Methods: Included analysis of 300 patients. Patients of all age groups and gender were included in this analysis. We reviewed their clinical records regarding age, gender, incidence and type of pneumothorax, pneumothorax episodes and its causes. Diagnosis of pneumothorax was based on clinical examination and plain chest X-rays of patients. Results: Pneumothorax occurred only in 26 (8.7%) patients. Out of these 26 patients, there were 3 (1.0%) patients in whom spontaneous pneumothorax occurred and in remaining 23 (7.7%) patients pneumothorax was iatrogenic in nature. There was significantly higher rate of mortality in patients who developed pneumothorax 38.46%versus 3.2% in patients without pneumothorax (p-value <0.001). Duration of ICU stay was also significantly prolonged in pneumothorax patients 11.4 days versus only 6.2 days in patients without pneumothorax (p-value <0.001). Patients with iatrogenic pneumothorax, mortality occurred in 5 (83.3%) patients in whom pneumothorax occurred due to mechanical ventilation, 1 (33.3%) in patients with central venous catheter insertion, 2 (22.3%) in patients with pericardiocentesis and 2 (40.0%) in patients with thoracentesis. Conclusion: Pneumothorax is associated with a very high mortality and increased length of ICU stay. Mortality rate is higher in pneumothorax due to mechanical ventilation (barotrauma) as compared to other procedure related pneumothoraxes.

Objectives: To determine the incidence and outcomes of pneumothorax incritically ill patients admitted in intensive care unit (ICU). Study Design: Retrospective study.Setting: Intensive care unit of Nishtar Hospital Multan. Period: 1 July, 2016 to 31 Dec, 2016.Methods: Included analysis of 300 patients. Patients of all age groups and gender were includedin this analysis. We reviewed their clinical records regarding age, gender, incidence and type ofpneumothorax, pneumothorax episodes and its causes. Diagnosis of pneumothorax was basedon clinical examination and plain chest X-rays of patients. Results: Pneumothorax occurred onlyin 26 (8.7%) patients. Out of these 26 patients, there were 3 (1.0%) patients in whom spontaneouspneumothorax occurred and in remaining 23 (7.7%) patients pneumothorax was iatrogenic innature. There was significantly higher rate of mortality in patients who developed pneumothorax38.46%versus 3.2% in patients without pneumothorax (p-value <0.001). Duration of ICU staywas also significantly prolonged in pneumothorax patients 11.4 days versus only 6.2 daysin patients without pneumothorax (p-value <0.001). Patients with iatrogenic pneumothorax,mortality occurred in 5 (83.3%) patients in whom pneumothorax occurred due to mechanicalventilation, 1 (33.3%) in patients with central venous catheter insertion, 2 (22.3%) in patients withpericardiocentesis and 2 (40.0%) in patients with thoracentesis. Conclusion: Pneumothorax isassociated with a very high mortality and increased length of ICU stay. Mortality rate is higherin pneumothorax due to mechanical ventilation (barotrauma) as compared to other procedurerelated pneumothoraxes.

Objective: To determine the peri-operative analgesic efficacy and quality of block by adding Dexmedetomidine as an adjuvant to Bupivacaine for spinal anaesthesia in patients undergoing abdominal hysterectomy. Study Design: Comparative cross-sectional Study. Place and Duration of Study: Anesthesia Department, Nishtar Hospital, Multan Pakistan, Jan to Jun 2019.Methodology: A total of 100 women aged 30-65 years, who were planned for abdominal hysterectomy due to benign causes, and having ASA) status I-II were included. The patients were divided into two equal groups. In Group-B, 12.5mg of 0.5% hyperbaric diluted in 3ml normal saline was administered for induction of spinal anaesthesia. In contrast, in Group-B+D, 10µg Dexmedetomidine and 12.5mg 0.5% hyperbaric Bupivacaine diluted in 3ml normal saline were given. Time of sensory and motor block onset, total duration of the block, and analgesia were noted. Results: The mean time of sensory and motor onset was significantly lower in the Group-B+D. The total duration of sensory block was 181.6±31.6 minutes in Group-B versus 345.2±23.5 minutes in Group-B+D (p-value <0.001). The total duration of the motor block was 142.9±8.6mins in Group-B versus 314.2±8.9mins in Group-B+D (p-value <0.001). Total analgesia duration was 129.4±8.3mins in Group- B versus 263.8±13.7mins in Group-B+D (p-value <0.001). A total of 2.54±0.35mg of rescue analgesia were required in Group- B versus 1.42±0.51mg in Group-B+D (p-value <0.001). Conclusion: The use of Dexmedetomidine as an adjuvant to Bupivacaine for spinal anaesthesia shortens the onset and prolongs the duration of sensory and motor block and the total duration of analgesia.

Objectives: To determine the efficacy of co-administration of magnesiumsulphate (MgSO4) with bupivacaine in enhancing the analgesic efficacy of Transversusabdominus plane block (TAP block) in patients undergoing total abdominal hysterectomy.Study Design: Randomized clinical single blinded trial. Setting: Department of Anesthesia,Nishtar Medical University/Hospital Multan. Period: 07 months from March 2017 to October2018. Methods: We included female patients who presented with uterine or ovarian cancer andplanned for total abdominal hysterectomy. In group B patients (n=30) TAP block was givenusing 0.25% bupivacaine (20 ml). In group M patients (n=30), 19.4 ml 0.25% bupivacaine plus0.60 ml Mg sulphate. Mean arterial blood pressure, heart rate, VAS pain score and time of1st rescue analgesia and total dose of rescue analgesia was noted in all patients. For dataanalysis we used independent sample t-test (Mann-Whitney U test for skewed data) to comparequantitative variables. Chi-square test we used for comparison of ASA status. P-value < 0.05was taken as significant difference. Results: Mean VAS pain score after 1 hour was 3.27+1.70in group B and 2.23+1.35 in group M (p-value 0.012), after 2 hours mean VAS pain score was4.03+2.10 in group B and 2.47+1.25 in group M (p-value 0.001), after 6 hours mean VAS scorewas 4.53+2.62 in group B and 3.27+1.36 in group M (p-value 0.02). Mean VAS pain score after12 and 24 hour of shifting the patient in recovery room was no significantly different between thegroups (p-value 0.55 & 0.08 resp.). Mean time of 1st rescue analgesia was 7.53+4.92 hours ingroup B versus 13.96+2.25 hours in group M. Conclusion: Administration of 200 mg of MGSO4with bupivacaine for TAP block significantly improves the duration of analgesia and reduces therequirement of rescue analgesics in patients undergoing total abdominal hysterectomy.