COMPARISON BETWEEN SINGLE BUCCAL INFILTRATION VERSUS CONVENTIONAL BUCCAL AND PALATAL INFILTRATION FOR REMOVAL OF MAXILLARY MOLAR TEETH.

Background: Although less painful injection techniques have been developed, most individuals still find palatal injection to be unpleasant. Aims: The purpose of this study was to evaluate the efficacy of single buccal infiltration versus conventional buccal and palatal infiltration for the removal of maxillary molar teeth. Fifty patie Materials and Methods: nts participated in a prospective randomized, split-mouth study, Group 1: 4% Articaine HCL infiltration – Only buccal, Group 2: 2% Lignocaine HCL – Buccal and palatal infiltration. Checking VAS score and Facial pain scale during Infiltration and during extraction. Factor analysis was used to determine the significance of the difference in mean scores between the two groups using both the independent sample t-test. Even though the Results: difference was not statistically significant (P > 0.05), patients in the articaine group reported much less discomfort during having their vital maxillary molars extracted compared to the lignocaine group. As was previously m Conclusion: entioned, it is feasible to avoid the palatal injection while removing molars from the maxilla. Specifically, the extraction of the upper molars, and buccal infiltration with articaine is a viable alternative to the use of traditional local anaesthetic.

Evaluation of Anaesthetic Challenges in Primary Cleft Lip and Palate Surgeries in a Single Center Study

Background: One of the most prevalent congenital malformations and the most frequent craniofacial defects in children is cleft lip and palate. The aim of the study was to investigate the anaesthetic procedures employed and to determine the challenges and postoperative complications associated with cleft lip and palate surgery. Material & Methods: A retrospective review of the anaesthetic procedures carried out from January 2022 to December 2022 at the Dhaka Dental College and Hospital. The hospital records were reviewed in order to learn about every occurrence of orofacial cleft surgery. In this study, a total number of 120 cases were reviewed. Results: Among 120 cases, 53 (44.2%) of the patients were female and 67 (55.8%) were male. The bulk of patients came after their first year of life. About 54(45%) of them were younger than five years old. 68(56.67%) underwent cleft lip surgery, 37(30.83%) for cleft palate surgery and rest 15(12.5%) patients under went for combined cleft lip and cleft palate surgeries. Upper Respiratory Tract Infection (URTI) was reported as the most common pre-existing morbidity. Bronchospasm was the main intraoperative complications occurred in 8 (6.67%) of the cases with URTI. After surgey 6(5%) patients experienced bleeding, 3(2.5%) patients needed to be reintubated. In addition, 2 (1.67%) instances had trouble controlling their pain, only 1(0.83%) patient had trouble swallowing and 1(0.83%) recovered slowly. Conclusion: Anaesthesia for surgical repair of cleft lip or palate in children is challenging. After a thorough preoperative evaluation, a trained anaesthesiologist should administer anaesthesia under strict supervision to minimize postoperative complications.

Scorpion venom component: AGAP exhibits local anaesthetic effects and attenuates nociceptive pain

The incidences of systemic toxicity and other complications associated with existing local anaesthetics can occur at clinical concentration level and vary with the anaesthetic techniques, types of surgery and patient factors. This evidence suggests the need for therapeutic interventions in peripheral and regional anaesthesia. Buthus martensii Karsch (BmK) scorpion venom is a compound that contains mixtures of peptides that have analgesic properties. This study aimed to investigate the local anaesthetic activity of scorpion venom peptide, AGAP (analgesic-antitumor peptide) in mechanical hyperalgesia or acute inflammatory pain. Method: Formalin was injected into the left hind paw after 20 minutes of infiltration of drugs. The time of licking or flinching of the injected hind paw was recorded as indicative of nociceptive or acute inflammatory pain. Paw flinching or quick withdrawal was considered a positive response to pain in the partial sciatic nerve ligation. The paw-withdrawal threshold (PWT) was determined by consecutively increasing and decreasing the magnitude of the stimulus. Results: The results indicated that AGAP exhibited a 67.9% inhibition in licking or flinching time and an 88.1% inhibition in paw withdrawal in mechanical hyperalgesia. The addition of AGAP to lidocaine showed an 89.5% inhibition in paw withdrawal. Conclusion: The data presented in this study suggest that local infiltration of AGAP significantly reduced mechanical hyperalgesia and acute inflammatory pain

Troubleshooting obstetric spinal anaesthesia at district hospital level

Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a presentation of this topic is provided.Keywords: anaesthesia; resource-limited settings; emergency surgery; obstetric spinal anaesthesia; anaesthetic complications; caesarean section.

