European Journal of Molecular & Clinical Medicine

As stated by Hippocrates - “Divine is the task to relieve pain”
Relief of pain during surgery is one of the components of balanced anaesthesia but this pain relief should be extended to the postoperative period also. According to Perkins and co-workers poorly managed acute pain like postoperative pain can lead to the occurrence of chronic pain.
Materials and Method: This clinical study was conducted on 156 adult patients of ASA physical status I to III in the age group of 18-60 years of either sex posted for elective lower abdominal or lower limb surgeries under spinal anaesthesia after taking informed consent at a tertiary hospital Vijayapur.
Results: Statistical tests used: anova, chi square test and tukey test.
Discussion: Spinal anaesthesia is currently wide spread popular anaesthetic technique available today. It has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anaesthetic.
Conclusion: Acute pain following surgical procedures is unique to the clinical practice of pain medicine. It is one of the few opportunities in which the cause of pain is known before its occurrence, the pain is reliably expected to occur and can be annulled effectively

Laparoscopic surgery has now become the most accepted surgical and safe technique for a number of surgery including cholecystectomy , appendcectomy , etc .Advantages over open procedures include lesser haemorrhoage , better cosmetic results , lesser post operative pain and better results . To compare the analgesic effect of intraperitoneal application of  bupivacaine and bupivacaine with dexmedetomidine in laparoscopic cholecystectomy . To assess the quality of analgesia by visual  analgesia scale score (VAS).
Material and Method: This study was an interventional, prospective, double blind, parallel group, randomised clinical study conducted on patients undergoing laparoscopic cholecystectomy surgeries. Institutional Ethical Committee Approval was obtained and written informed consent was obtained from all the patients before the screening in the study. Total of 162 patients were selected in which 81 were randomly allocated in each group using table of randomisation. Study Duration Period 2 Sep 2020 To 2 March  2021.
Conclusion: Hence our study showed that intraperitoneal instillation of dexmedetomidine 1 µgm/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the post-operative pain and significantly reduces the analgesic requirement in post-operative period as compared to bupivacaine 0.25% alone.

Background: brachial plexus block is a common technique instead of general anaesthesia. This type of anaesthesia primarily assists in achieving the best possible operating conditions by causing muscular relaxation, maintaining a stable intraoperative hemodynamic condition, and inducing sympathetic block, which lessens postoperative discomfort, vasospasm, and edoema. Aim & Objective:1. To compare the duration of post operative analgesia 2. To compare the onset & duration of sensory and motor block, hemodynamic changes and adverse effects. Methods: Study design:  Randomized comparative study.  Study setting: Department of Anaesthesia, Kamineni Institute of Medical Sciences, Sreepuram Narketpally, India. Study duration: From January 2021 to July 2022 (1.5 year). Study population: All patients undergoing upper limb surgeries (below shoulder) under brachial plexus block by supraclavicular approach. Sample size: 105. Results: Age distribution across groups was found statistically significant (p=0.033). This infers that age has a significant impact in causing the variation in results across various groups. mean duration of sensory block measured by return of pin prick sensation was 11.537 hours, 7.81 hours and 10.048 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of motor blockade was 9.784 hours, 7.05 hours and 8.774 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of effective analgesia (VAS>4) was 14.221 hours, 9.583 hours and 12.299 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of complete analgesia (VAS>0) was 11.537 hours, 7.81 hours and 10.048 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). Conclusion: dexmedetomidine is a better option than fentanyl when used for supraclavicular block techniques along with bupivacaine and lignocaine.

Alpha two agonists such as clonidine and dexmedetomidine have been popular in anaesthesia practice as adjuvants to provide sedation, anxiolysis, analgesia and controlled hypotension. Dexmedetomidine is eight times more selective for alpha 2 receptors than clonidine. Aim: The present study was undertaken to compare effects of clonidine and dexmedetomidine on haemodynamic stability, anaesthetics requirement and recovery profile in spine surgeries under general anaesthesia. Material and Method: A total 100 patients of American Society of Anaesthesiologists (ASA )grade I and II, age between 18 to 60 years, who were schedule for thoracic and lumbar spine surgery under general anaesthesia were included in the study. They were randomized in two groups of 50 patients in each. Group A received injection clonidine 2ug/kg bolus IV over 10 min followed by normal saline infusion and group B received injection dexmedetomidine 1ug/kg bolus IV over 10 minutes followed by dexmedetomidine infusion of 0.5ug/kg/hr. Assessment of haemodynamic parameters, anaesthetic requirement and recovery profile was done. Results: With clonidine and dexmedetomidine the intraoperative haemodynamic parameters remained stable without any statistical difference. Both the drugs were equally effective in reducing anaesthetic agent’s requirement and in reducing blood loss while comparable with respect to recovery profile and adverse effects. Group B had lesser extubation time (9.72±4.1 minutes) than group A (11.44±4 minutes) which was statistically significant however it was not clinically significant ,whereas the time to achieve aldrete score of > 9 was comparable between two groups. Conclusion: Dexmedetomidine and clonidine have similar effects on haemodynamic stability, anaesthetics requirement and recovery profile.

Background: Emergence agitation has potential to harm both patients and caregivers. This is more often witnessed in patient undergoing otolaryngology operations under general anesthesia with volatile anesthetic used for maintenance.
Aim: We investigated the effects of intra-operative dexmedetomidine infusion on emergence agitation and quality of recovery after functional endoscopic sinus surgery in adult patients.
Materials and Methods: One hundred patients undergoing functional endoscopic sinus surgery were randomized into two groups. The dexmedetomidine group (Group D, n = 50) received dexmedetomidine infusion at a rate of 0.4 mcg/kg/hr from induction of anaesthesia until extubation, while the control group (Group C, n = 50) received volume-matched normal saline infusion as placebo. Propofol (2 mg/kg) and fentanyl (2 mcg/kg) were used for induction of anaesthesia, and sevoflurane was used for maintenance of anaesthesia. The incidence of agitation, haemodynamic parameters, and recovery characteristics were evaluated during emergence. A 40-item quality-of-recovery questionnaire (QoR-40) was provided to patients 24 hours after surgery.
Results: The incidence of agitation was lower in Group D than Group C (28 vs 56 %, P = 0.018). Mean arterial pressure and heart rate were more stable intra-operatively and during emergence in Group D than in Group C (P < 0.05). Time to extubation, nausea and vomiting, and pain scores were similar between the groups. Global QoR-40 score at 24 hours after surgery was higher in Group D (mean 174.7 ± 6.99) compared with Group C (mean 169.4 ± 9.91) (P < 0.05).
Conclusion: Intra-operative infusion of dexmedetomidine provided smooth and hemodynamically stable emergence. It also improved quality of recovery after nasal surgery.

Regional nerve blocks with local anesthetics provide intra operative anesthesia as well as Postoperative analgesia. Our study has been undertaken to compare the onset time, duration and analgesic efficacy of clonidine with dexmedetomidine when added as adjuvant to bupivacaine(0.25%) for brachial plexus block by supraclavicular approach.
Methods: 60 patients aged 18-65 years belonging to ASA PS –I & II of both sexes undergoing elective upperlimb surgeries under Brachialplexus block were included in our study. Patients satisfying the inclusion criteria were allotted into 2 groups of 40 each. Group 1: Bupivacaine 0.25%( 35 cc) + clonidine 1 mcg/kg, Group 2: Bupivacaine 0.25%( 35 cc) +dexmedetomidine 1mcg/kg.
Results: The mean time for onset of sensory block in group A was (20.23 ±1.104 ) mins and that observed in group B was (14.83±1.744) mins. The mean time for onset of motor block in group A was( 18.43 ±1.135) mins and (12.67±1.539) mins in group B. . Mean duration of sensory block in group A was (476.77±9.313) mins and in group B was (730.13±52.208) mins. The mean duration of motor block in group A was (420.60±8.896 )mins and in group B was( 649.6±45.040 )mins. The mean duration of analgesia in group A was (522.23±11.047) and in group B was (757.13± 44.044) All the above differences were statistically significant with a p value < 0.05%. 

Background: Numerous pharmacological agents effectively lower the systemic blood pressure for hypotensive anaesthesia techniques. The present study was conducted to assess dexmedetomidine infusion during middle ear surgery under general anaesthesia.
Materials & Methods: 50 adults scheduled for elective middle ear surgery of both genders were divided into two groups of 25 each. Group I received infusion of dexmedetomidine 0.5 μg/kg/h and group II received placebo infusion of normal saline during middle ear surgery. Intra-operatively, the heart rate, arterial blood pressure, ECG, EtCO2 and peripheral pulse oximetry (SpO2) were monitored and recorded at 5 min intervals till end of surgery. The mean surgery time and isoflurane requirement was recorded.
Results: Group I had 12 males and 13 females and group II had 11 males and 14 females.ASA grade I was seen in 20 in group I and 19 in group II and II in 5 in group I and 6 in group II. The mean heart rate at baseline was 94.5 in group I and 92.1 in group II, after induction was 74.2 in group I and 70.6 in group II, after intubation was 76.4 in group I and 75.2 in group II and after extubation was 82.6 in group I and 96.4 in group II. Percentage of isoflurane requirement was 0.9 in group I and 1.5 in group II and the mean surgery time was 95.4 minutes in group I and 104.2 minutes in group II. The difference was significant (P< 0.05).
Conclusion: Dexmedetomidine infusion provided sufficient oligaemic surgical field for better visualisation under operating microscope for middle ear surgery.

Introduction: Spinal anesthesia has been the choice of anesthesia for infraumblical surgeries. Aim: to evaluate the efficacy of adding clonidine (30µg) or dexmedetomidine (5µg) to 0.75% isobaric ropivacaine for administration of subarachnoid lumbar block in lower limb surgical procedures.
Methods: The Hospital based comparative, randomized, double blind, study was done on 120 patients (ASA grade 1-2) undergoing lower limb surgeries at S.M.S. Medical College and attached group of hospitals, Jaipur, after taking permission from the institutional ethical committee and review board. 120 patients were randomized into three groups of 40 each by sealed envelope method as follow: GROUP RS (0.75% Ropivacaine + 0.5 ml Isotonic saline), GROUP RC (0.75% Ropivacaine + 30µg Clonidine), GROUP RD (0.75% Ropivacaine + 5µg Dexmedetomidine).
Results: The mean time taken to achieve maximum sensory level was 18.40 minutes, 11.70mins and 18.80mins in groups RS, RC and RD, respectively (p<0.05). Mean time taken for sensory block to regress to L1 sensory level was 227.50minutes, 202.30minutes and 159.40minutes in groups RC, RD and RS, respectively(p<0.05). The time between the administration of subarachnoid block and request for rescue analgesic was 193.10 minutes, 347.60 minutes and 381.30 minutes in groups RS, RC and RD, respectively (p<0.05).
Conclusion: We conclude that both drugs, Clonidine and dexmedetomidine can be safely added as adjuvant to intrathecal Ropivacaine for lower limb surgeries, in view of similar sensory and motor block characteristics.

