Objective: To compare propofol and sevoflurane anesthesia in terms of mean extubation time among patients undergoing laparoscopic cholecystectomy. Study Design: Randomized Controlled Trial Study Setting: National Hospital and Medical Centre, Lahore Sampling Technique: Consecutive non-probability sampling Study duration: 06-02-18 to 06-08-18 Methodology: The cases with age range of 16 to 60 years of either gender with ASA status 1 and 2 undergoing laparoscopic cholecystectomy were included. group A was given propofol and group B sevoflurane in standard dose and they were assessed for mean extubation time. Results: In the present study there were total 60 cases with 30 in each group. There were 14 (46.67%) males in group A vs 16 (53.33%) in group B. The mean age in the group A was 40.03±13.68 years while in group B was 36.83±10.64 years. Mean BMI was 25.27±2.05 vs 25.43±1.85 in group A and B respectively. There were 19 (63.33%) cases in ASA class 1 in group A and 16 (53.33%) in group B. Mean extubation time in group A and B was 7.16±2.80 vs 3.68±0.87 with p= 0.0001. Mean time of extubation was significantly longer in group A in terms of gender, age and ASA class. Conclusion: Mean extubation time was significantly shorter in group B managed by Sevoflurane as compared to Propofol and this difference was statistically significant in terms of all the variables in the form of age, gender and ASA class. Thus sevolflurane anaesthesia is superior to propofol. Keywords: Anesthesia, Sevoflurane, Propofol, Extubation Time, ASA Status.

Background: To keep the airway open, a flexible plastic tube (ETT) is inserted into the trachea during tracheal intubation. Even when done correctly, tracheal intubation requires much clinical experience, and catastrophic problems can occur. Mandibular space has been estimated using hyomental distance (HMD), although HMD has only been found to provide a limited amount of diagnostic accuracy on its own. In order to determine how well the Hyomental Distance Ratio (HMDR) predicts difficult laryngoscopy, we conducted this study. Objectives: Using the Cormack and Lehane classification as the gold standard, the objective is to assess the diagnostic validity of the Hyomental Distance Ratio (HMDR) for the prediction of challenging laryngoscopy in patients undergoing surgery under general anaesthesia. Materials & Methods: The department of anesthesiology and the general surgery operating rooms at Sir Ganga Ram Hospital in Lahore conducted this cross-sectional study over the course of six months in 2015–2016. The approach of non-probability purposive sampling was applied. Informed consent was acquired, and patient demographics were recorded. The researcher herself then assessed patients for HDMR. In order to determine if a patient had a difficult or normal laryngoscopy, HDMR was determined. After that, the researcher performed a laryngoscopy on the patients. If the vocal cords were visible, the mouth was opened, and the case was assessed using the Cormack and Lehane classification (CL), with easy or difficult laryngoscopy being designated. SPSS version 20 was used to enter and analyse all of the data. Results: The patients in our study had a mean age of 43.23 11.63 years and a male to female ratio of 1.5:1. In this study, 43.91% of patients had an HDR difficult intubation. HDR's difficult intubation has a sensitivity of 95.05%, a specificity of 96.12%, and a diagnostic accuracy of 95.65% when using CL as the gold standard. Practical Implication: According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Conclusion: According to the findings of our study, the HMDR is a viable diagnostic tool for anticipating challenging laryngoscopy in patients having general anaesthesia with tracheal intubation. According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Keywords: Laryngoscopy, difficult intubation, Cormack Classification, difficult surgery

