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Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee. Arthroscopic ACL reconstruction is the gold standard procedure for treating ACL tears. Good postoperative analgesia is the secret for immediate postoperative rehabilitation. Various techniques, such as Femoral Nerve Blocks (FNB), epidural blocks, adductor canal blocks, and Intra-Articular injections (IA), are used to manage postoperative pain. Aim: To compare the quality of postoperative analgesia using a combination of levobupivacaine with clonidine via IA and FNB in patients undergoing ACL reconstruction under spinal anaesthesia. Materials and Methods: This randomised, double-blinded trial was conducted at Pondicherry Institute of Medical Sciences, Puducherry, India, from August 2016 to May 2018. Forty patients with American Society of Anaesthesiologists (ASA) physical status I and II, aged between 18-60 years, undergoing arthroscopic ACL repair under spinal anaesthesia were randomly assigned to two groups, with 20 patients in each group. After the surgery, patients in group 1 received FNB with 15 mL of 0.25% levobupivacaine and 30 mcg clonidine, while patients in group 2 received IA with 15 mL of 0.25% levobupivacaine and 30 mcg clonidine. Parameters such as the total duration of sensory block, the need for rescue analgesia, and total analgesic consumption within 24 hours were recorded postoperatively. The data were analysed using Student’s unpaired t-test, Analysis of Variance (ANOVA), Chi-square test, and Fisher’s-exact test. Statistical analysis was performed using Statistical package for the Social Science (SPSS) software (version 20.0 and info version 3.5.1) for Windows, with a p-value <0.05 considered significant. Results: The quality of postoperative analgesia, including the total duration of block, the need for rescue analgesia, and total analgesic consumption within 24 hours, was similar in both groups. The total duration of block was 216±36.041 minutes for the FNB group and 224±47.395 minutes for the intra-articular group, with a p-value of 0.552. The time for rescue analgesia was 307±87.666 minutes for the FNB group and 305±82.00 minutes for the intra-articular group, with a p-value of 0.963. There were no significant differences between the groups in terms of sex, age, weight, or ASA physical status classification. Conclusion: The present study showed that the postoperative analgesia following arthroscopic ACL reconstruction was equally effective in both groups. Both combinations reduced postoperative pain, expedited the return of postoperative function, maintained vital parameters, and had no apparent side-effects. However, IA may be considered as the preferred option since it is easier to perform than a femoral block. [ABSTRACT FROM AUTHOR]

Adverse drug reactions are defined as the effects created by drugs producing unintended or noxious response in doses normally used for prophylaxis, diagnosis or therapy of diseases. Adverse drug reactions under anaesthesia occur by a number of mechanisms and several risk factors are often involved. The overall incidence of adverse drug reactions to anaesthetic drugs ranges between 1 in 10,000 and 1 in 20,000. Electronic databases were searched to obtain the relevant literature with keywords related to adverse drug reactions and anaesthesia. Total 110 articles were reviewed, bibliography cross-checked and relevant literature was included. This article discusses about the adverse drug reactions to various anaesthetic as well as non anaesthetic drugs used intraoperatively. Anaphylaxis under anaesthesia, its pathophysiology, clinical and laboratory diagnosis, management and prevention has also been discussed in detail. Allergic drug reactions and anaphylaxis in the operating room often presents unique diagnostic concerns as the early signs of anaphylaxis are often masked under general anaesthesia. The use of surgical drapes and use of multiple potential allergen drugs under anaesthesia also make the diagnostic process difficult. Thus, an adequate knowledge, understanding, vigilance and proper documentation with reporting in case of an event is warranted by the attending anaesthesiologist for a good perioperative outcome with decreased morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: A wide array of drugs are available for blunting the laryngoscopy response. Amongst them both dexmedetomidine, and esmolol belong to the non-opioid group having least interference with the recovery process without causing significant respiratory depression, thus are suitable intervention for this purpose. Dexmedetomidine a sedative highly selective α2 