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Objective:To evaluate pre-operative implications, anesthetic management and post-operative anesthetic concerns in patientswith co-morbid diseases undergoing ambulatory laparoscopic cholecystectomy under general anesthesia. Study Design and setting:Retrospective study was conducted at Rawal Institute of Health Sciences, Islamabad from 8thOct 2017 to 5th Nov 2018. Methodology:Total one hundred and twelve patients were placed in American society of Anaesthesiologist (ASA) classII, III & IV (medically optimized) on pre-operative evaluation for ambulatory laparoscopic cholecystectomy. Generalanesthesia was administered with co-induction (nalbuphine 0.1mg/kg plus midazolam 0.01mg/kg) tracheal intubationfacilitated by 0.15mg/kg cis-atracurium. Post-operatively on clinical status evaluation and Post Anesthesia Discharge score,patients were shifted to respective ward /intensive care. Statistical analysis was done by SPSS v.21. Results:Pre-operatively medical and cardiologist evaluation was taken in 34(30.35%) and 42(37.5%) cases respectivelywhereas consultant anesthesiologist reviewed all cases. In study single case was converted to open method due to mirrizisyndrome and adhesions creating difficult laparoscopic dissection in 9(8.03%) of cases. Post-operatively in single caseatrial fibrillation with fast ventricular response noted followed by sudden bradycardia, managed and sinus rhythm restored,whereas in other case of ischemic heart disease with viral respiratory infection, needed ventilatory support after 2 hoursdue to respiratory distress and weaned off after 24hrs. In the study 76(67.9%) cases were shifted post-operatively to surgical ward and 36 cases (32.1%) needed intensive care treatment. Conclusion:Laparoscopic cholecystectomy in patients with co-morbid states requires balanced anesthetic technique considering consequences of pneumoperitoneum to decrease morbidity.

Introduction: Human immunodefi ciency virus (HIV) infection is a global health problem. Around 90% of infected persons live in developing countries, particularly those in sub-Saharan Africa and Southeast Asia. Ocular manifestations occur in approximately 70% of these patients. The objective of this study was to document ocular manifestations in HIV positive patients attending Khyber Teaching Hospital Peshawar, Pakistan. Methodology: It was a descriptive case series. The study was conducted at Khyber Teaching Hospital Peshawar from January to December 2007. A total of 14 patients were examined. These patients underwent complete ocular examination including assessment of visual acuity, pupillary reaction, ocular motility, ocular adnexa, anterior segment and posterior segment. CD4 count was done in all the patients. Results: Out of the 14 patients examined 6 (42.9%) had ocular manifestations, all of whom were male. The ocular manifestations included herpes simplex keratitis, herpes zoster ophthalmicus with neurotrophic keratitis, iridocyclitis, HIV retinopathy, retinal vasculitis and cytomegalovirus retinitis in one patient each. Amongst those with ocular manifestations, 5 patients (83.3%) had CD4 cell count of 100/mm3 or less and 1 patient (16.7%) had CD4 count between 101 and 200/mm3; and the mode of transmission was homosexual contact in 5 patients (83.3%) and vertical transmission in 1 patient (16.7%). Conclusion: Ocular manifestations occur in a considerable number of HIV positive patients particularly in those with CD4 cell count less than 100/mm3. Therefore, all HIV positive patients should be screened for ocular manifestations. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5899 SAARCTB 2011; 8(2): 31-36

Objective: To assess symptoms of nausea and vomiting in laparoscopic cholecystectomy post-operatively, administered anesthesia by sevoflurane or propofol and to assess the effect of dexamethasone and ondansetron anti-emetic combination. Study design & Setting: It was an experimental study design conducted from 08-Oct-2017 till 11-Jul-2018 at Rawal General & Dental Hospital. Methodology: Patients were recruited in interventional groups by lottery method as n=160, with 80 cases allocated in each group. The patients with gallstones planned for laparoscopic cholecystectomy after preoperative assessment were classified to American Society of Anesthesiologist (ASA) physical status class I-II. All the patients placed in a particular ASA physical status class were (exposed to both induction methods) either anesthetic induction by propofol 1-2 mg/kg (group-A) or by employing sevoflurane 4-8% (group-B) in combination with oxygen, while maintenance was done in both study groups with 2% sevoflurane and 50% nitrous oxide in oxygen. After procedure patients stayed in post-anesthesia care unit where intra-operative monitoring was evaluated. The primary end point of the study was to note the rate of nausea and vomiting in 24 hours interval after surgery. Results: Both sevoflurane and propofol are equally effective anesthetic induction agents. The same combination of dexamethasone and ondansetron was given to both groups and so the actual effect of both anesthesia drugs in terms of side effects were nullified. Conclusion: In laparoscopic cholecystectomy, both sevoflurane and propofol are good enough when administered with dexamethasone and ondansetron anti-emetic combination, for post-operative nausea and vomiting up to 24 hours observation time in study.