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> Society for Health Care & Research Development en-US Academia Anesthesiologica International 2617-5479 Evaluation of Various Factors Affecting Emergency Intubation <p><strong>Background: </strong>Inadequate airway management is a major contributor to pre-hospital morbidity and mortality. The present study was conducted to evaluate various factors affecting endotracheal intubation. <strong>Subjects and Methods: </strong>This study was conducted on 474 patients requiring ETI. Informed consent was obtained from family members of all patients. Emergency intubation was performed as a ‘rapid sequence induction’ (RSI), with preoxygenation and cricoid pressure followed by an induction agent and then suxamethonium. Factors affecting ETI was recorded. <strong>Results: </strong>Out of 476 patients, males were 280 and females were 196. Indication of RTI was low GCS seen in 64, injury in 320, respiratory insufficiency in 10 and cardiac arrest in 82. The difference was significant (P&lt; 0.05). Method of ETI was RSI in 290, without relaxant in 81 and without any medication in 105. The difference was significant (P-0.05). Common difficulties in ETI were blood seen in 30%, vomit in 14%, hypersalivation in 28%, anatomical difficulties in 7%, patient position in 10% and technical problems in 11%. The difference was significant (P&lt;0.05). <strong>Conclusion: </strong>The presence of blood, vomit, hypersalivation, anatomical difficulties, patient position and technical problems are among various factors affecting ETI.</p> Meenakshi K. Moorthy ##submission.copyrightStatement## 2019-05-31 2019-05-31 4 2 1 3 A Comparative study of Agomelatine and Ramelteon for Attenuation of Haemodynamic response to Laryngoscopy and Endotracheal Intubation <p><strong>Background: </strong>Pressor response to laryngoscopy and endotracheal intubation is a well&nbsp; recognised clinical entity, and many medications have been used for its attenuation. Agomelatine and Ramelteon are analogues of Melatonin which have been recently used for preoperative anxiolysis and sedation with less known effects on pressor response. <strong>Subjects and Methods: </strong>60 ASA-I patients scheduled for elective surgeries under general anaesthesia were randomly allocated into 2 equal groups. Group-A (Tab.agomelatine 10 mg) and Group-R (Tab.ramelteon 8mg) were administered per oral 1 hour prior to induction of anaesthesia. Heart rate and blood pressure were assessed preoperatively and at 0,1,3,5,10,15 minutes. <strong>Results: </strong>Reduction heart rate and blood pressure were noted when compared to baseline in both the groups(p&lt;0.05). However there was no statistical difference between the two groups at various intervals of time and were comparable (p&gt;0.05). <strong>Conclusion: </strong>Oral agomelatine and ramelteon when administered 1 hour prior to induction of anaesthesia, resulted in comparable reduction of heart rate and blood pressure response to laryngoscopy and endotracheal intubation.</p> Pradeep Hosagoudar Arunashree S M. Venkateswara Pradeep ##submission.copyrightStatement## 2019-05-31 2019-05-31 4 2 4 7 Comparative Study of Attenuation of effects of Intubation on Blood Pressure Using IV Xylocard and IV Beta Blocker (Esmolol) <p><strong>Background: </strong>The occurrence of cardio vascular reactions to laryngoscopy and tracheal intubation has attracted the attention of anaesthesiologists and methods to avoid these potentially harmful responses even though transitory have been sought, particularly in critically ill patients, hypertensive patients. Tracheal intubation under light general anaesthesia is consistently accompanied by a pressor response, tachycardia and in some instances by cardiac arrhythmias. This pressor response, which was recognised early as 1951 is due to sympathetic reflex provoked by stimulation of the epipharynx and laryngopharynx. <strong>Subjects and Methods: </strong>Seventy five (75) patients belonging to ASA grade 1 &amp; 2 scheduled for general surgical, orthopaedic surgical, ENT, gynocological surgical producers were studied. <strong>Results: </strong>The age of the patients varied from 10 to 60 years. The MAP in group A decreased after induction. There was a highly significant raise to 109+/-11 mm Hg during laryngoscopy and intubation. This decreased to 105+/-9mm Hg after five minutes which is not significant. <strong>Conclusion: </strong>These responses are transitory, variable and are much more marked in a hypertensive patient than in the normotensive patient. Once the laryngoscopy and endotracheal intubation is completed, the increase in pulse and blood pressure subside, but the dysrhythmia persists for more than 2-3 minutes.