Objective: The aim of this study is to compare the effects of low dose methylprednisolone and metoclopramide on nausea, vomiting and respiratory complications after adenotonsillectomy. Study Design: Retrospective study Place and Duration: The study was conducted in Divisional Headquarter Teaching Hospital, Mirpur AJK for duration of six months from December 2020 to May 2021. Methods: Total 150 patients of both genders underwent adenotonsillectomy presented in this study. Patients were aged between 3-15 years. Detailed demographics of enrolled cases age, sex and weight were recorded after taking informed written consent. Patients were equally divided into two groups. Group I had 75 patients and received 1 mg/kg IV methylpredinosolone and group II received 0.15 mg/kg metoclopramide among 75 patients. Post-operative effects on PONV were assessed and compared among both groups in terms of oral intake time, vomiting episodes, respiratory complications and side effects. Mean pain score was calculated by VAS. Complete data was analyzed by SPSS 23.0 version. Results: There were 40 (53.3%) females and 35 (46.7%) males in group I with mean age 9.43±1.44 years while in group II 42 (56%) were females and 33 (44%) were male patients with mean age 8.04±3.36 years. Mean weight of the patients in group I was 23.08±4.61 kg and in group II mean body weight was 22.11±6.84 kg. Mean operative time in group I was 27.41±8.53 min and in group II mean time was 28.17±6.34 min. Post-operative frequency of vomiting and nausea was lower in group I 14 (18.7%) and 16 (21.3%) as compared to group II 21 (28%) and 24 (34%). Low pain score was found in group I 1.71±6.11 as compared to group II 3.02±4.09. Time to oral intake was higher in group II 2.98±3.48 hours as compared to group I 1.09±7.51 hours. Rate of respiratory complications and side effects were significantly higher in group II. Conclusion: We concluded in this study that the use of methylpredinosolone was effective among patients those underwent for adenotonsillectomy in terms of post-operative frequency of PONV, pain, respiratory complications and side effects. Except this low dose of methylpredinosolone were effective in earlier tolerance of oral intake. Keywords: Adenotonsillectomy, Metoclopramide, Methylpredinosolone, Oral Intake

Background and Aim: During anesthesia, hypertension is the most common additional risk factor that contributes to higher mortality rate. Antihypertension medicine’s withdrawal might leads to symptoms such as anxiety, rebound hypertension, myocardial infarction, tachyarrhythmia, angina exaggeration, and sudden death. The present study aimed to assess the perioperative management of blood pressure and effects of anesthesia in hypertensive patients undergoing general and orthopedic surgery. Patients and Methods: This cross-sectional study was carried out on 162 hypertensive patients in the General Surgery and Orthopedics Units of Khyber Teaching Hospital, Peshawar for the duration from April 2022 to September 2022. Study protocol was approved by institute ethical committee. Patients aged 16 to 70 years of either gender underwent general surgery and orthopaedic surgery were enrolled. The data was acquired during the anesthetist’s initial visit to the operated hypertensive patients' 24 hour postoperative period. Antihypertensive medications, hemodynamics, anesthesia drugs, fluid use, and blood loss were main variables noted. Heart rate, systolic blood pressure, and diastolic blood pressure were Intraoperative hemodynamics. SPSS version 27 was used for data analysis. Results: Of the total 162 hypertensive patients, there were 68 (42%) male and 94 (58%) females. The overall mean age was 58.62±8.4 years. Before surgery, about 119 (73.5%) patients took antihypertensive medication whereas 124 (76.5%) had antihypertensive medication within 24 hours. The most prevalent antihypertensive medication used and most common class during postoperative management was Calcium channel Blockers and Amlodipine. The most prevalent used anesthetic drug use was Bupivacaine. The incidence of Systolic Blood Pressure (SBP) fall and rise was found in 28 and 6 patients respectively. The incidence of Diastolic Blood Pressure (DBP) fall and rise during intraoperative management was 11 and 8 patient respectively. Conclusion: The present study found that a decreased heart rate in patients who were taking beta blockers consistently. Those who took diuretics had greater DBP and HR at the completion of the procedure. There was no significant change in hemodynamic parameters with any other antihypertensive treatment. Keywords: Hypertension, General Surgery, Orthopaedic, Hemodynamics

