ABSTRACT:Spinal Anaesthesia is the most common approach for geriatric patients undergoing urological surgeries. Efforts to find a better adjuvant in regional anaesthesia are underway since long. Various adjuvants have been used with local anesthetics in spinal anesthesia to improve quality of intraoperative analgesia and to provide prolonged postoperative analgesia with haemodynamic stability and minimal sideeffects. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. AIM: The aim of this study was to evaluate the efficacy of intrathecal isobaric 0.75% Ropivacaine with the combination of isobaric 0.75% Ropivacaine and 5µg of Dexmedetomidine in Geriatric Hypertensive patients undergoing Urological surgeries. MATERIALS AND METHODS: Fifty patients classified in American Society of Anesthesiologists classes II and III scheduled for Urological surgeries were studied. Patients were randomly allocated to receive either. Group R: 1.9 ml of 0.75% isobaric Ropivacaine + 0.1 ml normal saline. Group D: 1.9 ml volume of 0.75% isobaric ropivacaine +5 µg Dexmedetomidine (0.1ml). RESULTS: Patients in Dexmedetomidine group (D) had a significantly longer sensory and motor block time than patients in Normal Saline group (R). The mean time of the two segment regression time in group D (115.6 ± 14.5 min) was significantly higher than group R (57.4 ± 6.3 min) (P<0.001). The regression time of motor block to reach modified Bromage 0 was (246.4 ± 25.7 min) in group D and 140.1 ± 32.3 min in group R (P<0.001).The meantime of rescue analgesia is (425.4±18.9 min) in group D when compared to group R (210.3 ± 14.2). CONCLUSIONS: Intrathecal dexmedetomidine as a adjuvant is improved the quality of intraoperative analgesia and postoperative analgesia better, produced prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics in 24 hours as compared to control group.

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Congenital lobar emphysema (CLE) is a congenital anomaly of the lower respiratory tract characterized by over inflation of alveoli of the one or more lobes of the lung. CLE is potentially reversible, though possibly life threatening cause of respiratory distress in the neonate. We are presenting a 2 week old baby who presented with sudden onset of respiratory distress related to CLE affecting the upper lobe of left lung. Lobectomy was performed under general anesthesia with one lung ventilation. The anesthetic challenges and management of this case are discussed here.

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