ABSTRACT
Multiple sclerosis is one of the most common autoimmune demyelinating disorders. The commonest presentation includes multiple sensory deficits, cranial nerve palsies, limb weakness, paraesthesias, cardiac dysrhythmias, autonomic dysfunction, ventilatory disturbances leading to hypoxaemia and respiratory failure. Thus posing challenges to the anaesthesiologist. Appropriate preoperative evaluation, administration of a good premedication, careful selection of the anesthetic agents and effective postoperative pain control can prevent problems after prolonged major surgery in patients with MS. We report successful anesthetic management in a patient who was a known case of MS for past ten years and presented with renal cell carcinoma to undergo nephrectomy under general anesthesia.

ABSTRACT
Background: Post-operative pain is a frequent observation in patients undergoing knee arthroscopic surgeries and remains a challenge to anaesthesiologist. The current armamentarium of drugs as multimodal analgesia for post-operative pain utilizes many new medications with different complementary mechanism of action and remains the recommended intervention for the management of post arthroscopic knee pain. Aim: We compare the efficacy of preoperative duloxetine, melatonin and tapentadol for post spinal analgesia and sedation in knee arthroscopic surgeries. Setting and design: Randomised prospective double blind study. Methods: 124 American Society of Anaesthesiologist 1and II patients undergoing knee arthroscopic surgery requiring spinal anaesthesia were allocated randomly to four groups of 30 each to receive oral Placebo Group 1, 20 mg Duloxetine Group 2, 3 mg Melatonin Group 3, 100 mg Tapentadol Group 4, 90 minutes before surgery. We assessed block characteristics, intraoperative sedation using BIS scores, postoperative pain scores using Numeric Rating Score, time to use of first analgesic, 24 hour analgesic consumption, additional analgesic consumption and any adverse effects. Results: Mean duration of post-operativeanalgesia was 477.96±97.85 minutes in Tapentodol Group (P value<0.001). Total 24 hours diclofenac consumption is minimum in Tapentodol Group (P 0.04). No statistical significant differences were present in the onset of the spinal block, BIS and Ramsay Sedation Score among the Groups. Conclusion: Preoperative administration of oral tapentadol provides prolonged analgesia with reduced 24 hour analgesic consumption.

ABSTRACT
Background & Objectives: As most of the patients posted for cataract surgery belongs to geriatric age group, hypertension and coronary artery diseases (CAD) are more common. Most of the surgeries are performed under local anaesthesia and patients are conscious. This may cause an exaggerated neuroendocrine stress response which is detrimental to patients with compromised cardiac conditions. The aim of our study was to evaluate the hemodynamic and intraocular pressure effects of etomidate in comparison to midazolam during monitored anaesthesia care (MAC) in hypertensive and CAD patients undergoing cataract surgery. Methods: 60 patients posted for cataract surgery under MAC, were randomized into two groups (each of 30): Group E patients were given inj. etomidate 0.1 mg/kg dose and Group M patients were given inj. midazolam 0.03 mg/kg. Both drug were diluted up to 10ml of NS. Ramsay sedation score (RSS) was kept at 3. HR, SBP, DBP, MAP, SpO2, respiratory rate, intraocular pressure, RSS, and complications were recorded at specific time interval till the end of surgery. Results: Mean onset of time for sedation in group E was significantly shorter than group M. Group E produced significant decrease in intraocular pressure than group M. The decrease in HR, SBP, DBP, and MAP were comparable in both groups but the decrease was significant while comparing to baseline. Conclusion: Etomidate achieved adequate depth of sedation in shorter time and produced a significant reduction in intraocular pressure when compared with midazolam. Both drug caused comparable decreased in hemodynamic variables which was within permissible limit.