</p> Mirza Afzal Baig ##submission.copyrightStatement## 2019-06-02 2019-06-02 4 2 8 12 Effects of Intubation on heart rate: Xylocard and Esmolol <p><strong>Background: </strong>Lignocaine is a local anaesthetic of moderate potency and duration with good penetrative power and rapid onset of action carbonated lignocaine has remarkable penetrative power, rapid onset of action a high incidence of motor block and a reduced incidence of missed segments (When used for epidural anaesthesia) when compared to hydrochloride of lignocaine. <strong>Subjects and Methods: </strong>Seventy five (75) patients belonging to ASA grade 1 &amp; 2 scheduled for general surgical, orthopaedic surgical, ENT, gynaecological surgical producers were studied. <strong>Results: </strong>The age of the patients varied from 10 to 60 years. In our study, the heart rate in controls (Group A) before induction was 86+/-10 rose to 93+/-12 and 107+/-13 after induction and after laryngoscopy + ETI respectively. The changes seen after endotracheal intubation alone was statistically very highly significant (&lt;0.001).&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; In Group B, the pre induction heart rate was 94+/-17, which increased to 99+/-13, after induction.This increase not significant (P&gt;0.05). There was an increases of 15 at laryngoscopy + ETI which was very highly significant (P&lt;0.001). <strong>Conclusion: </strong>In Group C, the pre induction heart rate of 96+/-15 increased to 97+/-11 at induction and to 108+/-15 following endotracheal intubation.</p> Mirza Afzal Baig ##submission.copyrightStatement## 2019-06-02 2019-06-02 4 2 13 16 Small Dose-Clonidine Prolongs Postoperative Analgesia after Sciatic-Femoral Nerve Block With 0.75% Rovpivacaine for Foot Surgery <p><strong>Background: </strong>Foot surgery is associated with severe pain that can extend significantly up to 48 hours and often requires large amounts of parenteral opioids. . The benefit of adding clonidine to LAs for peripheral nerve blocks is less clear, although it is widely believed that clonidine improves quality and duration of a LA block. The aim of this study was to evaluate the effects of adding 1 mg/kg clonidine to 0.75% ropivacaine during combined sciatic-femoral nerve block for hallux valgus repair. <strong>Subjects and Methods: </strong>Thirty six ASA physical status I and II patients, scheduled for elective hallux&nbsp; valgus repair under combined sciatic-femoral nerve block, were enrolled in the study. By using a sealed envelope technique, patients were randomly allocated to receive sciatic-femoral nerve block with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n 5 15) or 0.75% ropivacaine plus 1 mg/kg clonidine (group Ropivacaine- Clonidine, n 5 15). Standard monitoring was used throughout the study, including noninvasive arterial blood pressure, heart rate, and pulse oximetry. The time from the end of anesthetic injection to resolution of motor block at the ankle of the operated foot and first request for postoperative analgesic was recorded. At discharge from the orthopedic ward and 3 wk after hospital discharge, patients were also evaluated regarding the occurrence of neurological complications. <strong>Results: </strong>No differences in the time required to achieve surgical anesthesia were observed between patients receiving only 0.75% ropivacaine (10 [5–20] min) and those receiving the ropivacaine-clonidine mixture (10 [5–30] min).&nbsp; The mean time from block placement to first request for pain medication was shorter in group Ropivacaine than in group Ropivacaine- Clonidine (P = 0.03,. No differences in postoperative consumption of ketoprofen were observed between patients. <strong>Conclusion: </strong>Adding 1mg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects.</p> Anil Ratnawat Vijay Kumar ##submission.copyrightStatement## 2019-06-23 2019-06-23 4 2 17 20 Comparison of Classic Laryngeal Mask Airway and I Gel Regarding Ease of Insertion and Efficacy of Ventilation in Lateral Position <p><strong>Background: </strong>The laryngeal mask airway (LMA) is a supraglottic airway device designed to maintain a clear airway, which sits outside of and creates a seal around the larynx. Aim of our study is to compare the ease of insertion and adverse effects using the insertion of classic LMA ad I gel in lateral position and to note if there are any adverse effects between both. <strong>Subjects and Methods: </strong>Hundred patients of either gender aged between 15 and 70 years who belonged to ASA physical status I and II, who were posted for elective surgical procedures under general anaesthesia under supraglottic airway devices were recruited for study. They were randomly divided into four groups of 25 patients each by closed envelop method. First group is Group IRL: Patients in whom I gel was used in right lateral position Second group is Group ILL : Patients in whom I gel was used in left lateral position Third group is Group CRL : Patients in whom classic laryngeal mask airway was used in right lateral position Fourth group is Group CLL : Patients in whom classic laryngeal mask airway was used in left lateral position. <strong>Results: </strong>Group IRL had success rate of 88.5% in 1st attempt 11.5% in this group had 2nd attempt of LMA insertion. Group ILL had 1st attempt success rate of 76% with.&nbsp; 24% patients needed 2nd attempt for LMA placement Group, CRL had success rate of 86% at 1st attempt 14% patients had LMA insertion in 2nd attempt. Group CLL had 1st attempt success rate of 67% only. 33% of patients in this group needed 2nd attempt for successful LMA insertion. <strong>Conclusion: </strong>Supraglottic airway devices can be successfully used for securing airway in lateral position. Both classic LMA and I gel can be used to secure the airway. I gel is a supraglottic airway device with its own advantages which can be successfully used in patients who need lateral position for their surgery.