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Background: In this study, we wanted to compare the haemodynamic responses to endotracheal intubation using Intubating Laryngeal mask airway (ILMA Fastrach TM) and direct laryngoscopy in adult patients with normal airway. Methods: This was a hospitalbased study conducted among 60 ASA grade I and II patients undergoing elective lumbar spine surgeries under general anaesthesia. They were grouped into two groups, group I - Laryngoscopy group and group II - ILMA Fastrach TM (group II). Circulatory response to intubation was recorded in both groups by invasive arterial Blood Pressure(BP) monitoring device placed before induction of anaesthesia. The values were recorded at pre induction, at induction, every minute post induction for 3minutes and at ILMA / laryngoscopy, every 10 second post intubation for 2 minutes followed by every minute for next 3 minutes. The maximum values and maximum increase in BP and HR were recorded in both groups. Results:Intubation through I LMA-Fastrach™ was associated with significantly lower cardiovascular responses compared to direct laryngoscopy and intubation. There was a significant increase in blood pressure and heart rate from baseline in both the groups. The maximum increase was above or equal to preinduction values with laryngoscopy and intubation. The maximum values in I LMA (Fastrach™) group were never beyond preinduction values with respect to changes in blood pressure. The maximum increase in blood pressure and heart rate from respective base line values were similar between the two groups. This occurred in spite of longer time required for intubation in I LMA(Fastrach™) group in comparison with laryngoscopy group. Conclusion:The intubation done through ILMA(Fastrach™) was associated with lesser haemodynamic response associated with intubation in adult normotensive patients with normal airway. [ABSTRACT FROM AUTHOR]

Heart rate, arterial blood pressure, and arrhythmias significantly surge during laryngoscopy and intubation. Anesthesiologists constantly look for ways to minimize these unwanted reactions. Several medicinal interventions have been suggested to mitigate these side effects; intravenous magnesium sulphate injection is one such intervention. Magnesium sulphate is a divalent salt widely recognized for its capacity to lower sympathetic nervous system muscle cell excitability, which lowers blood pressure and causes vasodilation. It is approved as a medicine to treat preeclampsia and control blood pressure. Moreover, there is growing recognition of its benefits on hemodynamic parameters in patients suffering from ischemic infective endocarditis and heart disease. Magnesium is an asset for reducing negative cardiovascular reactions occurring at the time of laryngoscopy and intubation because of its capacity to reduce catecholamine synthesis from adrenergic nerve ends and the adrenal medulla. Intravenous magnesium sulphate will be used in this trial to assess its effect on reducing adverse hemodynamic responses in candidates for elective laryngoscopy and intubation for ENT surgeries.

Context: Our aim was to study the haemodynamic response to endotracheal intubation through Linscope and compare it to the hemodynamic response to intubation with Kingvision video laryngoscope. The Kingvision has demonstrated promise in a number of settings while Linscope video laryngoscope is a newly launched device and no literature is available to the best of our knowledge. Aims: We aimed to compare the Linscope video laryngoscope with Kingvision video laryngoscope for haemodynamic response. Settings and Design: A Randomized Controlled Study. Methods and Material: Seventy patients after approval from Board of Study and ethical clearance divided into 2 groups. In Group A patient were intubated with Linscope videolayngoscope and in Group B patient were intubated with Kingvision videolaryngoscope as per the protocol. Hemodynamic parameters, mean arterial blood pressure and heart rate were recorded before and after induction of anesthesia and every minute up to 5 min after intubation. Results: Patients of Group A recorded a minimal rise in peak mean arterial blood pressure. In comparison patients of Group B recorded a significant sustained rise in mean arterial blood pressure The insertion of endotracheal tube through kingvision video laryngoscope assembly precipitated a rise in mean arterial blood pressure. However, this rise was not statistically significant when compared with baseline value. The increase in heart rate changes were recorded in both the groups, of which immediate post intubation Group B showed significant rise but overall, the rise was not significant. Conclusion: We conclude that intubation through Linscope generates a lower pressor response to intubation in comparison to intubation using Kingvision video laryngoscope. [ABSTRACT FROM AUTHOR]

Background: During laparoscopic surgeries immediately after pneumoperitoneum, hemodynamic alterations, which include decreased cardiac output (25%-35%), elevated mean arterial pressure & Increased systemic / pulmonary vascular resistance are seen. Present study was aimed to evaluate and compare the effect of intravenous clonidine versus dexmedetomidine for maintaining haemodynamic stability in patient undergoing laparoscopic surgery. Material and Methods: Present study was hospital based prospective study, conducted in patients of age group 18 - 60 years, of either sex, with ASA physical status I & II, undergoing laparoscopic surgery under general anaesthesia. On the day of surgery, patients were randomly allocated into two groups as group C (received 2 µg/kg of clonidine) & group D (received 1 µg/kg of dexmedetomidine) 10 mins prior induction of GA. Results: On comparison of age, gender, weight and duration of surgery in both the groups, p Values were insignificant (p > 0.05). In our study, post-extubation SBP values increased by 9.8% and 8.4% in Group D and Group C respectively. There was significant difference between the two groups (P < 0.05) at T105, T110, T115, T120 and Extubation respectively. There was significant difference between the two groups (P < 0.05) at T95, T100 T105, T110, T115, T120 and Extubation respectively. Group D more effectively controlled the dip than group C. There was significant difference between the MAP of two groups (P < 0.05) at T85, T90, T95T100, T110, T115, T120 and Extubation respectively. Regarding hypotension, bradycardia & tachycardia among both the groups, difference was not statistically significant. Conclusion: Our study has shown that, dexmedetomidine blunts haemodynamic response to laryngoscopy and tracheal intubation as well as it also improves intraoperative haemodynamic stability, causes postoperative sedation and decreases analgesic requirement just as clonidine. [ABSTRACT FROM AUTHOR]