Background: During general anesthesia laryngoscopy, tracheal intubation and extubation are the critical events provoking transient, but marked sympathoadrenal response manifesting as hypertension and tachycardia. In addition, in laparoscopic surgery, CO2 is routinely used to create pneumoperitoneum, which causes increased plasma level of catecholamine and vasopressin. Aim & Objective: 1. To compare the hemodynamic changes- heart rate and mean arterial pressure. 2.To study the postoperative emergence and recovery.3. To study the postoperative nausea and vomiting incidence. Methods: Study design:  Randomized comparative study.  Study setting: Department of Anaesthesia, Kamineni Institute of Medical Sciences, Sreepuram Narketpally, India. Study duration: From January 2021 to January 2022 (1 year) Sample size: 56. Results: There was a statistically significant difference in mean SBP at pre operative of subjects between group (i.e, p=0.024). There was no statistically significant difference in mean SBP after bolus of subjects between group. There was a statistically significant difference in mean SBP At 2 hour of subjects between group (i.e, p=0.012). There was a statistically significant difference in mean DBP at pre operative of subjects between group. There was a statistically significant association between other side effects and group (p=0.033) and strength of association was 0.290. Conclusion: The addition of dexmedetomidine provides better hemodynamic stability

Spinal anaesthesia is the most preferred technique for infraumbilical surgeries.Hyperbaric Ropivacaine has been shown to produce reliable and predictable anaesthesia for surgery. Fentanyl, a synthetic lipophilic opioid and Dexmedetomidine, a new highly selective α2-agonist, have been used as neuraxial adjuvants in spinal anaesthesia to prolong intraoperative and postoperative analgesia. The present prospective randomized study is undertaken to investigate and compare the clinical effects of 0.75% hyperbaric ropivacaine with additives such as fentanyl and dexmedetomidine on spinal anaesthesia for infraumbilical surgeries.
Aim: To compare the clinical effects of intrathecal 2ml of 0.75% hyperbaric ropivacaine with fentanyl 25μg and dexmedetomidine 10μg as additives in patients undergoing elective infraumbilical surgeries.
Materials & Methods: The study was conducted on 90 patients of both sexes, aged 18-60 years, of class I or II of the American Society of Anesthesiologists classification, who underwent elective infraumbilical surgery. Patients were randomly assigned to three groups (30 patients each): group RC (control group) received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of normal saline (0.9%) at a total volume of 2.5ml intrathecally, whereas group RF received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of 25μg fentanyl (50 μg/ml) at a total volume of 2.5ml intrathecally and group RD received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of 10μg dexmedetomidine (50μg dexmedetomidine diluted in 2.5ml of normal saline) at a total volume of 2.5ml intrathecally. The onset, extent, duration of sensory and motor blockade, time to first rescue analgesia request, hemodynamic parameters, and side effects such as nausea, vomiting, pruritis, respiratory depression and shivering were recorded.

The aim of this study is to compare the efficacy of dexmedetomidine and Fentanyl on onset and duration of sensory, motor blockade and duration of analgesia. The present study to compare the analgesic efficacy of Dexmedetomidine and Fentanyl as adjuvant to Levobupivacaine and Ligcocaine in PNS guided Supraclavicular Brachial Plexus block" was carried out in Department of Anesthesiology index medical college Hospital and Research centre, Indore M.P. after approval of institutional ethical committee in 60 patients of ASA 1 & ASA II posted for elective upper-limb surgery.

Background: Caesarean section is one of the most commonly performed surgical procedures worldwide and 80–90% of them are performed under spinal anaesthesia.Adding adjuvants drugs to intrathecal local anaesthetics improves quality and duration of spinal blockade, and prolongs postoperative analgesia. The aim of our study was to compare the efficacy of using intrathecal Fentanyl, morphine and Dexmedetomidine as adjuvants to Bupivacaine in patients undergoing caesarean section at a tertiary hospital.
Material and Methods: Present study was comparative study, conducted among pregnant women, 20-35 years age, ASA grade I/II, posted for elective Caesarean section. Patients received either Fentanyl or Morphine or Dexmedetomidine as adjuvants with Intrathecal Bupivacaine (H) 0.5% 10mg (2ml) with as a standard dose.
Results: In present study, 99 pregnant women, equally allotted (33 each) to each group (i.e. Group BF, Group BM & Group BD). Mean age & duration of surgery was comparable among all 3 groups & difference was not statistically significant (p>0.05). Onset of action (Group BD- 43.3 ± 10.22 secs < Group BF - 50.15 ± 10.56 secs < Group BM - 51.4 ± 9.46 secs) & Duration of analgesia (Group BD- 460.2 ± 40.27 mins > Group BM - 326.2 ± 32.92 mins> Group BF - 292.8 ± 34.61 mins) was significantly better in dexmedetomidine group as compared to fentanyl group & morphine group, difference was statistically significant (p<0.05). Maternal vitals (pulse rate, systolic blood pressure & diastolic blood pressure) were stable throughout surgery & early postoperative period among all 3 groups, difference was not statistically significant (p>0.05).
Conclusion: Intrathecal dexmedetomidine as an adjuvant to bupivacaine has early onset of action, prolonged post-operative analgesia combined with minimal side effects.

Shivering is one of the most common complications of neuraxial blockade. Some patients find shivering sensation worse than surgical pain. Therefore, both prevention and treatment of established shivering should be regarded as clinically relevant intervention in the perioperative period.
AIM: The present study was done to evaluate and compare the efficacy, hemodynamics and adverse effects of Magnesium sulphate and Dexmedetomidine when used for control of intra operative shivering during neuraxial anaesthesia.
Materials And Method: A prospective double blind study was conducted by enrolling 253 patients undergoing lower abdominal and lower limb surgeries under neuraxial anesthesia in age group 20 to 60year with written informed consent. Patients developing intraop shivering were randomly divided into two groups Group A (50patients)- received Magnesium sulphate 50mg/kg IV bolus and Group B (50patients)- received Dexmedetomidine 0.5microgram/kg IV. Study was done until 50 patients were studied by both the study groups.
Results: The study shows a highly statistically significant difference (P value 0.001) between both groups in terms of heart rate, systolic blood pressure, diastolic blood pressure, core body temperature, time to disappearance of shivering and mean respiratory rate between both the groups.
Conclusion: In the above study Dexmedetomidine was more efficacious than Magnesium sulphate interms of maintaining hemodynamics and control of shivering in neuraxial anaesthesia.

Background: To compare the efficacy standards and clinical status of two α-2 agonists dexmedetomidine and clonidine as adjuvant to bupivacaine in undergoing surgical procedures of lower limb and infraumbilical region. To estimate adjuvants analgesic property that provides superior anaesthetizing properties with sedation, haemodynamic stability in neuraxial anaesthesia.

Aims and Objectives: To compare the efficacy of sedation and time taken for extubation using
dexmedetomidine and fentanyl sedation in post-operative adult cardiac surgical patients.
Methods: A prospective randomized double-blind study involving 60 patients undergoing open heart surgery was conducted. The patients were divided into two groups, each involving 30 patients. One group received fentanyl at 1 µg/kg/h (Group A) and the other received dexmedetomidine at 0.5 µg/kg/h (Group B) for post-operative sedation with intermittent rescue dose of  fentanyl 0.5 µg/kg bolus in either group as per requirement. The efficacy of sedation was assessed using the Ramsay sedation score. The time taken for extubation from the stoppage of infusion was noted.
An open heart surgery prospective randomized double-blind trial including 60 patients was carried out. Two groups of 30 patients each were formed from the patients. With occasional rescue doses of fentanyl 0.5 g/kg bolus in either group as needed, one group (Group A) received fentanyl at 1 g/kg/h and the other (Group B) received dexmedetomidine at 0.5 g/kg/h for post-operative sedation. The Ramsay sedation score was used to evaluate the effectiveness of the sedation. It was noticed how long it took to extubate once the infusion was stopped.
 Results: Haemodynamic parameters between the two groups were comparable.  Sedation scores between fentanyl and dexmedetomidine groups were comparable. Average time (in minutes) required for extubation was 140.04 (±43.6 SD) in the dexmedetomidine group compared with 359.4 (±93.3 SD) in the fentanyl group. The difference in mean time for extubation was statistically significant. 

Background: To assess and contrast the effectiveness, hemodynamic stability, and side effects of dexmedetomidine and magnesium sulphate when used to reduce intraoperative shivering.
Methods: The study was conducted at Department of Anesthesiology at Government general hospital, Guntur, India from January 2021 to March 2022. The study was performed on 100 patients undergoing lower abdominal and lower limb surgeries under neuraxial anesthesia.
Result: In the magnesium sulphate group, it took an average of 3.88+0.25 mins for the shivering to stop, but in the dexmedetomidine group, it took an average of 2.18+0.26 mins. The shivering score of magnesium sulphate and dexmedetomidine was 3+0 mins. Magnesium sulphate was provided in one case, and no one in the dexmedetomidine group experienced shivering again.
Conclusion: Together, dexmedetomidine 1 mcg/kg and magnesium sulphate 50 mcg/kg significantly decreased intraoperative shivering. Dexmedetomidine stopped the shivering in the shortest length of time while simultaneously raising body warmth and maintaining reduced pulse and respiratory rates.

Aim: The aim of the study is to compare post-operative analgesic efficacy of 0.25% bupivacaine vs 0.25% bupivacaine with dexmedetomidine in transversus abdominis plane block for postoperative caesarean section.
Methodology: Prospective randomized double blinded experimental study was conducted among 60 patients posted for elective caesarean section surgery and were divided into two equal groups. Group B patients received 20ml of 0.25% Bupivacaine and Group BD patients received 20ml of 0.25% Bupivacaine with 50 mcg Dexmedetomidine. Visual Analogue Score was used to determine the pain at rest during postoperative period. The time of requirement of rescue analgesia during postoperative period was also assessed.
Results: The demographic variables such as age and sex were comparable between the two groups.VAS at rest was significantly reduced in group BD (p<0.05). Duration of analgesia was significantly prolonged in group BD when compared to group B with significant P value <0.05. Rescue analgesic consumption in 24 hours during postoperative period was significantly decreased in group BD (p<0.05). Intraoperatively the heart rate, systolic and diastolic bp was comparable between both the groups. Postoperatively there was a significant fall in heart rate systolic and diastolic bp in the group BD when compared to group B with a P value <0.05.
Conclusion: In this study we observed that Dexmedetomidine, in combination with bupivacaine when given for TAP block provided excellent postoperative analgesia, extending upto more than 12 hours. Dexmedetomidine seems to decrease postoperative analgesic consumption and improve pain scores.