</p> Viral Prakashkumar Patel Rekha Bayer Hippal Patel Kuntal Patel ##submission.copyrightStatement## 2019-06-23 2019-06-23 4 2 21 24 Prediction of Intraoperative Hypotension in Full Term Parturients Planned for Elective Caesarean Section with the Help of Supine Stress Test and to Find out Applicability of Supine Stress Test <p><strong>Background: </strong>The patients those have tendency to develop supine hypotension syndrome during advance pregnancy also lands in intraoperative hypotension after spinal anaesthesia and this can be predicted in advance with preoperative use of Supine Stress Test. <strong>Subjects and Methods: </strong>120 full term parturients with singleton pregnancy planned for elective caesarean section under spinal anaesthesia subjected to Supine Stress Test in preoperative period. <strong>Results: </strong>Parturients those were positive for Supine Stress Test in preoperative period, significantly land in hypotension during caesarean section. Intraoperative hypotension managed with Inj Ephedrine and fluid. <strong>Conclusion: </strong>Supine Stress Test is an important tool in predicting intraoperative hypotension in parturients under going elective caesarean section.</p> Vivek Tyagi Asad Mohammad Navab Singh ##submission.copyrightStatement## 2019-06-24 2019-06-24 4 2 25 29 A Comparison Study of Spinal Anesthesia with General Anesthesia in Cesarean Section <p><strong>Background: </strong>The present study was conducted to compare spinal anesthesia with general anesthesia in cesarean section. <strong>Subjects and Methods: </strong>The present study was conducted in the department of Anesthesiology. It comprised of 78 pregnant women with American Society of Anaesthesiologists (ASA) physical status grade I or II who were scheduled to undergo elective CS under SA. Patients were divided into 2 groups. In both groups, side-effects after surgery such as nausea, vomiting, headache, pain and other clinical symptoms were noted. <strong>Results: </strong>The mean WBC count in group I was 12.74 109/L and 10.62 109/L in group II which was significant (P&lt; 0.05). Other parameters such as mean RBCs, mean hemoglobin and mean platelet count was non- significant (P&gt; 0.05). In group I most common complication was fever (6) and hypotension (6) while in group II, fever (8) and hypotension (7). However, the difference was non- significant (P&gt; 0.05). <strong>Conclusion: </strong>Both spinal anesthesia and general anesthesia showed variations in hematological parameters as well as complications.</p> Rajeev Kumar Das Manu Seth ##submission.copyrightStatement## 2019-06-27 2019-06-27 4 2 30 32 Hemodynamic Stability of the Patients Receiving Intravenous Dexmedetomidine versus Intravenous Propofol Based Sedation in Cervical Disc Surgeries <p><strong>Background: </strong>The sedative effect of dexmedetomidine is exercised subcortically and mimics natural sleep. The area of the brain with the highest concentration of alpha2-ARs is the locus coeruleus (LC) in the upper brainstem, which is responsible for arousal, sleep, anxiety, and withdrawal symptoms from drug addiction. It projects into two areas in the thalamus: the ventrolateral preoptic nucleus and the tuberomamillary nucleus. When the alpha2-AR is activated, it inhibits adenylyl cyclase. This results in the reduction of cAMP, with net efflux of K+ (through Ca2+-activated K+ channels) and inhibition of Ca2+ entry into nerve terminals. This hyperpolarises the neuron and suppresses the release of noradrenaline (NA) from the LC. <strong>Subjects and Methods: </strong>In this prospective study hundred ASA Grades I and II patients between the ages of 20 and 60 years undergoing elective cervical disc surgeries were enrolled after Ethical committee and Scientific committee approval meeting the below selection criteria. <strong>Results: </strong>The intergroup variation in the SBP during the intubation and till 5 mins after intubation showed a significant lower values in patients with the dexmedetomidine as compared with the propofol (P &lt; 0.001). <strong>Conclusion: </strong>Patients on dexmedetomidine had significantly better hemodynamic response to Fiberoptic bronchoscopy and intubation compared to propofol group. Heart rate, systolic, diastolic and mean arterial pressures were significantly lower in dexmedetomidine group as compared to propofol group during intubation and at various intervals post intubation.