Patent ductus arteriosus (PDA) is a cardiac anomaly where the ductus arteriosus, a blood vessel connecting the pulmonary artery and the aorta, fails to close completely after birth. Anesthesia management during bedside PDA ligation in the Neonatal Intensive Care Unit (NICU) presents unique challenges and higher risks compared to the operating room environment. Manual cardiovascular and respiratory monitoring may be inefficient and  challenging for the anesthesiologists. This case report aims to discuss the anesthetic management of a one month and four days old male infant, who presented w ..read more

Acute intermittent porphyria is caused due to deficiency of porphobilinogen deaminase and usually presents with classic triad of neurologic dysfunction, abdominal pain and psychiatric disturbances. A 16-year old unmarried girl presented with 1-day history of recurrent episodes of generalized tonic clonic fits. There was history of mild diffuse abdominal pain for 15 days partially relieved by taking drotaverine. On examination, she was vitally stable and afebrile. Once the fits had stopped, there was no focal motor, sensory or cerebellar neurologic deficit and negative signs of neck rigidity. I ..read more

Pulmonary embolism (PE) risk is greater in women during pregnancy or puerperium. If indeed the peripartum pulmonary embolism is not recognized early and treated appropriately, it could have catastrophic consequences. We therefore present a case of a pregnant woman who unfortunately went from undiagnosed peripartum pulmonary embolism and had a crisis during delivery. She eventually had cardiac arrest and hypoxic-ischemic encephalopathy as complications. We emphasize early recognition and prompt treatment of pulmonary embolism in order to prevent such serious complications in pregnant women. We ..read more

Background & objective: Diabetes mellitus is a metabolic disorder, which is becoming more prevalent. It results from a defect in insulin secretion, or insulin action, or both, which is associated with increases risk of developing microvascular and macrovascular complications. Netrin-1 is originally considered an axon guidance protein, With a structure similar to laminine. It has been linked to the growth of numerous tissues, including the pancreas. During the initial phases of the formation of several tissues, such as pancreatic tissue, netrin-1 plays a critical function in controlling cel ..read more

This narrative review explores the importance of multimodal pain management options for postoperative cardiac surgery, focusing on maximizing pain alleviation while minimizing opioids usage and adverse consequences. It examines various pharmacological and non-pharmacological techniques, including opioids, NSAIDs, acetaminophen, gabapentinoids, alpha-2 agonists, local anesthetics, and ketamine, to maximize pain relief and improve patient outcomes. The review emphasizes the significance of a multimodal approach, combining different agents for better pain relief and patient outcomes. Non-pharmaco ..read more

Background & Objective: There is limited data from lower middle-income countries to describe the outcomes of COVID-19 and the prevalence of patients requiring critical care. We aim to assess and compare the demographics, clinical course and mortality of COVID-19 patients admitted to the intensive care unit (ICU) and those admitted to the specialized COVID unit (SCU). Methodology: A single-center, retrospective, observational study in which all patients admitted to Lady Reading Hospital (LRH), Peshawar (Pakistan) with laboratory-confirmed COVID-19 from March 25, 2020 to December 31, 2021 we ..read more

Background & objective: Fascial plane blocks have emerged as one of the main parts in multimodal analgesia after major abdominal surgeries. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks could cover both somatic and visceral pain, and have been extensively used by the anesthesiologists. We compared both of the blocks for effectiveness, ease to perform and safety after total abdominal hysterectomy (TAH). Methodology: We enrolled 64 female participants undergoing TAH, ASA PS I–III, aged 40-60 y, and BMI 18-40 kg/m2. The patients were randomized equally into either Group QLB, t ..read more

Background & objective: One-day surgery, defined as ambulatory surgery, is a service that provides surgery in certain cases without requiring hospitalization to minimize the cost incurred by one- day surgery service users. The objective of this study was to measure the ideal time for discharge of patients undergoing outpatient surgical procedures prospectively based on the cut- off time of the maximum PADSS (Post Anesthesia Discharge Scoring System) score. Method: This prospective observational study was conducted at a single site. The following patients were included in the inclusion crit ..read more

Background: Obese patients often pose endotracheal intubation (ETI) and/or ventilation difficulties, when compared to non-obese patients. Reducing the duration of intubation helps to prevent the associated respiratory and hemodynamic complications. We evaluated the effect of lubricating the undersurface of the Glidescope® blade at the intubation time as well as other associated drawbacks while intubating obese patients. Methodology: A total of 54 adult patients undergoing elective bariatric surgery requiring general anesthesia and oral ETI were included in this study. Out of these 27 patients ..read more

Background & objective: Transurethral resection of prostate (TURP) is usually performed under spinal anesthesia. To control spinal hypotension intravenous fluids are infused. We evaluated the effect of timing of hypertonic saline infusion as a preload or a co-load on hemodynamic parameters in patients undergoing TURP using non-invasive cardiometry. Methodology: A randomized controlled study was conducted. A total of 100 ASA physical status I-III patients planned for TURP under subarachnoid block were randomly assigned to either a preload of 4 ml/kg of hypertonic saline (NaCl 3%) over 15-20 ..read more