Background: Supraclavicular approach of brachial plexus block has been popular technique in delivery of anesthesia in patients undergoing upper limb surgeries. Of various local anesthetics, bupivacaine is used most frequently for brachial plexus block. Any adjuvant to the local anesthetics for brachial plexus block prolongs its analgesic effect. Hence the present study was undertaken to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine in supraclavicular nerve block for upper limb surgeries. Methods: A total 100 patients of ASA grade I and II were enrolled and randomly divided into two equal groups. Group A received 25-30mL of 0.5% Bupivacaine + 50μg Fentanyl and group B received 25-30mL of 0.5% Bupivacaine + 50μg Dexmedetomidine. The onset time and duration of sensory and motor blockade were recorded. Hemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. Results: The onset of sensory and motor block was significantly faster, and duration of sensory and motor block was significantly prolonged in group B as compared to group A (p<0.05). Rescue analgesic requirements were significantly less in group B compared to group A (p<0.05). Hemodynamic variables did not differ between groups in the post-operative period, except the pulse rate which was found to be on the higher side for fentanyl group. Conclusion: Addition of 50μg dexmedetomidine to 25-30ml bupivacaine 0.5% in supraclavicular brachial plexus block was more effective in prolongation of sensory and motor duration as well as providing adequate intra-operative analgesia when compared to 50μg fentanyl with 25-30ml bupivacaine 0.5%, without producing any adverse events.

Background:Sub Arachnoid block is the safe, satisfactory and most commonly used technique for lower abdominal, pelvic and lower limbs surgeries. The duration of action of Bupivacaine is prolonged; it may not produce adequate post-operative analgesia. Hence adjuvants were used for producing prolonged post-operative analgesia. The aims and objective is to Compare the onset, duration of sensory and motor blockade and requirement of post-operative analgesia with dexmedetomidine vs fentanyl as adjuvants to intrathecal 0.5% hyperbaric bupivacaine Secondary Objectives were compare the hemodynamic effects of adding dexmedetomidine vs fentanyl as adjuvants to intrathecal bupivacaine.
Materials and Methods: Patients were allocated into one of the three groups of 50 each using computer generated random number. Patients were counselled regarding the procedures.
Results: The Onset of Sensory Block amongst the groups was statistically insignificant with P-Value of 0.279.), The mean duration of motor block was 231.16±68.56, 263±64.46 and 178.52±26.60 mins in Groups A, B and C respectively. The prolonged motor block in Group B (Dexmedetomidine) was statistically significant with P-Value of <0.0001. The mean time for first rescue analgesia was 323.44±116.29 mins in Group A, 391.52±105.63 mins in Group B and 311.80±99.15 mins in Group C. Better post-operative analgesia in Group B, P value of <0.0001.
Conclusion: From this study it can be concluded that the use of intrathecal dexmedetomidine as an adjuvant to bupivacaine seems to be a better alternative to fentanyl for long duration surgical procedures due to its prolonged duration of sensory and motor block combined with minimal side effects. However, prolonged duration of motor blockade with dexmedetomidine may be undesirable for shorter surgical procedures or ambulatory surgeries.

Background: The incidence of Chronic Kidney Disease Stage-V and dialysis population requiring renal transplantation is increasing globally. Present study was aimed to evaluate the efficacy and safety of low dose continuous infusion of dexmedetomidine on hemodynamic changes, sedation and analgesic requirement intraoperatively and immediate postoperatively in patients undergoing for renal transplantation.
Material and Methods: Present study was single-center, Randomized, prospective, double blind, placebo-controlled study, conducted patients, age between 18-60 years undergoing renal transplantation, ASA grade 2 and 3. Patients were assigned into 2 groups, as study Group (continuous infusion of dexmedetomidine at rate of 0.2 mcg/kg/h) & control Group.
Results: Among both groups, distribution of age, gender, weight, Mallampatti grades, comorbidities, mean duration of surgery, mean duration of anaesthesia were comparable & no statistically significant difference was observed (p> 0.05). Mean heart rate was lower in study group as compared to the control group and significant differences were found at all-time points of the study period (p < 0.05).  SBP & DBP after 15 minutes of induction decreased significantly from the base line value in study group, and this lasted throughout the intraoperative period till the end of surgery, the difference being statistically significant (p < 0.05) Postoperatively, SBP & DBP in the study group were less than the SBP & DBP in control group at all the time points & difference being statistically significant (p < 0.05).

Background: 
Spinal anaesthesia remains one of the basic techniques despite the waxing and waning of its popularity over last 100 years since its introduction various agents have been used with local anaesthetics in spinal anaesthesia to improve the quality of block and to provide prolonged postoperative analgesia.
AIM: In the present study, we tried to study effectiveness of intrathecal 0.5% bupivacaine (heavy) alone and with Dexmedetomidine as an adjuvant for lower limb and lower abdominal surgeries.
Material and Methods: The study was conducted in the department of anaesthesiology, KIMS, Narketpally during Oct 2021 to Sep2022.This study was a prospective, randomised controlled, single blind, study conducted in 60 patients of ASA grade I and II undergoing elective surgeries. The patients were divided by random number table into two groups, containing 30 patients in each group. Dosages of drugs selected are divided as Group B: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) and Group BD: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) plus 5 µg Dexmedetomidine. Spinal block characteristics, haemodynamics and side effects were observed.
Results: It was found that in Dexmedetomidine group time to reach T10 sensory blockade and complete motor blockade and was earlier and a higher and prolonged when compared to the control group. Haemodynamic parameters were preserved both intra-operatively and postoperatively. There were a small percentage of patients who had minor side effects.
Conclusion: Intrathecal low dose Dexmedetomidine in a dose of 5µg along with 0.5% hyperbaric bupivacaine given intrathecally prolongs significantly the duration of sensory and motor blockade

Background: Monitored Anaesthesia Care (MAC) typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs.  Present study was aimed to compare middle ear surgeries under sedation and local anaesthesia with midazolam plus dexmed versus midazolam plus nalbuphine.
Material and Methods: Present study was a prospective, comparative study conducted in patients 18-60 years age, either gender, ASA Grade I /II, posted for middle ear surgery under Sedation & local anaesthesia. In first group MD, patients received intravenous inj. midazolam 1 mg plus inj. dexmedetomidine 1 ugm /kg bolus and 0.5 ugm kg added in 100 ml NS infusion, given at 0.3 to 0.4 ugm/ min. In second group MN, patients received intravenous inj. midazolam 1 mg plus inj nacphin 10 mg slowly.
Results: Patients were randomly divided in two groups of 30 each. In present study, age, gender, BMI, ASA grade, type of surgeries (Tympanoplasty, mastoidectomy, stapedectomy) & duration of surgery was comparable & difference was not statistically significant. Ramsay Sedation Score (RSS) at 30,40 & 90 minutes was better in MD group as compared to MN group, difference was statistically significant. Visual Analogue Score (VAS) at 20, 30,40, 60 & 90 minutes was better in MD group as compared to MN group, difference was statistically significant. Patient & Surgeon satisfaction score was better in group MD as compared to group MN, but difference was not statistically significant. Conclusion: Dexmedetomidine with midazolam was better than nalbuphine with midazolam, with respect to sedation, analgesic effect, patient & surgeon satisfaction.

Background: Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU).Data comparing Dexmedetomedine and Fentanyl as an effective sedation in mechanically ventilated patients are lacking.
Methods: In a prospective, bouble blind study, we randomly assigned newly mechanically ventilated patients  to receive  Dexmedetomidine (0.3 to 0.7mcg/kg/hr) or fentanyl (1 to 3mcg/kg/hr) with doses adjusted to achieve target sedation goals set by clinicians according to the Richmond Agitation–Sedation Scale (RASS, on which scores range from −5 [unresponsive] to +4 [combative]). Midazolam 0.002 mg/ Kg bolus was administered as rescue sedation if the target sedation score could not be achieved within the infusion range. Primary end points were to assess the total dose of the sedative drugs, time required to achieve target sedation as well as total dose of rescue sedation administered.
Results:  62 patients were included in the study, of which 31 received Dexmedetomidine, and 31 received fentanyl infusion. It was observed that there was a significant difference among the two groups with reference to the time required to achieve target Richmond Agitation Sedation score (RASS) of -1.The mean time to achieve target RASS of -1 in Dexmedetomidine group was 2.97 ± 1.278 hours whereas in Fentanyl group  6.29 ± 3.388 hours  (p<.001  vhs) . The mean rate of infusion required to achieve target RASS of -1 in Dexmedetomidine group was 0.5 ± 0.1 mcg/kg/min and in Fentanyl group 2.7 ± 0.8266 mcg/kg/hr. The mean dose of Midazolam as rescue sedation was higher in Fentanyl group (2.29 ± 1.657) as compared to Dexmedetomidine (0.39 ± 1.202) mg (P < 0.01).
Conclusion:  Dexmedetomidine group achieved adequate sedation in lesser time and in doses within the prescribed clinical range as compared to fentanyl group, in mechanically ventilated patients. Further, the 24 hour midazolam requirement was higher in fentanyl group.

Background: Intrathecal opioids are the gold standard for the treatment of post-operative pain with Buprenorphine adjudged as the most effective due its potent and prolonged effects. However, over the years it is losing popularity due to dose dependant side effects such as pruritus, nausea, vomiting and the most feared risk of delayed respiratory depression. Hence the search for an agent which can provide potent postoperative analgesia as comparable to morphine without its side effects still continues.
Aim & Objective: study intrathecal Dexmedetomidine 10mcg and Buprenorphine 75mcg used as adjuvant to 0.5% hyperbaric Bupivacaine to study- The onset of sensory block., Time of achieving highest level of sensory block. The onset of motor block. The Hemodynamic Effects. The Adverse Effects. Methods: Randomized clinical trial, Study setting:  Anaesthesia Department of tertiary care centre. Study duration: from April 2021 to March 2022 Study population: All patients with cataract requiring surgery admitted in tertiary care center. Sample size: 100. Results:  Dexmedetomidine group- 4 (8%) patients were less than 20 years of age, 34 (68%) patients were between 20-40 years of age, 12 (24%) patients were between 41-58 years of age. Buprenorphine group- 1(2%) patient was less than 20 years of age ,34(68%) were between 20-40 years of age, 15(30%) were between 41-58 years of age. 47(94%) patients in Dexmedetomidine group were males and 3(6%) were females.38(76%) patients in Buprenorphine group were males and 12(24%) were females. Dexmedetomidine group 47(94%) patients were ASA 1 grade whereas 3(6%) patients were ASA 2 grade. Buprenorphine group 43(86%) patients were ASA 1 grade whereas 7(14%) patients were ASA 2 grade. Dexmedetomidine group was earlier with mean 3.06 ± 0.45 min whereas 3.46 ± 0.59 min in buprenorphine group, P value 0.0002492 which was significant as it was less than 0.05. so onset of sensory block was significantly earlier in Dexmedetomidine group than Buprenorphine group. No significant difference was seen in the distribution of maximum sensory level among patients in both the group as observed p value is 0.532 which was >0.05. From 10 min onwards, Hollmen score was 3 among both group which denotes no perception of pinprick 15min after giving spinal anaesthesia. Conclusions: Time of onset of sensory block and motor block was earlier in Dexmedetomidine group   than the Buprenorphine group. Duration of sensory block and motor block was prolonged in Dexmedetomidine group than the Buprenorphine group. Two segment regression of sensory level was significantly later among Dexmedetomidine group than Buprenorphine group.

