The Anesthesiologist provides continuous medical care before, during, and after operation to permit the surgeons to perform surgeries; sometimes quite challenging that could otherwise cause substantial threats to the patient's survival. Anesthesiologists, because of their combination of skills are uniquely qualified to care for dying patients suffering from end diseases like cancer. These skills include knowledge of analgesic and sedative pharmacology for the management of pain, awareness of perceptual alterations along with well-known skills in drug titration and experience with critically ill and highly anxious, often agitated patients under stressful circumstances. Anesthesiologists are physicians who provide medical care to patients in a wide variety of situations. This includes preoperative evaluation, consultation with the surgical team, creation of a plan for the anesthesia (which is different in each patient), airway management, intraoperative life support, pain control, intraoperative stabilization of all the vitals, postoperative pain management. Outside the operating room, Anesthesiologist's spectrum of action includes with general emergencies, trauma, intensive care units, acute and chronic pain management. In spite of providing these highly skilled services, Anesthesiologists are facing a lot of stress these days which predisposes them to burnout, fatigue, substance abuse, and suicide. The practice of anesthesia in Indian scenario is different as compared to the western countries. In India, the Anesthesiologists are dependent on surgeons for their work. The degree of stress faced is due to a number of factors like the type and quality of work, his/her relationship with surgeons and the support he/she receives from colleagues and family.

Background:Ropivacaine, a newer local anesthetic, is gaining increased acceptance due to its improved safety profile over bupivacaine and lignocaine. Analgesic adjuvants have proved to be valuable in improving the quality of anesthesia and duration of analgesia.Aim:To compare the efficacy of clonidine and fentanyl as adjuvants to ropivacaine in spinal anesthesia in lower abdominal surgeries.Materials and Methods:A randomized, double-blind control study was carried out in 100 patients who were randomly divided into two groups. Ropivacaine-clonidine group (RC) received 30 μg of clonidine with 18.75 mg of 0.75% isobaric ropivacaine, Ropivacaine-fentanyl group (RF) received 25 μg of fentanyl with 18.75 mg of 0.75% isobaric ropivacaine intrathecally. The onset and duration of sensory and motor block, hemodynamic parameters, quality of surgical analgesia, total analgesia time, sedation score, and side effects were statistically analyzed using SPSS statistical package, paired and unpaired t-tests and Chi-square test.Results:The duration of sensory block in RC (240.00 ± 20.99), RF (196.80 ± 18.34), and motor block in RC (192.20 ± 17.36), RF (139.20 ± 17.93) outlasted the duration of surgery. In clonidine group, there was significant prolongation of sensory block, motor block and the total analgesia time. Hypotension and bradycardia occurred more commonly in RC group, whereas pruritus was more in RF group.Conclusion:Ropivacaine when combined with either clonidine or fentanyl provided an adequate subarachnoid block for lower abdominal surgeries. As an adjuvant, clonidine has advantage over fentanyl as it increased the duration of the subarachnoid block and the postoperative analgesia.

INTRODUCTION:Upper limb surgeries are mostly performed under peripheral blocks; the brachial plexus block. Peripheral nerve blocks not only provide intraoperative anaesthesia but also prolong analgesia in the post-operative period. Although studies have described the effects of dexmedetomidine on neuraxial and peripheral nerve blocks, till date, there are limited number of studies available on the effect of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. OBJECTIVE: In this study, we aimed to investigate the effects of adding 1 µg/kg of dexmedetomidine to levobupivacaine for an axillary brachial plexus block to assess the onset and duration of sensory and motor block along with duration of analgesia in the postoperative period. METHODS: Hundred patients with American Society of Anesthesiologists (ASA) physical status I/II, scheduled to undergo forearm and hand surgeries, were enrolled for the prospective randomized, double blind placebo controlled study. Patients were divided into two equal groups. Group I [Control Group]: 39 ml of 0.5% isobaric levobupivacaine + 1 ml of isotonic saline. Group II [Study Group]: 39 ml of 0.5% isobaric levobupivacaine + 1 ml of dexmedetomidine (1 µg/kg) solution. RESULTS: The results showed that the onset of sensory and motor block are significantly shorter in group II (study group)(p<0.05) while the duration of blocks were significantly longer in group II (p<0.05) along with better postoperative analgesia. None of the patients had bradycardia, hypotension or any other side effects in either of the groups. CONCLUSION: Addition of dexmedetomidine (1µg/kg) to 0.5% isobaric levobupivacaine shortens the onset time of sensory and motor block significantly, increases the duration of sensory and motor block and prolong the duration of postoperative analgesia without any side effects.