adrenoceptor agonist and has an anaesthetic-sparing effect at induction. It suppresses the release of catecholamine in response to a noxious stimulant because of its central sympatholytic action. Esmolol with a different pharmacokinetic profile is a water soluble, cardio-selective, an ultrashort acting beta blocker has a short t1/2 thus suited for suppressing the transient pressor reflexes following acute noxious surgical or anesthesia stimuli. Aim: To compare the degree of attenuation of the laryngoscopy response following the use of single preinduction dose (Intravenous infusion at a dose of 1 µg/kg) of dexmedetomidine with that of esmolol (intravenous bolus at a dose of 0.5 mg/kg) in adult normotensives undergoing elective intubations. Materials and Methods: The randomised clinical trial was conducted in Pondicherry Institute of Medical Sciences from September 2016 to March 2018, on 60 patients of either sex, aged between 20-60 years with American Society of Anesthesiologists (ASA) physical status I or II requiring elective intubations for general surgical procedures. The patients were randomly divided into two groups (n=30 each). Prior to induction group A received 1 µg/kg dexmedetomidine IV infusion over 10 min, and group B received 100 mL IV infusion of normal saline over 10 min. Also 2 minute before laryngoscopy group A received 10 mL of normal saline (IV) bolus, whereas, group B received esmolol 0.5 mg/kg IV diluted in 10 mL of normal saline as a bolus. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded at baseline i.e, pre-procedure before the study drug infusion, preinduction, at laryngoscopy (0min) and 1,3,5 min after intubation. A rise of MAP and/or HR more than 20% from the baseline was considered as positive laryngoscopy response. Student's unpaired t-test was used for analysis of inter group variables. Intra group variables were analysed using repeated measures Analysis Of Variance (ANOVA). results: Mean age of patients in group A was 38.77±13.082 years and group B was 37.20±13.069 years (p-value=0.644). Results revealed that both the groups had an increase in HR and MAP at 1 minute after laryngoscopy and intubation. Mean readings of MAP showed a maximum rise of group A (2.15%) vs group B (7.25%) from the baseline readings at 1min following laryngoscopy which showed no statistical significance. The maximum HR increase following laryngoscopy was at 1 minute in group A (8.28%) vs group B (13.59%), which were below the positive laryngoscopy response. The mean HR, SBP, DBP and MAP recorded at preinduction, at laryngoscopy, 1, 3 and 5 mins following intubation showed no statistical difference (p-value >0.05) between the two groups. conclusion: Usage of single dose preinduction dexmedetomidine iv infusion 1 µg/kg over 10 min was found to be equally effective in blunting the pressor response to laryngoscopy and intubation when compared to bolus dose of iv esmolol 0.5 mg/kg given 2 min prior to laryngoscopy. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasonography (USG) guided supraclavicular block is an excellent choice for upper limb surgeries. It not only allows smaller volumes of local anaesthetic usage but also provides optimal tourniquet coverage. Ropivacaine is structurally related to bupivacaine with reduced potential for toxicity and improved sensory and motor blocking profiles. Nalbuphine acquired a significant place in pain control but its efficacy as a local anaesthetic adjuvant is yet to be proved in peripheral nerve blockades. Aim: To evaluate the efficacy of adding nalbuphine to ropivacaine in supraclavicular brachial plexus blockade and to assess the quality of block for patients undergoing ambulatory forearm and hand surgeries. Materials and Methods: Seventy American Society of Anesthesiologists (ASA) grade 1 and 2 patients were randomised into two groups of 35 each. Group A (n=35): received 24 mL of 0.5% of ropivacaine + 1 mL of nalbuphine (10 mg) and Group B (n=35): received 24 mL of 0.5% of ropivacaine + 1 mL of normal saline. The parameters observed were duration of analgesia, onset of sensory and motor blockade, duration of motor blockade and haemodynamic changes during the procedure. Categorical variables were analysed using the Pearson's Chi-square test. Continuous variables were analysed using the independent sample t-test and p<0.05 was considered as statistically significant. Results: The onset of sensory and motor blockades were faster in the nalbuphine group compared to the control group (p<0.001). The duration of sensory and motor blockades was similarly longer in nalbuphine group (p<0.001). Also, the mean duration of analgesia was significantly longer with nalbuphine group (p<0.001). Conclusion: Nalbuphine significantly prolonged the duration of analgesia and duration of block while accelerating the onset of blockade thereby improving the overall quality of blockade. [ABSTRACT FROM AUTHOR]