Background: The increasing popularity of outpatient surgery has prompted the search for new anesthetic agent that can provide safe and effective anesthesia with a rapid and smooth recovery. Day care surgical procedure is extensively accepted and has been attaining recognition for over a time. The cost effectiveness and early recovery are an essential part of day-care surgical treatment in evolving countries. Aim: To compare the recovery score and cost-effectiveness after oral induction of midazolam and thiopental sodium with propofol alone in day-care surgical procedure. Methods: Eighty patients were selected, 40 in each ASA grade I and II group. In A group; patients were administered propofol at dose of 2 mg / kg for induction, and in group B; 0 2.5 mg / kg thiopental sodium and 0.25 mg / kg midazolam orally were given 30-mints prior to induction. Perioperative heart rate, time to ready to go home, blood pressure and recovery score were observed. The average induction cost was determined in group A and B. Results: After 30 minutes of reversal, the score of recovery in groups A and B were 8.90 ± 1.82 and 8.02 ± 1.01, correspondingly. The group B has significantly lesser cost (PKR 90.25±10.73) in comparison to the group A (PKR 700.0 ± 100.0) (p <0.05). Conclusions: Preoperative induction of oral midazolam and low doses of thiopental sodium is comparatively cost effective compared to induction of propofol in day-care surgical procedure. Keywords: Oral midazolam, Day care surgery, Propofol and Thiopental sodium.

Background and Aim: Most primary renal neoplasms are caused by renal cell carcinomas (RCCs). There is a high risk of morbidity and mortality following radical nephrectomy due to acute kidney injury (AKI). It is crucial to detect and prevent this complication as early as possible. The present study aimed to anesthesia comparison after radical nephrectomy for kids: a study with different anesthesia techniques. Patients and Methods: This retrospective study was carried out on 84 children of the age up to 12 years undergoing radical nephrectomy in the department of Anaesthesiology, Chaudhary Muhammad Akram Hospital (CMA) Lahore during three years, from August 2019 to July 2022. Prior to study conduction, ethical approval was taken from research and ethical committee. Patients were allocated to three different groups: Group-D (Dexmedetomidine group), Group-C (Caudal group), and Group-P (Placebo group). Children were evaluated by taking history, physical examination, and laboratory examinations such as liver function, CBC, kidney functions, and coagulation profile. SPSS version 28 was used for data analysis. Results: A total of 84 children investigated with different anesthesia techniques. Each group was assigned 28 children undergoing radical nephrectomy. A significant difference did not appear between the three groups in terms of serum creatinine at any of the times of measurement. Group D showed significant lower values for cystatin C and NGAL compared with group C and group P regardless of the measurement period. In all three studied groups, there were no significant differences in age, gender, or weight of the patients (p> 0.05). Comparatively to the other two groups, the Dex Group had significantly higher urine output, more sedation, and lower objective pain scores. Conclusion: Clinical prediction schemes using cystatin C and NGAL biomarkers showed that dexmedetomidine prevents AKI in children undergoing renal replacement therapy. The Dex Group had significantly higher urine output, more sedation, and lower objective pain scores as compare to the other two groups. Furthermore, dexmedetomidine provides renal protection and sedation as well as analgesia. Keywords: Radical nephrectomy; Dexmedetomidine; Cystatin C; Children

Objective: To determine the effectiveness of dexmedetomidine on the spinal anaesthesia as an adjuvant to the hyperbaric levobupivacaine in patients undergoing cesarean section. Study Design: Comparative/Observational Place & Duration: The study was conducted at Anesthesiology/Obstetrics and Gynaecology departments of Mayo hospital, Lahore for duration of six months i.e from 1st November 2020 to 30th April 2021. Methods: This analysis included a total of 120 cases. After the informed consent the patients had received comprehensive demographics. Three equal classes of patients were divided into groups A, B and C. Group I had 40 patients and received 2.5 ml isobaric levobupivacane, group II with 40 patients and received 2.5 ml isobaric levobupivacaine and 5μg dexmedetomidine, and group III received 2.5 ml isobaric levobupivacaine and 25 μg fentanyl intrathecally. The outcomes of these groups were analysed in which sensory and motor blockage period were measured from the time the intrathecal drugs were administered. The full SPSS 26.0 version was used to analyze the results. Results: The mean age of the patients in group I was 27.44 ± 7.64 years with BMI 23.19±8.44, mean age in group II was 27.22 ±7.42 years with BMI 24.44 ± 6.16 and in group III mean age was 26.99 ±9.61 years with BMI 24.72 ±4.34. Duration of sensory and motor blockade was observed and resulted that it was earlier in group III as compared to group I and II. Prolonged duration of sensory and motor blockade was observed in group II as compared to groups I and III with significantly P value< 0.001. Conclusion: We concluded that for an adjuvant of 0.5 percent isobaric levobupivalacaine, Intrathecal dexmedetomidine induces both prolonged motor blockage and post operative analgesia than fentanyl. Key words: Levobupivacaine; Spinal anesthesia, Fentanyl, Intrathecal analgesia, Cesarean section; Dexmedetomidine.