Background and Aims:Recently, low-dose intravenous (IV) dexmedetomidine has been evaluated for obtunding the pneumoperitoneum-induced haemodynamic changes and its analgesic efficacy in laparoscopic cholecystectomy. The aim was to determine the postoperative analgesic efficacy of low-dose bolus of 0.5 μg/kg dexmedetomidine via IV and intraperitoneal (IP) route in laparoscopic cholecystectomy.Methods:Seventy-five patients, aged 18–60 years of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anaesthesia were included. Patients in Group C received IP bupivacaine. Patients in Group IV received 0.5 μg/kg dexmedetomidine infusion IV after removal of gall bladder along with IP bupivacaine and Group IP received 0.5 μg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The primary outcome was 'time to first request of analgesia' and the secondary outcomes were 'total consumption of tramadol in 24 hours,' visual analogue scale (VAS) pain score.Results:In total, 75 patients with 25 in each group were included. Time to first request of analgesia was found to be significantly lower in IV (59.68 ± 71.05 min, P = 0.00) and IP group (90.80 ± 80.46 min, P = 0.001) compared tp Group C (59.68 ± 71.05 min). Mean tramadol consumption in 24 hours (152.40 ± 60.958 vs 137.64 ± 52.40 mg) and mean VAS pain score were comparable in both IV and IP groups in the initial 12 h.Conclusion:Low bolus dose of IP dexmedetomidine is as efficacious as IV dexmedetomidine (0.5 μg/kg) along with IP bupivacaine in laparoscopic cholecystectomy.

Background:Search for an ideal premedicant drug for children is still on. A prospective, randomized trial was conducted to compare the efficacy of midazolam, triclofos and hydroxyzine as premedication in children undergoing lower abdominal surgeries.Materials and Methods:Sixty American Society of Anesthesiologists I or II patients 2-8 years of age, scheduled for elective lower abdominal surgery were included. The patients were randomly divided into three groups M, T and H of 20 children each who received midazolam 0.5 mg/kg, triclofos 75 mg/kg and hydroxyzine 0.5 mg/kg respectively, orally 60 min before surgery. The acceptability of drugs, level of sedation, anxiety during separation and on mask application was assessed.Results:The acceptability of midazolam and hydroxyzine was better than triclofos. Hydroxyzine was found to have lesser sedative effect as compared to both midazolam and triclofos. No major adverse effects were observed.Conclusion:Midazolam was found to be a better premedicant in terms of sedation, anxiolysis and safety.

Background: Dexamethasone has been used for postoperative nausea and vomiting (PONV). Single dose dexamethasone in premedication does not cause any side effect. During our previous published study conducted on effect of dexamethasone for PONV, an unusual side effect of excruciating pain and perineal itching immediately following administration of this drug was observed. The present prospective incidence study was conducted in tertiary hospital of East Delhi, India to find out incidence and management of severe perineal pain and perineal pruritus immediately post-administration of dexamethasone. Methods: 30 ASA 1 or 2 males (Group 1) and 30 ASA 1 or 2 females (Group 2) patients were selected to find incidence and intensity of pain after dexamethasone administration in both sexes posted for routine ophthalmologic, ENT and gastrointestinal surgeries. An intravenous canula (18 G) was inserted ringer lactate fluid was started. Dexamethasone in dose of 0.15 mg/kg was administered (after dilution with normal saline to 5 ml volume) along with i.v. fluid. Immediately patients were asked for any discomfort, pain/pruritus. Onset of pain & duration of pain was noted. Intensity of pain was assessed with 11 point Numeric pain scale and Simple descriptive pain intensity scale and Chi-Square test was applied with P value of <0.05 was considered as significant. Any other adverse effect was noted, if any. Results: Seventy percent male patients suffered no pain as compared to 43.3% female patients (p<0.05). Only 30% male patients had suffered pain as compared to 56% female patients with similar perineal pruritus incidence and similar mean pain/pruritus onset time. The mean duration of persistence of pain was 23 seconds and 29 seconds in group 1 and 2 respectively. Conclusion: Perineal itching or excruciating pain in patients receiving dexamethasone is more common in female patients with incidence more than 55%. The pain subsides on its own without any treatment.