Background: The potential and duration of analgesia can be increased by adding a suitable alpha 2 adrenergic agonists as adjuvants to ropivacaine during elective lower limb surgical procedures under epidural anaesthesia. Still there is a scope for research on the effects of clonidine and dexmedetomidine as potent adjuvants in epidural local anesthetics. The aim of our study is to compare the effect of clonidine and dexmedetomidine when used as an adjuvant to epidural ropivacaine in lower abdominal and lower limb surgeries.
Materials and Methods: Patients were randomized into fourgroups Group R (n=30) patients received 10ml of 1% isobaric ropivacaine alone, Group RC (n=30) patients received 10ml of 1% isobaric ropivacaine with clonidine 1μg/kg, Group RD (n=30) patients received 10ml of 1% isobaric ropivacaine with Dexmedetomidine 1μg/kg, Group RCD (n=30) patients received 10ml of 1% isobaric ropivacaine with 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine. Onsetofsensory analgesia using colds wab, onset of motor blockade using Bromage scale, time to 2 dermatome regression of sensory level, time to first demand for analgesia, sedationusing Ramsaysedation scale, intra operative hemodynamic parameters and complication swere assessed.
Results: The impressive and practically applicable results were obtained in Group RCD with respect to Results: The impressive and practically applicable results were obtained in Group RCD with respect to time for onset of analgesia (29 ± 3.9 sec), maximum sensory level (T 4.12 ± 1.1), time to peak sensory level (3.49 ± 1.2 min), time for two segment sensory regression (150 ± 12.3min), time taken for sensory regression to s1 (372.5 ± 17.1), duration of analgesia (439.3 ± 64.6 min), regression to Bromage 0 (41±11.3), onset to Bromage 3 (390 ± 32.9 min) and vas score (3.10±0.50).
Conclusion: The study results strongly conclude the use of 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine as aneffective adjuvant to10ml of 1% isobaric ropivacaine forepiduralanesthesia in lower limb and lower abdominal surgeries.

Background & Aims: We compared  dexmedetomidine with combination of midazolam and ketamine via nebulization for sedation in pediatric patients posted for elective surgery
Methods: Ethical clearance followed by informed consent was taken from guardians. Sixty was our sample size which was divided into two groups of 30 per group. Group A   received dexmedetomidine 2µg/kg & Group B received midazolam 0.1 mg/kg with ketamine 1 mg/kg. The primary objective was mask acceptance scale. Secondary objectives were sedation score, parental separation anxiety scale, post operative emergence agitation, recovery times and side effects. The MS EXCEL was used for data entry & outcomes averaged as Mean with standard deviation (SD) or Median with inter quartile range (IQR). Chi‑square test/ Fisher Exact test, Independent t‑test/Mann‑Whitney U test was used. P < 0.05 was regarded as remarkable.

Background: Effective pain control after surgery is an important part of taking care of someone who has had surgery. A paravertebral block (PVB) is becoming more popular for breast surgery and is thought to be the best method for anaesthesia and pain relief after surgery. Several local and regional anaesthetic techniques were looked at to see if they could reduce post-surgery pain after breast surgery. The thoracic PVB technique looks promising because it reduces post-surgery pain, reduces opioid use, reduces side effects like drowsiness and the risk of breathing problems, and saves money. The goal of this study was to find out how well dexmedetomidine works with ropivacaine as a paravertebral block in breast cancer surgery.
Material and Methods: Randomly, 100 women having breast surgery were split into two groups, Group PR and Group PRD. For thoracic paravertebral block, Group PR got 0.5% ropivacaine (0.3 ml/kg) with 1 ml normal saline, while Group PRD got the same amount of ropivacaine with 1 mcg/ml of dexmedetomidine. The groups were watched to see how well the block worked, how the hemodynamic parameters changed at different times, when the sensory block started, how long it lasted and if there were any complications during or after the surgery.
Results: When added to ropivacaine in TPVB as an adjuvant, dexmedetomidine gives good pain relief during and after surgery and reduces the need for painkillers after surgery. There were no problems with the technique or the way the blood flowed and there were no bad effects from the dexmedetomidine.
Conclusion: TPVB with ropivacaine and dexmedetomidine as an add-on can be a better choice for good pain relief and stable blood flow during breast surgery without complications or side effects.

Background: Enhancing the duration of sensory and motor blockade of regional anaesthesia is often desirable for prolonged surgeries and also provides pain relief in the immediate postoperative period. We performed a prospective, randomised, study to evaluate the effect of Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in supraclavicular approach of brachial plexus block.
Study design: The study was a controlled, randomised, double-blinded, prospective study.
Methods: Sixty ASA physical status 1 and 2 patients undergoing elective hand, forearm and elbow surgeries under brachial plexus block were randomly divided to receive either 8 mg Dexamethasone + 30ml 0.5% Ropivacaine or 1 mcg/kg Dexmedetomidine + 30 ml 0.5% Ropivacaine. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade and total duration of analgesia were measured. Vitals were recorded at 3, 5,10,15,30 and 45 minutes. Two sample ‘t’ test of difference between two means was used to analyse the differences between various parameters that were used in the cases. Categorical data was assessed by Chi square test and Fishers exact test. P value of < 0.05 was considered significant.
Results: The onset of sensory block and onset of motor block both were found to be sooner with Dexmedetomidine than Dexamethasone. The duration of sensory block and motor blockade and duration of analgesia was longer with Dexmedetomidine than Dexamethasone.
Conclusion: Both Dexmedetomidine and Dexamethasone enhanced the onset and duration of blockade but, the effect was found to be more pronounced with Dexmedetomidine.
 

Dexmedetomidine is a highly selective alpha 2 agonist with properties of sedation, analgesia and anxiolysis. The purpose of this narrative review was to assess the effect and safety of dexmedetomidine in not only decreasing the magnitude of haemodynamic responses to laryngoscopy, surgery and pneumoperitoneum especially when used together with fentanyl but also decreases the dose of opioids and anaesthetics in achieving adequate analgesia and anaesthesia respectively. Intraoperative administration of dexmedetomidine is associated with decreased postoperative pain, opioid and analgesic consumption and it assures haemodynamic stability.

Background: Supraclavicular brachial plexus block is a commonly employed regional nerve block technique for upper extremity surgery. Various adjuvants were added to local anaesthetics in brachial plexus block to achieve rapid onset and prolonged block. To compare dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of blockade.
Material and Methods:Forty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a double- blinded fashion. Group one was given 0.25% Bupivacaine 2 milligram/kg as local anaesthetic and Dexmedetomidine 1microgram/kg as adjuvant. Group two was given 0.25% Bupivacaine 2 milligram/kg and Dexamethasone 100microgram/kg as adjuvant. Onset and duration of sensory and motor blockade and hemodynamic stability were recorded. All patients were observed for any side effects and complications. All data were recorded and statistical analysis was done.
Results: Sensory block and motor block onset was earlier in dexmedetomidine group.The duration of blockade was also prolonged in dexmedetomidine group when compared with dexamethasone group and is not associated with any major side-effect.
Conclusion: Dexmedetomidine is a better adjuvant than dexamethasone in supraclavicular brachial plexus block.

Background : Hypotensive anaesthesia is extensively used during surgery, particularly maxillofacial procedures. Hypotensive anaesthesia reduces blood loss during surgery by rendering the operative field bloodless. Normal blood pressure (BP) during surgery indicates skillful anaesthesia since organ perfusion is preserved. Achieving optimal hypotension is a skill, as excess BP reduction can be dangerous due to diminished circulation to organs like the brain, heart, and kidneys.
Materials and methods: AComparative study. 52 Indian phenotype patients were randomly selected from a table and divided into two groups of 26. Group D = dexmedetomidine (1 μg /kg diluted in 10 mL 0.9% saline administered over 10 minutes before anaesthesia, followed by 0.2–0.7 μg/kg/hour). Group P = propofol (100–150 μg/kg/hour). Mean arterial pressure (MAP) and hemodynamic stability were maintained by titrating infusions.
Results: In our research, neither hypotension nor bradycardia required medication. Group D had lower heart rate and blood pressure than group P. Group D awoke faster than group P. The usual dosages of dexmedetomidine and propofol for hypotensive anaesthesia are 0.2 0.04 μg/kg/hour and 140 41 μg/kg/hour, respectively. In India, little doses may not create issues.
Conclusion: In our investigation of the Indian population, both dexmedetomidine and propofol produced the necessary hypotension in ENT surgery patients to reduce blood loss and increase operational field vision. MAP was lower in dexmedetomidine than propofol, but not significantly. Higher propofol Ramsay sedation scores suggest stronger sedation than dexmedetomidine, making it a superior candidate for hypotensive anaesthesia

Introduction: Laparoscopic surgeries has revolutionized abdominal surgeries, however, this procedure is not risk free. Hence, the present study was designed to evaluate the efficacy of dexmedetomidine versus clonidine in prevention of such hemodynamic changes

Introduction: Both clonidine and dexmedetomidine are alpha-2 adrenergic agonists that have analgesic as well as sedative properties and are being tried as newer adjuvants for analgesia. In addition to this, both have been shown to reduce the requirements of local anesthetics and enhance the analgesic effects without increasing the incidence of side effects.Thus, the present study was undertaken to compare postoperative analgesia according to VAS with dexmedetomidine and clonidine and assessment of Ramsay sedation score after complication of surgery with each drug.

