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, 12 Feb 2021 11:22:31 +0000 OJS 60 Comparison of Dexamethasone and Dexmedetomidine as an Adjuvant to 0.375% Ropivacaine in Erector Spinae Plane Block for Lumbar Spine Surgery: A Randomized, Double-Blind, Placebo-Control Trial. <p><strong>Background: </strong>Erector spinae plane block (ESPB) is an interfascial plane block that successfully deposits a local anesthetic deep into the erector spinae muscle that lies adjacent to transverse processes. The present study was conducted to assess the effect of dexmedetomidine and dexamethasone as an adjuvant for the erector spinae plane block (ESPB) to control postoperative pain after lumbar spine surgery. <strong>Subjects &amp; Methods: </strong>60 patients selected for undergoing lumbar spine surgery were divided into 3 groups of 20 each. Group, I patients received 0.375% ropivacaine 20 mL group II patients received 0.375% ropivacaine 20 mL with 8 mg dexamethasone and group III patients received 0.375% ropivacaine 20 mL with 1 <em>µ</em>g/kg dexmedetomidine deep to the erector spinae muscle. Postoperative tramadol consumption, amount of rescue analgesia use, post-surgical hospital stay and postoperative nausea and vomiting (PONV) were recorded. <strong>Results: </strong>The demographic data and intraoperative opioid requirements were comparable in all groups. Postoperative tramadol consumption and rescue analgesic requirement were significantly less in group III as compared to group II and I. Postoperative stay in hospital was 6.1 days in 6.2 days in group II and 4.6 days&nbsp;&nbsp;&nbsp;&nbsp; in group III and the difference was significant. <strong>Conclusion: </strong>Dexmedetomidine is found to be better than dexamethasone as an adjuvant to ropivacaine in erector spinae plane block in lumbar spine surgery.</p> Rakhi Gupta, Nishat Nasar Copyright (c) 2021 Author Fri, 12 Feb 2021 00:00:00 +0000 A Comparative Study of Epidural Anaesthesia Versus Spinal Anaesthesia for Inguinal Hernioplasty <p><strong>Introduction: </strong>Epidural administration is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. Spinal anaesthesia is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. Hernia repair surgery, a single long incision is made in the groin. If the hernia is going down the inguinal canal (indirect), the hernia sac is either pushed back or tied off and removed. <strong>Subjects and Methods: </strong>The study has been conducted in 100 patients posted for elective inguinal hernia repair in the Dept. of Anaesthesia, at tertiary care teaching hospital over a period of six months. Pre anaesthetic evaluation was done along with all requisite blood and urine examination, Hb.BT, CT, ECG, 2D ECHO in pts above 50 yrs. All patients were assessed and they were graded according to the ASA physical status I and II. They were educated regarding the anaesthetic technique. <strong>Result:</strong> Total time taken for performing the procedure was significantly longer with Epidural Anaesthesia than that of Spinal Anaesthesia (8.24 0.32 Vs 4.23 0.52 minutes, p&lt;0.001) but onset of action was comparable in both the groups (7.18 1.18 in Spinal Vs 11.428 0.37 min in Epidural p&lt;0.001 Significant). Intraoperative fluid requirement was statistically higher in Spinal than Epidural (1654 193.2 ml vs 1158.22 78.27.16 ml) (p&lt;0.0001). Duration of Surgery was significantly shorter in Spinal as compared to Epidural (91.24 8.41 vs 126.04 11.32 mins.) (p=0.019). 2 % patients had failure of Epidural block whereas no Spinal Anaesthesia failed in patients.</p> Vivek Vaibhav Copyright (c) 2021 Author Fri, 12 Feb 2021 00:00:00 +0000 Comparison of Intrathecal Clonidine and Fentanyl in Hyperbaric Bupivacaine for Spinal Anesthesia and Postoperative Analgesia in Patients Undergoing Lower Abdominal Surgeries <p><strong>Introduction: </strong>Fentanyl and clonidine both prolong sensory and motor block of spinal anaesthesia and duration of postoperative analgesia when used as an adjuvant to intrathecal bupivacaine. Lack of studies that directly compare them regarding their efficacy prompted us to compare both drugs as an adjuvant to intrathecal bupivacaine for spinal anaesthesia and postoperative analgesia in patients undergoing caesarian section<strong>. Subjects and Methods: </strong>It was a prospective randomized study in which eighty patients posted for lower limb orthopedic surgery were divided into two groups of forty each. Group C – Received intrathecal hyperbaric bupivacaine (2.5 ml) +50 <em>µ</em>g clonidine (diluted to 0.5 ml). Group F– Received intrathecal hyperbaric bupivacaine (2.5 ml) + fentanyl 25 <em>µ</em>g (diluted to 0.5 ml). Duration of postoperative analgesia, sensory and motor block characteristics, hemodynamic parameters, and side effects were recorded and analyzed. <strong>Results: </strong>Both the groups were comparable in demographic data, onset and duration of sensory and motor blockade, hemodynamic parameters, but the duration of analgesia is significantly longer in clonidine group when compared with fentanyl group. Sedation score is more in clonidine group. <strong>Conclusion: </strong>Addition of clonidine to intrathecal bupivacaine offers longer duration of postoperative analgesia than fentanyl but with higher sedation.</p> Vivek Vaibhav Copyright (c) 2021 Author Fri, 12 Feb 2021 00:00:00 +0000 Truview Videolaryngoscopy and Mcgrath Videolaryngoscopy with Direct Laryngoscopy in Paediatric Airway Management - A Randomised Comparative Study <p><strong>Background: </strong>Videolaryngoscopes were developed mainly to manage difficult airway intubation. They also gained a great deal of attention recently as a new airway system for use in paediatric airway management. <strong>Subjects and Methods:</strong>183 children of bodyweight 10 – 30 kgs under ASA Physical Status Class I &amp; II with normal airway undergoing general anaesthesia requiring endotracheal intubation were included&nbsp;&nbsp; in the study. Based on the laryngoscope used, they were divided into three groups (Truview Group- TV, McGrath Group – MC, Macintosh Group - DL) of 61 children each. Time to intubation, number of attempts, intubation conditions were recorded. <strong>Results: </strong>The mean POGO score was significantly higher in Group TV (99.18 4.48) than Group MC (95.5 9) and Group DL (71 23.79). Group MC had improved glottic opening score than Group DL. Time Taken for intubation (in seconds) was significantly longer in the Group TV (40.15 9.93) than Group MC (27.2&nbsp; 4.996) and Group DL (17.23&nbsp; 2.88). Time to intubation was significantly longer in Group MC then Group DL. <strong>Conclusion:&nbsp; </strong>Though&nbsp;&nbsp; the Videolaryngoscopes offer excellent glottic visualization when compared to the conventional laryngoscope, the time taken for intubation is significantly prolonged with the videolaryngoscopes in the Paediatric population.