Anaesthetic Management of a Complicated Bilateral Tubo-Ovarian Abscess Posted for Diagnostic Laparoscopy followed by Laparotomy

A middle aged female presented with abdominal distension due to tubo ovarian abscess compressing both ureters leading to Acute Kidney Injury and reactive pleural effusion posted for diagnostic laproscopy and laparotomy done under general anaesthesia with Rapid Sequence Induction. The aims of anaesthetist during surgery were 1) To maintain hemodynamic stability and prevent regurgitation. 2) To provide optimum analgesia intraoperatively and post operatively and 3) To maintain Peak Airway Pressure within normal limits to prevent the basal lung atelectasis. Intra-operatively hemodynamic vitals were monitored and airway pressures were maintained within normal limits. Intra operatively laryngospasm occurred that was treated with i.v. succinylcholine and regurgitated contents were suctioned immediately. Patient was uneventfully managed and underlying pathology was corrected. Post-operatively; patient was shifted to ICU with endotracheal tube in situ that was weaned off eventually and successfully. Thus finally meticulous and collaborative efforts of Anesthesiologist, Gynecologist and para-medical staff, such critical patient can be well managed pre, intra and postoperatively uneventfully.

The handling of safety concerns among anaesthetists when restarting full surgical lists during the COVID-19 pandemic

@#Around June 2020, many institutions restarted full operating schedules to clear the backlog of postponed surgeries because of the first wave in the COVID-19 pandemic. In an online survey distributed among anaesthestists in Asian countries at that time, most of them described their safety concerns and recommendations related to the supply of personal protective equipment and its usage. The second concern was related to pre-operative screening for all elective surgical cases and its related issues. The new norm in practice was found to be non-standardized and involved untested devices or workflow that have since been phased out with growing evidence. Subsequent months after reinstating full elective surgeries tested the ability of many hospitals in handling the workload of non-COVID surgical cases together with rising COVID-19 positive cases in the second and third waves when stay-at-home orders eased.

Awake Fiberoptic Assisted Nasotracheal Intubation in Oral Malignancies - A Comparison between Airway Blocks and LA Spray - A Randomized, Interventional Crossover Trial

Awake fiberoptic assisted nasal intubation is the gold standard for securing airway in cases of oral malignancy posted for radical surgeries. Different techniques such as airway blocks, LA gargles, spray, nebulization along with light sedation are in practice. We wanted to evaluate the efficacy of airway blocks over airway spray for intubation conditions, time taken to intubation, patient comfort and complications. METHODSThis randomized, interventional and crossover study was conducted at Chirayu Medical College and Hospital. A total of 60 patients of ASA grade I-II with Mallampati score 3 & 4 undergoing wide local excision and neck dissection were selected after fulfilling of the selection criterion and were divided into two groups, Airway Block (AB, n-30) and Airway Spray group (AS, n-30). AB group received bilateral superior and transtracheal recurrent laryngeal nerve blocks and group AS local anaesthetic spray through the working channel of the fiberoptic scope. Haemodynamics, time taken for intubation, intubating conditions, patients’ comfort, and complications if any were noted. All data was tabulated and analysed using software SPSS 17.0. RESULTSMean total time taken for intubation in seconds was less. Intubating conditions were optimal in 90 % cases. 5-point comfort during and 3-point score immediately after intubation were excellent in AB compared AS group. Haemodynamically both the groups were comparable. CONCLUSIONSCombined block of the superior and recurrent laryngeal nerves provides optimal conditions to facilitate a successful fibreoptic assisted awake nasotracheal intubation in anticipated difficult airway

A Comparison of the Postoperative Analgesic Efficacy of Two Different Doses of Caudal Clonidine as Adjunct to Caudal Bupivacaine in Infraumbilical Surgeries in Younger Children.

Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. MethodsThe children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. ResultsGroup B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. ConclusionsAddition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.

