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Introduction: Endotracheal intubation often triggers a sympathetic response, leading to an increase in Heart Rate (HR) and blood pressure. Dexmedetomidine (DEX) and lignocaine have shown the potential to mitigate cardiovascular changes secondary to intubation. Aim: To compare the efficacy of 0.25 mcg/kg and 0.5 mcg/kg DEX with 1.5 mg/kg lignocaine in attenuating haemodynamic responses during the peri-intubation period. Materials and Methods: This randomised double-blind study included 90 patients classified as American Society of Anaesthesiologists (ASA) I and II, aged 16-65 years. Patients were divided into three groups: Group A received lignocaine (1.5 mg/kg); Group B received DEX (0.25 mcg/kg); and Group C received DEX (0.5 mcg/kg). Haemodynamic parameters were recorded at various intervals before and after laryngoscopy. Data were checked for normality before statistical analysis using the Shapiro-Wilk test. Normally distributed continuous variables were compared using Analysis of Variance (ANOVA), while categorical variables were analysed using the Chi-square test. For all statistical tests, a p-value of less than 0.05 was considered indicative of a significant difference. Results: All groups were found to be comparable in terms of age, weight, and gender distribution. The mean age in Group A was 36.10±12.60 years, in Group B was 36.10±13.47 years, and in Group C was 37.37±11.49 years. Inter-group comparisons between Group A and Group C showed statistically significant lower HR values in Group C (79.23±10.37 vs. 90.7±17.68) at T0 as well as T1 (90.07±14.65 vs. 99.93±17.02, p-value 0.019). The comparison between Groups A and C revealed significantly lower Systolic Blood Pressure (SBP) values in Group C at T0, T1, T3, and T5. Inter-group comparisons between Groups A and B showed that Diastolic Blood Pressure (DBP) values were significantly lower at T5 in Group B (69.33±10.09 vs. 62.33±9.11, p-value 0.006). Between Groups A and C, significant differences were noted at T0, T1, T3, and T5 in Mean Arterial Pressure (MAP). Conclusion: DEX at a dose of 0.5 mcg/kg appears to be a more effective option for managing haemodynamic responses compared to lignocaine. Nevertheless, the haemodynamic stability achieved with 0.25 mcg/kg of DEX is nearly equivalent to that observed with both 0.5 mcg/kg of DEX and 1.5 mg/kg of lignocaine. [ABSTRACT FROM AUTHOR]

Background, Aims and Objectives: Shivering is a common problem in obstetric patients undergoing cesarean section under spinal anaesthesia and its incidence is approximately 30% to 55%. Aim of our study was to compare the efficacy of intravenous Dexmedetomidine, intravenous Tramadol with placebo in prevention of post-spinal anaesthesia shivering in obstetric patients undergoing caesarean section. Secondary objective was to observe any side effects like nausea, vomiting, hypotension, bradycardia and sedation. Materials and methods: This prospective, randomized, and double-blinded study was conducted in the department of Anaesthesia, PGIMS, Rohtak . 126 Healthy pregnant women, 20-40 years of age, without any comorbid conditions requiring caesarean section under spinal anaesthesia were enrolled for the study and randomly allocated into one of the three groups according to computer generated randomisation . Group A (n=41) received 0.5 mcg/kg Dexmedetomidine, Group B (n=43) 0.5 mg/kg Tramadol and Group C (n=42) plain 100 mL normal saline IV infusion after spinal anaesthesia and delivery of baby. Shivering, sedation, blood pressure, heart rate was measured intraoperatively. Result: All data were summarised as mean ± SD for continuous variables, numbers and percentages for categorical variables. There was a significant difference between the various groups in terms of distribution of Incidence of Shivering (χ2 = 48.199, p-value < 0.001) . 9.8% (n=4) of the participants in the Group A, 53.5% (n=23) of the participants in the Group B, and 85.7% (n=36) of the participants in the Group C had shivering. Conclusion: This study showed dexmedetomidine as a better drug for the prevention of shivering after spinal anaesthesia as compared to tramadol as it has a low incidence of shivering, benefits of awake sedation and not associated with nausea and vomiting. [ABSTRACT FROM AUTHOR]

