Background and Objectives:We evaluated the effect of adding dexmedetomidine to lidocaine and bupivacaine for peribulbar block in two different doses. The primary endpoints were the onset and duration of corneal anesthesia, globe akinesia, and duration of analgesia.Materials and Methods:A randomized controlled clinical trial was conducted on 90 ASA I-II patients scheduled for elective cataract surgery under peribulbar anesthesia. Patients were randomly allocated to one of three groups of 30 each; group C (control) received 3 ml of 2% lidocaine with 3 ml of 0.5% bupivacaine; group D50 received 3 ml of 2% lidocaine with 3 ml of 0.5% bupivacaine and 50 ug of dexmedetomidine; and group D25 received 3 ml of 2% lidocaine with 3 ml of 0.5% bupivacaine and 25 μg of dexmedetomidine.Results:The onset of corneal anesthesia and globe akinesia was significantly shorter in group D50 (P < 0.001) as compared to group C; however, in Group D25 onset of corneal anesthesia was significantly faster, but not onset of globe akinesia (P = 0.45). The duration of corneal anesthesia and globe akinesia was significantly longer (P < 0.001) in both Group D50 and Group D25 in comparison to Group C. Decrease in IOP was observed in both group D50 and group D25 at 5 minutes and 10 minutes following peribulbar block which was significant (P < 0.05) compared to group C.Conclusion:Addition of dexmedetomidine to lidocaine and bupivacaine in peribulbar block shortens the onset time and prolongs the duration of the block and postoperative analgesia. It also provides sedation which enables full cooperation and potentially better operating conditions.

Situs inversus totalis is an uncommon congenital positional anomaly in which orientation of all asymmetric organs in the body are mirror image of normal morphology. The condition if undetected may pose a diagnostic problem of abdominal pathology. We present a case of situs inversus totalis with acute appendicitis in adult female who was previously unaware of her situs anomaly. A 35-year-old adult female presented with history of acute pain abdomen in left iliac region; clinically, she was diagnosed to be acute diverticulitis. Further investigation with abdominal computerized tomography (CT) and ultrasound imaging confirmed situs inversus with acute appendicitis. Patient underwent emergency laparoscopic appendectomy under general anesthesia; intraoperative electrocardiogram (ECG) monitoring was done with reverse lead placement.

Context:Alpha-2 adrenergic agonists clonidine and dexmedetomidine, are well known to produce analgesia through an opioid independent mechanism. Alpha-2 agonists are used as an adjuvant to local anesthetic agents to extend the duration of spinal, epidural and brachial plexus blocks.Aims:We compared clonidine and dexmedetomidine as an adjuvant to Ropivacaine in cervical epidural anesthesia (CEA) with respect to onset and duration of sensory block, duration of analgesia and adverse effects.Subjects and Methods:A total 150 American Society of Anesthesiologists Class I or II adult female patients who were scheduled to undergo modified radical mastectomy were randomly allocated to the following two groups to receive CEA: Group D receive 15 mL of 0.375% ropivacaine combined with 1 μg/kg of dexmedetomidine; Group C received 15 mL of 0.375% ropivacaine combined with 1.5 μg/kg of clonidine. The onset of sensory block, duration of analgesia, mean arterial pressure (MAP), heart rate (HR), sedation scores, and the incidences of adverse effects, such as hypotension, bradycardia, and oxygen desaturation were recorded.Results:The addition of dexmedetomidine to ropivacaine (Group D) resulted in faster onset of sensory block time compared with the addition of clonidine to ropivacaine (Group C) (95% confidence interval [CI]: 14.53 ± 2.96 vs. 16.72 ± 4.43 P = 0.032). The duration of analgesia block in Group D was significantly longer than that in Group C (95% CI: 234.65 ± 23.76 vs. 286.76 ± 34.65; P = 0.037). The Ramsay sedation score at in Group D were significantly higher between 20 and 60 min as compared to Group C (P < 0.022). MAP level and HR level in Group D and Group C were comparable.Conclusion:The addition of dexmedetomidine to low dose ropivacaine for CEA could shorten the onset of sensory block and extend the duration of analgesia with optimum sedation without episodes of hypoxemia as compared to addition of clonidine to ropivacaine.

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Background:Supine emergence from anesthesia in patients undergoing lumbar surgery in prone position leads to tachycardia, hypertension, coughing, laryngospasm and loss of monitoring as the patients are rolled back to supine position at the end of surgery. The prone extubation might facilitate a smoother emergence because the patients are not disturbed during emergence and secretions are drained away from patient's airway.Materials and Methods:The patients were randomly allocated to one of the two groups of 30 each at conclusion of surgery. First group was extubated in prone position and second in supine position at conclusion of surgery. Supine group patients were rolled back and prone group patients were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates (HR), mean arterial pressure (MAP) were noted at various points of time. Coughing, laryngospasm, vomiting, monitor disconnection if any were also noted.Results:During emergence from anesthesia heart rate was significantly more in group S than group P at all intervals (P < 0.001). Mean arterial pressure was significantly higher in the supine group at 2, 3, and 4 min compared to prone group (P = 0.003). Compared to supine patients, prone patients had fewer incidences of coughing (P = 0. 0004), laryngospasm, vomiting and monitor disconnection.Conclusion:In healthy normotensive patients, emergence from anesthesia in the prone position is associated with minimal hemodynamic change, and fewer incidences of coughing, laryngospasm, and monitor disconnections.