Background and Aims: Spinal anaesthesia (SA) with bolus dose has rapid onset but rapid onset may precipitate hypotension. If local anaesthetic is injected in fractions with some time gap, it may provide dense block with haemodynamic stability and prolonged duration of analgesia. We aimed to compare bolus dose with fractionated dose in SA for haemodynamic stability and duration of analgesia in patients undergoing lower limb surgery. Materials and Methods: After the Institutional Ethics Committee clearance, the study was carried out in sixty patients undergoing lower limb surgery. Patients were divided into two groups. Group B patients received single bolus SA with injection bupivacaine heavy (0.5%), 3 ml and Group F patients fractionated dose with two-third (2ml) of the total dose of injection bupivacaine heavy (0.5%) given initially followed by one-third (1ml) dose after 90s. Time of onset and regression of sensory and motor blockage, intraoperative haemodynamics and duration of analgesia were recorded and analysed with Student's unpaired t-test. Result: Patients were more haemodynamically stable in Group F as compared to Group B. Five patients in Group F and ten patients in Group B required vasopressor. Duration of sensory and motor block and duration of analgesia were longer in Group F compared to Group B. Conclusion: Fractionated dose of SA provides greater haemodynamic stability and longer duration of analgesia compared to bolus dose.

Background: For caesarean sections, local anesthetics e.g. bupivacaine, chloroprocaine, levobupivacaine, lidocaine, ropivacaine, and tetracaine have been used generally in combination usually with opioids like morphine or fentanyl or its derivatives. Aim and Objectives: Thus this study was conducted to compare the efficacy of two different doses of 0.5% hyperbaric bupivacaine (7.5mg and 10mg) in women undergoing caesarean section. Materials and Method:The study was conducted in the Department of Anaesthesiology, Teerthanker Mahaveer hospital, TMU, Moradabad among 80 American Society of Anaesthesiologists (ASA) physical status I and II patients scheduled for elective caesarean section. The spinal anaesthetic haemodynamic parameters, i.e., Heart Rate, Non Invasive Blood Pressure, ECG, MAP and SpO2 were monitored. The sensory and motor onset time and time to regression were recorded. Results: Group B patients had significantly higher pulse rate post-spinal(P<0.05); significantly lower pulse rate at 6,8,10,16,19,25,30,35,40,45 and 60 minutes. Group B patients had significantly high systolic blood pressure post-spinal, at 2, 4, 6, 35, and 50 minutes. Group B patients took significantly more time to attain maximum motor and sensory block than group A. APGAR scores of the neonates born to the patients of the two groups were compared. Group B patients had significantly high mean diastolic and MAP post-spinal, 2, 4, and at 6 minutes. Conclusion: Low dose (7.mg) Bupivacaine shows better hemodynamic stability whereas the conventional dose (10mg) showed a faster onset/duration of sensory block and a prolonged motor block.

Background: Among general anesthesia induction drugs, etomidate is the only imidazole, and it has the most favorable therapeutic index for single bolus administration. Propofol has been shown in clinical studies to be a safe, effective, hypnotic, and amnesic anesthetic agent at induction doses of 2-2.5 mg/kg and maintenance doses of approximately 9mg/kg per hour. Hence; we assessed hemodynamic changes and complications occurring with Propofol and Etomidate during general anesthesia. Subjects and Methods: A total of 100 subjects were enrolled in the present study and were broadly and randomly divided two study groups with 50 subjects in each group: Group A: Subjects who received 1% Propofol injection, and Group B: Subjects who received 0.3mg/kg of etomidate injection. Monitoring of the blood pressure, mean arterial pressure and heart rate was done throughout the surgery and until 10 minutes after induction. Recording of the pain during injection was done on a scale of 0 to 10 with 0 referring to no pain while 10 referring to maximum pain. Results: No significant difference was observed while comparing the mean arterial pressure and heart rate among subjects of both the study groups at different time intervals except for at the time of induction. Mean pain score was found to be significantly higher in group A in comparison to group B. Conclusion: Among patients with associated altered hemodynamic status, etomidate is an improved option. However; further studies are recommended.