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Background: Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering. Aims and Objectives: In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering. Materials and Methods: Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted. Results: The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P

Background: Pain could lead to an increased consumption of opioids intraoperatively as well as postoperatively with subsequent side effects and prolonged post-operative recovery. Transverse abdominus plain (TAP) block is commonly used for post-operative analgesia. We wanted to study the effect of TAP block, when given as pre-emtive analgesia. Aims and Objectives: The study was conducted to ascertain the benefit TAP block when given before surgical incision. The primary objective was to study the intraoperative fentanyl requirement in patients undergoing Laparoscopic gynecological surgeries. The secondary objectives was to analyze the Intra-operative hemodynamic parameters, time needed to extubate the patient, sedation score, visual analog scale (VAS) scores, and the time of first rescue analgesia. Materials and Methods: Sixty-two eligible female patients posted for total laproscopic hysterectomy or Laproscopic-assisted Vaginal Hysterectomy coming were divided into two groups. Group A – Standard General Anaesthesia with pre-operative TAP block. Group B- Standard General Anaesthesia. Whenever there was 15% rise in heart rate (HR) or mean blood pressure (MBP) above the baseline, 20 mcg bolus of fentanyl was given. Total intra-operative Fentanyl consumption, intraoperative HR and MBP, time needed to extubate, post-operative sedation, VAS score, and time of first rescue analgesia was noted. Results: There was no difference in the demographic profile between two groups. The mean intraoperative fentanyl required was significantly higher in Group B (140.33±12.17 mcg) than in Group A (101.33±5.07 mcg). HR and MBP were lower in Group A throughout the procedure. The mean time of extubation was 5.4 min and 15.77 min in Group A and B. The mean sedation score observed was significantly higher up to 30 min in Group B. Mean Time of first rescue analgesia in Group A was 452.90±110.46 min and Group B was 240±89.13 min. Conclusion: Pre-operative TAP block given in laparoscopic gynecological surgeries decreases intraoperative fentanyl consumption leading to early extubation and causes less sedation in early post-operative period.

Background and Aims: General anaesthesia (GA) is the preferred modality for breast surgeries; however, neuraxial anaesthesia can be performed in cases where GA poses a significant risk. We hypothesise that neuraxial blockade is a safe and effective alternative to GA in short-duration breast surgeries. Methods: This randomised study included 30 patients of the American Society of Anesthesiologists physical status I and II, who were scheduled for elective breast surgeries of a duration of less than 90 min. Group I received thoracic spinal anaesthesia, while in Group II, standardised GA was administered. The primary outcome was the time to the first rescue analgesic, and the secondary outcomes were time to recovery, patient satisfaction and the cost incurred. Results: The demographic characteristics of both groups were comparable (P > 0.05). The time to first rescue analgesic in Group I was more than in Group II (P = 0.001). Patient satisfaction score was superior in Group I compared to Group II (P = 0.002). The average cost was lower in Group I compared to Group II (P = 0.002). Recovery was quicker in Group I than in Group II (P = 0.001). There were no significant haemodynamic disturbances or major complications in either group. Conclusion: Thoracic spinal anaesthesia is an excellent alternative to GA in terms of analgesic efficacy, patient satisfaction, recovery and cost-effectiveness for short-duration breast surgeries.

Background: Spinal anesthesia for cesarean section is associated with significant hypotension due to sympathetic blockade and can cause adverse maternal and fetal outcomes. Although hypotension is considered to be dose-dependent, choosing a dose of bupivacaine to achieve an adequate level of blockade without causing hypotension is a challenge. Methods: Ninety-six eligible parturients posted for elective cesarean section under spinal anesthesia were divided into two groups. Group H received intrathecal bupivacaine dose calculated as per patients’ height and Group HW received intrathecal bupivacaine dose calculated as per patients’ height and weight chart. Heart rate and mean blood pressure were monitored in both groups. Time required to achieve sensory block up to T6, complete motor block, the dose of ephedrine required to treat hypotension, the incidence of complications, and neonatal appearance, pulse, grimace, activity, respiration (APGAR) scores were noted. Results: Hypotension occurred in 35.56% of parturients in Group H and 16.28% of parturients in Group HW, which was statistically significant. The mean dose of 0.5% bupivacaine was 9.12 mg in Group HW and 9.4 mg in Group H (P value = 0.02). The mean dose of Ephedrine was 12 ± 5.8 mg in Group H compared to 6.0 mg in Group HW, which was statistically significant. The time needed to achieve sensory and complete motor block were comparable in both groups. Conclusion: Height-weight-adjusted intrathecal hyperbaric bupivacaine achieved comparable sensory and motor block with lesser incidence and severity of hypotension compared to height-adjusted dose.

Background: Knowledge of basic life support (BLS) is one of the life-saving measures that every medical undergraduate student must possess. Aims and Objectives: This study focused on knowing the level of knowledge in fresh medical undergraduate entrants (knowledge A [KA]) and 3rdyear students with clinical exposure but no BLS training (knowledge B [KB]). We also assessed the knowledge in 1st-year students (retention A [RA]) soon after foundation course and compared it with retained knowledge after 6 months (retention B [RB]). Materials and Methods: This non-randomized multigroup cross-sectional study was done on medical undergraduate students in a tertiary care hospital attached to a medical school in South India. A validated questionnaire with 25 questions assessing knowledge of BLS was formulated and administered to 508 medical students. Results: After analyzing data in SPSS V24, the mean scores in KA and KB were 11.03±4.33 and 13.95±5.43, respectively, with a P50%, clinical exposure had some effect on mean scores in medical undergraduates. Mean scores in RA and RB were 23.16±5.09 and 16.17±6.97, respectively, with P