ABSTRACT
Middle ear surgery is a type of microsurgery which requires minimum extravasation of blood into the surgical field for a better vision during surgery and hence a better outcome of surgery. The objective of the present study was to use dexmedetomidine an alpha-2 agonist to provide hypotensive anesthesia to minimize blood spillage during the middle ear surgeries. In this study the sample size was 25 subjects for each group at an alpha error 0.05 and power 80%. With written, informed consent, 50 patients of ASA grade I and II, aged 18-58 years, weight 40-70 kgs, undergoing elective surgeries under general anaesthesia, were randomly allocated into two groups. Group-A received Dexmedetomidine 1mcg/kg loading dose over 10 mins after premedicatiom but before induction and a maintenance infusion of 0.4mcg/kg/hr which was stopped 20 mins before completion of surgery. Group-B received 10 ml normal saline as placebo. All the patients were observed intra operatively for vitals (HR, SBP, DBP, MAP, SPO2), suction requirement every 15 minutes and post operatively for Ramsay sedation score. It was observed that patients in group – A had significantly lower HR, SBP, DBP, MAP as compared to group – B. Both the groups were comparable for demographics, SPO2 , suctioning requirement during surgery and post operative sedation. Our study concluded that Dexmedetomidine is effective in providing hypotensive anesthesia and can be used to provide oligemic surgical field without post operative sedation.

ABSTRACT
Anaesthetic manoeuvres like direct laryngoscopy, tracheal intubation, extubation, pneumoperitoneum and CO2 insufflations necessary in laparoscopic surgeries causes increase in plasma stress hormone which leads to increase in heart rate (HR), mean arterial blood pressure (MAP), systemic and pulmonary vascular resistance and decrease cardiac output. In this randomized open labeled observer blinded study, we compared effect of esmolol and dexmedetomidine to attenuate pressure response to laryngoscopy, intubation and pneumoperitoneum during laparoscopic surgery. Ninety patients belonging to ASA I and II were divided into three groups. Patients of group-D received dexmedetomidine (0.5 mcg/kg) IV as loading dose over 10min, followed by 0.4mcg/kg/hr till the end of pneumoperitoneum and patients of group-E received esmolol (0.5mg/kg) IV as loading dose over 5 min followed by 50mcg/kg/min till the end of pneumoperitoneum. Patients of group-C received same volume of normal saline. During laryngoscopy, intubation, pneumoperitoneum, at reversal and extubation HR, MAP, oxygen saturation and end tidal CO2 (EtCO2) were observed. Recovery in terms of time to respond to oral-commands, extubation and full orientation was noted along with any adverse effects. In control group, there was significant increase in HR and MAP during intubation, extubation and pneumoperitoneum. In dexmedetomidine group we observed better control of HR and MAP as compare to esmolol and control groups. In esmolol group, only HR was controlled at intubation, while during pneumoperitoneum HR and MAP both were near baseline values. Dexmedetomidine and esmolol both are effective to provide hemodynamic stability in laparoscopic surgery. But dexmedetomidine is more effective than esmolol with minimal incidence of bradycardia.

ABSTRACT
Background: Cardiopulmonary bypass (CPB) is associated with increased fluid accumulation in body and ultrafiltration is a method used to decrease body fluid volume and tissue oedema as the consequences of haemodilution after cardiac surgery with CPB. This study aimed to compare the effects of modified ultrafiltration (MUF) versus combined conventional ultrafiltration (CUF) and modified ultrafiltration on the duration of mechanical ventilation and hemodynamic status in paediatric patients undergoing congenital heart surgery. Materials and Methods: A simple randomised clinical trial was conducted on eighty paediatric patients undergoing congenital heart surgery on cardiopulmonary bypass. Patient management was standardised, and intensive care staff were blinded to group allocation. Preoperative Aristotle comprehensive complexity level, ultrafiltrate volumes, perioperative haemodynamic data, haematocrit, Transesophageal echocardiographically (TEE) determined ejection fraction (EF), fractional area change (FAC), temperature drift, arterial oxygenation, time of extubation, ventilation, comparison of inotropic drugs, postoperative chest tube drainage, intensive care unit (ICU) and hospital stay were recorded in CUF and CUF plus MUF. Results: There was no operative mortality. Technical difficulties prevented completion of modified ultrafiltration in 3 patients of 40 in CUF+MUF. In this study there were 33.75% females and 66.25% males with a median age 441 days, mean weight 10.19 kg and Aristotle comprehensive complexity score level-2. CUF+MUF had greater ultrafiltrate volume (883 ± 82.7 ml; (p = 0.014). Duration of ventilatory support was 103.2±25.85 hours versus 61.4±13.74 hours in CUF and CUF+MUF respectively, (p= 0.004). Chest tube drainage in the first 48 hours was (107.63±23.83 and 79.31±47 ml) in CUF and CUF+MUF respectively, (p= 0.003). Inotropic infusion requirement was significantly less in CUF+MUF compared to CUF. EF and FAC were 10 % and 4 % higher at 45 minute