Background: The surgeries performed with securement of airway with endotracheal tube placement will be followed by extubation at the end of surgical procedure. Extubation may be associated with upper airway obstruction, laryngospasm, bronchospasm, tachycardia, hypertension and dysrhythmiasTracheal. Extubation evokes various haemodynamic stress response in the form of tachycardia, raised blood pressure,changes in the heart rhythm which is detrimental to susceptible patients. Hence a study is needed to find a pharmacological drug to attenuate the stress response to extubation. Aims and Objectives: To analyze the efficacy of iv labetalol 0.25/mg/kg in attenuation of haemodynamic response to extubation. Materials & Methods: 64 participants belonging to ASA 1 or 2 of age group 18 – 55yrs were randomly divided into groups of 2. Group Lt received injection Labetalol iv 0.25mg/kg and group Ct received normal saline. Heart rate,systolic and diastolic blood pressure were recorded at baseline, 2,5,8 minutes after drug infusion, at extubation, and 1,3,5,8,10 and 15 minutes post extubation. Results and Observations: Group Lt showed lowered heart rate, systolic and diastolic blood pressure at extubation and 15minutes post extubation compared to group CT. Conclusion: Injection Labetalol iv 0.25mg/kg effectively attenuated the haemodynamic stress response to extubation. [ABSTRACT FROM AUTHOR]

Introduction: Extubation of the trachea upon emergence from General Anaesthesia (GA) is often accompanied by potentially dangerous events, like coughing, hypertension, tachycardia, and agitation. The centrally acting a-2 agonist, dexmedetomidine, has been evaluated to attenuate the emergence/extubation response. However, there is insufficient evidence regarding the effectiveness of clonidine for the same purpose. Aim: This study aimed to evaluate the quality of emergence from GA in patients receiving clonidine infusion versus dexmedetomidine infusion. Materials and Methods: In this randomised, double-blinded trial conducted over a period of 5 months, 105 patients aged 18-70 years, of either sex, with American Society of Anaesthesiologists (ASA) grade I-III, scheduled for elective laparotomies with an estimated duration of 1-4 hours, were randomly assigned to groups D, C, and P. Group D received inj. dexmedetomidine 1 µg/kg, group C received clonidine 3 µg/kg, and group P received placebo (normal saline) via Intravenous (i.v.) route over 10 minutes using a syringe pump, 10 minutes prior to the anticipated end of surgery. Haemodynamic parameters, cough, agitation, shivering, time to extubation, sedation, Visual Analogue Score (VAS), and Postoperative Nausea and Vomiting (PONV) scores were recorded before, during, and after extubation. The incidence of complications (hypotension, bradycardia, or others) was also recorded. Categorical data were expressed as proportions, while numerical data were presented as mean±Standard Deviation (SD) or median±Interquartile Range (IQR). Appropriate data were compared using Statistical Package for Social Sciences (SPSS) version 16.0. Results: A total of 105 patients were included, with 53 males and 52 females. There was no difference in the demographic characteristics, such as age, gender, and Body Mass Index (BMI), amongst the three groups. Haemodynamic parameters (Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)) were significantly lower in patients of group D and group C compared to the placebo group at 5, 10, 10, and 15 minutes, respectively, after the beginning of drug infusion (p-value <0.05). Patients in groups D and C had significantly lower median cough scores at 20-25 minutes compared to the placebo group (p-value at 20 and 25 minutes was 0.012 and <0.001, respectively). There was a significant reduction in postoperative pain, as measured by VAS score, and an increase in sedation, as measured by Ramsay sedation score, in groups D and C compared to the placebo group. There was no statistical difference in agitation score, shivering score, PONV score, time to extubation, and incidence of complications among the three groups (p-value >0.05). Conclusion: Administration of 1 µg/kg of dexmedetomidine or 3 µg/kg of clonidine over 10 minutes prior to recovery from General Endotracheal Tube Anaesthesia (GETA) results in a better quality of recovery, as evidenced by a statistically significant reduction in cough scores in patients undergoing elective laparotomies when compared to patients of placebo group. [ABSTRACT FROM AUTHOR]

Background: The study was undertaken to compare between infusion of Dexmedetomidine and infusion of Magnesium sulfate on haemodynamic changes in laparoscopic surgeries under general anaesthesia – a prospective, randomized, double-blind study Materials and Methods: 80 patients of ASA grade I and II of both sexes undergoing elective surgery in SPS Hospitals, Ludhiana. They were randomly divided into two groups of forty each. Group M received Magnesium Sulfate 30mg/kg in 100ml NS over 10 mins as loading dose followed by 10mg/kg/h in NS to make 50ml and given as infusion. Group D received Dexmedetomidine 1mcg/kg in 100ml NS over 10mins as loading dose followed by 0.2mcg/kg/h in NS to make 50ml and given as infusion. Haemodynamic parameters were noted every 5 mins starting from the time when patient was shifted to operating room to initial 30 mins of pneumoperitoneum and thereafter every 10 mins till the time of deflation. Results: Attenuation of haemodynamic response during pneumoperitoneum was better with Dexmedetomidine group. More number of patients were comfortable with sedation score 2 or 3 (Modified Ramsay Sedation Score) while using Dexmedetomidine group for the first 30 mins than Magnesium Sulfate. No significant adverse effects were noted in both groups. Conclusion: Dexmedetomidine infusion even at a dose of 0.2mcg/kg/h provides a better attenuation of haemodynamic changes during pneumoperitoneum than Magnesium Sulfate in Laparoscopic surgeries. Dexmedetomidine also provides a better sedation score in terms of benefits versus side effects in patients.

