ABSTRACT:Spinal Anaesthesia is the most common approach for geriatric patients undergoing urological surgeries. Efforts to find a better adjuvant in regional anaesthesia are underway since long. Various adjuvants have been used with local anesthetics in spinal anesthesia to improve quality of intraoperative analgesia and to provide prolonged postoperative analgesia with haemodynamic stability and minimal sideeffects. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. AIM: The aim of this study was to evaluate the efficacy of intrathecal isobaric 0.75% Ropivacaine with the combination of isobaric 0.75% Ropivacaine and 5µg of Dexmedetomidine in Geriatric Hypertensive patients undergoing Urological surgeries. MATERIALS AND METHODS: Fifty patients classified in American Society of Anesthesiologists classes II and III scheduled for Urological surgeries were studied. Patients were randomly allocated to receive either. Group R: 1.9 ml of 0.75% isobaric Ropivacaine + 0.1 ml normal saline. Group D: 1.9 ml volume of 0.75% isobaric ropivacaine +5 µg Dexmedetomidine (0.1ml). RESULTS: Patients in Dexmedetomidine group (D) had a significantly longer sensory and motor block time than patients in Normal Saline group (R). The mean time of the two segment regression time in group D (115.6 ± 14.5 min) was significantly higher than group R (57.4 ± 6.3 min) (P<0.001). The regression time of motor block to reach modified Bromage 0 was (246.4 ± 25.7 min) in group D and 140.1 ± 32.3 min in group R (P<0.001).The meantime of rescue analgesia is (425.4±18.9 min) in group D when compared to group R (210.3 ± 14.2). CONCLUSIONS: Intrathecal dexmedetomidine as a adjuvant is improved the quality of intraoperative analgesia and postoperative analgesia better, produced prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics in 24 hours as compared to control group.

BACKGROUND: Dexmedetomidine has been shown to blunt the stress response to surgery and anaesthesia. Hence our study was designed to evaluate the effect of intravenous (IV) Dexmedetomidine infusion on propofol & Sevoflurane requirements during general anesthesia for laparoscopic cholecystectomies without intra operative awareness. MATERIALS AND METHODS: 60 patients scheduled for laproscopic surgeries under general anesthesia were divided into Dexmedetomidine (D) group and Placebo (P) group of 30 each. Group D received a loading dose of Inj. Dexmedetomidine at 1 μg/kg diluted to 100 ml given over 15min, followed by maintenance with 0.5 μg/kg/h till the end of surgery. Group P received similar volume of IV normal saline (100 ml). Anesthesia was maintained with nitrous oxide in oxygen and Sevoflurane keeping BIS values between 40 to 60.Patients were monitored intraoperatively for haemodynamic variables, depth of anaesthesia propofol and sevoflurane consumption & postoperative pain. Results were analysed. RESULTS: 50% reduction (1 mg/kg) in the induction dose of propofol was observed along with a mean hourly Sevoflurane requirement of 15.54±2.8 in group D when compared to (2 mg/kg) propofol, 33.35±4.2 sevoflurane in group P to maintain adequate Depth of anaesthesia using BIS. In peri-operative period, the heart rate and blood pressures were significantly lower in Group D, when compared to placebo. Patients in Group D were better sedated and post-operative pain score was lower in Group D compared to Group P. CONCLUSION: Dexmedetomidine is an effective anesthetic adjuvant that reduces propofol & sevoflurane requirements without fear of intraoperative awareness.