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Context: Laparoscopic cholecystectomy is one of the most commonly performed minimal access surgeries nationwide, safely done as a day care procedure. Anesthetic techniques facilitating early recovery and home discharge have become the need of the hour. Aims: To compare early, intermediate, late recovery characteristics and time to home readiness following use of sevoflurane or desflurane as maintenance anesthesia in laparoscopic cholecystectomy in Indian subpopulation. In addition, postoperative complications such as coughing and shivering and total antiemetic and analgesic requirements postoperatively were also noted. Settings and Design: This was a prospective randomized study, and randomization was done by computerized random number table into two groups (30 patients in each group). Group S received sevoflurane and Group D received desflurane as maintenance agent. Subjects and Methods: Sixty patients of age group 18–60 years belonging to the American Society of Anesthesiologists Grade I and II undergoing laparoscopic cholecystectomy were recruited. A standard anesthesia induction was done and airway was secured with a ProSeal laryngeal mask airway of appropriate size. The patients subsequently received either sevoflurane 1%–2% or desflurane 3%–6% with 60% N2 O in O2 as per group assigned. Inhalational agent was discontinued at the time of endoscope removal. Early, intermediate, and late recovery parameters were noted. Statistical Analysis: The tests of significance used were parametric test (unpaired t-test) and ANOVA. The outcome measures were compared statistically using unpaired t-test and ANOVA, and P < 0.05 was considered statistically significant. Results: Early recovery parameters were achieved faster in patients receiving desflurane as compared to sevoflurane with no difference in time to achieve intermediate recovery and home readiness. Conclusion: Despite a faster early recovery with desflurane, no additional benefit in terms of home discharge and patient satisfaction was found, thus making use of either of the agents suitable for laparoscopic cholecystectomy on a day care basis.

Restricted availability of cell and animal models is a rate-limiting step for investigation of salivary gland neoplasm pathophysiology and therapeutic response. Conditionally reprogrammed cell (CRC) technology enables establishment of primary epithelial cell cultures from patient material. This study tested a translational workflow for acquisition, expansion and testing of CRC-derived primary cultures of salivary gland neoplasms from patients presenting to an academic surgical practice. Results showed that cultured cells were sufficient for epithelial cell-specific transcriptome characterization to detect candidate therapeutic pathways and fusion genes, and for screening for cancer risk-associated single nucleotide polymorphisms (SNPs) and driver gene mutations through exome sequencing. Focused study of primary cultures of a low-grade mucoepidermoid carcinoma demonstrated amphiregulin-mechanistic target of rapamycin-protein kinase B (AKT; AKT1) pathway activation, identified through bioinformatics and subsequently confirmed as present in primary tissue and preserved through different secondary 2D and 3D culture media and xenografts. Candidate therapeutic testing showed that the allosteric AKT inhibitor MK2206 reproducibly inhibited cell survival across different culture formats. By contrast, the cells appeared resistant to the adenosine triphosphate competitive AKT inhibitor GSK690693. Procedures employed here illustrate an approach for reproducibly obtaining material for pathophysiological studies of salivary gland neoplasms, and other less common epithelial cancer types, that can be executed without compromising pathological examination of patient specimens. The approach permits combined genetic and cell-based physiological and therapeutic investigations in addition to more traditional pathologic studies, and can be used to build sustainable bio-banks for future inquiries. This article has an associated First Person interview with the first author of the paper.