Aim: To determine the effect of placebo vs intravenous lignocaine pre-intubation on hemodynamic responses during direct laryngoscopy. Study design: Randomized control trial Place and duration of study: Department of Anaesthesia, Indus Hospital, Karachi from 1st March 2017 to 31st August 2017. Methodology: One hundred and twenty patients were included and divided into two groups. In one group, lignocaine arm (1.5mg/kg I/V lignocaine) was given while placebo arm was given (6ml normal saline pre-intubation) in group two. In both groups after arrival at the operation theatre, base-line parameters like the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure was measured non-and later hemodynamic assessment was done before giving lignocaine, prior and post intubation and after 3,5 and 10 minutes of intubation. Results: Fifty six (46.15%) were male while 64 (53.85%) were females. No patients were found to have asthma, COPD, ischemic heart disease, TB, CHF, Cushing syndrome, phenochromcytoma, and drug allergy. No significant association was found between the two groups when comparing the gender, BMI, comorbids, ASA grade and Mallampati grade. The systolic blood pressure at 3,5 and 10 minutes was significant in the two groups, while diastolic was not significantly associated. The pulse rate at3 and 10 minutes was found to have a significant association while at 5 minutes was insignificant. MAP showed no significant association between the two groups. Conclusion: Hemodynamic stability is only affected in terms of systolic blood pressure, while other parameters are not significantly affected. Keywords: Lignocaine, Hymodynamic changes, Laryngoscopy

Aims: To assess the frequency of anesthesiologists practicing post-op anesthesia visit and to determine the reasons of not regularly performing post-operative anesthesia visit. Study design: Cross-sectional study. Place and duration of study: Tertiary and Secondary care hospitals of Karachi from 7th November 2019 to 7th April 2020. Methodology: One hundred and eighty four anesthesiologists were enrolled. The eligibility of the anesthesiologist was assessed based on the eligibility criteria. The PI or the study team member was met the anesthesiologist on the decided date and time and asked him/her to complete the questionnaire. The questionnaire would take 10-15 minutes. This questionnaire was used to assess post-op practice and reasons for not performing post-operative anesthesia visit. Results: The average age of the participants was 30.94±2.98 years. 52.72% of the anesthesiologists do not practice PAVs and 47.28% reported that they perform PAVs. Furthermore, majority of the anesthesiologist who do not practice PAVs reported that lack of time the most common reason for not performing PAVs regularly (80.4%) followed by long distances to the patients to be covered (19.6%), patients already discharge (18.6%) extensive research (17.5%) and others (13.4%). Conclusion: Most of the anesthesiologists do not practice PAVs. Considering the high appreciation of post-anesthesia visits by anesthesiologists, as well as the relevant incidence of postoperative complications detected during these visits, it seems desirable to consider organizational improvements for post-anesthesia care. Keywords: Post-operative anesthesia visit, Surgeon satisfaction, Post-operative complications of anesthesia

Aims: To assess the frequency of hand hygiene opportunities available to health care providers during surgeries and to assess the frequency of hand hygiene practices of health care providers in those hand hygiene opportunities. Study design: Cross sectional study Place and duration of study: Operation theatre and recovery room at The Indus Hospital Korangi Campus and Sheikh Saeed Memorial Campus from 21stMarch 2021 to 30th August 2021 Methodology: Two hundred and eighty one health care professional for 55 surgeries were included for hand hygiene opportunities and their hand hygiene practice. Every opportunity to practice hand hygiene was observed and noted as having occurred (hand wash or hand rub) or missed. Throughout the period, the PI was recorded opportunities for hand hygiene and missed opportunities using WHO’s hand hygiene observational form. Results: The average age of the health care provider was 31.22±8.15 years. The overall adherence to hand hygiene practice according to WHO guidelines was 16.1% while 83.9% were not according to WHO hand hygiene guideline. Failure of hand hygiene practice was significantly high in all type of hand hygiene opportunity. Rate of missed/failure hand hygiene practice was significantly high in nurses and technician and also their qualification (p<0.05). Conclusion: The poor hand hygiene compliance was frequently noticed among health care workers. Hand hygiene should be an educational priority and it needs to be implemented effectively. Therefore, hand hygiene resources is an integral part for better strategic and improvement strategy. Keywords: Hand hygiene, Contamination, Health care associated infections; Prevention.

Aim: To observe the effectiveness of sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia in local population Study design: Descriptive cross-sectional study Place and duration of study: Department of Anesthesia, The Indus Hospital, Karachi from 11th March 2013 to 15th March 2014. Methodology: One hundred and fourteen patients with elective operations like wound debridement of foot, amputation of toes were included. After 15 minutes of giving the block, and at the time of incision, the patient was asked about his/her pain level by showing the pain scale. If the patient points at level 0, the surgery was proceed and the block was termed as effective. Results: Most of the patients were between 51-70 years of age and mean age was 58.83±9.21 years. There were 73(64.04%) males and 41(35.96%) females. Seventy four (64.91%) were in ASA-III, 32(28.07%) were in ASAIV and 8(7.02%) were in ASAV. The pain was not reported in 103(90.35%) patients while 11(9.6%) had pain in which 4 patients had mild pain, 5 moderate and 2 had severe pain. Block was effective in 103(90.35%) cases and ineffective in 11(9.65%) cases. Conclusion: Sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia be taken as an anaesthesia method for surgeries below the knee as well as for the control of the post-operative pain specifically in patients where spinal anaesthesia is not favorable Keywords: Below knee surgery, Sciatic nerve block, Popliteal nerve block