Background and objectives: Post-operative airway symptoms can be troublesome to patients following an uneventful general anesthesia with endotracheal intubation. In this study, we compared the effectiveness of lubricating an endotracheal tube with betamethasone gel or lidocaine jelly with using an unlubricated tube in reducing the incidence and severity of postoperative sore throat, hoarseness and cough.Methods: This was a prospective, randomized, single-blind comparative study carried out among 120 ASA I and II patients aged 18-65 years undergoing elective surgery under general anesthesia with endotracheal intubation. Patients were randomly divided into three groups of 40 patients each. Endotracheal tube used for patients in group C was unlubricated, while that for group B and group L were lubricated up to 15 cm mark with 2.5 ml of 0.05% betamethasone gel or 2% lidocaine jelly respectively. Incidence and severity of postoperative sore throat, hoarseness and cough were observed at 1, 6 and 24 h following extubation. Results:At 24 h following extubation, group B had the lowest incidence of postoperative sore throat among the three groups (group B: 12.5% vs group L: 37.5% vs group C: 25%; p = 0.036). Severity of postoperative sore throat at 24 h was less with betamethasone (score 0: 87.5%, 1: 10%) compared with lidocaine (score 0: 62.5%, 1: 37.5%) and control (score 0:75%, 1: 20%) (p = 0.006). Observations at other times and of other variables were comparable. Conclusion:Wide spread application of 0.05% betamethasone gel to lubricate the endotracheal tube significantly reduces the incidence and severity of sore throat at 24 h of extubation but not of hoarseness or cough.

Introduction: Postoperative nausea and vomiting are frequent complications after laparoscopic cholecystectomy. Several risk factors have been associated with postoperative nausea and vomiting. This study aimed to find out the prevalence of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anaesthesia in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the patients undergoing laparoscopic cholecystectomy under general anaesthesia at a tertiary care centre from 1 July 2021 to 30 April 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 050-077/078). Convenience sampling was done. All the patients received antiemetic prophylaxis with ondansetron. The general anaesthetic technique was standardised in all the patients. They were followed up 24 hours after surgery for an episode of nausea and vomiting. Point estimate and 95% Confidence Interval were calculated. Results: Among 200 patients, postoperative nausea and vomiting were seen in 28 (14%) (9.19-18.81, 95% Confidence Interval). Among them, 7 (25%) of the patients experienced post-operative vomiting as well. Conclusions: The prevalence of postoperative nausea and vomiting among patients undergoing laparoscopic cholecystectomy in our study was lower when compared to other studies conducted in similar settings.

Spinal anaesthesia (SA) in paediatric patients was first introduced by August Bier in 1899. But this technique did not gain wide spread popularity in paediatric age group because of the introduction of various muscle relaxants and inhalational agents for general anaesthesia. SA in paediatric population has been gradually reintroduced as an alternate to general anaesthesia. The study was performed at the Nepal Medical College Teaching Hospital to evaluate the efficacy and safety of SA in paediatric age groups, compare the change in vital parameters such as heart rate, blood pressure and oxygen saturation during preoperative and intraoperative period, the complications of SA and time of demand for first rescue analgesia in postoperative ward. Sixty-seven patients aged between 3 years to 14 years of ASA I and ASA II were selected after screening for anaesthesia fitness. The duration of surgery ranged from 49.85 ± 11.55 to 56.30 ± 9.68 minutes and the blood loss was less than 10% of total blood volume, thus there was no need to transfuse during operation. The duration of analgesia ranged between 107.69 ± 7.25 to 115.00 ± 7.07 minutes in different age groups. Sixty patients (89.55%) achieved Bromage Scale Score (BSS) 3 with interpretation of complete block; seven patients (10.45 %) achieved Bromage Scale Score 2 (partial block) and were operated after supplemental intravenous sedation. None of the patients needed conversion to general anaesthesia. Successful CSF drain with placement of spinal needle in 1st attempt was achieved among 55 patients (82.1%) and in 2nd attempt among 12 patients (17.9%). No unsuccessful attempt was recorded. SA in children appears to be a relatively safe technique with few complications and may be considered as an alternative for general anaesthesia. It is cost effective in comparison to general anaesthesia as the drugs and equipment required are less and cheaper and the length of hospital stay is usually shorter.

Background: Induction of anesthesia with propofol is known to produce systemic hypotension. Co-induction adds a small dose of other anesthetics to reduce the dose of induction agent to decrease hemodynamic disturbances. The aim of the study was to compare hemodynamic changes associated with Midazolam and ketamine as a coinduction agent with Propofol and to compare induction dose of Propofol following the co-induction.

The purpose of this study is to compare the outcome of traditionally advised pre-anesthetic fasted childrenwith those who fasted for lesser time in our setup.One hundred and Sixty two children undergoing surgery under general anaesthesia were selected randomly.They were divided into two groups. Group one was advised in a traditional way – no solid food aftermidnight and no liquid drink at least six hours before anaesthesia. Group two was given either glucosewater 2-4 hours before induction or breast milk 4 hours before induction of anaesthesia. None of the childrenwere premedicated.Anesthetic techniques were either sole intravenous anaesthesia (IVA) for minor cases or general anaesthesia(GA) and combined methods (IVA or GA with regional blocks). Patients were closely monitored for anyactive regurgitation and vomiting during the induction of anaesthesia, perioperative and postoperativeperiod. Complications were analyzed in different age groups, different fasting hours and type of anaesthesiadelivered.None of the children had any regurgitation or vomiting during induction and perioperative period. Fewchildren of both groups vomited during postoperative period when they were fully conscious.As the chances of regurgitation and vomiting with clear fluid given two hours before is comparable with thetraditional system, there is no need to put the child starved for prolonged period. This will avoid unnecessarydehydration, hypoglycemia and uncoperation in the children.Key Words: Pre-anaesthetic fasting, regurgitation, dehydration.