BACKGROUND- Laryngoscopy and endotracheal intubation is known to cause hemodynamic changes which are usually increase in heart rate and blood pressure.Various drugslike beta blockers,opioids and alpha 2 agonists have been tried to attenuate these hemodynamic responses. AIMS-To compare the effects of Fentanyl and Nalbuphine in attenuating the stress response to directlaryngoscopy and endotracheal intubation. METHODS- After informed consent we studied 90patients,all posted for surgery under general anaesthesia between the age group of 15 to 60. We conducted the study over a period of 6months. Data was collected and analysed. Three groups of patients were made Group A – Inj. Fentanyl 2µg/kg ivGroup B– Inj. Nalbuphine 0.2mg/kg ivGroup C- Inj Normal Saline 10cc. Only ASA I and II patients were included in the study.Haemodynamic changes were noted by meticulous monitoring and analyzed. RESULTS-The hemodynamic stress response to laryngoscopy and endotracheal intubation in the form of increased heart rate,systolic blood pressure,diastolic blood pressure and mean blood pressure were less with Fentanyl as compared to Nalbuphine and Normal Saline.CONCLUSION-Fentanyl is more effective than Nalbuphine in attenuating hemodynamic stress response tolaryngoscopy and endotracheal intubation.

Children with gross hydrocephalus present various challenges to the anaesthesiologists. The problems encountered are not only limited to associated congenital abnormalities and physiological derangements due to raised intra cranial tension, even intubation in such cases can pose great difculty owing to the increased head circumference that makes the alignment of oro-pharyngo- [1,3] laryngeal axis under direct laryngoscopy almost impossible . Difcult airway cart, C- MAC, paediatric breoptic bronchioscope and all possible difcult airway armamentarium must be checked to be in place before induction of anaesthesia in such cases to potentially avoid any [2] airway disaster . Here is a case report of a child with gross hydrocephalus posted for emergency VP shunt placement that turned out to be an extremely challenging airway.

Background: Almost every patient undergoing a major surgical procedure will experience some degree of physiologic alteration in lung function. A postoperative pulmonary complication is dened as any respiratory complication that occur within 48-72 hours following a surgical procedure. The relationship between preoperative variables and postoperative pulmonary complications in surgical patients has been the subject of numerous studies. Development of POPC is due to a combination of factors, including surgical pathology and existing comorbidities, as well as surgical and anaesthetic management in the perioperative period. The main risk factors that have been associated with postoperative pulmonary complication are smoking, chronic obstructive pulmonary disease, advanced age, site and duration of surgery, obesity and comorbidity.

BACKGROUND: Post-operative nausea and vomiting (PONV) affects 30-40% of patients after general anaesthesia.[11] AIMS: To compare the effect of Ondansetron and Dexamethasone for prevention of nausea and vomiting in diagnostic gynaecological laparoscopy. METHODS: Ethical committee approval was taken. Consent was obtained. Patients were divided into 2 groups of 30 each. General anaesthesia was administered to all patients. Inj. Ondansetron 0.15 mg/kg i.v. was given to patients of group O. Injection Dexamethasone 0.2 mg/kg IV was given to patients of group D. Patients were monitored for nausea, vomiting, retching, pain score, side effects and requirement of rescue antiemetic. RESULTS: Inj. Dexamethasone is better than Inj. Ondansetron for prevention of P.O.N.V. in diagnostic gynaecological laparoscopy.

BACKGROUND-Most of the lower abdominal surgeries are performed under spinal anaesthesia which is a popular technique using hyperbaric local anaesthetic solutions such as 0.5% Bupivacaine. The advantages are simplicity of technique, rapid onset of action and reliability in producing uniform sensory and motor blockade. Main disadvantage of using plain local anaesthetic agent arelimited duration of action and lack of longer postoperative analgesia.To overcome this problem, administration of different adjuvant in local anaesthetic is an excellent technique. AIMS-To compare the effect of adding Clonidine and Dexmedetomidine to Bupivacaine for neuraxial block. METHODS-This study was be conducted after the approval of institutional ethical committee. It is a prospective study in which 75 selected patients who were posted for lower abdominal surgeries were randomly allotted into three groups.Group B -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj. Normal saline Group C -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj.Clonidine 30 mcgGroup D -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj.Dexmedetomidine 3 mcg, Total volume injected in all group was 3.5 ml.The end of drug injection was taken as zero time. Onset, duration of sensory blockade, duration of motor blockade was noted. RESULTS –prolonged sensory and motor blockage and superior post-operative analgesia was observed in group D. CONCLUSION- Addition of Dexmeditomidine 3 mcg is significantly more effective than plain 0.5% Bupivacaine or when Clonidine 30mcg was used as adjuvant, for prolongation of sensory and motor blockage and post-operative analgesia.