</p> B. Gayathri, G. Venkatesan, S. Sowmiya Copyright (c) 2021 Author Mon, 15 Feb 2021 00:00:00 +0000 Pattern of Microorganisms of Urinary Tract Infection (UTI) and its Outcomes in Diabetic Patients of Tertiary Intensive Care Unit (ICU) <p><strong>Background: </strong>To assess pattern of microorganism of urinary tract infection (UTI) &amp; its outcomes in diabetic patients admitted in intensive care unit (ICU). <strong>Subjects &amp; Methods: </strong>One hundred twenty type II diabetes patients admitted in intensive care unit (ICU) of Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand comprising of 78 males and 42 females were studied for UTI. <strong>Results: </strong>70 patients had UTI. It was seen in 50 (71.4%) catheterized and 20 (28.6%) non- catheterized, 22 (31.4%) controlled diabetics and 48 (68.6%) uncontrolled diabetics and 38 (54.2%) on insulin and 32 (45.8%) on OHA. Most common gram- negative organism seen in UTI was E coli seen in 42%, gram positive organism was Staphylococcus sciuri in 7% and yeast was Candida albicans in 1% and Candida glabrata in 1.3%. Septic shock occurred in 18 (25%), re- infection in 7 (10%) and death in 4 (5.7%) patients <strong>Conclusion: </strong>Most commonly occurring gram negative pathogens among diabetic ICU patients was E coli and gram- positive pathogen was Staphylococcus sciuri. UTI was commonly seen among catheterized, uncontrolled diabetics.</p> Nand Kishore, Sushant Khanduri, Barnali Kakati Copyright (c) 2021 Author Tue, 30 Mar 2021 00:00:00 +0000 Spinal Anaesthesia for Laparoscopic Appendectomy - Single Center Pilot Study <p><strong>Background: </strong>Appendectomy is commonly performed by laparoscopic method now-a-days because of its promising benefits over open method. The most commonly used and preferred mode of anaesthesia for laparoscopic abdominal surgeries is general anaesthesia with intubation and positive pressure ventilation. Studies regarding use of regional anaesthesia for laparoscopic abdominal surgeries are very limited. Therefore, this study was designed to conduct laparoscopic appendectomy with spinal anaesthesia as the first choice with contention that it can be better alternative to general anaesthesia. <strong>Subjects and Method: </strong>This was a single center pilot study conducted with permission and approval of institutional ethical committee.100 patients with ASA grade I and II belonging to age group 18 to 60 years diagnosed with acute appendicitis undergoing laparoscopic appendectomy were enrolled. Standard spinal anaesthesia procedure was carried out using 0.5% hyperbaric injection bupivacaine intrathecally. Injection ketamine 0.25 mg/kg injected intravenously just before pneumoperitoneum in view of management of shoul- der pain. Conversion of procedure to general anaesthesia and open surgical method, relief of shoulder pain, hemodynamic changes, postoperative complications, postoperative pain and postdural puncture headache were recorded and analysed. <strong>Result</strong>: The appendectomy procedure was completed laparascopically in 94 patients while only 6 patients required conversion to open method due to surgical factors. None of the patients had any cardiopulmonary complication except bradyarrythmia in 4 and transient hypotension in 10 patients which were managed successfully. No one needed conversion to general anaesthesia.5 patients complained about mild right shoulder pain. None of the patients complained about postdural puncture headache, postoperative nausea and vomiting. Only 3 patients required rescue analgesia postoperatively within 2 hours. <strong>Conclusion: </strong>Spinal anaesthesia using 0.5% hyperbaric bupivacaine and injection ketamine 0.25 mg /kg intravenously provided effective anaesthesia for laparoscopic appendectomy. It can be considered as a better alternative for general anaesthesia with minimal complications.</p> Bhagyashree Shivraj Almaji, Prakash R. Dhumal, Pradnya Milind Bhalerao Copyright (c) 2021 Author Tue, 30 Mar 2021 00:00:00 +0000 Anaesthetic Management of a Parturient with Incidental Diagnosis of Ebstein Anamoly in COVID 19 Era-A Rare Case Report <p>Ebstein anamoly is a rare congenital disorder comprising less than 1% of patients with congenital heart diseases. Although it is rare, but this congenital cardiac anamoly is one of the most diverse in presentation, severity and management. Average life expectancy in the patients born with this anamoly is around 25-30 years. However, pregnancy in these patients is well tolerated but they are at increased risk of developing severe complications especially in the current scenario of covid 19. Here we present a case of 26-year-old, unbooked, primigravida patient with severe preeclampsia at period of gestation 32 weeeks for emergency cesarean section with unknown covid status. Patient was diagnosed with ebstein anamoly after presentation to hospital.