Aims and Objectives: The aim of the study was to compare the effects of intravenous esmolol and intranasal nitroglycerine spray on attenuation of extubation pressor response in terms of hemodynamic parameters and to compare the adverse effects, if any, of either drug. Methods: This was a randomized comparative study conducted in a tertiary care medical college in which 64 patients of ASA Grade I with age between 18 and 60 years, including both males and females undergoing elective non cardiac surgeries under general anesthesia with orotracheal intubation were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were divided into two groups (Depending on whether they received Intravenous Esmolol or NTG spray) of 32 patients each. Attenuation of extubation pressor response in terms of hemodynamic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate, and rate pressure product) were recorded and compared before induction, during surgery and postoperatively up to 10 min after surgery. Results: The gender distribution was comparable in both the groups. The mean age of patients in Group A and Group B was found to be 36.90±10.12 and 35.20±11.32 years, respectively. The mean age of both the groups was found to be comparable with no statistically significant difference. Both the study groups were comparable in base line parameters with no significant difference seen in mean age, mean heart rate, mean SBP and DBP, MAP, anesthesia time, and surgery time. Both drugs controlled the blood pressure changes effectively; however, NTG group had a better control of systolic as well as DBP. Heart rate was better controlled in esmolol group. Conclusion: Intranasal nitro-glycerine and intravenous esmolol before tracheal extubation in ASA Grade I patients are simple, effective, and practical methods of blunting cardiovascular responses to tracheal extubation.

Background: Effective anaesthesia is required to overcome complications of epidural anaesthesia and relieve the patients undergoing lower limb surgeries such as total knee replacement from severe pain. Aims and Objective: The current study was aimed to study combined spinal- epidural anaesthesia (CSEA) and spinal plus single shot femoral nerve block (SSFNB) for post-operative analgesia in total knee replacement surgeries. Materials and Methods: This prospective observational and randomized study included 60 subjects undergoing Total knee replacement which were randomized into two groups and administered combined spinal epidural block and single shot femoral nerve block as per standardised protocol for post-operative pain management. Pain as per visual analogue scale and need of rescue analgesia and other haemodynamic parameters were compared between two groups and at different time interval. Result: Two study groups were found to be matched for age, gender, weigh, height and ASA grading. SSFNB group showed significantly high VAS score at 6 Hr, need for rescue analgesia, compared to CSEA group. CSEA group had significantly high number of patients with motor block. significant difference in the variation of pulse rate was observed within both the groups. Significantly higher systolic blood pressure at 6h, 12h, 24h and 36h., diastolic blood pressure at 6h, 24h and 48h and in mean arterial pressure at 6h, 24h and 36 h was observed in SSFNB group compared to CSEA group. Conclusion: We concluded that, patients undergoing total knee replacement show better analgesia and hemodynamic stability with CSEA in comparison to SSFNB, but at the cost of more motor blockade on non-operative limb and delayed recovery.