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Objective: To compare the ease of placement of arterial catheters using palpation versus ultrasound guidance under aseptic measures. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2022. Methodology: Patients of either gender, aged 18 to 90 years presenting to a paranesthesia clinic that required intra-arterial blood pressure monitoring were included in the study. After induction, under General Anaesthesia, arterial lines were placed following an aseptic technique using ultrasound or palpatory method; in Group-U (ultrasound) or Group-P (Palpation), respectively. Demographic variables of the patient along with hemodynamic readings and success rate at first or multiple attempts, along with the total time of cannulation, were recorded. Results: Out of the total 74 patients, 59(79.7%) patients belonged to ASA-1 Grade, and 15(20.3%) patients in ASA-2 Grade. The mean age of the patients was 48.3±16.3, while mean BMI was 25.42±2.8kg/m2. In Group-P, the first-pass success was achieved in 19(51.4%) patients as compared to 32(86.5%) in Group-U when ultrasound was used (p<0.05). Conclusion: The success rate in placing an arterial line using ultrasound was significantly greater than the conventional palpatory method. Therefore, ultrasound should be a preferred modality during intra-arterial line placement. [ABSTRACT FROM AUTHOR]

Objective: To compare the antiemetic effects of Metoclopramide and Ondansetron in female patients undergoing laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital Rawalpindi, Pakistan, Feb to Jul 2022. Methodology: Female patients aged between 15-80 years, American Society of Anesthesiologists Grade I or II planned for laparoscopic cholecystectomy were included in the study. Using non-probability consecutive sampling technique 66 patients were assigned to two Groups with 33 participants in each Group i.e., Group-A (Metoclopramide) and Group-B (Ondansetron) Group. Patients from Group-A received 10mg Metoclopramide while patients from Group-B received Ondansetron 4mg as a part of premedication. Recorded variables were nausea, vomiting and requirement of antiemetic medication at recovery, during the first 06 hours and during 06-24 hours post-operatively. Results: Mean age of the patients was 44.61±12.74 years. ASA distribution of the patients in our study revealed 28(84.8%) patients from Group-A and 26(78.8%) patients from Group-B belonged to ASA I while 05(15.2%) and 07(21.2%) were from ASA II in Group-A and Group-B respectively. Both Metoclopramide and Ondansetron were effective, however results were significant only for nausea and the requirement of antiemetic medication in post-anesthesia care unit. Conclusion: Metoclopramide and Ondansetron both are effective in reducing nausea and vomiting after laparoscopic cholecystectomy in female patients. Ondansetron is superior to Metoclopramide in the reduction of nausea postoperatively however in case of vomiting there is no significant relationship between the two drugs. [ABSTRACT FROM AUTHOR]

