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Background: Modern laparoscopic surgeries with insufflation of gas into peritoneal cavity are gold standard treatment for cholelithiasis. Propofol, a GABA receptor positive allosteric modulator and Sevoflurane, an inhalational anesthetic are used for maintenance of general anesthesia. In laparoscopy, significant hemodynamic changes occur. Searching in field of anesthesia is going on for anesthetic agent for better recovery. Aims and Objectives: Objective of the study is to compare sevoflurane with propofol for intraoperative hemodynamic changes and post-operative recovery profile of patient’s undergone laparoscopic cholecystectomies under general anesthesia. Secondary objective is to compare post-operative complications. Materials and Methods: A prospective, randomized, single-blinded, and comparative study done after permission from the institutional ethical committee and informed consent from patients. Total 84 patients of 20–50 years age of either sex were scheduled for laparoscopic cholecystectomy, divided in two equal groups – Group P, induced with propofol and anesthesia was maintained with propofol (100–120 μg/kg/min), nitrous oxide and oxygen and Group S induced with propofol and anesthesia was maintained using sevoflurane (1–2%), nitrous oxide, and oxygen. Results: We found that time for eye opening was 9±1.21 min in Group P and 8±1.34 min in Group S. Time for following verbal command was 10±1.20 min in Group P and 9±1.32 min in Group S. Time for speaking name by patient was 11±1.20 min in Group P and 10±1.34 min in Group S. Difference between two groups regarding eye opening, following verbal command, and time to speak own name are highly significant with P<0.001 which proves that eye opening, following verbal command and time for speaking name by patient were significantly shorter in sevoflurane group. Time to achieve modified aldrete score >8 was 14±1.30 min in Group P and 13±1.37 min in Group S. Difference between two groups is also highly significant with P<0.001 which proves that time to achieve modified aldrete score>8 were significantly shorter in sevoflurane group. Conclusion: From our study, maintenance of general anesthesia with sevoflurane is associated with faster recovery from anesthesia.

BACKGROUND Transversus Abdominis Plane Block (TAPB) is a newer regional anaesthesia technique which is commonly used now a days. It provides analgesia mainly after lower abdominal surgery where parietal wall pain is the major component of pain. Here sensory blockade of lower abdominal wall skin and muscles occur due to local anaesthetic deposition above transversus abdominis muscle. But it has been shown that it also useful in upper abdominal surgeries and retroperitoneal surgeries. We evaluated the effect of addition of dexmedetomidine to ropivacaine in TAP block in a single blind, and prospective, randomized controlled clinical trial. METHODS A total of 60 adult patients, 20 to 50 yrs. of age, of both sexes, ASA physical status I or II were randomized to Group R (n = 30) receiving TAP block with 20 ml of 0.375% ropivacaine and 2 ml of normal saline while Group RD (n = 30) received 0.5 mcg/Kg of dexmedetomidine diluted in normal saline to make 2 ml and 20 ml of 0.375% ropivacaine bilaterally followed by general anaesthesia. Hemodynamic responses to surgical incision were noted. Visual analog scale (VAS) scores were assessed on the emergence, then every 1 hr. up to 12 hrs. And at 24 hrs. Time to first rescue analgesic (when VAS ≥40 mm or on demand), duration of postoperative analgesia, incidence of postoperative nausea-vomiting were also noted. RESULTS Intraoperative heart rate decreases in group RD p<0.05). VAS score at 60-and 120min post-operatively was low in group RD (p<0.05). Duration of analgesia in group R (255.83 ± 51.96) less than group RD (405.33 ± 106.04) which is statistically significant. (p<0.05). No complication or side effect attributed to TAP block, local anaesthetic or dexmedetomidine were noted in any patient. CONCLUSIONS Addition of dexmedetomidine improves quality and duration of analgesia in laparoscopic cholecystectomy patients when used as adjuvant to ropivacaine in TAP block.

BACKGROUNDLevobupivacaine is the S (-) isomer of bupivacaine, developed as an alternative to bupivacaine for regional anaesthesia after the evidence of its less cardiotoxicity and neurotoxicity. The present study was undertaken to compare the quality of sensory and motor block, haemodynamic changes and side effects if any, following intrathecal levobupivacaine and hyperbaric bupivacaine, in parturients undergoing elective caesarean section. MATERIALS AND METHODSNinety parturients of ASA status I or II for the elective caesarean section were enrolled in this prospective randomised, doubleblinded study. The parturients were randomly assigned to two groups with patients in Group L (n = 45) and Group B (n = 45). Subarachnoid block was performed with 2.5 mL of 0.5% isobaric levobupivacaine in Group L and 2.5 mL of 0.5% hyperbaric bupivacaine in Group B. Characteristics of sensory and motor block were assessed with pinprick using Hollmen scale and modified Bromage scale, respectively. Side effects such as hypotension, bradycardia, nausea, and vomiting were recorded. Observed data were analysed with the help of Statistical Package for Social Sciences (IBM SPSS software version 20). RESULTSThe two study groups were comparable in terms of age, height, body weight and duration of surgery. Patients who received intrathecal levobupivacaine (Group L) experienced effective spinal anaesthesia with significantly late onset of sensory and motor block (5.72 min. vs. 5.13 min.; p=0.001 and 7.0 min. vs. 5.47 min.; p=0.001), but longer duration of analgesia (124.49 min. vs. 120.58 min.; p=0.001) in comparison to the patients who received intrathecal bupivacaine (Group B). Few patients experienced shivering, few reported nausea and vomiting in both groups intraoperatively. CONCLUSIONIntrathecal levobupivacaine seems to be an effective alternative to intrathecal bupivacaine in infra-umbilical surgeries like caesarean section with reduced toxic potential and excellent quality of analgesia.

BACKGROUNDLaryngoscopy and endotracheal intubation produces distinct but transient increase in cardiac workload. In this study, a comparison is made between dexmedetomidine, esmolol and control in their effect in attenuation of pressure response during laryngoscopy and endotracheal intubation.