Introduction: Extubation of the trachea upon emergence from General Anaesthesia (GA) is often accompanied by potentially dangerous events, like coughing, hypertension, tachycardia, and agitation. The centrally acting a -2 agonist, dexmedetomidine, has been evaluated to attenuate the emergence/extubation response. However, there is insufficient evidence regarding the effectiveness of clonidine for the same purpose. Aim: This study aimed to evaluate the quality of emergence from GA in patients receiving clonidine infusion versus dexmedetomidine infusion. Materials and Methods: In this randomised, double-blinded trial conducted over a period of 5 months, 105 patients aged 18-70 years, of either sex, with American Society of Anaesthesiologists (ASA) grade I-III, scheduled for elective laparotomies with an estimated duration of 1-4 hours, were randomly assigned to groups D, C, and P. Group D received inj. dexmedetomidine 1 μg/kg, group C received clonidine 3 μg/kg, and group P received placebo (normal saline) via intravenous (i.v.) route over 10 minutes using a syringe pump, 10 minutes prior to the anticipated end of surgery. Haemodynamic parameters, cough, agitation, shivering, time to extubation, sedation, Visual Analogue Score (VAS), and Postoperative Nausea and Vomiting (PONV) scores were recorded before, during, and after extubation. The incidence of complications (hypotension, bradycardia, or others) was also recorded. Categorical data were expressed as proportions, while numerical data were presented as mean±Standard Deviation (SD) or median±Interquartile Range (IQR). Appropriate data were compared using Statistical Package for Social Sciences (SPSS) version 16.0. Results: A total of 105 patients were included, with 53 males and 52 females. There was no difference in the demographic characteristics, such as age, gender, and Body Mass Index (BMI), amongst the three groups. Haemodynamic parameters (Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)) were significantly lower in patients of group D and group C compared to the placebo group at 5, 10, 10, and 15 minutes, respectively, after the beginning of drug infusion (p-value 0.05). Conclusion: Administration of 1 μg/kg of dexmedetomidine or 3 μg/kg of clonidine over 10 minutes prior to recovery from General Endotracheal Tube Anaesthesia (GETA) results in a better quality of recovery, as evidenced by a statistically significant reduction in cough scores in patients undergoing elective laparotomies when compared to patients of placebo group.

Objective: To compare the haemodynamic response of both a ketamine-propofol (ketofol) combination and etomidate for anaesthesia induction in patients undergoing coronary artery bypass grafting (CABG). Methods: This randomised study was conducted in 120 patients (n = 60 for each group) who were scheduled for elective CABG surgery. Patients in group K received ketofol (a ketamine and propofol combination [1:1]) and group E received etomidate, until loss of verbal response. Baseline haemodynamic variables including heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI) and systemic vascular resistance (SVR) were measured for all patients at 1, 2 and 3 minutes post induction. Serum cortisol and blood sugar levels were also compared before induction, after cardiopulmonary bypass (CPB) and at 24 hours postoperatively. Results: Statistically significant reduction occurred in HR, SAP, DAP and MAP from baseline until 3 minutes post induction in both groups (p < 0.001), but intergroup comparison was comparable. Maximum fall in CO and CI from baseline at 3 minutes were greater in group E than in group K (38.18% and 22.36%, and 34.16% and 19.86%, respectively). Maximum fall in SVR at 3 minutes post induction was greater in group K than in group E and was statistically significant (p < 0.05). Significant increase in cortisol levels occurred within group K from baseline until 24 hours postoperatively. Significant fall in serum cortisol levels occurred after weaning off CPB within group E, which returned to almost baseline at 24 hours. Blood glucose levels rose from baseline until 24 hours postoperatively in both groups, but peaked more in group K after weaning from CPB than in group E (p < 0.05). Conclusion: We concluded that both ketofol and etomidate produced stable haemodynamics in patients undergoing CABG. [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: 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 half-life (t1/2) thus suited for suppressing the transient pressor reflexes following acute noxious surgical or anaesthesia 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, Puducherry, India from September 2016 to March 2018, on 60 patients of either sex, aged between 20-60 years with American Society of Anaesthesiologist (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 Intravenous (i.v.) infusion over 10 minute, and group B received 100 mL IV infusion of normal saline over 10 minute. 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, preprocedure before the study drug infusion, preinduction, at laryngoscopy (0 min) and 1, 3, 5 minute 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 intergroup variables. Intragroup 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 1 minute 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 minutes 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 minute 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 minute prior to laryngoscopy.

