BACKGROUND The choice of an anaesthetic agent for induction of anaesthesia is based mainly on its pharmacodynamic properties. We wanted to compare the effect of etomidate and propofol induction on haemodynamic response, serum cortisol level, and adverse effects in patients undergoing laparoscopic cholecystectomy. METHOD After approval from the institutional ethics committee, eighty-three American Society of Anaesthesiologist (ASA) grade I or II patients of 20-60 yrs. undergoing elective laparoscopic cholecystectomy were enrolled in the study. Patients were allocated randomly to receive either propofol or etomidate for induction of anaesthesia. Anaesthesia was maintained in both the groups with sevoflurane air and oxygen mixture, vecuronium bromide 0.08 mg/Kg for muscle relaxant. RESULTS The mean baseline haemodynamic parameters (SBP, DBP, MAP, HR) are comparable in both the groups. Post induction blood pressure was significantly lower in propofol group as compared to etomidate group. Immediately after intubation surge in blood pressure was more in etomidate group than propofol group. Also there was no difference in mean baseline serum cortisol levels in both the groups. But after induction, serum cortisol level was significantly decreased in etomidate group. However, after 24 hrs. of induction mean serum cortisol level in both the groups returns to baseline value. CONCLUSIONS Etomidate has more stable cardiovascular profile than propofol. It has the added advantage of minimizing induction hypotension which can cause coronary hypoperfusion, dysrhythmia and even cardiac arrest. Etomidate causes temporary reduction in serum cortisol level and this reduction in serum cortisol gets normalized 24 hrs. after induction.

No abstract

Introduction: Postdural Puncture Headache (PDPH) is the most common complication of dural puncture. Clinical studies have shown that use of small guage needles with pencil point tip is associated with lower incidence and severity of PDPH than with cutting tip needles. Aim: To compare the incidence and severity of PDPH between 25G cutting (Quincke) and 25G non cutting (Whitacre) needles. Materials and Methods: In this randomised controlled study conducted at Jawaharlal Nehru Institute of Medical SciencesImphal, Manipur, India from September 2019 to September 2021. A total of 150 patients of both sexes, age <60 years and American Society of Anaesthesiologists (ASA) grade I and II, undergoing lower abdominal or lower limb surgeries under spinal anaesthesia were enrolled for this study and divided into two groups with 75 patients in each group. Spinal anaesthesia was performed with 25G Quincke needle in one group and 25G Whitacre needle used in other group to compare the incidence and severity of PDPH (severity was determined by limitation of patient activity and treatment required). Results: Overall 14 patients (9.33%) developed PDPH – 2 in the Whitacre spinal needle (2.6%), and 12 in the Quincke spinal needle (16%), with p-value of 0.009. The incidence of failed spinal anaesthesia was significantly higher with Whitacre spinal needle 12 (16%) than with Quincke needle 4 (5.3%), with p-value of 0.03. Incidence of PDPH was more in female patients 12 (14.8%) compared with male patients 2 (2.9%),with p-value of 0.018. Severity of PDPH ranged from mild (n=10) to moderate (n=2) in Quincke needle group, whereas in Whitacre group patients had only mild form of PDPH (n=2). Conclusion: Incidence and severity of PDPH was significantly lower in 25G Whitacre spinal needle than 25G Quincke needle. Failure rate of spinal anaesthesia was more in Whitacre needle than in Quincke needle.

BACKGROUND Spinal anaesthesia is the technique of choice for caesarean section as it is devoid of many potential problems associated with general anaesthesia. The usual dose required for reaching the desired block height for hyperbaric bupivacaine is 10-12 mg. A lower dose of bupivacaine with an adjuvant is used as a reliable combination which produces synergistic effect, prolonging the duration of sensory block without increasing sympathetic block or delaying recovery. METHODS A total of 110 patients undergoing elective or emergency Caesarean section under spinal anaesthesia, were screened for eligibility and 105 were randomised in the trial, allocated to 3 groups to receive injection bupivacaine 7.5 mg along with fentanyl 15 mcg (Group BF1, n=35), fentanyl 20 mcg (Group BF2, n=35), fentanyl 25 mcg (Group BF3, n=35). RESULTS The average time required to reach the block height of T4-T6 was around 3.26 min in BF1, 3.97 min in BF2, 4.63 min in BF3. The two-segment regression time of BF1 was 68.06 min; BF2 72.17 min and BF3 80.06 min. The recovery time of sensory block for BF1 is around 129.71 min, for BF2, 193.43 min and for BF3 200.86 min. The time for onset of motor block was BF1 1.49 min, BF2 1.51 min and BF3 2.34 min. The time to maximum of motor block was 2.8 min for BF1, 3.69 min for BF2, 7.8 min for BF3. The recovery time of motor block for BF1, was 107.14 min; BF2, 91.57 min and BF3, 65.66 min. CONCLUSIONS All the three doses of fentanyl-15mcg, 20mcg, 25mcg can be used as an adjuvant to 7.5 mg of 0.5% heavy bupivacaine for caesarean section to provide good quality surgical anaesthesia. Larger fentanyl dose group (25mcg) scores over small dose group in terms of sensory block with prolonged post-operative analgesia, early motor recovery and lesser incidence of hypotension.