Objective: The main goal of this study was to investigate the groups receiving fentanyl-propofol (fentP) against ketamine-propofol (ketP) in ERCP in terms of sedation, rescue sedation requirement, and recovery scores. Additionally, evaluated were the procedure's hemodynamic changes, postoperative pain score, complications, and endoscopist satisfaction. Methodology: A double-blinded randomized clinical trial was undertaken at the Dr. Ruth K.M. Pfau Civil Hospital Karachi's endoscopic room (DUHS) for six months. By using OPEN EPI sample size calculator, sample size was calculated. A total of 124 patients for elective ERCP were randomized into two groups by SNOSE protocol. Groups A and B, fentanyl-propofol (fentP) and ketamine-propofol (ketP), respectively, each contain 62 patients. All patients were given a loading dose of propofol 0.5 mg/kg, followed by a 75 ug/kg/minute infusion. The group fentP received fentanyl 1ml/kg (1 ug/kg) and the group ketP received ketamine 1ml/kg (0.5mg/kg). Ramsay sedation scores, the necessity for rescue sedation, and the Aldrete score post-operatively were noted. Hemodynamics during surgery and complications were also noted. Results: Sedation began noticeably earlier than usual in the group B at 0, 2 and 4 minutes (p-value <0.05), whereas sedation scores were higher in the group A at 8,10, and 15 minutes (p-value <0.05). Early sedation in the group B led to less consumption of rescue sedation doses (p-value <0.01). However, recovery scores were comparable in each groups (p-value >0.05). Conclusion: We were able to conclude that during ERCP, ketP had a significantly faster sedative onset than fentP, with less complication and a quicker recovery. Keywords: Propofol, KetP, FentP, ketamine, fentanyl, Sedation, Analgesia, ERCP, Monitored Anesthesia care.

Background & Objective: Laryngoscopy and intubation (L&I) are strong stimulus for cardiovascular system. Hypertensive patients have a greater incidence of coexisting coronary artery disease and cerebrovascular insufficiency. Several methods have been in practice to prevent or alter the hemodynamic response to L&I. Although the main use of gabapentin has been as an antiepileptic, but its effect on the hemodynamic reflexes is still under evaluation. We compared the effectiveness of a single dose of gabapentin 800 mg on the mean arterial pressure (MAP) in response to L&I in hypertensive patients undergoing day care surgery. Methodology: This randomized, control trial was conducted in operating rooms, Dr Ruth K M Pfau Civil Hospital Karachi, from May 2017 to November 2017. A total of 150 patients undergoing elective surgery requiring general anesthesia with tracheal intubation were included in this study. Patients were randomly allocated equally into two group; Group G (gabapentin group) and Group P (placebo group). Patients in Group G received gabapentin 800 mg and Group P received placebo, 2 h prior to induction of anesthesia. MAP was measured at baseline (before induction), before intubation (after induction), at time 0 (immediately after intubation), and at 1 min, 3 min, 5 min, and 10 min after intubation. Effectiveness was defined as all the MAP reading to be within 30% of the baseline reading. Results: There were 72(48%) males and 78(52%) females. Effectiveness was significantly higher in patients of Group G, as compared to placebo group (Group P) [94.7% vs. 65.3%; p = 0.0005]. Conclusion: Gabapentin effectively suppresses the increase in MAP in response to laryngoscopy and tracheal intubation as compared to the placebo. Abbreviations: L&I: Laryngoscopy and intubation; MAP: Mean arterial pressure; ECG: Electrocardiography; ASA: American Society of Anesthesiologists; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure  Key words: Laryngoscopy; Intubation; Hypertension; Gabapentin; Stress response Citation: Riasat MI, Chohan HT, Kumar A, Sultan SF, Javaid H, Siddiqui SZ. Premedication with gabapentin for laryngoscopy: a double-blind randomized control trial in hypertensive patients. Anaesth. pain intensive care 2021;25(2):163-169. DOI: 10.35975/apic.v25i2.1464

Severe spine curvature disorders are commonly associated with multiple pathophysiological challenges during airway management, secondary to physiological and anatomical factors. These factors are mostly related to the reduced vital capacity and chest wall compliance, along with the misalignment of axes and limitation in neck movement. Careful assessment and planning of alternative strategies by experienced anesthesiologists, appropriate positioning, and proper use of rescue devices can significantly improve the chances of successful intubation. In this report, we present a case of a 26-year-old man with severe spine curvature abnormality, unstable vitals, low Glasgow Coma Scale (GCS) score, and low oxygen saturation necessitating emergency intubation. We shed light on the importance of proper airway assessment and good team communication and also highlight the technique used for emergency intubation in case of an anticipated difficult airway.