Background and Aims: Glidescope®videolaryngoscope (GVL) is a video intubation system with 60° angle blade that provides excellent laryngeal view, does not require alignment of oral, pharyngeal, and laryngeal axes for visualisation of glottis, thus causing less stimulation of orolaryngopharynx. The aim of this study was to compare haemodynamic responses (blood pressure and heart rate) and airway morbidity using the Macintosh direct laryngoscope (MDL) and the Glidescope®videolaryngoscope (GVL) in hypertensive patients. Methods: Fifty patients with hypertension controlled on antihypertensive medications scheduled for elective surgery under general anaesthesia were randomly assigned to group GVL (n = 25) or group MDL (n = 25). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) were recorded at baseline, after induction, pre-intubation, at intubation, 1, 2, 3, 4, and 5 min after intubation. Time to intubation, number of attempts, complications during intubation, and postoperative airway complications (sore throat, hoarseness, dysphagia, and cough) were also recorded. Results: There was a statistically significant increase in SBP, DBP, and MBP at intubation [(P = 0.003, 0.013, 0.03), 1 min (P = 0.001, 0.012, 0.02), 2 min (P = 0.04, 0.02, 0.04), and 3 min (P = 0.02, 0.01)] in the MDL group as compared to GVL group. The time to intubate was significantly greater in the GVL group as compared to MDL group (P = 0.0006). There was no significant difference in the incidence of intraoperative and postoperative airway complications. Conclusion: In the hands of an experienced anaesthesiologist, the use of GVL in controlled hypertensive patients is associated with less haemodynamic response as compared to Macintosh Laryngoscope without any increase in airway complications.

Purpose: To investigate haemoglobin oxygenation in the visual cortex of myopic patients using functional near‐infrared spectroscopy (fNIRS). Methods: The experiment consisted of two parts. Part 1 examined functional changes in the visual cortex before and after refractive correction in myopic patients. Subjects were divided into normal controls, uncorrected and corrected myopes. Part 2 examined functional changes in the visual cortex caused by lens‐induced myopia in normal subjects, and whether this activity recovered after a period of rest. Here, subjects were divided into three groups: emmetropes, lens‐induced myopia and a rest group. The rest group completed a test with the uncorrected eye following lens removal and 5 min of rest. The visual stimulus was a black and white checkerboard. fNIRS was used to detect changes in oxyhaemoglobin content within the visual cortex. The original fNIRS data were analysed using MATLAB to obtain the β values (the visual cortical activity response caused by the task); these were used to calculate Δβ, which represents the degree of change in oxygenated haemoglobin caused by visual stimulation. Results: The Δβ value measured in each single channel or only in the region of interest (ROI) was significantly higher in the emmetropic control group than the uncorrected myopic group. After optical correction, the responses of myopic subjects approached those of the emmetropes and were not significantly different. If myopia was induced in emmetropic subjects by imposing defocus with positive lenses, a decline in functional activity was observed similar that observed in uncorrected myopes. Activity recovered after the lenses were removed. Conclusions: Myopic defocus reduced the level of haemoglobin oxygenation in the visual cortex, but activity could be restored by optical correction. [ABSTRACT FROM AUTHOR]

Display luminance is one of the most important factors that influence not only display performance but also visual discomfort greatly. To investigate the influence of display luminance and image content on visual discomfort, the haemodynamic response and subjective perception were recorded respectively when participants watched different visual stimuli. Different white levels (WLs) of display and images with different spatial amplitude spectra were adopted as the visual stimuli, and specific dark environment was applied in the study. The results showed that under dark ambient condition, the WL had significant influences on visual discomfort, which varied in images with different spatial amplitude spectra. The findings also indicated that, for visual discomfort measurement, the sensitivity of haemodynamic response was better than subjective evaluation.

Background and aims Laryngoscopy and intubation cause an increased sympatho-adrenergic pressor response, which can be detrimental to patients with coronary artery disease, hypertension, etc. Various drugs and manoeuvres have been tried to reduce the pressor response with acceptable results but the quest for the ideal drug still continues. Hence, we planned to compare the effects of magnesium sulfate with paracetamol and fentanyl with lignocaine on attenuating the hemodynamic responses due to direct laryngoscopy and intubation and to note the complications of these drugs. Methods We studied 60 adult patients of the American Society of Anaesthesiologists (ASA) physical status I and II of either sex, scheduled for elective surgery under general anaesthesia. The patients were randomly divided into two groups. Group A received 25 mg/kg magnesium sulphate mixed with paracetamol 1 gram IV (100 ml) given over 10 minutes before induction and Group B received 2 mcg/kg fentanyl and 1.5 mg/kg lignocaine, 3 minutes before intubation. All patients were uniformly pre-medicated, induced, and intubated as per standard protocol. Heart rate (HR) and systemic arterial pressures were recorded at baseline, after study drug infusion, after induction, and 1, 3, 5, 10, and 15 mins after intubation. Hemodynamic parameters were compared using repeated measures analysis of variance (ANOVA). In the post-hoc tests, p value < 0.05 was considered statistically significant. Results We observed the mean pre-op HR (p = 0.161) and mean HR one-minute post-induction (p = 0.144). The percentage change from baseline at one-minute post-induction was 9.7 in Group A and 15.2 in Group B. We observed the mean pre-op mean arterial pressure (MAP) (p = 0.119) and mean MAP one minute post-induction (p = 0.585). The percentage change from baseline at one-minute post-induction was 3.3 in Group A and 2.8 in Group B. The percentage change from baseline was found to be within 15%, for HR in Group A and for systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP in Group B. However, there was no statistically significant difference (p > 0.05) between the mean HR, SBP, DBP, and MAP between the time points. Conclusion In our study, both the combinations of drugs, magnesium sulphate with paracetamol (Group A drugs) and fentanyl with lignocaine (Group B drugs) were found to be equally effective (i.e. neither group was superior to the other) in attenuating the hemodynamic response to laryngoscopy and intubation., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. PIMS Institute Ethics Committee (IEC) issued approval IEC: RC/19/112, CTRI/2019/12/022315, 11/12/2019. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Murugesan et al.)

