To compare the haemodynamic response to laryngoscopy and intubation with intravenous MgSO4 and intravenous fentanyl. METHODS Fifty adult patients were divided into two groups randomly into group M and group F. Patients of group M received 30 mg/kg body weight of IV MgSO4 and group F received IV fentanyl 1.5 µg/kg 5 minutes before intubation. RESULTS IV Fentanyl showed greater degree of haemodynamic stability i.e. rise in heart rate, mean arterial pressure during laryngoscopy and intubation compared to IV MgSO4. IV fentanyl showed side effects like respiratory depression, nausea and vomiting. CONCLUSION IV fentanyl is a better drug in controlling haemodynamic response to laryngoscopy and intubation.

BACKGROUND AND AIMSTo study and compare Labetalol and Clonidine as premedication to attenuate haemodynamic changes to Laparoscopy through oral route, as it is safe method of administration and easy to prescribe. METHODSIn a prospective, comparative randomised study, 60 adult patients of both sexes of ASA Grade I and II were divided randomly into 2 groups of 30 each, Group L and Group C. Group L were given Tab. Labetalol 200mg orally 60-90 minutes before induction. Group C were given Tab. Clonidine 300µg orally 60-90 minutes before induction. We compared the degree of attenuation of haemodynamic changes during laparoscopic surgeries. RESULTSOral Clonidine has better control on the rise in heart rate and mean arterial pressure (MAP) during laryngoscopy for laparoscopy compared to oral Labetalol. CONCLUSIONWe conclude that oral Clonidine showed better attenuation of haemodynamic changes than oral Labetalol.

Quadriplegia following spinal anaesthesia due to spinal epidural haematoma is a rare but critical complication that usually occurs within 24 hours to a few days of the procedure. I report a case of a 32 year old male who underwent Uretero-Renal Scopy (URS) and double 'J' (DJ) stenting for right ureteric calculus under spinal anaesthesia. The patient was on nonsteroidal anti-inflammatory agents (NSAIDS) and oral Prednisolone for sero-negative rheumatoid arthritis. The preoperative investigations were normal. About four hours after surgery, the patient developed paraesthesia of lower limbs, a little later paraplegia and gradually quadriplegia within 12 to 15 hours of surgery. Magnetic Resonance Imaging (MRI) revealed an extensive spinal epidural haematoma and cord oedema extending from C2 to L5 vertebrae. In consultation with neuro-surgeon, the patient was treated conservatively, while awaiting for the results of coagulation profile, which proved to be Haemophilia. By the end of 2nd and 3rd postoperative day, the upper limbs showed signs of recovery and within a week's time, both the upper limbs regained normal power and tone. The lower limbs showed sensory as well as motor recovery by 3 rd week and about total recovery to normalcy by 6 weeks. Residual paresis remained in left lower limb. The patient was sent for physiotherapy and he recovered completely by 9 months.

