BACKGROUND Stress response to intubation produces marked hemodynamic changes during direct laryngoscopy using muscle relaxants. Since attenuation of hemodynamic response to laryngoscopy and tracheal intubation leads to better outcomes, a method for providing good intubating conditions rapidly without using muscle relaxants is being sought. The objective of the present study was to compare the hemodynamic changes occurring while intubating with 2 different doses of propofol. METHODS We compared heart rate, systolic blood pressure, diastolic pressure and mean arterial pressure changes during tracheal intubation with 2 different propofol doses without using muscle relaxants. Intravenous fentanyl inhibits the sympathetic nervous response to direct laryngoscopy and tracheal intubation in both groups of patients and acts as pre-emptive analgesia. RESULTS Comparison of the hemodynamic parameters revealed no statistically significant differences between the low dose propofol (PL) and high dose propofol (PH) groups with regard to heart rate or blood pressure changes at similar intervals postintubation. Both patient groups showed blood pressure fall along with a reflex increase in heart rate at 1 minute to 5 minutes post-intubation, returning to nearbaseline values 10 minutes post-intubation. None of these changes was either clinically detrimental or produced incidents of desaturation or arrhythmias in any study patient. CONCLUSIONS Low dose propofol may be useful in elderly or mildly hypovolemic patients, intolerant to a higher drug dosage whereas, the higher propofol dose may be particularly useful in the adult with a higher muscle mass in situations where muscle relaxant is to be restricted or avoided. KEY WORDS Tracheal Intubation, Hemodynamic Changes, Different Doses Propofol.

BACKGROUND Effective postoperative pain control is an important part of postoperative care which leads to shortened hospital stays, reduced hospital costs and increased patient satisfaction. Variety of adjuvants has been used along with local anaesthetics in regional blocks to increase the duration of effective analgesia. We have conducted a prospective study to compare the effect of clonidine and dexmedetomidine as additives to 30 ml of 0.5 % ropivacaine in supraclavicular brachial plexus block for upper limb orthopaedic surgeries. METHODS A prospective study was conducted among 50 patients belonging to ASA 1 or 2 undergoing upper limb orthopaedic surgeries under supraclavicular brachial plexus block. Patients who received 1mcg/kg clonidine added to 30 ml of 0.5 % ropivacaine in supraclavicular brachial plexus block were taken into Group A. Patients who received 1mcg/kg dexmedetomidine added to 30 ml of 0.5 % ropivacaine in supraclavicular brachial plexus block were taken into Group B. Sensory block – onset, duration; motor block – onset and duration; duration of analgesia were monitored and recorded. Data analysed using IBM SPSS (version 17) software. P value < 0.05 was considered as statistically significant. RESULTS Onset of sensory block was 9.04 ± 1.74 min in clonidine group and 12.0 ± 2.00 min in dexmedetomidine group which was statistically significant. Onset of motor block was 11.80± 1.87 min in clonidine group and 15.48 ± 2.08 min in dexmedetomidine group which was statistically significant. Duration of motor block was 502.8 ± 60.9 min in clonidine group and 566.0 ± 59.6 min in dexmedetomidine group which was statistically significant. Duration of sensory block was 589.2 ± 56.6 min in clonidine group and 673.6 ± 53.4 min in dexmedetomidine group which was statistically significant. Duration of analgesia was 665.20 ± 52.20 min in clonidine group and 760.40 ± 48.20 min in dexmedetomidine group which was statistically significant. CONCLUSIONS The addition of clonidine to 0.5 % ropivacaine in supraclavicular brachial plexus block significantly reduces the onset of sensory block and motor block whereas addition of dexmedetomidine significantly prolongs the duration of sensory and motor block compared to clonidine. Addition of dexmedetomidine also prolongs the duration of analgesia compared to clonidine. KEY WORDS Supraclavicular Brachial Plexus Block; Ropivacaine; Clonidine; Dexmedetomidine.

Regional anesthesia is widely used for abdominal hysterectomies. It is divided into spinal and epidural anaesthesia. Epidural anesthesia has got the advantage of extending the period of anesthesia to post-operative analgesia. We can use various pharmacological agents as adjuvants, which prolong the duration of action of local anesthetics. They include opiods, alpha 2 agonists like clonidine and dexmedetomidine. In this we studied the efficacy of local anesthetic agent -ropivacaine alone, ropivacaine with clonidine and ropivacaine with dexmedetomidine for epidural block. Present study showed that Epidural Dexmedetomidine and clonidine have synergistic action in combination with epidural ropivacaine resulting in smooth and prolonged postoperative analgesia and sedation. Group RD (Ropivacaine and Dexmedetomidine) had significant difference in comparison of postoperative block characteristics, such as time of two segment regression, time to Bromage scale 1, time of regression to S1 dermatome and time of first epidural top up than group RC and R. (Ropivacaine with clonidine and Ropivacaine alone). Thus epidural dexmedetomidine is a better neuraxial adjuvant in combination with epidural ropivacaine in producing prolonged analgesia and better sedation for abdominal hysterectomy.

BACKGROUND This study compared the characteristics of hyperbaric and hypobaric bupivacaine in patients undergoing unilateral lower limb surgeries under lumbar subarachnoid block with regard to their onset and level of sensory and motor blockades, haemodynamic stability, and recovery profile in terms of analgesic duration and motor recovery. METHODS This is a comparative study. Two groups, each of 36 patients who satisfied American society of Anaesthesiologist (ASA) I & II aged 18 – 65 years, were observed intra operatively and during immediate post-operative period. Group 1 received 2.4 ml of 0.5 % bupivacaine (heavy) with operated limb in dependent position. Group 2 received 4 ml of reconstituted hypobaric bupivacaine 0.3 %, with the operated limb positioned in non-dependent position. Onset, level and duration of motor and sensory block, hemodynamic changes and duration of surgical analgesia were compared between groups. RESULTS The level of sensory block attained in the hypobaric group was at T12 with maximum at T9, in the hyperbaric group it is variable and at higher level. Duration of sensory blockade was less with hypobaric. Motor block of modified Bromage scale 3 after 10 minutes was none in group 2 and 91.7 % in group 1. Significant fall in systolic blood pressure at 15 to 30 minutes and diastolic BP at 15 and 20 minutes was noted in hyperbaric group after subarachnoid block. There was significant percentage of change in systolic blood pressure from 4 to 70 minutes and mean arterial pressure (MAP) from 4 to 90 minutes in hyperbaric group. Duration of surgical analgesia in hypobaric group was longer compared to hyper baric. CONCLUSIONS Intrathecal hypobaric bupivacaine showed better haemodynamic stability and longer duration of analgesia in comparison with hyperbaric bupivacaine in lower limb surgeries. KEYWORDS Anaesthesia, Bupivacaine, Hypobaric, Subarachnoid Block