Background:A prospective randomized clinical study was conducted to study the efficacy and safety of ropivacaine with bupivacaine intrathecally for lower abdominal and lower limb surgeries.Material and Methods:70 patients aged between 18 to 65 years were randomized into two groups, n = 35 in each group. Group A received 3 ml of (0.5%) isobaric bupivacaine (15 mg) and Group B 3 ml of (0.75%) isobaric ropivacaine (22.5 mg). Spinal anesthesia procedure was standardized. Haemodynamic parameters, onset and duration of sensory and motor blockade, level achieved, regression and side effects were compared between the two groups.Results:Onset and regression of sensory blockade in ropivacaine group was faster with a P < 0.001 which was statistically significant. Onset of motor blockade was rapid in both the groups but duration of motor blockade was significantly shorter in ropivacaine group. Excellent analgesia, with no side effects and stable haemodynamics was noted in ropivacaine group.Conclusion:Hence ropivacaine was safe and equally effective as bupivacaine for lower abdominal and lower limb surgeries with early motor recovery, providing early ambulation.

A one-year randomized placebo-controlled trial was conducted to study the effectiveness of intravenous lidocaine in the prevention of post extubation laryngospasm in children, following cleft palate surgeries. Children of age three months to six years were randomly assigned into two groups. Group P placebo (saline) and Group L (Lidocaine), 1.5 mg/kg. A sample size of 74 with n = 37 in each group was selected. The anaesthetic procedure was standardized. At the end of the procedure, three minutes after reversal, the study drug, that is, intravenous lidocaine (1.5 mg/kg) or placebo (saline) was administered and two minutes later the child was extubated. Following extubation for 10 minutes, the haemodynamic parameters, that is, pulse, blood pressure, oxygen saturation, severity of coughing, and laryngospasm were noted. The total reduction of laryngospasm and coughing was 29.9% and 18.92% with IV lidocaine. Significant alterations in haemodynamics and oxygen saturation were noted for 10 minutes, following extubation. Hence, intravenous lidocaine 1.5 mg/kg was effective in the prevention of post extubation laryngospasm in children undergoing cleft palate surgeries.

Background: Acute pain leads to adverse physiological and psychological disturbances. Hence, this study was done to evaluate and compare the onset and duration of sensory anesthesia, motor paralysis and duration of analgesia using 0.5% plain bupivacaine, with clonidine (2μg/kg) in patients posted for lower abdominal and lower limb surgeries under epidural anaesthesia. Materials and methods: 62 Patients posted for elective lower abdominal, gynaecological and lower limb surgeries under epidural anesthesia, aged 18 to 60 years, height more than 150 cms of ASA physical status 1 or 2 were included. All patients were randomized into two groups of 31 individuals each. Results: Clonidine in the dose of 2μg/kg added to bupivacaine injected into epidural space significantly prolonged the duration of analgesia when compared to bupivacaine alone. No effect on the onset of sensory and motor blockade was observed. However, it increases the duration of motor blockade. Clonidine also has effect on sedation level, pulse rate and mean arterial blood pressure. Conclusion: Clonidine causes increased sedation; fall in pulse rate and mean arterial blood pressure, which however, did not require active intervention in this study.

Background:Regional anesthesia has been the choice of preference for elective cesarean sections. This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence of hypotension.Materials and Methods:This study was conducted on 50 nonlaboring American Society of Anesthesiologists class I and II women undergoing elective cesarean section. Patients were randomly divided into two groups and were preloaded either with 1000 ml Ringer's lactate (RL) or 500 ml of 6% hetastarch 30 min prior to the surgery. Spinal anesthesia was performed with patients in the left lateral position and 2 cc (10 mg) of 0.5% of bupivacaine injected into subarachnoid space. Hemodynamic variables (heart rate, noninvasive blood pressure, and SpO2) were recorded from prior to preloading until the recovery from the subarachnoid blockade.Results:Our study showed the incidence of hypotension to be 28% in the hetastarch group and 80% in the RL group. Rescue ephedrine requirements for the treatment of hypotension were significantly less in patients who were preloaded with 6% hetastarch prior to cesarean section. The neonatal outcome, as determined by Apgar scores was good and similar in both groups.Conclusion:Hence, we conclude that 6% hydroxyl ethyl starch is more effective than lactated Ringers solution and that its routine use for preloading prior to spinal anesthesia should be considered.