Background:Ambulatory anorectal surgery is an appealing approach for patients and physicians due to its increased efficiency and decreased surgical costs. The present study was conducted to evaluate intrathecaldexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries.
Materials & Methods:50 adult patients presenting for perianal surgeries were divided into 2 groups of 25 each. Group I patients received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of distilled water and group II received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of distilled water. The parameters such as time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic wasassessed.
Results: The mean weight in group I was 64.7 kg and in group II was 63.4 kg, height was 156.8 cm in group I and 157.3 cm in group II, ASA grade I was seen in 15 in group I and 16 in group II and grade II was seen in 10 in group I and 9 in group II.  The difference was non- significant (P>0.05). The mean duration of surgery was 26.5 minutes in group I and 28.2 minutes in group II. The mean duration of sensory block in group I was 430.6 minutes in group I and in group II was 318.6 minutes, duration of motor block was 324.8 minutes in group I and 230.6 minutes in group II and time to ambulation was 314.2minutes in group I and 216.1 minutes in group II. The difference was significant (P< 0.05). Side effects were shivering seen in 1 in group II, bradycardia 1 in group I, hypotension 1 in each group and Nausea/vomiting 1 in group I and 2 in group II. The difference was significant (P< 0.05).
Conclusion: Intrathecaldexmedetomidine provides prolonged post-operative analgesia.

Background: Functional endoscopic sinus surgery (FESS) has been recommended as a
treatment option for chronic sinusitis patients who have failed to respond to medical
treatment. In order to maximize the visibility of the operative site during functional
endoscopic sinus surgery (FESS), it is critical to reduce bleeding. The goal of this study was
to examine the effectiveness of dexmedetomidine and magnesium sulphate as hypotensive
agents in FESS in adult patients in order to achieve a bloodless surgical field.
Materials and methods: Sixty patients aged between 18-65 years were randomly assigned into
two groups, the D group for dexmedetomidine (n = 30) the and M group for magnesium
sulfate (n = 30). Patients in the D group received a loading dose of 1 g/kg dexmedetomidine
in 100 mL saline solution 10 minutes before induction and a 0.5–1 g/kg/h infusion via syringe
pump throughout the surgery. Patients in the M group received 40 mg/kg magnesium sulfate
in 100 ml saline solution over 10 min as the intravenous loading dose 10 min before
induction,followed by a 10–15 mg/kg/h infusion.

Background: Spinal anesthesia has been widely used to provide anesthesia and analgesia for cesarean section, which allows a patient to remain awake for the birth of her baby while avoiding the risks of general anesthesia. Hence; the present study was conducted for assessing the efficacy of Intrathecal Dexmedetomidine or Meperidine for Post-spinal Shivering.
Materials and methods: 40 Healthy subjects scheduled for caesarean delivery under CSEA were eligible for the present study and were broadly divided into two study groups as follows: Dexmedetomidine group (Group 1, n=20) and meperidine group (Group 2, n=20). Complete demographic and clinical details of all the subjects were obtained. C section was performed at L3-4 or L2-3 interspace. If primiparas shivered before cord clamping, dexmedetomidine 0.5 µg/kg or meperidine 0.5 mg/kg was administered intravenously. If shivering lasted more than 15 min, the treatment was considered invalid. If treatments were not effective, 4 mg ondansetron could be administered intravenously as a rescue medicine
Results: Incidence of shivering was similar among both the study groups. However; incidence of nausea and vomiting was significantly higher among subjects of group 2.
Conclusion: Both Dexmedetomidine and Meperidine had similar effect on Post-spinal Shivering.

Background:Aim: To evaluate and compare the following factors in two groups –
intrathecal dexmedetomidine and intrathecal buprenorphine as an adjuvant to 0.5%
hyperbaric bupivacaine for lower abdominal surgeries and lower limb surgeries.
Materials and Methods: A clinical study was undertaken to compare the effects of
intrathecal Buprenorphine and dexmedetomidine as additives to 0.5 % hyperbaric
bupivacaine for spinal anaesthesia. This prospective, randomized, Double blind study
was conducted on 60 adult patients of ASA physical status 1 and 2 in the age group of
18 to 60 years, posted for elective lower abdominal surgeries at Osmania Medical
college Hospital, Hyderabad from the period 2017 – 2020. Patients were randomly
allocated into two groups namely, Group BB and Group BD of 30 each. Patients in
Group BB received 60mcg of Buprenorphine with 0.5% bupivacaine 15mg
intrathecally. Patients in Group BD received 5mcg of Dexmedetomidine with 0.5%
bupivacaine 15mg intrathecally. After connecting monitors, the required preloading
done to all patients. Subarachnoid block was carried out under aseptic precautions.
Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation were
recorded at 0, 2, 5 minutes and thereafter every 10 minutes up to 90 minutes
intraoperatively.
Results: The following parameters were observed - onset and duration of sensory block
and motor block, time for sensory regression to S1, degree of sedation, hemodynamic
stability and any side effects associated with these drugs. Collected data were analysed
using appropriate statistics. Demographic datas were not statistically significant. The
onsets of sensory and motor blockades were not statistically significant. The duration of
sensory blockade was prolonged in dexmedetomidine group (51%) compared to
buprenorphine group. The Motor blockade, sensory regression to S1 were also got
prolonged in Dexmedetomidine group Hemodynamic parameters were comparable
between the groups. In our study The onsets of sensory and motor blockades were not
statistically significance between the groups. The duration of both sensory and motor
blockades were prolonged in dexmedetomidine group compared to buprenorphine
group with the best statistical significance. Both groups had stable and comparable
hemo dynamics during the study. Compared to buprenorphine, intrathecal
administration of dexmedetomidine as additive to hyperbaric bupivacaine was
associated with fewer side effects.
Conclusion: Our study concludes that dexmedetomidine as an adjuvant to intrathecal
bupivacaine prolongs both sensory and motor block duration with fewer side effects
compared to buprenophine.

Introduction: Spinal anesthesia is the most commonly performed anesthetic technique for
lower limb, abdominal, perineum surgeries. It has been seen that multiple drugs are being
added to the local anesthetics in subarachanoid blockade which results in better
haemodynamic stability, increased duration of surgical analgesia and even provide post
operative analgesia. Here we did a case series of adding intrathecal dexmedetomidine to
hyperbaric bupivacaine in cases which were posted for infraumbilical surgery and lasted for
more than 2 hours. Even two cases lasted for more than 5 hours were done comfortabily with
addition of dexmedetomidine.Dexmedetomidine is a selective alpha 2 adrenoceptor agonist
which can be used in low doses and it prolongs sensory block in a dose dependent manner
without major haemodynamic effects. Patient also had significant post operative analgesia
which reduced the requirement of rescue analgesia and also resulted in early recovery of the
patient.

Several theories have been proposed, the most consistent being that it acts in a similar fashion to NSAIDs by the inhibition of the cyclo-oxygenase pathways. However, paracetamol lacks both the peripheral anti-inflammatory and anti-platelet response seen with NSAIDs28. More recently, it has been suggested that paracetamol may also be linked with both direct and indirect stimulation of the cannabinoid, nitric oxide synthase, and serotonergic pathways. Patients satisfying the inclusion criteria were selected during the study period from the operation register on a daily basis. After obtaining a written informed consent, sixty patients were recruited for this study. They were allocated into two groups of 30 each. 10 patients in group D and 08 patients in group P complained of nausea, none of the patients in either group had vomiting, bradycardia, and hypotension

Introduction: Laryngoscopy and endotracheal intubation often provoke an undesirable increase in arterial blood pressure and/or heart rate1,2,3. Alpha 2-adrenergic agonists like dexmedetomidine have been extensively used to suppress the hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: The study was conducted among 60 ASA grade I and II patients between 18-60 years of age, scheduled for elective surgeries under general anaesthesia. The study population was subdivided randomly into 2 groups each consisting 30 patients. Group D received Dexmedetomidine 0.5mcg/kg IV diluted to 10 ml with normal saline. Group S received Normal saline 10 ml IV.
Results: There was a significant fall in HR in group D at 5 and 10 minutes after drug administration. The mean HR increase observed at 1, 3, 5 and 10 minutes after intubation in group NS was statistically significant. The mean SBP values at 5 and 10 minutes after drug administration were significantly low in group D. The increase in SBP in group NS at 1, 3, 5 and 10 minutes after intubation was statistically significant. The mean DBP values at 5 and 10 minutes after drug administration were significantly low in group D. The increase in DBP in group NS at 1, 3, 5 and 10 minutes after intubation was statistically significant. There was a significant difference in MAP values at 5 and 10 minutes after drug administration which was statistically significant. The increase in MAP in group NS was statistically significant at 1, 3, 5 and 10 minutes after intubation.
Conclusion: We conclude that Dexmedetomidine 0.5 μg/kg before laryngoscopy and endotracheal intubation effectively attenuates the hemodynamic response as compared to normal saline without major adverse effects.

Aim: The purpose of this study is to analyze and compare the properties of
Dexmedetomidine with that of Nalbuphine regarding duration of sedation, recovery and
adverse effects in short surgical procedures.
Materials and methods: It is observational clinical study involving 60 patients belonging to
ASA grade 1 & 2 posted for elective minor surgical procedures lasting about 45 -60 minutes,
comparison between Dexmedetomidine and Nalbuphine was done and the onset of sedation,
duration of sedation and recovery from sedation including adverse effects of both drugs,
hemodynamic and respiratory parameters were evaluated. Patients were randomly divided
into 2 groups of 30 each .Group N( Nalbuphine) received 50 mcg /kg of Nalbuphine and
Group D(Dexmedetomidine) received 1 mcg/kg of Dexmedetomidine over 10 minutes .
Results: Demographic parameters in both groups were comparable (p>0.05).Nalbuphine and
Dexmedetomidine has comparable onset of time for sedation, duration of sedation and
recovery from the sedation. Onset of sedation is fast in Dexmedetomidine; total duration of
sedation is more with dexmedetomidine and has provided good sedation during the surgical
procedure. As reported in several studies dexmedetomidine offered good cardiovascular
stability without the risk of hypotension . No significant side effects were noted with
dexmedetomidine when compared with Nalbuphine.
Conclusions:Dexmedetomidine when used as a peri operative sedative agent has faster onset
of sedation ,longer duration of sedation ,and the recovery from sedation

Background: The present aim of the study is to compare the clinical efficacy of
dexmedetomidine versus fentanyl added to intrathecal levobupivacaine for orthopedic
surgeries on the lower limb.
Materials and Methods: The current study was a prospective randomized double-blind
comparative study. This study was done in 90 ASA grade I & II patients. The patients
were aged between 18 to 60 years scheduled for elective orthopedic surgeries under
spinal anaesthesia at Government General Hospital, Kurnool District, Andhra Pradesh.
The patients were distributed into three groups (30 patients each). Namely., Group-C
[Study group LN:15mg of 0.5% of Levobupivacaine + 0.5 ml of normal saline]-Total-
3.5ml, Group-D [Study group LD:15mg of 0.5% of Levobupivacaine + 5 mcg (0.05ml=2
units from insulin syringe) of dexmedetomidine+0.45 ml of normal saline]-Total-3.5ml
and, Group-F [Study group LF: 15 mg of 0.5% of Levobupivacaine + 25 mcg of
fentanyl]- Total =3.5 ml.