</p> Padma S Bhaskar Babu BD ##submission.copyrightStatement## 2019-06-27 2019-06-27 4 2 33 38 Clinical Profile of the Patients Undergoing Awake Fiberoptic Intubation Along with Airway Blocks in Cervical Discectomy Patients <p><strong>Background: </strong>The optical characteristics of fine glass strands are what make fiberoptic technology possible. When glass rods are heated and stretched to diameters of 8 to 25µ, a flexible fiber capable of transmitting light is formed. Light that enters the distal end of the fiber is reflected off the walls until it emerges at the proximal end. To keep a fraction of the light from being lost during transmission, the fiber is clad in a layer of glass that has a different optical density. This process results in total internal reflection of light entering the fiber. The light transmitted along a single fiber emerges uniformly distributed over the cross-sectional area at the end. The resolution of a fiberoptic image is inversely proportional to the diameter of the glass fiber. <strong>Subjects and Methods: </strong>After overnight fasting, all patients under the study were premedicated with tab ranitidine 150mg orally and tab diazepam 10mg with sips of water 90 mins before shifting to operating theatre. Premedication with glycopyrrolate 0.2mg IM, administered 30-45 minutes prior to application of the local anesthetic. <strong>Results: </strong>At baseline, SO2 in both the groups were comparable. There were no significant differences between the groups with respect to changes in SO2 after bolus infusion, during intubation and after intubation clinically. <strong>Conclusion: </strong>Patients with study (D) group had a consciousness score of 2 (eyes open on command) in 41 patients out of 50 (82%), where as in control (P) group 17 patients (34%) had score of 2 (eyes open on command). 20 patients (40%) had score of 1 (response to ear pinching),in control (P) group compared to 3 patients in study(D) group.</p> Bhaskar Babu BD Padma S ##submission.copyrightStatement## 2019-06-27 2019-06-27 4 2 39 43 A Comparative Study of Plain and Hyperbaric Solution of Ropivacaine for Spinal Anaesthesia in Minor Gynaecological and Urological Surgeries <p><strong>Background: </strong>To compare the clinical effects of 3ml of intrathecal hyperbaric ropivacaine 0.5% (2ml of 0.75% plain ropivacaine and 1ml of 25%dextrose)&nbsp; with 3ml of 0.5% plain ropivacaine (2ml of 0.75% plain ropivacaine and 1ml of 0.9% normal saline) for spinal anaesthesia in minor gynaecological and urological surgeries. <strong>Subjects and Methods: </strong>60 patients belonging to ASA physical status I &amp; II scheduled for minor gynaecological and urological surgeries under spinal anaesthesia were randomly selected for the study and are divided into two groups of 30 each. Group H patients received 3 ml of intrathecal hyperbaric&nbsp;&nbsp; ropivacaine 0.5% (2 ml of 0.75% plain ropivacaine and 1 ml of 25% dextrose). Group P patients received 3 ml of plain ropivacaine 0.5% (2 ml of 0.75% plain ropivacaine and 1 ml of 0.9% saline). <strong>Results: </strong>There was significant difference between the two groups in mean time to onset of sensory block at T10, 257.5 ± 23.03 sec with group H and 478.0 ± 16.48 sec with group P, (P&lt;0.0001). Total duration of sensory block was 201.7 ± 8.64 min in group H and 261.17 ± 8.27 min in group P, which is significant (P&lt;0.0001).Mean time of onset of motor block was 355.50 ± 16.83 sec in group H and 568.33 ± 2.76 sec in group P, which is significant (P&lt;0.0001). Duration of motor block was 127.33 ± 6.53 min in group H and 168.83 ±&nbsp; 8.27&nbsp; min in group P which is clinically and statistically significant (P&lt;0.0001). Hemodynamic parameters were comparable in both groups. <strong>Conclusion: </strong>Addition of glucose to plain ropivacaine&nbsp;&nbsp; increases the speed of onset of both sensory and motor block, and also increases the speed of recovery from sensory and motor block in minor gynaecological and urological surgeries. Plain solutions are less reliable for surgery above a dermatomal level of T10.</p> Irfan Waris Imran Khan KD ##submission.copyrightStatement## 2019-07-05 2019-07-05 4 2 44 47 A Study on Haemodynamic Changes in Plain and Hyperbaric Solution of Ropivacaine for Spinal Anaesthesia <p><strong>Background: </strong>Historically bupivacaine was used as it had a long duration of action, but subsequently it was found that “propyl derivatives” of pipecoloxylidides were less toxic than ‘butyl derivatives’ (bupivacaine). Thus ropivacaine was developed after bupivacaine was noted to be associated with significant number of cardiac arrests. <strong>Subjects and Methods: </strong>A comparative study of plain and hyperbaric solution of ropivacaine for spinal anaesthesia in minor gynaecological and urological procedures was undertaken in 60 patients. Patients were randomized in to two groups with 30 patients in Group H (2ml of 0.75% plain ropivacaine and 1ml of 25% dextrose) and 30 patients in Group P (2ml of 0.75% ropivacaine and 1ml of 0.9% normal saline). The onset and duration of sensory and motor blockade, sensory level achieved, and haemodynamic parameters were assessed. <strong>Results:</strong> The mean age of patients in group H was 45.83 ± 5.43 years compared to 45.76 ± 6.97 years in group P. In group H there were 11 males (37%) and 19 females (63%). In group P there were 10 males (33%) and 20 females (67%). The mean height of the patients in group H was 157.20 ± 5.06 cms and in group P was 159.70 ± 7.78 cms. The mean weight of the patients in group H was 56.63 ± 6.46 kgs and in group was 59.07 ± 7.53. There was no statistically significant difference between the two groups with regard to age, sex, height and weight (p&gt;0.05). Both the groups were comparable with respect to age, sex, height and weight distribution. <strong>Conclusion:</strong> There was no significant change in systolic blood pressure following subarachnoid block in both groups. The systolic blood pressure values were comparable in both groups without any clinical or statistical significance.