BACKGROUNDThere are no studies comparing the outcomes of using Fentanyl or Neostigmine as adjuvants to Ropivacaine in terms of postoperative analgesia for paediatric caudal block. The aim of our study is to compare the outcomes of using Ropivacaine 0.2% vs Ropivacaine 0.2% with Neostigmine 2 mcg/kg vs Ropivacaine with Fentanyl 1 mcg/kg as a single shot caudal block on postoperative analgesic effect in children aged 3 -8 yrs. undergoing subumbilical surgeries. MATERIALS AND METHODSThis is a double-blind, randomised, controlled, prospective study. Our study included 60 paediatric patients undergoing elective lower abdominal surgeries at Rajiv Gandhi Institute of Medical Sciences, Srikakulam, Andhra Pradesh. RESULTSThe patient groups were comparable with respect to age and weight. The mean pain scores at 24 hrs. in R, RF and RN groups are 3.05 ± 0.6, 2 ± 0.5, 2.65 ± 0.67 respectively with a p-value of 0.008, which is statistically significant. The duration of analgesia in R, RF and RN groups are 383, 353 and 680.5 mins. respectively with a p-value of ˂ 0.05, which is statistically significant. CONCLUSIONWe conclude in the present study that the addition of neostigmine to caudal Ropivacaine resulted in prolongation of duration of analgesia, while a Ropivacaine and Fentanyl mixture did not cause any statistically significant increase in the duration of analgesia. KEYWORDSRopivacaine, Fentanyl, Neostigmine, Caudal Analgesia. HOW TO CITE THIS ARTICLE:Rao MP, Babu SP, Saroj P. A randomised, double-blind, prospective study of caudal ropivacaine versus ropivacaine with fentanyl versus ropivacaine with neostigmine for combined epidural and general anaesthesia in children. J. Evolution Med. Dent. Sci. 2017;6(44):3459-3468, DOI: 10.14260/Jemds/2017/748 BACKGROUND Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage" as defined by the International Association for the Study of Pain. [1] Pain is always subjective.In children even the definition of pain has been debated. [2] The structural components necessary to perceive pain are already present at about 25 weeks gestation, whereas the endogenous descending inhibitory pathways are not fully developed until mid-infancy. [3,4] It has been recognised for some time that the management of acute pain, especially post-operative pain, has been consistently inadequate. If anything, the situation in children has been even worse, who have long been undermedicated for acute pain. [5] The various drugs used for the treatment of acute postoperative pain are local anaesthetics (local/regional Financial or Other, Competing Interest: None. Submission 21-04-2017, Peer Review 19-05-2017, Acceptance 25-05-2017, Published 01-06-2017. Corresponding Author: Dr. Soumya Panickessery Babu, D/No. 39-6-72, Muralinagar, Visakhapatnam-530007. E-mail: pbsoums.k@gmail.com DOI: 10.14260/jemds/2017 analgesia), opioids, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and acetaminophen. The different availab...

BACKGROUND: Intra Venous Regional Anesthesia (IVRA) is technically straight forward and doesn't require specific anatomical knowledge. The potential use of a local anesthetic that could provide anesthesia of greater duration than lidocaine with less toxicity than bupivacaine prompted the need for comparison of ropivacaine and lidocaine for IVRA in healthy volunteers and thus the need for the study. A 0.2% solution is to be used because it is the commercially available concentration of ropivacaine for IVRA. Aim of the study was to study and compare the efficacy of 0.5% lignocaine and 0.2% ropivacaine in Intra venous regional analgesia. METHODS: 60 Patients being electively operated on upper limb, below elbow were enrolled into the study. Patients were divided into two groups. Group L-30 patients were to receive 40ml of 0.5% Lignocaine and Group R-30 patients were to receive 40ml of 0.2% Ropivacaine. Double tourniquets set up was connected to pneumatic pump with pressure gauge placed over it. The proximal cuff was inflated to 100mm Hg higher than the systolic BP and the bandage was removed. Onset of action of the anaesthetic, intensity of motor blockade, intensity of analgesia, duration of analgesia and complications arising were noted. RESULTS: Onset of analgesia was immediate with Lignocaine (3-5 minutes) whereas it took 7-10 minutes in patients given Ropivacaine. The quality of analgesia with regards to VAS was better in patients receiving Ropivacaine than those who received Lignocaine. Degree of motor block was grade 0 in 86% patients in Ropivacaine group as compared to 76% in patients of Lignocaine group. Duration of post-operative analgesia was found to be in the range of 3-8 minutes with Ropivacaine group whereas duration with Lignocaine was found to be dependent on the time of tourniquet release. Pain reappeared almost immediately in the Lignocaine group compared to the Ropivacaine group. No side-effects or complications with either of the drugs were noticed. CONCLUSION: Ropivacaine appears to be a better alternative to Lignocaine with regards to the onset of analgesia, quality of analgesia, degree of motor blockade and post-operative analgesia.