Background: The risk of medication error is high in the operating room, since the anesthesiologist prepares, stores, and administers the medication. Poor labeling practices and cluttered drug trays increase the risk of syringe swap and medication error. Well-organized drug tray can reduce the incidence of erroneous drug administration and decrease the response time during intraoperative emergencies. Aims and Objectives: The aim of the study was to determine the attitude and practices of anesthesiologists in organizing drug trays. Materials and Methods: In the first part of the study, 30 drug trays with 209 syringes were observed before and after the procedure for 14 parameters. At the end of the procedure, a questionnaire was given to the anesthesiologists involved about their knowledge of labeling and organizing drug tray. Results: All the labels were handwritten with 139 (74.7%) syringes labeled circumferentially, and 47 (25.2%) syringes labeled vertically. Unlabeled syringes found were 23 (11.0%). Labels were legible in 168 (90.3%) syringes. Syringes were not found to be replaced in their designated place according to the template at the end of surgery in 7 (23.3%) trays. About 66.7% of anesthesiologists had experienced incorrect pickup of the syringe and 40.0% of anesthesiologists reported that they rely on other pointers apart from the label to identify the drug. Conclusion: This study identifies the variation of practices in labeling, organizing, and maintaining drug tray among anesthesiologists. Adherence to institutional protocol, eternal vigilance, and improvement in error reporting practice would minimize the incidence of medication error.

The article discusses a study which explores the awareness of the Anaesthesiology postgraduate students on the scope of specialty, attitude, and stress levels associated with Diploma course. Topics include the use of questionnaires distributed to 800 anesthesia postgraduates in India during 2011 and 2012, the 31.6% of students who are unaware of Anaesthesiology's scopes, and the need to emphasize the positive aspects of operating room and pain management.

Background: Dexmedetomidine has been used by multiple routes in laparoscopic surgeries to attenuate the hemodynamic response. The present study was done to compare the efficacy of dexmedetomidine nebulization with intravenous dexmedetomidine and fentanyl in laparoscopic surgeries under general anesthesia., Methods: A prospective, double blind study was conducted, and 90 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing laparoscopic surgeries under general anesthesia were randomized into three groups. (1) Group N (n = 30) received dexmedetomidine nebulization 1 mcg/kg in 3 mL of 0.9% saline 15 minutes before induction and 10 mL of intravenous 0.9% saline over 10 minutes at the time of induction of anesthesia. (2) Group I (n = 30) received 0.9% saline nebulization 3 mL and intravenous dexmedetomidine 1 mcg/kg in 10 mL of 0.9% saline. (3) Group F (n = 30) received 0.9% saline nebulization 3 mL and intravenous fentanyl 2 mcg/kg in 10mL of 0.9% saline. Heart rate, blood pressure, propofol requirement, and opioid consumption were monitored throughout surgery and for 1 hour in post-operative period. Statistical analysis was done by using analysis of variance test, chi-square test. P value ＜ 0.05 was considered signifi cant., Results: Suppression of hemodynamic response following intubation and pneumoperitoneum by dexmedetomidine nebulization was compared to intravenous dexmedetomidine and fentanyl. Opioid requirement was significantly lower in dexmedetomidine group than fentanyl group (P ＜ 0.05). Propofol requirement was lower with intravenous and nebulized dexmedetomidine than intravenous fentanyl., Conclusions: In laparoscopic surgeries, nebulized dexmedetomidine suppresses hemodynamic response when compared to intravenous dexmedetomidine along with dose sparing effect of opioid and propofol.

Background and Aims: In percutaneous nephrolithotomy (PCNL), distension of renal capsule, pelvicalyceal system and nephrostomy tube causes intense postoperative pain. The present study was done to compare the efficacy of peritubal infiltration of Ropivacaine with Dexmedetomidine and ultrasound guided single level T10 paravertebral block for post-operative analgesia in patients undergoing PCNL., Material and Methods: A prospective, double blind study was conducted on 60 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing PCNL who were randomized into 3 groups. Group PV [ n = 20] received paravertebral block at T 10 level with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group PT [ n = 20] received peritubal infiltration along nephrostomy tube with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group C [ n = 20] control group received intravenous Tramadol 1mg/kg. Postoperative pain scores, opioid consumption and side effects if any were recorded for 24 hrs. Statistical analysis was done using ANOVA test, Chi-square test. P value <0.05 was considered significant., Results: Demographic data were comparable. Reduced dynamic VAS score was noted for first 8hrs in peritubal infiltration compared to paravertebral group. Dynamic VAS scores were significantly lower in paravertebral group at 8 th , 12 th and 24 th hr as compared to peritubal infiltration ( P < 0.05). During all time intervals peritubal infiltration and paravertebral group had significantly lower VAS scores as compared to control group. Opioid requirement was more in control group compared to study groups., Conclusion: In PCNL, peritubal infiltration and single level paravertebral block produces effective postoperative analgesia without significant side effects., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Anaesthesiology Clinical Pharmacology.)

Oesophageal webs are thin (2-3mm) membranes of normal oesophageal tissue consisting of mucosa and submucosa. They can be congenital or acquired. Congenital oesophageal webs are very rare and usually present in adulthood. This report describes an unusual presentation of congenital web in lower oesophagus in a premature neonate with respiratory distress who was posted for diagnostic bronchoscopy and oesophagoscopy under general anaesthesia to rule out tracheo-oesophageal fistula or tracheomalacia. Endoscopic dilatation of the web was done and the baby improved after the procedure.