Objective: To evaluate the diagnostic accuracy of auscultation in the detection of inappropriate positioning of endotracheal tube, in patients undergoing elective surgeries, by taking fiberoptic bronchoscopy as gold standard. Study design: cross sectional study Place and duration: Department of anesthesia, Nishtar Hospital, Multan Methodology: A total of 205 patients admitted in general surgery ward were included in the study. The pre-operative assessment was done one day before surgery. The level of difficulty of intubation was assessed during pre-operative assessment. SPSS version 23 was used for data analysis. Tests of significance chi square and t-test were applied. P-value < 0.05 was taken as statistically significant. Results: Therefore, the estimated sensitivity was 72.03%. The estimated specificity was 65.6%. Positive predictive value was 73.9% and negative predictive value was 63.3%. Two hundred and five patients were included in this study of both genders. Gender distribution revealed as n=144 (70.2%) males and n=61 (29.8%) females. The mean age of the patients was 38.92±10.61years. ASA status I and II observed as n=121 (59.0%) and n=84 (41.0%), respectively. Mallampati grading I and II observed as n=127 (62.0%) and n=78 (38.0%), respectively. Laryngoscopy grading I and II observed as n=135 (65.9%) and n=70 (34.1%), respectively. Practical Implication: The main objective of this study was to evaluate the relative diagnostic accuracy of auscultation during GA. Therefore, we evaluated each technique's sensitivity, specificity, (PPV), (NPV) and overall accuracy in detecting incorrect endotracheal tube positioning. Conclusion: The five point auscultation technique is a reliable method of confirmation of endotracheal intubation, as verified by flexible fiberoptic bronchoscope. Keywords: Auscultation, Fiberoptic bronchoscopy, General analgesia, Diagnostic accuracy, sensitivity.

Aim: Patient loyalty is a crucial indicator of health-care effectiveness. Moreover, there are really only some few researches has looked into this topic. The major goal of our current research was to associate patient satisfaction in people treated upper limb procedures under regional anesthetic vs general anesthesia. The objectives were to compare span of hospital stay also durability of analgesia here among two procedures. Material and Methods: The cross-sectional research remained conducted in the tertiary care teaching hospital. The research comprised individuals seen between ages of 17 and 61 who were receiving upper limb surgery and had a physical state of American Society of Anesthesiologists grade 1–3. A 10-item prefab perioperative scale was used to collect client experience with anesthesia in cases getting GA and RA, having 120 Individual in every set, at least 24 hours following surgery. The Mann–Whitney–Wilcoxon tests remained utilized to associate statistical information among sets, while the Chi-square test has been employed for explanatory data. Results: Participants in the RA condition had substantially greater overall satisfaction than those in the GA group (P 0.002) across all 12 questionnaire items and the overall score. Analgesia frequency remained likewise considerably greater in RA than in GA (P 0.002). The period of hospital admittance in GA remained similarly considerably greater than in RA (P 0.002). Conclusion: For upper limb procedures, RA gives higher client experience than GA, as well as the longer time of analgesia in addition a shorter hospital admittance. Keywords: Individual loyalty, crucial indicator of health-care effectiveness, Regional Anesthetic Vs General Anesthesia.

Objective: To compare the analgesic efficacy of ultrasound (US) guided TAP block with landmark technique guided TAP block for management of post-op pain after open appendectomy in patients of acute appendicitis. Methods: In this study, we include 80 patients of acute appendicitis who were planned for open appendectomy were included. The study was conducted from June-2021 to Jan-2022 in Nishtar Hospital Multan. In Landmark TAP group; TAP block was given using bupivacaine (0.25%) after completion of surgical procedure using blind landmark technique. In US TAP group; TAP block was administered under US supervision. VAS Score and time of first rescue analgesia were main study outcomes. Results: Mean age was 33.5±9.9 years in landmark TAP group and 32.8±10.4 years in US TAP group (p-value 0.75). There was no significant difference in mean VAS score at 1, 6, 12 and 18 hours after surgery between the groups, However, after 24 hours of surgery mean VAS score was higher in landmark TAP group; 3.5±1.2 versus 2.9±1.0 in TAP group (p-value 0.02). Time of first rescue analgesia was significantly prolonged in US TAP group; 1320.7±275.9 minutes versus 1180.4±320.7 minutes in landmark TAP group (p-value 0.04). Conclusion: Ultrasound guided TAP block is superior to landmark guided TAP block, as it provides better analgesic outcomes in comparison of landmark guided TAP block. Keywords: Ultrasonography, landmark technique, transversus abdominus plane block.

Objective: To validate modified mallampati test with addition of thyromental distance and sternomental distance in prediction of difficult endotracheal intubation in adults presenting in surgical emergency. Study Deign: Prospective, single-blinded observational study Place and duration: Department of Anesthesia and intensive care Nishtar Hospital, Multan from August 2021 to January 2022 in one year duration. Methodology: A total of 120 patients were included in the study. Difficult intubation was predicted by measuring modified mallampati test following thyromental distance and sternomental distance. Validation of mallampati test and combining predictors was assessed by measuring sensitivity, specificity, positive & negative predictive value. Contingency table 2x2was designed. Results: The sensitivity and specificity of this procedure was 62.5% and 80.0%, respectively. Validity of combining all parameters to predict the difficult in endotracheal intubation was shown in table IV. The sensitivity and specificity of this procedure was 25.0% and 27.0%, respectively. Practical Implication: Endotracheal intubation is a common pre-operative complication having potential to lead poor post operative results. This study will help the anesthesiologists to overcome the problem of intubation and reduce the incidence of post operative complications in routine practice. Conclusion: Specificity of modified mallampati is too high, validity of combine parameters modified mallampati, sternomental distance and thyromental distance is very high when compared with mallampati test alone. All three parameters MMT, SMD and TMD can be used collectively for assessment of difficult airway in adult patients planned for surgery under general anesthesia. Keywords: Validity, anaesthesia, modified Mallampati test, endotracheal intubation, thyromental distance, sternomental distance

Aim: Patient loyalty is a crucial indicator of health-care effectiveness. Moreover, there are really only some few researches has looked into this topic. The major goal of our current research was to associate patient satisfaction in people treated upper limb procedures under regional anesthetic vs general anesthesia. The objectives were to compare span of hospital stay also durability of analgesia here among two procedures. Methods: The cross-sectional research remained conducted in the tertiary care teaching hospital. The research comprised individuals seen between ages of 17 and 61 who were receiving upper limb surgery and had a physical state of American Society of Anesthesiologists grade 1–3. A 10-item prefab perioperative scale was used to collect client experience with anesthesia in cases getting GA and RA, having 120 Individual in every set, at least 24 hours following surgery. The Mann–Whitney–Wilcoxon tests remained utilized to associate statistical information among sets, while the Chi-square test has been employed for explanatory data. Results: Participants in the RA condition had substantially greater overall satisfaction than those in the GA group (P 0.002) across all 12 questionnaire items and the overall score. Analgesia frequency remained likewise considerably greater in RA than in GA (P 0.002). The period of hospital admittance in GA remained similarly considerably greater than in RA (P 0.002). Conclusion: For upper limb procedures, RA gives higher client experience than GA, as well as the longer time of analgesia in addition a shorter hospital admittance. Keywords: Individual loyalty, crucial indicator of health-care effectiveness, Regional Anesthetic Vs General Anesthesia.