BACKGROUNDThe addition of adjuncts like Neostigmine, opioids, midazolam, dexmedetomidine, hyaluronidase, clonidine etc., to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Fentanyl, a phenylpiperidine derivative, is known to produce antinociception and enhance the effect of local anaesthetics when given epidurally or intrathecally. The purpose of the present study is to assess the effect of fentanyl added to brachial plexus block by axillary approach.

Endotracheal intubation is one of the most commonly performed procedures, where the role of the anaesthesiologists in patient care is noteworthy. Endotracheal intubation is translaryngeal placement of endotracheal tube into the trachea via the nose or mouth. General anaesthesia procedures involve stressful events at various stages. The most stressful situations are seen during the period of induction, intubation and extubation. A 25% to 50% increase in mean arterial pressure and heart rate is seen during induction followed by laryngoscopy and intubation peaking at 1-2 minutes and returning to baseline within 10-15 minutes. AIMS AND OBJECTIVES A comparative study of attenuation of cardiovascular response to laryngoscopy and intubation with IV dexmedetomidine vs IV lignocaine, to compare changes in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in patients premedicated with dexmedetomidine and lidocaine and to observe for any significant difference in the anaesthetic requirement and intraoperative complications if any in both the groups. METHODOLOGY A total of 60 patients undergoing elective surgeries were selected. Group D consists of 30 patients, who received IV dexmedetomidine loading dose, 1 mcg/kg diluted in 50 mL NS for 10 minutes prior to laryngoscopy. Group-L consists of 30 patients who received plain preservative-free Lidocaine 2%, 1.5 mg/kg body weight IV bolus ninety seconds prior to laryngoscopy. RESULTS Dexmedetomidine in a bolus dose of 1 ug/kg IV attenuates heart rate response to laryngoscopy and intubation effectively than plain preservative-free lignocaine. The basal values of heart rate were reached within 1 min after intubation in case of dexmedetomidine group. Dexmedetomidine blunts the increase in systolic, diastolic and mean arterial pressure effectively than Plain preservative-free Lignocaine.

The aim of the study is to isolate, identify and quantitate bacteria and to perform the antibiotic susceptibility testing from the endotracheal aspirates in RICU patients with suspected Ventilator associated Pneumonia. MATERIALS AND METHODS This study is a prospective study conducted on 80 patients during the period of February 2011 to January 2012 in the Department of Anaesthesia & Dept. of Microbiology in Govt. Chest and General Hospital, Hyderabad, in patients, who were suspected to have ventilator associated pneumonia. INCLUSION CRITERIA Patients above 18 years, who received mechanical ventilation for more than 48 hours and clinically suspected of having contracted VAP were included in this study. Clinical pulmonary infection score (CPIS, was used to diagnose VAP which was evaluated on a daily basis until the patient was on ventilator support. CPIS of >6 was used as diagnostic criteria for VAP till clinically diagnosed ventilator-associated pneumonia was observed. EXCLUSION CRITERIA Patients who were suspected to have clinical and radiological pneumonia when admitted & paediatric patients were excluded. RESULTS 97 patients taken up for the study were meeting eligibility criteria and were on mechanical ventilation for more than 48 hours, out of which 65 developed VAP. There were 40 males and 25 females. 69 (92%) were multidrug resistant out of the total 75 isolates, and it was observed that not even a single isolate was sensitive to all the drugs tested. Some of this resistance can be because of the presence of various degradative enzymes like ESBLs, AmpC β-lactamase and MBLs within these pathogens. Out of the total 28 isolates of Acinetobacter spp., (45%) isolates produced AmpC β-lactamase. In P. aeruginosa, it was seen to be produced by 20.1% isolates, in K. pneumoniae by 25.7% isolates, and in C. freundii it was seen to be produced by 64.2% isolates. The ESBL production was highest in case of E. coli (98%). It was also produced by 63.8% of Enterobacter spp. isolates, 15.9% of C. freundii and 12.2% of K. pneumoniae isolates. The MBL production was maximum in case of P. aeruginosa (25.9%). In case of Acinetobacter spp., it was 19.9% and in K. pneumoniae only 7.8% isolates produced MBL. CONCLUSION Almost all the pathogens were multidrug resistant and in all the isolates resistance was due to presence of ESBL, MBL, AmpC β lactamase. Thus, the intensivists can choose the antibiotics based on the bacteriological review of management of VAP. This study has shown that it is helpful in diagnosis of ventilator associated pneumonia and early specific treatment of these patients.