Airway fires pose a serious risk to surgical patients. Fires during surgery have been reported for many years with flammable anesthetic agents being the main culprits in the past. Association of airway fires with laser surgery is well-recognized, but there are reports of endotracheal tube fires ignited by electrocautery during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially grave consequences. While airway fires are relatively uncommon occurrences, they are very serious and can often be fatal. Success in preventing such events requires a thorough understanding of the components leading to a fire (fuel, oxidizer, and ignition source), as well as good communication between all members present to appropriately manage the fire and ensure patient safety. We present a case of fire in the airway during routine adenotonsillectomy. We will review the causes, preventive measures, and brief management for airway fires.

Objective: To determine the characteristics, management and outcome of patients with traumatic brain injury (TBI) and associated risk factors. Methods: This cross-sectional study was conducted at Shaheed Mohtarma Benazir Bhutto Institute of Trauma from January 2018 to April 2019. TBI patients ≥16 years of age that were admitted to the intensive care unit (ICU) or high dependency unit (HDU) and managed conservatively or surgically, were included. Central nervous system (CNS) infection, mortality and associated risk factors were noted. Results: The mean age was 30.9 ± 13.6 years with 116 (91.3%) males. CNS infection developed in 72 (56.7%) patients. Of 72, 29 (40%) had positive CSF culture and in 28 (38.8 %) multidrug resistant Acinetobacter spp. susceptibile to only colistin was reported. Antimicrobial therapy with intravenous colistin with meropenem was used in 63 (87.5%) patients. A significant association of CNS infection was found with age (p-value 0.047), cerebrospinal fluid (CSF) leak at presentation (p-value 0.045), type of surgery (p-value 0.001), and duration of ER stay (p-value 0.047). Mortality occurred in 83 (65.4%) patients. A significant association of mortality was found with low Glasgow coma scale (GCS) at presentation (p-value 0.031), CSF leak at presentation (p-value <0.001), intraventricular hemorrhage, TBI type (p-value <0.001), polytrauma (p-value 0.003), CNS infection (p-value <0.001), and duration of emergency room stay (p-value 0.009). Conclusion High mortality was observed in patients with traumatic brain injury. Intracranial infection is strongly correlated with mortality underscoring the need for strict infection control and prevention measures.

Objective: To compare the analgesic effectiveness of Dexmedetomidine and Fentanyl as an adjuvant to 0.5% Bupivacaine in spinal anaesthesia for patients undergoing lower limb surgery. Study Design: Randomized controlled trial. Place & Duration:The study was conducted at department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi for duration from 15thJuly2020 to 15thFebruary 2021. Methods: In this study 52 patients of both genders undergoing lower limb surgeries were included. Patient’s ages were ranging from 20 to 70 years. All the patients were divided into two Groups. Group A included 26 patients and received Inj. Dexmedetomidine 10 μg in 0.5ml normal saline with 12.5mg of 0.5% hyperbaric bupivacaine, Group B had 26 patients and received 25mg fentanyl with 12.5mg of 0.5% hyperbaric bupivacaine. Time to achieve T10 blockade, time to first rescue analgesia were examined and compare between both groups. All the statistical data was analyzed by SPSS 24.0. P-Value <0.05 was significantly considered. Results: Mean age of group A was 40.52±12.28 years and in group B it was 40.14±13.34 years. There were 18 (69.23%) male patients and 8 (30.77%) females in group A while in Group B 19 (73.08%) patients were male and 7 (26.92%) were females. No significant difference was observed between both groups regarding time to T10 blockade with p-value >0.05. A significant difference was found regarding time to rescue analgesia, in Group A it was 426.58±92.44 minutes and in Group B, it was 206.44±48.47 minutes (p-value <0.0001). Patients’ satisfaction was high in dexemedetomidine group as compared to fentanyl group. Conclusion: Dexmedetomidine 10 μg with 0.5% bupvicaine showed better effectiveness regarding time to first rescue analgesia as compared to fentanyl. No significant difference was observed regarding time to sensory blockade between both medications. Keywords: Dexmedetomidine, Fentanyl, Spinal Anaesthesia, Lower Limb Surgery, Sensory Block, Analgesia