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Objectives: To determine the safety and efficacy of Sevoflurane anaesthesia with a supraglottic airway device for MRI. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Anaesthesiology, of Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2019. Methodology: A sample size of 152 patients were calculated, including both genders from birth to 12 years. After applying inclusion and exclusion criteria, patients were chosen to undergo inhalational anaesthesia with Sevoflurane, including supraglottic airway device (SAD) insertion. After MRI, SAD was removed upon awakening and patients were shifted to the post-anaesthesia care unit (PACU) for further monitoring. Results: The mean age of patients was 4.07±2.312 years. Out of 152 patients, ninety (60%) were males, and sixty patients (40%) were females. Hypoxemia was seen in 1.3% cases, laryngospasm in 1.3%, and apnoea in 8% and coughing in 5% patients. There were no any other complications. Conclusion: The study concluded that Sevoflurane anaesthesia with SAD is a safe and reliable technique for artefact-free MRI of paediatric patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevailing practices regarding personal protective equipment in operation theaters. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi, from May to Jun 2020. Methodology: After the approval of the approval of the hospital ethical committee, 300 online forms were send. A total of 227 respondents returned the 22 questions survey forms. Data was collected and analyzed using online site www.surveyplanet.com. Results: A total of 203 forms were included in our final analysis. Most 128 (63.1%) were males with 90 (44.3%) common aged between 31-40 years and 168 (82.8%) working in tertiary care hospitals. One hundred and fifty eight (77.8%) were routinely managing known Covid cases per-operatively. One hundred and seventy four (85.7%) reported that personal protective equipment was being provided by the hospital administration; 55 (27.1%) have bought part of full protective equipment at their own expense; 72 (35.5%) re-using protective equipment; 167 (82.3%) being provided with N-95 masks and 120 (59.1%) re-using N-95 masks. One hundred and twenty one (59.6%) wearing level III protective gear during all surgeries, 192 (94.6%) respondents reported maintaining hand hygiene after each patient. Only 65 (32%) taking shower at the hospital at the end of their shift. Conclusion: Most of the operation theaters were providing protective equipment to their staff with nearly half reusing protective gear and N-95 masks. [ABSTRACT FROM AUTHOR]

The pandemic of COVID-19 corona virus is the most deadly and frightening situation of our times and it is the greatest challenge to which whole world is exposed. We are fighting this pandemic since February 2020 and up till now there is increased surge of cases. Pak Emirates Military Hospital has been declared as corona special hospital, all entitled cases that are corona positive and need surgeries are being operated here. Special protocols and rules have been designed by hospital management and consultants of different specialities to minimize the risk of cross contamination. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic took world by storm soon after its emergence. People living in all parts of world fell a prey to this deadly disease. It affected individuals in all walks of life in one way or the other. After declaration of Pak Emirates Military Hospital as COVID-19 specific hospital, development of four intensive care units and involvement of multiple specialties led us to new horizons of clinical care. We experienced a transition of usual medical practice. [ABSTRACT FROM AUTHOR]