Introduction: Supraglottic Airway Devices (SAD) are integral part of airway management during General Anaesthesia (GA) and are less invasive than endotracheal intubation. I-gel is a novel and innovative SAD, with non inflating cuff and it is widely used among available devices. Various drug combinations are being studied to obtain better insertion conditions. Lignocaine nebulisation is popularly used as topical anaesthesia for the airway. Authors hypothesised that it could improve the insertion conditions of the airway in addition to induction agents. Aim: To assess the efficacy of lignocaine nebulisation for I-gel insertion conditions in terms of the frequency of optimal insertion conditions and haemodynamic changes observed during and after the insertion of I-gel. Materials and Methods: This randomised controlled trial was conducted for one year from January 2019 to January 2020 in Karnataka Institute of Medical sciences, Hubli, Karnataka, India. Ninety patients of age group 18 to 45 years, belonging to American Society of Anaesthesiologists' (ASA) grade I and II, undergoing minor surgical procedures were included. They were randomised into two equal groups, group L received 5ml of 4% lignocaine and group D received 5 mL of normal saline nebulisation 5 minutes before induction of GA. Optimal insertion conditions (successful insertion at the first attempt without adverse response) and haemodynamic responses were noted down as primary and secondary outcomes respectively. The data was analysed using Chi-square test and Student's t-test according to parameters. Results: A total of 43 patients were in group lignocaine nebulisation (Group L) and 44 in the normal saline nebulisation group (Group D) and they had the mean age of 28.8±6.3 and 29.0±5.1 respectively. The optimal insertion (p-value 0.26), successful first attempt insertion (p-value 0.175) and time for insertion (p-value 0.512) were not statistically significant between the two groups. In group L at 1 and 5 minutes, fall in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was noted and compared with other group which was not statistically significant. Conclusion: Preinduction lignocaine nebulisation doesn't improve optimal insertion conditions of I-gel statistically. Even though better haemodynamic were noted with the same, it cannot be recommended for the sole purpose by nebulisation route. [ABSTRACT FROM AUTHOR]

Introduction: Supraglottic Airway Devices (SAD) are integral part of airway management during General Anaesthesia (GA) and are less invasive than endotracheal intubation. I-gel is a novel and innovative SAD, with non inflating cuff and it is widely used among available devices. Various drug combinations are being studied to obtain better insertion conditions. Lignocaine nebulisation is popularly used as topical anaesthesia for the airway. Authors hypothesised that it could improve the insertion conditions of the airway in addition to induction agents. Aim: To assess the efficacy of lignocaine nebulisation for I-gel insertion conditions in terms of the frequency of optimal insertion conditions and haemodynamic changes observed during and after the insertion of I-gel. Materials and Methods: This randomised controlled trial was conducted for one year from January 2019 to January 2020 in Karnataka Institute of Medical sciences, Hubli, Karnataka, India. Ninety patients of age group 18 to 45 years, belonging to American Society of Anaesthesiologists' (ASA) grade I and II, undergoing minor surgical procedures were included. They were randomised into two equal groups, group L received 5 mL of 4% lignocaine and group D received 5 mL of normal saline nebulisation 5 minutes before induction of GA. Optimal insertion conditions (successful insertion at the first attempt without adverse response) and haemodynamic responses were noted down as primary and secondary outcomes respectively. The data was analysed using Chi-square test and Student's t-test according to parameters. Results: A total of 43 patients were in group lignocaine nebulisation (Group L) and 44 in the normal saline nebulisation group (Group D) and they had the mean age of 28.8±6.3 and 29.0±5.1 respectively. The optimal insertion (p-value 0.26), successful first attempt insertion (p-value 0.175) and time for insertion (p-value 0.512) were not statistically significant between the two groups. In group L at 1 and 5 minutes, fall in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was noted and compared with other group which was not statistically significant. Conclusion: Preinduction lignocaine nebulisation doesn't improve optimal insertion conditions of I-gel statistically. Even though better haemodynamic were noted with the same, it cannot be recommended for the sole purpose by nebulisation route.

Background: Laryngoscopy and endotracheal intubation alters cardiovascular physiology causing hypertension and tachycardia. Dexmedetomidine, an alpha 2 adrenergic receptor produces analgesia by direct activation of descending inhibitory pain pathway and inhibiting the release of substance P. Clonidine a centrally acting alpha 2 adrenergic agonist decreases central sympathetic nervous system in all hyperadrenergic situations. Hence we compare haemodynamic effects between dexmedetomidine 0.5 mcg/kg and clonidine 1mcg/kg during after laryngoscopy and tracheal intubation for patients undergoing general anaesthesia. Method: Patients were allocated randomly into 2 groups of 30 each. Group D received dexmedetomidine 0.5mcg/kg diluted in 10ml NS and group C- clonidine 1 mcg/kg diluted in 10ml NS intravenously and hemodynamic parameters were observed. Dexmedetomidine/ Clonidine according to groups is given intravenously with premedication. After 5 minutes patients were induced with 2.5% thiopentone 5-7 mg/kg and succinyl choline 2mg/kg and intubated with appropriate sized cuffed ETT. Anaesthesia was maintained with O2, N2O, isoflurane and vecuronium bromide 0.08mg/kg. Results: Haemodynamic changes after laryngoscopy and intubation were recorded at baseline, premedication, induction, intubation, 1, 3, 5,10 and 15 minutes. The initial fall in HR is more in Group C compared to Group D but the difference was insignificant, but since intubation till 10min post intubation HR was significantly (p<0.05) supressed more in Group D. Similarly fall in SBP and DBP is significantly (p<0.05) more in Group D compared to Group C. Conclusion: Dexmedetomedine 0.5 mcg/kg intravenously 15 minutes prior to laryngoscopy and intubation attenuates the sympathetic response better as compared to clonidine without major side effects. [ABSTRACT FROM AUTHOR]

