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Objective: To evaluate the contribution of member countries of the South Asian Association for Regional Cooperation towards anaesthesia research. Method: The retrospective study was conducted at Department of Anaesthesia, Aga Khan University from January 2018 to June 2018 and comprised literature search to identify published articles related to anaesthesia, critical care and pain research contributed by authors from member countries of the South Asian Association for Regional Cooperation region and published in Pakistani indexed journals between January 2007 and December 2016. Data was analysed using SPSS 19. Results: Of the 183 articles extracted, 179(97.8%) were contributed from Pakistan and 4(2.2%) from India. Overall, there were 50(27%) randomised controlled trials, 38((20%) case reports and 36(19.5%) observational studies. There was 1(0.5%) collaborative study involving researchers from two member countries. Conclusions: The contribution to anaesthesia, critical care and pain research was not ideal from the member countries of the South Asian Association for Regional Cooperation. Key Words: South Asia, Research, Anaesthesiology, Pakistan.

Alternative medicine techniques such as music therapy have been a recent interest of medical practitioners and researchers. Significant clinical evidence suggests that music has a positive influence over pain, stress and anxiety for the patients of cancer, pre and post surgery, insomnia, child birth, end of life care, etc. Similarly, the technologies of Internet of Things (IoT), Body Area Networks (BAN) and Artificial Neural Networks (ANN) have been playing a vital role to improve the health and safety of the population through offering continuous remote monitoring facilities and immediate medical response. In this article, we propose a novel ANN enabled IoT architecture to integrate music therapy with BAN and ANN for providing immediate assistance to patients by automating the process of music therapy. The proposed architecture comprises of monitoring the body parameters of patients using BAN, categorizing the disease using ANN and playing music of the most appropriate type over the patient&rsquo, s handheld device, when required. In addition, the ANN will also exploit Music Analytics such as the type and duration of music played and its impact over patient&rsquo, s body parameters to iteratively improve the process of automated music therapy. We detail development of a prototype Android app which builds a playlist and plays music according to the emotional state of the user, in real time. Data for pulse rate, blood pressure and breath rate has been generated using Node-Red, and ANN has been created using Google Colaboratory (Colab). MQTT broker has been used to send generated data to Android device. The ANN uses binary and categorical cross-entropy loss functions, Adam optimiser and ReLU activation function to predict the mood of patient and suggest the most appropriate type of music.

Context: The South Asian region is comprised of eight countries, i.e., Pakistan, India, Bangladesh, Sri Lanka, Afghanistan, Bhutan, Nepal, and Maldives. There is dearth of literature documenting anesthesia research in this region. Aim: The aim of this audit was to look at research productivity in the region by examining the volume and the type of anesthesia publication in five high-index anesthesia journals. Settings and Design: The study design was a survey of literature in the top five high-impact anesthesiology journals carried out at a tertiary care hospital. Materials and Methods: The journal citation report 2016 was accessed to identify the top five anesthesia journals based on their impact factor. We identified articles published in these journals between January 2000 and December 2015. Statistical Analysis: Microsoft Excel 2003 worksheet was used for data collection from extracted articles. Results: The highest number of publications came from India (n = 487) 95.9%; 58.5% of these were correspondence, 21% were original articles, 12.8% were case reports and case series, 1.2% reviews, and 1% editorials. Fourteen articles were published from Pakistan, with 1.2% original articles, 0.8% letter to editor, 0.6% audits, and 0.2% case reports. Nepal and Sri Lanka contributed seven publications. There were no publications in these journals from authors from Bangladesh, Afghanistan, Bhutan, and Maldives in the reviewed journals. The highest number of publications was equally distributed between two journals, i.e., “Anesthesia and Analgesia” (29.5%) and “Anesthesia” (28.9%). Conclusion: We found that scientific contributions from the South Asian region in terms of original anesthesiology research in five high index anesthesiology journals was suboptimal and has not shown an increasing trend over the last 16 years.

