Introduction: Laparoscopic cholecystectomy is routinely preferred for symptomatic gallbladder disease, yet carbon dioxide pneumoperitoneum, reverse Trendelenburg positioning, laryngoscopy and tracheal intubation can provoke clinically relevant tachycardia and pressor responses. Dexmedetomidine, through central alpha-2 adrenergic agonism, may blunt this sympathetic activation without meaningful respiratory depression. To evaluate whether a single intravenous bolus of dexmedetomidine given before intubation attenuates perioperative haemodynamic responses during elective laparoscopic cholecystectomy. Materials and Methods: This prospective, randomized, double-blind, placebo-controlled comparative study included 60 ASA physical status I-II adults aged 20-55 years undergoing elective laparoscopic cholecystectomy. Group A received dexmedetomidine 1 mcg/kg diluted in 10 mL normal saline 15 minutes before intubation, while Group B received 10 mL normal saline. Pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, SpO2 and EtCO2 were recorded at baseline, after intubation and during pneumoperitoneum. Results: Group A showed consistently lower pulse rate and blood pressure readings across the critical perioperative intervals. At 15 minutes of pneumoperitoneum, pulse rate was 70.83 ± 12.02 beats/min in Group A compared with 100.74 ± 6.08 beats/min in Group B (p=0.008). At 30 minutes, systolic blood pressure was 112.34 ± 10.75 mmHg versus 138.59 ± 7.25 mmHg (p=0.003), and diastolic blood pressure was 69.27 ± 7.63 mmHg versus 82.89 ± 7.07 mmHg (p=0.007). Mean arterial pressure at 75 minutes was 83.88 ± 6.63 mmHg in Group A and 102.76 ± 5.88 mmHg in Group B (p=0.004). SpO2 and EtCO2 showed statistically significant but clinically small between-group differences, with both parameters remaining within acceptable intraoperative ranges. Conclusion: A single pre-intubation intravenous bolus of dexmedetomidine 1 mcg/kg was associated with better attenuation of perioperative tachycardic and pressor responses during laparoscopic cholecystectomy, without clinically meaningful deterioration in oxygenation or ventilation.
Background Spinal anaesthesia is the preferred anaesthetic technique for Lower Segment Cesarean Section (LSCS). Conventional doses of hyperbaric bupivacaine provide effective surgical blocks but are frequently associated with a high incidence of maternal hypotension. This study evaluated whether a low-dose hyperbaric bupivacaine regimen combined with intrathecal fentanyl improves maternal hemodynamic stability while maintaining high-quality operative block characteristics and neonatal safety. Methods This prospective, randomized, double-blind clinical trial evaluated 60 American Society of Anesthesiologists (ASA) physical status II parturients undergoing elective LSCS. Participants were randomly allocated into two equal groups (n=30 each): Group B (Conventional-dose): Received 0.5% hyperbaric bupivacaine 1.8 mL (9.0 mg). Group BF (Low-dose adjuvant): Received 0.5% hyperbaric bupivacaine 1.6 mL (8.0 mg) combined with fentanyl 0.2 mL (10 mcg) intrathecally. The primary outcomes included sensory and motor block characteristics and postoperative analgesia duration. Secondary outcomes evaluated intraoperative hemodynamic stability, maternal adverse event profiles, and neonatal Apgar scores. Results Parturients in Group BF achieved significantly faster sensory onset times to both the T10 and T6 dermatomes compared to Group B (p = 0.002 and p = 0.033, respectively). The overall duration of effective sensory blockade (96.00 ±10.59 min vs. 82.53 ±15.40 min; p < 0.001) and total postoperative analgesia duration (239.27 ±40.69 min vs. 171.07 ±30.58 min; p < 0.001) were significantly prolonged in the low-dose fentanyl group. Hemodynamically, Group BF exhibited superior stability, demonstrating a significantly lower incidence of maternal hypotension (20.0% vs. 46.7%; p = 0.028) and a reduced requirement for therapeutic vasopressor support (16.7% vs. 40.0%; p = 0.045) with lower total ephedrine consumption (0.82 ±2.21 mg vs. 5.36 ±8.07 mg; p = 0.004). Pruritus occurred exclusively in Group BF (20.0% vs. 0.0%; p = 0.024). Neonatal Apgar scores at 1 and 5 minutes were statistically comparable between the groups (p > 0.05). Conclusion A low-dose intrathecal bupivacaine regimen (8.0 mg) co-administered with 10 mcg of fentanyl provides reliable, rapid surgical anesthesia for Cesarean section while significantly mitigating maternal hypotension and vasopressor requirements, with the added benefit of extended early postoperative analgesia.
