Introduction: Hyperbaric Bupivacaine is the extensively used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block. The addition of Fentanyl or Midazolam can provide excellent quality and prolong the duration of analgesia. The study aims to compare the effect of intrathecal Fentanyl with that of intrathecal Midazolam in combination with 0.5% hyperbaric Bupivacaine on the duration and quality of spinal anesthesia in patients undergoing appendicectomy.Materials and Methods: This is a prospective, comparative and interventional study where patients were randomized into two equal groups. The study was conducted in a tertiary referral hospital from July 2018 to December 2018 after ethical approval. Group BF received Fentanyl and group BM received Midazolam The outcomes measured were, peak sensory level, quality of intraoperative analgesia and motor block, duration of effective analgesia, intraoperative and postoperative complications.Results: A total of 44 patients were studied with 22 in each arm. The two groups were comparable in terms of age, weight, height, duration of surgery, and ASA status of the patients. Peak sensory level and degree of motor block were not statistically different in the two arms. Duration of effective analgesia was 293.16±35 min in the BF group and 267.80±32 min in the BM group (p=0.01). Increased incidence of pruritus was recorded during the postoperative period in the Fentanyl group.Conclusions: Fentanyl and Midazolam both are equally effi cient adjuvant added to hyperbaric Bupivacaine for intrathecal use to improve the quality of spinal anesthesia in patients undergoing appendicectomy.

Introduction: Induction of anaesthesia has been dominated by intravenous induction agents. The commonest induction agent in use is Sodium Thiopentone. However it is increasingly being replaced by Propofol. The advantage of propofol is faster induction, rapid and clear headed recovery and less postoperative nausea and vomiting. Very little research has been done to compare propofol with thiopentone in children. The aim of this study was to compare the anesthetic effects of thiopentone and propofol in children.

preferences occurred in 87% of consults. 93% of referrals had documentation of an HCA and 100% had a POLST completed, as compared with a previous rate of 50%. Conclusions and Implications. There has been limited data on the feasibility and outcomes of concurrent PC services in the SNF. A pilot of concurrent interdisciplinary PC in the SNF demonstrated feasibility and positive outcomes. More implementation research is needed to further support the expansion of PC in this setting.

Introduction: Laryngoscopy and tracheal intubation are two powerful noxious stimuli that can be potentially deleterious specially in hypertensive patients. This study evaluated the efficacy of low dose oral pregabalin used as a premedication for attenuation of this marked sympathetic response of airway instrumentation. Materials and Methods:This was a double blind randomised study done at a tertiary level referral hospital. The trial was registered as UMIN-000037103 (https://www.umin.ac.jp/ctr/). Patients were randomly assigned into two groups. Placebo arm received multivitamin capsule and treatment arm received Cap. Pregabalin (75 mg), 60 minutes before the induction of general anesthesia. The level of preoperative sedation was assessed with the Ramsay Sedation Scale. Heart rate, systolic, diastolic and mean arterial blood pressure were monitored and recorded before and during induction, during laryngoscopy and 1, 3 and 5 minutes of intubation.Results: A total of 50 patients, 25 in each arm were enrolled. The baseline characteristics were comparable. SBP was significantly lower in the Pregabalin group than in Placebo at all the periods of recording, however, DBP and MAP decreased significantly during, after 1 and 3 minutes of laryngoscopy (p=0.001). Sedation was significantly better in the Pregabalin group with 86% in RSS 3 compared to 80% of a placebo arm in RSS2 (P <0.001). Conclusions:Premedication with a single oral dose of Pregabalin (75 mg) is effective for sedation and attenuation of hemodynamic response to direct laryngoscopy and endotracheal intubation in controlled hypertensive patients without any side effects.

Pheochromocytoma is rare, accounting for less than 0.1 % of hypertensive population. In this report, wedescribe a 40-year-old male a diagnosed case of pheochromocytoma who underwent adrenalectomyunder general anaesthesia with epidural analgesia. The patient was adequately prepared with alphaadrenergic blockers. Intraoperative course was stormy but was managed with antihypertensives,inotropes and intravenous fluid. The patient was electively ventilated overnight and had an uncomplicatedrecovery.Pheochromocytoma is a rare medical condition and an anaesthesiologist comes across it only a few timesin his or her practice. Therefore there is a limited exposure in management. Furthermore hemodynamicinstability encountered intra and postoperatively itself is a challenge. Hence management of a case ofpheochromocytoma demands a meticulous preoperative preparation, advanced monitoring devices andgood interdepartment coordination preferably in a tertiary medical center for a favourable outcome.Key words: Haemodynamic instability; inotropes; pheochromocytoma; Sodium Nitroprusside.DOI:  10.3126/mjsbh.v9i1.3486Medical Journal of Shree Birendra Hospital Vol.9(1) 2010 19-23