BACKGROUND:Various agents have been used as adjuvants to prolong the duration of action and improve efficacy of local anaesthetic agents. Recently, alpha2 agonists have become the focus of interest as adjuvants to local anaesthetics. AIM: To compare the onset time, duration of sensory and motor block and duration of analgesia when Clonidine or Dexmedetomidine is added to Bupivacaine in supraclavicular brachial plexus block. METHODS: Sixty ASA Grade I and II patients scheduled for elective forearm and hand surgeries under supraclavicular brachial plexus block were divided into two equal groups in a randomized fashion. Group C received Bupivacaine 0.25% (35cc)+Clonidine 1µg/kg and Group D received Bupivacaine 0.25% (35cc)+Dexmedetomidine 1µg/kg. Onset and duration of sensory and motor block, and duration of analgesia were compared. STATISTICAL ANALYSIS USED: Qualitative data-Chi Square test; Quantitative data-Unpaired student's 't' test. RESULTS: The onset of sensory block was earlier in Group D (8.53±0.72) than in Group C (8.18±0.55) which was statistically significant (p <0.05).There was no significant difference in onset of motor block between the two groups. Duration of sensory block and motor block was 331.43±6.693 and 271.43 6.69min, respectively, in group C, while it was 395.93±12.55 and 335.93±12.55min respectively in group D which was statistically significant (p <0.05). The duration of analgesia (Time to requirement of rescue analgesia) in group C was 407.06±10.90 min, while in group D was 497.06 10.90 and this difference was significant (p <0.001). Patients in Group D were more sedated than those in Group C (p <0.001). There was no significant difference in hemodynamics between the two groups. CONCLUSION: Dexmedetomidine when added to Bupivacaine in supraclavicular brachial plexus block enhanced the duration of sensory and motor block and also the duration of analgesia when compared with Clonidine.

BACKGROUND AND OBJECTIVES: Rapid and dramatic hemodynamic changes which adversely affect the patient may occur during laryngoscopy and intubation. The present study evaluates the effect of oral ivabradine on the hemodynamics during laryngoscopy and endotracheal intubation in patients undergoing surgical procedures under general anesthesia. METHODS: A prospective randomized, single blinded study was conducted in 50 ASA-I adult patients undergoing various procedures under general anesthesia. The patients were randomly divided into two groups. Patients in group I (test group) (n=25) received oral Ivabradine, 5mg one tab at 6.00pm on the evening before the day of surgery and one 5mg tab one hour before intubation. Patients in group II (control group) (n=25) received placebo. Hemodynamic variables were recorded from pre-operative period to 10 minutes after intubation. RESULTS: There was not a very significant increase in the hemodynamic parameters in response to laryngoscopy and intubation in the Test group, when compared to the control group and the minimal raise also returned to baseline immediately within a minute. INTERPRETATIONS AND CONCLUSION: Ivabradine is an extremely useful drug to prevent abnormal increase in heart rate and minimizes the extent of hypertension seen during laryngoscopy and endotracheal intubation.

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BACKGROUND: Pneumoperitoneum required for laparoscopic surgeries results in various pathophysiologic changes in the body, especially in the cardiovascular system. Moxonidine is a selective Imidazoline I1-receptor agonist with an I1:α2 affinity ratio of 40:1 to 70:1. Through an action in the Rostral Ventrolateral Medulla (RVLM), where the I1 receptors are situated, it reduces sympathetic outflow and lowers peripheral vascular resistance. BP reduction is not accompanied by any significant change in heart rate or cardiac output. AIMS AND OBJECTIVES: The aim of our study was to evaluate effect of orally administered Moxonidine in attenuating the hemodynamic responses that occur during laparoscopic cholecystectomy. MATERIALS AND METHODS: 50 adult ASA I and II patients scheduled for elective laparoscopic cholecystectomy were selected for this prospective randomized double blinded comparative study. They were randomly allocated to two groups; Moxonidine group and Placebo group. Moxonidine group received oral Moxonidine 0.3 mg at 8 PM the day before surgery and at 8 AM on the day of surgery. Placebo group received a placebo at the same timing as that of the Moxonidine group. RESULTS: When vital parameters were compared significant rise in heart rate, systolic, diastolic and mean blood pressure was noted in the Placebo group following pneumoperitoneum, where as in Moxonidine group the rise was not more than 20% of baseline. CONCLUSION: In conclusion, Moxonidine when administered preoperatively provides perioperative hemodynamic stability in ASA I and II patients undergoing laparoscopic cholecystectomy. It's other benefits such as absence of reflex tachycardia, preservation of hepatic and renal function makes it a good choice for laparoscopic procedure.

BACKGROUND: The discovery of opioid receptors and ligand in the brain and spinal cord lead to the feasibility of their intrathecal use. Pethidine is the only narcotic that has been shown to be effective intrathecally for surgery. This is because it as a phenyl-piperidine derivative and has a structure and action similar to that of local anesthetic. METHODS: It is a prospective study of 50 patients belonging to ASA grade I and II physical status were administered intrathecal Pethidine (preservative free) 1mg/kg body weight for lower limb surgeries. The time of onset and level of sensory blockade, onset and degree of motor blockade, hemodynamic parameters, time for regression of sensory and motor blockade, duration of postoperative analgesia and side effects were assessed in the patients. RESULTS: Majority of the procedures performed were below knee amputation or external fixation. The mean duration of onset of sensory block was 6.55 mins (SD:±0.79) and onset of motor block was 8.39mins (SD:±0.83). Peak level of sensory block was attained at L1 level in majority of patients (82%). Degree of motor block was II degree in 66% of patients. Mean time required for motor recovery was 62.2 mins (SD: ±5.0). This was followed by sensory regression at 94.6mins (SD:±7.3). Mean duration of postoperative analgesia was 333 minutes (SD:±29.9). Side effects observed were hypotension, nausea, vomiting, sedation, and pruritus. CONCLUSION: Pethidine (preservative free) 1mg/kg body weight can be used intrathecally as a sole anesthetic agent to provide prolonged postoperative analgesia associated with hemodynamic stability and early ambulation in patients undergoing lower limb surgeries.