No abstract

Dexmedetomidine (DEX) is currently being used as a premedication for anxiolysis, as an adjunctive drug both during and after surgery and as an adjunct to attenuate emergence agitation, postoperative pain, and shivering. It is an alpha-2 agonist which is 8 times more potent than clonidine and is also has sympatholytic effects1. It is also being used as an adjunct in central neraxial blocks to enhance the quality and to prolong the duration of the block2,3. Its use in peripheral nerve blocks is also reported. Keywords: Anxiolysis, fibroadenoma, agitation

Spinal myoclonus is a rare and less known sequel e after central neuraxial blocks and hereby we present a case of 68 yrs old lady undergoing removal of infected femur implant under sub-arachnoid block (SAB), developing myoclonus after the procedure ended but before regression of block. It was treated successfully with an infusion of lignocaine and magnesium sulphate. The patient was called in for follow-up after one week and had no any complains thereafter. Keywords: Spinal myoclonus, sub-arachnoid block, neuraxial block

Objective: The aim of current study is to determine the effectiveness of caudal bupivacaine and bupivacaine-tramadol combination for postoperative analgesia in children undergoing lower abdominal surgeries. Study Design: Randomized Control trial Place and Duration: Department of Anesthesiology Surgical ICU & Pain Management Ghulam Muhammad Mahar Medical College, Sukkur and Lahore General Hospital, Lahore, during the period from March 2021 to August 2021. Methods: There were 110 children of both genders with ages 2-8 years undergoing lower abdominal surgery were included in this study. A detailed demographics of enrolled patients, including age, sex, and weight were computed after obtaining informed written consent from each individual. Patients were equally divided in two groups. Group I had 55 patients and received combination of tramadol (1 mg/kg) and bupivacaine (0.5 ml/kg of 0.25%) and group II received only bupivacaine 0.5 ml/kg of 0.25% after induction of anesthesia in caudal epidural space. Post-operatively pain score, requirement of rescue analgesia and sedation score was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results: There majority males 35 (63.6%) in group I and 32 (58.2%) in group II. In group I mean age of the patients was 5.9±4.61 years and in group II mean age were 4.8±9.44 years. Mean weight of the patients in group I was 17.6±4.52 kg and in group II mean weight was 19.5±7.34 kg. During the first 24 hours, we noticed a reduced pain score in the bupivacaine–tramadol group. When it comes to postoperative analgesia, the bupivacaine-tramadol group had much longer analgesia durations and a significantly lower need for rescue analgesia with p value <0.003. Postoperative frequency of adverse effects in group II was greater found in 4 (7.3%) cases as compared to group I in 1 (1.8%) patients. Conclusion: In children having abdominal surgery, we found that caudal tramadol with bupivacaine provided more extended and better quality postoperative analgesia than plain bupivacaine. Keywords: Tramadol, Bupivacaine, Abdominal Surgery, Pain Score, Rescue Analgesia

Aim: To explore the effects of dexmedetomidine infusion combined with lignocaine on the intraoperative hemodynamic profile. Study Design: randomized, double-blind study Place and Duration of Study: Department of Anesthesia, Isra University Hospital, Hyderabad from 1st May 2021 to 31st October 2021. Methodology: Sixty patients from the daily operation list were randomly assigned to group D (dexmedetomidine intravenous infusion only) and group LD (dexmedetomidine plus lignocaine intravenous infusion) using a sealed envelope system. Results: The majority of the patients presented ASA status II (41.7%) were in the age group of 35-44 years (23.3%) and had BMI ranging from 25-34. Analysis of various clinical parameters showed a significant difference between group D and LD in terms of reduced heart rate, average mean arterial pressure, and need for transfusion. A higher number of patients receiving combination infusion had negligible blood loss with reference to patients maintained at dexmedetomidine alone. The satisfaction levels of the surgeon and attending anesthetist were significantly higher for surgical outcomes in the group receiving a combinative infusion of dexmedetomidine and lignocaine. Conclusion: The hemodynamic profiles of patients undergoing different surgeries showed significant favor for the combination of dexmedetomidine and lignocaine infusion as compared to infusion of dexmedetomidine only. Keywords: Deliberate hypotension, Intraoperative, Hemodynamic, Dexmedetomidine, Lignocaine