Background and Objective: Laryngoscopy and endotracheal intubation employed for general anaesthesia cause noxious stimuli and are associated with laryngo-sympathetic stimulation manifested by hypertension, tachycardia and arrhythmias. This study compares the efficacy of dexmedetomidine and fentanyl in attenuating haemodynamic stress responses to laryngoscopic endo-tracheal intubation in adult patients undergoing surgeries under general anaesthesia. Materials and Methods: 90 adult participants of any sex aged between 18-55yrs undergoing elective surgeries under general endo-tracheal anaesthesia were divided into 3 groups of 30 patients in each group. Group C: Control group -received 10ml of normal saline (NS) intravenously (IV) over 10 minutes (min), 10min before induction. Group D: Dexmedetomidine group -received IV Dexmedetomidine 0.6µg/kg body weight diluted to 1 0ml of NS IV over 10min using a syringe pump and 3ml of NS IV 2min before induction. Group F: Fentanyl group -received 10ml of NS IV over 10min using a syringe pump and IV Fentanyl 2µg/kg body weight diluted to 3ml of NS IV 2min before induction. Anaesthesia was induced with IV Thiopentone sodium 5 mg/kg body weight and IV Vecuronium 0.1mg/kg body weight to facilitate endotracheal intubation. Lignocaine 1.5mg/kg IV was given 90seconds before intubation in all the groups. Anaesthesia was maintained with Oxygen, Nitrous Oxide, 1-2% Sevoflourane and IV Vecuronium. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at various time intervals. Results: In group C, 1min after laryngoscopy and intubation, the rise in HR, SBP, DBP and MAP were 42bpm, 30mmHg, 22 mmHg and 24mmHg respectively compared to basal values. In group F, 1min after laryngoscopy and intubation, the rise in HR was 14bpm, rise in SBP, DBP and MAP each by 2mmHg compared to basal values. In group D, HR, SBP, DBP and MAP were decreased by 4bpm, 23 mmHg, 25mmHg and 24 mmHg respectively compared to basal values at 1min after laryngoscopy and intubation which was statistically highly significant (p=0.000). Interpretation and Conclusion: Both IV Dexmedetomedine 0.6µg/kg body weight administered over 10min and IV Fentanyl 2µg/kg body weight administered over 2min prior to induction are effective in obtunding the haemodynamic stress response to laryngoscopy and intubation without any significant side effects. However IV Dexmedetomidine is more effective and superior than Fentanyl in attenuating haemodynamic response to laryngoscopy and endotracheal intubation.

Background and objectives: Various intrathecal adjuvants have been clinically tried for the prolongation of intraoperative and postoperative analgesia. This study aims at evaluating the effects of intrathecal nalbuphine and clonidine as adjuvants to isobaric levobupivacaine in subarachnoid block. Methodology: 60 patients scheduled for elective infra umbilical surgeries were allocated into two groups of thirty each to receive 15 mg of 0.5% isobaric Levobupivacaine with either 1 mg nalbuphine (Group LN) or 30 µg clonidine (Group LC) intrathecally. Characteristics of spinal anesthesia in terms of sensory analgesia and motor blockade were noted. Hemodynamic parameters and adverse effects if any were recorded. Data obtained was compiled and statistically analysed with appropriate tests. Results: Onset of sensory and motor blocks was faster in group LN (2.43 ± 0.93 and 2.2 ± 0.9 min) compared to group LC (3.26 ± 1.04 and 3.13 ± 1.0 min). However, time to two segment regression (186.8 ± 24.5 vs 146.5 ± 21.4), total duration of effective analgesia (384.1 ± 56.6 vs 292.1 ± 40.9) and total duration of motor block (345.3 ± 41.7 vs 235.6 ± 29.5 min) were significantly prolonged in group LC than in group LN. There was no significant difference in hemodynamic changes and adverse effects between the groups. Conclusion: The addition of 30 µg clonidine to intrathecal 0.5% isobaric levobupivacaine as adjuvant, is associated with prolonged sensory and motor blockade with better perioperative analgesia compared to 1 mg nalbuphine. Citation: Shalini A, Kokila N, Manjunatha HG, Supriya L. Comparative study of intrathecal nalbuphine versus clonidine as adjuvants to 0.5% isobaric levobupivacaine for elective infra umbilical surgeries. Anaesth pain & intensive care 2019;23(4)__ Received: 21 August 2019, Reviewed:  13 September, 22 November 2019, Accepted: 26 November 2019