Survey of neuromuscular monitoring and assessment of postoperative residual neuromuscular block in a postoperative anaesthetic care unit

INTRODUCTION@#The use of neuromuscular blocking agents (NMBAs) is common during general anaesthesia. Neuromuscular monitoring with a peripheral nerve stimulator (PNS) is essential to prevent postoperative residual neuromuscular block (PRNB), defined as a train-of-four (TOF) ratio < 0.9. PRNB remains a common complication and may contribute to morbidity in the postoperative anaesthetic care unit (PACU).@*METHODS@#An online survey was sent to anaesthesiologists in our department to assess their knowledge and clinical practices related to neuromuscular blockade. Next, a study was conducted on adult patients scheduled for elective surgery under general anaesthesia requiring NMBAs. Upon admission to the PACU, TOF monitoring was performed.@*RESULTS@#A large proportion of anaesthesiologists showed a lack of knowledge of neuromuscular blockade or non-adherence to the best clinical practices associated with it. The majority (98.7%) stated that they did not routinely use PNS monitoring. In the clinical study, TOF monitoring was only used in 17.9% of the 335 patients who were assessed. The prevalence of PRNB was 33.4% and was associated with the elderly (age ≥ 65 years), a higher dose of NMBA used, a shorter duration of surgery, and a shorter duration between the last dose of NMBA and measurement of PRNB in the PACU. The incidence of adverse symptoms in the PACU was observed to be higher in patients with PRNB.@*CONCLUSION@#PRNB remains a clinically significant problem, but routine PNS monitoring is rare in our institution. This is compounded by inadequate knowledge and poor adherence to best clinical guidelines related to neuromuscular blockade.

The Efficacy of Two Different Concentrations of Local Anaesthetic on Pain in Mandibular Third Molar Surgery

@#Mepivacaine is a common local anaesthetic used with claims of a high safety profile. There are two commercial types, 2% mepivacaine with vasoconstrictor and 3% without vasoconstrictor. There are many suggestions regarding the usage of plain 3% without vasoconstrictor for systemic medical problems, however, there have not been any previous studies to confirm this necessity in impacted lower third molar surgery (ILTMS). This study aims to evaluate the anaesthetic efficiency and the effect on the patient of 2% and 3% mepivacaine, adding vasoconstrictor to the 3% mepivacaine. This crossover study comprised of 24 patients with bilateral, symmetrically positioned, impacted lower third molars. Patients received either 2% or 3% mepivacaine for the inferior alveolar nerve block (IANB). Onset and duration of anaesthesia, and haemodynamic considerations were analysed as primary outcomes. Furthermore, pain, duration of postoperative anaesthesia and pulp vitality were analysed as secondary outcomes. Different concentrations of mepivacaine showed similar anaesthetic onset time (p > 0.05). There was no statistically significant difference regarding the duration of anaesthesia, as well as the postoperative analgesia (p > 0.05). The two concentrations did not lead to any haemodynamic changes or complications during ILTMS. Thus, adding the vasoconstrictor to mepivacaine 3% did not cause any adverse effects on the patients intra or postoperatively. Therefore, it is possible for dentists to use only 2% mepivacaine with vasoconstrictor for IANB effectively and safely when the case necessitates the need for a vasoconstrictor, or in other words, longer duration of haemostasis.

Comparison of Pain Scores and Rescue Analgesia Required Amongst Subjects Receiving Ropivacaine and Clonidine versus Ropivacaine Alone: An Institutional Based Study

