Background and Aims:There has been a paradigm shift of focus toward quality of spinal anesthesia with sedation being an integral aspect of this regional anesthesia technique. Thus, this study was designed to compare efficacy of intravenous dexmedetomidine and propofol for moderate sedation during spinal anesthesia.Material and Methods:A total of 120 patients of age group 18-60 years of American Society of Anesthesiologists grade I & II, posted for surgeries under spinal anesthesia were randomly divided in to three groups (n = 40 each); Group D received infusion of dexmedetomidine 1 μg/kg over 10 min followed by maintenance infusion of 0.5 μg/kg/h. Group P received infusion of propofol 6 mg/kg/h for 10 min followed by the infusion maintenance of 2.5 mg/kg/h. Group C (control group) received normal saline. Level of sedation (using observer's assessment of alertness/sedation score), pain intensity (by visual analogue scale), onset and recovery from sedation, hemodynamic changes, and overall patient's satisfaction were assessed.Results:The onset and recovery from sedation were significantly earlier with propofol (15.57 ± 1.89 min vs. 27.06 ± 2.26 min; P < 0.001) however intraoperative sedation (level 4), and overall patient's satisfaction was significantly better with dexmedetomidine group (p < 0.05). Duration of postoperative analgesia was significantly prolonged with dexmedetomidine (225.53 ± 5.61 min vs. 139.60 ± 3.03 min; P = 0.0013). Mean heart rate and blood pressure were significantly lower in the propofol group (P < 0.05).Conclusion:Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient's satisfaction, and analgesia could be a valuable adjunct for intraoperative sedation during spinal anesthesia.

Aim:To evaluate the effect of intravenous (IV) clonidine premedication for the bloodless surgical field in patients undergoing middle ear or nasal surgery comparing three different doses.Subjects and Methods:This prospective randomized, clinical trial was performed on 90 normotensive patients belonging to American Society of Anesthesiologists grade I/II, aged 18–60 years, of either sex, undergoing routine middle ear or nasal surgery. These patients were divided into three Groups A, B, and C with 30 patients in each according to the dose of IV clonidine used as premedicant that is 3, 4, and 5 µg/kg, respectively. The hypotensive period commenced 10 min after the start of surgery till the surgeon's request for no hypotension required any longer. The target mean blood pressure for producing bloodless surgical field was 60–70 mmHg. During the hypotensive period, the surgeons were asked to rate the bleeding severity score on a six-point scale from 0 (no bleeding) to 5 (severe bleeding).Statistical Analysis Used:ANOVA, Chi-square test, Z-test, standard deviation and P value.Results:IV clonidine premedication in a dose of 4 and 5 µg/kg reduces bleeding and provides a clear field for surgery. It also reduces the requirement of isoflurane, fentanyl, and metoprolol for controlled hypotension. However, clonidine 5 µg/kg was not more effective than clonidine 4 µg/kg in producing these effects rather was associated with some side effects.Conclusion:IV clonidine premedication in a dose of 4 µg/kg is safe and effective for producing a bloodless surgical field in the middle ear and nasal surgery.

Epidural anesthesia is a safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. To address the problems of limited duration of action and to improve the quality of analgesia intra-operatively and postoperatively, various adjuvants have been added to bupivacaine. The present study is designed to evaluate the effect of magnesium sulphate vs clonidine as an adjunct to 0.5% Bupivacaine in epidural anesthesia for patients undergoing lower limb surgeries in terms of onset, duration and degree of sensory and motor block, sedation and pain. 90 patients of age group 18-60 years of ASA grade I & II of either sex undergoing lower limb surgeries were included in this prospective study who were randomly allocated into three groups. Group A received bupivacaine 0.5%(19ml) +normal saline 0.9% (1.0ml), Group B received bupivacaine 0.5%(19ml)+magnesium sulphate 50mg dissolved in 0.9% normal saline (1.0ml) and Group C received bupivacaine 0.5%(19ml) +clonidine 150µgm(1.0ml). Assessments of sensory block were performed at 5, 10, 15, 20, 25, 30 min and then every 10 min until the return of normal sensation.). Assessment of motor block were performed immediately after the assessment of sensory block until the return of normal motor function. The onset and end of all degrees of motor blocks were assessed bilaterally according to the Modified Bromage scale. Duration of analgesia, patient's satisfaction, duration of motor block and adverse effects were assessed and recorded. We concluded that co-administration of epidural magnesium sulphate 50MG with bupivacaine 0.5% produces predictable rapid onset of surgical anesthesia without any side-effects, and addition of clonidine 150µgmto epidural bupivacaine 0.5% produces prolonged duration of anesthesia with sedation. The results of our study suggest that magnesium may be a useful alternative as an adjuvant to epidural bupivacaine as clonidine.

ABSTRACT:In the era of day care surgery there is growing need for the anaesthetic technique which provides stable haemodynamics, adequate analgesia, and minimal complications and at the same time rapid recovery and early ambulation. This prospective study is aimed to compare efficacy and safety of propofol with ketamine in short surgical/diagnostic procedures in paediatric age group. We randomly allocated 100 patients in to two equal groups receiving either propofol (Group I) or ketamine (Group II). It was observed that in propofol group, mean systolic and diastolic blood pressures decreased by 5.28% to 9.98% and 7.40% to 11.40% respectively, while in ketamine group mean SBP and DBP increased by 7.53% to 12.32% and 11.98% to 13.24% respectively and the difference between the two groups was statistically significant. Heart rate and respiratory rate increased in both the groups, the difference was statistically insignificant (p>0.05). Propofol has the properties of smooth induction and rapid recovery associated with transient perioperative complications which makes it an ideal intravenous anaesthetic agent for day care surgery.

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