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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 evaluate the factors that act as a barrier for medical students and young doctors in Pakistan to choose anesthesia as a career choice. Study design: Cross-sectional study. Study settings: CMH Lahore. Study duration: From January to June 2021. Materials and Methods: A total of 163 medical students and house officers who were on rotation in operation theatre in various specialties were recruited for this study. A questionnaire was distributed to all the participants. Participants had to select their specialty of choice and the reason for not choosing anesthesia. They also had to choose the most important factor for choosing the specialty and the person who influenced them the most to choose the specialty. Results: Only 10 (6.1%) participants chose the anesthesia specialty for their post-graduation, out of these ten, 5 (50%) were male and 5 (50%) were female. The most commonly chosen option {62 (54.87%)} for not selecting anesthesia was "no personal interest". In response to "What is the most important factor while choosing a specialty?" most of the participants (55%) chose the option "Scope of the specialty". In response to "Who had the most influence in choosing a specialty?" most of the participants {63 (38.7%)} chose the option "Teachers of the clinical rotations". Conclusion: It is concluded in our study that only a very small number of students and young doctors willingly opt for anesthesia for their post-graduation which results in a shortage of workforce in this specialty. It is recommended that anesthesia rotation be made compulsory and that the barriers to mentorship in anesthesia be properly addressed. [ABSTRACT FROM AUTHOR]

Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia. Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours postoperatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327. Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements. [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]

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]