Introduction: The use of Ultrasound (USG) for needle precision aids in reduction of local anaesthetic volume needed for peripheral nerve blockade. Conventional dosages of 30 to 40 mL of local anaesthetic mixture have been used in peripheral nerve blockades but using a lesser volume will reduce the incidence of local anaesthesia associated systemic toxicity. Aim: To assess the efficacy of two different doses 20 mL and 25 mL of Bupivacaine in USG guided axillary plexus block. Materials and Methods: Sixty patients requiring forearm and hand surgeries were randomised into two groups. Group A received low volume (20 mL of 0.375% bupivacaine) and group B received intermediate volume (25 mL of 0.375% bupivacaine). The quality of anaesthesia in regards to sensory and motor blockade, duration of analgesia, haemodynamic variability and complications were evaluated. Successful block was defined by Vester Anderson’s criteria. Duration of analgesia was measured using Visual Analogue Scale (VAS). Statistical comparison of all continuous variables were assessed utilising Student’s t-test and Mann-Whitney U-test as applicable. Results: No significant difference in onset times were observed as far as sensory and motor blockade was concerned between the two groups A and B with p-values of 0.69 and 0.40, respectively. Group B had significantly longer duration of block in comparison with Group A (p<0.001). Two patients in group A and one patient in Group B required supplemental analgesia with fentanyl boluses. Haemodynamics were stable and no complications were seen in both the groups. Conclusion: Lower volume of Bupivacaine is convincingly prudent for regional blockade under USG guidance than suggested in literature. [ABSTRACT FROM AUTHOR]

Introduction: Patients with suspected cervical spine fracture or cervical pathology, utmost care has to be taken while intubating these patients to prevent further cervical cord injury. Protective measures include application of rigid collar, a forehead tape and manual inline stabilisation. Application of these manoeuvres reduces the cervical spine movement, making it more difficult to intubate. Aim: To compare the performance of McCoy blade with C-MAC D blade for endotracheal intubation in patients with simulated cervical spine injury. Materials and Methods: One hundred and twenty adult patients were randomly allocated into two groups to achieve tracheal intubation with McCoy (group M=sixty patients), or C-MAC D video laryngoscopes (group C=sixty patients). The ASA patients of grade I-II undergoing elective surgery for having immobilised cervical spine using manual inline axial cervical spine stabilisation technique were enrolled in the study. Patient's Comparative data on the total time to intubate (Z-test), Cormack- Lehane (CL) laryngoscopic view (Chi-Square test), number of optimising manoeuvres (Yate's corrected Chi-Square test) and haemodynamic variables (Z-test) were recorded in both groups. Results: The time taken for tracheal tube insertion was significantly longer with C-MAC D blade group of thirty eight seconds compared with McCoy blade group which was thirty one seconds. There was an increase in heart rate at first and second minute in both the groups which returned back to normal after five minutes. Good grade glottic visualisation was obtained with both the laryngoscopic blades. Conclusion: C-MAC D blade as well as McCoy blade forms an effective tool for the airway management of suspected cervical spine injured patients with cervical immobilisation. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative Nausea and Vomiting (PONV) is defined as any nausea or vomiting that occurs during the first 48 hours after surgery. It is considered as a distressing event following anaesthesia. The incidences of PONV is 25-30% in all post-surgical patients and the incidence of PONV with middle ear surgeries are 50%-80%. Various pharmacological techniques were used to prevent PONV. Five-HT3 receptor antagonists are most commonly used prophylactic agents. Aim: To compare the efficacy and safety of intravenous Palonosetron 75 mcg, and intravenous Dexamethasone 8 mg in preventing PONV. Materials and Methods: Hundred patients of 18-60 years undergoing ear and nose surgeries under general anaesthesia requiring intubation for more than one hour were randomised into two groups of 50 patients each. Group P received 75mcg of palanosetron and Group D received 8 mg of dexamethasone before induction. The incidence of PONV in the two groups was noted using a four point score until 24 hours postoperatively. Results: The overall incidence of PONV in 0-24 hours were maximum in the dexamethasone group with 50% and 20% in palanosetron group. The four point score was higher in dexamethasone group compared to palanosetron group & with statistically significant difference. The requirement of rescue antiemetic medication was 30% in dexamethasone group and 10% in palanosetron group. Conclusion: Our study has shown that palanosetron is more effective in the prevention of PONV without apparent side effects. [ABSTRACT FROM AUTHOR]