Background: Pain is an individual and subjective experiencewhich can be modulated by several physiological,psychological and environmental factors such as previousexperience, fear, anxiety and cultural factors .The usual trendis to prescribe an opioid or a NSAID for postoperativeanalgesia. NSAIDs also have certain side effects likehemostasis alteration, renal dysfunction, gastrointestinalhemorrhage etc. TAP block is a local anaesthetic block used toprovide analgesia to the anterior and lateral abdominal wall.The present study was conducted to compare pain scores andrescue analgesia required amongst subjects receivingropivacaine and clonidine versus ropivacaine alone.Materials and Methods: A prospective, randomized, doubleblinded control trial undertaking 70 patients was conductedbetween September 2014 to March 2016 at the Department ofAnesthesiology, Northern Railway Central Hospital, New Delhi.Patients undergoing infra umbilical surgery under subarachnoidblock were included hysterectomy, caesarean section,cystolithotomy and bilateral inguinal hernias. All investigatorsinvolved in study were unaware of envelope details throughoutstudy period. Group C was given 20 ml of 0.2% ropivacainewith 25 microgram clonidine on each side, total of 40 ml of0.2% ropivacaine with 50 mcg clonidine. Group R was given 20ml of 0.2% ropivacaine on each side, total 40 ml of 0.2%ropivacaine. The postoperative pain at 1 hr, 3 hr, 6 hr, 9 hr, 12hr,18 hr, 24 hr by VAS score were noted and the totalpostoperative rescue analgesic dose in two groups. All the datathus obtained was arranged in a tabulated form and analyzedusing SPSS software.Results: Total males included in the study were 17 andfemales were 53. There was significant difference in group Cand group R in VAS score. It was consistently lower in group Cwhen compared with group R for first 12 hours. Total amount ofrescue analgesia used in the two groups was significantlydifferent. Total mean 150 mg of diclofenac sodium was given topatients in group C.Conclusion: USG-TAP block when used with adjuvant a2agonist (clonidine) along with local anaesthetic (ropivacaine)leads to prolongation of analgesic effect, lower vas scores andreduced requirement of rescue analgesic.

Comparative study of postoperative analgesia by epidural ketamine and ketamine plus dexamethasone in lower limb orthopedic surgery

Aim & Objectives: To compared the effect of ketamine and combination of ketamine plus dexamethasone on the duration of postoperative analgesia and to evaluate the effect of dexamethasone on postepidural backache and other complications. Methods: 50 patients (ASA I and II) posted for elective surgery of lower limb in orthopedics, were divided at random into two groups of 25 each. Patients in group I received Inj. Ketamine HCl 0.3 mg/kg diluted in 10 ml normal saline while patients in group II received ketamine HCl 0.3 mg/kg and dexamethasone 8 mg diluted in 10 ml normal saline postoperatively through epidural catheter. The relief of pain and perioperative sequelae were compared. Results: Groups were compared with respect to quality of epiduralanaesthesia and pain relief as felt by the patient. The quality of epidural anaesthesia was found adequate in 80% cases of group 2 and 76% cases of group 1. Pain relief was 20% excellent and 76% good in group 2 and 12% excellent and 68% good in group 1. In group I the mean duration of pain relief after epidural injection of ketamine 0.3 mg/kg was 363.91±180.94 min and in group II after epidural injection of ketamine 0.3 mg/kg with dexamethasone 8 mg was 582.63±182.03 min. These values differ markedly and are statistically highly significant (p<0.001). Conclusion: Ketaminecan be used epidurally safely for rapid onset and is effective for prolonged postoperative analgesia with minimum side effects and high acceptability. The duration can be further prolonged with the addition of dexamethasone and the incidence of postepidural backache is also minimised with dexamethasone.

Anesthetic management of carcinoid syndrome: is octreotide enough? A case report / Manejo anestésico del síndrome carcinoide: es el octreótido suficiente? Presentación de un caso

Abstract: Carcinoid tumors are rare slow-growing neuroendocrine tissue neoplasms. Their ability to secrete bioactive substances to the systemic circulation is accountable for a clinical presentation known as carcinoid syndrome. Main symptoms include bronchoconstriction, flushing, diarrhea and hemodynamic instability. Octreotide, a somatostatin analogue, is the current mainstay for carcinoid syndrome treatment and perioperative management. However, no regimen has proven to be completely effective in preventing systemic manifestations and recent literature suggests that it might be an insufficient measure. We report a case of a 51-year-old male with a functioning small bowel neuroendocrine tumor and carcinoid syndrome presenting for a primary tumor resection, discussing possible pitfalls and key points in the care of these patients.

Resumen: Los tumores carcinoides son neoplasias de tejido neuroendocrino poco comunes y de crecimiento lento. Su capacidad para secretar sustancias bioactivas a la circulación sistémica es responsable por una presentación clínica conocida como síndrome carcinoide. Los principales síntomas incluyen broncoconstricción, enrojecimiento, diarrea e inestabilidad hemodinámica. Octreótido, un análogo de la somatostatina, es el pilar actual para el tratamiento del síndrome carcinoide y su manejo perioperatorio. Sin embargo, ningún tratamiento ha demostrado ser completamente eficaz para prevenir las manifestaciones sistémicas y estudios recientes indican que puede ser una medida insuficiente. Presentamos un caso de un varón de 51 años con un tumor neuroendocrino funcionante en el intestino delgado y un síndrome carcinoide, sometido a una resección del tumor primario, discutiendo posibles dificultades y puntos clave en la atención de estos pacientes.