</p> Irfan Waris Imran Khan KD ##submission.copyrightStatement## 2019-07-05 2019-07-05 4 2 48 51 Assessment of Efficacy of Dexmedetomidine and Propofol for Sedation during Gastrointestinal Endoscopy: A Comparative Study <p><strong>Background: </strong>Gastrointestinal Endoscopy is performed as diagnostic and therapeutic procedure. Hence; we compared the clinical profile of propofol and dexmedetomidine in patients undergoing gastrointestinal endoscopy. <strong>Subjects and Methods: </strong>A total of 20 subjects scheduled to undergo gastric endoscopy were included in the present study and were broadly divided into two study groups as follows: Group A: included subjects who were given propofol, Group B: included subjects who were given dexmedetomidine. All the baseline parameters were recorded. Gastric endoscopy was performed in all the patients according to their respective groups.&nbsp; Patient satisfaction score was recorded in all the patients. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. <strong>Results: </strong>Mean heart rate among the subjects of group B at baseline, intraoperative and postoperative time were found to be 72.1, 66.8 and 69.4 respectively. Non- significant results were obtained while comparing the mean heart rate in between the two study groups at different time intervals. Mean PSS (Patient Satisfaction Score) of subjects of propofol group and dexmedetomidine group was found to be 42 and 45 respectively. However; the difference was found to be statistically non-significant. <strong>Conclusion: </strong>Both the anaesthetic solutions can be used with equal effectiveness among patients undergoing gastric endoscopy.</p> Swati Trivedi Aditya Kumar Tripathi Rajeev Kumar ##submission.copyrightStatement## 2019-07-11 2019-07-11 4 2 52 54 The Study was Conducted Using Isobaric 0.75% Ropivacaine 3.5ml (26.25mg) Intrathecally for Lower Limb Surgeries to Evaluate Onset and Duration of Sensory Block & Onset and Duration of Motor Block <p><strong>Background: </strong>This study was conducted at Civil Hospital, BJ Medical College, Ahmedabad, after approval from the ethical committee. Fifty patients admitted in our hospital undergoing lower extremity surgeries under spinal anaesthesia were included in the study. <strong>Subjects and Methods: </strong>Patients in the age group 18 – 60 years were selected including 45 males and 5 females. 39 patients had a ASA grade I and 11 patients had ASA grade II. Various lower limb and orthopaedic surgeries like arthroscopic ligaments repair, tibial and flap surgeries were included. <strong>Result:</strong> The duration of surgeries ranged from 45 to 270 minutes. 2%&nbsp; (1 patient) attained a maximum level of T4, 22% (11 patients) had a maximum level of T6 , 26% (13 patients ) had a maximum level of T8. Maximum number of patients, 44% (20 patients) had a level of T10. 6% (3 patients) had attained a maximum level of T12. Three patients did not achieve complete motor level.By the end of 15 minutes, 86% ( 43) patients had achieved a <strong>complete</strong> motor block.By the end of 20 minutes 94% (47) patients had attained a complete motor block. The mean time for complete motor block was 10.59 minutes (S.D.±4.7).<strong>Conclusion: </strong>A study was conducted in 50 patients belonging to ASA grade I and II posted for lower limb surgeries. They received 3.5ml of 0.75% isobaric Ropivacaine in L2-3 interspace. All patients were preloaded with 1000 ml of ringer lactate. Following institution of subarachoid block sensory characteristics such as onset of sensory block, maximum level achieved, duration of sensory block and request for first dose of rescue analgesics were studied. Motor blockade characteristics such as onset of motor block, duration and quality of motor blockade were studied. Onset of sensory block till T10 level was found to be 8.5minutes with a complete regression in 229.28minutes.</p> Monika Saini Nagesh Mudgal Smita Engineer ##submission.copyrightStatement## 2019-05-31 2019-05-31 4 2 55 57 To Compare Isobaric 0.5% Levobupivacaine with Isobaric 0.5% Ropivacaine in Brachial Plexus Block For Elective Upper Limb Surgery. <p><strong>Background: </strong>The study entitled "To compare the effects of 0.5% Levobupivacaine with 0.5% Ropivacaine for brachial plexus block in elective upper limb surgeries" was conducted at Bombay Hospital, Indore (M.P.). <strong>Subjects and Methods: </strong>The study entitled "To compare the effects of 0.5% Levobupivacainewith 0.5% Ropivacaine for brachial plexus block in elective upper limb surgeries" was conducted at Bombay Hospital, Indore (M.P.) Sixty patients aged between 18yrs and 60yr physical status ASA grade 1 and ASA grade 2 undergoing elective upper limb surgeries were included in the study. <strong>Results: </strong>Mean onset time of sensory block was rapid ingroup L (11.203±1.58) minutes