Introduction: The Laryngeal Mask Airway (LMA) is frequently used for managing paediatric airways for short surgical procedures. While it is easy to insert, it can lead to several complications if not removed at the appropriate plane of anaesthesia. Aim: To establish better timing for the removal of the LMA in deeply anaesthetised and awake paediatric patients by comparing the complications associated with each approach. Materials and Methods: The present randomised clinical study, enrolled 90 American Society of Anaesthesiologists (ASA) I and II paediatric patients aged 1 to 12 years, posted for elective short surgical procedures under general anaesthesia with airway management by Classical LMA. The patients were allocated into two groups: Group D (LMA removal under a deep plane/surgical plane of anaesthesia) and Group A (LMA removal in a fully awake state). At emergence from anaesthesia and during LMA removal, both groups were studied for complications including cough, desaturation (SpO2 < 95%), excessive salivation, vomiting, and laryngospasm. Descriptive statistics were reported using mean±standard deviation or median (range) for continuous variables. Comparison of continuous variables was done using the Student's t-test or Wilcoxon rank sum test. Results: Demographic data like age, weight, duration of surgery, heart rate, and respiratory rate were comparable in both groups. A significantly higher incidence of cough was found in group A compared to group D (p-value=0.001). The incidences of desaturation (p-value=1.000), excessive salivation (p-value=0.361), vomiting (p-value=1.000), and laryngospasm (p-value=0.142) were comparable between the two groups. Cough was the most frequent complication in group A (16 out of 45 patients), while laryngospasm was the most frequent complication in group D (8 out of 45 patients). The total number of complications (p-value=0.043) was significantly higher in group A compared to group D. Conclusion: The removal of the Classical LMA in paediatric patients can be safely carried out in a deeply anaesthetised state. Based on the results of present study, the removal of the LMA in deeply anaesthetised paediatric patients is associated with fewer complications compared to its removal in the awake state. [ABSTRACT FROM AUTHOR]

Byline: Teena. Bansal, Rajmala. Jaiswal, Manju. Bala, Deepika. Seelwal Sir, Peripartum cardiomyopathy leading to decreased ejection fraction affects the parturient during late pregnancy or immediately after delivery. Anaesthetic management of [...]

Introduction: Transurethral Resection of Prostate (TURP) is a common surgical procedure performed for Benign Prostatic Hypertrophy (BPH), most commonly under Spinal Anaesthesia (SA). It is generally tolerated well by the elderly but since they suffer from several co-morbidities, therefore, it is desirable to avoid hypotension following SA, in these patients. Levobupivacaine, a pure S enantiomer of racemic bupivacaine has emerged as a safe alternative to bupivacaine with similar efficacy and better pharmacokinetic profile. Aim: To compare the efficacy of intrathecal levobupivacaine with bupivacaine using fentanyl as adjuvant in TURP. Materials and Methods: This randomised controlled trial was conducted at Pandit BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, between March 2022 to September 2022. Fifty patients, 50-80 years of age, American Society of Anaesthesiologists (ASA) I-III, posted for TURP under SA, were included in the study and divided into two groups: group B (n=25): Inj. bupivacaine (0.5%) hyperbaric 12.5 mg+25 µg fentanyl citrate, group L (n=25): Inj. levobupivacaine (0.5%) isobaric 12.5mg+25µg fentanyl citrate. Onset of sensory and motor block, time to onset of maximum sensory and motor block, Heart Rate (HR), Systolic Bood Pressure (SBP), Diastolic Bood Pressure (DBP) and Mean Arterial Pressures (MAP) were recorded. Data analysis was done with the help computer software using Statistical Package for the Social Sciences (SPSS), version 24.0. Means, standard deviations, Chi-square, t-values and p-values were calculated, p-value <0.05 was considered significant at 95% confidence level. Results: Demographic data of the patients was comparable. The mean time to onset of sensory block in group B was significantly faster (3.72±0.96 min) than group L (4.47±0.73 min). The mean time to onset of motor block was faster in group B (4.74±0.91 min) than group L (7.57±1.51 min). HR was lower in group B, after SA at 5, 10, 15, 20, 30, and 45 min after SA. Group B recorded a lower SBP, DBP and MAP following SA, compared to group L (p<0.001). The duration of analgesia was significantly longer in group B (232.80±14.07 min vs 221.80±15.47 min in group L) (p<0.05). No adverse effects were reported from either of the groups. Conclusion: Levobupivacaine provided very stable haemodynamics, good quality analgesia and muscle relaxation intraoperatively. Postoperative analgesia was clinically similar to bupivacaine, no adverse effects were reported. Thus, levobupivacaine is a safe and reliable alternative to bupivacaine for elderly patients undergoing TURP. [ABSTRACT FROM AUTHOR]