Introduction:  After induction of anaesthesia, tracheal intubation is usually facilitated by the use of muscle relaxants. Neuromuscular blocking drugs, particularly Succinylcholine, may cause serious side effects, but remain in clinical use to facilitate tracheal intubation due to a lack of suitable alternatives. Recent studies have suggested that propofol provides good intubating conditions without muscle relaxants, due to its relaxing action on upper air way. A search for better and ideal intravenous induction agent has led to propofol, a 2, 6, di-isopropyl phenol which was developed following a series of investigations. Propofol reduces hypertension and tachycardia during intubation. The changes in blood pressure observed are due to both decrease in cardiac output and decrease in systemic vascular resistance. Increasing the depth of anaesthesia by administering supplementary increments of induction agent, opioids or lignocaine may improve conditions. These techniques also protect against the potentially adverse effects of tracheal intubation namely systemic, intra-cranial and intra-ocular hypertensions and tachycardia. Material and Methods: 50 patients were randomly divided into two groups of 25 patients each. Group I: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. Group II: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. After loss of eye lash reflex, induction time was noted with stop watch and then injection succinylcholine 2mg/kg body weight was injected. Patients were monitored throughout the operation E.C.G. using cardiac monitor on lead II, PaO2 with Pulse Oxymeter. Pulse and blood pressure were recorded. Results: Youngest patient was of 20 years in group I and 22 years in group II. Eldest patient was of 56 years in group I and 60 years in group II. Maximum number of patients were in 20-30 years of age 15 (60%) in group I and 11 (44%) in group II. Excellent intubating conditions were seen in 15 (60%) patients of group I and 25 (100%) patients of group II. The pre induction mean pulse rate (base line) was 103.04±13.08 and 104.56±17.14 in group I and group II respectively. There was slight decrease in pulse rate initially after induction with mean 99.92±13.87 and 98.32±14.60 in group I and group II respectively, but the difference was not statistically significant from the baseline values. (p>0.05). There was slight decrease in arterial pressure initially after induction with mean 80.88 ±6.59 and 85.31±8.71 in group I and group II respectively, but the difference was not statistically significant (P>0.05) from the baseline values. There was slight increase in mean arterial pressure just after intubation with mean 94.10 ±8.07 and 95.58±9.46 in group I and group II respectively, which was not statistically significant (p>0.05). These changes in M.A.P. values return to baseline values 5 minutes after intubation. Conclusion: Propofol 2.5mg/kg when used alone as inducing agent without the aid of any neuromuscular blocking agents produced acceptable intubating conditions, when compared to propofol, 2.5mg/kg along with succinylcholine. It was shown that there were no significant cardiovascular changes when intubation was done without relaxant after induction with propofol.

Background: Total intravenous anaesthesia has gained popularity, partly in order to reduce pollution by volatile agents. Propofol has proven to be suitable as a hypnotic for TIVA. The drug has fast onset of action and rapid metabolism without accumulation. Objectives: To compare propofol in combination with ketamine and fentanyl in TIV A technique in a population of Chhattisgarh region. Subjects and Methods: Patients of group-I were induced with ketamine and propofol. Patients of group-II were induced with fentanyl and propofol. Parameters like Induction time, induction dose and total dose of propofol, top up doses of ketamine and fentanyl were observed and recorded. Continuous monitoring of pulse rate, arterial blood pressure, respiratory rate and arterial oxygen saturation was done throughout peri-operative period and readings were recorded at different time interval. Results: Propofol and ketamine combination took less time. The induction dose and total dose of propofol was less in propofol ketamine as compared to in propofo1 fcntany1 group. Number of top-ups of ketamine were less than the number of top ups of fentanyl. Stability of pulse and blood pressure with propofol ketamine combination were comparable and better. In propofol ketamine group respiratory rate was well maintained within normal range. Maintenance of arterial oxygen saturation was good with both the groups. Propofol ketamine combination took longer time for recovery from anaesthesia in comparison with propofol fentanyl combination. Conclusion: So to conclude, combination of propofol and ketamine gives better haemodynamic stability during induction and maintenance of total intravenous anaesthesia. Sub anesthetic doses of ketamine may be an alternative, cheaper analgesic to supplement propofol anaesthesia, instead of short acting potent expensive opioids like fentanyl.

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Introduction:  Arthroscopic shoulder surgery is a minimally invasive technique performed for diagnostic and therapeutic purposes. Advances in arthroscopy permit many procedures to be performed primarily or adjunctively through the arthroscope. Commonest indications of shoulder arthroscopy is usually performed for Shoulder instability, Bankart’s lesion, Supraspinatus tear, Meniscus tear, Impingement syndrome, Rotator cuff tears, Calcific tendonitis tendinitis and Frozen shoulder. Recent evidences, however, have increasingly focused on complications related to use of irrigation fluid, patient positioning and anaesthesia during shoulder arthroscopy. The risk of complications can be reduced with an experienced surgeon, lesser surgical duration, use of controlled pump pressures and controlled flow rate of irrigation fluids. Material and Methods: The present prospective study involves an analysis of perioperative monitoring of effects of amount of irrigation fluid in patient undergoing shoulder arthroscopy. With objective to see the Effect of irrigation fluid absorption on measurable parameters and to identify whether these parameters help in predicting airway/ respiratory compromise or cardiac complications.All the patients of any ASA Grade, sex and above 18 years who were posted for shoulder arthroscopy were included in the study. 72 patients who were undergoing shoulder arthroscopy were invited to participate in this observational study. Complete histories were obtained and thorough clinical examination was carried out. Brachial plexus block with general anaesthesia were given to all the patients. Results: Out of 72 patients 54(75%) were males and 18(25%) were females.30 litres or less irrigation fluid is used in 47(65.3%) patients, between 30-40 litres is used in 24(33%) patients and 40 litres or more irrigation fluid is used in 1( 1.4%) patient. Baseline pulse rate was 79.85±8.11 per minutes, which started decreasing from T4 (1.4%) to throughout the procedure and this fall was found to be statistically significant. The maximum fall in pulse rate at 160 minutes (19.8%). Pulse rate increases from 200 minutes till the end of the surgery. Baseline mean BP was 101.63±7.90 mm Hg, which started decreasing from T1 (16.1%) to throughout the procedure and this fall was found to be statistically significant. the leak test and delayed extubation in patients undergoing shoulder arthroscopy. Towards the end of procedure and prior to extubation 4(5.6%) patients showed negative leak test and hence, had delayed extubation, and 68(94.4%) patients showed positive leak test and normal extubation and statistically significant. Mid arm circumference was increased by 14.2%, neck circumference was increased by 10.4%, haemoglobin (Hb) was decreased by 6.6%, serum sodium (Na) was decreased by 4.6% and serum potassium (K) was decreased by 16.2%. Post-operative changes in all these parameters was found to be statistically significant. Conclusion: Extravasation of irrigation fluid used during shoulder arthroscopy can be disastrous leading to various complications like airway oedema, tracheal compression extensive subcutaneous emphysema, pneumomediastinum, tension pneumothorax and air embolism. The risk of regional and systemic absorption of irrigation fluid is directly proportional to amount of irrigation fluid used and duration of surgery. The measurement of neck circumference can be a clinical predictor for airway oedema following shoulder arthroscopy. We recommend to with hold extubation when the neck circumference increases by more than 6 cm