Background and Aims:Bupivacaine has been the most frequently used local anaesthetic in brachial plexus block, but ropivacaine has also been successfully tried in the recent past. It is less cardiotoxic, less arrhythmogenic, less toxic to the central nervous system than bupivacaine, and it has intrinsic vasoconstrictor property. The effects of clonidine have been studied in peripheral nerve blockade. The purpose of this study was to evaluate the effects of clonidine on nerve blockade during brachial plexus block with ropivacaine using peripheral nerve stimulator.Methods:Sixty patients were randomly divided into two groups, Group A and B. Group A received 30 ml of 0.5% of ropivacaine with 0.5 ml normal saline while Group B received same amount of ropivacaine with 0.5 ml (equivalent to 75 μg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia and intra and post-operative complications.Results:There was a significant increase in duration of motor and sensory block and analgesia in Group B as compared to Group A patients (P < 0.0001). There was no significant difference in onset time in either group (P = 0.304). No significant side effects were noted.Conclusion:The addition of 75 μg of clonidine to ropivacaine for brachial plexus block prolongs motor and sensory block and analgesia without significant side effects.

A B S T R A C TBackground: Laryngoscopy and intubation are associated with a sympathetically mediated circulatory response due to irritation of respiratory tract which is associated with increase in pulse rate and blood pressure that may be dangerous. Aims and Objectives: The aim of the present study was to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation and to detect any complication or side effect as a result of these drugs. Materials and Methods: Following approval by ethical committee, 60 ASA grade I and II patients of either sex undergoing general anaesthesia for elective surgery were included in this study. Patients were randomly divided into two groups of 30 patients each. Dexmedetomidine in a dose of 1µg/kg was given to Group A patients and Fentanyl 2 µg/kg was given to Group B patients. Both the drugs were diluted with normal saline solution to make 10ml and were administered slow intravenous 10 min before induction.The hemodynamic parameters were recorded, demographic data was analyzed using unpaired t-test and hemodynamic variables were analyzed by using unpaired and paired t-test. Side effects were analyzed using chi square test. Result: The two groups were comparable in their demographic profiles. Dexmedetomidine proved itself to be an excellent drug when given intravenously as a premedicant in dose of 1µg/kg to attenuate hemodynamic response to laryngoscopy and intubation. It blunted the hemodynamic response to laryngoscopy and intubation to a greater magnitude than fentanylin a dose of 2µg/kg intravenously as a premedicant. Conclusion: We conclude that fentanyl 2µg/kg i.v. given ten minutes prior to airway instrumentation shows an inconsistent response to laryngoscopy and intubation. Between the two drugs under study, the use of dexmedetomidine 1µg/kg i.v. is satisfactory and produces a more favorable hemodynamic profile while fentanyl 2µg/kg is found to be non-dependable and less effective for the attenuation of the pressor response to laryngoscopy and endotracheal intubation. However, further larger studies are required to strengthen these conclusions.

Background: Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and King Vision video laryngoscopes in patients with immobilized cervical spine. Method: Ninety adult patients of ASA grade I-II with immobilized cervical spine using manual inline axial cervical spine stabilization technique, undergoing elective cervical surgery were enrolled. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh (MAC group n=30), McCoy (MCC group n=30), or King Vision video laryngoscopes (KVL group). When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening (POGO) score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Haemodynamic parameters and any airway complications were also recorded. Result: King Vision video laryngoscope reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the King Vision video laryngoscope group. However, there were no statistically significant differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. Conclusion: The use of a King Vision video laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

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