BACKGROUND Numerous attempts have been made in the past to attenuate the haemodynamic responses occurring during laparoscopic cholecystectomy. The present study compared the effect of three opioids namely Butorphanol, Fentanyl and Nalbuphine in obtundation of haemodynamic responses in laparoscopic cholecystectomy in terms of Heart rate, BP (SBP, DBP and MAP) and secondary aim was to calculate duration of analgesia and sedation score. MATERIALS AND METHODS This was a randomised study comparing three opioid drugs-nalbuphine, fentanyl and butorphanol. It was carried out on 75 patients of either sex aged 18-60 years scheduled for elective laparoscopic cholecystectomy under GA. Subjects were enrolled into three groups-Group B (n= 25) patients received inj. Butorphanol 25 mcg/kg IV, Group F (n= 25) received inj. Fentanyl 2 mcg/kg IV and Group N (n= 25) patients received inj. Nalbuphine 0.2 mg/kg 5 minutes before the induction. RESULT At the time of extubation, mean MAP in Group B, F and N was 99.88, 95.32 and 97.24 respectively. This difference is highly significant when compared statistically (p value is 0.005). CONCLUSION With this study, we conclude that the administration of intravenous fentanyl and nalbuphine five minutes prior to induction of anaesthesia helps in better obtundation of haemodynamic responses to laparoscopic cholecystectomy than butorphanol.

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BACKGROUND Awake nasal or oral flexible fiberoptic intubation (AFOI) is the airway management technique of choice in known or anticipated difficult airway, severe cervical stenosis, Chiari malformation, unstable cervical fracture, limited mouth opening as in temporomandibular disease, mandibular-maxillary fixation, severe facial burn and vertebral artery insufficiency. [1] Fiberoptic intubation is the best, easiest and most successful method for awake intubation. MATERIALS AND METHODS A prospective, comparative and randomized study was conducted on 100 patients undergoing elective surgery under general anaesthesia. Patients were randomly divided into two groups of 50 each. Group I: Patient received bolus of I.V. fentanyl 1 ug/kg+ propofol 1 mg/kg so as to achieve an adequate level of sedation i.e. RSS=3. Group II: Patient received bolus of I.V. nalbuphine 0.2 mg/kg + propofol 1 mg/kg to achieve adequate level of sedation. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure, mean arterial pressure), SpO2, EtCO2, total comfort scale and patient's tolerance were assessed during preoxygenation, fiberscope insertion and endotracheal intubation. RESULTS Significant difference (p<0.05) between two groups in terms of HR, SBP, DBP, MAP, total comfort score and patient tolerance was seen during fiberscope insertion and endotracheal intubation. CONCLUSION Fentanyl plus propofol regimes are suitable for fiberoptic intubation. Fentanyl plus propofol appeared to offer better tolerance, preservation of an airway and spontaneous ventilation, while maintaining haemodynamic stability.

BACKGROUNDEpidural analgesia is the most commonly accepted and used technique for painless labour. Local anaesthetic bupivacaine when combined with low dose of opioid analgesics gives excellent results.The aim of this study is to evaluate and compare the efficacy and safety of epidural fentanyl vs butorphanol for painless labour and effect on newborn (Apgar score).Settings and Design -Randomised double-blind trial. MATERIALS AND METHODS50 parturients were randomly allocated in two groups. Group I: receive epidurally 15 mL bupivacaine 0.0625% + fentanyl 30 mcg and Group II: receive epidurally 15 mL bupivacaine 0.0625% + butorphanol 1 mg. RESULTSThe mean onset of analgesia was faster in Group I, whereas duration of analgesia was longer in Group II. There was no incidence of motor block, high rate of Normal Vaginal Delivery and very low incidence of forceps application or LSCS in both the groups. Somnolence was the main side effect in Group II and other side effects were seen equally in both groups. CONCLUSIONThe addition of low dose of opioids has greatly improved the quality of labour analgesia and at the same time reduced the incidence of instrumental deliveries and LSCS without depressing the neurobehavioral status of the newborn.