General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

Objective: This study was designed to compare the mean pain score with bupivacaine versus tramadol plus bupivacaine in patients undergoing surgery under general anesthesia. Randomized Controlled Study. Anesthesia department of SIMS medical college/Services Hospital, Lahore. Duration is 13 months from 20th August2017 till 24th September 2018. Method: 80 patients aged 20-60 years of ASA I & II status, undergoing elective surgery were selected. Patients were randomly divided into two groups (Group A and B) of 40 each, using random numbers table. An epidural catheter was placed at L3-L4 intervertebral level. Group A was given 30 ml of 0.125% bupivacaine and Group B was given 25mg Tramadol plus 0.125% bupivacaine mixture in the same volume. General anesthesia was induced with IV Propofol 2mg/kg and atracurium 0.5mg/kg. After recovery from anesthesia, patients were shifted to HDU. Post-operative pain was assessed using the 10-point VAS score. Injection nalbuphine 0.1mg/kg was given as rescue analgesic when VAS score became more than 4. Results: The mean age of patient in Group A was 37.5 ± 9.1 years and 38.6 ± 7.0 years in Group B. Mean BMI in Group A was 33.2 ± 4.3 and 32.2 ± 4.2 in Group B. The mean pain score after 12 hours of surgery was 3.6 ± 0.8 in Group A and 1.5 ± 0.9 in Group B, p value was significant. Conclusion: Thus, the present study concludes that epidural administration of tramadol as adjuvant with bupivacaine is more effective in postoperative pain relief as compared to bupivacaine alone. Key Words: Bupivacaine, Epidural, Postoperative pain, Tramadol. How to Cite: Khaleeq S, Ali A, Shafiq S, Butt M M, Aslam M, Jehangir MU. A Comparison between Bupivacaine alone and Bupivacaine with Tramadol in epidural block for postoperative pain management. Esculapio.2021;17(1): page number. Esculapio.2020;16(04):101-104.

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

Objective: Brachial plexus block is one of the commonly used anesthetic technique for upper limb procedures in orthopedics. A number of drugs have been used as adjuvants to local anesthetic agents, to prolong the duration and enhance the quality of the block. Some of these are clonidine, dexmedetomidine, ketamine, dexamethasone and magnesium sulfate. We conducted this study to evaluate dexmedetomidine and dexamethasone with respect to the onset and duration of sensorimotor block. Their effects on hemodynamic parameters as well as duration of analgesia after surgery were also recorded. Study Design: Prospective Randomized controlled design. Settings: Anesthesia, ICU and pain management department of Services Hospital/SIMS, Lahore Pakistan. Duration: From 15th September 2019 till 15th March 2020. Methodology: Sixty patients fulfilling the inclusion criteria were enrolled in the study after taking informed written consent for upper limb procedures under supraclavicular brachial plexus block. These patients were divided into two groups BD and BG with 30 patients in each group. Patients in Group BD received 32ml of 0.375% bupivacaine (30 ml) with 100microgram of dexmedetomidine(2ml). Group BG patients received 32ml of 0.375% bupivacaine(30ml) with 8mg of dexamethasone (2ml). The onset and duration of sensory and motor block, time to request for first rescue analgesic and hemodynamic changes in both groups of patients were recorded. Results: The results of our study revealed that the patients in group BD had earlier onset and longer duration of sensory and motor block with minimal hemodynamic changes. Conclusion: Dexmedetomidine is superior to dexamethasone as an adjuvant, in terms of rapid onset and prolonged duration of sensorimotor block and postoperative analgesia after supraclavicular block, with minimal hemodynamic changes.