Background: A middle ear surgery (tympanoplasty), is done under various modes of anaesthesia such as local anaesthesia (LA), general anaesthesia (GA) or sedation with local anaesthesia (MAC). It is usually performed under MAC providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilization of the patient. Aims and Objectives: The aim of this study was to compare effectiveness of nalbuphine and propofol with pentazocine and promethazine combination for intraoperative sedation under monitored anesthesia care for tympanoplasty under local anesthesia (LA). Materials and Methods: A total 60 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV nalbuphine (50 mcg/kg) and propofol 750 mcgs/kg in 10 min followed by a maintenance infusion at the rate of 25 mcg/kg/min. Group N or pentazocine 0.6 mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10 ml normal saline over 10 min followed by 25 mcg/kg/min infusion of normal saline (Group P). Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Vital parameters such as HR, BP, SpO2, RSS, visual analog scale score (VAS), requirement of rescue analgesics, mean bleeding score, and surgeon satisfaction score (Likert Scale) were recorded and analyzed. Results: RSS was higher and VAS score was lower in Group N at 30, 60, 90, and 120 min (P<0.05) that mean bleeding score was lower in Group N as compare to Group P which was statistically significant. Conclusion: Nalbuphine and propofol combination are superior to pentazocine and promethazine combination in terms of producing better analgesia, sedation with batter surgical field.

INTRODUCTION: During laryngoscopy and intubation there is an increase in both heart rate and blood pressure due to sympathetic response mediated by catecholamines and activation of tracheal nociceptors due to its manipulation. Melatonin has been used for sleep regulation and ICU sedation but there are very few studies to evaluate its effect on reducing haemodynamic stress response during laryngoscopy and intubation. In our study we evaluated the effects of melatonin in reducing the haemodynamic changes during laryngoscopy and intubation. : 100 patients belonging to ASA grade 1 and 2 of either gender METHODOLOGY , of age 18 to 60 years who were planned for elective surgery under general anaesthesia were randomly divided into two groups: Group M (n=50) was given 6 mg oral melatonin (two capsules of 3 mg each) and Group C (n=50) was given multivitamin capsules with a sip of water 90 minutes before induction of anaesthesia. General anaesthesia was induced using standard method for both the groups and changes in heart rate and blood pressure were noted in pre operative period, during intubation and at 1, 3, 5 and 10 min after intubation. The me RESULTS: an pulse rate was comparable between the two groups at baseline. During intubation heart rate was increased in both groups but rise was signicant in control group which persisted upto10 minutes, while in melatonin group it started settling within 3 minutes. There was a signicant rise in SBP, DBP and MAP in control group during and after intubation till 5 minutes as compared to melatonin group. Oral melat CONCLUSION: onin can be used in pre operative period to effectively reduce the hemodynamic stress response during and after laryngoscopy and intubation.