Aims:Dexmedetomidine is very dynamic drug, used for analgesia, sedation, blunting the laryngoscopic responses and as adjuvants in regional anesthesia. Studies have shown that intravenous (iv) dexmedetomidine given during spinal anesthesia increases the quality of subarachnoid block (SAB). In this study, we compare the two iv regimen of dexmedetomidine on analgesic effect of spinal anesthesia. One is bolus dose of dexmedetomidine and other is infusion during the surgery, both given after induction of spinal anesthesia.Subjects and Methods:Sixty American Society of Anesthesiologists I and II patients scheduled to undergo surgeries under SAB were randomly allocated into two groups namely B and I. After SAB with 3.0 ml of bupivacaine 0.5% heavy, Group B received 0.5 μg/kg of dexmedetomidine bolus over 15 min, Group I received 0.5 μg/kg/h of dexmedetomidine infusion until the end of surgery.Statistical Analysis Used:All parametric data were statistically analyzed using Student's t-test and nonparametric data analyzed using Chi-square test and Fischer exact test as appropriate. P < 0.05 was considered as statistically significant. Statistical analysis was performed using the SPSS.Results:Time to reach desired level T10 was quick in Group B compared to Group I. Regression of sensory and motor was prolonged in Group I compared to Group B. Total duration of analgesia was significantly prolonged in Group I 230.39 ± 16.20 compared to Group B 196.01 ± 14.32 and the difference is statistically significant (P = 0.0001). Both groups had Ramsay sedation score of 3 which lasted for 45 min in Group B while it was maintained in Group I. Side effects profile of both groups was comparable with few incidence of bradycardia and hypotension in both groups requiring treatment.Conclusions:We conclude that the continuous infusion of dexmedetomidine after SAB results in prolonged analgesia than just a bolus dose. Therefore, we suggest use of the maintenance dose of iv dexmedetomidine after SAB for prolonging the duration and achieving adequate sedation

BACKGROUND:The addition of clonidine as an adjuvant has allowed the use of lower concentration of the local anaesthetic for achieving the same level of anaesthesia but with the prolonged duration of analgesia which increases the margin of safety and reduces the incidence of unwanted motor blockades. With these facts in mind we undertook the study to compare the analgesic properties of 0.25% ropivacaine with the addition of clonidine (1µg/kg) to that of ropivacaine 0.25% following caudal administration in children. METHODS: After approval from ethical committee 60 children of age 1-10 yrs of ASA grade I or II undergoing elective sub umbilical surgeries were selected for the study. We gave caudal block with 0.25% ropivacaine 1ml/kg+1ml normal saline for group R or 0.25% ropivacaine 1ml/kg + clonidine 1microgram/kg+1ml normal saline to make volume 1ml for group C. To perform caudal block all patient received IV injection glycopyrolate-0.01mg/kg, IV injection midazolam-0.1mg/kg and IV Injection ketamine-1mg/kg. Hemodynamic parameters were observed before, during and after the surgical procedure. Quality of surgical anesthesia & requirement of supplemental midazolam/ketamine were also noted. Duration of Post-operative analgesia, pain scores, level of sedation and side effects if any were looked for and duly recorded. RESULT: Duration of analgesia in group R was 6.45±0.52 hrs. and in group C was 13.01±0.89hrs i.e. significantly prolonged in group C (P<0.0001). Post-operative pain score and sedation score were also significantly better in group C (P<0.0001). The quality of surgical analgesia was also significantly excellent in group C. Other vital parameters were not statistically significant in both the groups. CONCLUSION: Ropivacaine (0.25%) with clonidine (1μg/kg) in caudal block showed prolong duration of analgesia as well as better quality of surgical anaesthesia than plain ropivacaine (0.25%) in pediatric patients without any significant side effects.