Background: Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways. Objectives: We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed. Methods: An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways. They were divided into video laryngoscopy (Group V) and direct laryngoscopy (Group D). The primary outcome measures included time taken for intubation, number of attempts required, Cormack-Lehane glottic view, use of optimization maneuvers, the requirement of tube repositioning, and hemodynamic parameters before and after intubation. Results: The time taken for intubation was longer in the video laryngoscopy group ( group D, 24.28 sec vs. group V, 27.65 seconds (P = 0.01). The Cormack-Lehane glottic view was grade 1 in all the patients in the video laryngoscopy group, while only 35 children showed grade 1 in the direct laryngoscopy group. (P < 0.001). We observed a significant increase in both heart rate and mean arterial pressure in the video laryngoscopy group at 1, 3, 5, and 10 min after intubation ((P < 0.001, P < 0.05). Conclusions: The time taken for intubation was more in group V, but the glottic view was much better, and the requirement for external maneuvers was also less. Pressure response to intubation was more in group V compared to group D.

Background: Central venous catheters have been used in various lengths based on the height of the patient or predetermined lengths. This study compared the different lengths of right IJV central venous catheters to determine the better length for average heights of Indian population. Patients and Methods:  This was a prospective observational study done on 148 patients with average heights of Indian population (160±10cm) who are scheduled for right IJV central venous catheters are a part of this study. The patients are divided into 3 group (10,13,15 cm). Three different lengths of catheters are inserted. An anteroposterior chest X-ray was taken for the patients and carina was taken as the acceptable landmark. The outcome measured between the three groups is need for repositioning. Statistical analysis was done using Chi square test, Fisher’s exact test. Results: 10 cm catheters were considered acceptable in terms of less incidence of repositioning and statistically significant with p value of 0.0001(H S) with respect to other lengths (13,15cm) for heights of average Indian population. (160±10 cm). Conclusion: From our study, we concluded that 10 cm CVC catheters are acceptable in cannulating right IJV for an average Indian height adult patients (160±10 cms).

Background: Sevoflurane in Nasal Surgeries has a slightly higher incidence of emergence. The purpose of this study was to observe the effect of Dexmedetomidine over Emergence from General Anaesthesia (GA) in Nasal Surgeries. Method: It is an observational study with 120 participants aged between 18 and 60 years belonging to ASA class 1 and 2, undergoing elective Nasal Surgeries under General Anaesthesia (GA). Partcipants were grouped into 2 groups with one group receiving low dose of Dexmedetomidine infusion and the other saline infusion. RICKER score was observed post extubation. Data was analysed using Fishers test. p value < 0.05 was considered significant. Results: The RICKER score was better with Dexmedetomidine, with p value of 0.003, which was highly significant.  Conclusion: Emergence from General Anaesthesia (GA) is smoother with Dexmedetomidine in Nasal Surgeries.

Background: To compare the efficacy of saline, lignocaine 2% and Lignocaine 4% in the endotracheal tube cuff to decrease the incidence of post operative cough and sore throat. A unique, efficient and easy method designed to decrease cough and sore throat during emergence. Hence there was a need for the study. Methods: After approval from institutional Ethical Committee, Kasturba Medical college, Mangaluru and written informed consent from 120 patients of A.S.A class I & II, aged between 18-60 years posted for various surgeries were included. Randomization was done into three groups of 40 patients each. Group 1 – Normal saline, group 2 - 2% Lignocaine and group 3 - 4% Lignocaine. Postoperatively patients were assessed for incidence of cough and sore throat pain based on visual analogue scale (VAS) Results: 65% of patients in group 2 and 72% of patients in group 3 were extubated smoothly, whereas only 20% of patients in group 1 had smooth extubation, p<0.001. There was significant difference in sore throat pain and cough in group 2 and 3 when compared to group 1. Conclusion: The incidence of sore throat and cough was significantly reduced with Lignocaine in the endotracheal tube cuff when compared to saline. Lignocaine 4% was found to be far more better than 2% in reducing sore throat.