as compared to group R (13.62±1.544) minutes which is statistically significant with p value &lt; 0.05.Mean duration of sensory block wassignificantly prolonged in group L (12.07±1.09) hours as compared to group R(10.840±1.713) hours which is statistically significant with p value &lt; 0.05.Mean duration of motor block was significantly prolonged in group L (11.137±1.513) hours as compared to group R(10.063±1.209) hours which is statistically significant with p value &lt;0.05. Mean onset time of motor block was rapid in group L (17.3701.618) minutes as compared to group R (18.9771.375) minutes which is statistically significant with p value &lt; 0.05. Mean duration of Analgesia motor block was significantly prolonged in group L (15.073.902) hours as compared to group R(12.6631.608) hours which is statistically significant with p value &lt;0.05. <strong>Conclusion: </strong>To conclude the study, we observed Levobupivacaine 0.5% having better profile in comparison to ropivacaine 0.5%in having Faster onset of sensory and motor blockade, Prolonged duration of sensory and motor blockade, Prolonged duration of analgesia, Levobupivacaine should be considered for peripheral nerve block when postoperative analgesia is a concern but not when an early return of motor function is desired in postoperative period for upper limb elective surgeries.</p> Nagesh Mudgal Monika Saini ##submission.copyrightStatement## 2019-05-31 2019-05-31 4 2 58 60 Association of Platelet Counts with Outcome of ICU Stay <p><strong>Background: </strong>Low platelet count is common in intensive care unit (ICU). Thrombocytopenia has also been associated with poor outcome in ICU.1-4 There is sketchy data regarding thrombocytopenia and its effect on outcome from ICUs in India.5 We aimed to study association of platelet counts with outcome of ICU stay. <strong>Subjects and Methods: </strong>This was a retrospective study. This study was carried out in patients admitted with a diagnosis of sepsis in the medical ICU, Sepsis was defined using the criteria laid down in the surviving sepsis guidelines 2012.6 Data regarding demography (age and sex), probable source of sepsis, platelet count at admission (Plat-adm), lowest platelet count during the ICU stay (Plat-nadir), platelet fall- defined as Plat-adm – Plat-nadir, APACHE-II score and SOFA score at admission were recorded. Outcome parameters were mortality, length of ICU stay and length of hospital stay. <strong>Results: </strong>During the study period, a total of 87 patients were admitted in the medical ICU. In 29 patients, criteria of sepsis or outcome of ICU stay were not met, and were excluded from the study. Out of the 48 patients included in the study, 35 patients died and 13 patients survived to transfer out from ICU. Age and sex were similar between them. Data was analyzed for associations. In univariate analysis, there was no association between the platelet counts and disease severity scores, except for Plat-nadir exhibiting a weak negative association with SOFA score at admission (Pearson’s R: - 0.303, p= 0.036). Mortality was associated with platelet fall, APACHE-II and SOFA scores at admission (Table 2). A unit increase in APACHE-II-adm and SOFA-adm, and an increment of 10,000 in Plat-fall, increased the odds ratio (OR) of mortality by 14%, 33% and 21% respectively. Multivariate analysis was carried using logistic regression methodology and none of the aforesaid were associated with mortality. It is notable that platelet fall narrowly missed independent association, p= 0.07. <strong>Conclusion: </strong>This study demonstrates that patients with larger fall in platelet counts may be at increased risk of dying. Larger, prospective studies are needed to further clarify the association of platelet count with outcome of ICU stay.</p> Maninder Patni Uday Pratap Ruchi Sarawgi Ruchi Gupta ##submission.copyrightStatement## 2019-05-31 2019-05-31 4 2 61 63 Evaluation of Recovery Profiles of Different Anesthetic Techniques for Ambulatory Anorectal Surgery: A Comparative Study <p><strong>Background: </strong>Ambulatory surgery encompasses those surgical interventions that are more complex than office-based procedures performed under local anaesthesia but fewer complexes than major procedures requiring at least an overnight stay. Hence; we planned the present study to assess the recovery profiles of different anesthetic techniques for ambulatory anorectal surgery. <strong>Subjects and Methods: </strong>A total of 90 subjects were included in the present study who were about to undergo anorectal surgery. Random division of all the patients was done into three study groups: Group 1- Patients undergoing ambulatory anorectal surgery under spinal anesthesia, Group 2- Patients undergoing ambulatory anorectal surgery under local anesthesia, and Group 3- Patients undergoing ambulatory anorectal surgery under general anesthesia.