</p> Neha Yadav, Khushbu Rani, BK Sandhya, Simar Anand Copyright (c) 2021 Author Sun, 16 May 2021 00:00:00 +0000 Preoperative Anxiety in Patients Undergoing Laproscopic Cholecystectomy in a Rural Area in Haryana Region - An Observational Study <p><strong>Background: </strong>Preoperative anxiety is common in patients undergoing surgical procedures, as it causes emotional and psychiatric problems as well as physical problems for patients, surgeons and anesthesiologist. Therefore, detecting the patient’s existing preoperative anxiety is vital&nbsp;&nbsp; so that appropriate measures can be taken accordingly. Our primary aim in this study is to observe the level of anxiety, on the day and the&nbsp;&nbsp;&nbsp;&nbsp; day prior to surgery, in the patients undergoing laparoscopic cholecystectomy. <strong>Subjects and Methods: </strong>An institutional based observational study was conducted on 30 patients scheduled for laparoscopic cholecystectomy under general anaesthesia. The data was collected using the Amsterdam Preoperative Anxiety and Information Scale on the day and a day before the surgery and the scoring was done according the&nbsp; Likert scale. Statistical analysis was done by using SPSS 21. Data were expressed using descriptive statistics for continuous variables and frequency. Chi-square test was used among categorical variables. <strong>Results: </strong>Demographic variables like age, gender, ASA grade and history of anesthesia/operation are correlated with the prevalence of preoperative anxiety on the day and the day before of the surgical procedure and were not found significant. Higher anxiety level was observed in patients who have not experienced any previous anesthesia or operation. Statistical significant difference was found in heart rate and mean blood pressure one day before and on the day of surgery. <strong>Conclusion : </strong>According to the results, the study illustrates that patients lacked significant preoperative anxiety levels.</p> Sachin Chandola, Neha Yadav, Swati Kanchan, Ankit Rohal, Kuldeep Singh, Nishu Kadyan Copyright (c) 2021 Author Sun, 16 May 2021 00:00:00 +0000 Comparision of Propofol versus Combination of the Sevoflurane -Propofol for Inclusion of Laryngeal Mask Airway (LMA) Insertion of Adults <p><strong>Background: </strong>In the case of suspected injury, the most significant duty for an anaesthetist is to protect the airway with minimal cervical spine movement. The most significant cause of morbidity and mortality in these patients is an rise in the number of intubation attempts or the number of unsuccessful intubations. The aim of the studie is to compare the characteristics of insertion of LMA, and to calculate the extent of the respiratory problem and the cardiovascular problem between groups. <strong>Subjects and Methods: </strong>A proposed randomized research was organized on 60 patients grade of ASA I<em><sup>st</sup></em> &amp; II<em><sup>nd</sup></em> aged in between 18 - 60 years were randomized into two groups go through minor surgical measures under the normal anesthesia. Inj. Fentanyl 1ug/kg was given to both the Groups of sick person. Propofol 2 mg/kg was given in a Group of P. Group SP patients were induced with 8% sevoflurane in the 2:1 ratios of the nitrous oxide to O2 using vital capacity breathing technique with the Propofol 1 mg/kg. The characteristics of LA insertion, hemodynamics and extent of respiratory complications were assesses while inserting LMA. <strong>Results: </strong>There do no difference with groups along respects to the weight, sex, age, Patients in the Group SP get a lengthy time to losing of the eyelash responsive as of in comparison to the Patients in a Group of P. the time for the successful inclusion of the LMA was continued in Group of SP as in comparison with Group of P. All inclusions of LMA do victorious in the two groups. the period of the apnea has continued in the group of P as in comparison with the Group SP , &amp; extent apnea has other frequent in a Group of P as in comparison with the Group SP.&nbsp; the total extent of problem associated to introduction of the anesthesia, were comparable with two groups. During inclusion of LMA, another patients carry movements in a Group of P. the extent of the vomiting (PONV) &amp; postoperative nausea, Hence this was another frequent in a Group of SP as in comparison with the Group of the P. <strong>Conclusion : </strong>Sevoflurane is therefore an appropriate alternate to the propofol in adults for the LMA inclusion.</p> Kari Bala Krishna, Pradeep Kumar Das, Hemnath Babu Kotla, Sri Harsha Merugu Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 A Comparison of Onset of Anesthesia Between Spinal Bupivacaine 5 mg with Immediate Epidural 2% Lignocaine 5ml and Bupivacaine 10 mg for Caesarean Delivery <p><strong>Introduction: </strong>In separate surgeries, spinal anesthesia is usually performed using lidocaine percent 5 and bupivacaine percent 0.5. This procedure is followed by many difficulties, including extending the level of anesthetics to places greater than the local injection site. <strong>Materials and methods: </strong>This research was performed with 60 patients posted for elective caesarean delivery belonging to ASA Grade I &amp; II. Patients were allocated randomly into 2 groups of 30 each. (Spinal bupivacaine 5 mg with instant epidural 2 percent lignocaine) mixed spinal epidural (CSE) group and Spinal (S) group (Spinal bupivacaine 10 mg). <strong>Results: </strong>Compared to patients who underwent mixed spinal-epidural anesthesia, patients in group S showed a quicker onset of anesthesia (meantime) (group CSE). There is no clinically relevant onset of anesthesia (p-value = 0.08). In group S, the time for the first hypotension is considerably early. For a value of &lt; 0.001, the p-value is statistically important. In Category&nbsp;&nbsp;&nbsp; S, the lowest calculated SBP was substantially found. The p-value with a value of &lt;0.001 is statistically important. In Group S, the number of patients with hypotension was slightly (p-value = 0.03) higher (19 patients) than in Group CSE (11 patients). Group CSE reported a statistically important early 2 segment regression period with a p &lt; 0.001 value. The early recovery in the CSE community is statistically important, with a value of p&lt;0.001. <strong>Conclusions: </strong>The low-dose CSE procedure, especially for high-risk patients at risk of precipitous hypotension, is a choice for supplying anesthesia for caesarean delivery.