Background and Aims: Glidescope®videolaryngoscope (GVL) is a video intubation system with 60° angle blade that provides excellent laryngeal view, does not require alignment of oral, pharyngeal, and laryngeal axes for visualisation of glottis, thus causing less stimulation of orolaryngopharynx. The aim of this study was to compare haemodynamic responses (blood pressure and heart rate) and airway morbidity using the Macintosh direct laryngoscope (MDL) and the Glidescope®videolaryngoscope (GVL) in hypertensive patients. Methods: Fifty patients with hypertension controlled on antihypertensive medications scheduled for elective surgery under general anaesthesia were randomly assigned to group GVL (n = 25) or group MDL (n = 25). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) were recorded at baseline, after induction, pre-intubation, at intubation, 1, 2, 3, 4, and 5 min after intubation. Time to intubation, number of attempts, complications during intubation, and postoperative airway complications (sore throat, hoarseness, dysphagia, and cough) were also recorded. Results: There was a statistically significant increase in SBP, DBP, and MBP at intubation [(P = 0.003, 0.013, 0.03), 1 min (P = 0.001, 0.012, 0.02), 2 min (P = 0.04, 0.02, 0.04), and 3 min (P = 0.02, 0.01)] in the MDL group as compared to GVL group. The time to intubate was significantly greater in the GVL group as compared to MDL group (P = 0.0006). There was no significant difference in the incidence of intraoperative and postoperative airway complications. Conclusion: In the hands of an experienced anaesthesiologist, the use of GVL in controlled hypertensive patients is associated with less haemodynamic response as compared to Macintosh Laryngoscope without any increase in airway complications. [ABSTRACT FROM AUTHOR]

Early detection and evaluation of cognitive alteration in chronic liver disease is important for predicting the subsequent development of hepatic encephalopathy. While visuomotor tasks have been rigorously employed for cognitive evaluation in chronic liver disease, there is a paucity of auditory processing task. Here we focused on auditory perception and examined behavioral and haemodynamic responses to a melodic contour identification task (CIT) to compare cognitive abilities in patients with chronic liver disease (CLD, N = 30) and healthy controls (N = 25). Further, we used support vector machines to examine the optimal combination of channels of functional near-infrared spectroscopy that can classify cognitive alterations in CLD. Behavioral findings showed that CIT performance was significantly worse in the patient group and CIT significantly correlated with neurocognitive evaluation (i.e., number connection test, digit span test). The findings indicated that CIT can measure auditory cognitive capacity and its difference existing between patient group and healthy controls. Additionally, optimal subsets classified the 16-dimensional haemodynamic data with 78.35% classification accuracy, yielding markers of cognitive alterations in the prefrontal regions (CH6, CH7, CH10, CH13, CH14, and CH16). The results confirmed the potential use of behavioral as well as haemodynamic responses to music perception as an alternative or supplementary method for evaluating cognitive alterations in chronic liver disease.

Background: Videolaryngoscopes are now being advocated as the universal device for airway management due to their ability to provide an improved glottic visualisation. Due to their ability to see around the corners, they obviate the need to align the airway axes and thus may lead to less airway stimulation. This may result in less haemodynamic response during laryngoscopy and intubation. The present study was designed to compare the haemodynamic response to intubation with King Vision and C-MAC® videolaryngoscopes. Methods: After obtaining informed consent, adults with unanticipated difficult intubation, scheduled to undergo surgery under general anaesthesia were randomised to be intubated with either King Vision (Group K) or C-MAC® (Group C) videolaryngoscope. Following a standardised general anaesthesia induction protocol all subjects were intubated with the allocated videolaryngoscope and haemodynamic parameters (heart rate, systolic pressure, diastolic pressure and mean arterial pressure) were recorded at specific time points. Statistical analysis was done using the SPSS Software (version 18.0). Results: The changes in the heart rate, systolic pressure, diastolic pressure and mean arterial pressure following laryngoscopy and intubation with the allocated videolaryngoscope were statistically similar between the two groups at all time points. Conclusion: Haemodynamic responses to laryngoscopy and intubation with King Vision and C-MAC® videolaryngoscopes were similar.

Background: Multimodal therapy can be used for obtundation of the haemodynamic response to laryngoscopy and tracheal intubation. The current study was undertaken to compare the haemodynamic response to laryngoscopy and tracheal intubation after administration of 0.2 mg/kg morphine or 2 μg/kg fentanyl with 2% end tidal sevoflurane during induction of anaesthesia. Methods: Sixty patients were randomised into two equal groups to receive either 2% end tidal sevoflurane + fentanyl 2 μg/kg (Group SF) or 2% end tidal sevoflurane + morphine 0.2 mg/kg (Group SM). General anaesthesia technique was standardised for both the groups. Haemodynamic parameters heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded for 15 min. Results: The maximum increase in HR compared to baseline was statistically significant in Group SM (16.5%, P = 0.0002) which occurred at one min after tracheal intubation. The maximum increases in SBP, DBP and MAP compared to baseline occurred at one min after tracheal intubation in both the groups, Group SF (7.04%, 6.5% and 7.9% respectively) and Group SM (6.2%, 8.2% and 8.1% respectively) which was not statistically significant. The attenuation of haemodynamic response between the two groups was not statistically significant (for HR P = 0.1428, for SBP P = 0.8558, for DBP P = 0.1958 and for MAP P = 0.5303). Conclusions: With 2% end tidal sevoflurane during induction of anaesthesia, both 0.2 mg/kg morphine and 2 μg/kg fentanyl were equally effective in attenuating haemodynamic response to laryngoscopy and tracheal intubation. However morphine appeared to be less effective in attenuating the chronotropic response resulting in a greater increase in heart rate from baseline.

