Background: As no ideal drug has been found to blunt the stress response, our aim was to study the attenuation of haemodynamic stress response to laryngoscopy and tracheal intubation using Dexmedetomidine, Dexmedetomidine with Fentanyl and Lignocaine. Methods: 60 patients scheduled for various elective surgical procedures were included in the study. The study population was divided randomly into three groups.Group I -D (Dexmedetomidine group) 20 patients will receive IV Dexmedetomidine 1µm/Kg in 100 ml NS infused over 10-15 minutes before induction.Group II -DF (Dexmedetomidine with fentanyl group) 20 patients received IV Dexmedetomidine 1µgm/Kg combined with Fentanyl 1µgm/Kg in 100 ml NS infused over 10-15 minutes before induction. Group III -L (Lignocaine group) 20 patients received IV bolus lignocaine 1.5mg/Kg 90 seconds before intubation. All the patients were premedicated with injection glycopyrrolate 0.2mg, injection Ondansetron 4mg, injection Tramadol 2mg/kg and injection Midazolam 0.05mg/kg given slowly IV 15 minutes before induction. The HR, SBP, DBP, MAP was recorded at 1, 3, 5 minutes after intubation. In Group LLignocaine could not blunt the intubation response until 3 or 5 minutes after intubation. Results: In Group D, Dexmedetomidine showed marked decrease in hemodynamic response but the attenuation was highly significant in Group DF (Dexmedetomidine with Fentanyl) throughout the study period. Conclusion: IV Dexmedetomidine in the dose of 1µg/kg with Fentanyl 1µg/kg given 15 minutes before induction as infusion effectively attenuated the pressor response during Laryngoscopy and Intubation without any deleterious side effects.

Background: Various adjuvants including α-2 adrenergic agonist have been used to prolong the action of local anaesthetics in epidural anaesthesia. Now a days dexmedetomidine is most commonly used adjuvant in epidural anaesthesia but still it may produce side effects like hypotension and bradycardia.There is limited study on efficacy of ketamine as adjuvant in epidural anaesthesia. Aim: The aim of the study was to compare the duration of postoperative analgesia and side effects of epidural dexmedetomidine with ropivacaine versus epidural ketamine with ropivacaine in lower abdominal and lower limb surgery. Methods: This prospective randomised study was carried out in 100 patients of 20-60 years of age and of ASA classes I/II. All the patients, posted for lower abdominal and lower limb surgery were divided into two groups of 50 each. Group RD received 15ml ropivacaine(0.75%) with dexmedetomidine(1µgm/kg) and group RK received 15ml ropivacaine with ketamine(0.5mg/kg).Time for first rescue analgesia request, sensory and motor block characteristics and side effects were recorded. p<0.05 was considered statistically significant. Results: Time of first rescue analgesia request was delayed in group RD (360.15±35.23min) than group RK (311.14±32.48min) which was statistically significant. Both onset of sensory and motor block was earlier and duration of sensory and motor block was prolonged in group RD compared to group RK which was statistically significant. Hemodynamic parameters and side effects were comparable in both groups. Conclusion: Dexmedetomidine is a superior additive to ropivacaine compared to ketamine. Dexmedetomidine provides prolonged postoperative analgesia, earlier onset of sensory and motor block with minimal side effects.