</p> H.L. Baby Rani, T. Haritha Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Blood Glucose Concentration Profile After Prophylactic Administration of Intravenous Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia <p>Dexamethasone has been shown to reduce nausea and vomiting after surgery (PONV), but it can also raise blood glucose levels. The effect of two doses of 2 mg and 4 mg dexamethasone on blood glucose levels, PONV, and analgesia in the first 24 hours after laparoscopic cholecystectomy was investigated in this study. At the time of anesthesia induction, 90 patients were enrolled and randomized to receive either saline (control group) or 2 mg or 4 mg dexamethasone in three groups. At baseline and 1, 2, 4, 6, and 24 hours after induction, blood glucose concentrations were measured. PONV and pain scores score were assessed following extubation at 0, 4, 8, 12, and 24 hours. Blood glucose levels rose dramatically in both the control and dexamethasone classes over time (from a median baseline of 87, 87, and 89.5 mg/dL to a final median of 148.5, 168, and 151 mg/dL. (P &lt; 0.001). For every time, there was no significant change in blood glucose concentration between the groups receiving dexamethasone (2 or 4 mg) and those receiving saline. Groups of Dexamethasone showed lower pain score and PONV levels. Dexamethasone administration (2 and 4 mg) did not change blood glucose levels, but it decreased PONV and pain scores that were significantly low at all times. Dexamethasone prophylactic administration can easily be used for nausea and vomiting without hyperglycemia-related issues.</p> Sai Lakshman Pasupuleti, Abinash Patro, Nirmala Jonnavithula, Srikanth Yelliboina, Hemalatha Bora, Sharmila Chaganti Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Comparison of 0.5% Bupivacaine vs 0.5% Bupivacaine with Dexamethasone in USG Guided Axillary Brachial Plexus Block - A Prospective, Randomised, Double Blinded Study <p><strong>Background: </strong>Long-acting local anaesthetic bupivacaine is widely used in brachial plexus blocks. Ultrasound guidance reduces procedure time, speeds up the onset of operation, and increases block success rates without causing neural injuries, both of which improve effectiveness. The addition of dexamethasone to regional anaesthesia with local anaesthetics has given corticosteroids a new dimension in medical practice. The aim isto compare0.5% bupivacaine and 0.5% bupivacaine with dexamethasone in ultrasound-guided axillary brachial plexus block. <strong>Subjects and Methods: </strong>In this study, 60 patients were divided into 2 groups, Group B (n=27) control group received 18ml of 0.5% Bupivacaine with 2ml of isotonic sodium chloride solution and Group BD received 18ml of 0.5% Bupivacaine with 2ml (8mg) of dexamethasone. <strong>Results: </strong>In&nbsp;&nbsp; 60 patients, the onset time of sensory block was earlier in GROUP BD (11.45 2.18) than in GROUP B (13.85 3.76) (P=0.003). Duration of motor block was longer in GROUP BD (581.52 47.97) than in GROUP B (427.04 21.81) (P &lt;0.0001). GROUP BD (808.48 35.98) has a significantly longer duration of analgesia than in GROUP B (627.41 36.54) (P&lt;0.001). Total dose of rescue analgesia was lower in GROUP BD (112.12 33.14) when compared to GROUP B (192.59&nbsp; 47.44) (P&lt;0.0001). <strong>Conclusion : </strong>To conclude, 0.5% Bupivacaine with 2ml (8mg)&nbsp; of dexamethasone combination effectively provides postoperative analgesia and delays the time for rescue analgesia.</p> G. Venkatesan, T. Padma Rubini Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Comparative Study of Efficacy of 0.5% Ropivacaine and 0.25% Levobupivacaine When Used in Tranversus Abdominus Plane Block for Post-Operative Analgesia in Lower Abdominal Surgeries <p><strong>Background: </strong>Transversus Abdominis Plane Block (TAPB) is a form of regional anesthetic. After lower abdominal surgery, analgesia is provided, particularly if parietal wall pain is a major source of discomfort. The skin of the lower abdominal wall and the muscles above the Transversus Abdominis muscle can be visually blocked with local anesthetic deposition. The aim is to analysis was to see how effective 0.25 percent Levobupivacaine and 0.5 percent Ropivacaine is as an analgesic in the Transversus Abdominis Plane Block for Post-Surgical Analgesia following lower abdominal surgery. Subjects and Methods: The research included 60 patients between the ages of 18 and 60 who performed elective lower abdominal surgery and had an ASA score of I or II. Using an 18 gauge Tuohy needle and the double pop technique, the TAP block was developed. For a VAS greater than 4, rescue analgesia was administered postoperatively. Injection Tramadol was the pain reliever of choice. Rescue analgesia criteria were also reviewed. Results: In the demographic data, both categories were equal. In both classes, the diagnosis and the operations are undertaken were identical. In both classes, the decrease in the VAS score was equivalent. (P&gt; 0.05). In both classes, the need for rescue analgesia in the postoperative phase was similar. Conclusion: Levobupivacaine and Ropivacaine have similar analgesia after lower abdominal surgery in the Transversus Abdominis Plane Block for Post-Surgical Analgesia.</p> H. Baby Rani, Snigdha Reddy Patlolla Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Anesthetic Management and Outcome of Non-cardiac Surgery in Ischemic Heart Disease Patients <p><strong>Background: </strong>Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in the world and of perioperative complications in cardiac patients<strong>. </strong>Present study was done with objectives to study common coronary artery disease and their patho physiology, to identify patients at risk through history, physical examination and electrocardiogram, to evaluate the severity of underlying cardiac disease through cardiac testing taking care to minimize expenditure and to perform specialized test only on high risk patients, testing low risk patients increases cost may causes harm by delaying a non-cardiac operation. <strong>Subjects and Methods</strong>: In the present study total 60 patients (37 males &amp; 23 females) having Ischemic heart disease were enrolled in three different groups. The study was carried out at P.D.U. Hospital, Rajkot from October 2006 to October 2008. Patients were divided into 3 different study groups according to type of anesthesia given. Group A included 20 patients received spinal and epidural anesthesia. Group B included 20 patients given