Background: Postoperative nausea and vomiting is one of the most typical side effects following surgery and anaesthesia (PONV). There has been a significant paradigm shift in the approach taken to prevent PONV. There have also been a few new medical treatments for the prevention and treatment of PONV. Clinical trials and meta-analyses show that aprepitant prevents PONV better than ondansetron. Objective: To compare the frequency of PONV after administration of Aprepitant vs Ondansetron in laparoscopic cholecystectomy Materials and Methods: The Jinnah Hospital in Lahore's Laparoscopic Operation Theater conducted this randomised control trial over the course of six months, from 15 April to 15 October 2019. Two groups of patients were randomly assigned. Ondansetron 8 mg was given orally to Group O two hours before induction with a sip of water. Two hours prior to induction, Group A took 80 mg of aprepitant orally with a sip of water. Every patient was instructed to fast for 6–8 hours. A 20G cannula was used to create an intravenous line after entering the operation room, and Ringer lactate was started. During surgery, the following parameters are all monitored: heart rate, oxygen saturation (SpO2), electrocardiography, noninvasive blood pressure (NIBP), and end-tidal carbon dioxide concentration (EtCO2). Using an intravenous infusion of propofol 2 mg/kg, anaesthesia was induced. Atracurium 0.6 mg/kg intravenous was used to aid in endotracheal intubation. In order to maintain anaesthesia, oxygen and (0.5–1%) isoflurane were used. As an analgesic, nalbuphine 0.1 mg/kg and paracetamol 15 mg/kg were administered. Neostigmine 0.04 mg/kg intravenous and Glycopyrotate 0.008 mg/kg intravenous were administered at the conclusion of operation to reverse the neuromuscular blockade. The last stitch or staple was made at 0 hours. Prior to surgery, the patient or attendant was instructed to contact the on-call doctor about any episodes of PONV. PONV occurrence was observed every 12 hours for 48 hours. Results: In this study we compared Aprepitant and Ondansetron on prophylaxis of PONV in patients undergoing laparoscopic cholecystectomy. Results showed that frequency of PONV was significantly higher with Ondansetron as compared to Aprepitant. i.e. (14.6% vs. 24.2%, p-value=0.032). From 0-12 hours frequency of PONV was higher with Ondansetron while from 12-24 hours PONV was higher in Aprepitant. Practical Implication: Government and hospitals should devise ways and procedures for effective research work for the benefit of patients, so that patient’s post-operative complications and symptoms can be managed efficiently. Conclusion: Aprepitant is more effective than ondansetron at preventing PONV in patients having laparoscopic cholecystectomy, according to the findings of this trial. Keywords: Vomiting, Postoperative nausea, PONV, Aprepitant, Cholecystectomy, Ondansetron, General anesthesia

Objective: To assess the knowledge and understanding of importance of pre-anaesthesia assessment in developing countries like Pakistan. Design: Consecutive non-probability sampling Setting: CMH, Rawalpindi Subjects: All the patients coming to preanaesthesia assessment clinics for preoperative anaesthesia assessment Statistical Analysis: All statistical analysis was done in SPSS Ver. 22.0, descriptive analyses were used in terms of frequency and percentages, and unpaired t test was used to test the significance. Interventions: A predefined questionnaire was filled either passively by the doctor or actively by the patients themselves before being evaluated for anaesthesia fitness Result: About 50.6% of the population knew that they had come to the PAC for PAA and risk assessment, whereas 30.1% and 18.5% said they had come because the surgeon had ordered them to do so or to get the date of the surgery, respectively. 62.7% were aware that anaesthesiologist does the PAA, whereas the rest were not sure. On being asked why PAA is necessary 49.1% replied that it reduces the risks associated with surgery and anaesthesia whereas 29.5% said it helps to get the date of surgery. All these responses were compared with literacy levels and to their history of prior exposure to PACs, all of them were statistically significant with a p value <0.15. Practical Implications: The aim of this study was to know the importance of preanaesthesia assessment among the general population of a developing country like Pakistan coming for surgery, almost half of the patients were unaware of the purpose and were just obeying their surgeons advice to visit PACs, this attitude is what needs to be eliminated and awareness should be created among patients and also surgeons by incorporating importance of anaesthesia related risks in morbid patients and importance of preanaesthesia assessment and investigation Conclusion: Knowledge and perception regarding preanesthesia assessment is still lacking resulting in post-op complications for the patients and there is need of creating awareness regarding PAA so that complications could be avoided. Keywords: preanaesthesia assessment (PAA), preanaesthesia clinics (PACs), questionnaire, third world countries.

Background: Pain is a common complaint of patients after surgery. Different techniques or medications including local anesthetics infiltration, non-steroidal anti-inflammatory drugs or opioids have been used for postoperative analgesia. Lidocaine is an amide local anesthetic agent that works by influencing the complex phenomenon of pain. Aim: To compare the mean pain score with intraoperative lidocaine versus control in patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: 350 patients aged 20-60 years of either sex scheduled for laparoscopic cholecystectomy were included in the study. Patients with allergy to lidocaine; patients with neuromuscular disease, endocrine or metabolic disorder and pregnant patients were excluded from study. Patients were randomly divided in two groups by using lottery method after taking informed consent. On arrival to the operating room, monitor was attached to display continuous ECG, mean arterial blood pressure, and arterial oxygen saturation. Results: In lidocaine group, the mean age of patients was 39.93±11.56years. In control group, the mean age of patients was 37.93±11.83years. In lidocaine group, there were 91 (52%) males and 84 (48%) females. In control group, there were 77 (44%) males and 98 (56%) females. In lidocaine group, the mean BMI of patients was 26.66±4.81kg/m2. In control group, the mean BMI of patients was 26.77±4.76kg/m2. In lidocaine group, the mean pain score of patients was 1.00±0.84. In control group, the mean pain score of patients was 2.39±1.10. The difference was significant (p<0.05). Conclusion: Thus lidocaine is found to be more effective in reducing postoperative pain than control. Keywords: General anesthesia, laparoscopic cholecystectomy, lidocaine, postoperative pain.