Introduction: Supraclavicular brachial plexus block is commonly performed for upper limb surgeries. A variety of adjuvants are added to the local anaesthetic to fasten the onset and prolong the duration of sensorimotor block. Aim: To assess the efficacy of two different doses of Dexmeditomidine as an adjuvant in supraclavicular brachial plexus block. Materials and Methods: This was a prospective randomised study conducted on 99 ASA I and II patients, aged 18-60 years, posted for upper limb surgeries. Patients were randomised into three groups. Group S received 25 mL of 0.5% bupivacaine and 2 mL of NS, Group D20 received 25 mL of 0.5% bupivacaine and 20 μg of Dexmeditomidine in 2 mL NS, Group D40 received 25 mL of 0.5% bupivacaine and 40 μg of Dexmeditomidine in 2 mL NS. Statistical analysis was performed using ANOVA test and Bonferoni's correction for intergroup comparison. Results: The onset of sensory block was faster in D40 group (8.94±2.99 minutes) compared to D20 (14.55±2.89 minutes) and S group (21.36±4.3 minutes). The onset of motor blockade was 24.55±4.5 minutes in S group, 16.97±16.97 minutes in D20 group and 10.15±2.92 minutes in D40 group. Duration of sensory block was longer in D40 (14.47±0.975 hours) compared to D20 (12.52±1.307 hours) and S group (7.27±1.26 hours). The total mean duration of motor blockade was 6.242±1.22 hours in S group, 11.17±1.254 hours in D20 group and 13.09±1.18 hours in D40 group. The haemodynamic parameters were comparable in all the three groups. Conclusion: Faster onset, longer duration of sensorimotor blockade and prolonged postoperative analgesia proved Dexmeditomidine was effective when used with bupivacaine as an adjuvant in supraclavicular blocks and the effect is also dose dependent. [ABSTRACT FROM AUTHOR]

Introduction: General Anaesthesia should provide rapid smooth induction and optimal conditions during the perioperative period. It should also provide rapid recovery and minimum monitoring period to meet discharge criteria in Post Anaesthesia Care Unit (PACU). Aim: To assess the efficacy of sevoflurane and desflurane with regards to emergence and recovery in surgical procedures lasting less than 120 minutes when used as maintenance anaesthetic agents. Materials and Methods: This was a hospital based prospective randomised study. After obtaining informed and written consent, 60 patients belonging to ASA I or II scheduled for surgery under general anaesthesia were recruited and distributed to two groups each of 30 to receive sevoflurane or desflurane for maintenance of anaesthesia after randomization with computer generated numbers. Unpaired t-test and chi-square test were used for qualitative data, ANOVA for quantitative data and Mann-Whitney test was used for Modified Aldrete Score (MAS). Results: The mean duration of surgery was 92.83±25.820 minutes in desflurane and 92.67±28.062 minutes in sevoflurane groups, the time for spontaneous eye opening on verbal commands was 5.17±1.48 minutes in desflurane group compared to sevoflurane group which was 8.96±1.58 minutes with mean difference of 3.79±0.1 minutes, p-value<0.001, 95% confidence interval 3.7 (2.703 to 4.953). A median MAS of 10 was attained at five minutes in desflurane group and 15 minutes in sevoflurane group, in PACU and was statistically significant (p<0.001). Conclusion: Desflurane had faster emergence and early recovery from anaesthesia with clear-headedness than sevoflurane. [ABSTRACT FROM AUTHOR]

