Background:Pneumoperitoneum and altered positioning 1in laparoscopic cholecystectomy predispose to alterations in cardiorespiratory physiology. We compared the effects of volume controlled, pressure controlled, and the newly introduced pressure controlled-volume guaranteed ventilation (PCV-VG) modes of ventilation on respiratory mechanics and oxygenation during laparoscopic cholecystectomy.Materials and Methods:Seventy-five physical status American Society of Anesthesiologists Classes I and II patients with normal lungs undergoing laparoscopic cholecystectomy were randomly allocated to receive volume controlled ventilation (VCV), pressure-controlled ventilation (PCV), or PCV-VG modes of ventilation during general anesthesia. In all modes of ventilation, the tidal volume was set at 8 mL/kg, and respiratory rate was set at 12 breaths/min with inspired oxygen of 0.4. After pneumoperitoneum, respiratory rate was adjusted to maintain an end-tidal carbon dioxide between 32 and 37 mm Hg. The peak airway pressures, compliance, the mean airway pressures, oxygen saturation, end tidal carbon dioxide and hemodynamics were recorded at the time of intubation (T1), 15 min after pneumoperitoneum (T2) and after desufflation (T3) and were compared. Arterial oxygen tension, arterial carbon dioxide tension at T2 and T3 were compared.Results:PCV-VG and PCV mode resulted in lower peak airway pressures than VCV (23.04 ± 3.43, 24.52 ± 2.79, and 27.24 ± 2.37 cm of water, respectively, P = 0.001). Compliance was better preserved in the pressure mediated modes than VCV (fall from baseline was 42%, 29%, and 30% in VCV, PCV, and PCV-VG). The arterial to end-tidal carbon dioxide gradient was lower in PCV-VG and PCV compared to VCV. No difference in oxygenation and hemodynamics were observed.Conclusion:PCV and PCV-VG modes are superior to VCV mode in providing adequate oxygenation at lower peak inspiratory pressures.

Background:Lumbar spine surgery demands intense analgesia. Preemptive multimodal analgesia (MMA) is a novel approach to attenuate the stress response to surgical stimulus.Aims:The aim of the study was to assess the intraoperative morphine consumption in patients undergoing lumbar spine surgery.Patients and Methods:A randomized, prospective, double-blind study involving 42 patients belonging to the American Society of Anesthesiologists Class I and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Group A (study group) received injection diclofenac sodium, paracetamol, clonidine, and skin infiltration with bupivacaine adrenaline and Group B (control group) received paracetamol and skin infiltration with saline adrenaline. Preemptive analgesia was practiced in both the groups. Intraoperative morphine consumption was documented.Statistical Methods:Intraoperative morphine consumption between the two groups was compared using Mann–Whitney U-test. Postextubation sedation score between the two groups was compared using Chi-square test and presented as number and percentage. P < 5% was considered statistically significant.Results:Intraoperative morphine consumption was significantly low in the study group (P < 0.001). Postextubation sedation score was comparable between the two groups.Conclusion:Preemptive MMA has demonstrated significant morphine sparing effect intraoperatively in patients undergoing lumbar spine surgeries.

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BACKGROUND AND OBJECTIVES: Hemodynamic and cough response to extubation can result in raised heart rate, blood pressures and intracavitary pressures which could be detrimental in highrisk patients. The aim of our study was to estimate the difference in hemodynamic and cough response to orotracheal tube extubation with saline (control group), I.V lignocaine 0.5mg/kg and I.V lignocaine 1mg/kg and to evaluate the comparative efficacy between the groups. METHODS: In our clinical prospective descriptive double blind study 90 patients of either sex scheduled for elective surgical procedures requiring orotracheal intubation, who met inclusion criteria, were considered. They were randomly divided into three groups of 30 each, Group-1 (control-saline), group-2 (lignocaine 0.5mg/kg) and group-3 (lignocaine 1mg/kg). They were administered study drug 2 minutes prior to extubation, following a standard peri operative anesthetic course. Hemodynamic parameters like heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure (HR, SBP, DBP and MAP) prior to administration of the study drug and at 1min, 3min, 5min and 10min post extubation were considered for statistical analysis. Post extubation cough graded as per Eshak's grading (Grade 0, 1, 2 and 3). Data obtained were analyzed using Analysis of variance (ANOVA), Post-hoc Tukey test and Chi-square/Fisher Exact test. Results on continuous measurement were, presented on Mean±SD. Significance was assessed at 5% level of significance. RESULTS: In control group, there was significant rise in HR, SBP and MAP throughout the study period and the incidence of moderate and severs cough was 43.3% and 30% respectively. Diastolic blood pressure and mean arterial pressures attenuation with lignocaine 1mg/kg found to be superior (P<0.001). There was no significant difference in heart rate and systolic blood pressure attenuation between patients who received 0.5mg/kg lignocaine and 1mg/kg lignocaine at 1min (P-0.101 and P-0.938 respectively). Post extubation cough suppression was 100% in patients who received lignocaine 1mg/kg. CONCLUSION: Study concludes that lignocaine 1 mg/kg is superior to 0.5 mg/kg in attenuating the hemodynamic responses to tracheal extubation. For post extubation cough suppression (100%) lignocaine 1mg/kg is ideal.

Background and Aims: Preoxygenation is supplementation of 100% oxygen prior to induction of general anaesthesia to increase the body’s oxygen stores. Efficacy of preoxygenation can be increased by optimising fresh gas flow (FGF) rate and pattern of breathing. Methods: Based on pattern of breathing—Tidal Volume Breathing (TVB) or Deep Breathing (DB) and FGF-10 L/min or 15 L/min—100 subjects of the American Society of Anesthesiologists physical status I/II posted for elective surgery were recruited and randomised into four groups: T10 - TVB with 10 L/min; D10 - DB with 10 L/min; T15 - TVB with 15 L/min; and D15 - DB with 15 L/min. A tight-fitting anaesthesia mask along with continuous positive airway pressure of 5 cm of H2O with 20° head-up was used for preoxygenation. The total time taken and the total number of breaths required to achieve end tidal oxygen concentration (EtO2) of 90% were noted. Exhaled tidal volume (Vte), end tidal carbon dioxide, fraction of inspired oxygen, and EtO2 were recorded at each breath. Analysis of variance (ANOVA) was used for inferential statistics and Tukey’s honestly significant difference (HSD) test was used to calculate mean difference in total time and number of breaths amongst the groups. Results: Total time taken was significantly low (P < 0.001) in DB compared to TVB (D10: 70.2 ± 19.91, D15: 68.4 ± 20.27 vs T10: 112.28 ± 47.96, T15: 113.6 ± 48.57 seconds). Number of breaths was significantly high (P < 0.001) in TVB with 22.84 ± 8.73, 23.76 ± 11.64, 10.56 ± 3.69, and 8.32 ± 1.8 in T10, T15, D10 and D15, respectively. Vte was significantly low in TVB (P < 0.001). Conclusion: Rapid preoxygenation can be achieved by DB at high FGF of a minimum of 10 L/min.