Multiple anaesthesia books are available about the state-of-art anaesthetic management, including management of the obstetric patient. There has been considerable advancement in the field of anaesthesiology in recent years; however, incidents of morbidity and mortality continue to be reported from resource limited settings. The current ebook is aimed to describe safe practice of safe anaesthesia in resource-limited situations. The authors are well aware about the available resources in different parts of their country and other countries with similar resources, are capable of suggesting a safe standard of care that can be applicable in resource limited situations, while at the same time describing the standard of care in the developed world. Format of the eBook: • Typical descriptive case scenarios • Current standards of care in the best institutes of the world • Suggested standards of care in resource limited situations

Pain after laparoscopic cholecystectomy is mild to moderate in intensity. Several modalities are employed for achieving safe and effective postoperative analgesia, the benefits of which adds to the early recovery of the patients. As a part of multimodal analgesia, various approaches of Transversus abdominis plane (TAP) block has been used for management of parietal and incisional components of pain after laparoscopic cholecystectomy. This study was designed to compare the analgesic efficacy of two different approaches of ultrasound guided TAP block, i.e., Subcostal-TAP block technique with ultrasound guided Posterior-TAP block for postoperative pain management in patients undergoing laparoscopic cholecystectomy under general anaesthesia.In this double blinded randomized controlled study, consecutive nonprobability sampling was done and a total of 126 patients admitted for elective laparoscopic cholecystectomy fulfilling the inclusion criteria were selected. After induction of general anaesthesia, patients were randomized through draw method and received either ultrasound guided posterior TAP block with 0.375% bupivacaine (20ml volume) on each side of the abdomen or subcostal TAP block bilaterally with the same. Up to 24 hours postoperatively, static and dynamic numeric rating pain scores were assessed.We found statistically significant difference in mean static pain scores over 24 hours postoperatively in subcostal TAP group, suggesting improved analgesia. However, mean dynamic postoperative pain scores were comparable between the two groups. Whereas, patients in both groups were satisfied with pain management.Ultrasound guided subcostal TAP block provides better postoperative analgesia as compared to the Posterior TAP block in laparoscopic cholecystectomy. Otherwise both of the approaches improve patient outcomes towards early recovery and discharge from hospital.

Perioperative anaesthetic management of patients with pulmonary hypertensive crisis is complex and challenging because of limited window period and treatment options. This case report describes the successful management of a patient with severe valvular heart disease superimposed by severe pulmonary hypertension, who developed pulmonary hypertensive crisis soon after induction of general anaesthesia for cardiac surgery. Pulmonary hypertensive crisis is not a usual phenomenon in these patients, but if it occurs it can be fatal. Anticipatory care of the patient to prevent crisis is the mainstay of treatment, otherwise it adds additional morbidity to such patients. Fortunately our patient survived the crisis without causing any additional morbidity during his hospital stay.

Background: The aim of this study was to determine the frequency of patients admitted to Intensive Care Unit (ICU) after elective interventional neuroradiology (INR) procedures under general anesthesia. Materials and Methods: We retrospectively evaluated 121 patients underwent INR procedures performed with general anesthesia within a 5-year period. Information including demographics, aneurysm/arteriovenous malformations pathology (ruptured or un-ruptured), preoperative neurological status, co-morbidities, complications during procedure and postoperative admission in ICU were recorded on a predesigned form. Results: Elective INR procedure for both ruptured (n = 29, 24%) and un-ruptured (n = 85, 70.25%) aneurysms was performed. Rate of postoperative admission in ICU was significantly high in patients with preoperative ruptured aneurysm (P < 0.01). High rate of neurological deficit, sub-arachnoid hemorrhage (SAH) and hypertension in patients were significant factors of postoperative admission in ICU (P < 0.05). Out of 24 patients, 12 were admitted to ICU postoperatively because of procedure-related complications and 11 were sent due to preexisting significant co-morbidities with added complication of SAH. Conclusion: The authors conclude that patients without major co-morbidities, intraoperative complications, or complex aneurysm morphology can be safely observed in a regular ward rather than being admitted to the ICU.

Acute transient parotid gland enlargement in association with general anesthesia is a rare complication and has also been called anesthesia mumps. Unilateral or bilateral parotid or submandibular swelling usually develops during surgery under anesthesia or, a few hours later and usually resolves in a few days with no sequelae. It has been reported as a complication after general anesthesia in patients undergoing spinal surgeries in prone and lateral decubitus position, even after cesarean section in the supine position and also reported in Intensive Care Unit patients. We present a case of a unilateral parotid swelling noticed in immediate postoperative course, in a patient who underwent spine surgery.