Background: The invention of McCoy blade in the early 1990s is a modification of the Macintosh blade with a hinged tip. The McCoy blade reduces the amount of force applied during laryngoscopy and endotracheal intubation, thus the increased reflex haemodynamic changes in response to tracheal intubation becomes less significant. Objective: To determine the advantages of McCoy blade laryngoscope in obtunding the pressor response, better glottic visualization and ease of intubation during laryngoscopy and endotracheal intubation as compared to Macintosh blade laryngoscope. Methods: The present study was done on 60 adult patients of ASA I and II, between the age group of 20 to 50 years. We observed the haemodynamic changes, glottic view and ease of intubation by using either Macintosh or McCoy blade laryngoscope during general anesthesia at laryngoscopy and endotracheal intubation. The changes in HR, SBP, DBP, and MAP were recorded before induction, at laryngoscopy and intubation and at 1 min, 3 min and 5 min after tracheal intubation. Glottic view obtained on laryngoscope was compared as per Cormack and Lehene grading. Tracheal intubation grading was also compared between the groups. Complications during the procedure like arrhythmias, injury, and bleeding were noted. Results: In our study, a significant haemodynamic changes were observed in both the groups following laryngoscopy and endotracheal intubation. The rise in HR, SBP, DBP and MAP were more significant with Macintosh blade laryngoscope, where as better visualization of the glottis, ease of intubation and less haemodynamic changes were noted with McCoy blade laryngoscope. Conclusion: McCoy blade laryngoscope produces significantly less marked haemodynamic changes, better glottic view and ease of intubation as compared to Macintosh blade laryngoscope during laryngoscopy and tracheal intubation.

Early detection and evaluation of cognitive alteration in chronic liver disease is important for predicting the subsequent development of hepatic encephalopathy. While visuomotor tasks have been rigorously employed for cognitive evaluation in chronic liver disease, there is a paucity of auditory processing task. Here we focused on auditory perception and examined behavioral and haemodynamic responses to a melodic contour identification task (CIT) to compare cognitive abilities in patients with chronic liver disease (CLD, N = 30) and healthy controls (N = 25). Further, we used support vector machines to examine the optimal combination of channels of functional near-infrared spectroscopy that can classify cognitive alterations in CLD. Behavioral findings showed that CIT performance was significantly worse in the patient group and CIT significantly correlated with neurocognitive evaluation (i.e., number connection test, digit span test). The findings indicated that CIT can measure auditory cognitive capacity and its difference existing between patient group and healthy controls. Additionally, optimal subsets classified the 16-dimensional haemodynamic data with 78.35% classification accuracy, yielding markers of cognitive alterations in the prefrontal regions (CH6, CH7, CH10, CH13, CH14, and CH16). The results confirmed the potential use of behavioral as well as haemodynamic responses to music perception as an alternative or supplementary method for evaluating cognitive alterations in chronic liver disease. [ABSTRACT FROM AUTHOR]

Background: Trypophobia is a common condition in which sufferers are averse to images of small holes arranged in clusters.Methods: We used photo-plethysmography to examine cardiovascular correlates and near infrared spectroscopy to examine cortical correlates of the phenomenon in order to validate the Trypophobia Questionnaire and explore the several interlinked explanations of the disorder.Results: Trypophobic images were found to increase both heart rate and heart rate variability, but only in individuals with high scores on the Trypophobia Questionnaire. Trypophobic images were also found to elicit larger haemodynamic responses in posterior cortical areas, but again only in individuals with high scores.Limitations: The results are consistent with a contribution from both parasympathetic and sympathetic systems.Conclusion: The data demonstrate the validity of the Trypophobia Questionnaire and show an involvement not only of the autonomic system but cortical mechanisms including cortical hyperexcitability. [ABSTRACT FROM AUTHOR]

