How green is my operation theater?

To ascertain the awareness regarding global warming and the anesthesia practices contributing to it in the city of Delhi. A questionnaire was circulated amongst the qualified anesthesiologists [consultants and senior residents] in the city of Delhi. The initial contact was made through e-mail and the questionnaire was required to be filled and returned electronically. The questionnaire was also made available online at http:/sites.google.com/site/surveydelhi. After 1 month, the forms were distributed physically. Assuming that at least 50% of the approximately 1200 practising anesthesiologists would be able to recognize the greenhouse gases correctly, the target number of responses was 150 with 99% confidence limit. Of the 831 anesthesiologists contacted, only 184 responded. Ninety-eight percent were aware of the greenhouse effect, but only 15.8% [29] could correctly identify all the greenhouse gases. However, 47.28% [87] could identify nitrous oxide and inhalational agents as a cause of greenhouse effect. Ninety percent of the respondents use circle system and 87% use low flows frequently. Ninety-three percent [171] of respondents routinely use nitrous oxide, and 32.1% [59] would, however, not use air even if made available. Seventy-nine percent [145] advocated total intravenous anesthesia as an alternative to reduce the menace. Only 22% were motivated enough to respond to the survey. More than half of these anesthesiologists were not aware about the anesthetic agents contributing to the greenhouse effect. However, their clinical practices inadvertently do not add to the environmental pollution

effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: a randomized control trial

Intrathecal clonidine prolongs spinal anesthesia but the optimum dose to be used in cesarean delivery is not yet known. We evaluated the effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section. A total of 105 parturients carrying a singleton fetus at term, scheduled to undergo elective LSCS under spinal anesthesia were randomized in a double blind fashion to one of the three groups. Group BF [n=35] received 2 ml of 0.5% hyperbaric bupivacaine + 25 microg fentanyl, Group BC[50] [n=35] received 2 ml of 0.5% hyperbaric bupivacaine + 50 microg clonidine, Group BC[75] [n=35] received 2 ml of 0.5% hyperbaric bupivacaine + 75 microg clonidine. The duration of postoperative analgesia was 184.73 +/- 68.64 min in group BF, 360.71 +/- 86.51 min in group BC[50] and 760.50 +/- 284.03 min in group BC[75], P0<0.001. The incidence of hypotension was comparable, P =0.932, whereas the incidence of nausea and pruritis was significantly lower in groups BC[50] and BC[75] as compared to group BF, P <0.001. No other side effects of intrathecal clonidine were detected. Neonatal outcome was similar in all the three groups. Addition of 75 microg clonidine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia without any increase in maternal side effects. There was no difference in neonatal outcome

randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation

Procedural sedation and analgesia is widely being used for female laparoscopic sterilization using combinations of different drugs at varying doses. This study compared the combination of fentanyl and propofol, and ketamine and propofol in patients undergoing outpatient laparoscopic tubal ligation, with respect to their hemodynamic effects, postoperative recovery characteristics, duration of hospital stay, adverse effects, and patient comfort and acceptability. Randomized, double blind. Patients were assigned to receive premixed injection of either fentanyl 1.5 micro g/kg + propofol 2 mg/kg [Group PF, n=50] or ketamine 0.5 mg/kg + propofol 2 mg/kg [Group PK, n=50]. Hemodynamic data, peripheral oxygen saturation, and respiratory rate were recorded perioperatively. Recovery time, time to discharge, and comfort score were noted. Chi-square [[2]] test was used for categorical data. Student's t-test was used for quantitative variables for comparison between the two groups. For intragroup comparison, paired t-test was used. SPSS 14.0 was used for analysis. Although the heart rate was comparable, blood pressures were consistently higher in group PK. Postoperative nausea and vomiting and delay in voiding were more frequent in group PK [P<0.05]. The time to reach Aldrete score >/= 8 was significantly longer in group PK [11.14 +/- 3.29 min in group PF vs. 17.3 +/- 6.32 min in group PK, P<0.01]. The time to discharge was significantly longer in group PK [105.8 +/- 13.07 min in group PF vs.138.18 +/- 13.20 min in group PK, P<0.01]. Patient comfort and acceptability was better in group PF, P<0.01]. As compared to ketamine-propofol, fentanyl-propofol combination is associated with faster recovery, earlier discharge, and better patient acceptability