Comparative Study of Dexmedetomidine versus Dexamethasone as an adjuvant for supraclavicular brachial plexus block

Introduction: Brachial plexus block is the most preferred anaesthetic technique for upper limb surgeries. Adding adjuvant to local anaesthetics for achial plexus block may enhance the duration and quality of analgesia and also to decrease the dose of postoperative opioid analgesic. Aims and Objectives: The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine when added as adjuvant during supraclavicular achial plexus blocks (BPB) in respect to the onset and duration of sensory and motor block along with duration of analgesia. Methods: Sixty ASA physical status I-II patients of age group between 20 to 60 years with elective forearm and hand surgery under achial plexus blocks were randomly allocated into two equal groups in a randomised double blind fashion. Group DM (n = 30), to receive 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with Adr + 1 ml of Dexmedetomidine (50mcg) + 1ml distilled water, making a total of 32 ml and another Group DX (n = 25), to receive 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with Adr. + 2ml of Dexamethasone (8 mg). A nerve stimulation technique was used in all patients. The onset time and duration of sensory and motor blocks, quality of intraoperative analgesia and duration of analgesia were assessed. Results: The time of onset of sensory and motor block was significantly less in group DM as compared to group DX (P ＜ 0.05). The duration of the sensory and motor block as well as duration of post operative analgesia was significantly more in group DM as compared with group DX (P＜0.05), but there was no statistically significant difference between both the groups with respect to the heart rate, mean arterial pressure and spo2. Conclusions: Dexmedetomidine 50 g was more effective than dexamethasone 8 mg in extending the duration of supraclavicular achial plexus block and prolonging the duration of post operative analgesia and it also significantly decreases the onset time of block.

Fibreoptic intubation in airway management: a review article

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.

Ropivacaine promotes apoptosis of hepatocellular carcinoma cells through damaging mitochondria and activating caspase-3 activity

BACKGROUND: Recent evidences indicated that some local anaesthetic agents played a role in inhibiting the proliferation of cancer cells; Whether ropivacaine is able to promote apoptosis of hepatocellular carcinoma (HCC) cells is still unclear. The aim of this study was to investigate the effect of ropivacaine on the apoptosis of HCC cells. METHODS: In the present study, we treated the HCC cell lines, Bel7402 and HLE with ropivacaine. MTT, DAPI stain, trypan blue exclusion dye assay, flow cytometry, electron microscopy, computational simulation, laser confocal microscope, Western blotting, and enzyme activity analysis of caspase-3 were applied to detect the growth and apoptosis of HCC cells and to explore the role mechanism of ropivacaine. RESULTS: Ropivacaine was able to inhibit proliferation and promote apoptosis of HCC cells in a dose- and time-dependent manner. Ropivacaine also has a trait to inhibit the migration of HCC cells; ropivacaine damaged the mitochondria of HCC cells. The results also indicated that ropivacaine was able to interact with caspase-3, promote cytoplasmic caspase-3 migration into the nucleus, stimulate cleavage of caspase-3 and PARP-1, caspase-9 proteins, inhibit the expression of Bcl-2, promote expression of Apaf-1 and mitochondria release cytochrome C, and activate the activity of caspase-3. CONCLUSIONS: Ropivacaine has a novel role in promoting apoptosis of HCC cells; The role mechanism of ropivacaine maybe involve in damaging the function of mitochondria and activating the caspase-3 signalling pathway in HCC cells. Our findings provide novel insights into the local anaesthetic agents in the therapy of HCC patients.

Accentuation of general anaesthetic activity of ketamine by glutamate NMDA (N-methyl D-aspartate) receptor antagonist

Background: The aim of the present study was to evaluate the potentiation of general anaesthetic activity of ketamine by NMDA receptor antagonist ‘amantadine’ in wistar albino rats.Methods: The wistar albino rats of either sex were divided into three groups of five animals in each group. Group I received ketamine 80mg/kg, group II received ketamine 40mg/kg along with amantadine 40mg/kg and group III received ketamine 80mg/kg along with amantadine 40mg/kg to evaluate the potentiation of general anaesthetic effect of ketamine. The sleep latency time and the total sleeping time were measured in all the three groups.Results: The sleep latency time of group III is significantly decreased (p <0.035) and as equal to that of group II when compared to group I. The sleeping time of group III is significantly increased (p <0.001) when compared to group I.Conclusions: Amantadine - the NMDA receptor antagonist potentiates the general anaesthetic activity of ketamine.

