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Hypotension is a frequent complication of spinal anesthesia. Decrease in peripheral vascular tone that occurs during pregnancy is one of the factors causing hypotension in patients undergoing cesarean section under spinal anesthesia. Perfusion index derived from pulse oximeter can be an easy and non-invasive measure of peripheral perfusion. This study was conducted to test the usefulness of pulse oximeter in predicting hypotension following spinal anesthesia for cesarean section. In this study, 247 parturients undergoing elective cesarean section under spinal anesthesia were included. Parturients who had baseline PI3.5 were kept in Group II. All the patients were given 0.5% bupivacaine heavy 2.2 ml for spinal anesthesia. In group I, 30 patients (23.62%) had hypotension whereas in Group II, 119 patients (100%) had hypotension. The episodes of hypotension were significantly lower in Group I as compared to Group II (p3.5 is a prediction of hypotension following spinal anesthesia in patients undergoing cesarean section.

Introduction: Dexmedetomidine has an ideal pharmacodynamic profile for attenuation of stress response during general anesthesia for laparoscopic cholecystectomy. Since, the value of dexmedetomidine as a single premedication dose remains largely unexplored, this study compared dexmedetomidine in 0.5μg/kg and 1μg/kg dose for laparoscopic cholecystectomy under general anesthesia. Objectives: The primary objective of this study was to compare dexmedetomidine in a single premedication dose of 0.5μg/kg and 1μg/kg in terms of hemodynamic (heart rate and mean arterial pressure) changes to critical incidences such as laryngoscopy, endotracheal intubation, pneumoperitoneum and extubation. The secondary objectives were to compare induction dose of propofol required, sedation scores in the immediate post anesthesia period and adverse events such as bradycardia and hypotension. Methodology: This was a prospective double blind study. Ninety-two patients aged 18-55 years of either gender of American Society of Anesthesiologists physical status I-II were randomly allocated into two groups to receive either Dexmedetomidine 1μg/kg or 0.5μg/kg slowly IV over 10 minutes as a premedication before induction. Heart rate, Mean arterial pressure, induction dose of propofol, sedation scores, and adverse events were compared. Results: The patient characteristics, Fentanyl consumption, duration of surgery and anesthesia in both groups were comparable. There was comparable attenuation of hemodynamics in both groups during laryngoscopy and intubation. Dexmedetomidine in 1μg/kg compared to 0.5μg/kg had significantly better attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum. After 40 minutes, there was no attenuation in either group. The post anesthesia sedation scores were comparable. The induction dose of propofol was significantly less and the incidence of bradycardia was significantly higher with dexmedetomidine 1μg/kg. Conclusion This study demonstrates that a premedication dose of Dexmedetomidine in 1μg/kg compared to 0.5μg/kg has significantly betier attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum.

Laryngoscopy and end tracheal intubation are stressful situation for the patients, as these procedures are capable of producing tachycardia, hypertension and arrhythmias. This study was conducted with the objective of arriving at an optimal dose of dexmedetomidine that can attenuate the hemodynamic response to laryngoscopy and intubation with minimal side effects. The current study was conducted in 60 patients, posted for elective surgery under general anesthesia withendotracheal intubation. The patients were divided into two groups: Group A and Group B. Group A received dexmedetomidine 0.5 μg/kg and group B received dexmedetomidine 1 μg/kg intravenously over 10 min prior to induction of anesthesia. The anesthesia technique was standardized in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were monitored and recorded at 5min and 10 min of completion of infusion of study drug, after induction, and at 1 min, 2 min, 5 min after intubation. The baseline heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were statistically similar in both the groups. After the infusion of the study drug the mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure at all times were comparable in both the groups. Episodes of hypotension and bradycardia were also statistically similar in both the groups. Attenuation of hemodynamic response to laryngoscopy and intubation by dexmedetomidine is similar with the two doses: 0.5 μg/kg and 1 μg/kg. Both the doses of dexmedetomidine were devoid of any significant adverse effects.

Background: Laryngoscopy and intubation cause hypertension and tachycardia which can lead to myocardial ischemia or cerebrovascular hemorrhage in patients with raised intracranial pressure, hypertension. The objective of this study was to compare the efficacy of dexmedetomidine (1 mcg/kg) and fentanyl (2 mcg/kg) in attenuating hemodynamic response to laryngoscopy and intubation. Methods: Sixty patients scheduled for elective surgeries under general anaesthesia were randomly divided into two groups: Group D and Group F. Group D received dexmedetomidine 1 mcg/kg and group F received fentanyl 2 mcg/kg intravenously over 10 min prior to induction of anesthesia. All the drugs and techniques of anesthesia were standardized in patients in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were recorded at following intervals: at baseline, after drug administration (at 2 and 5 min), after induction, and at 1, 2 and 5 min after intubation. Results: Heart rate and blood pressure was found to be significantly lower in dexmedetomidine group as compared to fentanyl group at 1, 2 and 5 min after intubation. Conclusions: Dexmedetomidine 1 mcg/kg is superior to fentanyl 2 mcg/kg for attenuation of hemodynamic response to laryngoscopy and intubation.

Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist. Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia. Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups. Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication. Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.

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Introduction: Laparoscopic surgeries are known to be associated with a higher incidence of postoperative nausea and vomiting. Prophylaxis of PONV is usually achieved with a single-dose antiemetic drug administered during the surgical procedure. The aim of this study was to compare the antiemetic efficacy of two different 5-hydroxytryptamine-3 receptor antagonists, ondansetron and granisetron when given prophylactically to patients undergoing laparoscopic cholecystectomy.Methods: It was a randomized, double blind study, conducted in 90 patients. Patients were divided into two groups: Group A and Group B with 45 patients in each group. Patients in groupA were given 100microgram/kg ondansetron intravenously (IV),and patients in Group B were given 40 microgram/kg granisetron. Both the drugs were diluted in 10 ml of 0.9% NaCl and were given at the end of surgery. The standard general anesthetic technique was administered to all the patients. Episodes of nausea, retching and vomiting were assessed during the first 24 hours after anesthesia.Results: There was no statistically significant difference for demographic data and duration of surgery among the two groups (P > 0.05). Evaluated nausea and vomiting scores in the first 3hours period revealed that each of the drugs had a similar antiemetic effect (P > 0.05). Between 4–12 hours also the episodes of nausea, retching as well as vomiting were statistically insignificant in both the groups. In the last 12 hours, episodes of nausea, retching and vomiting were significantly higher in ondansetron group.Conclusions: Granisetron, when given prophylactically, resulted in a significantly lower incidence of PONV than ondansetron in the first 24 hours.Keywords: Granisetron; Laparoscopic cholecystectomy; Ondansetron; postoperative nausea vomiting.