Morgagni hernia (MH) is a congenital diaphragmatic hernia that is often asymptomatic in adult patients. These defects may be discovered incidentally during the intraoperative period and repaired laparoscopically with tension-free synthetic mesh when surgery is warranted. Presently, there is a dearth of studies addressing incidental MH repair in the setting of concomitant bariatric surgery. As such, there are no clear guidelines as to whether or not asymptomatic hernias found incidentally during bariatric surgery require operative repair. Herein, we present the case of a morbidly obese female patient with an incidental Morgagni defect that was identified during an elective sleeve gastrectomy. We also reviewed the literature to assess the efficacy of concurrent bariatric surgery and hernia repair.

Background: The myoclonus after induction of anesthesia with etomidate can lead to increased risk of regurgitation and aspiration. We conducted this study to compare the effectiveness of midazolam and lidocaine for the prevention of etomidate induced myoclonus. Methodology: This randomized controlled trial was done in the Department of Anesthesiology and Intensive Care, Holy Family Hospital, Rawalpindi from January-June 2015 after approval of hospital ethical committee. Informed consent (written) was taken from 224 patients. Patients were allocated into 2 equal groups randomly with the help of computer-generated numbers. Two minutes after induction with etomidate, Group A got 1 ml of 2% lidocaine, and one ml (1 mg) of midazolam was given to Group B. Myoclonus was evaluated in the following one minute, after which 0.5 mg/kg of succinylcholine was given to the patient to facilitate endotracheal intubation. Time of onset of induction was marked by loss of eyelash reflex. Myoclonus was recorded at 20, 40, and 60 seconds. Drug was found to be effective if there was no myoclonus within one minute of etomidate induction. Analysis of data was done using SPSS 17. Results: Lignocaine was effective in preventing myoclonus in 55.40% of patients and Midazolam prevented it in 69.60%. The variation between the results of the groups was found significant statistically. (P< 0.05) Conclusion: Both midazolam and lignocaine are effective in preventing the occurrence of myoclonus associated with etomidate. However, midazolam is the more effective of the two drugs. Keywords: Etomidate, Lignocaine, Midazolam, Myoclonus

Background: Postoperative pain creates complications by increasing circulating level of catecholamines and systemic vascular resistance, thus putting the patients on increased risks of having stroke and myocardial infarction. In addition, it increases hospital stay, causing burden over economic as well as healthcare infrastructure. The aim of this study was to determine the frequency of pain in the postoperative period while using Pregabalin as pre-medication among patients undergoing laparoscopic cholecystectomy.Material and Methods: The randomized control trail was conducted at Department of Anesthesiology, Holy Family hospital, Rawalpindi from 1st Sept 2015 to 28th Feb 2016 over a period of 6 months. A total of 200 patients undergoing laparoscopic cholecystectomy were randomly divided in group A and B by consecutive non-probability lottery method. Group A received 100 mg oral Pregabalin 1 hour before surgery and Group B were not given Pregabalin and were taken as controls. Post-operative pain was measured by visual analog scale (VAS) in terms of pain scores at 4 hours postoperatively after the arrival of patient in the post-anesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data.Results: A total of 200 patients were included in the study. There were 100 patients in each group. Based on the visual analog pain scores, 9 patients were pain free in group A compared with none in group B. Similarly, there were 55 patients in group A, who reported a pain score of 1 whereas no patient in group B had a VAS score of 1. There were 29 patients in group A and only 3 patients in group B with VAS score of 2 (90.6% vs. 9.4%). For VAS score of 3, there were 6 patients in group A and 34 patients from group B (15% vs. 85%). For a VAS score of 4, there were 1 patient in group A and 61 patients in group B (1.6% vs. 98.4%). Two patients in group B experienced a VAS score of 5. All this data was significant with chi square p value of 0.0001.Conclusion: Oral Pregabalin administered prior to laparoscopic cholecystectomy was effective in reducing postoperative pain in the patients. Further studies are needed for post-operative evaluation of side effects, different dosing schedules at different time intervals for both rest and dynamic pain.

Objective: To compare the efficacy of intravenous paracetamol and rectal diclofenac combination with caudal block using 1ml/kg of 0.25% bupivacaine in the management of post-operative pain following paediatric inguinal herniotomy. Methodology: This quasi-experimental study was conducted at the Department of Anesthesia, Holy Family Hospital, Rawalpindi, from February 2020 to August 2020. A total of 342 children aged 2-12 years requiring inguinal herniotomy were enrolled after satisfying the inclusion and exclusion criteria. Computer-generated random numbers were used to split the patients into two groups. Group A received intravenous paracetamol (30 mg/kg) and rectal diclofenac (1mg/kg). Group B received a caudal block using 1ml/kg of 0.25% Bupivacaine. Pain was assessed postoperatively in the PACU by modified Objective Pain Scale (OPS) every 15 minutes for the 1st hour and hourly up till 8 hours. Effective analgesia was defined as a modified OPS score of ≤ 3 for upto 8 hours after shifting to PACU. If at any time, the score was >3 and the patient required a rescue analgesic, effective anaglesia was not achieved. Results: Effective analgesia was achieved in 82.46% of the patients (n=141) in Group-A versus 87.13% patients (n=149) in Group-B (p-value: 0.23).  Conclusion: There is no significant difference in the efficacy of analgesia in paracetamol/diclofenac combination group compared with caudal bupivacaine group.