We report a case of fibroid uterus with Wolff–Parkinson–White (WPW) syndrome in a 48-year-old female, posted for elective hysterectomy. Patient gave history of short recurrent episodes of palpitation and electrocardiograph confirmed the diagnosis of WPW syndrome. The anaesthetic management of these patients is challenging as they are known to develop life threatening tachyarrhythmia like paroxysmal supra-ventricular tachycardia (PSVT) and atrial fibrillation (AF). Epidural anaesthesia is preferred compared to general anaesthesia to avoid polypharmacy, noxious stimuli of laryngoscopy and intubation. To deal with perioperative complications like PSVT and AF, anti-arrhythmic drugs like adenosine, beta blockers and defibrillator should be kept ready. Perioperative monitoring is essential as patients can develop complications.

Background: Various anaesthetic agents have been tried to attenuate pressor response to laryngoscopy and intubation. Among the recommended groups intravenous nalbuphine satisfies without much undesired effects. The objective was to study efficacy of two different doses of nalbuphine to attenuate pressor response to laryngoscopy and intubation.Methods: This was hospital based comparative study was carried out at Karnataka institute of Medical Sciences Hospital, Hubli, India. Patients were divided into two groups of 50 each randomly. First group was named as N1 and the second group was named as N2. Patients in N1 were given 0.1mg/kg Nalbuphine in 10ml of normal saline and patients in N2 were given 0.2-0.1mg/kg Nalbuphine in 10ml of normal saline. Appropriated statistical tests were applied like t test, ANOVA. P value if found less than 0.05 was recorded as statistically significant.Results: There was marked increase in HR, SBP, DBP and MAP immediately following laryngoscopy and intubation in the both the groups. Intravenous Nalbuphine given 5 minutes before intubation in the dose of 0.2mgkg-1 body weight effectively attenuated the hemodynamic response after laryngoscopy and intubation. However, there was a rise in HR, SBP, DBP and MAP immediately following intubation in group N2 which was clinically not significant though statistically significant. Side effects like nausea, vomiting, respiratory depression and sedation was not observed in both study groups.Conclusions: Authors concluded that 0.2mg/kg body weight dose of Nalbuphine was found to be more effective than 0.1mg/kg body weight dose of nalbuphine in maintaining the haemodynamics of the patients.

Background: Studies comparing the efficacy of dexmedetomidine and clonidine as adjuvants to ropivacaine 0.75% in spinal anesthesia are few. The objective was to study the safety and efficacy of dexmedetomidine in comparison to clonidine as an adjuvant to ropivacaine in subarachnoid block.Methods: Patients were randomly allotted into 3 groups. Group R (n=30) patients received 3ml of 0.75% isobaric ropivacaine +0.5ml of 0.9% normal saline to a total volume of 3.5ml. Group RD (n=30) patients received 3ml of 0.75% isobaric ropivacaine +5μg of dexmedetomidine +0.9% normal saline to a total volume of 3.5ml. Group RC (n=30) patients received 3ml of 0.75% isobaric ropivacaine +30μg of clonidine +0.9% normal saline to a total volume of 3.5ml. The patients and the investigator were blinded for the study.Results: Time to reach T10 level of sensory block in group R was 7.6±1.3 min, group RC was 7.8±1.4 min and in group RD it was 7.9±1.4 min which was statistically not significant with p value 0.66. Time to reach motor onset to Bromage scale 4 was 9.8±1.4 min in group R, 10±1.4 min in group RC, 10.5±1.5 min in group RD which was statistically not significant with p value 0.24. Time to reach maximum sensory block in group R was 10.7±1.4 min, 10.6±1.1 min in group RC, 11±1.7 min in group RD which was statistically insignificant with p value 0.51.Conclusions: Intrathecal dexmedetomidine had superior anaesthetic effects with respect to duration of sensory blockade, motor blockade and duration of analgesia compared to intrathecal clonidine.

: Fentanyl has evinced its property of being a potent opioid and benumbing stress response to laryngoscopy and intubation (L&I). However respiratory depression and chest wall rigidity limits its utility at high doses. Nalbuphine, reported to have a ceiling effect for respiratory depression, can serve as an alternative. We studied and compared the efficacy of fentanyl and nalbuphine in preventing the rise in heart rate and blood pressure after L&I. A randomized double blind study was conducted in 60 subjects divided in two groups (Group F n=30 and Group N n=30) was done. Group F received 2µg kg fentanyl intravenously while group N received nalbuphine 0.2mg kg intravenously. Hemodynamic variables including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at baseline and at intervals of five minutes of administering test drug, each minute up to five minutes after intubation, 10 minutes and 30 minutes after intubation. Complications, if any, were recorded after surgery. Change in HR, SBP, DBP and MAP between the two groups was compared using independent t-test. : The two drugs were equally effective in preventing HR rise at all-time points except after 30 minutes where fentanyl performed better. The change in SBP, DBP and MAP from baseline in both the groups was comparable.: Nalbuphine can serve as an alternative to fentanyl in obtunding stress response when given five minutes before intubation.