Display luminance is one of the most important factors that influence not only display performance but also visual discomfort greatly. To investigate the influence of display luminance and image content on visual discomfort, the haemodynamic response and subjective perception were recorded respectively when participants watched different visual stimuli. Different white levels (WLs) of display and images with different spatial amplitude spectra were adopted as the visual stimuli, and specific dark environment was applied in the study. The results showed that under dark ambient condition, the WL had significant influences on visual discomfort, which varied in images with different spatial amplitude spectra. The findings also indicated that, for visual discomfort measurement, the sensitivity of haemodynamic response was better than subjective evaluation. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder (MDD) is a debilitating condition with a high disease burden and medical comorbidities. There are currently few to no validated biomarkers to guide the diagnosis and treatment of MDD. In the present study, we evaluated the differences between MDD patients and healthy controls (HCs) in terms of cortical haemodynamic responses during a verbal fluency test (VFT) using functional near-infrared spectroscopy (fNIRS) and serum amino acid profiles, and ascertained if these parameters were correlated with clinical characteristics. Methods: Twenty-five (25) patients with MDD and 25 age-, gender-, and ethnicity-matched HCs were recruited for the study. Real-time monitoring of the haemodynamic response during completion of a VFT was quantified using a 52-channel NIRS system. Serum samples were analysed and quantified by liquid chromatography-mass spectrometry for amino acid profiling. Receiver-operating characteristic (ROC) curves were used to classify potential candidate biomarkers. Results: The MDD patients had lower prefrontal and temporal activation during completion of the VFT than HCs. The MDD patients had lower mean concentrations of oxy-Hb in the left orbitofrontal cortex (OFC), and lower serum histidine levels. When the oxy-haemoglobin response was combined with the histidine concentration, the sensitivity and specificity of results improved significantly from 66.7% to 73.3% and from 65.0% to 90.0% respectively, as compared to results based only on the NIRS response. Conclusions: These findings demonstrate the use of combination biomarkers to aid in the diagnosis of MDD. This technique could be a useful approach to detect MDD with greater precision, but additional studies are required to validate the methodology.

Objectives: This study aimed to clarify haemodynamic responses of different age groups to simulated long working hours.Methods: Men of three age groups participated in this study (16 in their 30s (mean 33.9±2.7 years old), 15 in their 40s (45.5±2.9) and 16 in their 50s (54.1±2.7)). All participants conducted 12 45-min personal computer-based tasks from 09:00 to 22:00. Nine 10-min to 15-min breaks between task periods, a 1-hour break at noon, and a 50-min break in the evening were provided. Haemodynamic responses were measured during task periods. All participants had normal resting systolic blood pressure (SBP <140 mm Hg) and diastolic blood pressure (DBP<90 mm Hg), which were measured before tasks started in the morning. Two-way repeated-measures analysis of variances and multiple comparisons (Bonferroni) were conducted.Results: No haemodynamic indices were significantly different among groups at baseline. Compared with baseline, SBP was almost unchanged for the 30s group but increased for the 40s and 50s groups during task periods. The 50s group showed higher SBP compared with the 30s group especially in the latter half of the working hours (p<0.05). In addition, the 50s group also showed higher total peripheral resistance (TPR) than the 30s group (p<0.1).Conclusion: The 50s group showed higher SBP and TPR responses than the 30s group, especially in the latter half of working hours. These results suggest that older workers might suffer more cardiovascular damage related to long working hours. [ABSTRACT FROM AUTHOR]

Background: Multimodal therapy can be used for obtundation of the haemodynamic response to laryngoscopy and tracheal intubation. The current study was undertaken to compare the haemodynamic response to laryngoscopy and tracheal intubation after administration of 0.2 mg/kg morphine or 2 μg/kg fentanyl with 2% end tidal sevoflurane during induction of anaesthesia. Methods: Sixty patients were randomised into two equal groups to receive either 2% end tidal sevoflurane + fentanyl 2 μg/kg (Group SF) or 2% end tidal sevoflurane + morphine 0.2 mg/kg (Group SM). General anaesthesia technique was standardised for both the groups. Haemodynamic parameters heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded for 15 min. Results: The maximum increase in HR compared to baseline was statistically significant in Group SM (16.5%, P = 0.0002) which occurred at one min after tracheal intubation. The maximum increases in SBP, DBP and MAP compared to baseline occurred at one min after tracheal intubation in both the groups, Group SF (7.04%, 6.5% and 7.9% respectively) and Group SM (6.2%, 8.2% and 8.1% respectively) which was not statistically significant. The attenuation of haemodynamic response between the two groups was not statistically significant (for HR P = 0.1428, for SBP P = 0.8558, for DBP P = 0.1958 and for MAP P = 0.5303). Conclusions: With 2% end tidal sevoflurane during induction of anaesthesia, both 0.2 mg/kg morphine and 2 μg/kg fentanyl were equally effective in attenuating haemodynamic response to laryngoscopy and tracheal intubation. However morphine appeared to be less effective in attenuating the chronotropic response resulting in a greater increase in heart rate from baseline. [ABSTRACT FROM AUTHOR]

Background: In spine surgery rapid emergence and extubation with haemodynamic stability is crucial for early neurological examination. Here, we have studied the effect of α2 agonist – dexmedetomidine intravenous (IV) and lignocaine spray instilled into the endotracheal tube at the end of the procedure to attenuate the extubation responses. Methods: A total of 45 patients undergoing spine surgery were randomly allocated in three groups. After the return of spontaneous respiration, Group-D: Dexmedetomidine 0.3 mcg/kg IV, Group-L: 10% lignocaine spray 1.5 mg/kg through endotracheal route and Group-P: Normal saline IV given over 60 s. Haemodynamic responses (systolic blood pressure, diastolic blood pressure, mean arterial pressure [MAP], heart rate [HR] and SpO2) were recorded before and after administration of drugs and also duration of emergence, extubation, quality of extubation and post-operative sedation level were evaluated. Results: The increase in MAP and HR during extubation was significantly less in Group-D than Group-L and Group-P, 2 min after administration of the respective drugs (P < 0.05). There were no significant differences in the grade of a cough after extubation and post-operative sedation level. Conclusion: Dexmedetomidine (0.3 mcg/kg) attenuates haemodynamic response better than lignocaine spray (1.5 mg/kg) during emergence and extubation. It also provides smooth extubation and easy recovery without any post-operative sedative effect.