peripheral nerve blockade. Remaining 20 patients were included into group C who were given general anesthesia. Various parameters of Cardiac risk index were calculated. <strong>Results</strong>: The shortest procedure in group A and group B was 30 minutes while group C had 40 minutes. The longest surgical procedure in group and group B was 145 minutes while, of the group C was 180 minutes. Prolong and major surgical procedures are more associated with the cardiac complications and mortality. Both the patients expired during surgery had developed cardiac complications. Majority of the patients were belonged to grade III &amp; IV of ASA risk classification. <strong>Conclusion: </strong>High standard of post-operative care including pain relief and continuous ECG monitoring is required to reduce the increased morbity and mortality in susceptible patients. Choice of anesthetic technique depends up on type of surgery, duration of surgery and surgical risk factors of patients.</p> Kajal A Bhatt, Vandana S Parmar, Pringalkumar Gohil, Niyati D Maru Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Perioperative Safety and Efficacy of Pre-Surgical Multimodal Analgesia versus Intravenous Opioids in Children Undergoing Infraumbilical Urogenital Surgery <p><strong>Background: </strong>MMA (multimodal analgesia) alleviates pain through blockade of multiple nociceptive and inflammatory pain receptors along the pain pathway. Thus it maximizes pain control and minimizes drug induced adverse effects especially of opioids. We studied safety and efficacy of MMA comprising anti-inflammatory, local anaesthetics and alpha 2 agonist (in caudal block) against conventional opioid analgesia in children undergoing infra-umbilical urogenital surgery. <strong>Subjects and Methods: </strong>A randomized, prospective, single blind study was conducted in 40 patients aged between 1-8 years. After pre-medication, patients were given general anaesthesia with controlled ventilation via LMA. In Multimodal analgesia group, pre-surgical caudal block was given with Inj.Bupivacaine 0.25 %( 1ml/kg) +Inj.Clonidine (1mcg/kg).Paracetamol 30mg/kg inserted per rectally. In Opioid group, pre-surgical intravenous Fentanyl (2 mcg/kg) was given. Intra-operative fentanyl requirement, hemodynamic parameters ,sevoflurane dial concentration, side effects like nausea , vomiting, respiratory depression, emergence agitation, excessive sedation and post-operative fentanyl requirement(0.5mcg/kg, on demand/FLACC score&gt;4 at 1,4,6 hrs) were noted. Patients were observed for 6 hrs in postoperative period. <strong>Result: </strong>We found significant increase in postoperative analgesic requirement in opioid group (18/20; p&lt;0.001), while intra-operative opioid requirement was stastically insignificant between both the groups (p=0.17).Though linear decreasing trend in intraoperative inhalational agent requirement was observed in MMA group. Both the groups were comparable in terms of adverse effects. <strong>Conclusion: </strong>Presurgical MMA with caudal block and rectal paracetamol is safe and efficacious in children undergoing infraumbilical surgery.</p> S Jani Noopur, P Butala Bina Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Comparison of Analgesic Effect of Intrathecal Fentanyl & Dexmedetomidine with Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgery <p><strong>Background: </strong>To evaluate effectiveness of dexmedetomidine and fentanyl supplementary to intrathecal bupivacaine in orthopedic events in lower limbs at stipulations of block potency and instance. <strong>Subjects and Methods: </strong>in the present study, 120 subjects enduring possible lower limb surgeries were arbitrarily owed to bupivacaine and normal saline (BN), bupivacaine and dexmedetomidine (BD) and bupivacaine and fentanyl. Hemodynamic changes, the maximum sensory level, regression from block, analgesic request, Time to attain the whole motor block, and period of the drug consequence, and side effects were evaluated among the groups. <strong>Results: </strong>There was noteworthy dissimilarity among BD with BF and BN groups in terms of all parameters like two segmental regression, regression to Bromage etc. <strong>Conclusion: </strong>Dexmedetomidine as a subsidiary to bupivacaine for intrathecal analgesia in lower limb surgeries has larger period of sensory and motor block, larger postoperative analgesia with little consequences.</p> Usha P. Patel, Pravinkumar Chunilal Patel Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 A Comparative Study of Intrathecal Ropivacaine-Fentanyl versus Levobupivacaine-Fentanyl in Adult Patients Undergoing Planned Inguinal Hernioplasty <p><strong>Introduction: </strong>Levobupivacaine and Ropivacaine are S-enantiomer of Bupivacaine and have less cardiac toxicity than Bupivacaine. Very few studies have compared these two cardio-stable drugs with Fentanyl as an adjuvant in spinal blockade. The objective is to evaluate the char- acteristics of spinal anaesthesia with equipotent doses of intrathecal Levobupivacaine-Fentanyl versus Ropivacaine-Fentanyl. <strong>Subjects and Method: </strong>80 adult patients, ASA I and II undergoing hernioplasty under subarachnoid block were arbitrarily owed to Group LF (n=40) to get intrathecally 3.0 ml of 0.5% Isobaric Levobupivacaine + 25<em>µ</em>g Fentanyl and Group RF(n=40) to receive 3 ml of 0.5 % Isobaric Ropivacaine+ 25 <em>µ</em>g Fentanyl. The onset, peak effect and duration of sensory and motor block, effective analgesia were noted. <strong>Result: </strong>No significant dissimilarity among demographic parameters and the haemodynamic parameters. Onset of sensory block was earlier in group RF (1.49 0.45min) than Group LF (2.17 0.45min),p&lt;0.01. Period of effective analgesia was considerably larger in group LF (270.92 15.94min) than group RF (193.52 16.94min), <strong>Conclusion</strong>: Intrathecal use of Isobaric Ropivacaine-Fentanyl produced early onset of sensory block but period of effective analgesia was longer in Levobupivacaine-Fentanyl group.