Background: Direct laryngoscopy followed by endotracheal intubation is prone to
haemodynamic fluctuations which may be detrimental in subjects with coronary artery
disease, hypertension, and cerebral vascular disease. The aim is we wanted to compare
Dexmedetomidine with Magnesium sulphate to determine the better drug with regard
to attenuation of the haemodynamic responses during laryngoscopy and endotracheal
intubation.

Background: Various adjuvants have been used with local anaesthetics in spinal
anaesthesia to prolong postoperative analgesia. Dexmedetomidine, the new highly
selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this
study was to evaluate the onset and duration of sensory and motor block, hemodynamic
effect, postoperative analgesia, and adverse effects of dexmedetomidine, or fentanyl
when given intrathecally with hyperbaric 0.5% bupivacaine.
Materials and Methods: Ninety patients classified in American Society of
Anaesthesiologists classes I and II scheduled for lower abdominal surgeries requiring
spinal anaesthesia were studied. Patients were randomly allocated to receive either 12.5
mg hyperbaric bupivacaine plus 10 μg dexmedetomidine (group D, n=30) or 12.5 mg
hyperbaric bupivacaine plus 25 μg fentanyl (group F, n=30) intrathecal. The control
group received 12.5 mg hyperbaric bupivacaine intrathecally (n=30).
Results: Patients in the dexmedetomidine group (D) had a significantly longer sensory
and motor block time than patients in the fentanyl group (F) and control group (B).
VAS score at rescue analgesia was significantly higher in the control group. Duration of
analgesia was significantly more in the dexmedetomidine, and fentanyl group as
compared to control. The total duration of analgesia was longer with dexmedetomidine
than fentanyl. Sedation scores were significantly higher in the Dexmedetomidine group.
No hemodynamic changes were noted in any group.
Conclusion: Intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric
bupivacaine prolong sensory and motor block with minimal hemodynamic instability
and reduced demand for rescue analgesia. Intrathecal dexmedetomidine has a longer
duration of analgesia than fentanyl.

Dexmedetomidine the S-enantiomer of medetomidine a highly sedative and potent α2-
adrenergic agonists has a potentially useful role as a sedative agent. In healthy volunteers
dexmedetomidine increases sedation, analgesia and amnesia and decreases heart rate, cardiac
output and circulating catecholamine in a dose dependent fashion. Anaesthesia workstation
was checked. Appropriate size endotracheal tubes, working laryngoscope with medium and
large sized blades, stylet and working suction apparatus were kept ready before the induction
of general anaesthesia. Emergency drug tray consisting of atropine, adrenaline and
mephentermine were also kept ready for any eventuality. Post extubation Ramsay sedation
score was significantly higher in group D compared to group S at 30th, 60th and 90th minute
with p value = 0.001, 0.001 and 0.051 respectively. However no patients in group D required
intervention for sedation and were easily arousable. There was no statistically significance
between the groups immediately after extubation and at 120th minute postoperatively. 3
patients in group D (8.57%) and 3 patients in group S (8.57%) had vomiting immediately
following extubation which was statistically not significant (p = 0.721). 1 patients in group D
(2.86%) and 2 patients in group S (5.71%) had vomiting after 30 minutes of extubation which
was statistically not significant (p = 0.555).

Surgeries involving general anaesthesia where airway manipulation occurred during laryngoscopy and endotracheal intubation produces stimulation of epipha1ynx and laryngopharynx giving rise to hae1nodynatnic alteration due to catecholamine surge or response. Haemodynamic changes are accentuated in high risk cardiac patient. After obtaining approval from the institutional ethical committee patients fulfilling the inclusion/exclusion criteria were included in the study after obtaining informed consent. A preanesthetic evaluation of history of surgical and medical illness, drug allergies previous anaesthetic exposure and Baseline investigations of blood, ECG, radiograph of chest and airway examination was done. Patient was kept nil by mouth for at least 8hrs prior to surgery. All patients were premedicated with injection Pantoprazole 40mg (IV) one hour prior to surgery. Preoperative vital parameters like baseline pulse, blood pressure were noted. Systolic blood pressure in significantly lower in Group D patient after 40 minutes of intubation continues to be low at 6th, 8th, 10th, 15th and 20th minutes compared to Group C.

In laparoscopic surgeries, marked hemodynamic changes occur due to the effect of absorption, positioning of the patient, anesthetic agents and pneumoperitoneum. When the intra-abdominal pressure is < 10mmHg, hemodynamic alteration is not significant. Significant alteration in hemodynamics occurs, when the intra-abdominal pressure is > 10 mmHg after insufflation. When the intra-abdominal pressure is >10mmhg, it will cause inferior vena cava compression and pooling of blood in the lower extremities, which decreases the venous return to the heart thereby reducing the cardiac output. On receiving patient in operating room, the patient monitoring included electrocardiogram (ECG), noninvasive blood pressure (NIBP), heart rate (HR), oxygen saturation (SPO2). The baseline HR, NIBP, SpO2 scores were recorded. The hemodynamic parameters taken into consideration were the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure. Mean values of these parameters were analyzed from the baseline, every minute for the first 10 min thereafter for every 5 min till the end of surgery. The heart rate was significantly lower in dexmedetomidine group during the initial 10 min during infusion, lowest mean of 79.53±13.08, none of the patients from either group had bradycardia requiring atropine. Mean value of HR was higher in paracetamol group compared to dexmedetomidine group till 1 h postoperatively. Using preanesthetic dexmedetomidine 1μg/kg infusion followed by 0.5 μg/kg/h showed there was no difference in MAP between the groups, but heart rate of dexmedetomidine group was lower compared to the control group.

Introduction: Spinal anesthesia is most commonly used for lower abdominal surgeries due to its low cost and ease of administration as well as rapid onset of anaesthesia. Adjuvants like Fentanyl and dexmedetomidine are used to accelerate and prolong the anaesthetic effect depending on the purpose. This study was done to compare the effects of intrathecal hyperbaric bupivacaine with fentanyl and bupivacaine with dexmedetomidine for lower abdominal surgeries.

Etomidate is a popular intravenous induction agent because it has a stable haemodynamic profile and
results in minimal histamine release. Myoclonus is observed in 50%–80% of patients who did not
receive pretreatment before etomidate administration, which increases the risk of regurgitation and
aspiration in emergency conditions. Various drugs were used in the treatment of myoclonus but the
results have been inconclusive. Dexmedetomidine, a new alpha-2 agonist has been tried by several
authors to suppress the myoclonus induced by etomidate. A prospective randomized controlled double
blind study was conducted in seventy patients aged between 18-55 years belonging to ASA I and II
scheduled for elective surgery under general anaesthesia. After obtaining informed written consent, a
detailed preanaesthetic evaluation was done and investigations were obtained as indicated. The patients
were randomized into 2 groups with 35 patients each, received either 0.5 μg/kg of dexmedetomidine in
10 ml saline (Group D) or 10 ml of Saline (Group S) over a period of 10 minutes prior to etomidate
induction. The incidence of severe myoclonus was significantly less in group D compared to saline
group with p = 0.031 (8.57% in group D and 28.5% in group S). However there was no change in the
incidence of myoclonus (P = 0.237) and pain on injection (p = 0.309) in both groups. Recovery profile
was comparable in both groups. Our study shows that pretreatment with dexmedetomidine 0.5 μg/kg
IV is effective in reducing the severity of etomidate induced myoclonic muscle movements without
however dexmedetomidine does not have any significant effect on the incidence of myoclonus
following etomidate induction.

Background:The major problems during laparoscopic surgery are related to the
cardiopulmonary adverse effects of pneumoperitoneum, systemic carbon dioxide absorption,
and patient positioning. Due to the requirement of steep head-up position, the chances and
severity of unwanted hemodynamic responses such as hypertension and tachycardia are much
higher in laparoscopic cholecystectomy when compared with other laparoscopic
surgeries.Objective: The goal of anesthetic management in laparoscopic surgeries is to
minimize these hemodynamic responses along with adequate depth and pain control with the
target of minimal stress response and early discharge.
Materials & Methods:The present study was conducted in MLB Medical College and
hospital, Jhansi,UP.Participants of eithersex with ASA physical status grade I & II, aged 20
to 50 years and planned for elective laparoscopic cholecystectomy under general
anaesthesiawith tracheal intubationwere included in this study.This study was carried out in
100 participants. All selected participants under study were randomely divided into two
groups depending on the premedication used.Group A patients were given i.v.
dexmedetomidine in a dose of 1ug/kg over a period of 10 minutes, diluted with 100ml normal
saline,20minutes prior to induction of anaesthesia.Group B patients were given oral
pregabalin 75 milligrams with sips of water 1.5 hour before induction. Data was analysed in
SPSS 17.0 using unpaired students t test.
Result:We found that Systolic Blood Pressure and Heart Ratewere decreased after intubation
in both the groups but fall was significantly greater in group A when compared to group B
.There was also significant fall in Mean Arterial Pressure after intubation in group A as
compared to group B.

The sensory unit consists of free nerve endings that lie between the mucosal cells of the airway epithelium. Sensory units appear to be particularly abundant over the arytenoid cartilages and are also found on the laryngeal side of the epiglottis. Study was undertaken in patients planned for elective surgeries under General Anaesthesia. Patient were selected between 18 to 60yrs of Age with ASA 1 and ASA 2 grades. They were divided into 2 groups of 30 each and allocated randomly. All patients were explained about the procedure and its complication and informed consent obtained. There were no significant differences between the two groups with regard to demographic data such as age and weight. The average age in Group-C (clonidine) was 31.90 years and average age in Group D (dexmedetomidine) was 34.80 years.

