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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 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]

Objectives: To document the frequency of complications following Laparoscopic Sleeve gastrectomy in morbidly obese patients in population of Khyber Pakhtunkhwa province, Pakistan Material and Methods: This descriptive study was conducted at Lady Reading Hospital and Mohmand Medical Center, Peshawar from 1st May 2018 to 30th April 2019. All patients who underwent Laparoscopic Sleeve Gastrectomy were included in this study whether operated in public or private hospital. All patients were operated by a single surgeon. Data of complication was collected and analysed by using SPSS version 16.0. Results: A total of 22 patients enrolled with mean age of 36.2±8.1 years. Male to female ratio was 3.4:1. Mean pre-operative weight was 133.2±33.1 Kg and pre-operative Body Mass Index (BMI) was 47.6±7.5 kg/m2. Post-operative weight loss at one month was 10.79±15.6 kg, and post-operative BMI was 39.7±5.3 Kg/m2 at same point. Mean percentage of excess weight loss at one month was 38.9%. Post-operatively 2-patients had developed suture line bleed and 1-patient has developed pulmonary complication, while 1-patient needed invasive ventilation in post-operative period. 3-patients presented with rapid weight loss at one month follow up. Re-exploration and mortality was zero. Conclusions: Sleeve Gastrectomy is a safe and easy procedure to perform in a wide range of BMI's in obese patients with greater earlier benefits of significant weight loss. Consideration to a gastric bypass as a definitive procedure at a later date may be required in some patients. [ABSTRACT FROM AUTHOR]

Blights, blasts and leaf spot diseases of rice limit the grain yield and deteriorate the produce quality. A field study was carried out for evaluating various fungicides to manage paddy diseases; brown leaf spot, blast & sheath blight under field conditions at research area of Adaptive Research Farm Sheikhupura, Punjab Pakistan during crop season kharif 2018 & 2019. An experiment was conducted in RCB design with three repeats and five treatments including control. Treatments comprised of four different fungicides viz: Azoxystrobin + Difenoconazol, Kasugamysin + Copperoxychloride, Copper Hydroxide & Trifloxystrobin + Tubeconazol @ 500 ml, 625 ml, 625 g & 160 g ha-1 respectively and a control (untreated check plot). Among the chemical fungicides Azoxystrobin + Difenoconazol @ 500 ml ha-1 was found effective against brown leaf spot and sheath blight with 84.6 % & 81.7 % decrease over control along with 37.4 & 36.7 percent higher yield than check plot followed by Trifloxystrobin + Tubeconazol with 74.8 & 74.3 percent protection values as compared to control during years 2018 & 2019 respectively. In case of paddy blast the fungicide containing Kasugamycin + Copperoxychloride showed better results with 82.5% & 79.4% decrease over control. Maximum incidence level of Brown leaf spot, paddy blast and sheath blight were found in control (non-treated plot) during both years. So, azoxystrobin+ difenoconazol and kasugamycin containing fungicides could be suggested for management of brown leaf spot, sheath blight and paddy blast. [ABSTRACT FROM AUTHOR]

Background: Acute small intestinal obstruction (ASIO) is one of the commonest causes of emergency hospital admissions, morbidity and mortality. Intestinal tuberculosis (ITB) is common cause of ASIO in developing countries leading to significant morbidity and mortality. Our objectives were to determine prevalence, distribution and determinants of ITB in adult indoor patients with ASIO in population of Peshawar Division, Pakistan. Materials & Methods: This cross-sectional study was conducted at Department of Surgery Peshawar Medical College, Peshawar, Pakistan from January 2019 to June 2020. The data was collected from its three affiliated hospitals; Mercy Teaching Hospital, Kuwait Teaching Hospital & Prime Teaching Hospital, Peshawar. 207 ASIO subjects were selected from population at risk consecutively. Sex, age groups and presence of ITB were variables. Prevalence and distribution were described by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were tested by chi-square goodness of fit and of association by chisquare test of association. Results: Out of 207 patients with ASIO, 128 (61.84%) were men and 79 (38.16%) women, 87 (42.03%) were in age group 18-40 and 120 (57.97%) in 41-60 years. Out of 207 patients with ASIO, 41 (19.81%) had ITB, while 166 (80.19%) had no ITB. Out of 41 ITB patients, 25 (12.08%) were men and 16 (7.73%) women, 17 (8.21%) in age group 18-40 and 24 (11.60%) in 41-60 years. The prevalence of ITB was similar to expected (p=.5695). The distribution across sex (p=.00001) was different and across age groups (p=.12501) was similar to expected. Presence of ITB was not associated to sex (p=.8992) and age groups (p=.9347). Conclusion: Prevalence of intestinal TB in adult indoor acute small intestinal obstruction (ASIO) population of Peshawar Division, Pakistan was 19.81%. Prevalence was higher in men than women and higher in 41-60 years than 18-40 years age group population. Overall prevalence of intestinal TB was similar to expected. Observed distribution across sex was different and across age groups was similar to expected. Presence of intestinal TB was not associated to sex and age groups respectively. [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]

Objective: To compare the frequency of respiratory complications encountered in two different positions used for extubation i.e. conventional recovery position versus the modified recovery position (recovery position with 10-degree left tilt and head-down)., Study Design: Comparative study. Place and Duration of the Study: Department of Anaesthesia, Combine Military Hospital, Kohat, Pakistan, from April 2022 to March 2023., Methodology: Two hundred patients scheduled for elective nose and throat surgeries were equally divided into two groups (Group C and Group M). Patients with history of bronchial asthma, chronic obstructive pulmonary disease (COPD), recent respiratory infection, and gastro-oesophageal reflux disease (GERD) were excluded from this study. Patients with more than two intubation attempts were also excluded. Group C patients were extubated in a conventional left lateral recovery position, whereas Group M patients were extubated in a modified recovery position with patient in a left lateral position with 10-degree head-down and 10-degree left tilt. All patients were observed for persistent coughing (coughing that lasted for at least 2 minutes after extubation), breath holding for 20 seconds or more, desaturation (oxygen saturation less than 90%), laryngospasm, need for reintubation, vomiting, and regurgitation., Results: Frequency of airway complications was significantly higher in Group C as compared to Group M. In Group C, 18 (18%) out of hundred patients had complications compared to 6 (6%) patients only in Group M (p = 0.009)., Conclusion: Extubation in a modified recovery position is associated with reduced frequency of airway complications as compared to the conventional recovery position., Key Words: Airway complications, Extubation, Cough, Laryngospasm, Recovery position.