</p> Khushbu Patel, Komal Modi Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Evaluation of the Efficacy and Safety of Dexmedetomidine versus Propofol for Sedation in Children Undergoing MRI <p><strong>Background: </strong>The present research was performed to assess the efficacy and safety of dexmedetomidine versus propofol for sedation in children endures MRI. <strong>Subjects and Method: </strong>This prospective randomized research was performed in the Department of Anaesthesia at Medical College, Surendranagar. Baseline HR, systolic blood pressure (SBP), respiratory rate (RR), and oxygen saturation (SpO2) Onset of sedation were documentated on entrance to the research room. Children were divided in dexmedetomidine (Group D) or propofol (Group P). Group D (n= 30) received injection dexmedetomidine1<em>µ</em>g/kg for 10 min trailed by constant Dexmedetomidine 0.5-0.7<em>µ</em>g/kg/h. Group P (n = 30) received injection propofol 1 mg/kg bolus trailed by constant infusion of 100 <em>µ</em>g/kg/min. Site and duration of MRI, onset of sedation (RSS = 5), duration of sedation, incremental infusion requirement, and recovery time were recorded. <strong>Results: </strong>Mean age, weight, and sex ratio among the two groups were comparable. The mean time to attain the requisite level of sedation was comparable in both the groups The utilization of Dexmedetomidine for postoperative analgesia consequences in considerably fewer added pain medication and sluggish heart rates than a control group. <strong>Conclusion: </strong>Dexmedetomidine is analogous with propofol as maintenance anesthetic agent and it can create improved organize of hemodynamic erratics. Propofol has a benefit of given that quick onset of sedation and faster revival instance.</p> Khushboo Bhavsar, Naynaben Vaghani, Annirudh Gadhavi, Rajesh Naval Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Efficiency of Analgesic Effects of Nsaids and Opioids in Ureteric Colic Patients <p><strong>Background</strong>: Evidences indicate that renal colic is the very painful conditions that will require very urgent pain relief. Patients who are suffering from renal colic usually do not recover from pain using pain killers. Hence, considerable percentage of patients will be admitted to the emergency department usually be used as pain relievers in the emergency department are non-steroidal antiinflammatory drugs and/or intravenous opioids for effective pain relief. <strong>Subjects and Methods</strong>: A retro respective study, comparing intravenous single-dose paracetamol and combination&nbsp;&nbsp;&nbsp; of paracetamol, Hyoscine, diclofenac suppository and fentanyl for ureteric colic patients presenting in the emergency medicine department. <strong>Results: </strong>Ureteric colic seen in predominantly with 18-40 age group with Male Predominance. Majority of patients presented with pain abdomen with NRS of 0-6. Paracetamol and Hyoscine Used in 44% of cases, Diclofenac in Combination in 34% and along with fentanyl in 22%. Duration of Stay less than 24 hours in combination of paracetamol , Hyoscine and Diclofenac suppository combination when fentanyl used patients length of stay 24hours in 12%. Patients with NRS 0-6 majority of patients required paracetamol, Hyoscine and diclofenac suppository and Patient with NRS &gt;7 (20%) Patients required fentanyl<strong>. Conclusion: </strong>In our study concluded that patient with mild to moderate pain paracetamol and diclofenac suppository shown good results and with severe pain additional analgesics fentanyl is used.</p> MR Keshava Murthy, Aruna C Ramesh, K N Vikas Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Comparative Analysis of Different Techniques of Airway Management in View of Hemodynamic Stability and Postoperative Complication in Patients Undergoing Atlantoaxial Joint Dislocation Surgery <p><strong>Background: </strong>An ideal technique of intubation of the trachea in patients of atlantoaxial joint dislocation surgery remains unclear. This study was undertaken with the primary objective to compare the three different techniques of airway management, in view of hemodynamic stability in patients undergoing atlantoaxial joint dislocation surgery. The secondary objective was to assess the association of postoperative airway complications and the technique of intubation. <strong>Subjects and Methods: </strong>Adult patiënts aged &gt;18years, American Society of Anaesthesiologists grade I-III, undergoing elective atlantoaxial joint dislocation surgery requiring tracheal intubation were included in the study. Patients with anticipated difficult airway, previous history of cervical spine injury or surgery were excluded from the study. Patients were divided into 3groups, Group1: conventional laryngoscopy, Group 2: video laryngoscopy, Group 3: fiberoptic intubation. Hemodynamic and postoperative neurological status was assessed. <strong>Results: </strong>90 patients were studied. The mean age of patients of Group 1, Group 2 and Group 3 was 45.23 &nbsp;10.29,46.8 6.8 and 44.73 9.97 years respectively. At baseline MAP, HR and SpO2 were comparable in all three groups with insignificant intergroup difference (P&gt;0.05). After securing the airway, significant increase in MAP(P= 0.016), HR (p=0.001) was seen on comparing the three groups. No significant association was seen between postoperative airway complications and the intubation technique. Among the 90 patients included, 24(26.67%) patients developed postoperative neurological deficit (quadriparesis, n=18 and upper limb paresis, n=6). 15(16.67%) patients required postoperative mechanical ventilation. 8(53.33%) out of 15 were tracheostomized. No correlation was observed between time duration of securing the airway and postoperative neurological deficit (P=0.7224).&nbsp; <strong>Conclusion:&nbsp; </strong>No corrélation was observed between the technique&nbsp;&nbsp; or duration of intubation and neurological deterioration in patients undergoing AAD surgery. Conventional laryngoscopy is associated with maximum hemodynamic perturbations and number of reattempts.