Background: The supraclavicular approach to brachial plexus block is the most common peripheral nerve block technique used for upper limb surgeries. Aim of the present study was to evaluate and compare the efficacy of clonidine and dexmedetomidine as an adjuvant to 0.25% bupivacaine in peripheral nerve stimulator guided supraclavicular brachial plexus block in upper limb surgery.
Method: Total 80 patients of ASA grade I and II, age between 25-55 years were enrolled in the study and divided into two groups of 40 each. Group C received 39ml bupivacaine 0.25% (2.5mg/ml) + 1ml clonidine (1µg/ml) and group D received 39ml bupivacaine 0.25% (2.5mg/ml) + 1ml dexmedetomidine (1µg/ml). Parameters were observed include hemodynamic stability, onset time and duration of sensory and motor blockade, duration of analgesia and complications.
Results: Onset of sensory (2.32±1.16min) and motor blockade (5.55±1.50min) was earlier in dexmedetomidine group compared to clonidine group (sensory= 6.52±0.71min and motor= 11.65±1.05min), (p<0.0001). Duration of sensory blockade was 427.75±19.14 minutes in dexmedetomidine group and 226.0±11.72 minutes with clonidine group. Duration of motor blockade was 486.50±28.96 minutes with dexmedetomidine group and 275.25±17.53 minutes with clonidine group. However, the duration of analgesia was 588.25±28.27 minutes with dexmedetomidine group and 341.00±27.34 minutes with clonidine group. Hemodynamic parameters and side effects were comparable between the two drugs.
Conclusion: Dexmedetomidine shortens the onset, prolongs the duration of sensory and motor block, and also provides longer postoperative analgesia as compared with clonidine when used as an adjuvant to bupivacaine in peripheral nerve stimulator guided supraclavicular brachial plexus block.

Background: Many anesthetic pre-medications are used to relieve this stress response. Of these premedications,
midazolam and dexmedetomidine are effectively used as sedatives. The present study was
planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Many anaesthetic pre-medications are used to relieve this stress response. Of
these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present
study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Fear of unpleasant and painful procedures, separation from parents and
unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in
unpremeditated patients. Because of this premedication should be an integral part of paediatric
anaesthetic practice.

Background:Juvenile nasopharyngeal angiofibroma(JNA) is a locally invasive benign vascular tumor. Controlled hypotension is used to facilitate endoscopic resection to reduce the blood loss and stabilize the hemodynamics. Various agents are tried till now to achieve the goal.
Objective: To compare the effectiveness of Nitroglycerine withDexmedetomidine in terms of hemodynamics and blood loss during Endoscopic resection of Juvenile Nasopharyngeal Angiofibroma
Methods: Ethics Committee has approved this Randomized Controlled trial which was conducted among 40 patients randomly divided into two groups by simple randomization using computer generated random numbers.Informed consent was taken from all the eligible participants. Group D(n=20) receivedDexmedetomidine 1µg/kg over 15 min followed by a maintenance infusion at 0.5µg/kg/hourand GroupN (n=20)received (n=20), Nitroglycerine 0.5µg/kg/min and titrated in doses 0.5-5µg/kg/min for target blood pressure respectively. Standard guidelines were followed throughout the study protocol for data collection. Data was analyzed using mean and standard deviation in two groups.
Results:Both the groups were comparable for baseline parameters. There is statistically significant difference in mean pulse rate between two groups Group D: 66.09±2.83, Group N: 86.59±4.24 (p=0.0001). Blood loss was lower in Group D: 310.71±140.58 compared to Group N: 482.61±141.42, and is statistically significant (p=0.0004). SBP,DBPand MAP were lower in Group D throughout the surgery.
Conclusions:Dexmedetomidine is a better hypotensive agent with favorablehemodynamics and less blood loss when compared to Nitroglycerine. Hence we recommend use of Dexmedetomidine over nitroglycerine in patients during Endoscopic resection of Juvenile Nasopharyngeal Angiofibroma.

Background: Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia.
Aim: The aim of this study is to evaluate and compare intrathecal plain levobupivacaine and Dexmedetomidine as an adjuvant to 0.5% Levobupivacaine for infra umbilical surgeries with respect to sensory and motor blockade, hemodynamic changes, and adverse effects.
Materials and methods: This is a prospective, randomized double blinded study conducted among 60 patients who were posted under elective infra-umbilical surgery. They were equally divided into Group L: They received intrathecal 0.5% Levobupivacaine 3cc Group LD: They received intrathecal 3 mcg dexmedetomidine with 0.5% Levobupivacaine.
Results: The addition of dexmedetomidine significantly prolonged the duration of sensory and motor block. The addition of dexmedetomidine significantly prolonged the time for rescue analgesia. The addition of intrathecal dexmedetomidine lead to an early onset of sensory block. The incidence of side effects was limited to the occurrence of hypotension and bradycardia in the group that received dexmedetomidine intrathecally.
Conclusion: Intrathecal dexmedetomidine as an adjuvant to spinal anaesthesia is good choice since it produces prolonged sensory and motor block.

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

Background: Dexmedetomidine and midazolam both affects duration of spinal
analgesia by different mechanisms, and yet, no studies are available to compare them
for postoperative analgesia after neuraxial administration. We investigated the addition
of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of
effective analgesia.
Materials and Methods: The patient posted for elective procedure under spinal
anaesthesia were randomly allocated in to three group of 20 patient and each group.
Group D- Patient in the group receiving 3 ml of 0.5% hyperbaric Bupivacaine with
5mcg Dexmedetomidine the total volume is 3.5ml. Group M - Patient in the group
receiving 3 ml of 0.5% hyperbaric Bupivacaine with 1mg of Midazolam, the total
volume is 3.5 ml. Group B-: Patient in the group receiving 3 ml of 0.5% hyperbaric
Bupivacaine with 0.5 ml of normal saline, the total volume is 3.5 ml. The groups were
compared to the regression time of sensory block, duration of effective sedation score,
and side effects.
Results: The mean duration of sensory and motor block was quite prolonged in group D
patients The results were, statistically highly significant (P<0.0l) There
is significant difference between all the three groups in group D the sensory duration
block is 226 minutes while in group M is 158.7 minutes, In group B this Is 134.8 minutes
which is much less than the above groups. The motor block in group D 202.35 minutes,
in group M is 110.5 minutes and in group B is 96.8 minutes.
Conclusion: Dexmedetomidine (5mcg) when used as an adjunct to 3 ml of 0.5%
hyperbaric bupivacaine and prolongs the duration of effective analgesia in the
immediate postoperative period without any significant hemodynamic instability in
comparison to 1 mg midazolam.

Background: Spinal anaesthesia is the most commonly used technique for lower abdominal
surgeries as it is very economical and easy to administer. Dexmedetomidine, a new highly
selective α2-agonist, is under evaluation as a neuraxial adjuvant as it provides stable
hemodynamic conditions, good quality of intraoperative and prolonged postoperative
analgesia with minimal side effects.
Methods: Prospective double blinded, placebo-controlled study was undertaken in 60
patients allocated randomly by envelop method, divided into 2 groups (30 in each) between
18-50 years of age of either gender belonging to ASA class I and II scheduled for elective
lower segment caesarean section. Group A received 2 mL of 0.5% hyperbaric bupivacaine
and 0.2ml dexmedetomidine and Group B received 2ml of 0.5% hyperbaric bupivacaine with
0.2ml normal saline. The comparison was studied using the Chi-square test or Fisher's exact
test as appropriate, with the P value reported at the 95% confidence interval. P<0.05 was
considered statistically significant.
Results: The addition of dexmedetomidine resulted in a dose dependent prolongation of
sensory regression to S1 segment, prolonged motor block, the time to first analgesic rescue
was significantly prolonged in Group B as compared to Group A and showed Lower pain
scores as compared to placebo group.
Conclusion: Based on study results we recommend addition of dexmedetomidine 5 μg to
intrathecal hyperbaric 0.5% Bupivacaine 9 mg in elective lower segment caesarean section.

Introduction: TAH is associated with significant post-operative pain. Epidural analgesia
with a variety of local anaesthetics and adjuvants is widely used for TAH as it provides both
intra and post-operative analgesia. The aim is to compare the effect of post-operative epidural
analgesia with 0.2% ropivacaine and dexmedetomidine versus 0.125% levobupivacaine and
dexmedetomidine in patients undergoing TAH.
Method: Afterobtaining ethical committee permission and patient consent, 50 women aged
35-65 years of ASA 1&2 were included in the study. We have excluded patients with
hypersensitivity to local anaesthetics, infection at the site of injection. Patients were divided
into 2 groups of 25 each. Group RD-received 10ml of 0.2% ropivacaine and
dexmedetomidine 1 mcg/kg. Group LD-received 10ml of 0.125% levobupivacaine and
dexmedetomidine 1mcg/kg. Using chi-square test and student t-test statistical results were
obtained.
Results: The mean onset of analgesia in Group RD was 11.86min and in Group LD was
8.468min which is statistically significant (P<0.05). Mean duration of analgesia in Group RD
was 210min and in Group LD was 271min which is statistically significant (P<0.05).
Conclusion: We conclude that 0.125% levobupivacaine with dexmedetomidine as adjuvant
was found to have faster onset and prolonged duration of analgesia than 0.2% ropivacaine
with dexmedetomidine.

Background: Most urologic surgeries are performed in a narrow, limited space with
minimally invasive technique or cystoscope& anaesthesia for these procedures is
administered with the goals of safety, satisfactory procedural condition for the performance
of therapeutic or diagnostic procedures ensuring rapid recovery with minimal post-operative
complications. Therefore, we decided to compare the efficacy & safety of IV Propofol @1.5
mg/kg +Dexmedetomidine @1μg/kg versus IV Ketamine @ 1mg/kg + Dexmedetomidine @
1μg/kg in providing procedural sedation in urological procedures.
Material & Methods: This prospective randomized study was conducted in Department of
Anaesthesiology of Mamata medical hospital. In this study 50 patients scheduled for elective
daycare urological procedures were included and divided equally in two groups. Group Areceived
IV Propofol 1.5 mg/kg, then infusion of Dexmedetomidine@ 1μg/kgand group Breceived
IV Ketamine 1mg/kg, then Dexmedetomidine@ 1μg/kg.
Results: In our study, there is no significant difference in age, weight, gender. The
comparison of mean between two groups after giving dexmedetomidine was statistically
significant (p< 0.05) in heart rate, SBP, onset, duration of analgesia, VAS & Ramsay scores
but DBP & SpO2 was statistically not significant.
Conclusion: Comparison of baseline & intraoperative hemodynamics, showed that the values
were better maintained in Dexmedetomidine + propofol (Group-A) than Dexmedetomidine +
Ketamine (Group B). We have concluded that Dexmedetomidine + Propofol combination was
superior to Dexmedetomidine + Ketamine, providing early onset of sedation, prolonged
analgesia & stable intraoperative hemodynamics.

