: </strong>The mean time of post-operative analgesia in nalbuphine group (Group-I) was found to be highly significant (P&lt;0.001) than control group (Group-II), no patient developed any side effects in our study. <strong>Conclusion: </strong>Nalbuphine hydrochloride&nbsp; provides better quality of blockade as well as prolongs the post-operative analgesia when used as adjuvant with bupivacaine in spinal anesthesia.</p> Bappa Ditya Pal Shailesh Kumar Smriti Anand ##submission.copyrightStatement## 2019-04-12 2019-04-12 4 1 57 60 General Anaesthesia versus Spinal Anaesthesia for Laparoscopic Cholecystectomy: Which Is Better Choice https://aijournals.com/index.php/aan/article/view/591 <p><strong>Background: </strong>There is a growing evidence to suggest that regional anesthesia has an important role to play in the management of patients undergoing laparoscopic procedures. <strong>Subjects and Methods:</strong> We compared spinal anesthesia with general anesthesia, for laparoscopic cholecystectomy in 100 ASA grade 1 and 2 patients between the age of 18-50 years, divided equally into two groups given either GA or SA. The groups were compared by hemodynamic variables, intra operative events, post operative pain, operative conditions for surgeon and complications if any. Statistical Analysis: Data summarised as Mean ± SE.&nbsp; Groups were compared by Student’s t test , (ANOVA), Newman-Keuls post hoc test and chi-square (χ2) test. <strong>Results: </strong>Hemodynamic comparison showed better hemodynamic profile in group SA than group GA. The time of rescue analgesia was comparatively higher in SA than GA. The no. of diclofenac used lower comparatively in SA than GA. Comparing the intra operative events of two groups there was higher shoulder pain in SA as compared to GA. However, hypotension was found similar between the two groups. Post operative side effects&nbsp; showed&nbsp; higher pruritis&nbsp; and urinary retention whereas lower sore throat&nbsp; in SA as compared to GA. However PONV and headache were found similar between the two groups. There was higher surgeon and patient satisfaction in GA as compared to SA.&nbsp; &nbsp;<strong>Conclusion: </strong>We concluded that laparoscopic cholecystectomy can be conducted safely under Spinal anaesthesia with excellent recovery and high degree of satisfaction in selected patients.</p> Singh Vishwadeep Karki Geeta Mowar Ashita Singh Ankita Pahade Akhilesh Singh Lalit ##submission.copyrightStatement## 2019-04-12 2019-04-12 4 1 61 66 Effectiveness of Prophylactic Use of Intravenous Ketamine, Dexmedetomidine and Tramadol for Prevention of Shivering After Spinal Anesthesia https://aijournals.com/index.php/aan/article/view/592 <p><strong>Background: </strong>Shivering after spinal anesthesia is a common complication and can occur in as many as 40%-70% of patients after regional anesthesia. Present study was done with an aim to assess and evaluate the effectiveness of prophylactic use of intravenous (IV) ketamine, dexmedetomidine, and tramadol for prevention of shivering after spinal anesthesia. &nbsp;<strong>Subjects and Methods:</strong> Present study was conducted at tertiary care institute of Gujarat, India. The study was carried out in 160 patients and the participants were randomized into four groups of 40 patients each as&nbsp; Group A ‑ patients receiving ketamine 0.5 mg/kg intravenous (IV) diluted in 10 mL of normal saline (NS) given as IV infusion over 10 min&nbsp; Group B ‑ patients receiving tramadol 0.5 mg/kg diluted in 10 mL of NS given as IV infusion over 10 min, Group C ‑ patients receiving dexmedetomidine 0.5 mcg/kg diluted in 10 mL of NS given as IV infusion over 10 min, Group D ‑ patients receiving 10 mL of NS given as IV infusion over 10 min. <strong>Results: </strong>There was no statistically significant difference among mean age, gender, and the duration of surgery. There was statistically significant difference among the four groups, when overall shivering grades were compared. The overall sedation score, when compared among four groups was statistically significant. <strong>Conclusion: </strong>Dexmedetomidine is effective and comparably better than tramadol or ketamine in preventing shivering after spinal anesthesia. Apart from preventing shivering, dexmedetomidine offers other advantages in the form of sedation without any respiratory depression. However, with its use a watch should be kept on the fall hemodynamic parameters.</p> Poonam M Vaghela Madhuri Sureshbhai Vyas ##submission.copyrightStatement## 2019-04-12 2019-04-12 4 1 67 70 Comparison of Dexmedetomidine with Pentazocine and Promethazine in Tympanoplasty Surgeries under Monitored Anaesthesia Care: A Prospective, Randomized, Double Blind Study https://aijournals.com/index.php/aan/article/view/593 <p><strong>Background: </strong>Monitored Anaesthesia Care is a planned and suitable technique for tympanoplasty surgeries.The present study has been conducted to compare the effectiveness of dexmedetomidine with combination of&nbsp; pentazocine and promethazine&nbsp; under local anaesthesia with primary end point being the&nbsp; haemodynamic stablity, sedation score and patient and surgeon satisfaction. <strong>Subjects and Methods:</strong> A prospective randomized double blind study was conducted in 60 ASA grade I-II patients in age groups of 18-60 years undergoing tympanoplasty surgeries. Patients were divided in 2 groups of 30 patients each. Group D received dexmedetomidine loading 1µg/kg intravenously followed by 0.2µg/kg/hr infusion whereas Group PP received pentazocine and promethazine 0.5 mg/kg intavenously followed by normal saline infusion at 0.2µg/kg/hr .Patients were assessed for Ramsay sedation score,intraoperative haemodynamic parameters, surgical bleeding score,patient and surgeon satisfaction scores, VAS score, need for rescue analgesics and side effects if any. <strong>Results: &nbsp;</strong>There was no difference in demographic data in both groups. Ramsay sedation score, surgeon and patient satisfaction scores were significantly higher in Group D than Group PP (p&lt;0.001). Intraoperative bleeding scale and Haemodynamic parameters like heart rate,systolic ,diastolic and mean arterial pressure&nbsp; were significantly lower in Group D than Group PP (p&lt;0.001).Lesser number of patients requiring rescue sedatives and&nbsp; analgesics in Group D as compared to Group PP(p&lt;0.001). There was no significant difference in side effects&nbsp; in both groups. <strong>Conclusion: </strong>We concluded that Dexmedetomidine provides adequate sedation with better haemodynamic stability,good surgical field vision, surgeon and&nbsp; patient comfort without any adverse effects in tympanoplasty patients under local anaesthesia.</p> Kajal A. Bhatt Ila A. Prajapati ##submission.copyrightStatement## 2019-04-12 2019-04-12 4 1 71 75