&nbsp; All the subjects were prepared for surgical procedure. According to their respective groups, all the surgeries were performed. A master chart was prepared, where recovery profile of all the subjects was recorded and compared. All the results were analyzed by SPSS software. <strong>Results: </strong>Mean duration of anesthesia among subjects of group 1, group 2 and group 3 was 74.5 minutes, 43.8 minutes and 79.1 minutes respectively. Mean duration of surgery among the subjects of group 1, group 2 and group 3 was 27.5 minutes, 26 minutes and 26.5 minutes respectively. Mean duration of hospital stay among subjects of group 1, group 2 and group 3 was 260.4 minutes, 131.8 minutes and 255.3 minutes respectively. In the present study, recovery profile of local anesthesia was significantly faster in comparison to the recovery profile of general and spinal anesthesia. <strong>Conclusion: </strong>Local anesthesia is the most effective technique in terms of recovery profile in patients undergoing ambulatory anorectal surgeries.</p> Atanu Mukherjee Gagandeep Singh ##submission.copyrightStatement## 2019-07-19 2019-07-19 4 2 64 66 Comparative Study of Safety and Efficacy between Propofol-Fentanyl Versus Propofol-Dexmeditomidine Combination For Sedation in Upper Gastro-Intestinal (GI) Endoscopic Procedures- A Prospective Randomised Study <p><strong>Background: </strong>Endoscopy in patients with gastrointestinal disorders (GI) is of immense benefit for diagnostic and therapeutic measures.&nbsp; Inspite of use of flexible fibreoptic equipments, endoscopy remains an unpleasant experience for most patients. The purpose of sedation in these patients is to relieve anxiety, discomfort or pain, and diminish memory of the event.<sup>[1] </sup>There has been a general consensus that moderate sedation provides adequate control of pain and anxiety during endoscopic procedures. Conscious sedation enables patients to maintain their response to verbal and tactile stimuli without losing cardiovascular and ventilatory function.<sup>[2]</sup> The aim of study is&nbsp; to compare the safety and efficacy between propofol-fentanyl and propofol-dexmeditomidine&nbsp; combination for sedation&nbsp; in upper gastro-intestinal (GI) endoscopic procedures. <strong>Subjects and Methods: </strong>A prospective study of 70 cases of both sexes belonging to ASA Grade I,II and III. Planed for elective upper GI endoscopies under sedation were included in this study were randomly selected. The study group was divided in two groups of 35 each, Group A Propofol-Fentanyl (PF) and Group (B) Propofol-Dexmeditomedine (PD). In the PF group, patient was administered fentanyl 2mcg/kg initially followed by Propofol loading dose of 1.5mg/kg over five minutes. Then propofol infusion was started at 50mcg/kg/min to achieve bis value 50-60. Then endoscopy was done. If the subject did not tolerate the endoscope or patient experienced pain during the entire procedure then additional propofol bolus of 0.3 mg/kg was given. Similarly in PD group, the subject was given 1mcg/kg dexmeditomidine instead of Fentanyl, rest the same. Meanwhile HR, BIS value, SPO2, MAP were noted. <strong>Results: </strong>It was found that there was significant difference in SpO2 Heart rate,,Mean, BIS Meanwhile 54.3% of patients required airway manoeuvre to maintain Saturation in PF group while only 2.9% patients of PD group required airway support. This difference in airway manoeuvre was statistically significant. <strong>Conclusion: </strong>we concluded that propofol dexmeditomidine group had better respiratory parameters, better hemodynamic stability, lesser need of total propofol. Propofol dexmeditomidine had better satisfaction levels among patients as compared to propofol fentanyl group butrecovery time of Propofol-fentanyl group was faster than propofol dexmeditomidine group.Except for time taken for recovery, PD group was both safer and more efficacious. Overall Propofol Dexmeditomidine group achieved better conditions for sedation in upper GI endoscopy than Propofol-Fentanyl.</p> Ajay Basarigidad Sandeep Killedar ##submission.copyrightStatement## 2019-07-24 2019-07-24 4 2 Determination of Spinal Anesthesia Induced Hypotension in Cesarean Section <p><strong>Background: </strong>Spinal anesthesia is the global standard method of anesthesia for cesarean section. The present study was conducted to determine spinal anesthesia induced hypotension in cesarean section in study group. <strong>Subjects and Methods: </strong>The present study was conducted in the department of Anesthesia. It comprised of 68 pregnant women in age range 18-30 years. In all patients, ASA grade, gravidity, history of previous cesarean section and hypotension was recorded. <strong>Results: </strong>Age group 18-22 years had 32 patients, 23-27 years had 22 and 27-30 years had 14 patients. The difference was significant (P&lt; 0.05). ASA grade I was seen in 48 patients and II in 20 patients. Gravidity 1 was seen in 24, 2 in 16, 3 in 15 and 4 in 13. 46 had 1 previous cesarean section and 22 had 2. The difference was significant (P&lt; 0.05). Mild hypotension was present in 2, moderate in 3 and severe in 6. The difference was significant (P&lt; 0.05).<strong>Conclusion: </strong>Authors found that hypotension is frequently seen in cesarean section.&nbsp; In this study, 11 patients exhibited spinal anesthesia induced hypotension.