INTRODUCTIONMany physiological changes occur during the administration an anesthetic agent intravenously. Amongst them, most important changes occur in the hemodynamics of the patients mainly blood pressure and heart rate. Although propofol is preferred over thiopentone sodium for induction of anesthesia but one of the disadvantages of propofol is significant hypotension.A typical induction dose of propofol 2 mg/kg results in approximately 30% reduction in systolic blood pressure. The hypotensive effect of propofol is attributable to a decrease in sympathetic activity, direct vasodilatation and myocardial depression.2 Blood concentration of propofol depends on many factors such as age, gender, body weight, dose, cardiac output and infusion rate.2-4 Dose requirements of propofol induction depend on patient characteristics and infusion rate. 4 Cardiac output (CO) is ABSTRACT Background: The hypotensive effect of propofol is attributable to a decrease in sympathetic activity, direct vasodilatation and myocardial depression. The aim of the study was to assess the effect of propofol when injected at different speeds for induction of general anesthesia on the following parameters: blood pressure, time of induction of anesthesia, dose of propofol used.

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and  average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter  total hospital stay and reduction in days away from work at the cost of  longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Background: The purpose of this study is to evaluate the role of multi-slice computed tomography (CT) with reference to presence or absence of intestinal obstruction, level of obstruction, the cause of obstruction, and correlating with their clinical diagnosis.Methods: Patients were admitted directly from Out Patient Department or emergency department with complaints suggestive of intestinal obstruction. Computed tomography scan interpretations performed by experienced radiologists were compared with the final diagnosis that was made on the basis of information obtained clinically, by investigations, and by surgical findings.Results: Majority of patients were males 62%. Mean age 51.62±17.46 years. Majority presents with abdominal pain 94% and constipation 72%.The most common cause of obstruction was adhesion bands 18%.The pre CT diagnosis was changed because of CT findings in 28 patients. Only in 50 (89.28%) patients CT findings matched with intra-operative and cause of obstruction was also found, and in 6 (10.71%) patients intra-operative findings are different from CT findings. In bowel obstruction, the CT sensitivity was 89.28%, specificity 90.90%, positive predictive value 92.59%, negative predictive value 86.95% and accuracy 92.59%.Conclusions: We concluded that multi-slice CT is highly sensitive and specific in determining the presence, the cause and site of bowel obstruction, the site of obstruction and cause of obstruction. We recommended the use of CT scan when diagnosis between ileus and obstruction on the basis of clinical and plain radiographic are difficult or in patients in whome small bowel obstruction is diagnosed when conservative management is contemplated.

Background: The purpose of the study was to determine the sensitivity and specificity of laparoscopy in localizing non-palpable testes, its therapeutic role, mean operative time, conversion rate, complications and hospital stay.Methods: A total of 52 patients were included in the study and was conducted from June 2012 to June 2017. These boys were examined as outpatients, at the time of admission and after general anesthesia to exclude palpable testes and were subjected to diagnostic and operative laparoscopy.Results: We identified 52 patients with 66 non palpable un-descended testes. The most common age of presentation was 1-4 years. Majority of patients i.e. 27 were on the left side. Ultra-sound identified testis >2 cm from deep inguinal ring in 20, near deep ring <2 cm in 20 and at inguinal canal in 6 patients. In the diagnostic laparoscopy, high intra-abdominal testis found in 34, low intra-abdominal testis in 24, blind ending of vas and vessels in 2 patients. The operative procedures performed are diagnostic laparoscopy, laparoscopic orchidopexy, laparoscopic orchidectomy, conversion to open orchidopexy and open orchidectomy. The mean operative time was 53.67±2.37 for unilateral and 102.76±5.38 for bilateral cases. The postoperative complications include surgical emphysema, wound infection and scrotal haematoma. The mean hospital stay was 14.23±2.37 hours for unilateral and 16.27±5.38 hours for bilateral.Conclusions: Laparoscopic orchidopexy appears to be a feasible, minimally invasive, less postoperative pain and trauma, faster convalesce and return to normal activity and an effective technique for the management of low intra-abdominal testes.