Background:The cardiopulmonary bypass (CPB)-associated atelectasis accounted for most of the marked post-CPB increase in shunt and hypoxemia. We hypothesized that pressure-regulated volume-control (PRVC) modes having a distinct theoretical advantage over pressure-controlled ventilation (PCV) by providing the target tidal volume at the minimum available pressure may prove advantageous while ventilating these atelactic lungs.Methods:In this prospective study, 36 post-cardiac surgical patients with a PaO2/FiO2 (arterial oxygen tension/Fractional inspired oxygen) < 300 after arrival to intensive care unit (ICU), (n = 34) were randomized to receive either PRVC or PCV. Air way pressure (Paw) and arterial blood gases (ABG) were measured at four time points [T1: After induction of anesthesia, T2: after CPB (in the ICU), T3: 1 h after intervention mode, T4: 1 h after T3]. Oxygenation index (OI) = [PaO2/ {FiO2 × mean airway pressure (Pmean)}] was calculated for each set of data and used as an indirect estimation for intrapulmonary shunt.Results:There is a steady and significant improvement in OI in both the groups at first hour [PCV, 27.5(3.6) to 43.0(7.5); PRVC, 26.7(2.8) to 47.6(8.2) (P = 0.001)] and second hour [PCV, 53.8(6.4); PRVC, 65.8(7.4) (P = 0.001)] of ventilation. However, the improvement in OI was more marked in PRVC at second hour of ventilation owing to significant low mean air way pressure compared to the PCV group [PCV, 8.6(0.8); PRVC, 7.7(0.5), P = 0.001].Conclusions:PRVC may be useful in a certain group of patients to reduce intrapulmonary shunt and improve oxygenation after cardiopulmonary bypass-induced perfusion mismatch.

Background and Aims:Intraperitoneal local anaesthetic instillation (IPLAI) reduces postoperative pain and analgesic consumption effectively but the timing of instillation remains debatable. This study aims at comparing pre-emptive versus post-surgery IPLA in controlling postoperative pain after elective laparoscopic cholecystectomy.Methods:Ninety patients belonging to American Society of Anesthesiologists physical status I or II were randomly assigned to receive IPLAI of either 30 ml of normal saline (C) or 30 ml of 0.5% bupivacaine at the beginning (PE) or at the end of the surgery (PS) using a double-dummy technique. The primary outcome was the intensity of postoperative pain by visual analogue scale score (VAS) at 30 minute, 1, 2, 4, 6, 24 hours after surgery and time to the first request for analgesia. The secondary outcomes were analgesic request rate in 24 hours; duration of hospital stay and time to return to normal activity. Data were compared using analysis of variance, Kruskal-Wallis or Chi-square test.Results:For all predefined time points, VAS in group PE was significantly lower than that in groups C (P < 0.05). The time to first analgesic request was shortest in group C (238.0 ± 103.2 minutes) compared to intervention group (PE, 409.2 ± 115.5 minutes; PS, 337.5 ± 97.5 minutes;P < 0.001). Time to attain discharge criteria was not statistically different among groups.Conclusion:Pre-emptive intraperitoneal local anaesthetic instillation resulted in better postoperative pain control along with reduced incidence of shoulder pain and early resumption of normal activity in comparison to post surgery IPLAI and control.

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Background: The present study aim was designed to compare and evaluate the efficacy of adding two different doses of magnesium sulphate to 0.5% hyperbaric levobupivacaine for spinal anaesthesia in terms of block characteristics, haemodynamic and safety profile.Methods: Ninety American Society of Anaesthesiologist (ASA) grade I-II patients undergoing elective infra-umbilical surgeries under spinal anaesthesia were randomly allocated into three groups. Group C (n=30, control group) received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine; Group M50 (n=30): received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine + 50 mg of magnesium sulphate. Group M100 (n=30) received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine + 100 mg of magnesium sulphate. A standard protocol was followed after which a blinded observer assessed the sensory and motor blocks. The onset and duration of sensory (pin-prick) block, onset, intensity and duration of motor block were recorded.Results: All the subarachnoid blocks were adequate. The addition of magnesium sulphate to intrathecal levobupivacaine had not only increased the time to onset of sensory block (p=0.007) but also prolonged the duration of sensory (p<0.001) and motor block (p<0.001) to statistically significant level in a dose dependent manner. Conclusions:Addition of magnesium sulphate does not offer any further advantage in terms of haemodynamic stability. However, it certainly increases the duration of sensory block to a significant level.

INTRODUCTIONPain is an unpleasant sensation, which produces a reaction consisting of withdrawal response, metabolic response, hormonal response and conscious aversion. The side-effects of pain include peripheral vasoconstriction, reduced functional residual capacity and reduced sputum clearance.1,2 Pain relief has many advantages, namely, reduction in metabolic response to trauma, there by prevent postoperative negative nitrogen balance. Moreover pain-free patients have better mobility with immediate benefits in reduced incidence of chest infections and deep vein thrombosis. Laparoscopy has been promoted aggressively and has advantages like shorter hospital stay, more rapid return to normal activities, less pain associated with the small, limited incisions and less postoperative ileus compared with the open laparotomy technique.3,4 Pneumoperitoneum causes various cardiovascular and respiratory derangements. The purpose of this study was to compare equipotent moderate doses of two different analgesics i.e., butorphanol and fentanyl in healthy adult patients undergoing laparoscopic cholecystectomy and appendicectomy under general anaesthesia in terms of intra-operative haemodynamics and post-operative pain relief. MATERIAL AND METHODSThis prospective, randomized and double-blind study was conducted after obtaining approval from the Institutional Ethical Committee to compare the analgesic efficacy of equipotent moderate doses of butorphanol and fentanyl in patients undergoing laparoscopic surgeries under general anaesthesia. ABSTRACTBack ground: Laparoscopic surgeries have advantages like shorter stay and rapid return to normal activities because of small incision and les pain. Pain is an unpleasant sensation in the post-operative period. Methods: Fifty patients of American society Anesthesiologists (ASA) grade I and II, scheduled to undergo laparoscopic surgery, were randomized into butorphanol group (Group B) (n=25) and fentanyl group (Group F) (n=25). Four minutes before induction of anesthesia, Group B received inj. butorphanol 40 µg/Kg intravenously while Group F received Inj. fentanyl 2 µg/kg intravenously. All patients received general anaesthesia with controlled ventilation. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), end tidal carbon dioxide (ETCO 2 ), and oxygen saturation were monitored at different intervals. Results: The demographic data was comparable in both groups (p<0.05). There was a significant difference between the two groups in pulse rate after 12 minutes after intubation that persisted till the 2 nd hour of post-operative period. There was no significant difference in DBP till 9 min after intubation, and then onwards significant changes were noted till 4 th hour of post-operative period. Butorphanol provided prolonged analgesia when compared to fentanyl. Conclusions: We conclude that butorphanol is a better alternative to fentanyl for use as analgesic in laparoscopic surgeries because of its ability to produce prolonged analgesia, and less post-operative compli...