Background:Ketamine, in low doses, is known to possess intense analgesic properties. The available literature shows wide variation regarding the time and dose of administration of ketamine during surgery.Aim:The aim of this study was to evaluate the effect of intraoperative administration of ketamine when used as sole analgesic in low doses, on hemodynamics and postoperative analgesia in patients undergoing laparoscopic gynecological surgery and compared on the basis of duration of surgery.Settings and Design:This prospective, observational study was conducted from July to December 2015, over a period of 6 months in a tertiary care medical college and hospital.Materials and Methods:Seventy patients between 23 and 55 years planned for laparoscopic gynecological surgery were recruited. Ketamine was given in a dose of 0.5 mg/kg preoperatively and then repeated every ½ hourly in a dose of 0.25 mg/kg throughout the surgery. Hemodynamic parameters, time to the first rescue analgesia and complications were recorded for the first 8 h. Statistical evaluation was done and result expressed as percentage. Paired t-test was employed for the comparison of numerical variables within the group.Results:Seventy percent of the patients did not require any postoperative rescue analgesia during the first 8 h after surgery. None of the patients complained of pain immediately after extubation, and 16% of the patients had minor postoperative complications. The intraoperative hemodynamic profile was significantly altered. Duration of surgery and dose of ketamine required did not affect the duration of analgesia.Conclusion:Ketamine in low dose proved to be an efficacious analgesic even in the long duration laparoscopic gynecological surgeries. It stabilizes intraoperative hemodynamics thereby reducing the requirement of other anesthetic and antihypertensive agents.

Vesicovaginal Fistula (VVF), also called 'obstetric fistula', is an abnormal fistulous tract that extends from the urinary bladder ('vesico') to the vagina, resulting in an involuntary continuous discharge of urine into the vagina (urinary incontinence). It most commonly results from neglected and obstructed labor. Here we report a case of VVF with 18 years of distressing urinary incontinence after a difficult forceps delivery.

Vesico -cervical fistula is very rare accounting for approximately 4% of all urogenital fistulas. Vesico vaginal fistulas are commoner and usually follow prolonged obstructed labour and pelvic surgery. The woman may present with urinary incontinence, menouria and/ or amenorrhoea. Locating the exact site of the fistula may be difficult and surgical procedure depends on the same. A case of vesico cervical fistula following lower segment caesarean section is reported, thus highlighting the risks associated with caesarean section.

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