Background: Procedural sedation is required for multiple short duration procedures outside of the operating rooms especially in radiology and endoscopy suites. Intravenous anesthetic agent with rapid recovery profile is desirable in such circumstances. This study aims to compare two regimens of intravenous anesthetic agents. Aim: To compare the mean recovery time of propofol and midazolam with propofol alone for sedation in endoscopic retrograde cholangiopancreatography. Study Design: Randomized controlled trial. Settings: Department of Anesthesia, Shalamar Hospital, Lahore. Study Duration: June 2017 to December 2017. Methods: A total of 70 adult patients aged 20-60 years undergoing ERCP under sedation were included. Patients were given a combination of propofol and midazolam in group A while propofol alone was given in group B. After procedure, pts were transferred to recovery room and were followed for assessment of recovery time. Data were analyzed in SPSS vr 21, Independent t-test was applied & p-value ≤0.05 was considered statistically significant. Results: Significant difference was found in mean recovery time amongst both the groups. Mean recovery time in Group A (propofol and midazolam) was 19.29±4.50 minutes while in Group B (propofol alone) was 26.66±3.70 minutes showing statistically significant result with p-value = 0.0001. Conclusion: We conclude that mean recovery time with propofol plus midazolam is shorter as compared to propofol alone for sedation in ERCP. Keywords: Propofol, midazolam, sedation outside operation theatre.

Background: Patients in ICU presenting with severe disease suffer from multidrug-resistant bacteria, resuting in reduced therapeutic options which cover ICU pathogens spectrum. Identification of causative organism and its antibiotics sensitivity pattern has become cornerstone for antibiotic selection. β-Lactams i.e. cephalosporins, carbapenems, penicillins, and monobactams constitute 60% of total antibacterials used, however; with high usage of such antibiotics the emergence of resistance. Aim: To determine prevalence of local type of bacterial isolates and their antibiotic susceptibility. Study Design: Cross sectional study Place and Duration of Study: Medical ICU, Pakistan Ordinance Factories Hospital, Wah Cantt from 1st January 2020 till 31st July 2021. Methodology: One hundred patients were enrolled. Samples were taken from blood, sputum, bronchoalveolar lavage and tracheal secretions of the patient and sent to microbiologist for culture and sensitivity reports. Results: The mean age was 57.52+13.427 years, 47 females and 53 male patients. 72 patients were shifted out and remaining 28 died. In 57 patients, sputum specimen was taken, blood specimen of 24 patients, tracheal secretion of 8 patients and 11 patients bronchoalveolar lavage was taken. 33 were positive for Klebsiella pneumoniae, 29 patients were positive for acinetobacter baumanii. Pseudomonas aeuriginosa was positive in 18 patients, 05 patients for E. coli. In gram positive category; 05 patients were positive for staph aureus, 06 patients for MRCONS, 3 to MRSA and 1 patient for coagulase negative staphylococcus species. Conclusion: The high levels of antibiotic resistance are seen among both gram negative and gram positive isolates. Presence of elevated resistance to multiple drugs is an indicator for high prevalence of multi-drug resistant gram positive as well as gram negative organisms, so proper identification of organism in order to ascertain administration of emperical drugs most effective against the isolated organism is recommended in severe cases. Keywords: Antibiogram, Bacterial isolate, Pneumonia, Sensitivity

Background: Rotator cuff (RC) tendinopathy accounts for majority of shoulder conditions in adult patients resulting in shoulder pain and occupational disability. Recently injections around joint area typically including corticosteroid, local anaesthetic, opioid and a non-steroidal anti-inflammatory drug (NSAID) have been used for treatment of such conditions. Aim: To compare the efficacy of ultrasound-guided injections of platelet-rich plasma (PRP) and corticosteroids on clinical and functional assessment. Study design: Double blind randomize controlled trial Place and duration of study: Department of Orthopaedic Surgery, POF Hospital, Wah Cantt and Izzat Ali Shah Hospital Wah Cantt 1st January 2020 to 31st January 2021. Methodology: Sixty patients was tendinitis or partial tear of rotator cuff tendon, had pain for >3 months and >40 years old were enrolled. Patients were randomly divided into two groups; Group A patients were administered corticosteroid injections, the Depo-medrol 40mg and Group B patients were administered PRP injections. Results: The mean age was 55.9±4.3 years in group A while in group B mean age was 55.2±5.2 years. After treatment the mean VAS scores were 4.39±1.8 in group A and in group B was 3.27±1.5. In group A after treatment mean ROM was 28.34±4.6 and in group B mean ROM was 32.64±5.2 (P<0.001) considered significant. Conclusion: Corticosteroids use limitation of being contraindicated in few individuals and associated risk of tendon rupture. The use of PRP among patients with rotator cuff tendinopathy as results showed marked improvement in pain intensity and range of movements after PRP administration. Keywords: Corticoteroids, Plasma rich plasma (PRP), Rotator cuff tendinopathy