Introduction: For any surgery in the upper extremity that does not involve the shoulder, a supraclavicular block is preferred, as it is a safe procedure associated with rapid onset and reliable anaesthesia. Although ropivacaine has been extensively studied for epidural anaesthesia, very few reports exist on its use in supraclavicular brachial plexus block. Aim: This study was conducted to investigate and compare the effectiveness of supraclavicular brachial plexus anaesthesia with two different concentrations of ropivacaine (0.5% and 0.75%) and to compare them with the standard 0.5% bupivacaine. Materials and Methods: Ninety patients of age 18 to 60 years belonging to American Society of Anaesthesiologists (ASA) status 1 or 2, admitted to Pondicherry Institute of Medical Sciences were chosen for the study and were divided into three groups. Group A received 30 ml of 0.5% bupivacaine, group B received 30 ml of 0.5% ropivacaine and group C received 30 ml of 0.75% ropivacaine into the supraclavicular region, by a nerve-stimulator technique. Onset time of each of the drug was recorded both for the sensory and motor block. Duration of sensory and motor block was recorded along with perioperative haemodynamic monitoring. Results: The onset of complete sensory and motor block observed with both ropivacaine groups and bupivacaine was similar (16.85 ± 6.67 min in group A, 17.79 ± 5.03 min in group B and 18.48 ± 6.14 in group C, p < 0.05); onset of motor block (21.45 ± 4.45 min in group A, 22.23 ± 4.05 min in group B and 22.33 ± 5.17 in group C, p < 0.05). The duration of sensory block with 0.5% bupivacaine was 11.58 hours, with 0.5% ropivacaine was 9.02 hours with 0.75% ropivacaine was 8.87 hours (p<0.001). The duration of motor block with 0.5% bupivacaine was 12.94 hours, with 0.5% ropivacaine was 8.29 hours with 0.75% ropivacaine was 7.89 hours (p<0.001). Multiple comparison test with Bonferroni correction showed there was statistically significant difference in mean duration of sensory block between Group A (0.5% bupivacaine) and Group B (0.5% ropivacaine) and also between Group A (0.5% bupivacaine) and Group C (0.75% ropivacaine). However, there were no statistically significant difference in mean duration of sensory block between Group B (0.5% ropivacaine) and Group C (0.75% ropivacaine). The preoperative, intra operative and postoperative heart rate, systolic & diastolic blood pressure and oxygen saturation were comparable among the three study groups (p>0.05). No side effects were recorded in the study. Conclusion: The onset of sensory and motor block was similar in all the three groups. However, when compared to bupivacaine group, recovery of motor functions was faster in both the ropivacaine groups. Patients in all the 3 groups did not experience any adverse effects. [ABSTRACT FROM AUTHOR]

Background: Genetic variations in the promoter of uridine diphosphate (UDP)-glucuronosyltransferase 1A1 (UGT1A1) may be associated with hyperbilirubinaemia and it appears to be a risk factor for gallstone formation. Aims: Our aim was to detect the correlation between the UGT 1A1 (TA)n repeats and hyperbilirubinaemia and gall stone formation in Indian sickle cell patients. Settings and Design:This was a cross-sectional study; which was carried in an autonomous tertiary care hospital. Materials and Methods: The study subjects were 50 sickle cell anaemia and 70 sickle cell β-thalassaemia patients who were diagnosed by HPLC. The haemogram of the patients was measured by using an automated cell analyzer, while the serum bilrubin measurement was done by using a Beckman- CX-9 auto analyzer. The presence of gall stones was detected by ultra sound examination. Statistical Analysis: ANOVA and the T-test were applied to compare the means of the groups. The allele frequencies were calculated according to the Hardy-Weinberg equilibrium. Results: The allele, 7/7 TA of the UGT1A1 genotype was more frequent in the sickle cell patients and it was associated with hyperbilirubinaemia and gall stone formation. Conclusions: The allele, 7/7 TA of the UGT1A1 polymorphism affects the bilirubin levels and the development of gallbladder stone in the Indian sickle cell patients. [ABSTRACT FROM AUTHOR]

Treating pain that patient experiences from repair of distal clavicle fracture can be a challenge for the anaesthesiolgists. The primary technique employed in the management of distal clavicular surgeries is by incorporating the use of interscalene block. One important factor that reduces the overall effectiveness of the interscalene block is the inability to cover area incised for the surgery due to the dual innervation in this region. While in contrast the use of cervical plexus block for clavicular pain is relatively new, studies have shown that the combination of superficial cervical plexus and selective C5 nerve root blockade under USG is a novel approach to alleviate the pain associated with distal clavicular fracture repair. In this case report, authors describe the use of combination of Ultrasound guided superficial cervical plexus plus superior trunk interscalene block as sole anaesthetic technique in management of right Acromial-clavicular disruption. [ABSTRACT FROM AUTHOR]