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Hypotension is a common complication, subsequently spinal anaesthesia in lower segment caesarean section, which can cause adverse maternal & foetal outcomes. A new decisive research area in obstetric anaesthesia is prevention & early treatment of spinal hypotension to improve maternal & foetal outcomes. A novel parameter, Perfusion index (PI) is tried during sub arachnoid block for predicting hypotension in lower segment caesarean section (LSCS). In this study, 60 parturient belonging to ASA status 1 or 2 with apparent pregnancies scheduled for elective LSCS received spinal anaesthesia with 2ml of 0.5% heavy bupivacaine by using an orange (25G) Quincke needle at L3-L4 or L4-L5 interspinous space. Haemodynamics & perfusion index were recorded at regular intervals. Baseline perfusion index was correlated with degree of hypotension by using Receiver Operative Characteristic curve. Baseline perfusion index & other parameters were correlate by Karl Pearson correlation method. : In our study 34.5% incidence of hypotension among study theme & momentous correlation between fall in systolic blood pressure from baseline & baseline perfusion index (r = 0.436; P < 0.05). The optimal utmost point for perfusion index was found to be 3.5 with a sensitivity of 37% & specificity of 97%. A higher incidence of hypotension was found in Parturient having baseline perfusion index more than 3.5 following sub arachnoid block in elective LSCS.

Background: Midazolam is often used for premedication in children. We investigated the efficacy of different doses of intranasal midazolam for premedication in 75 children, ASA physical status I and II, aged 3 to 10 years of either sex undergoing various elective surgical procedures. Methods: In a randomized, double blind, placebo controlled design, all children were allocated to one of the three groups of 25 each. Group – A received 0.2 mg/kg intranasal midazolam (5mg/ml). Group – B received 0.3 mg/kg intranasal midazolam (5mg/ml). While Group – C received intranasal normal saline. After 20 minutes of premedication, sedation scores and ease of separation from parents were noted. Children’s response at the time of intravenous cannulation and face mask application was also measured. Results: Sedation scores in group A and B were excellent (3.64 ±0.5 & 3.76 ±0.7 respectively) compared to group C (1.24 ±0.4). Separation of children from their parents was easier in group A & B than in Group C. In group A & B, children were calm on intravenous cannulation and face mask application. Conclusion: We conclude that intranasal midazolam is effective and very well accepted premedication drug in children. Key words: Children, Premedication, Intranasal route and Midazolam.

Introduction and Aims: We compared the safety, efficacy, hemodynamic variation, recovery duration and adverse effects of propofol and etomidate, with or without fentanyl, in patients undergoing dilatation and curettage for incomplete abortions. Materials and Methods: One hundred patients, ASA status I & II, aged 20-50 years, undergoing dilatation and curettage, were randomly divided into four groups of 25 patients each. Group P received propofol 2 mg/kg + normal saline 2 ml for anesthesia induction. Group PF received propofol 2 mg/kg +fentanyl 1mcg/kg to make volume 2 ml for anesthesia induction. Group E received etomidate 0.2 mg/kg + normal saline 2 ml for anesthesia induction and Group EF received etomidate 0.2 mg/kg + fentanyl 1 mcg/kg to make volume 2 ml for anesthesia induction. Heart rate, arterial pressure and SpO2 were recorded at different time intervals. The recovery time, pain on injection, myoclonus and postoperative nausea vomiting were also recorded. Results: During induction, mean arterial pressure fall significantly in both propofol groups. Amongst four groups, there was no significant difference observed in recovery time after anesthesia. The incidence of pain on injection was lower in etomidate groups. Myoclonus and Postoperative nausea and vomiting were significantly higher in etomidate groups. Conclusion: This study demonstrates that etomidate is superior in term of hemodynamic stability and less incidence of pain on injection. Etomidate combined with low dose fentanyl is more favourable than etomidate alone for attenuating myoclonus. Keywords: Etomidate, Dilatation and curettage, Propofol.

Background: The patients admitted to the emergency department with the fracture of femoral shaft and neck have severe pain, and these patients require adequate analgesia to allow radiological, orthopedic, and other procedures to be performed. Femoral nerve block (FNB) has proved to be effective in providing satisfactory analgesia. Dexmedetomidine has analgesic and sedative property when used as an adjuvant in regional anesthesia. The aim of this study was to evaluate the efficacy of dexmedetomidine added to ropivacaine in FNB with regard to onset, duration, efficacy of analgesia, and patient acceptance. Materials and Methods: Sixty patients of American Society of Anesthesiologists grade I and II of either sex, aged 18–60 years, who presented with the fracture of femoral shaft and neck in the emergency department were randomly divided into two groups of 30 patients each: group D (n = 30): patients were administered 15 mL ropivacaine (0.5%) plus dexmedetomidine 1 μg/kg body weight (total volume, 16 mL) and group R (n = 30): patients were administered 15 mL ropivacaine (0.5%) plus 1 mL saline. Results: The onset of analgesia was much earlier in group D (3.77 ± 0.84 min) than that in group R (4.6 ± 1.1 min). The mean duration of analgesia was prolonged in group D (744.33 ± 179.6 min) than that in group R (263 ± 67 min). The fall in visual analog scale score was significantly higher in group D in comparison to group R. The patient acceptance after 24 h of the procedure was better in group D. Conclusion: We concluded that the addition of dexmedetomidine to ropivacaine in FNB provides early onset of analgesia, prolongs the duration of analgesia, improves the quality of analgesia, and has better patient acceptance.

Background and Aims: Various additives are mixed with local anesthetic agents to increase the quality of block in regional anesthesia. We compared clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block with respect to the onset and duration of sensory and motor block and duration of analgesia. Material and Methods: Sixty American Society of Anesthesiologists Grades I and II patients scheduled for various orthopedic surgeries of the upper limb under supraclavicular brachial plexus block were divided into two equal groups in a randomized, double-blind manner. Patients were assigned randomly to one of the two groups. In Group C (n = 30), 39 ml of 0.25% bupivacaine plus 1 ml (1 μg/kg) clonidine and in Group D (n = 30), 39 ml of 0.25% bupivacaine plus 1 ml (1 μg/kg) dexmedetomidine were given. The onset and duration of sensory and motor block, duration of analgesia, and quality of anesthesia were studied in both the groups. Results: There was no statistically significant difference in the onset of sensory and motor block in both the groups. The durations of sensory and motor block were 316.67 ± 45.21 and 372.67 ± 44.48 min, respectively, in Group C, whereas they were 502.67 ± 43.78 and 557.67 ± 38.83 min, respectively, in Group D. The duration of analgesia was 349.33 ± 42.91 min, significantly less in Group C compared to 525.33 ± 42.89 min in Group D (P < 0.001). The quality of anesthesia was significantly better in dexmedetomidine group compared to clonidine group (P < 0.001). Conclusion: The addition of dexmedetomidine prolongs the durations of sensory and motor block and duration of analgesia and improves the quality of anesthesia as compared with clonidine when injected with bupivacaine in supraclavicular brachial plexus block.