Background: Bezold Jarisch reflex is important cause of hypotension and bradycardia which occur after spinal anaesthesia. This reflex is elicited by stimulation of peripheral serotonin receptors 5- hydroxytryptamine (5- HT3 type). These receptors have antinociceptive effect, which is confirmed by many studies.The two most commonly used 5HT3 antagonist are ondansetron and granisetrone. Very few comparative studies of the two drugs on the effect after spinal anaesthesia are available.Methods: Ninety adulted patients of either sex aged 18-58 years scheduled for elective infraumbilical surgeries were randomly allocated in three groups to receive intravenous ondansetron 4mg, granisetrone 2mg or normal saline in equal volume 5mins before spinal anesthesia. Hemodynamic changes and time to sensory motor onset and regression were evaluated.Results: There was statistically significant difference in fall of systolic diastolic and mean blood pressure among the three groups. Time to two segment regression of sensory block and time to regression to S1 was faster in ondansentron (76.6±17.2mins, 176±22mins) and granisetrone group (69±17.3mins, 165±19.2mins) in comparision to control group(77.4±24.3mins, 178±21mins) which was statistically significant also p value-0.019, 0.0001 respectively.Conclusions: The prophylactic therapy with 4mg i.v. ondansetron, given five minutes before spinal anaesthesia appears to be significantly most effective and safe for attenuating haemodynamic response after spinal anaesthesia without affecting the duration of sensory block in patients undergoing infraumbilical surgeries.

Dural ectasia is one of the likely causes of incomplete or failed spinal anaesthesia. Its association with diseases like Marfans syndrome, neurofibromatosis, osteogenesis imperfecta, vertebral fracture, postopertative adhesions, trauma etc., is often overlooked as a reason for inadequate spinal anaesthesia. Greater than normal volume of cerebrospinal fluid in the lumber theca in dural ectasia is postulated to restrict the spread of intrathecally injected Local anaesthetic. Here, we report a case of failed spinal anaesthesia but successful epidural anaesthesia in later setting in a patient with dural ectasia.

Background: Laparoscopic cholecystectomy is one of the commonest surgery performed under general anesthesia in this set up but maintaining the hemodynamic stability is challenging in these patients. The present study was conducted to comparatively analyse the hemodynamic variations using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.Methods: Study was conducted on 90 adult patients aged 18-60 years, of ASA grade I or II of both gender, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized into three groups of 30 patients each. Patients of Group A received esmolol infusion (loading: 1mg/kg and maintenance: 5-15µg/kg/min), patients of Group B received dexmedetomedine infusion (loading: 0.7µg/kg and maintenance: 0.4µg/kg/hr) and Group C (control group) received normal saline infusion. Patients were monitored for changes in heart rate, ECG, systemic blood pressure and EtCO2, at baseline, at 5 min and 10 min after giving study drug bolus, after induction, intubation, skin incision and CO2 insufflation. Thereafter, these changes were recorded at 15 min intervals till the end of surgery.Results: It was observed that perioperative use of dexmedetomidine and esmolol infusions maintained better hemodynamic stability as compared to the normal saline in control group. Though the patients in esmolol group showed less fluctuations in BP and HR (as compared to control group), but, stability was better in the patients of dexmedetomidine group at all-time intervals.Conclusions: Dexmedetomidine infusion was a better option for maintaining hemodynamic stability in comparison to emolol infusion during laparoscopic surgeries.

Background: Accentuated hemodynamic changes during direct laryngoscopy can be modified by appropriate premedication. The present study was aimed to comparatively evaluate the clinical efficacy of intravenous clonidine with nalbuphine premedication for reduction in hemodynamic changes during direct laryngoscopy and intubation. Subjects and Methods: Sixty adult consenting patients of ASA physical status I and II of either gender, were randomized into two equal groups of 30 patients each to receive either clonidine (2 µg/kg) Group I or nalbuphine (0.2 mg/kg) Group II, intravenously 10 minutes before induction. Anesthetic technique was standardised and direct laryngoscopy with intubation was facilitated with vecuronium bromide. Changes in heart rate, arterial blood pressure and ECG were recorded at baseline, after giving study drug, after laryngoscopy and intubation, then after at 1st, 2nd, 3rd, 5th, 10th, and 15th min of intubation and were noted as primary end points. Any side effects and complications were recorded as secondary end points. Results: After premedication in patients of comparable demographic profile, the fall in heart rate and blood pressure showed statistically significant difference between the groups. After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups but persisted up to 5 to 7 min in patients of clonidine group and up to 10 minutes in patients of nalbuphine group with statistically significant difference between the groups. Conclusion: Intravenous clonidine premedication (2 µg/kg) could effectively reduce the hemodynamic changes during direct laryngoscopy and intubation when compared to intravenous nalbuphine (0.2 mg/kg), administered 10 min before induction.

