Background and Objectives:The purposes of this study were to evaluate the onset, quality and duration of sensory and motor blockade between hyperbaric bupivacaine and clonidine combination with bupivacaine alone when administered intrathecally for unilateral spinal anesthesia in below-knee orthopedic surgery, efficacy of clonidine for post-operative analgesia and side-effects of clonidine, if any.Methods:Sixty ASA I and ASA II patients scheduled for elective surgery with time duration up to 90 min were studied. Patients were randomised in two equal groups by the lottery method. Group A (control group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 0.5 ml of normal saline intrathecally. Group B (clonidine group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 50 mcg clonidine in 0.5 ml volume intrathecally.Results:The mean peak sensory block was earlier in Group B (4.7±1.23 min) as compared with Group A (6.27±1.51 min). The mean peak motor block was earlier in Group B (6.17±1.20 min) as compared with Group A (8.63±1.71 min). The two-segment regression of sensory block was longer in Group B (106.23±9.17 min) as compared with Group A (104.43±17.75 min), which is clinically significant. Requirement of rescue analgesia was considerably prolonged in Group B (450.33±95.10 min) as compared with Group A (220±36.36 min), which was also clinically highly significant.Conclusion:Intrathecal clonidine potentiates bupivacaine induced spinal sensory block and, motor block and reduces the analgesic requirement in the early post-operative period in unilateral spinal anesthesia for lower limb below knee surgery.

Background: Spinal anaesthesia provided by bupivacaine alone may be too short for the planned surgery. The addition of clonidine 1 µg/kg to bupivacaine provides a prolonged anaesthetic action. The aim of this randomized double-blinded controlled study was to investigate the effects of addition of low dose clonidine to hyperbaric bupivacaine 0.5%, for spinal anaesthesia in patients undergoing lower abdominal and lower limb surgeries, on analgesic efficacy, quality of block, duration of analgesia and adverse effects. Methods: Forty adult ASA Grade I and II patients of either sex posted for lower abdominal and lower extremity surgeries were randomly divided equally in to clonidine or control group. Control group received intrathecal 3.5ml of 0.5% hyperbaric bupivacaine with 0.5 ml of normal saline and Clonidine group received identical volume of intrathecal clonidine 1 µg/kg with 0.5% hyperbaric bupivacaine. Results: Average two level regression time (129.55 min) was significantly prolonged in clonidine group than in the control group (74.5 min). (p-value < 0.01) Mean time for post operative analgesia was significantly longer in clonidine group (8.8 hours) than in the control group (4.1 hours). (p-value < 0.01). Heart rate at 15 minute intervals compared to 2 minute intervals was significantly less in clonidine group. (p-value < 0.05). Bradycardia, hypotension, urinary retention and headache did not require any therapeutic intervention Conclusion: Adding clonidine 1 µg/kg to intrathecal bupivacaine prolongs the duration of spinal anaesthesia and analgesia. It is safe and is likely to be as effective as higher doses of bupivacaine without severe adverse effects.

Introduction: Laryngoscopy and endotracheal intubation are noxious stimuli capable of producing tachycardia, arrhythmias and hypertension. This study was being done to compare the effectiveness of a pre-induction dose of clonidine with dexmedetomidine administered by intravenous infusion inattenuating the haemodynamic stress responses resulting from laryngoscopy and endotracheal intubation. Materials and Methods: Sixty adult patients included in this study were randomly divided into two groups, namely, Group A (Clonidine 4 mcg/kg) & Group B (Dexmedetomidine 1 mcg/kg) using computer generated random allocation chart and haemodynamic parameters were analyzed and recorded quantitatively from preoperative period to 30 mins postintubation period.In the immediate post operative period and 2 hours after surgery, patient's recovery was assessed with ALDRETE recovery score and BRUSSEL'S sedation score. Results: Mean heart rate showed fall following dexmedetomidine or clonidine infusion (19% and 23% respectively from the baseline) which was clinically significant in clonidine group but was statistically not significant in both the groups (p>0.05), while the increase in Mean heart rate following intubation was 8% and 10% respectively. In the current study, there was fall in blood pressure following infusion of study drug which was clinically not significant. Following tracheal intubation, maximal average increase was 5% in systolic and 3% in diastolic blood pressure in dexmedetomidine group, as compared to clonidine group in which, it was 6% and 4%, respectively. Isoflurane consumption, propofol requirement and opioid requirement throughout the intraoperative period was reduced in both the Groups. Aldrete recovery score and Brussels sedation score were calculated and found better in group B as compared to group A. Patients were sedated but arousable. Conclusion:Based on our study we conclude that both clonidine and dexmedetomidine are equally effective in attenuating the pressor response caused by laryngoscopy and tracheal intubation.

In this study, our primary aim was to compare the efficacy of and haemodynamic changes related to nalbuphine and tramadol when used for the control of post-spinal anaesthesia shivering, as per Wrench shivering grades. The secondary aim was to study the complications and adverse effects associated with the drugs. MethodologyA total of 60 patients with the American Society of Anesthesiologists (ASA) physical status class I/II who were scheduled to undergo elective surgeries under spinal anaesthesia were divided into two groups of 30 each. Group N received intravenous nalbuphine 0.05 mg/kg and Group T received intravenous tramadol 1 mg/kg, two minutes after the patients started shivering after undergoing spinal anaesthesia. The anaesthesia technique was standardised for all the patients in the study. The shivering grade was measured using the Wrench shivering grade and the level of sedation was studied using the Ramsay Sedation Scale. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded. All the parameters were measured at the baseline and at one, two, five, 10, 15, and 30 minutes after administering the drug. ResultsImmediately after giving the drug, the time taken to control shivering was significantly lower in Group T: 3.633 minutes. However both the drugs controlled shivering effectively. There were no significant haemodynamic changes in both groups, probably due to the lower dosage of drugs used in our study. A different set of side effects were seen in each group. In Group N, out of 30 patients, five (16.67%) patients were sedated, four (13.33%) had hypotension, and two (6.67%) had bradycardia, whereas In Group T, out of 30 patients, five (16.67%) patients had nausea, four (13.33%) had nausea and vomiting, and two (16.67%) had dizziness following the administration of the drug. Respiratory depression or itching was not seen in any patients in either group. ConclusionBased on our findings, both Intravenous nalbuphine 0.05 mg/kg and intravenous tramadol 1 mg/kg are effective in treating patients with post-spinal anaesthesia shivering; however, the time taken to control shivering is lower with tramadol than nalbuphine. Both the drugs resulted in minimal haemodynamic changes and adverse effects.

Malignant hyperthermia (MH) is a very rare life threatening condition. It has an incidence of 1:4,500 to 1:60,000 patients undergoing general anaesthesia. Disorder occurs worldwide and affects all racial groups. Clinical MH produces rapidly increasing body temperature and extreme acidosis as a result of acute loss of control of intracellular calcium levels and compensatory uncontrolled increases in skeletal muscle metabolism that may proceed to severe rhabdomyolysis. MH has a mortality rate of about 10%. We report a rare case of 59 year old male patient with history of malignant hyperthermia posted for laproscopic cholecystectomy and its perioperative management.