Background: Caudal anaesthesia is a useful adjunct to general anaesthesia for lower abdominal surgery in children as it provides intraoperative analgesia, smooth recovery period and good post-operative pain control which reduces Perioperative narcotic requirements. Aims & Objective: This Study was designed to evaluate duration of analgesia of Ropivacaine and Ropivacaine with Tramadol administered caudally for postoperative pain relief in children. Materials and Methods: Study was conducted in 60 paediatric patients of either sex belonging to ASA grade I or II in the age group 1 to 6 years scheduled for elective lower abdominal and lower limb surgery. Patients were randomly selected by sealed envelope method and divided into two groups of thirty patients each. Group RS received 0.2% Ropivacaine, 1 ml/kg with saline 0.04 ml/kg and Group RT received 0.2% Ropivacaine, 1 ml/kg with Tramadol 2 mg/kg by caudal route immediately after induction of general anaesthesia. Vitals and oxygen level was monitored. The analgesic effect of the caudal block was evaluated by using the observational Pain discomfort Scale and Four Point Sedation Score was used for assessment of sedation after extubation at 30 minutes and at 1, 2, 4, 6, 12 and 24 hrs. The time for the first analgesic requirement and side effects in 24 hours period were recorded. Results: Duration of analgesia was longer in Group RT [19.21 ± 2.25 hours] as compared to Group RS [6.38 ± 0.897 hours] (p<0.01). There were no significant changes in heart rate, blood pressure and oxygen saturation between two groups. Conclusion: Caudal Tramadol 2 mg/kg, combined with 0.2% Ropivacaine, 1ml/kg, provides longer duration of postoperative analgesia as compared to 0.2% Ropivacaine alone in children undergoing lower abdominal and lower limb surgery.

Anesthetic agent propofol needs to be administered at an appropriate rate to prevent hypotension and postoperative adverse reactions. To comprehend more suitable anesthetic drug rate during surgery is a crucial aspect. The main objective of this proposal is to design robust automated control system that work efficiently in most of the patients with smooth BIS and minimum variations of propofol during surgery to avoid adverse post reactions and instability of anesthetic parameters. And also, to design advanced computer control system that improves the health of patient with short recovery time and less clinical expenditures. Unlike existing research work, this system administrates propofol as a hypnotic drug to regulate BIS, with fast bolus infusion in induction phase and slow continuous infusion in maintenance phase of anesthesia. The novelty of the paper lies in possibility to simplify the drug sensitivity-based adaption with infusion delay approach to achieve closedloop control of hypnosis during surgery. Proposed work uses a brain concentration as a feedback signal in place of the BIS signal. Regression model based estimated sensitivity parameters are used for adaption to avoid BIS signal based frequent adaption procedure and large offset error. Adaptive smith predictor with lead-lag filter approach is applied on 22 different patients' model identified by actual clinical data. The actual BIS and propofol infusion signals recorded during clinical trials were used to estimate patient's sensitivity parameters EC 50 and λ. Simulation results indicate that patient's drug sensitivity parameters based adaptive strategy facilitates optimal controller performance in most of the patients. Results are obtained with proposed scheme having less settling time, BIS oscillations and small offset error leads to adequate depth of anesthesia. A comparison with manual control mode and previously reported system shows that proposed system achieves reduction in the total variations of the propofol dose. Proposed adaptive scheme provides better performance with less oscillation in spite of computation delay, surgical stimulations and patient variability. Proposed scheme also provides improvement in robustness and may be suitable for clinical practices.

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