BACKGROUND Direct laryngoscopy and endotracheal intubation elicits a haemodynamic response associated with increased heart rate and blood pressure. The aim of the study is to compare the efficacy of intravenous dexmedetomidine and fentanyl in attenuation of stress response to laryngoscopy and intubation. MATERIALS AND METHODS Study was carried out on 60 patients belonging to ASA grade I & II, aged 15 to 65 years including either gender scheduled for elective surgical procedures under general anaesthesia in Osmania General Hospital. Patients were randomly divided into two groups of 30 each. Group D received 0.6g/kg dexmedetomidine and Group F received 2 g/kg fentanyl diluted in 10 mL normal saline 10 minutes before laryngoscopy and intubation. Anaesthesia was standardised in both groups and vital parameters heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded preoperatively, during intubation and up to 10 minutes after intubation. RESULTS The groups were well matched for their demographic data. It was observed that increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure after intubation was highly significant in fentanyl group as compared to dexmedetomidine. There was a statistically significant difference (P <0.05) between dexmedetomidine and fentanyl groups in heart rate, systolic, diastolic blood pressure and mean arterial pressure at all time points after tracheal intubation. CONCLUSION Both the drugs attenuated the pressor response. Among the two drugs administered dexmedetomidine 0.6 µg/kg provides reliable and effective attenuation of pressor response to laryngoscopy and tracheal intubation when compared to fentanyl in a dose of 2 µg/kg.

Controlled hypotensive anesthesia is essential during FESS surgeries for better view of surgical field. This study is conducted to compare Dexmedetomidine and Fentanyl-Propofol groups for controlled hypotensive anesthesia. A prospective, randomized, single blinded study was conducted on 50 ASA 1 or 2 patients undergoing Functional Endoscopic Sinus Surgery. Patients were randomly divided into 2 groups. Patients in Group 1 were administered Dexmedetomidine loading dose of 1μg/kg in 20 min followed by infusion of 0.5-0.7μg/kg/hr. and patients in Group 2 were administered Fentanyl 2μg/kg preoperatively and Propofol infusion (80-100μg/kg/min) intraoperatively. Pulse rate, Blood pressure was recorded for every 5 min throughout the intraoperative period and quality of surgical field was assessed by "surgeons scale for assessment difference of quality of surgical field". There was no statistically significant between the two groups regarding hemodynamic parameters or quality of surgical field. CONCLUSION: Both Dexmedetomidine & Fentanyl-Propofol are good and effective in achieving bloodless visually improved surgical fields. The only advantage with Dexmedetomidine is that it has got inherent analgesic, sedative & anesthetic sparing properties which avoid administration of multiple drugs.

Pulmonary oedema may complicate the perioperative period and the aetiology may be different from non-operative patients. Broadly pulmonary oedema is classified as Cardiogenic 1 and non-cardiogenic. 2 There are many different and varied reasons for non cardiogenidc perioperative pulmonary oedema including high altitude, 3 neurogenic 4 causes, hypoproteinaemia being one of them. Diagnosis may be difficult during anaesthesia and consequently management may be delayed. A careful preoperative assessment to detect hypoalbumineamia in relevant cases may be necessary to expect a complication of such cause and to take steps to prevent and treat. A case is presented here which presented as Chronic intestinal obstruction with marked nutritional imbalance and anasarca, posted for laprotomy under general anaesthesia. Intraoperatively she developed pulmonary oedema which subsequently was managed successfully. KEYWORDS: Hypoproteinemia, hypoalbunimaemia, malnutrition, pulmonary oedema. INTRODUCTION:Marked reductions in the circulating levels of proteins, especially albumin, as a cause of Intraoperative pulmonary oedema that relates to intravascular factors is a known entity. Hypoproteinemia may result from rapid loss of proteins across a compromised glomerular barrier in diseased kidneys, impaired hepatic synthesis of plasma proteins in liver disease, severe malnutrition or protein-losing enteropathy (Which limits the availability of substrate for protein synthesis) , or from infusion of intravenous fluids lacking macromolecules. The ensuing reduction in the colloid osmotic pressure gradient, which favours reabsorption in the non-steady state and opposes the hydrostatic pressure gradient that favours filtration, induced by hypoproteinemia can result in a large transcapillary flux of protein-poor fluid into the interstitial spaces.Hypoproteinemia as a cause of perioperative pulmonary oedema, though rare is one of the cause. The other common non cardiogenic causes under anesthesia being neurogenic pulmonary oedema, negative pressure pulmonary oedema hypoxia and anaphylaxis as a cause are more frequently related to pulmonary oedema.

The aim of the study is to compare the efficacy of intravenously administered 5-HT3 receptor antagonists namely Ondansetron, Palonosetron and Granisetron given as prophylaxis for postoperative nausea and vomiting in patients undergoing laparoscopic surgeries under general anaesthesia. A single dose of palonosetron (0.75 µg) when given prophylactically results in a significantly lower incidence of PONV after laparoscopic surgeries than ondansetron (4mg) and granisetron (2.5mg) during the first 24 hours.

Intravenous Paracetamol is a centrally acting antipyretic and analgesic, has less gastrointestinal and platelet inhibiting side effects and is clinically better tolerated. IV Paracetamol could potentially provide adequate perioperative analgesia as a single agent for mild to moderate pain. Diclofenac a NSAID that mediate anti-inflammatory, analgesic and platelet inhibiting effects. NSAIDS are effective in peri operative setting for mild to moderate pain, but their usefulness may be limited due to their tendency to cause gastrointestinal and surgical site hemorrhage and renal failures in high risk patients. The present study conducted in 50 patients aged between 12-20 yrs who are scheduled for elective Tonsillectomy under general anesthesia in ENT hospital, Osmania Medical College, Hyderabad. To conclude that Paracetamol given every 6 th hourly parenterally can be used for intra operative and postoperative analgesia (mild to moderate pain) in elective Tonsillectomy in view of its good quality of analgesia, and its anti-pyretic effect.