</p> Samiksha Parashar, Prateek Bais, Abhinav Agarwal, Deepak Malviya, Manoj Giri, Sujeet Rai Copyright (c) 2021 Author Sat, 05 Jun 2021 00:00:00 +0000 Intravenous Dexamethasone versus Tramadol for Prevention of Shivering after General Anaesthesia: A Randomised Double Blind Placebo Controlled Trial <p><strong>Background: </strong>Postoperative shivering is very common and followed by many complications. In most operating and recovery rooms, shivering is controlled by the use of humidifiers, warming blankets and humidified oxygen. However pharmacological control is an alternative modality. The goal of this study was to compare the effect of dexamethasone, tramadol and saline for prevention of shivering and nausea/vomiting after general anaesthesia. <strong>Subjects and Methods: </strong>This double blind randomised controlled study was carried out on 300 patients being operated under general anaesthesia. The patients were block randomised into three groups (n=100 each). Group D received 0.1<em><sup>−</sup></em><sup>1</sup>dexamethasone, Group T received 1<em><sup>−</sup></em><sup>1</sup>tramadol and Group C received normal saline I.V as 10 ml solution just after endotracheal intubation. Temperature monitoring was done. In the recovery room, all patients were continuously observed for occurrence of shivering, nausea and vomiting. Quan- titative parameters were compared by unpaired t-test and qualitative parameters by Chi-square / Fisher’s exact test. Hemodynamic parameters were compared using repeated measure ANOVA. <strong>Results: </strong>The incidence of shivering was 23% in group D, 9% in group T and 51% in group C (p&lt;0.001). In group D, 22% patients developed PONV as compared to 62% in group T and 59% in group C (p&lt;0.001). <strong>Conclusion: </strong>Both dexamethasone and tramadol are effective anti-shivering agents with tramadol being more effective. However, since tramadol has a slightly higher clinical incidence of nausea/vomiting, dexamethasone should be the preferred anti-shivering agent in surgeries or patient subgroup who are at a higher risk of developing PONV.</p> Jainendra Chauhan, R. S. Rautela, Rashmi Salhotra, Nilima Das Copyright (c) 2021 Author Thu, 17 Jun 2021 00:00:00 +0000 Prospective Randomized Double Blind Study to Evaluate the Analgesic Efficacy of Low Dose of Intrathecal Neostigmine in Combination with Fentanyl and Bupivacaine for Lower Abdominal and Lower Limb Surgery <p><strong>Background: </strong>More than 80% of patients undergoing surgical procedures under spinal anesthesia experience acute post-operative pain. The present study was conducted with aim to compare the analgesic efficacy and side effects of addition of neostigmine to fentanyl and bupivacaine. <strong>Subjects and Methodology</strong>: The study was conducted at Christian Medical College and Hospital, Ludhiana in the Department of Anaesthesia and Critical Care, from 15<em><sup>th</sup> </em>Oct 2015 to 14<em><sup>th</sup> </em>Oct 2016. 50 patients aged between 18 - 60 years belonging to the ASA grade I &amp; II undergoing elective surgery for lower abdominal and limb region (likely to finish within 3 hours), were divided into 2 groups(25 each) . Group A was given Intrathecal Bupivacaine 12.5 mg (2.5 ml) + Fentanyl 20 <em>µ</em>g (0.4 ml)+0.1 ml Normal Saline (Total 3 ml) and Group B was given Intrathecal Bupivacaine 12.5 mg (2.5 ml) + Fentanyl 20 <em>µ</em>g (0.4 ml) + Neostigmine 1<em>µ</em>g (0.1 ml) (Total 3 ml). Various parameters such as sensory and motor block onset, point of maximum sensory level attainment, VAS pain score, rescue analgesia and adverse effects were recorded. <strong>Results: </strong>The results showed that both the groups showed statistically significant difference in terms of sensory blockade and recovery of sensory blockade was. It was observed that group B showed the early onset of sensory blockade and prlonged recovery time. No difference was seen in maximal sensory blockade. <strong>Conclusion: </strong>Intrathecal neostigmine precipitated the onset of motor and sensory blockade and prolongs the block significantly when used with bupivacaine and fentanyl in spinal anesthesia in a low dose. The duration of analgesia was also significantly prolonged when neostigmine is added. Although the addition of neostigmine produced side effects like nausea and hypo tension, they were not statistically significant and were cautiously managed.</p> Bhanu Prakash, Arti Raj Kumar, Valsamma Abraham Copyright (c) 2021 Author Thu, 17 Jun 2021 00:00:00 +0000 Comparative Evaluation of Analgesic Efficacy of Intra-Articular Vs Intrathecal Clonidine in Arthroscopic Anterior Cruciate Ligament Repair: A Randomised, Double Blind Prospective Study <p><strong>Background</strong>: The purpose of this study was to compare the analgesic effects of Clonidine as an adjuvant through different routes for ACL repair surgeries. <strong>Subjects and Methods: </strong>Ninety adult patients of ASA grade I and II, both sex, age 18-60 years scheduled for ACL repair under Sub-arachnoid block (SAB) were randomly allocated into three groups. All patients received 0.5% bupivacaine intrathecally as in control group. Group IT received 1 <em>µ</em>g/kg of clonidine in saline intrathecally with hyperbaric bupivacaine. Group IA received Clonidine 1<em>µ</em>g/kg with 30 ml saline injected intra-articularly at the end of surgery. The duration of analgesia and block characteristics were the primary outcomes studied. <strong>Results : </strong>Statistical analysis was done by Statistical Package for Social Sciences (SPSS version 20.0) and epi info 7 (CDC Atlanta). The mean duration of Analgesia in Group IA(5.9&nbsp; 1.02h) was significantly (p=0.01) longer than that of Group IT(5.2&nbsp; 0.85h) and Group C (4.0&nbsp; 0.78h) and the requirement of total number of rescue analgesics in 24 hr period was lesser in Group IA(1.1&nbsp; 0.33) and Group IT (1.3&nbsp; 0.50) than&nbsp; Group C (3.4 0.69). The mean duration of sensory and motor block in Group IT was (4.5 0.88 h) and (3.8 0.78 h) respectively which was significantly longer than other groups. <strong>Conclusion: </strong>Clonidine is a useful adjuvant in prolonging analgesia through various routes for ACL repair surgeries arthroscopically. Intra-articularly administered clonidine provided most effective postoperative analgesia with least hemodynamic changes and complications.