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Objective: To compare the effectiveness of two types of haemostatic sutures to secure bleeding in thinned out caesarean section scars. Study Design: Comparative Interventional Study. Setting: CMH Okara, Pakistan. Period: September 2019 to September 2021. Material & Methods: Patients were divided in four categories. Category I was previous one scar patients while category II was previous two scars patients. Similarly, categories III and IV were previous three and four scar patients respectively. In each category hemostasis was secured either by purse string suture or transverse mattress sutures. Hemostasis whether achieved with difficultly or without difficulty was assessed and time utilized was also calculated. Results: In patients with previous one caesarean section 3 out of 15 (20%) had haemostatic difficulty with both purse string suture and horizontal mattress suture. In patients with previous two caesarean sections the number was 5 (33.33%) and 6 (40%) in both purse string and horizontal mattress suture respectively. In patients with previous three caesarean sections there were 7 (46.66%) women who had difficulty in haemostasis in both group I and II. The average time to achieve the procedure in group I (purse string suture) was 3.25 minutes while it was 7.5 minutes in group II (Horizontal mattress sutures). There was two times difference in time consumption between two groups. Conclusion: Purse string suture is more effective, convenient and quicker to apply as compared to transverse mattress sutures for haemostasis in thinned caesarean section scars. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of preoperative leukocytosis and its association with wound infection. Study Design: Prospective-cross sectional, analytical study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital, Thall, from Jan to Dec 2017. Methodology: After the approval of hospital ethics committee, 340 pregnant ladies undergoing both elective and emergency cesarean section were included in our study. The outcome of our study was the frequency of preoperative leukocytosis and its association with postoperative wound infection. SPSS version 20 was used to analyze data. The qualitative data was presented as frequency and percentage. Chi-square was used to analyze significance. A p-value ≤0.05 was taken as significant. Results: Frequency of preoperative leukocytosis was 121 (36.6%). A total of 111 (64.1%) pregnant ladies had pre-operative leukocytosis without post-operative wound infection versus 10 (66.6%) in patients with wound infection, p≤0.05, odd ratio 3.77. The sensitivity of pre-op total leukocyte count (TLC) for prediction of post-op wound infection was 66.6% (95% CI 38.3 to 88.8%) and specificity of 65.1% (59.5% to 70.34%). Most patients, 13 (86.6%), with wound infection required only debridement and intravenous antibiotics: IV linezolid and metronidazole; rest 2(13.4%) required secondary suturing for patient recovery. Conclusion: Preoperative leukocytosis was common in parturient undergoing cesarean section incidence of wound infection was low in this study. The post-operative wound infection risk is shown to correlate with the preoperative leukocytosis. [ABSTRACT FROM AUTHOR]

Objective: To find out effectiveness of precautions and preventive measures against COVID-19 for emergency surgery at CMH Okara with limited resources. Study Design: Cross sectional observational study. Place and Duration of Study: Combined Military Hospital Okara, from Mar 2020 to Jun 2020. Methodology: All emergency surgery patients were included while excluding elective cases done under spinal or general anaesthesia. The clinical symptoms along with complete blood count and X-ray chest were our method for corona screening. Personal protective measures were adopted for suspected patients who were operated in a separate room with restricted entry. The data was collected for total operated patients, suspected patients, and health care workers contracting infection. SPSS-16 was used for analysis. Results: Four hundred and fifty (100%) emergency surgeries were performed during this study period. Twenty patients had clinical suspicion of COVID-19 and 7 patients had X-ray chest findings suggestive of COVID-19 infection. Computerized tomorgraphy scan done in 2 patients, was negative. 425 (94.4%) were operated under spinal anaesthesia whereas 25 (5.55%) patients had general anesthesia. One staff member was positive for corona after 15 days of study. All the other staff (30 health care workers) did not develop any clinical symptoms suggestive of corona. Conclusion: Strict preventive measure, screening of patients and teaching of health care workers may help control this infection. [ABSTRACT FROM AUTHOR]

Objective: To determine the magnitude of various types of maternal emergencies and neonatal outcomes in order to ascertain the impact of maternal presentation on perinatal mortality in a peripheral hospital in Khyber Pakhtun Khwa Province. Study Design: Retrospective cross-sectional study. Place and Duration of Study: This study was carried out in the Department of Anesthesiology and Gynecology & Obstetric Department, Combined Military Hospital Thal, from Oct 2016 to Mar 2017. Methodology: Total 181 obstetric patients were included in the study. The patients’ documents were evaluated retrospectively for adverse maternal and neonatal outcomes, the incidence of various obstetrical emergencies, average time before proceeding with the emergency surgery and average duration of stay in our hospital. Results: The mean age of our study group was 27.1 ± 5.7 years. The mean time to operative delivery 57.0 ± 49.1 minutes. The mean length of hospital stay was 2.0 ± 0.50 days. Most of the patients presented at night (51.2%), without any antenatal visits (67.4%) with obstructed labour (24.8%). There were 30 (16.6%) perinatal deaths. Perinatal was correlated to obstructed labour, maternal hemorrhagic disorder, fetal distress and hypertensive disorder and presentation at night; p<0.05. However, it was not correlated to antenatal visit; mode of referral or transport. Conclusion: Obstructed labour, fetal distress and maternal hemorrhagic were the most common of obstetric emergencies at our peripheral hospital; with a direct, significant correlation with the perinatal mortality. [ABSTRACT FROM AUTHOR]