When appendix is found in the inguinal hernia sac whether inflamed or non-inflamed then this type of inguinal hernia is called Amyand's Hernia. It is found mostly on right side in incarcerated inguinal hernia with male gender preponderance. Here we present case of 80-year-old male with incarcerated inguinal hernia and was operated in emergency operation theatre. Intraoperatively type 3 Amyand's hernia was found, operation was converted to midline laparotomy and appendectomy was performed with no mesh placement in inguinal region due pus collection in hernia sac. Amyand's hernia is rare pathology and is found intraoperatively most of the time. It should be kept in mind while operating incarcerated or strangulated inguinal hernia. CT scan may provide clear picture of pathology preoperatively. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of intravenous phenylephrine infusion versus boluses for blood pressure management in elective caesarean sections. Study Design: Quasi-experimental study. Place and Duration of Study: Anaesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Jul 2022. Methodology: Three hundred ninety patients requiring elective caesarean section were divided into an Infusion Group (n=195) and a Bolus Group (n=195). The Infusion Group received phenylephrine with 100 mcg/ml titration immediately after spinal anaesthesia as per weight and height at a 1 ml/minute rate and continued for 5 minutes. Infusion stopped if MAP at 5 minutes was above baseline and restarted if dropped below baseline in subsequent readings. In the case of bradycardia, 600mcg of Glycopyrrolate was administered. Parameters recorded at 1, 5, 10 and 15-minute intervals. In the bolus group, total numbers of 100mcg boluses at the end of fifteen minutes were recorded. Protocol for bradycardia and data record intervals was the same. The primary variables were mean arterial pressure (MAP), heart rate(HR), the total dose of phenylephrine used, and nausea and vomiting. Results: Primary outcome variables showed consistent improvement in maintaining MAP in the Infusion Group versus the Bolus Group (p<0.05). A similar trend was seen with heart rate between both groups (p<0.05). However, the infusion group had an average fall in heart rate compared to the bolus group at all-time intervals. Conclusion: Phenylephrine infusion offers better hemodynamic stability, requiring less ephedrine support than when given in boluses. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of "just seal" method of endotracheal tube cuff inflation with the "stethoscope guided" method for reduction of post-operative sore throat. Study Design: Prospective observational study. Place and Duration of Study: Main Operation Theatre, Combined Military Hospital Kohat, from Sep to Nov 2018. Methodology: Forty-four patients were divided in two groups (just seal-group and stethoscope guided-group). Injection Propofol and Atracurium were used to induce general anaesthesia, and injection Nalbuphine was used as an analgesic. Endotracheal intubation with 7.5 internal diameter was done after 3 minutes of injecting Atracurium. In group-JS, the ETT cuff was inflated gradually till no leakage was heard. In group-SG, the ETT cuff was inflated slowly, and a stethoscope bell was placed over the thyroid lamina till harsh sounds stopped. Volume used to inflate the cuff, cuff pressure generated and complain of sore throat two hours after extubation were noted. Results: The mean volume used to inflate the cuff was 6.81 ± 0.41 ml and 4.95 ± 0.29 ml for group-JS and SG, respectively (p <0.001). Mean pressure generated was 34.90 ± 4.48 cmH2O and 28.91 ± 2.37 cmH2O (p<0.001). Postoperative sore throat was observed in 54.55% (12/22) in JS-group and 18.18% (4/22) in SG-group (p=0.012). Conclusion: Stethoscope guided technique for inflation of ETT cuff is more effective in reducing the frequency of postoperative sore throat. [ABSTRACT FROM AUTHOR]

Objective: To compare the ease of intubation using glide scope video laryngoscope versus direct laryngoscopy for nasotracheal intubation. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, Aug 2022 to Feb 2023. Methodology: Patients of either gender with age greater than 18 years with American Society of Anesthesiologists (ASA) Grade I or Grade II planned for elective dental or maxillofacial procedures requiring nasotracheal intubation were included. A total of 60 patients were included, with 30 patients in each group. Recorded variables were time to intubate, glottic grade, use of Magill forceps, first attempt success, failure to intubate and postoperative sore throat. Results: With 60 patients after randomised allocation, 30 were allocated to Group-DL (Direct laryngoscopy) and Group-VL(Video laryngoscopy). The success rate in the first attempt was 27(90%) in Group-DL vs 30 (100%) in Group-VL, and the number of patients who could not be intubated was 1(3.3%) vs 0(0%) in both groups. The glottic grade recorded by the operator under vision, time to intubation, use of Magill forceps and post-operative sore throat in both groups was significant with a p-value of <0.05. Conclusion: Glide scope video laryngoscopy provides a better view of the vocal cords with less time to intubation, greater chances of successful intubation, and fewer post-operative chances of sore throat than direct laryngoscopy. [ABSTRACT FROM AUTHOR]

Objective: To compare the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block with intravenous Nalbuphine in patients with breast cancer planned for modified radical mastectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesia Department Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2022. Methodology: A total of 106 patients diagnosed with breast cancer Stage I and II requiring modified radical mastectomy were included. Comparison of the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block and intravenous Nalbuphine were noted. Results: One hundred six patients were included in the study, and divided into the Nalbuphine Group (n=53) and the Paravertebral Block (PVB) Group (n=53). The per-operative Nalbuphine requirement was significantly reduced in the PVB-Group, 2.28±0.37 mg versus 5.30±0.24 mg in the Nalbuphine-Group (p<0.001). Similarly, the time to the first dose of rescue analgesia was significantly prolonged in the PVB Group at 238.32±5.22 minutes versus 37.71±1.72 minutes in the Nalbuphine Group. The mean satisfaction score between both Groups was 4.33±0.64 in the Nalbuphine was 5.69±0.66 and in the PVB Group (p<0.001). Conclusion: We conclude that paravertebral block is superior to intravenous opioids in decreasing the per-operative and post-operative dose of intravenous opioids with a more favourable profile and a decreased incidence of adverse events. [ABSTRACT FROM AUTHOR]