ABSTRACT
Background: Regional anesthesia is defined as loss of sensation in a body produced by administration of anaesthetic agent to the nerves supplying that region. Regional anesthesia whether by spinal, epidural, peripheral nerve blocks offer a number of advantages. Bupivacaine has become standard agent for intrathecal anesthesia. A number of adjuvants can be added to prolong the duration of analgesia. In our study we are comparing fentanyl & dexamedetomidine as an epidural adjuvant to spinal bupivacaine in abdominal hysterectomies. Materials and Methods: A total of 60 patients scheduled for abdominal hysterectomy under CSE were enrolled for this prospective randomized study which was conducted in hospital from November 2019 to October 2020. This work has been granted ethical committee approval. Results: Two groups comprising of 30 patients each were taken randomly. Haemodynamic parameters of heart rate, blood pressure, spo2, were monitored and recorded every 5 min for first 20 minutes and then every 10 minutes till the end of surgery and thereafter postoperatively. The sensory block was assessed by bilateral pin prick method and motor blockade according to Modified Bromage Scale. Duration of anesthesia was taken as time period till VAS of 4 was recorded. Conclusion: In our study we concluded that dexmedetomidine is better adjuvant as compared to fentanyl in combined spinal epidural anaesthesia with intrathecal bupivacaine.

ABSTRACT
Aim and background: Pulmonary embolism (PE) is a life-threatening medical emergency where a blood clot travels from somewhere else in body, usually from deep vein thrombosis of legs to pulmonary artery and blocks it, leading to high mortality and morbidity. If not treated on time, it can lead to death. Case Description: In the following two cases, we describe patients with presentation of pain abdomen which was finally diagnosed as acute pulmonary embolism. Conclusion: Pulmonary embolism has a varied clinical symptomatology and can cause frequent diagnostic dilemma and challenge, which can delay timely diagnosis. Clinical Significance: It is essential for the critical care physician to be aware of varied symptoms and to have a high index of suspicion.

ABSTRACT
Anesthetic management approach to achieve optimal outcome in hydatid cyst removal surgery is essential to prevent the dreaded intraoperative complication the anaphylaxis. Hydatid cysts are parasitic infections caused by Echinococcus granulosus. Laparoscopic large hydatid Cyst removal surgeries offer enhanced post-surgery benefits. Anesthesia plays a crucial role in ensuring optimal patient outcomes. This case report discusses the essential aspects of anesthetic management for such procedures.

ABSTRACT
The objective of this study was to compare the effectiveness and safety of two different drug combinations used for monitored anesthesia care (MAC) in tympanoplasty procedures. The first combination consisted of pentazocine and phenergan, while the second combination included pentazocine and dexmedetomidine. A prospective, randomized controlled trial was conducted on patients scheduled for tympanoplasty surgery. A total of 100 patients were randomly assigned to either the pentazocine-phenergan group or the pentazocine-dexmedetomidine group. The primary outcome measured included the level of sedation achieved, pain scores during surgery, and the incidence of adverse events such as respiratory depression, nausea, vomiting, bradycardia and hypotention. The results showed that the pentazocine-dexmedetomidine combination achieved a higher sedation score and lower pain scores compared to the pentazocine-phenergan combination. Sedation score in Group PP mean RSS of 1.928571429, while Group PD had a higher mean RSS score of 3.142857143 also VAS scores in Group PP mean VAS sore of 4.542857143, and Group PD had mean VAS score of 3.285714286. However, higher incidences of adverse events were noted in Group PD compared with Group PP. In conclusion, this comparative study suggests that the pentazocine-dexmedetomidine combination may offer superior sedative effects and better analgesia compared to the pentazocine-phenergan combination during tympanoplasty with manageable adverse effects.

ABSTRACT
Bradycardia occurring post creation of pneumoperitoneum in patients undergoing laproscopic procedures is quite common. The aim of this study is to find out which age groups between the adult and elderly population are more susceptible to bradycardia. 60 patients of age between belonging to ASA grade I and II, scheduled for elective laproscopic cholecystectomy were included in the study. The patients were allocated into two groups of 30 each, Group-A and Group-E. Patients in group-A (Adult) were between age group 18 to 60 years of age Patients in group-E (Elderly) were above 60 years of age Occurrence of bradycardia (heart rate of less the 50/minute) after creation of pneumoperitoneum / gas insufflation was observed in the two groups. Comparison of bradycardia between the two groups revealed higher incidence/occurrence in Elderly group with a p-value of between 0.278 which is statistically insignificant. Bradycardia did not result in intraoperative cardiac arrest, neither did it increase the frequency of intensive care unit admission or mortality rate. Surgery resumed in all cases without adversity. Bradycardia is common occurrence post creation of pneumoperitoneum/ gas insufflation in laproscopic surgeries. It usually arises in response to gas insufflation as a vagal mediated physiologic response, and is benign in the majority of cases. Occurrence of bradycardia was more in elderly patients but did not significantly effect outcome. Deflation of pneumoperitoneum and Atropine administration are effective in reversing Bradycardia and possible avoid progression to cardiac arrest.