Objective: To compare the current practices in obstetric anesthesia in different level of hospitals across Pakistan and their adherence to guidelines and standards. Study Design: Cross sectional analytical study. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Okara for two months, from Dec 2018 to Feb 2019. Material and Methods: Five hundred questionnaire were sent to Department of Anesthesiology of 100 different hospitals. The proforma was a self-administered 22-questions that asked about the various aspects of the conduct of obstetric anesthesia. The data were analyzed using SPSS version 20. The qualitative variables were presented as frequency and percentage. Chi square used to calculate significance; p-value ≤0.05 taken as significant. Results: We received 311 questionnaires (62.2%) from various institutes. At the tertiary care hospital, most of respondents were aged less than 35 years and had an experience of 11-20 years as compared to 35-50 years in primary and secondary care hospitals; p<0.01. Although males (68.5%) make up a bulk of anesthetist, most of the females were working in tertiary care hospitals, p-value<0.01. Most of the obstetric anesthesia practices were comparable between the levels of hospitals. Anesthetist at tertiary care hospitals more commonly used colloid preload; a lesser volume for preload; routine left uterine tilt, prophylactic vasopressors and epidural analgesia for painless labor in obstetric anesthesia practices, p<0.05. Conclusion: Most the obstetric anesthesia practices were comparable between the three levels of hospital. These are in accordance with the latest guidelines by international societies. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of critical incidents and operative mortality in a CEE Class (100 bedded) Hospital and to set reference values to assess quality of anesthesia related health care in future. Study Design: A retrospective study. Place and Duration of Study: This study was carried out in the Department of Anesthesia and Pain Management, Pakistan Air Force Hospital Sargodha, and retrospective data of all surgical patients from Jan 2014 to Dec 2015 were studied. Material and Methods: Two year data of all surgical patients including gynecology, obstetrics, otolaryngology, ophthalmology, orthopedics, psychiatry and emergency surgery were included in the study. Patients' documents were evaluated retrospectively for any critical incident and operative mortality and to determine whether anesthesia solely was responsible for the adverse event or patient co-morbid condition had any contribution. Results: During the two year study period 20,293 patients were given either general or regional anesthesia. Out of these 20,293 patients, critical incidents were reported in 14 cases (0.06%) with complete recovery in 12 (0.05%) patients. Mortality occurred in 2 (0.009%) cases. Conclusion: Anesthesia continues to be associated with morbidity and mortality despite the advancements made in equipment, monitors and drugs. This article may prove as reference for anesthesia related critical incidents and mortality in Pakistan. [ABSTRACT FROM AUTHOR]

We present a case of large multinodular goiter with retrosternal extension scheduled for thyroidectomy under general anesthesia (GA). We anticipated difficult airway due to tracheal compression as well as perioperative hemodynamic instability. She had had hyperthyroidism previously, which had been treated successfully. We planned and prepared to encounter airway problems in the light of Difficult Airway Society guidelines. After counselling and consent, her upper airways were sprayed with local anesthetic solution. Awake, flexible fiberoptic nasal intubation was performed and GA was induced. She had two episodes of bradycardia and hypotension peri-operatively, which were treated with inj atropine. Tracheostomy was performed in anticipation of tracheomalacia, which was de-cannulated on 3rd postoperative day. She was discharged on 4th post-operative day. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. Study Design: Double blind study. Duration of Study: This study was of six months duration and was carried out from March 2004 to September 2004. Setting: Combined Military Hospital Kharian. Patients and Methods: One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawal movements of the arm were studied. Results: Out of total of 120 patients, only 17 patients (14%) developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 patients out of 60 patients had withdrawal movements while in Group B, who received normal saline as pre-treatment fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Conclusions: Pretreatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To find out the electrophysiological changes including pulse, blood pressure, Oxygen saturation and ECG after electroconvulsive therapy (ECT) under Propofol General Anaesthesia (GA). METHODS: Fifty patients with Depression who underwent ECT were studied. All patients were anesthetized using propofol. They were stratified according to electrophysiological changes including SPAO2, pulse and blood pressure at 60, 90 and 120 seconds after a course of 6 sessions of ECTs. Oxygen saturation was measured using a pulse oximeter. RESULTS: The age of the patients ranged from 18-60 years and mean age was 45±12.02.The ranges of oxygen saturations recorded before ECT was 96-100%. It was 94-97% at 60 sec, 90-92% at 90 sec, 95-98% at 120 seconds. There was initial decrease in diastolic pressure from pre - ECT (77±07) to 72±05 at 60 sec followed by increase of 73±05 at 90 sec and again coming to 74±05 at 120 sec, whereas in case of systolic pressure initial decrease of 117±06 at 60 sec, 114±04 at 90 sec and 116±07 at 120 sec. There was a decrease in mean pulse from 77±4.64 (pre - ECT) to 73±2.87 at 60 sec, 74±4.02 at 90 sec and maintaining at 74±3.52 at 120 sec after ECT procedure. Out of 50 patients, 3 (6%) developed bradycardia and 2 (4%) had ST-segment flattening at 60 seconds. CONCLUSION: ECT under Propofol is very safe modality of treatment for patients with depressive illness and it gives much better and stable hemodynamic changes with rapid recovery from anesthesia. [ABSTRACT FROM AUTHOR]