Background:The stress response is a common phenomenon occurred during laryngoscopy. Although this response can be transient and less harmful in healthy individuals, it might be hazardous among the many patients with underline disorders. Aim of the study:The purpose of the study was to compare the two different routes for lidocaine to determine the blunt stress response during laryngoscopy. Study design: A randomized control study was designed. Method: This randomized control study design was performed in the Department of Anesthesia, Critical Care, and Pain Medicine at Aziz Bhatti Shaheed Teaching Hospital, Gujrat. The duration of the study was from February 2021 to Jun 2022. The participant of this study was 70 in number having age between 30-60 years and was divided into two groups via a computer-generated randomization sheet. The first group name, group-A contains 35 patients, single dose of 200mg intravenous lidocaine was given before the laryngoscopy procedure. The second group was group B consisted of 35 patients who had to receive the topical (spray) lidocaine in a single dose of 200mg. Results: Group-A patients who had received the IV, lidocaine had a systolic blood pressure mean ± SD value of 120.03 ± 9.72 with a p-value of 0.021 which indicate the systolic was under control. Diastolic pressure means ± SD value was 75.81 ± 10.46 with a P-value of 0.012 which shows the significant effect of lidocaine to reduce the pressure. Arterial pressure was measured with mean ± SD = 75.34 ± 9.61 value. Group B patients who received the topical lidocaine dose, shows a 140 ± 10.87 mean ± SD value of systolic blood pressure and diastolic blood pressure mean ± SD value was 85.42 ± 11.01 recorded. Arterial pressure with mean ± SD = 98.34± 9.13 value and significant p-value shows the higher arterial pressure. The use of topical lidocaine was not effectively controlling heart rate as indicated by mean ± SD = 99.87±10.14. Conclusion:Overall, the study suggests that prophylactic intravenous given laryngoscopy will provide a significantly positive response to handle the blunt stress response in a better way as compared to topical use of lidocaine.

Mini-Percutaneous Nephrolithotomy (Mini-PCNL) and Retrograde intra-renal surgery (RIRS), can be carried out in a single stage or numerous phases depending on the burden, size, and/or location of the stone. Objective: To check the efficacy of Mini-Percutaneous Nephrolithotomy and Retrograde intra-renal surgery on adult patients with a renal stones. Methods: A total of 101 patients were included who underwent RIRS (n=51) or mini-PCNL (n=50) at Doctors Hospital Jail Chowk in Gujrat, Pakistan in 2021. Retrospective observations were made on 101 individuals who received RIRS or mini-PCNL. Results: The mean hospital stay time was significantly lower in RIRS group i.e., 01.81 ± 0.59 days as compared to mini-PCNL group (p value <0.001). The operation time was 63.72 ± 14.94 minutes for mini-PCNL and 72.65 ± 15.83 minutes for RIRS group. The stone clearance rate was 92% in mini-PCNL group and 82.35% in RIRS group. Conclusions: In conclusion, we found that both mini-PCNL and RIRS are safe and effective ways to treat renal calculi. RIRS is a non-invasive, practical therapeutic option with reduced hospitalizations times, morbidity, and complication rates for these individuals.

Background: Hypotension is a frequent complication highly associated with spinal anesthesia during lower segment cesarean section that imposed adverse effects related to maternal as well as fetal. Purpose: The purpose: of this study is to lighten the comparison of vasopressor (Phenylephrine boluses vs. noradrenaline boluses) use to treat hypotension after spinal anesthesia in LSC patients Study design: randomized double-blind study design. Method: This randomized double-blind study was performed at the department of anesthesia, critical care, and pain medicine at Aziz Bhatti Shaheed Teaching Hospital, Gujrat Pakistan, and was conducted from Jun 2020 to Jun 2021. The patients aged between 20 to 40 years who went through lower segment cesarean section were part of this study. A total of 60 patients were divided into two groups namely groups A and B. Group A contain 30 patients in the same way group occupied with 30 patients and by using a random allocation procedure or protocol, the randomized number was assigned to all patients via the computergenerated system. Group A received phenylephrine and Group B received noradrenaline. Results: Statically analysis was performed using SPSS software. In the case of group A, the mean arterial pressure was measured at 115.03 ± 8.69, heart rate, beats/min was measured at 65.72 ± 9.46, and bradycardia was found in 14 (46.6%) patients out of 30 of group A with a mean value of beats 43.65 ± 3.23, hypotension was found in 4.31 ± 2.11 cases and to treat its repeated episodes with phenylephrine boluses was used 4.21 ± 1.21. In the case of group B, the mean arterial pressure was measured at 121± 9.86, heart rate, beats/min was measured at 80.42± 8.01, and bradycardia was found in 8 (26.6%) patients out of 30 of group B with a mean value of beats 45.23± 2.13, hypotension was found in 2.21± 1.03 cases and to treat its repeated episodes with noradrenaline boluses was used 3.98± 1.32 and all the variables was found with significant results. Conclusion:We conclude that noradrenaline shows ameliorated response to handle the hypotension situation after spinal anesthesia as compared to phenylephrine.

Kidney stones, also known as renal calculi, are crystal concretions that primarily occur in the kidney and are referred to as nephrolithiasis. Ideally, calculi should form in the kidneys and pass out of the body through the urethra painlessly. Larger stones are uncomfortable and thus require surgery. Mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are the minimally invasive procedures employed these days to target renal stones. Objective: To compare the effectiveness of both mini-PCNL and RIRS in terms of targeting larger stones in adult patients along with other factors including hospital stay, operative time, stone passing rate and associated complications. Patients and Methods: In the year 2021, 101 patients undergoing mini-PCNL or RIRS in Doctors Hospital, Gujrat were observed in this study. Effectiveness of both the techniques, exposure time, transfusions required, stone free rates and hospital stay were compared in both groups of patients. Results: It was found that mini-PCNL has greater potential than RIRS in terms of stone clearing and operating time. However, RIRS has performed better in terms of reducing the hospital stay with mild complications in both the procedures. Conclusion: Both RIRS and mini-PCNL are extremely safe and highly efficient treatments for renal lithiasis with a diameter of 1.5 to 2.5 cm, and either one can be chosen to achieve outstanding stone-free rates.