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Introduction: The inhibition of the pituitary gland, an increase in the production of catabolic hormones, and the stimulation of the sympathetic nervous system culminate in surgical stress. These factors result in elevated hepatic glycogenesis and gluconeogenesis, decreased skeletal muscle glucose uptake and glycogen synthesis, and hyperglycaemia. Aim: To examine the effects of Subarachnoid Block (SAB) and General Anaesthesia (GA) on perioperative Capillary Blood Glucose (CBG) levels in individuals undergoing surgery lasting 1-3 hours. Materials and Methods: This prospective interventional study included 100 non diabetic patients undergoing surgery of 1-3 hours duration with 50 patients in each group (GA and SAB). CBG was checked 30 minutes before the administration of anaesthesia, 30 and 60 minutes after the induction of anaesthesia, and 30 minutes after shifting to the Post Anaesthesia Care Unit (PACU) in both the GA and SAB groups. Differences in participant characteristics, such as age and CBG levels in the two groups (SAB and GA), were examined using the two-tailed Independent samples t-test and the Chi-square/Fisher’s exact test Results: The mean CBG levels measured 30 minutes before anaesthesia in the GA group were 105.50±21.13 mg/dL, while in the SAB group they were 99.67±19.04 mg/dL, with a p-value of 0.330. However, CBG levels measured 30 minutes after anaesthesia in the GA group were 125.69±22.95 mg/dL, compared to 104.67±20.94 mg/dL in the SAB group, with a p-value of 0.001. At 60 minutes after anaesthesia, CBG levels in the GA group were 152.41±28.97 mg/dL, while in the SAB group they were 99.65±22.69 mg/dL, with a p-value of 0.003. Finally, 30 minutes after shifting to PACU, CBG levels in the GA group were 147.49±27.20 mg/dL, compared to 92.86±24.35 mg/dL in the SAB group, with a p-value of 0.002. Conclusion: CBG levels significantly increased in individuals receiving GA for surgery. This indicates that the hormonal stress response is greater during GA compared to SAB.

Background: Percutaneous nephrolithotomy (PCNL) is a standard procedure to remove and disintegrate large kidney stones. Despite minimal invasiveness, it is associated with significant postoperative pain. Erector spinae plane block (ESPB) is a novel interfacial plane block recently introduced to provide analgesia in acute and chronic pain. The current study was conducted to compare the efficacy of ultrasound (USG) guided ESPB and conventional analgesia (CA) following PCNL. Methodology: After obtaining the institute's ethical committee approval and informed consent, 50 patients were included in the study and were randomized into two equal groups of 25 to receive ESPB with 20 ml of 0.25% bupivacaine or CA. Patients in both groups were given intravenous paracetamol 8th hourly and intravenous tramadol 2mg/kg as rescue analgesia. Results: Both study and control groups were similar in demographic profile. Pain assessment by Visual analogue scale (VAS) scores in the postoperative period were significantly lower at hours of 20min, 40min, and 1,3,6,12 hrs (P<0.0001) and at 9,18 hrs (P<0.05) in the group E, than the control group. The time to first rescue analgesia was observed longer in the ESPB group than in the control group (2.28± 0.58hrs Vs 15.48± 3.17 hrs) (P<0.0001). The average tramadol consumption was less in the ESPB group compared to the control group (139.28±41.36 mg Vs 337.20± 38.66mg) (P< 0.0001). Conclusion: Ultrasound-guided ESPB provides safe and effective postoperative analgesia following PCNL, with decreased VAS scores. ESPB extends the retrieval analgesia time and lessen the requirement for tramadol. [ABSTRACT FROM AUTHOR]

Background : Covid 19 a contagious illness caused by SARS corona virus 2. One of the newly emerging respiratory concerns is the emergence of spontaneous pneumothorax (PNX) in patients on mechanical ventilation as well as patients not on any form of ventilations. Surveys primary objective was to evaluate if Covid 19 patients on mechanical ventilation are more prone for development of spontaneous Pneumothorax. The secondary goal was to determine whether spontaneous pneumothorax is a standalone risk factor for COID 19 mortality. Methodology : Anaesthesiologists, Pulmonologists, Physicians, and Intensivists who were involved in the treatment of COVID 19 patients were invited to participate in the survey. A google form, with twenty questionnaires were provided with four options in each question. Participants were asked to tick the appropriate option. To determine whether spontaneous pneumothorax is a standalone risk factor for Covid-19 mortality, the chi-square test of association and Fisher's Exact test were used. Statistical significance is taken at a p-value of <0.05. Results : 42.9% reported on an average 0-5 patients were on IPPV (intermittent positive pressure ventilation, 49.5% reported on an average 0-5 patients were on NIV (non-invasive ventilation), 49.45% of the respondents agreed on an average >10 number of patients on invasive ventilation developed spontaneous pneumothorax and 29.47% reported on an average >10 number of patients on non-invasive ventilation developed spontaneous pneumothorax. On an average,patients who needed ICD insertion after developing spontaneous pneumothorax, the incidence was 6.6% .Most of the respondents reported on an average patients recovered after developing spontaneous pneumothorax, incidence was 76.9%. Average number of patients who succumbed to Covid 19 after developing spontaneous pneumothorax was 50.5%. Conclusion : Dreaded complication of COVID 19 viral pneumonia is spontaneous pneumothorax . Both IPPV as well as NIV increases the risk of developing spontaneous pneumothorax. This cannot be attributed only to barotrauma caused due to use of higher PEEP during ventilation, as there are multiple contributing factors. Lung protective ventilator settings should be used for better outcome of the patient. [ABSTRACT FROM AUTHOR]