Context:Subarachnoid block or spinal anesthesia is a commonly used technique for lower abdominal and lower limb surgeries. Bupivacaine is the commonly used cost-effective drug which gives satisfactory analgesia for 90–120 min. Additives such as opioids and α2 agonists extend the analgesia in the postoperative period. In this study, we compared the effects of nalbuphine with fentanyl.Aims:The aim of this study is to compare the effects of intrathecal nalbuphine and fentanyl as adjuvants to hyperbaric bupivacaine in regard to time of onset of sensory blockade, duration of sensory blockade, two-segment sensory regression time, duration of effective postoperative analgesia, and incidence of side effects.Settings and Design:This was a prospective, randomized double-blind study.Subjects and Methods:After ethical committee permission and patient consent, 124 patients aged 18–55 years with American Society of Anesthesiologists physical status I and II were randomly divided into two groups – Group N: hyperbaric bupivacaine with nalbuphine (300 μg); Group C: hyperbaric bupivacaine with fentanyl (25 μg).Results:Duration of onset of sensory blockade was 3.9 ± 0.35 min in Group C and 3.1 ± 0.18 min in Group F. Two-segment sensory regression time was prolonged in Group C (193.16 ± 39.55) compared to Group F (167.41 ± 30.17 min).Conclusions:Intrathecal nalbuphine at a dose of 300 μg in 3 ml 0.5% heavy bupivacaine in patients undergoing elective lower abdominal surgeries showed delay in onset time for sensory blockade and produced prolonged postoperative analgesia, prolonged sensory blockade, and minimal bradycardia which could be easily managed.

A 25-year-old primigravida with 39 wk gestation of height 152 cms weighing 55 kgs was posted for LSCS in view of Cephalo pelvic disproportion (CPD). She was nil by mouth for 10 h. On physical examination patient was moderately built and nourished, pale with alopecia and buck tooth. Patient gives history of fever in childhood at the age of 10 y with loss of hair. Examination of respiratory, cardiovascular and central nervous system revealed no abnormalities, including Investigations (Her blood sugars were normal).After taking informed consent, Spinal anaesthesia was planned for this patient. Monitors were connected and baseline vitals recorded. Spinal anaesthesia was induced with 2ml (10 mg) hyperbaric bupivacaine 0.5% with a 25 G spinal needle in L2-L3 interspace in sitting position. A wedge was given to right buttock and 10 degree head up was given. Sensory and motor block was adequate for surgery. Within 5 min patient became drowsy not responding to oral commands associated with sweating. As the patient was not responding, high spinal was suspected. Oxygen was administered with assisted ventilation. As it was an emergency LSCS surgery was continued with 100% oxygen throughout the surgical period. Baby extracted after 9 mins cried immediately after birth. Surgery was uneventful with no intraoperative hypotension or bradycardia. Patient was still drowsy, not responding to oral commands after closure of abdomen, after 50 min of Spinal anaesthesia and the level could not be assessed. As the patient had a episode of preoperative hypoglycemia, blood glucose level was checked and it was found to be 50mg/dl. Fifty ml of 25% Dextrose was infused after which the patient started responding to oral commands. There were no further episodes of hypoglycemia postoperatively. DisCussionHigh or complete spinal block is a known complication of spinal anesthesia. Pregnant women demonstrate increased sensitivity to both regional and general anesthetics. From early stages when neuraxial anesthesia is administered, pregnant women require less local anesthetic than non-pregnant women do to reach a given dermatomal sensory level [1].As high spinal is common in parturients, when the patient became unresponsive she was managed as a case of high spinal with 100% aBstRaCt Spinal anaesthesia is a suitable choice for emergency LSCS (lower segment caesarian section). High spinal is common in parturients. We report a case of 25-year-old primigravida with cephalo pelvic disproportion coming for emergency LSCS with no comorbidities. The patient became unresponsive after 5 min of Sub Arachnoid Block (SAB), managed as a case of high spinal. Still the patient remained unresponsive at the end of surgery, 50 min after SAB. Patient started responding to oral commands after correction of hypoglycemia with 25% dextrose infusion.Keywords: Anaesthesia, High sub arachnoid block, Low blood sugars, Pregnancy oxygen supplementation with assisted ventilation. As she remained unresponsive after the end of surgery other reasons were sought for her unresponsiven...

Introduction:Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate (HR) due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a sodium channel blocker, attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a calcium channel blocker, attenuates hemodynamic response by blocking voltage-sensitive L type channels and inhibiting calcium entry-mediated action potential in smooth and cardiac muscle.Aims and Objectives:The aims and objectives of this are to study and to compare the efficacy of combination of intravenous (i.v.) diltiazem 0.1 mg/kg and i.v. lidocaine 1.0 mg/kg, diltiazem 0.2 mg/kg and lidocaine 1.0 mg/kg, lignocaine 1.0 mg/kg with normal saline given to attenuate exaggerated hemodynamic extubation responses and airway reflexes during extubation.Materials and Methods:This study was undertaken with 105 patients belonging to the age group 20–65 years with physical status ASA Classes I and II of either sex. Group A received injection diltiazem 0.1 mg/kg and preservative-free lignocaine 1 mg/kg. Group B received injection diltiazem 0.2 mg/kg and lignocaine 1 mg/kg. Group C received injection lignocaine 1 mg/kg with normal saline. In this study group, the drug dosage was fixed based on the previous studies.Results:At postextubation, significant difference in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were observed from 1 to 10 min between three groups. The difference in HR, SBP, DBP, and MAP were statistically significant between Group C in comparison with Group A and Group B from 1 min postextubation to 10 min.Conclusion:Combined diltiazem and lidocaine are more effective prophylaxis than lidocaine alone for attenuating the cardiovascular responses to tracheal extubation.

Background and ObjectivesFunctional endoscopic sinus surgery (FESS) is a type of minimally invasive surgery done for acute and chronic sinus diseases or paranasal illnesses. The idea of FESS is to preserve the normal anatomy, which is non-obstructing and mucous membrane while removing tissue obstructing OMC (osteo metal complex) and facilitating drainage. The critical structures, including the brain, orbit, and carotid veins, the lack of adequate operating room, and bleeding that obscures endoscopic vision throughout the procedure may increase the likelihood of unfavorable surgical results. This study seeks to examine the hemodynamic effects of intubation and extubation as well as the impact of fentanyl infusion on lowering blood pressure during FESS procedures. Materials and MethodsSixty-eight patients from the American Society of Anesthesiologists classes 1 and 2 who were planned for functional endoscopic sinus operations were randomly split into two groups for this randomized prospective trial. Group 1 patient belonging to the fentanyl 2 mcg per kg bolus 30 minutes before induction followed by 2 mcg per kg per hr infusion for 90 minutes of surgery, and Group 2 patient belonging to fentanyl 1 mcg per kg bolus 30 minutes before induction followed by 1 mcg per kg per hr infusion for 90 minutes of surgery. The significance of the difference in quantitative measures was measured using the student-t test, and the Chisquare test was used to measure up the difference in proportion. Statistically significant was set at P<0.05. ResultsMean systolic blood pressure was higher in members of Group 2 than in Group 1. In contrast to Group 2, Group 1 had considerably better surgical field conditions, surgeon satisfaction on the AONO'S scale, postoperative nausea and vomiting, and a post-operative VAS Score during the first 24 hours. ConclusionPre-induction Fentanyl with infusion can effectively control hypotension during functional endoscopic sinus surgery.