</p> Shilpa Sarathy, Vrinda Oza, Vandana Parmar, Payal Adhiya, Krupa Patel Copyright (c) 2021 Author Sun, 20 Jun 2021 00:00:00 +0000 A Comparative Study of Clonidine versus Dexmedetomidine as an Adjunct to Hyperbaric Bupivacaine in Spinal Anesthesia for Orthopaedic Lower Limb Surgeries <p><strong>Background: </strong>To compare clonidine versus dexmedetomidine as an adjunct to hyperbaric bupivacaine in spinal anesthesia in lower limb surg- eries. <strong>Subjects &amp; Methods: </strong>Ninety patients belonging to physical status American Society of Anesthesiologists (ASA) Classes I and II between 18- 60 years’ age group posted for limb surgeries of both genders were randomly divided into 2 groups. Group I were given 3.5 ml volume of injection bupivacaine 0.5% hyperbaric and 0.5 ml normal saline. Group II patients were given 3.5 ml volume of injection bupivacaine 0.5% hyperbaric and 0.5 ml of injection clonidine (30 <em>µ</em>g) and group III patients were prescribed 3.5 ml volume of injection bupivacaine 0.5% hyperbaric and 0.5 ml of injection dexmedetomidine (5 <em>µ</em>g). Parameters such as sensory onset, motor onset, duration of motor blockade, time for rescue analgesia, VAS and adverse effects were recorded in both groups. <strong>Results: </strong>Common adverse events such as nausea in 3 in group I,&nbsp; 1 in group 1 and 2 in group II, bradycardia 2 in group I, 1 in both group II and III, hypotension 2 in group I and group II and 1 in group III and shivering 1 in group I. Sensory onset duration was 2.9 minutes in group I, 1.5 minutes in group II and 1.3 minutes in group III, motor onset duration was 4.1 minutes in group I, 1.7 minutes in group II and 1.2 minutes in group III, duration of motor blockade was 168.2 minutes in group I, 281.4 minutes in group II and 304.2 minutes in group III, time for rescue analgesia was 168.5 minutes in group I, 345.7 minutes in group II and 367.2 minutes in group III and VAS was 6.0 minutes in group I, 5.0 minutes in group II and 4.8 minutes in group III. A significant difference was found in all parameters (P&lt; 0.05). <strong>Conclusion: </strong><em>α</em>2-agonists with hyperbaric bupivacaine intrathecally have a faster onset of both motor and sensory block, prolonged duration of block and better post operative analgesia</p> Shruti Hiremath, S. Ashwini Copyright (c) 2021 Author Sun, 20 Jun 2021 00:00:00 +0000 Controlled Comparative Study of Post-operative Analgesic Effect of Pre-emptive use of Pregabalin & Ketorolac in Patients Undergoing Single Level Decompressive Lumbar Laminectomy <p><strong>Background: </strong>Pre-emptive analgesia helps to reduce the physiological consequences of nociceptive transmission. Pregabalin has anti-convulsant, anti-hyperalgesic, and anxiolytic properties and Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with potent analgesic effects and a relatively low incidence of side effects. The aim is to assess and compare post-operative analgesic effect of pre-emptive use of Pregabalin&nbsp;&nbsp;&nbsp; &amp; Ketorolac in patients undergoing single level decompressive lumbar laminectomy. <strong>Subjects and Methods : </strong>It is randomised, prospective, double blinded study in which 75 patients of ASA physical status grade I and II scheduled for single level elective decompressive lumbar laminectomy (L2-3, L3-4, or L4-5) were enrolled in the study. They were then randomly divided into three groups of 25 each, group C (control), P (pregabalin) and K (Ketorolac) by chit-in box method.Patients in group C, P and K receivedplacebo drug, 150 mg pregabalin tablet and 10 mg ketorolac tablet respectively one hour before surgery with a sip of water. The patients werefollowed up to 24hr in post-operative period for pain relief and pain scoring was done by Numerical rating scale. <strong>Results: </strong>NRS was statistically insignificant at 1, 4, 12 &amp; 24 hr. Rescue analgesic consumption at 1hr, 4hr, 12hr and 24hr was statistically insignificant.12%, 4% and 4% patients experienced drowsiness in group C, P and K respectively.32%,12% and 16 % patients experienced nausea and vomiting in group C, P and K respectively. Significantly higher mean systolic blood pressure is observed in group C at 1hr, 4hr and 12hr when compared to group P and group K. Significantly higher mean diastolic blood pressure is observed in group C at 1hr when compared to group P and group K. <strong>Conclusion: </strong>It was found that Pregabalin and Ketorolac do not decrease post-operative analgesic consumption when compared to control. There is no difference in adverse effect profile between Pregabalin and Ketorolac.</p> Ankitkumar K Chauhan, Mona Bana, Rajeev Lochan Tiwari, Guriqbal Singh, Ishraq Khan Copyright (c) 2021 Author Sun, 20 Jun 2021 00:00:00 +0000 Norepinephrine and Phenylephrine for the Treatment of Hypotension During Spinal Anesthesia for Caesarean Section <p><strong>Background: </strong>To compare norepinephrine and phenylephrine for the treatment of hypotension during spinal anesthesia for caesarean section. <strong>Subjects and Methods: </strong>104 American Society of Anesthesiologists I or II, primiparity, singleton, term pregnancy, elective caesarean section scheduled for spinal anesthesia were divided into two groups viz. Group P (phenylephrine) and group N (Norepinephrine). Following parameters such as systolic BP (SBP), Systolic blood pressure; HR: Heart rate; incidence of requirement for extra bolus, time to first extra bolus, and frequency of extra bolus, incidence of bradycardia was recorded. <strong>Results: </strong>The incidence of nausea, vomiting and dizziness was higher in group N as compared to group M. A significant difference was observed in two groups (P&lt; 0.05). Time to first extra bolus was 5.2 minutes in group N and 5.7 minutes in group M, frequency of extra bolus was seen 1 in each group and incidence of bradycardia was seen among 2 in group N and 8 in group M. A non- significant difference was observed (P&gt; 0.05). <strong>Conclusion: </strong>A greater SBP and a lower incidence of bradycardia with norepinephrine compared to phenylephrine for the management of maternal hypotension during elective cesarean section with spinal anesthesia.</p> Gagan Deep Singh, Atanu Mukherjee, Deepika Bagga Copyright (c) 2021 Author Fri, 25 Jun 2021 00:00:00 +0000