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Objective: To compare the effectiveness of topical Proparacaine 0.5%, topical Proparacaine 0.5% and topical Proparacaine 0.5% for intraoperative analgesia and surgeon's score undergoing simple cataract surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Sep 2022 to Mar 2023. Methodology: Sixty patients aged 40 years and more, ASA-l and ll, undergoing elective simple cataract surgeries were observed by taking 20 patients in all three groups (n=20). Group-T: Topical Anesthesia group, 0.5% Proparacaine Group-I: Topical Anesthesia & Intracameral 1% Lignocaine Group-A: Topical Anesthesia and IV Acetaminophen groups were randomly allocated for pretreatment to either receive the 0.5% Proparacaine Eye drops (Group-T) or 0.5%Proparacaine eye drops with Intracameral 1ml 1% Lignocaine (I group) or 0.5% Proparacaine Eye drops with intravenous Acetaminophen 15ml/kg (A group). Incidence of pain by Visual analogue scale/wong-baker faces scale was noted. The surgeon's comfort was assessed by using Gupta's surgeon score questionnaire. Results: The results showed Group-I had better analgesic score than Group-T with only 1(5%) patient had a score of 4 but even more significant efficacy of intravenous acetaminophen plus topical anesthesia (Group-A) was shown as compared to rest of the groups with none (0%) patient had a VAS score of 4 (p-value=0.002). The results also showed Group-I had better surgeon comfort score than both Group-T and Group-A, with only 1(5%) patient had a score of 7 or above as compared to Group-T, 9(45%) patients and Group-A 7(35%) patients. (p-value=0.005). Conclusion: Intravenous acetaminophen plus topical anesthesia is better at reducing perioperative pain scores as compared to topical anesthesia alone or augmented intracameral Lidocaine plus topical anesthesia. And intracameral 1% Lidocaine injection plus topical is better combination for surgeon comfort perioperative as compared to topical anesthesia and intravenous acetaminophen plus topical anesthesia. [ABSTRACT FROM AUTHOR]

Objective: To compare effectiveness of Laryngeal mask airway versus endotracheal tube to evaluate post-operative sore throat and hoarseness of voice among anesthetized adults. Study Design: Prospective comparative study Place and Duration of Study: Operation Theatre Complex, Surgical Ward 1 and 2, Combined Military Hospital, Lahore Pakistan, from Jun to Oct 2020. Methodology: A total of 70 patients of both gender undergoing elective surgeries were included. Afterwards a lottery method was applied to segregate patients randomly into Group-L and Group-T. In Group-L, airway was secured with laryngeal mask airway while in Group-T, airway was secured with endotracheal tube. Hoarseness of voice was evaluated at time of extubation and 24 hours post extubation. Results: Demographic data was comparable in both groups. Mean time of anesthesia was 71.31±22.87 and 82.86±32.34 minutes for Group-L and Group-T respectively with p-value of 0.09. Sore throat was seen in 12(34.29%) patients in Group-L as compared to 19(51.43%) in Group-T (p-value=0.094). Hoarseness of voice was seen in 3(8.57%) patients in Group-L as compare to 13(37.14%) in Group-T (p-value= 0.005). Conclusion: There was less occurrence of postoperative sore throat and hoarseness of voice in patients undergoing elective surgery with laryngeal mask airway as compared with endotracheal tube. [ABSTRACT FROM AUTHOR]

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 blunting of hemodynamic stress response to intubation using Magnesium Sulphate versus Lidocaine in hypertensive patients. Study Design: Prospective comparative study. Place and Duration of Study: Anaesthesia Department Combined Military Hospital, Lahore Pakistan, from Jan to Jun 2019. Methodology: A total of 232 hypertensive patients of the ASA status II, undergoing elective surgical procedures requiring intubation, were randomly divided into two groups, Group-L (Lidocaine) and Group-M (Magnesium Sulphate). Lidocaine 1.5mg/kg was given to Group-L 90 seconds before laryngoscopy, whereas Magnesium Sulphate 30mg/kg was given over ten minutes to Group-M before laryngoscopy. Baseline means arterial pressure was recorded. Mean arterial pressure was subsequently recorded each minute after intubation for five minutes. Results: Both groups were similar with regard to demographic data. After intubation, both groups had an increase in mean arterial pressures. Blunting of stress response was observed in 78 patients (67.2%) in Group-L and 55 patients (47.4%) in Group-M. Two groups showed a significant statistical difference (p=0.003). Conclusion: Both drugs are effective in blunting hemodynamic stress response to intubation in hypertensive patients, but Lidocaine is more effective than Magnesium Sulphate. [ABSTRACT FROM AUTHOR]

