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Objective: To compare motor and sensory blockade and hemodynamic effects of standard dose Bupivacaine versus low dose Bupivacaine mixed with Dexmedetomidine for spinal anesthesia in elderly male patients undergoing genitourinary surgery. Study Design: Prospective comparative study. Place and Duration of Study: Anesthesia Department Combined Military Hospital, Lahore Pakistan, from Sep 2019 to Feb 2020. Methodology: Hundred elderly male patients of American Society of Anesthesiology status-II undergoing surgery under spinal anesthesia were divided in two Groups. Group B (Bupivacaine Group) was given 11.25mg Bupivacaine and Group BD (Bupivacaine+Dexmedetomidine Group) received 7.5mg Bupivacaine and 5µg Dexmedetomidine intrathecally. Both Groups were given equal volume of 2ml. Results: Mean time for onset of sensory block for Group B and BD was 2.72±0.81 and 2.28±1.03 minutes respectively (p-value= 0.02). Mean time for onset of motor block for Group B and BD was 3.09±0.62 and 2.84±0.64 minutes respectively (p-value= 0.045). Mean duration of analgesia in Group B and BD was 171.87±10.19 and 187.60±18.42 minutes (p-value=0.01). Mean heart rate in Group B and BD was 80.04±5.51 and 75.68±6.11 beats/minutes (p-value=0.001). Mean arterial pressure's mean in Group B and BD was 62.78±78.13.49 and 87.96±10.15 (p-value=0.001). Conclusion: Onset of sensory and motor block was significantly shorter; analgesic effect was longer when Dexmedetomidine was combined with Bupivacaine for spinal anesthesia in comparison to Bupivacaine alone. Hemodynamic complications were also less in combination approach. [ABSTRACT FROM AUTHOR]

Objective: To compare dexmedetomidine and midazolam for effective sedation and pain relief during monitored anesthesia care for septoplasty using ramsay sedation scale and visual analogue scale. Study Design: Prospective observational study. Place and Duration of Study: Anesthesia Department, Combined Military Hospital Malir, from May 2019 to Jul 2019. Methodology: After ethical committee approval, 100 patients were recruited and divided in two groups to undergo septoplasty under local anesthesia. Group1 received dexmedetomidine 1 microgram/kg intravenously given over Five minute followed by 0.5 micrograms/kg/hr. Group 2 received midazolam 0.06 mg/kg intravenously slowly followed by 0.01mg/kg/hr. Sedation was titrated with ramsay sedation scale. The target end point was patient having ramsay sedation scale 3 by the end of 10 minutes. Rescue sedation was given in patients having ramsay sedation scale <3. Intraoperative pain was assessed using visual analogue scale. Visual analogue scale target value was <6. Rescue analgesia was given if visual analogue scale >5. Results: Mean ramsay sedation scale was significantly high in group-1 (2.6 ± 0.48) as compared to group-2 (2.18 ± 0.54) with a p-value of 0.008. Intra-operative rescue sedation was provided in significantly less number of patients in group-1 18 (36%) as compared to group-2 35 (70%) with a p-value of 0.009. Visual analogue scale was also significantly less in group-1 (2.4 ± 1.4) than in group-2 (3.2 ± 1.6) with a p-value of 0.017. Intra-operative rescue analgesia was also required in significantly lesser number of patients in group-1 13 (26%) than group-2 27 (54%) with a p-value of 0.007. Conclusion: This study proved that dexmedetomidine is superior to midazolam for providing sedation and analgesia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of external fixator to treat the soft tissue condition along with metacarpal and phalangeal fracture in terms of fracture union and active range of motion. Study Design: Descriptive, case series. Place and Duration of Study: Department of Orthopedics, Bahawal Victoria Hospital, Bahawalpur from Jun 2011 to May 2013. Subjects and Methods: Total 56 patients of 20-60 years age of both genders with comminuted and open fractures of metacarpal or phalanges bone of the hand, Swanson's Type-I were included by non-probability, consecutive sampling. Patients with Swanson's type-2, associated neurovascular injury, intra-articular fractures and fractures with tendon injuries were excluded. In all patients, mini-external fixators were applied and fracture was assessed for union and functional assessment on basis of active range of movement (Excellent, Good, Fair, Poor) at 6th and 12th weeks and 6th month. Results: Mean age was 36.31 ± 8.79 years. Males were 73.21% and remaining 26.79% were females. The most common etiology of fracture was road traffic accident (64.29%) and 69.64% had phalangeal bone fractures. In 76.79% patients, only one digit was fractured while fracture of two and three digits was seen in 16.07% and 7.14% patients respectively. Functional results were excellent in 66.07%, good in 16.07%, fair in 10.71% and poor in of cases. Fracture union was seen in 91.07% at the end of 6 months. Conclusion: This study concluded that mini external fixators are an effective treatment of open fractures of metacarpal or phalanges bone of the hand with high functional outcome and union rates. [ABSTRACT FROM AUTHOR]