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Background: Anaesthesiologists most commonly perform the procedure of internal jugular vein cannulation(IJV) in emergency and also in elective cases. With the use of ultrasound guidance placement of guide wire and catheter into the internal jugular vein has been made easy, safe and with less complications. Aims: The aim of the study was to compare IJ vein cannulation under ultrasound guidance with respect to Short and Long axis (SA and LA) view approaches. Methods: Patients who may require central venous cannulation for undergoing surgery and will be in intensive care unit were randomized using computer generated randomization for ultrasound guided cannulation into one of short axis and long axis (SA and LA) approaches group. Success rate of first pass, number of needle attempts made, guide wire insertion time, catheter placement time and complications were noted for each procedure. Results: Successful cannulation of IJV was achieved in all the patients. Significant results were not noted among the two groups with respect to demographic profile of the patient, catheter placement time, rate of carotid artery puncture. Whereas a significant result was noted in terms of success rate of first pass (97% in SA v/s 53% in LA, P-0.0001), number of needle attempts (mean of 1.05±0.18 in SA v/s 1.55±0.68 in LA, P-0.0001), guide wire insertion time (mean of 43.20±5.64 in SA v/s 74.83±39.36 in LA). Conclusion: We conclude from the above study that short axis view approach is better with respect to success rate of first pass, number of needle attempts and guide wire insertion time than long axis view approach for internal jugular vein cannulation under ultrasound guidance.

Background: Transverse abdominus plane (TAP) block is a regional anesthetic technique which provides an excellent analgesia without major adverse effects. The primary aim of this study was to evaluate the efficacy of dexmedetomidine in comparison to tramadol when added as adjuvant to levobupivacaine in TAP block on duration of post operative analgesia following laproscopic orchidopexy. Methods: Sixty American Society of Anaesthesiologists (ASA) grade 1 pediatric patients undergoing laproscopic orchidopexy under general anaesthesia were randomized into two groups (GroupLD and Group LT). Group LD recieved ultrasound guided bilateral TAP block with 0.3 ml/kg 0.25% levobupivacaine with 1µg/ kg of dexmedetomidine on both sides and Group LT recieved TAP block with 0.3 ml/kg 0.25% levobupivacaine with 1mg/ kg of tramadol. During the first 24 h postoperatively, we assessed hemodynamic stability, respiratory depression, and postoperative pain using face, legs, activity, cry, consolability (FLACC) pain scale. Results: Total duration of analgesia (986.67 ± 47.29 min vs. 690 ± 53.49 min, P value- 0.000), and the total consumption of paracetamol in the first 24 hours postoperatively (324.28 ± 35.5 mg vs. 580.14 ± 38.23, P value – 0.000) were statistically highly significant in group LD in comparison to group LT. The FLACC score were lower in Group LD as compared to group LT and side effects profile were similar in both the groups. Conclusion: Dexmedetomidine in a dose of 1 μg.kg-1 when added to levobupivacaine in ultrasound guided transverse abdominus plane block significantly prolongs the duration of postoperative analgesia as compared to tramadol with levobupivacaine without major side effects.

Background and Aims: Majority of patients undergoing modi􀃶ed radical mastectomy experience severe acute postoperative pain. Pectoral nerve block (Pecs) using local anesthetic agent is a novel analgesic technique for breast surgeries. The present study evaluates the effect of incorporation of dexmedetomidine as an adjuvant to ropivacaine on duration of analgesia and postoperative morphine consumption. Material and Methods: Sixty female patients with American Society of Anesthesiologist status I and II posted for modi􀃶ed radical mastectomy were enrolled and randomized into two equal groups. Group R (n = 30) received ultrasound guided Pecs block with 20 ml of 0.5% ropivacaine. Group RD (n = 30 patients) received ultrasound guided Pecs block with 20 ml of ropivacaine 0.5% and dexmedetomidine 0.5 μ/kg body weight. Statistical analysis was done by using Unpaired t-test and Chi-square test. Results: Total duration of analgesia (in minutes) was signi􀃶cantly higher in Group RD as compared to Group R (465.2 ± 10.42 in Group RD and 311.3 ± 16.35 in Group R) (P = 0.000). We observed signi􀃶cantly lesser consumption of morphine in Group RD as compared to Group R (13.86 ± 1.8 in Group RD and 23.5 ± 1.7 in Group R) (P = 0.000). None of our patients reported any side effects. Conclusion: Dexmedetomidine 0.5 μ/kg added as an adjuvant to 0.5% ropivacaine for ultrasound guided Pecs block prolongs the duration of analgesia and reduces postoperative morphine consumption. [ABSTRACT FROM AUTHOR]