</p> Sanjay Kumar Gupta Saurabh Singhal ##submission.copyrightStatement## 2019-07-29 2019-07-29 4 2 71 73 Dandy Walker Syndrome – Always A Challenge <p>Dandy-Walker syndrome is classically described as a neuropathological triad consisting of hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and hydrocephalus. Clinical manifestations of the syndrome usually appear in the first year of life, but can occur during the neonatal period. Obstructive hydrocephalus with dilatation of the third and lateral ventricles occurs frequently.’ The syndrome was first described in 1914 by Dandy and Blackfan who postulated the pathogenetic theory of atresia of the fourth ventricle’s foramina of Luschka and Magendie; but today most authors consider the cerebellar hypoplasia to be a malformation independent of this atresia. DWS is also associated with abnormalities in the skeletal, cardiac, and genitourinary systems. In this report, we aimed to present a case of a patient with DWS who was scheduled for VP shunt surgery and was managed successfully without any perioperative complications.</p> Aman Preet Dr Kulsaurabh Dr Anshul Mohit Jain Satyavir Verma ##submission.copyrightStatement## 2019-08-01 2019-08-01 4 2 74 75 Ultrasound a Savior for Lost Central Line <p>Central line insertion is often needed for perioperative care as well for patients admitted in intensive care units. It has well established advantages for drug and nutrition delivery. Ultrasound guidance has improved first prick success rate as well as reduced the peri-procedural complications. We encountered an unusual situation of dissection right IJV cental line catheter with buried end under the skin. Careful planning was done and interventional endovascular removal of lost catheter was planned. Ultrasound scanning of neck was done to evaluate and assess the position and direction of the catheter and its findings changed the initial plan. During this crises ultrasound came as a savior to help removal of catheter avoiding major interventional procedure.</p> Tarun Yadav Mayuri Golhar Dr Kulsaurabh Prashant Kumar Dr Anshul Samsher Singh Lochab ##submission.copyrightStatement## 2019-08-01 2019-08-01 4 2 76 77 A Study to Compare and Evaluate the Efficacy of Granisetron and Granisetron Dexamethasone Combination as Anti-Emetic <p><strong>Background: </strong>Dexamethasone,&nbsp; a&nbsp; glucocorticoid&nbsp; is shown to produce stronger antiemetic effect, probable&nbsp; mechanism is prostaglandin&nbsp; antagonism, serotonin inhibition, releasing endorphins and&nbsp; 5HT3 antagonism&nbsp; with biological&nbsp; half life&nbsp; 36 to 72 hrs, confers&nbsp; longer&nbsp; duration&nbsp; of&nbsp; prophylaxis.Since etiology of PONV is multifactorial , combination of different classes of antiemetic can increases clinical efficacy compared to single drug alone. <strong>Subjects and Methods: </strong>A detail preoperative assessment was performed on preoperative visit on the day before surgery. Where detail history, thorough general examination, airway assessment and systemic examination was performed. All routine investigations were done like haemogram, routine urine examination, random blood sugar, blood urea, serum creatinine and serum liver function test.X-ray chest and ECG were done when indicated. &nbsp;<strong>Results:</strong> In Group-GD, only 13.33% had PONV which was statistically significantly low as compared to Group-G which was 36.66% (P&lt;0.05). Complete response in Group-GD was 86.67% which was statistically significantly high as compared to Group-G which was only 63.34% (P&lt;0.05). <strong>Conclusion: </strong>Requirement of Rescue anti-emetic was less in Granisetron-Dexamethasone combination group than Granisetron group.</p> Asha Rani BN Swati Bhatt ##submission.copyrightStatement## 2019-08-11 2019-08-11 4 2 78 83 Haemodynamic Stability and Side Effects of Granisetron and Granisetron Dexamethasone Combination <p><strong>Background: </strong>Granisetron is a selective 5-hydroxy tryptamine -3(5HT3) receptor antagonist with little or no affinity for other serotonin receptors. Chemically, it is endo-N-(9-Methyl-9-Azabicyclo [3.3.1]non-3-yl)-1-methyl-1H-indazole-3-carboxamide hydrochloride. Serotonin receptors of the 5HT3 type are located peripherally on vagal nerve terminals and centrally in the CTZ of the area postrema. <strong>Subjects and Methods: </strong>The protocol was explained to patients and informed consent was taken. All the patients received tab. Diazepam (10mg) and tab. Ranitidine (150mg) on the previous night before surgery. Patients were kept nil by mouth for 8 hours before surgery. On the day of surgery, nil by mouth status of patient was confirmed and written and informed consent obtained. Intravenous line was secured with crystalloid infusion was started. <strong>Results:</strong> In Group-GD, 2 patients had Headache, 1 patient had dizziness and 2 patients had dry mouth, while in Group-G, 3 patients had Headache, 1 patient had dizziness and 2 patients had dry mouth which did not require any treatment. No other side effect was observed during study. No difference in incidence of side effects in between two groups. <strong>Conclusion: </strong>Patients were haemodynamically stable throughout the study in both the groups.</p> Asha Rani BN Swati Bhatt ##submission.copyrightStatement## 2019-08-11 2019-08-11 4 2 84 90