Background: Brachial plexus block is widely used for upper limb surgeries but intraoperatively, patients remain awake and anxious. This study has compared the intraoperative sedation of dexmedetomidine infusion versus propofol infusion during upper limb surgeries by using monitored anesthesia care. Subjects and Methods: Sixty adult consenting patients of ASA physical status I to III of either gender were enrolled and brachial plexus block was established with 20 mL of 0.5% bupivacaine using ultrasound. Patients were randomized into two equal groups of 30 patients each to receive either dexmedetomidine1µg/kg over 10 min, followed by maintenance fusion of 0.4 µg/kg/h (Group D) or propofol infusion of 75µg/kg/min over 10 min, followed by 50µg/kg/min (Group P). Intraoperative sedation and duration of postoperative analgesia were primary objectives. The hemodynamic changes, respiratory depression, recovery from sedation or any adverse events were noted as secondary outcomes. Results: Ultrasound helped to observe the spread of local anesthetic agent at brachial plexus. The patients of propofol group had faster onset with early recovery from sedation but sedation in patients of dexmedetomidine was clinically better with statistically significant difference. Duration of postoperative analgesia was also significantly enhanced with dexmedetomidine infusion. In propofol group, the blood pressure and heart rate remained lower when compared to dexmedetomidine infusion. There was no episode of respiratory depression in any patient. Conclusion: Dexmedetomidine infusion was better due to its stable hemodynamic profile, better intraoperative sedation and enhanced duration of postoperative analgesia without respiratory depression during upper limb surgeries.

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Background: The ability to predict difficult laryngoscopy preoperatively allows anaesthesiologists to take precautions to reduce the anesthesia-related risks but till now, no single airway test can provide a high index of sensitivity and specificity for prediction of difficult airway. The present analytical study was aimed to correlate the various physical indices with maxillo-pharyngeal angle, measured on lateral cervical radiograph, for preoperative prediction of difficult airway. Subjects and Methods: After approval from Institutional Ethical Committee and written informed consent, 200 patients of ASA physical status I and II, aged between 18 to 58 years of either gender with BMI <25 Kg/m 2 , were studied. Patients with any obvious airway related abnormality, restricted mouth opening, short and thick neck, fixation of the trachea, malformation of the skull, teeth or mandible were excluded. Preoperatively, they were assessed for Modified Mallampati grading, thyromental distance, protrusion of jaw and head-neck movements along with Maxillo-pharyngeal angle, measured on lateral cervical radiograph. These parameters were correlated with Cormack Lehane grading during direct laryngoscopy. The observed data were analyzed by using one way analysis of variance (ANOVA) and Pearson's correlating coefficient. Results: Modified Mallampati test sensitivity and specificity was found as 39.29% and 65.12% respectively with accuracy of 61.5%. The sensitivity and specificity of Maxillo-Pharyngeal Angle was 85.71 % and 97.09% respectively with accuracy of 95.50 %. Conclusion: The combination of various physical indices along with maxillo-pharyngeal angle in parallel is more sensitive and specific with clinically relevant higher discriminative power.

Background: In laparoscopic surgeries, insufflation with carbon dioxide triggers vagal afferents on the bowel and peritoneum which induces emesis by activating the vomiting center. It is hypothesized that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. So, the present study was planned to compare the efficacy of granisetron, dexamethasone and combination of granisetron with dexamethasone to prevent PONV.Methods: This randomized prospective double-blind study was performed on 120 patients, aged between 18 and 58 years of ASA physical status I and II of either sex undergoing laparoscopic surgeries under general anesthesia. Patients were randomized in three groups, group I (granisetrone 2 mg I.V.), group II (dexamethasone) 8 mg I.V., group III (granisetrone+dexamethasone) 2 mg+8 mg I.V. with 40 patients in each group. Complete response, incidence of nausea, vomiting, and rescue antiemetic were recorded at specified intervals.Results: A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 75% of the patients given granisetron, 70% in dexamethasone and in 92.5% of the patients given granisetron plus dexamethasone (P <0.05). The overall cumulative incidences (0-24 hours) of PONV were 10 (25%) in the granisetron, 12 (30%) in the dexamethasone and 3 (7.5%) in the combination group. No difference in adverse events were observed in any of the groups.Conclusions: The prophylactic therapy of granisetron 2 mg plus dexamethasone 8 mg just before induction of anaesthesia is significantly effective in prevention of PONV in patients undergoing laparoscopic surgeries.