Objective: Comparing the efficacy of crystalloid pre-load and co-load on reducing hypotension and improving APGAR score in patients receiving spinal anaesthesia for elective caesarean sections. Study Design: Randomized controlled study. Place and Duration of Study: This study was carried out at Combined Military Hospital Bahawalpur, after seeking permission from ethics committee. The data was collected for 06 months from Jan to Jul 2017. Methodology: Patients with ASA classification 1 and 2, aged 18-40 years were included. Group A received 15ml/kg Hartmann’s solution as preloading solution in 15 minutes before the induction of spinal anaesthesia. Group B received 15ml/kg of Hartmann’s solution as co-loading solution after performing a block in 15min. Results: This study includes 314 patients (157 in each group). Our study population was slightly predominated by females 170 (54%) as compared to 144 (46%) males. The average Apgar score in both groups were 9.8 ± 0.58 and 9.7 ± 0.436. Out of 314 patients, 169 patients (54%) were ASA I and remaining 46% were ASA II. Overall hypotention was noted in 67 patients (21.3%) of group A and 30 patients (9.6%) of group B. The difference between two groups was statistically significant (p=0.001*). Improving Apgar score was noted in 54 patients (17.2%) of group-A and 117 patients (37.3%) of group-B. The difference between two groups was statistically significant (p=0.001*). Conclusion: It is concluded that co-load is better than pre-load in reducing hypotension and improving Apgar score in patients receiving spinal anaesthesia for elective caesarean sections. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the stability of blood pressure in parturient patients undergoing caesarean section in spinal anaesthesia after prophylactic dose of phenylephrine. Study Design: Quasi experimental study. Place and Duration of Study: The study was carried out at Combined Military Hospital Bahawalpur, from Jan 2018 to Jun 2018. Methodology: In this study a total of 100 patients were taken, (only females) divided in two equal groups, fulfilling the inclusional criteria. Group A was given Inj phenylephrine 50 micrograms (50ug) intravenously right after spinal block and group B was not given anything until required. Non invasive blood pressure was monitored before Spinal anaesthesia then at 01, 03 and 05 mins after the Spinal anaesthesia. Digital monitor was used for noninvasive blood pressure monitoring. The result of non invasive blood pressure was recorded in mmHg. Detailed procedure was explained to patients. Results: In our study, baseline interval non invasive blood pressure was 107.5 ± 4.75/67.5 ± 7.20 mmHg in group A and 118.3 ± 5.64/78.6 ± 3.94 mmHg in group B. After 01 min it was 112 ± 5.22/70 ± 6.3 mmHg in group A and group B had 103.6 ± 4.94/59.8 ± 2.79mmHg. After 03 mins group A had 108 ± 4.25/74 ± 5.62 mmHg and group B had 85.3 ± 3.14/49.6 ± 2.90 mmHg. Finally, at 05 mins, non invasive blood pressure in group A was 99.5 ± 4.11/63.6 ± 3.34 mmHg and group B had 77.1 ± 3.26/47.8 ± 3.67 mmHg. Group A has significant results (p<0.05) while statistically significant decreased in group B when compared with group A. Conclusion: When phenylephrine was given prophylactically immediately after spinal anaesthesia, patients remained hemodynamically stable with less incidence of hypotension. [ABSTRACT FROM AUTHOR]

Objectives: To compare the mean post-operative pain score with ultrasound-guided transversus abdominis plane block and wound infiltration with local anaesthetic agents in abdominal surgeries. Study design: Comparative prospective study Place and Duration of Study: Department of Anaesthesia, Intensive Care and Pain Management, Combined Military Hospital, Bahawalpur Pakistan, from Oct 2018 to Apr 2019. Methodology: Sixty patients undergoing abdominal surgery aged 18-60 years were included. The patients in Group-A received transverses abdominis plane block with 20 ml of 0.25% Bupivacaine bilaterally, while those in Group-B received 20 ml of 0.25% Bupivacaine as local wound infiltration. Each patient was followed till 6 hours post-operatively. Results: Out of 60 patients, 35(58.33%) were male, and 25(41.67%) were females. In our study, the Visual analogue score was 1.63±0.85 in Group-A (ultrasound-guided TAP block) compared with 4.47±1.07 in patients with Group-B (wound infiltration with a local anaesthetic agent) with a p-value of 0.001, which was statistically significant. Conclusion: The study concluded that the mean pain score in patients with ultrasound-guided Transversus abdominis plane block is less compared to wound infiltration with local anaesthetic agents in abdominal surgeries. [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 compare mean arterial pressure (MAP) variation after anaesthetic induction with inhalational sevoflurane versus intravenous propofol. Study Design: Randomized controlled study. Place and Duration of Study: The study was carried out at Combined Military Hospital Bahawalpur - a tertiary care hospital, after seeking permission from hospital ethical committee. The data was collected for 06 months starting, from Jul 2017 to Dec 2017. Material and Methods: In this study a total of 110 patients fulfilling the inclusion criteria were selected. Patients were randomly divided into two groups (55 in each group). Group A were anaesthetized with sevoflurane and group B with propofol. Mean arterial pressure measurement was carried out before induction, and then 02 minutes after induction. Difference of change in MAP from baseline was recorded both for sevoflurane and propofol. Digital monitor was used for MAP monitoring. The result of MAP was recorded in mmHg. Results: In our study, MAP at baseline was calculated as 102.62 ± 5.22 mmHg in group-A and 101.69 ± 5.57 mmHg in group-B, p-value was 0.36 showing insignificant difference at baseline and after 02 minutes of induction was calculated as 87.65 ± 3.49 mmHg in group-A and 84.11 ± 3.62 mmHg in group-B, p-value was 0.0001, a significant difference. Mean change in arterial pressure after 02 minutes of induction was calculated as 14.96 ± 6.89 mmHg in group-A and 17.58 ± 5.33 mmHg in group-B, p-value was 0.0001, a significant difference. Conclusion: It is concluded that induction with sevoflurane is significantly better than induction with propofol for prevention of hypotension. [ABSTRACT FROM AUTHOR]