BACKGROUND Subarachnoid block (SAB) is a versatile regional anaesthesia technique for lower limb surgeries. Hypothermia (shivering) is a frequent, potentially serious event after spinal anaesthesia which can lead to severe complications. Several methods are used to minimize perioperative hypothermia and shivering. METHODS A hospital based prospective study was conducted in Government Medical College, Thrissur, over 12 months from January 2019 to January 2020. 260 American Society of Anesthesiologists physical status I and II patients undergoing elective surgeries under spinal anaesthesia were included. Prior to surgery patients were randomly allotted into two groups; Group 1 and Group 2. Group 1 patients were pre-warmed for 20 minutes and Group 2 were not pre-warmed. Measurement of body temperature, vital signs and shivering score was taken peri-operatively. Occurrence of hypothermia and shivering was observed intraoperatively and one hour postoperatively. RESULTS Baseline demographic data of the 2 groups was comparable. Temperature was persistently lower at all points except baseline in Group 2 compared to Group 1. Of those pre-warmed, 4.6 % and amongst those not pre-warmed, 65.4 % had shivering. Difference is statistically significant with chi square of 105.5 and p value <.001. CONCLUSIONS Incidence of hypothermia and shivering is found to be less in the pre-warmed. Hence, forced pre-warming has significant influence on hypothermia and shivering. KEY WORDS Subarachnoid Block, Pre-Warming, Hypothermia, Shivering.

BACKGROUND Direct laryngoscopy and endotracheal intubation have been a part of the mainstay modalities of providing anaesthesia. Both lignocaine and dexmedetomidine have proven effects of attenuating the stress response to laryngoscopy and intubation. This study compared the efficacy in attenuating the pressor response of lignocaine when given at 1.5 mg/kg and dexmedetomidine given at 0.5 µg/kg body weight. METHODS This is a prospective observational study involving 80 patients of both sexes who underwent elective surgeries under general anaesthesia. They were divided into two groups: Group D and Group L. Group D received dexmedetomidine 0.5 µg/kg body weight slow IV, 10 minutes prior to laryngoscopy and Group L received 2% preservative free lignocaine 1.5 mg/kg body weight i.v. bolus ninety seconds prior to laryngoscopy. Hemodynamic changes like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) were monitored before induction (baseline), post induction and at 1, 5, and 10 minutes after endotracheal intubation. Structured proforma was formulated and obtained data was analysed using STATA software. RESULTS In the lignocaine group, heart rate, SBP, DBP and MAP increased and gradually returned to baseline value. The dexmedetomidine group showed highly significant attenuation of sympathetic response to laryngoscopy and intubation compared to lignocaine groups. CONCLUSIONS The study results go on to demonstrate that dexmedetomidine infusion is better at attenuating the pressor response to intubation than preservative free intravenous lignocaine when given prior to induction. KEY WORDS Stress Response, Direct Laryngoscopy, Intubation, Dexmedetomidine, Lignocaine.

BACKGROUND Stress response to intubation produces marked hemodynamic changes during direct laryngoscopy using muscle relaxants. Since attenuation of hemodynamic response to laryngoscopy and tracheal intubation leads to better outcomes, a method for providing good intubating conditions rapidly without using muscle relaxants is being sought. The objective of the present study was to compare the hemodynamic changes occurring while intubating with 2 different doses of propofol. METHODS We compared heart rate, systolic blood pressure, diastolic pressure and mean arterial pressure changes during tracheal intubation with 2 different propofol doses without using muscle relaxants. Intravenous fentanyl inhibits the sympathetic nervous response to direct laryngoscopy and tracheal intubation in both groups of patients and acts as pre-emptive analgesia. RESULTS Comparison of the hemodynamic parameters revealed no statistically significant differences between the low dose propofol (PL) and high dose propofol (PH) groups with regard to heart rate or blood pressure changes at similar intervals postintubation. Both patient groups showed blood pressure fall along with a reflex increase in heart rate at 1 minute to 5 minutes post-intubation, returning to nearbaseline values 10 minutes post-intubation. None of these changes was either clinically detrimental or produced incidents of desaturation or arrhythmias in any study patient. CONCLUSIONS Low dose propofol may be useful in elderly or mildly hypovolemic patients, intolerant to a higher drug dosage whereas, the higher propofol dose may be particularly useful in the adult with a higher muscle mass in situations where muscle relaxant is to be restricted or avoided. KEY WORDS Tracheal Intubation, Hemodynamic Changes, Different Doses Propofol.

No abstract

BACKGROUND Effective postoperative pain control is an important part of postoperative care which leads to shortened hospital stays, reduced hospital costs and increased patient satisfaction. Variety of adjuvants has been used along with local anaesthetics in regional blocks to increase the duration of effective analgesia. We have conducted a prospective study to compare the effect of clonidine and dexmedetomidine as additives to 30 ml of 0.5 % ropivacaine in supraclavicular brachial plexus block for upper limb orthopaedic surgeries. METHODS A prospective study was conducted among 50 patients belonging to ASA 1 or 2 undergoing upper limb orthopaedic surgeries under supraclavicular brachial plexus block. Patients who received 1mcg/kg clonidine added to 30 ml of 0.5 % ropivacaine in supraclavicular brachial plexus block were taken into Group A. Patients who received 1mcg/kg dexmedetomidine added to 30 ml of 0.5 % ropivacaine in supraclavicular brachial plexus block were taken into Group B. Sensory block – onset, duration; motor block – onset and duration; duration of analgesia were monitored and recorded. Data analysed using IBM SPSS (version 17) software. P value < 0.05 was considered as statistically significant. RESULTS Onset of sensory block was 9.04 ± 1.74 min in clonidine group and 12.0 ± 2.00 min in dexmedetomidine group which was statistically significant. Onset of motor block was 11.80± 1.87 min in clonidine group and 15.48 ± 2.08 min in dexmedetomidine group which was statistically significant. Duration of motor block was 502.8 ± 60.9 min in clonidine group and 566.0 ± 59.6 min in dexmedetomidine group which was statistically significant. Duration of sensory block was 589.2 ± 56.6 min in clonidine group and 673.6 ± 53.4 min in dexmedetomidine group which was statistically significant. Duration of analgesia was 665.20 ± 52.20 min in clonidine group and 760.40 ± 48.20 min in dexmedetomidine group which was statistically significant. CONCLUSIONS The addition of clonidine to 0.5 % ropivacaine in supraclavicular brachial plexus block significantly reduces the onset of sensory block and motor block whereas addition of dexmedetomidine significantly prolongs the duration of sensory and motor block compared to clonidine. Addition of dexmedetomidine also prolongs the duration of analgesia compared to clonidine. KEY WORDS Supraclavicular Brachial Plexus Block; Ropivacaine; Clonidine; Dexmedetomidine.