BACKGROUND AND AIMS: Intravenous regional anaesthesia is used for short procedures for upper limb and hand surgery. IVRA with adjuvants like opioids, NSAIDS, muscle relaxants increases the efficacy in terms of analgesic duration and quality of anaesthesia. We conducted this study for evaluation of adding clonidine with dexmedetomidine during bier's block in upper limb orthopedic surgeries. MATERIAL AND METHODS: Sixty patients of American society of anaesthesiologist (ASA) class I, II, III patients undergoing upper limb surgeries were enrolled. IVRA was established using 3mg/kg of 0.5% lignocaine diluted with saline to a total volume of 40ml to which 1µg/kg of clonidine in group I or 1µg/kg dexmedetomidine in group II was added. The sensory block and motor block onset and recovery, hemodynamic parameters sedation score, VAS score, doses of analgesic requirement, patient satisfaction score, surgeon satisfaction score were noted and recorded at 15min, 30min, 1hr, 2hr, 3hr, 12hr and 24hr time interval. RESULTS: Both like groups were comparable with respect to age, sex, weight, ASA grade, baseline hemodynamic vitals, duration of surgery and intra-operative and post-operative hemodynamic variables. Sensory block onset and recovery was 4.85 ±0.49 min and 5.9±0.66 min in group II (LD). Motor block onset and recovery was 10.91±0.6 min and 6.83±0.69 min in group I (LC) and 11.2±0.59 min and 7.13±0.57 min respectively in group II (LD). CONCLUSION: The addition of 1µg/kg of clonidine or 1µg/kg or 1µg/kg of dexmedetomidine to 3mg/kg of 0.5% of lignocaine is found to be effective, comparable in terms of onset and recovery of sensory and motor blockade, hemodynamically stable and without any side effects and complications.

Lumbosacral meningomyelocele and hydrocephalus are two major congenital neurological defects in paediatric patients. METHODSWe have discussed management of two cases, one of large meningomyelocele and second of massive hydrocephalus. Both cases were done successfully under general anaesthesia taking care of proper positioning. Child with meningomyelocele was positioned supine on two sand bags, creating a doughnut shaped depression to accommodate the meningomyelocele. Patient with hydrocephalus was placed on 25cms high pillow with head on a high head ring and an assistant's hand supporting the head while intubation. RESULTSMajor challenges for anaesthesiologist in these patients include airway management with proper positioning, replacement of blood and fluid losses and maintenance of body temperature.