Background: Blood pressure (BP) is volatile in nature and also it affects post-operative outcomes therefore, regular perioperative BP monitoring is essential. Intraoperative variability of BP is permitted in range and proportion to baseline BP according to various guidelines. Pre-operatively BP is measured many times and it is highly variable. In this study we attempt to predict which pre-operative BP can be used as reference during intraoperative monitoring.       Methods: This observational study was conducted at hamidia hospital, Bhopal. 260 normotensive patients undergoing elective surgery who got clearance during PAC were enrolled. BP was measured by gold standard mercury sphygmomanometer in PAC clinic (PAC1), review PAC one day prior to surgery (PAC2), morning BP in preoperative room (POR) and inside OT room (IOR) before surgery.    Results: In 260 enrolled patients males were slightly predominant 52.31%. Mean age was 34.68±11.63 years. Mean of Systolic BP (SBP) during PAC1, PAC2, Morning BP in POR and IOR prior surgery were 122.85±8.24, 118.18±8.08, 123.06±8.24 and 135.73±10.24 respectively and was significant (P<0.001). Mean of heart rate (HR/minute) during PAC1, PAC2, Morning BP in POR and IOR prior surgery were 79.77±7.22, 78.90±7.44, 80.40±7.49 and 89.15±7.60 respectively and was significant (P<0.001). Conclusions: Aaaaaa Due to stress of surgery SBP and HR were significantly higher in IOR just prior surgery. Also, BP of PAC2 at ward was lowest though not significantly lower than BP in PAC1 or POR. Thus, BP of PAC2 can be used as an ideal reference BP but larger study is required for further generalization. Keywords: Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure

The study was conducted to assess & compare the effect of pretreatment with intravenous Dexmedetomidine and Magnesium sulphate on characteristics of SAB with hyperbaric bupivacaine. 80 ASA grade I and II patients (age: 18-60 years) scheduled for infraumblical surgery under spinal anesthesia were included & randomly divided into group-D (dexmedetomidine 1μ gm/kg) and group-M (magnesium sulfate 50 mg/kg). patients were given prefixed doses of either intravenous dexmedetomidine or Magnesium sulfate 15 mins before SAB. Incidence of hypotension, highest level & duration of sensory & motor blockage, duration of analgesia, vasopressor requirement and incidence of sedation, nausea & vomiting were compared. highest upper level of sensory block after SAB was higher in group-D (p value &#60; 0.001) than group-M. onset of sensory & motor block was earlier & duration of sensory and motor block, time of rescue analgesia was longer in group-D (p value &#60; 0.001). Depth of sedation was higher in group-D though oxygen saturation and respiratory rate was comparable in both groups. Postoperative VAS score (p value &#60; 0.001) was lower in dexmedetomidine group.Study suggests that Intravenous dexmedetomidine at a dose of 1μg/kg is a better adjuvant to 0.5% hyperbaric bupivacaine than MgSo at a dose of 50 mg/kg in infra-umbilical surgeries, with complications of hypotension and bradycardia occurring at acceptable incidences.

Post-operative analgesia in children is a challenging task before the anesthesiologist. Caudal analgesia is an accepted and popular method of providing intraoperative and postoperative analgesia for genitourinary and inguinal surgeries in children. Because of short duration of action of Bupivacaine, various adjuncts have been tried by many anesthesiologists. Fentanyl and Clonidine are used along with local anesthetics to prolong duration of analgesia. Hence we are comparing 1 mcg/kg of Fentanyl and 1 mcg/kg of Clonidine as adjuvants to 0.25% bupivacaine at a volume of 0.75 ml/kg in children undergoing genitourinary and inguinal surgeries. AIMS AND OBJECTIVES: To compare the efficacy of Fentanyl and Clonidine as adjuncts to Bupivacaine for postoperative analgesia in pediatric patients and to evaluate the sequel and side effects of both. MATERIALS AND METHODS: Study design -Comparative randomized controlled study. Sample size: 120 children aged between 2-7 years posted for genitourinary and inguinal surgeries. Group I (B) received 0.75 ml/kg of 0.25% Bupivacaine alone caudally. Group II (BF) received 0.75 ml/kg of 0.25% Bupivacaine and 1 µg/kg Fentanyl caudally. Group III (BC) received 0.75 ml/kg of 0.25% Bupivacaine and 1 µg/kg Clonidine caudally. Postoperatively the duration of analgesia, motor blockade and sedation was assessed by Modified Objective Pain Scale, Ramsay Sedation Score and modified Bromage scale respectively. Side effects and complications, if present were recorded. Tests used for statistical analysis were Fishers exact test and student t test. RESULTS: The mean duration of analgesia in group BC (601.5 + 60.17 minutes) was much higher than group BF and B but with side effect of sedation. We observed that there was a statistically increased duration of analgesia in Clonidine group as compared to Fentanyl and plain Bupivacaine group with no difference in duration of motor blockade. There was increased sedation in group BC. Group BF had nausea and vomiting, shivering and pruritus as side effects. Hence we conclude that Clonidine is a better adjunct than Fentanyl in prolonging duration of analgesia of Bupivacaine in pediatric caudal block.