Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements.

Objective: To analyze efficacy of intrathecal Dexmedetomidine as adjunct to hyperbaric Bupivacaine in terms of postoperative analgesia after caesarean section. Study Design & Setting: This randomized controlled trial was conducted at Department of Anesthesia, Rawal Institute of Health Sciences, Islamabad from20th, October 2018 to 20thApril 2019 after taking Ethical board approval from the Institute. (letter no RIHS-REC/030/18, dated, 18th October 2018). Methodology: Total n=120 patients having ASA status I, II undergoing elective cesarean section were randomly divided into 2groups (60 each) by lottery method. Group-A, was given hyperbaricBupivacaine (0.5%) 12mg alone and group-B, was given hyperbaricBupivacaine (0.5%) 12mg along with injection Dexmedetomidine 4ug in intrathecal space respectively. Patients were followed in postoperative period for onset of pain and requirement for rescue analgesia in first 6 hours. Results: There was statistically significant difference in mean onset of postoperative pain among both the groups-A and B (178.18 ± 12.51 versus 364.07± 35.58min respectively with p value 0.000), as well as, postoperative analgesic requirement, in first 6 hours, 39 (65.0 %) versus 31 (51.7 %) with p-value 0.000 respectively. However, on stratification, considering effect modifiers, like age (20-30 years and 30-40 year and previous history of cesarean section), there was statistically significant difference in mean onset of pain in both groups, but no significant difference was found regarding rescue analgesic requirement in both groups. Conclusion: Intrathecal Dexmedetomidine along with hyperbaric Bupivacaine was better than hyperbaric Bupivacaine alone in controlling postoperative pain in caesarean section.

Background:   Reduced hemoglobin, excessive transfusions and raised lactate levels are important determinants of patient outcome after cardiopulmonary bypass. Many strategies have been studied for optimum management of these parameters. In this study, we evaluated the impact of retrograde autologous priming (RAP) method on hemoglobin and lactate levels in patients undergoing coronary artery bypass grafting (CABG) on cardiopulmonary bypass. Methodology: This prospective randomized controlled trial was conducted at Army Cardiac Centre, CMH, Lahore, from January 01, 2021 to June 30, 2021. After approval of institutional ethical committee and taking informed consent from patients, 272 patients undergoing CABG were enrolled. Patients with ages less than 18 y, LVEF ≤ 20%, emergency operations, repeat operations, valvular or combined procedures, recent myocardial infarction, with preoperative lactate levels of more than 2 mmol/L and Hb of less than 9 gm/dL and other preoperative systemic diseases or infection were excluded.  Patients were divided into two groups. Group A received conventional priming of bypass circuit with ringer lactate, and Group B received RAP with patient’s own blood. Hb and lactate levels were measured in arterial blood gases before induction and upon weaning from bypass. Results: The demographic features of both groups were identical, Group A patients had significantly high levels of lactate (3.76 ± 0.81 vs. 2.64 ± 0.47 mmol/L, P < 0.01). Hb levels of patients in RAP (RAP) (Group B) were significantly better (9 ± 0.31 vs. 7.9 ± 0.39 gm/dL, P < 0.01) than Group A. Conclusion: Our study concludes that when compared with crystalloid priming, retrograde autologous priming technique is associated with reduced lactate levels and better hemoglobin levels after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting. Abbreviations: CABG - Coronary artery bypass grafting; CPB - cardiopulmonary bypass; LVEF – Left ventricular ejection fraction; Hb – Hemoglobin; RAP – Retrograde autologous priming; FFP - Fresh frozen plasma; Key words: cardiopulmonary bypass; coronary artery bypass grafting; lactate levels, retrograde autologous priming. Citation: Naseer M, Feroze R, Akram MA, Fakhar-e-Fayaz. Effect of retrograde autologous priming on lactate and hemoglobin levels of adult patients undergoing coronary artery bypass grafting. Anaesth. pain intensive care 2022;26(1):20–24   DOI: 10.35975/apic.v26i1.1761 Received: October 4, 2021, Reviewed: November 14, 2021,, Accepted: January 19, 2022

Objective: To compare blunting of hemodynamic stress response to intubation using Magnesium Sulphate versus Lidocaine in hypertensive patients. Study Design: Prospective comparative study. Place and Duration of Study: Anaesthesia Department Combined Military Hospital, Lahore Pakistan, from Jan to Jun 2019. Methodology: A total of 232 hypertensive patients of the ASA status II, undergoing elective surgical procedures requiring intubation, were randomly divided into two groups, Group-L (Lidocaine) and Group-M (Magnesium Sulphate). Lidocaine 1.5mg/kg was given to Group-L 90 seconds before laryngoscopy, whereas Magnesium Sulphate 30mg/kg was given over ten minutes to Group-M before laryngoscopy. Baseline means arterial pressure was recorded. Mean arterial pressure was subsequently recorded each minute after intubation for five minutes. Results: Both groups were similar with regard to demographic data. After intubation, both groups had an increase in mean arterial pressures. Blunting of stress response was observed in 78 patients (67.2%) in Group-L and 55 patients (47.4%) in Group-M. Two groups showed a significant statistical difference (p=0.003).Conclusion: Both drugs are effective in blunting hemodynamic stress response to intubation in hypertensive patients, but Lidocaine is more effective than Magnesium Sulphate.

Objective: To compare the efficacy of aprepitant and dexamethasone versus metoclopramide and dexamethasone combination in prevention of post-operative nausea and vomiting in females undergoing laparoscopic cholecystectomy. Study Design: Prospective Comparative study. Setting: Department of Anesthesia, CMH Lahore. Period: October 2019 to April 2020. Material & Methods: A total of 140 female patients planned for laparoscopic cholecystectomy under general anesthesia, of age ranges from 35-65 years and ASA classification I and II were recruited for the study and were divided into two equal groups. In group A (n=70), patients were given oral aprepitant 80 mg with once sip of water one hour prior to induction and dexamethasone 8 mg upon induction. In group M (n=70), patients were given a placebo one hour prior to induction and intravenous metoclopramide 10 mg and dexamethasone 8 mg upon induction. Results: Age range in this study was from 37 to 65 years with mean age of 46.82 ± 7.29 years. The mean age of patients in group A was 45.73 ± 6.77 years and in group M was 47.91 ± 7.66 years with p-value of 0.076. In our study, significant difference was found between the efficacy of two groups of drugs. The efficacy of aprepitant and dexamethasone was found in 62 (88.57%) patients, while with metoclopramide and dexamethasone, it was found in 51 (72.86%) patients with p-value of 0.031. Conclusion: it is concluded that aprepitant and dexamethasone combination has higher efficacy as compared to metoclorpromide and dexamethasone in prevention of post-operative nausea and vomiting in elective laparoscopic cholecystectomy.