The number of day-care surgeries is increasing every day. The boundaries of day-care surgeries are being redefined on a continual basis. Multi-dimensional benefits to the patient, hospital and national economy are the driving forces behind the changing scenario on the horizon of day surgery. The literature search included Google, medlinx, pubmed and medline. We have attempted to look at the controversies in patient selection with comorbidities, pre-operative assessment and an acceptable ASA grade of patients. An attempt is also made to look at suitable surgical procedures, a pathway of introducing procedures, which are still complex and specialist procedures in challenging environment. The techniques of general anaesthesia, central neuraxial blocks, regional nerve blocks with indwelling catheters and monitoring techniques are deliberated upon. Finally the most important post-operative issues of discharge criteria, including recovery after spinal anaesthetic, oral fluid intake, voiding and travel after day surgery, are considered.

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Introduction: Understanding pain and continued efforts to alleviate pain is utmost priority perioperatively. Most often pain is underestimated in all age groups. This study is intended to evaluate and compare analgesic efcacy of two drug combinations with local anesthetic agent in spinal anesthesia. In this study efcacy of Clonidine-Bupivacaine, Buprenorphine-Bupivacaine and Bupivacaine is studied in patients undergoing total abdominal hysterectomy. This study was a prospective randomized study conducted on 114 patients age Material and Methods: d 35-60 years who underwent total abdominal hysterectomy at Sri Siddhartha Medical College and Research institute for a period of 24 months.After the approval of institutional ethical clearance committee, 114 ASA I and II patients scheduled for elective total abdominal hysterectomy were selected for study. All the patients were evaluated as per the protocol. The anesthetic procedure was explained to the patients in a simple language and informed consent were obtained. The patients were divided into three groups of 38 each using chit in a box technique. Three groups included Bupivacaine 0.5% hyperbaric (Group B), Clonidine and Bupivacaine 0.5% hyperbaric (Group BC), Buprenorphine and Bupivacaine 0.5% hyperbaric (Group BB). Time of onset of sensory blockade, the height of sensory blockade, motor blockade as per Bromage scale were recorded. Total duration of sensory blockade and motor blockade were also noted. Quality of analgesia (visual analogue score), two segment sensory regression time and time to rst rescue analgesia in 24h were documented. Results:The total duration of analgesia was statistically signicant in all three groups. The mean duration of analgesia was 2.436 ± 0.24h in group B, 2.96 ± 0.32h in group BB and 4.35± 0.62h in group BC. The total duration of motor block was found to be statistically signicant between the groups. Mean duration of motor block was 3.10 ± 0.34h in group B , 3.41 ± 0.25h in group BB, 4.48± 0.19h in group BC. The VAS score was found to be statistically signicant between the groups. It was 4.68 ± 0.47 in group B, 4.92 ± 1.07 in group BB and 4.42± 0.50 in group BC. Clonidine is an effective intrathecal Conclusion: adjuvant to Bupivacaine(H) than Buprenorphine in providing post-operative analgesia and the analgesic efcacy of both Clonidine and Buprenorphine as adjuvants with Bupivacaine(H) were better than Bupivacaine(H) alone.

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Background: Atracurium and Cisatracurium are intermediate-acting nondepolarizing neuromuscular drugs. They both are promising drugs offering a predictable recovery due to non-organ dependent elimination. However, due to the variability in metabolism and narrow therapeutic window, monitoring of neuromuscular functions has signicant importance. Cisatracurium is approximately four times as potent as atracurium. In contrast to Atracurium, Cisatracurium is devoid of chemically mediated histamine release. Routinely atracurium is used for the neuromuscular blockade in most pediatric surgeries. On the other hand, 2 ED95 doses of Cisatracurium do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. Aim: Ÿ To compare the intubating conditions of Atracurium(0.5mg/kg) and Cisatracurium 0.15mg/kg). Ÿ To compare the hemodynamic parameters (MAP, PR, SPO2,) between atracurium and Cisatracurium Ÿ To compare the signs of histamine release potential between atracurium and Cisatracurium. Materials and Methods : A Prospective, observational study was conducted at SRI SIDDHARTHA MEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 74 patients. In Atracurium group, there were 15 patients Results: with ASA grade of 1 and 17 patients with ASA grade of II. In Cis-Atracurium group, there were 15 patients with ASA grade of 1 and 22 patients with ASA grade of II. Chi square test was performed between the 2 groups and p value was observed to be > 0.05 indicating no statistically signicant difference between the groups. Average onset time for Atracurium group was 177 ± 22.4 seconds and same was 184 ± 17.3 seconds in Cis Atracurium group. In Atracurium group, intubation was successful at 1st attempt in 33 subjects, 2nd attempt in 2 subjects, 3rd attempt in 2 subjects. In Cis Atracurium group, intubation was successful at 1st attempt in 35 subjects and 2nd attempt in 2 subjects. In Atracurium group, duration of action of the muscle relaxant was 46 ± 4.9 minutes, Duration of 25% recovery was 33 ± 4.2 minutes, Time of recovery from reversal was 1.7 ± 0.8 minutes. In Cis Atracurium group, duration of action of the muscle relaxant was 68 ± 7.1 minutes, Duration of 25% recovery was 48 ±5.6 minutes, Time of recovery from reversal was 2.2 ± 1.1 minutes. Cis atracurium had longer recovery time and duration of action. Atracurium c Conclusion: aused signicant hemodynamic impact than Cis atracurium. Adverse effects were comparable in both.