Background: Dexmedetomidine has emerged as a wonder drug in regional anesthesia practice owing to its co-analgesic properties. However, there is a lack of literature for comparison of intrathecal with intravenous routes of dexmedetomidine administration on the effectiveness of subarachnoid block.
Methods: Prospective, randomized, double-blind study was carried out in 40 patients aged 18-60 years with ASA I and ASA II physical status scheduled for elective infraumbilical surgery under subarachnoid block. Participants were randomly divided into two groups. Subarachnoid block was administered with 3ml of hyperbaric Bupivacaine in both groups. Patients in Group 1 received intrathecal 5µg dexmedetomidine and intravenous infusion of normal saline during surgery. Patients in Group 2 received intravenous bolus dexmedetomidine infusion of 0.5 µg /kg followed by maintenance infusion of 0.5 µg/kg/hr. Block characteristics, Ramsay Sedation score and hemodynamic variables were recorded for all patients.
Results: The duration of motor block, the dermatomal level achieved and duration of analgesia was higher in group 1 compared to group 2. The groups were similar with respect to onset time of sensory and motor block, sedation score and hemodynamic variables. There were no significant side effects in either of the groups.
Conclusions: Dexmedetomidine by either intrathecal or intravenous route is an attractive adjuvant for infraumbilical surgical procedures performed under subarachnoid block. In cases where the requirement is to prolong duration of intraoperative anesthesia and postoperative analgesia intrathecal route is desirable. Whereas, in daycare surgeries where the requirement is only to intensify the block in the intraoperative period with early postoperative ambulation intravenous route is preferable.

Background:Decreasing MAP (mean arterial blood pressure) using controlled hypotension, is introduced to improve visibility of the surgical site by reducing blood loss during FESS.
Aims:The present study was conducted to compare and assess the hemodynamic stability and hypotensive efficacy of Clonidine and Dexmedetomidine in FESS.
Materials and Methods:40 subjects were randomly divided into two groups of 20 subjects each. Subjects from Group I received 1 μg/kg dexmedetomidine, whereas, Group II subjects received 2 μg/kg Clonidine. Postoperative complications and Haemodynamic parameters were assessed at baseline, following the loading dose, 1- and 5-minutes following intubation, and every 10 minutes till recovery. These parameters were mean arterial pressure, systolic and diastolic blood pressures, oxygen saturation, and heart rate (HR).
Results:MAP and HR decreased significantly from baseline at all the time intervals of assessment (p<0.001). These values were statistically significant for both intragroup and intergroup for Group I and Group II. Also, statistically non-significant results were seen concerning the visibility of the surgical field. Emergence time was significantly higher for Group I (7.38±0.58 min) than Group II (6.44±0.72 min) with p=0.001. Sedation scores were higher significantly for group I (1.88±1.23) than Group II (1.37±0.12) with p=0.001. VAS scores were significantly lower for Group I (2.24±0.78) than Group II (3.01±0.14) at all time intervals with p=0.001. First rescue analgesia was significantly higher for Group I (110.45±12.25 min) than Group II (84.31±10.06) with the p-value of <0.0001
Conclusion:Present study concludes that, better hemodynamic stability was seen with dexmedetomidine compared to Clonidine. However, decreased blood loss and intraoperative visibility were comparable for both dexmedetomidine and Clonidine. Sedation and prolonged anesthesia were also better with dexmedetomidine.

Introduction: Pneumoperitoneum from Carbon di oxide insufflation will result in increase plasma levels of catecholamines and vasopressin that leads to hemodynamic disturbances. These effects are exaggerated by the steep trendelenburg position. This study was designed to evaluate the effect of Dexmedetomidine and fentanyl on hemodynamics in laparoscopic gynaeconcolgy surgeries which requires steep trendelenburg position.
Methods: After obtaining Ethical committee clearance and patients consent, prospective randomised comparative study was done on 60 ASA I and II patients who were randomly assigned to receive either dexmedetomidine or fentanyl infusion. Patients with ASA III & IV, on β blockers were excluded. Intraoperative hemodynamics, recovery and emergence was assessed. Students ‘t’ test was used
Results: The study included 60 patients undergoing laparoscopic gynaecology oncology surgeries requiring steep trendelenburg positions. Dexmedetomidine group of patients had better intra operative hemodynamics throughout and postoperative recovery when compared with Fentanyl group of patients.
Conclusion: Using Dexmedetomidine infusion in patients will have stable hemodynamics and postoperative recovery also smooth as compared to fentanyl.
 

Background: Choice of anaesthesia for surgery below the umbilicus is Subarachnoid block
with Bupivacaine traditionally. Dexmedetomidine is being used with Ropivacaine to avoid
side effects of Bupivacaine. The objective of this study is to compare the groups (group 1-
only Ropivacaine and group 2- Ropivacaine with Dexmedetomidine) with respect to
duration of sensory block and motor block, sedation, and complications.
Material and Methods: This is a prospective observational study and 30 patients in each
group were included. Duration of sensory block and motor block, scale of sedation and
complications were looked for. Patients with bradycardia, AV block, using beta blockers,
calcium channel blockers or anti-arrhythmic and hepatic or renal dysfunction were
excluded. Mean and standard deviation for continuous variables, frequencies and
percentages for categorial variables were determined. Chi-Square test, Paired T test,
Independent T test or Unpaired Test, and Wilcoxon Sum Rank Test were done.
Results: Mean age and weight of the group-1 were 38.80±4.2years and 62.23±5.43 kg and
that of group-2 were 39.67±5.9 years and 63.45±6.23 kg respectively. Mean duration of
sensory and motor blockade of the group-1 were 189±18.2 minutes and 158±18.77 minutes
respectively and that of group-2 were 230±19.7 minutes and 189±21.34 minutes
respectively (p<0.001). Ramsay sedation scores in the group with only Ropivacaine was 1.7
± 0.3 while in Dexmedetomidine group was 2.4±0.3 (p<0.001). 13 patients experienced
hypotension, 5 were from only Ropivacaine group and 8 were from Dexmedetomidine
group(p<0.001). 12 patients experienced bradycardia among which 4 were from only
Ropivacaine group and 8 from Dexmedetomidine group(p<0.001).
Conclusion: Intravenous dexmedetomidine in patients getting 0.75% isobaric ropivacaine
for subarachnoid block, increases time to two dermatomal regression of sensory blockade,
duration of sensory block, duration of motor block and provides good sedation.

Background & Method: The aim of this study is to study the effect of Intravenous Dexmedetomidine in prevention of intra-operative shivering in the patients undergoing lower abdominal surgeries under spinal anesthesia.
Result: The mean sedation score in control group was 1.32 ± 0.47, while in study group it was 4.44 ± 0.61.  The difference was found to be statistically significant (P<0.05), with a higher sedation score in study group in comparison to control group. Statistically significant proportional difference was seen between control and study group for Grade 2, 3 and 4 (P < 0.05), with a higher proportion of patients in control group in comparison to study group.
Conclusion: Patients were randomly allocated in to two groups of 50 each, dexmedetomidine group and control group. Just after intrathecal injection drug were infused intravenously. Dexmedetomidine group was given an iv loading dose of dexmedetomidine 1mcg /kg administered over a 10 minute period followed by an infusion of 0.5mcg /kg body weight. The infusion was stopped at the end of the surgery. Control group were given normal saline slowly. Drug dexmedetomidine is effective in preventing shivering following spinal anesthesia The incidence of shivering in patients under spinal anesthesia after dexmedetomidine is 2% and in control group is 62 %.

LC combines the benefit of complete removal ofgall bladder with the advantage of limited
abdominal incisions, early recovery, shorter hospital stay and less postoperative complication.
Laparoscopic cholecystectomy can be associated with severe complications in the form of
arrhythmias,sudden intraoperative cardiovascular collapse, severe pulmonary edema and
postoperative thromboembolic phenomenon. All patients underwent a thorough
preanaesthetic check-up. Written informed consent was obtained from each patient after
explaining the procedure in a language that the patient understood. Patients were randomly
allocated into 2 groups of 40 each. Mean time to first analgesic in Group D was 4.38 ± 0.86
hrs and in Group C was 2.50 ± 0.68 hrs. On comparing, time to first analgesia was
significantly longer in Group D both statistically and clinically. Nausea and Vomiting was
noted in 5 patients in Group D and 14 patients in Group C. This incidence though statistically
not significant was clinically significant.

Dexmedetomidine (Dexmed) belongs to the imidazole subclass of α2 receptor agonists,
similar to clonidine. It is a potent and highly selective α2 adrenoreceptor agonist,approved
by FDA in 1999 for use in humans for analgesia and sedation. It has a greater affinity for
α2 receptors over α1 (1620:1). Its α2/α1 selectivity ratio is eight times higher than that of
clonidine. All patients underwent a thorough preanaesthetic check-up. Written informed
consent was obtained from each patient after explaining the procedure in a language that
the patient understood. Patients were kept NPO from midnight and advised Tab. Diazepam
(0.1-0.15 mg/kg) and Tab. Rantac 150 mg night before and at 6 AM on the morning of
surgery with sips of water. The mean Etsevo in Group D was 0.29±0.02% and in Group C, it
was 0.31±0.01% upto 5 mins after intubation. Thereafter, it showed an increasing trend in
both the groups.From 5 minutes post insufflation, mean Etsevo (0.48±0.20%) was higher in
Group C as compared to Group D (0.33±0.11%). The difference was very highly significant
upto about 30 minutes of CO2 insufflation. There after mean Etsevo (0.32±0.01%) was
comparable in both the groups till the end of surgery.

We have done this trialin order to correlate analgesic dexmedetomidine (DXM) &dexamethasone (DX) efficacyin form of an additive for supraclavicular brachial plexus(SCBP)‘s ropivacaine blockage for upper extremity surgery. This is trial in which, 18–65 yrs 70 ASA status type one and two individuals suffering from disease, posted for upper extremity surgery was splitrandomly within couple of categories. Class DXMgot 2 mlof normal saline containing dexmedetomidine (1mcg/kg) with 0.5%ropivacaine(30 ml) and Class DXgot 2 ml(8 mg) of dexamethasone with 0.5%ropivacaine(30 ml). SCBP block was performed under ultrasonography(USG). The primary outcome was time of 1st analgesic request and no of analgesic request in 1st 24hrs. Secondary endresult of the trial were Motor block& sensory were secondary trial end result onset & time & incidence associated with drug’sside effects. Time for request of 1st rescue analgesia was 720.50±67.87min in Class DXM and 591.83±52.25min in Class DX. Total rescue analgesia required within post -operative for 1 dayinto DXM Class is less in comparison to DX Class. The mean of onset time of motor block& sensory into Class DXM is lesser in comparison to Class DX, which is statistically important. In Class DXM mean of duration of sensory block was 656.50± 50.58min, which was significantly longer than Class DX where duration was 534.10± 62.43min. Mean of motor block duration was 611.83± 45.3min in Class DXM and 470.83± 59.40min in Class DX (p<0.001). Dexmedetomidine provided prolonged relief from suffering after utilizing it in form of an additive to SCBP portion’s ropivacaine when compared to dexamethasone