The objective of the study is to study the procedure of endotracheal intubation; its methods between Rapid sequence intubation and crash intubation its success rates and the associated short term complications at the accident and emergency department of a government run hospital in Karachi, Pakistan. Study Design: Case series. Setting: Accident and Emergency Department of Civil Hospital Karachi. Period: 2010 to 2012. Methods: The sample size taken is of 260 patients, all of whom must be above the age of 14 years, and undergo the procedure of emergency endotracheal intubation. Rapid sequence intubation is analyzed against crash intubation using descriptive type of statistical analysis. The significance level was p<0.05. Results: From the 260 Endotracheal intubations performed, 45 (17.30%) had to be discarded on account of incomplete data. The remaining study population was 215 patients (123 males, 92 females) Rapid sequence intubation was the commonest type (n=138, 64.18%). Head and neck injury, pulmonary edema was the common complication. Crash intubation was the second type (n= 77, 35.8%) Primary attempt success was found to be 97% (n=134) in rapid sequence intubation and 80% (n = 62) in crash Endotracheal intubations. A total of 13 complications (6.04 %) were observed. Conclusion: In light of the results obtained our study shows a satisfactory success rate on using either mentioned types of intubation procedures that is either RSI or Crash Intubation.

Background: Pain is a complex phenomenon for which many pharmacological agents have been discovered and utilized for pain relief. Ketamine is a more preferred pain reliever over opioids in the emergency department (ED). The aim of this study was to compare the safety and efficacy of low dose ketamine (LDK) with morphine (opioid) for pain relief among patients presenting to the ED. Methodology: A prospective, cohort study was conducted over a sample of 280 patients presented with acute pain to the ED, Ziauddin University Hospital, Karachi. These patients were then divided into two groups via simple random sampling with randomization being assured using an online randomizer software tool. The 1st group (n=140) was given 0.2 mg/kg of LDK while 0.1 mg/kg of intravenous morphine (opioid) was given to the 2nd group (n=140). The pain intensity was measured using the Visual Analogue Scale (VAS) from admission to 60 mins, the records were taken after every 15 mins. The adverse events (AE's) were also recorded for both groups. The data was then analyzed using SPSS Version 21 & Microsoft Excel 2016. Results: Out of 280 patients enrolled in the study, there was male majority i.e. 76.07% while the remaining were females with the mean age of 29±7 years. Within 15 minutes of initial dose administration in both groups, a marked reduction in pain intensity was observed. Reduced respiratory rate, pruritus and decreased O2 saturation were common AE's observed, which were comparatively higher among patients receiving morphine as compared to ketamine. Conclusion: The efficacy of morphine (opium) and LDK is similar in alleviating pain in an emergency setting, however, LDK is visibly safer than its opioid counterpart and thus may be used as a safer alternative.

The aim of my study is to evaluate post-operative pain relief on patients who had hemorrhoidectomy. Materials and Methods: 300 patients who had hemorrhoidectomy were divided equally in to three groups, according to anesthesia type, group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and general anesthesia was considered to be group 3. Pain relief, post-operative complications, hospital staying time were measured and compared between the three groups. Period: Study was performed between Jan 2012 to Dec 2014. Results: The study showed that patients who had local anesthesia infiltration and sedation a significant decrease of post-operative total pain scores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group II as compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperative analgesia doses in the 3 groups were 120:140:180 respectively, total hospital staying time were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients, nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value < 0.05. On the other hand, spinal anesthesia which is group 2 showed slight decline of patients numbers who had respiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia, total cost, hospital staying time, nausea and vomiting have been significantly reduced by local anesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higher rate in post-operative urine retention, headache and hypotension compared to local anesthesia with sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced in local anesthesia with sedation compared to spinal and general anesthesia.

While operating upon the brain, deep seated lesions need to be approached by using retractor’s system, due to the soft and gelatinous nature of the brain. Using a conventional rigid, fixed retractor system for brain retraction appears harmful. As an alternative Thudicam Nasal Speculum (TNS) retractors can be used. This study was aimed to explore the outcome of TNS retractors in brain surgery. The cross-sectional study was conducted at Ziauddin University hospital north campus and National Medical Center Defense, Karachi, Pakistan, during a period between August 2019 to March 2020. A total of 60 patients were included (42 males and 18 females), with a median age of 25 years. In all these cases intra-cranial hematoma were removed with unremarkable damage, in aneurysm clipping it was found useful, without damaging adjacent areas and extraction of brain tumors was found to be very easy and non-damaging to the surrounding brain tissue. Patients had a follow-up period of about 03 months and contusion, ischemia or brain edema was not present in any patient. Only one patient died during second month after surgery due to Ischemic stroke of contra-lateral MCA. The study concludes that using TNS retractors was very helpful and non-damaging to the brain.

Background: The aim of my study is to evaluate post-operative pain reliefon patients who had hemorrhoidectomy. Materials and Methods: 300 patients who hadhemorrhoidectomy were divided equally in to three groups, according to anesthesia type,group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and generalanesthesia was considered to be group 3. Pain relief, post-operative complications, hospitalstaying time were measured and compared between the three groups. Period: Study wasperformed between Jan 2012 to Dec 2014. Results: The study showed that patients who hadlocal anesthesia infiltration and sedation a significant decrease of post-operative total painscores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group IIas compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperativeanalgesia doses in the 3 groups were 120:140:180 respectively, total hospital stayingtime were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients,nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value < 0.05. On the otherhand, spinal anesthesia which is group 2 showed slight decline of patients numbers who hadrespiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia,total cost, hospital staying time, nausea and vomiting have been significantly reduced by localanesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higherrate in post-operative urine retention, headache and hypotension compared to local anesthesiawith sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced inlocal anesthesia with sedation compared to spinal and general anesthesia.