Background: Various intrathecal additives are added to local anesthetics to increase the speed of onset, improve the quality, and prolong the inuence of spinal anesthesia. Midazolam has a synergistic effect on postoperative analgesia when administered intrathecally with bupivacaine. Opioids such as fentanyl are extensively used as an adjunct to local anesthetics in neuraxial blockade to enhance the duration of postoperative analgesia. Aim: The aim of our study was to compare the effects of intrathecal midazolam(1mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine 0.5% (15mg) with spinal anesthesia.Materials and Methods: Prospective, observational study was conducted at SRI SIDDHARTHAMEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 94 patients. Results: In Bupivacaine and Midazolam group, mean duration of surgery was 84 ± 12.3 minutes and in Bupivacaine and Fentanyl group, mean duration of surgery was 92 ± 14.4 minutes. In Bupivacaine and Midazolam group, mean time for onset of sensory block was 7.1 ± 0.9 minutes and in Bupivacaine and Fentanyl group, mean time for onset of sensory block was 6.9 ± 1.1 minutes. In Bupivacaine and Midazolam group, mean time for onset of motor block was 7.6 ± 1.3 minutes and in Bupivacaine and Fentanyl group, mean time for onset of motor block was 8.1± 1.2 minutes. In Bupivacaine and Midazolam group, mean duration of sensory block was 213.6 ± 16.1 minutes and in Bupivacaine and Fentanyl group, mean duration of sensory block was 218.3 ± 19.2 minutes. Conclusion- The onset of sensory and motor blockade was comparable in Fentanyl with Bupivacaine and Midazolam with Bupivacaine. Additional of intrathecal Fentanyl prolonged the duration of analgesia signicantly than that of Midazolam. There was signicantly less consumption of rescue of analgesia among patients with Fentanyl with Bupivacaine than Midazolam with Bupivacaine. The duration of postoperative analgesia was also signicantly prolonged in the fentanyl and midazolam groups

Background: The second most frequent post-operative complaint after pain is post-operative nausea and vomiting (PONV). There are numerous factors that can cause PONV, including the length of the procedure, the type of medicines used during anaesthesia, the anaesthetic technique, age, sex, and smoking habits. Depending on the type of operation and related risk factors, the incidence of PONV has been reported to range from 30 to 80%. Without any antiemetic medication, there is a 60% to 80% chance of PONV following general anaesthesia. Prevention of PONV can improve both the physical & phycological recovery of patient post-surgery. Palonosetron is a selective 5-hydroxytryptamine type3(5-HT3) receptor antagonists. It has a greater receptor binding afnity and a much longer half-life, conferring a prolonged duration of action, exceeding 40 hours, compared with other 5-HT3 receptor antagonists.[1] Olanzapine is an atypical antipsychotic agent of the thienobenzodiazepine class, blocks multiple neurotransmitter receptors, including dopaminergic (D1, D2, D3, D4), serotonergic (5-HT2a, 5-HT2c, 5-HT3, 5-HT6), adrenergic (alpha1), histaminic (H1), and muscarinic (m1, m2, m3, m4) receptors.[2] Aim: To compare the effect of palonosetron and palonosetron plus olanzapine for prevention of post operative nausea vomiting in patients undergoing gynecological surgeries

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