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Background: Ludwig’s angina (LA) is a life-threatening condition, in which there is gangrenous cellulitis of floor of mouth that spreads through facial planes to involve neck region and has the potential to cause airway obstruction. Even though with advent of broad-spectrum antibiotics, it’s incidence has decreased considerably, the anesthetic management of patients, particularly children, undergoing drainage for LA group STILL remains a challenging task. Aims and Objectives: The aim of this study was to test the efficacy and safety of intravenous combination of dexmedetomidine and ketamine (DEXKET) for the drainage of abscess in patients having LA. Materials and Methods: This was a prospective study, in which 40 cases having LA and posted for Abscess drainage were included on the basis of a redefined inclusion and exclusion criteria. Abscess drainage was done under anesthesia using DEXKET as the only intravenous drug. DEXKET was prepared by mixing dexmedetomidine 0.5 mcg/kg along with ketamine 1 mg/kg in a 5 ml syringe and then diluted until 5 ml with distilled water. This was given as bolus dose. Drainage was accomplished under IV (DEXKET) sedation. Results: In this study, there were 28 males and 12 females with a M: F ratio of 1:0.42. The mean age of male and female patients was found to be 38.35±10.58 and 36.41±11.37 years, respectively. Dental caries was the most common cause leading to LA which was seen in 32 (80%) patients. There were no episodes of significant bradycardia, hypotension or desaturation during surgical procedure, as well as in post-operative period. The procedure could be accomplished without any additional doses of DEXKET. Two of the patients (5%) had post-operative nausea and vomiting. Conclusion: Drainage under sedation by intravenous combination of DEXKET is found to be an effective approach for drainage of abscess in cases of LA.

Background: Magnesium and clonidine both inhibit catecholamine and vasopressin release. They also attenuate hemodynamic response to pneumoperitoneum.Methods: This randomized double-blind study was designed to assess which agent attenuates hemodynamic stress response to pneumoperitoneum better in 70 patients undergoing laparoscopic cholecystectomy.Results: After the administration of drug, heart rate in group M was mean 84.29 while in group C was mean 79.89. Thus, there was more fall in Heart rate in C group. After intubation, heart rate at 1min, 3 min, 5 min was 101.20, 96.69, 93.94 respectively in group M and in C group was 96.37, 85.83, 86.17 respectively with p values (0.12, 0.001, 0.008). After giving drug, there was fall in blood pressure in both groups but in C group, there was significant fall in systolic blood pressure. There was no significant difference in the mean diastolic BP in both the groups immediately at intubation (76.17±10.74 for group M and 78.86±10.48 for group C with p>0.05) as also at 3 min (63.29±8.76 for M group and 65.14±11.705 for clonidine with p>0.05) and 5 min (63.03±7.909 for magnesium sulphate and 67.69±13.588 for clonidine with p>0.05) following intubation. Thus, the rise in mean diastolic BP was statistically similar in both Group M and Group C. There was no significant difference in the mean for MAP in both the groups immediately at intubation (88.86±12.76 for magnesium sulphate and 91.74±11.59 for clonidine) as also at 3 min (73.17±10.019 for M and 75.80±12.849 for C group. But at 5 min (71.71±9.11 for magnesium sulphate and 77.66±13.715 for clonidine) following intubation with p<0.05 which is significant.Conclusions: Administration of magnesium sulfate or clonidine attenuates hemodynamic response to pneumoperitoneum. Although magnesium sulfate produces hemodynamic stability comparable to clonidine, clonidine blunts the hemodynamic response to pneumoperitoneum more effectively.

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Background: Laryngeal mask airway (LMA) insertion requires anesthesia and suppression of airway reflexes. In search of an optimal drug, we compared dexmedetomidine and fentanyl, in combination with Propofol for ease of LMA insertion and haemodynamic stability. Method: Total 120 patients belonging to ASA status I & II posted for elective surgery were randomly divided into 2 equal groups. Both the groups received I.V glycopyrrolate 4μg/kg prior to receiving the study drugs. Group D received dexmedetomidine I.V 1μg/kg diluted in 10cc NS over 10min while group F received fentanyl I.V 2μg/kg diluted in 10cc NS over 10min. Induction was done with IV Propofol 2mg/kg in both the groups. After 90 sec, LMA insertion (no 3 for females and no.4 for males) was done by the consultant anaesthesiologist blinded to the technique. Results: Jaw opening, ease of LMA insertion, requirement of additional Propofol was clinically insignificant and comparable between two groups. Cough though seen more in fentanyl group, (p=0.042) while the incidence of bradycardia was more with dexmedetomidine group. Between the two groups, the change in blood pressure from baseline to 30sec after induction and upto 10min after LMA insertion was statistically insignificant. Within the individual groups, the changes in the blood pressure reached statistical significance. These changes did not reach a clinical significance and required no additional medication. Conclusion: Either dexmedetomidine or fentanyl when used along with propofol provides comparable conditions for the ease of LMA insertion with stable haemodynamic parameters in pre-hydrated, healthy and young patients.