Background and Aims: Hypotension occurs in most of the cases following subarachnoid block in for cesarean sections. Studies comparing different bolus doses of phenylephrine for preventing hypotension induced by subarachnoid block in cesarean sections are sparse. Settings and Design: This study was conducted to compare the efficacy of two different bolus doses of phenylephrine for preventing subarachnoid block-induced hypotension in cesarean sections. Materials and Methods: Sixty parturients undergoing cesarean section were allocated into two groups. Group A (n = 30) received 150 mcg phenylephrine intravenously (IV) and Group B (n = 30) received 200 mcg phenylephrine IV prophylactically immediately after subarachnoid block. Then, for every 2 min, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate (HR) were measured for 20 min, and APGAR scores were measured. Statistical Analysis: The observations are expressed as mean ± standard deviation and were compared using unpaired t-test. The statistical significance of difference between groups was based on P value. P < 0.05 was considered statistically significant. Results: There was no difference in preventing hypotension in both the groups, the incidence in Group A being 16.6% and Group B also 16.6%. However, the rise in systolic pressure in Group B was higher than Group A in the first 2–6 min. The incidence of bradycardia was higher in Group B (43.3%) than Group A (20%). Conclusions: Both the doses of phenylephrine were equally efficient in prevention of hypotension after subarachnoid block. Lower prophylactic bolus phenylephrine 150 mcg IV is better in the prevention of hypotension after subarachnoid block in cesarean sections as the incidence of bradycardia is higher with phenylephrine 200 mcg. [ABSTRACT FROM AUTHOR]

Background and Aims: Cardiovascular stress response to extubation can result in elevated heart rate (HR) and mean arterial blood pressures which can be detrimental in high-risk patients. Settings and Design: The objective of this study is to compare the esmolol and labetalol efficacy in attenuating hemodynamic response to tracheal extubation. Materials and Methods: Sixty patients scheduled for elective surgical procedures were selected randomly and divided into two groups of thirty each. Group I - esmolol 1.5 mg/kg and Group II - labetalol 0.25 mg/kg were administered 2 min before extubation after following a standard perioperative anesthetic management. Hemodynamic parameters recorded include HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) at baseline, reversal, study drug, 1 min after study drug, extubation, and at 1, 2, 3, 4, 5, and 15 min postextubation. Statistical Analysis: Student's t-test and analysis of variance have been used to find the significance of study parameters between groups of patients. P <0.05 was considered statistically significant. Results: Both esmolol and labetalol obtunded extubation response throughout the extubation and postextubation period. At extubation and immediately postextubation at 1st and 2nd min, there was statistical significance (P < 0.05) in SBP, DBP, and MAP which showed esmolol was better than labetalol. Whereas labetalol was more efficient in controlling HR at 5th and 15th min postextubation having statistical significance. Conclusions: Both esmolol and labetalol attenuated hemodynamic response. Esmolol was more efficient than labetalol at extubation and immediately postextubation. If patient has tachycardia at extubation, labetalol is preferred. If patient has raised blood pressure, then esmolol is a good option in blunting the response. [ABSTRACT FROM AUTHOR]