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.

INTRODUCTION Monitored anaesthesia care involves administering a combination of drugs for anxiolytic, hypnotic, amnestic and analgesic effect. Ideally it should result in less physiological disturbance and allow for more rapid recovery than general anaesthesia. It typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and analgesic drugs which is a common practice during various ENT surgical procedures. AIM OF STUDY Is to "Compare Dexmedetomidine with Fentanyl for sedation in tympanoplasty (ENT Surgeries)". The objective of the study is to evaluate the efficacy of dexmedetomidine and fentanyl as an appropriate sedative drug for Monitored Anaesthesia Care in Tympanoplasty (ENT surgeries) METHODS & MATERIALS A total of 60 patients are being recruited into this study with regards to assess, Pain, Discomfort, Sedation, Peripheral Oxygen Saturation (SPO2) & Systolic Blood Pressure (SBP), Diastolic blood pressure (DBP), Mean arterial blood pressure(MAP) & Heart rate This study was undertaken at Govt. ENT Hospital Hyderabad. Sixty (60) patients undergoing Tympanoplasty surgery were taken for study. Thus the study contains 30 patients in Dexmedetomidine group-(Group D) and 30 patients in Fentanyl group (Group F) RESULT Dexmedetomidine provides less discomfort, better sedation, and analgesia when compared with fentanyl under monitored anaesthesia care (Conscious sedation). However, the risk of adverse effects requires monitoring for ready intervention. It provides a unique type of sedation, "conscious sedation" in which patients appear to be sleepy but are easily arousable, cooperative and communicative when stimulated. It is sedative and analgesic agent, with opioid-sparing properties and minimal respiratory depression.

BACKGROUND:The prolongation of spinal anaesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha-2 agonist, dexmedetomidine has been proved to prolong the spinal anaesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block also prolongs spinal analgesia. A placebo controlled randomized controlled trial study was done. METHODOLOGY: 50 Patients were randomly allocated into two equal groups group D and group C. Both group received spinal hyperbaric bupivacaine 15mg intrathecally. Patients in group D received intravenously a loading dose of 1mcg/kg dexmedetomidine over 10 min followed by C maintenance dose of 0.5mcg/kg/hr till the end of surgery. Patients in group C (The control group) received normal saline. The regression times to reach S1 sensory level and bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. RESULTS: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (264.32+15.3 min vs 164.2+13.12 min, p 0.001). The duration of motor block was longer in dexmedetomidine group than control group (198.8+16.9 min vs 135.8+12.38 min, p 0.001) CONCLUSION: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability. The incidence of bradycardia is significantly high when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anaesthesia. Dexmedetomidine induced bradycardia and hypotension can be easily managed with atropine and mephentermine respectively. Dexmedetomidine provides excellent sedation and postoperative analgesia. HOW TO CITE THIS ARTICLE: H. L. Rani, I. Upendranath. "Comparative Study of Intravenous Dexmedetomidine Plus Intrathecal

BACKGROUND Postoperative nausea and vomiting is one of the many side effects of patients undergoing laparoscopic surgeries under general anaesthesia. Its prevention is major concern of anaesthesiologist managing the case. To this effect, many drugs have been used and use of serotonin (5-HT3) receptor antagonists like ondansetron, granisetron, tropisetron and dolasetron has been compared in many studies. This study was undertaken to study the efficacy of ondansetron, granisetron and their side effects. MATERIALS AND METHODS Patients were allocated into two groups, each group consisting of 50 patients. Group O received ondansetron 4 mg IV before induction. Group G received granisetron 1 mg IV before induction. The incidences of PONV were recorded within the first 24 hours after surgery at intervals of 0-2 hours, 3 hours, 6 hours, 12 hours and 24 hours. Episodes of PONV were identified by spontaneous complaints by the patients or by direct questioning. RESULTS In present study, incidence of nausea at different intervals in granisetron group is less than in the ondansetron group, which is statistically significant (p <0.05). The incidence of nausea was 36% in Group O and 12% in Group G, which was significantly low. The incidence of retching was 22% in Group O and it was less in Group G that is 2%. Greater percentage of patients in Group O (16%) experienced vomiting compared to Group G (2%). CONCLUSION The overall frequency of Postoperative Nausea and Vomiting (PONV) was less in Group G than Group O.

Intravenous induction is smooth, fast and pleasant. In search for alternative to thiopentone, various agents such as propofol, etomidate are introduced. AIM OF STUDYPresent study is undertaken to evaluate induction characteristics and haemodynamic responses and side effects of etomidate as an intravenous induction agent in comparison with thiopentone and propofol. MATERIAL AND METHODSSeventy five ASA I and II patients between 18 -50 years undergoing elective surgical procedures were randomly divided in to 3 groups of 25 patients each. Each group received either etomidate or propofol or thiopentone as an induction agent. Time taken for induction, heart rate, blood pressure, pain on injection of drug and severity of myoclonus were recorded. BP and HR recorded at preinduction, after induction at one minute intervals till 5 minutes, thereafter at 5-minute intervals. RESULTSTime taken for induction was almost same in all groups. Heart rate was increased in thiopentone and etomidate groups. Blood pressure was decreased significantly in propofol group whereas blood pressure was well maintained in etomidate group. Pain on injection with etomidate lipuro was much less than propofol. Myoclonic movements were much higher in etomidate group. CONCLUSIONEtomidate is more cardio stable agent.