Objective: To determine factors responsible for anxiety in children and parents undergoing dental procedures under general anaesthesia. Study Design: Cross-sectional study. Place and Duration of Study: Department of Anaesthesia, CMH Lahore Medical College, from Sep 2019 to Feb 2020. Methodology: Ninety-one children aged between 3 to 10 years were included in this study. Parental anxiety was assessed using a visual analogue scale-anxiety before induction of anaesthesia, and child's anxiety was assessed using the modified facial affective scale (3-face) at the time of induction of anaesthesia. Results: Gender, school-going status and previous exposure to GA were not significant factors in predicting pre-operative anxiety in children with p-values of 0.399, 0.183 and 0.122, respectively. On the other hand, parental anxiety had a very strong impact on children pre-operative anxiety (p-value = 0.001), suggesting that children of anxious parents had high pre-operative anxiety. Moreover, the personality of child also had statistical significance (p-value = 0.001). Conclusion: Non-social behavior of the child and the anxiety level of parents are major determinants of pre-operative anxiety in children undergoing dental procedures. [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 find out the difference in the backache when a 27G Quincke needle with no more than two attempts is used for spinal anaesthesia versus general anaesthesia. Study Design: Prospective comparative study. Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun 2020 to May 2021. Methodology: A total of 150 patients were divided into two Groups. C-sections were performed under general and spinal anaesthesia in Group-GA and Group-SA, respectively. General anaesthesia was induced with intravenous anaesthetics following rapid sequence induction. The 27G Quincke needle was used for spinal anaesthesia with no more than two attempts. Post-operative follow-ups for backache were carried out at 24-hours, 1, 4 and 12 weeks. Results: At 24-hours post-operative follow-up, 8 patients from the GA-Group and 17 from the SA-Group had backache; the difference was significant (p-value of 0.049). At week-1, two patients from the GA-Group and five from the SA-Group complained of backache (p-value 0.246). Similarly, at week-4, only one patient from the GA Group and four from the SAGroup had backache (p-value 0.127). At the 12-week follow-up, only one patient complained of backache, and she belonged to the SAGroup (p-value 0.316). Conclusion: Spinal anesthesia results in a significantly high frequency of backache as compared to general anaesthesia in the immediate post-operative period; however, there is no long-term difference in backache. [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]

ABSTRACT Objective: To compare the frequency of sore throat and cough after prophylactic Lignocaine versus Beclomethasone in adults undergoing tracheal intubation. Study Design: Prospective longitudinal study. Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun to Sep 2019. Methodology: A total of 180 patients of both gender scheduled for elective surgery under general anaesthesia with endotracheal intubation were recruited for this study. Ninety patients of Group-A received Lignocaine, while 90 patients of Group-B received Beclomethasone. After 24 hours of the procedure, sore throat and cough were assessed from both groups and noted. Results: The age range in this study was from 18 to 50 years, with a mean age of 34.22±5.31 years in Group -A while 36.57±7.22 years in Group-B. Sore throat was seen in 22(24.4%) patients in Lignocaine-Group (Group-A) as compared to 9(10.0%) patients in BeclomethasoneGroup (Group-B) (p=0.010). Cough was seen in 18(20.0%) patients in the Lignocaine-Group as compared to 5(5.6%) patients in the BeclomethasoneGroup (p=0.003). Conclusion: This study concluded that spraying Beclomethasone on the endotracheal tube reduces the frequency and severity of postoperative sore throat and cough in patients given general anaesthesia with endotracheal intubation. [ABSTRACT FROM AUTHOR]