Background: Nonalcoholic fatty liver disease (NAFLD) is present in the majority of the patients undergoing bariatric surgery. Weight loss induced by bariatric surgery has been shown to improve clinical measurements and liver histology of NAFLD. The present study aims to evaluate the impact of bariatric surgery on NAFLD in Indian patients with severe obesity using noninvasive parameters. Materials and Methods: This prospective study was conducted on 67 patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass). The Asia-Pacific Metabolic and Bariatric Surgery Society guidelines were followed to ensure the indications for bariatric surgery. Data collected included anthropometrics, biochemical parameters, and other noninvasive parameters. Results: Fifty-four patients were included in the final analysis, with the majority being males (54.2%). The mean age was 44.77 ± 12.64 years old. One-year follow-up postsurgery demonstrated a statistically significant improvement in total weight loss and body mass index (BMI) reduction (P < 0.00001). Mean NAFLD fibrosis scores improved from −1.70 to −1.95; however, the improvement was not statistically significant (P = 0.4295). Biochemical improvement was found in the serum levels of alanine aminotransferase (P = 0.0169) and aspartate aminotransferase (P = 0.0004). Concomitantly, significant improvements in AST to Platelet Ratio Index score, BMI, AST/alanine aminotransferase ratio, diabetes score, and liver stiffness measurement on Fibroscan (8.9 ± 1.01 pka [initial] to 7.2 ± 0.40 pka [follow-up]) were observed. Conclusions: Our findings suggest a beneficial association of bariatric surgery in NAFLD patients. Bariatric surgery is found to induce weight loss significantly and improve liver functions as measured by noninvasive parameters. Further, long-term studies are needed to consolidate these results.

Background: Spinal anesthesia is the most commonly used technique for lower abdominal surgeries as it is very economical and easy to administer. This study aims to determine the effect of intrathecal administration of Neostigmine and Dexmedetomidine as adjuvants on the onset and duration of sensory and motor block and postoperative analgesia produced by spinal Bupivacaine. Subjects and Methods: prospective randomized clinical study was carried out on 100 patients belonging to ASA grade I and II, posted for elective Sub umbilical surgeries under spinal anaesthesia, The study was designed to compare neostigmine 50mcg and Dexmedetomidine 10mcg along with 15mg 0.5% bupivacaine, in subarachnoid block. 100 patients were divided into two groups using randomized double blind method with 50 patients in each group. Results: The time of onset of peak sensory block is higher in Group D as compared to Group N. Mean Time for onset of peak sensory block in Group N was 5.48 ± 0.43 min and Group D was 7.31 ± 0.44 min. p value is < 0.01(statistically significant). Time for two segment regression was significantly higher in Dexmedetomidine group as compared to Neostigmine group. The onset of motor block in group N is earlier as compared to group D. The duration of analgesia is significantly higher in group D as compared to group N. Conclusion: Our study concludes that the use of intrathecal Neostigmine 50 mcg added to 15mg hyperbaric bupivacaine significantly hastens the onset of sensory and motor block. Dexmedetomidine(10mcg) when used intrathecally along with Bupivacaine significantly prolongs the duration of motor blockade, two segment regression and duration of effective post-operative analgesia.

Background: The major responsibility of an anaesthesiologist is management of airway so as to provide adequate ventilation to the patient by securing an unobstructed airway when general anaesthesia is administered. Advanced airway devices like Laryngeal Mask Airway (LMA) and Combitube are now considered as alternatives to endotracheal intubation for securing the airway and providing adequate ventilation even in difficult intubation and emergency situations. Objectives: To determine and compare the insertion conditions and pressor responses of two airway devices 'combitube and laryngeal mask airway' during elective anesthetic procedures. Subjects and Methods: 60 patients of age between 18-55 years, belonging to ASA grade I and II, scheduled for elective surgeries under general anaesthesia were included in the study.Patients with uncontrolled cardiovascular, respiratory, hepatic, renal diseases, morbid obesity, pharyngeal masses, history of chronic obstructive pulmonary diseases, oesophageal pathology were excluded in the study. All patients were allocated randomly by envelope method into two groups of 30 each, Group-L and Group-C.For patients in group L-airway was secured with laryngeal mask airway.Patients in group C-airway was secured with combitube. Results: Insertion conditions were better with LMA when compared to Combitube (P= 0.00325). Mean heart rate of LMA group was less at 1, 2, 3,7 minutes compared to combitube group. Mean systolic blood pressure of LMA group is significantly less at 1, 2, 3, 5, 7, 10, minutes than that of combitube group. Mean diastolic blood pressure of LMA group is significantly less at 1,2, 3 & 5 minutes compared to combitube group. Conclusion: We concluded that the insertion conditions (ease of insertion) were better and the associated pressor responses were less with LMA than with combitube.Based on our conclusions, we can say that LMA is a better alternative device when compared to combitube in maintaining an intact airway. However, both can be safely used to conduct general anaesthesia for elective surgical procedures.