Objective: To determine the effect of intravenous xylocaine and magnesium sulfate on attenuation of hemodynamic response to laryngoscopy and intubation in patients undergoing general anaesthesia. Methods: This was a randomized controlled study carried out at operation theaters of services hospital lahore after obtaining approval from IRB of hospital. The data was collected over period of six month from 20.05.2020 to 20.12.2020 through electronic databases. 60 patients were divided into two groups of 30 each by lottery method in this randomized control trial. Intravenous magnesium sulphate 30 mg/ kg diluted in 50 ml normal saline 15 min before induction was administered in M group and 50 ml normal saline given in L group. Induction was done with propofol 2 mg/ kg, followed by suxamethonium 2 mg/ kg. I/V lignocaine 1.5 mg/kg diluted in N/S (5ml) was given as bolus in L group and 5 ml N/S IV bolus in M group 1 minute before intubation. Laryngoscopy was performed and the trachea was intubated after 1 minute. HR, systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP) were measured just before securing intravenous access, just before induction, after intubation and 1,3,5 min post intubation. Results: Mean age for both groups was 36.0±12.8 and 38.2±10.8. Mean HR was significantly different between two groups immediately after intubation (p=0.010), and at 1, 3 and 5 minutes also (p=0.004, p=0.018 and p=0.024) respectively. No significant difference was seen in systolic, diastolic and mean blood pressures at intubation, 1 minute, 3 minutes and 5 minutes after intubation among the groups (p>0.05). Conclusion: Both Magnesian Sulfate and lignocaine are effective in attenuating haemodynamic response to laryngoscopy and intubation but magnesium sulphate provides better efficacy in control of heart rate. Key Words: Haemodynamic response, laryngoscopy, Intubation, magnesium sulphate, lignocaine. How to cite: Azam M., Amjad A.W.M., A. Khaleeq S., Asad N. Comparison of Intravenous Magnesium Sulphate and Lidocaine effects on attenuating haemodynamic variables to laryngoscopy and intubation in patient undergoing general anesthesia. Esculapio 2021; 17(01):65-70 DOI

Background: Shivering is a normal physiologic protective mechanism of the body, which in response to core hypothermia, increases metabolic heat production that results in involuntary, oscillatory muscle activity. Spinal anesthesia promotes redistribution of body heat from central to the peripheral compartments. After spinal anesthesia shivering occurs in 40-60% of patients. Tramadol is synthetic codeine analog that is weak Mu opioid receptor agonist. It also has effect of norepinephrine and serotonin reuptake inhibition. It proves to be more effective in prevention and treatment of shivering and it also has less side effects then Mu opioid agonists. Objective: To compare the outcome of hyperbaric bupivacaine alone, with combination of hyperbaric bupivacaine and tramadol to prevent frequency of shivering in spinal anaesthesia. Study Design: Randomized clinical trial study. Place and Duration of Study: Department of Anaesthesiology & Gynaecology, POF Hospital, Wah Cantt, HIT Taxilla and Izzat Ali Shah Hospital, Wah Cantt from 1st December 2018 to 31st December 2020. Methodology: One hundred and 100 patients were included and divided into two equal groups. Patients in Group A received 2ml of 0.75% hyperbaric bupivacaine (15mg) and group B received 2ml of 0.75% hyperbaric bupivacaine (15mg) and preservative free tramadol (10mg, 0.2ml) in spinal anesthesia. Results: There were 13 (26%) female patients in group A and 37 (74%) male patients. In group B there were 35 (70%) male patients and 15 (30%) female patients. The mean age in group A was 42±8.05 years and 42±8.02 years in group B. Thirty two (64%) in whom shivering was present and 18 (36%) no shivering accrued in group A while in group B, 11 (22%) in whom shivering was present and 39 (78%) no shivering accrued (P<0.05). Conclusion: Post-anesthetic shivering appeared to be present in post spinal anaesthesia patients very commonly. Administration of tramadol has proved to significantly reduce incidence of shivering. More studies still need to be done on tramadol to confirm its efficacy in preveting and stopping shivering without systemic effects on patients. Keywords: Spinal anaesthesia, Bupivacaine, Tramadol, Shivering