BACKGROUND: Dexmedetomidine, a potent α2-adrenoceptor agonist, is approximately eight-times more selective towards the α2-adrenoceptor than clonidine. AIM: Comparison of clonidine and dexmedetomidine as an adjuvant to local anaesthetic in supraclavicular brachial block. MATERIALS AND METHODS: Sixty patients of age group 18-60 years, scheduled for various elective orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial block were divided into two equal groups in a randomized, double-blinded fashion. In group C (n = 30), 30 ml of 0.25% bupivacaine+clonidine 1µg/kg; and in group D (n=30), 30 ml of 0.25% bupivacaine+ dexmedetomidine 1µg/kg were given. Onset of motor and sensory block, duration of sensory and motor block, quality of block, and duration of postoperative analgesia were recorded. RESULTS: Demographic data and surgical characteristics were similar in both groups. The sensory and motor block onset time was same in both groups (P >0.05). Sensory and motor blockade durations were longer in group D than in group C (P < 0.001). Duration of postoperative analgesia was longer in group D than in group C (P < 0.001). The 24 h Numerical Rating Pain score was more in Group D as compared to Group C. The quality of anaesthesia was excellent in group D as compared to group C (P <001). The mean pulse rate and mean blood pressure levels at different time intervals were statistically insignificant between the groups (P > 0.05). CONCLUSIONS: Dexmedetomidine added to bupivacaine for supraclavicular brachial plexus block prolongs the duration of the motor and sensory block and the duration of postoperative analgesia significantly as compared to clonidine.

BACKGROUND:The airway instrumentation of direct laryngoscopy and tracheal intubation are powerful noxious stimuli that should be attenuated by appropriate premedication, smooth induction and rapid intubation. The present study evaluated the clinical efficacy of oral premedication with Clonidine and Pregabalin in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation. MATERIAL AND METHODS: A total of 120 healthy adult consented patients aged 20 to 50 years with American Society of Anesthesiologist (ASA) physical status I of either sex scheduled to undergo elective general surgical procedures under general anaesthesia, were randomized to receive clonidine (300μg) Group 1, pregabalin (75mg) Group 2, or placebo Group 3, given 120 minutes before surgery as oral premedication. Anaesthetic technique was standardized and all groups were compared for preoperative sedation and anxiety level, along with the haemodynamic changes after premedication, before and after induction, after laryngoscopy and intubation, and along with the intraoperative haemodynamic stability and post-operative side-effects. RESULTS: Oral clonidine (300µg) given 120 min before induction was effective in attenuating haemodynamic stress response to laryngoscopy and endotracheal intubation besides providing effective pre-operative anxiolysis and sedation. Oral pregabalin (75mg) given 120 min before induction was not effective in attenuating hemodynamic stress response to intubation, although it provided a moderate level of anxiolysis and minimal sedation as compared to placebo. No significant differences in the parameters of recovery were observed between the groups. None of the premeditated patient has suffered from any postoperative side effects. CONCLUSION: Oral premedication with Clonidine 300μg was superior to pregabalin 75mg resulting in adequate sedation and pre-op anxiolysis along with hemodynamic stability during laryngoscopy and endotracheal intubation, without prolongation of recovery time and side effects.

BACKGROUNDPresent study was conducted to evaluate the efficacy of esmolol and sodium nitroprusside as hypotensive agents in functional endoscopic surgeries.

ABSTRACT:Paracetamol is primarily thought to be a cyclo-oxygenase inhibitor acting through central nervous system. Indirect effects of paracetamol are through serotonergic system as a nonopioid analgesic. We studied intravenous paracetamol 1 gram preoperatively to assess its intraoperative and post-operative analgesic effects, in reducing intraoperative morphine requirements, to reduce the requirement of postoperative analgesia, enable early recovery from anaesthesia and to reduce postoperative nausea and vomiting. One hundred patients from either sex classified in ASA Class I and II scheduled for laparoscopic cholecystectomy were randomly allocated into two groups of 50 patients each. Group I (Study group) received paracetamol 1 gram infusion prior to induction with 50µg/kg morphine diluted with normal saline to a total volume of 5ml. Group II (Control group) received l00µg/kg morphine diluted with normal saline to a total volume of 10ml at induction. We observed that there was significant increase in mean time for rescue analgesia from induction of anaesthesia in Group I (study group) was 11.25±1.827 hours and Group II (Control group) was 6.98±4.568 hours (p value < 0.001). The median value of visual analogue score was lower at all-time points in group I when compared to group II at each interval and it was statistically significant (p value < 0.001). A significant decrease in mean number of administered doses of rescue analgesia during 24 hours was seen in the study group (0.52±0.505) as compared to the control group (1.3±0.463) with a p value of < 0.001. Mean modified Aldrete score in the study group was 9.78±0.465 and in control group it was 8.1±1.15. It was statistically significant p value of <0.001. The mean number episodes of nausea and vomiting in group I were 0.74±0.633 and in group II 0.94±0.652 and was statistically insignificant with p value of 0.361. CONCLUSION: Administration of intravenous paracetamol and 50% doses of morphine prior to induction in patients undergoing laparoscopic cholecystectomy ensures effective analgesic intra-operatively as well as postoperatively and was associated with earlier discharge from post anaesthetic care unit when compared with full doses of IV morphine, however above combination was not able to decrease significantly reduction in morphine related adverse effects in these patients.

BACKGROUND: Dexmedetomidine, an α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, anaesthetic sparing and haemodynamic stabilizing properties without significant respiratory depression. METHODS: We assessed the efficacy of dexmedetomidine in attenuating stress response to laryngoscopy, endotracheal intubation and analyzed reduction in the dose of thiopentone. Sixty patients scheduled for elective general abdominal surgeries were randomly selected. Control group (C) received isoflurane-opioid-saline and study group (D) received isoflurane-opioid-dexmedetomidine anaesthesia. Dexmedetomidine infusion in a dose of 1 μg/kg and Saline (at same rate-ml/hr.) was given over 10 min before the induction of anaesthesia. All patients were induced with thiopentone, fentanyl and vecuronium. Haemodynamic variables were recorded at different time intervals. RESULTS: The need for thiopentone was decreased by 22.96% in the dexmedetomidine group as compared to the control group. After laryngoscopy and endotracheal intubation, maximal average increase was 8.18% in systolic and 10.07% in diastolic blood pressure in dexmedetomidine group, as compared to 33.81% and 24.02%, respectively, in the control group. Similarly, average increase in heart rate was 7.48% and 19.28% in the dexmedetomidine and control groups, respectively. CONCLUSION: Preoperative infusion of dexmedetomidine is effective in attenuating the stress response to laryngoscopy and endotracheal intubation. It has significant anaesthetic sparing effect.