AIM:To compare the attenuation of haemodynamic changes to laryngoscopy and intubation with IV bolus Esmolol 2mg/kg and IV Fentanyl 2µg/kg. METHODS: 90 adult patients of both sex between age 18 and 55 years with ASA grade I and II normotensive with normal rhythm in ECG are divided randomly into three groups. Group-C was control group. In these patients no drug was given. Group-E was Esmolol group. In this group patients were given Inj. Esmolol-2mg/kg IV 3 min. before intubation over 30 seconds Group-F was Fentanyl group. In this group patients were given Inj. Fentanyl-2µg/kg IV 3 min. before intubation over 30 seconds. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded as baseline and after administration of study drug. RESULTS: Heart rate, systolic, diastolic blood pressures and mean arterial blood pressures were compared at pre op, 1 minute after induction and 1, 3, 5 and 10 minute intervals from the onset of laryngoscopy and intubation. Esmolol showed better attenuation of sympathetic response which is statistically highly significant. It remains significant till the end of 5 minutes. CONCLUSION: Esmolol is more effective than Fentanyl in attenuation of sympathetic response to laryngoscopy and intubation. IV. bolus dose of Esmolol 2mg/kg administered 3 minutes before laryngoscopy and intubation can be recommended to attenuate the sympathetic response to laryngoscopy and intubation without any side effects of the drug.

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Background: Modified radical mastectomies (MRM) is conventionally done under general anaesthesia. Various regional anesthetic techniques have also been used to provide effective analgesia in the perioperative period. This study was to compare the analgesia and hemodynamic effects of bupivacaine and ropivacaine when used in thoracic epidural for modified radical mastectomy. Methods: 67 patients scheduled for MRM were enrolled in the study. They were randomized into two groups -Group R and Group B. Through an epidural catheter inserted at T5-T6, the patients in Group R received 12ml of 0.5% ropivacaine whereas those in group B received 12 ml of 0.5% bupivacaine.After one hour, 4 ml of the test drug was repeated every 30 minutes till the end of surgery. Intraoperative hemodynamic, side effects and postoperative VAS scores were recorded. 60 patients completed the study and their results were analyzed. Results: Statistically significant differences were observed in heart rate and mean arterial pressure between the two groups at various time intervals. The mean time of onset of the analgesia was shorter in Ropivacaine group 12.90±2.04mins, 19.27±5.51 in the Bupivacaine group. Post operative VAS scores were similar in both the groups. Patients in both groups were equally satisfied. Conclusion: High thoracic epidural is a safe and reliable alternative to general anaesthesia in modified radical mastectomies. Ropivacaine 0.5% is preferred due to its faster onset, better hemodynamic stability and good analgesia.