Background: Residential schooling is expanding in rural India, yet comparative data on resilience, coping, and mental health across residential and day boarding settings remain limited. Methods: A cross-sectional mixed-methods study was conducted among 937 adolescents (12–17 years) from residential (n=495) and day boarding (n=442) schools in rural Karnataka. Resilience was assessed using an adapted Adolescent Resilience Scale. Additional items evaluated emotional well-being and help-seeking. Qualitative data on adversities and coping were analysed thematically. Group differences were examined using chi-square tests. Results: Sociodemographic differences were noted in family type (p=0.019) and class category (p<0.001), while gender distribution was comparable. Residential students were less likely to report persistence in goal attainment (76.6% vs 87.8%, p<0.001) and help-seeking (58.6% vs 79.9%, p<0.001). They reported higher rates of prolonged sadness (37.0% vs 30.1%, p=0.026) and suicidal thoughts or attempts (22.2% vs 14.7%, p=0.003), and were less likely to feel happy with others (71.7% vs 84.4%, p<0.001). Other resilience domains were largely comparable. Qualitatively, day boarders described predominantly academic and family-related stressors with task-focused coping, whereas residential students reported more intense emotional and adjustment-related challenges, including homesickness and social stress, alongside a broader repertoire of coping strategies such as peer support, emotional regulation, and adaptive behavioural responses. Conclusion: Residential schooling was associated with greater emotional distress and reduced help-seeking despite more diverse coping strategies. Strengthening school-based mental health support in residential settings is warranted.
Background: Axillary brachial plexus block is a widely utilized technique for upper limb surgeries, and the search for effective adjuvants to local anesthetics continues. Dexmedetomidine, an alpha-2 adrenergic agonist, has shown potential to enhance the quality of nerve blocks. This study aimed to compare the efficacy of Ropivacaine 0.75% with and without Dexmedetomidine in axillary brachial plexus blocks. Methods: This prospective, randomized, comparative study enrolled patients undergoing upper limb surgery, who were allocated into two groups: Group A received Ropivacaine 0.75% with Dexmedetomidine, and Group B received Ropivacaine 0.75% alone. Demographic data, onset and duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and complication rates were recorded and analyzed for statistical significance. Results: Both groups were demographically comparable in terms of age, sex distribution, body weight, and ASA physical status, with no significant differences observed. Group A exhibited a significantly faster onset of sensory and motor block compared to Group B, and also demonstrated prolonged durations of both sensory and motor blockade. The duration of analgesia was notably extended in Group A. Hemodynamic variables, including systolic and diastolic blood pressure, mean arterial pressure, oxygen saturation, and heart rate, remained largely stable and comparable across groups, with only a transient statistically significant difference in heart rate at 10 minutes. Although minor complications were slightly more frequent in Group A, this difference was not statistically significant, and all adverse events were self limiting. Conclusions: The addition of Dexmedetomidine to Ropivacaine 0.75% in axillary brachial plexus block significantly improves the onset and duration of sensory and 13motor blockade and enhances postoperative analgesia, without compromising hemodynamic stability. The minor increase in complication rate was not statistically significant and did not impact overall safety.
Background: Total laparoscopic hysterectomy (TLH) is associated with pneumoperitoneum-induced sympathetic stimulation and postoperative pain that can compromise haemodynamic stability. Intrathecal opioids combined with ropivacaine may attenuate this stress response and enhance analgesia, but direct comparative data on buprenorphine versus morphine in this setting are limited. Objective: To compare intrathecal buprenorphine and intrathecal morphine, each combined with 0.75% hyperbaric ropivacaine, for attenuation of the pressor response to carboperitoneum, postoperative analgesic profile, and opioid-related adverse effects during TLH under general anaesthesia. Methods: In this randomized controlled trial, 80 ASA I–II women aged 30–60 years undergoing elective TLH were allocated equally to Group B (intrathecal buprenorphine 60 mcg with 1 ml 0.75% hyperbaric ropivacaine) or Group M (intrathecal morphine 100 mcg with 1 ml 0.75% hyperbaric ropivacaine), followed by standardized general anaesthesia. Heart rate and mean arterial pressure (MAP) were recorded at baseline, during spinal anaesthesia, at intubation, and serially through carboperitoneum. Postoperative pain (VAS) was assessed for 24 hours along with time to first rescue analgesia, total rescue doses, and adverse effects. Results: Baseline characteristics were comparable between groups. MAP rose more during spinal anaesthesia in Group B than Group M (4.35 ± 4.83 vs 0.88 ± 5.15 mmHg, p = 0.001) and remained consistently higher in Group B throughout carboperitoneum (all p ≤ 0.002 on repeated-measures ANOVA). VAS scores over 24 hours were significantly lower in Group M (p = 0.001), while time to first rescue analgesia was longer in Group B (18.16 ± 3.59 vs 16.05 ± 3.38 hours, p = 0.015); total 24-hour rescue analgesic requirement did not differ significantly. Nausea was more frequent in Group M (37.5% vs 10%, p = 0.004); vomiting, pruritus, urinary retention and respiratory depression were low and comparable, with no respiratory depression in either group. Conclusion: Intrathecal morphine 100 mcg with ropivacaine provides superior attenuation of carboperitoneum-induced MAP elevation and lower postoperative pain scores than intrathecal buprenorphine 60 mcg, at the cost of more postoperative nausea; buprenorphine offers a modestly longer interval to first rescue analgesia with a more favourable nausea profile. Opioid choice can therefore be individualized based on hemodynamic priorities and tolerability.