Minimum Effective Volume Of A Combination Of Bupivacaine And Lignocaine For Supraclavicular Brachial Plexus Block Using Ultrasound Guided Technique

Background: To determine the effective volume of a combination of bupivacaine and lignocaine for supraclavicular achial plexus block using ultrasonography (USG). Methods: This study is an intervention study to determine the minimum effective volume of a drug combination. The principle statistical method applied in this study is Staircase Up-down method as described by Dixon and Massey.([i]) Results: By using the log transformation of the data of required volume and outcome as successful or unsuccessful we have calculated EV 50 = 11ml and EV 90 = 14ml. Conclusion: Minimum Effective Volume in 90% individuals (MEV 90) for a combination of 0.25% bupivacaine and 1% lignocaine for ultrasound guided achial plexus block via supraclavicular approach is 14ml.

The Anaesthetic Potency of Intrathecally Administered Levobupivacaine and Racemic Bupivacaine: A Hospital-Based Study

Background: Lower limb surgeries are often performed under spinal anesthesia. The conventional anesthetic method for lower limb surgeries is caudal epidural block. The currently available local anesthetic for this purpose is Bupivacaine which has long duration of action of around 6-12 hour. Methods: 60 adult cases ranging in age from 20 to 60 years with ASA Grade I and II requiring elective lower limb surgery under epidural anesthesia were selected for this prospective, randomized, double-blind study. Results: 60 adult cases ranging in age from 20 to 60 years with ASA Grade I and II, requiring elective gynecological surgery under epidural anesthesia were selected for this study. Cases were randomly allocated into two groups containing 20 cases each. Cases in Group B received Bupivacaine 0.25% and those in Group T received Tramadol 100mg. Conclusion: Current study concluded that both intrathecally administered levobupivacaine and racemic bupivacaine are safe and effective local anaesthetics for lower limb surgeries. Overall parameters observed in this study showed no significant difference between the two forms of the same drug. However, intrathecal levobupivacaine produces less toxicity.

Effect of intranasal dexmedetomidine on agitation during emergence from general anesthesia with sevoflurane in pediatric patients: a meta-analysis / 中华麻醉学杂志

Objective To systematically evaluate the effect of intranasal dexmedetomidine on agita-tion during emergence from general anesthesia with sevoflurane in pediatric patients. Methods Pubmed, Embase, The Cochrane Library, China National Knowledge Infrastructure, VIP, Wan-Fang databases were searched for randomized controlled trials involving the effect of intranasal dexmedetomidine on agitation during emergence from general anesthesia with sevoflurane in pediatric patients from the start of their data-base until June 2017, and the reference lists of all included studies were checked manually. Data were ex-tracted independently by two reviewers, and primary evaluation indexes included the incidence of emergence agitation and sedation score. Secondary evaluation indexes included emergence time, extubation time, du-ration of post-anesthesia care unit stay, postoperative consumption of analgesics, incidence of adverse reac-tions ( such as bradycardia, nausea and vomiting, pruritus, laryngeal spasm) during recovery from anes-thesia. The quality of methodology of included studies was assessed. Meta-analysis was conducted with Rev-Man 5. 3 software. Results Eight randomized controlled trials involving 520 pediatric patients were includ-ed in this meta-analysis. Compared with placebo group, the incidence of emergence agitation was signifi-cantly decreased, sedation score was increased, extubation time was prolonged ( P<0. 05) , no significant change was found in the duration of post-anesthesia care unit stay or incidence of postoperative nausea and vomiting in intranasal dexmedetomidine group ( P>0. 05) . The emergence time was prolonged in intranasal 0. 3-1. 0 μg∕kg dexmedetomidine group ( P<0. 05 ) , and no significant change was found in emergence time in intranasal dexmedetomidine 1. 0-2. 0μg∕kg group ( P>0. 05) . Conclusion Intranasal dexmedeto-midine can decrease the occurrence of agitation during emergence from general anesthesia with sevoflurane and raise the quality of emergence in pediatric patients.