OBJECTIVE:The aim of this study was to evaluate the effects of nitroglycerine (NTG) Sublingual Spray on prevention of haemodynamic responses to tracheal extubation in patients undergoing lumbar disc surgery. METHODS: With approval from the institutional ethical Committee, written consent, 30 patients between 20-60 years of age undergoing elective lumbar disc surgery were randomly placed in either the Group A (n=30) or the Group B Control (n=30).Anaesthesia was induced with 2mg kg-1 propofol, 0.5mg kg-1pentazocin, and 0.1mg kg-1 vecuronium bromide iv, and was maintained with 0.8-1 MAC isoflurane in oxygen-nitrous mixture (40:60). After dressing of the surgical wound, all anaesthetic agents were discontinued and the patients were ventilated with 100% oxygen. Two sublingual NTG sprays (0.8mg) was given to Group A (n=30), after regain of spontaneous respiratory attempts, while no drug given to Group B. Hemodynamic variables were noted before administering study drug, during extubation then at 1, 3, 5, 10, 15 and 20 min after the extubation. RESULTS: In the sublingual NTG group, mean arterial pressures decreased significantly after sublingual NTG Spray and were significantly lower than in the control group at exubation and 1,3 and 5min after extubation (p<0.05).The heart rate and Rate pressure product (RPP) were comparable in both groups (p>0.050). CONCLUSION: We concluded that 0.8mg (Two sprays) sublingual NTG before extubation can prevent hypertension caused by extubation in patients undergoing elective lumbar disc surgery without much affecting heart rate and RPP . KEYWORDS: Nitroglycerine (NTG), Subligual, Extubation, Lumbar disc surgery. INTRODUCTION:Recovery from general anesthesia and extubation is a period of intense physiological stress for patients. There are several physiological responses to postoperative stress, including increases in oxygen consumption, catecholamine blood levels, blood pressure and heart rate. In most cases blood pressure and heart rate increases gradually as patient awakens. Tracheal extubation causes additional transient increase by 10-30% in arterial pressure and heart rate lasting 5-15 min. 1 it is more hazardous in patients with hypertension, myocardial insufficiency or cerebral vascular diseases. Patient with coronary artery disease experience a 40-50% decrease in ejection fraction. 2 Therefore, attenuation of haemodynamic responses to tracheal extubation such as hypertension, tachycardia and arrhythmias is important for an anesthesiologist. In order to control haemodynamic changes during tracheal intubation and extubation, local anaesthetics, opioids, beta-blocking agents, and calcium channel blockers have been used with varying success rates. 3-6 all of them require time for preparation and administration.Nitroglycerine generates NO (Nitric oxide) in vascular smooth muscles which produce vasodilatation leading to decrease in blood pressure.

Purpose: Continuous Spinal Anesthesia (CSA) is the technique of initiating and maintaining spinal anesthesia with small incremental doses of local anaesthetic injected intermittently into the subarachnoid space through a catheter. Hemodynamic instability due to high block largely limits the use of conventional Single Shot Spinal Anesthesia (SSSA) in high risk patients. Our primary aim was to observe hemodynamic changes, total fluid and vasopressor consumption and incidence of Post Dural Puncture Headache (PDPH), meningitis, focal sensory block after CSA and SSSA in young adults.Methods: Total 44 patients of ASA grades I-III aged 18-60 years, scheduled for lower abdominal and hip surgery received either CSA using 19G paediatric epidural Touhy needle and 22 G catheter (Group CSA; n=22) or SSSA with 25G Quinkes spinal needle (Group SSSA, n=22) using 0.75 % isobaric ropivacaine. Hemodynamics, total fluids &vasopressor consumption and incidence of adverse events were recorded.Results: Demographically, patients were comparable between the groups. HR and DBP was found comparable within the groups and between the groups (p>0.05). Fall in SBP was significant in SSSA group from 10-45 min with respect to baseline and from 5-25 min when compared to CSA group after induction. Mean fluid infused higher in group SSSA (p=0.0176). Five patients in SSSA group while none in CSA group had significant hypotension (p=0.190). PDPH, meningitis, focal sensory block were not observed in any of the patients.Conclusion: CSA provides better hemodynamic stability with minimal incidence of adverse events when compared to SSSA in young patients undergoing lower abdominal and hip surgeries using 0.75% Ropivacaine.

Objective(s): To compare the intubating conditions, onset and duration of action, side effects and complications with rocuronium bromide and atracurium besylate. Material and Method: This prospective, randomized double blind study was conducted with a sample size of 100 patients. After standard general anaesthesia technique group I received IV. rocuronium bromide 0.6 mg/kg and group II received iv. atracurium besylate 0.5 mg/kg. Laryngoscopy was attempted60 sec after administration of NMBA and thereafter every 30 sec till good or excellent intubating conditions were achieved. Intubating condition was scored on fourpoint scale (0-3). Intubating conditions, onset and duration, side effects and complications were observed and recorded. Result: Overall intubating condition was acceptable (excellent + good) in 50(100%) patients in group I and 47(94%) patients in group II. It was excellent in 45(90%) and 16(32%) patients in group I and II respectively. Good intubating condition was found in 5(10%) and 31(62%) patients in group I and II respectively. Fair intubating condition was found in 3(6%) patients in group II. None of the patients had poor intubating condition in either group. Cutaneous flushing was found in 4% cases in group II. No other side effects and complications were observed. Conclusion: Rocuronium with its faster initial response and possibly early laryngeal muscle paralysis provides better intubating conditions in shorter duration of time than atracurium.

Obstructing lesions of the central airways present with a variety of symptoms and are often associated with pneumonia or asthma-like states. Anesthesia to these patients often presents challenges right from the preoperative stabilization of underlying lung condition, mask ventilation in the supine position to maintaining oxygenation and ventilation in the intraoperative and postoperative period. We present here a case of a young woman with a central bronchial tumor with significant airway obstruction with potential for major bleeding and subsequent anesthetic management without lung sacrificing measures and cardiopulmonary bypass assistance.