Assessing the Adequacy of Perioperative Pain Management on Immediate Post-Operative Analgesia for Patients Anesthetised Under General Anesthesia who had Elective Intraabdominal Surgeries in Lautoka Hospital – A Retrospective Audit

Introduction@#Perioperative pain is a major problem for patients undergoing surgery. Inadequate pain relief can lead to complications like pneumonia, extended hospital stay, re-admissions and patient dissatisfaction. The aim of this research was to determine adequacy of perioperative pain management on immediate post-operative analgesia for elective Intra-abdominal procedures done under general anaesthesia.@*Method@#This is a retrospective study which involved auditing inpatient folders from the 1st of January to 31st of December, 2015.The inclusion criteria were those between the ages of 18 to 60years who had Elective Intra-abdominalprocedure done under general anesthesia.Each folder was audited for perioperative pain management from surgical and anaesthetic charts and data were entered into a proforma list. EpiInfo 3.1 software and Microsoft Excel Spreadsheetwere used for analysis of the extracted data.@*Results@#159 records met the inclusion criteria but only 127 folders were recovered. 28% of patients recorded pain in the immediate postoperative period. There were more females than males and Total Abdominal Hysterectomies was the most common procedure. The age between 31 to 40 years, reported the most pain. Open cholecystectomy’s procedures recorded the most pain complaints and hernia repairs had the least. Verbal response was the highest pain indicator used and 11% of patients who indicated having some pain went from PARU untreated. There were no records of usage of pain scales in any folder retrieved.@*Discussion@#Pain recording in the recovery unit was heavily dependent on the recovery nurse and the patient. The incidence of immediate postoperative pain from this study group was lower when compared to other studies. This could be due to a lack of documentation or a reflection on how well perioperative pain treatment has been done in Lautoka. @*Conclusion@#Overall management of perioperative pain still needs improvement. The anaesthetic team should seriously look at this problem as Anaesthetists are still unaware of their patients pain. It is highly recommend that the formulation of an Acute Pain Management Protocol for Fiji to ensure that Pain be included as the 5th vital sign.

ANAESTHETIC MANAGEMENT OF A PATIENT WITH HYPERHOMOCYSTEINEMIA FOR TOTAL ABDOMINAL HYSTERECTOMY

Hyperhomocysteinemia is a disorder caused by a disruption of any of the enzymes or cofactors involved in the pathways of homocysteine metabolism. The resultant high plasma levels of homocysteine increase the risk for thromboembolic events. These patients are frequently anticoagulated in the perioperative setup. Interruption of anticoagulant therapy may subject the patient to an increased risk of thrombosis, infarction, and death. Neuraxial anaesthesia techniques may be relatively contraindicated in anticoagulated patients and nitrous oxide may exacerbate the condition by inhibiting the conversion of homocysteine to methionine. We describe a case of the anaesthetic management of a unique case of hyperhomocysteinemia with multiple recent thrombotic episodes proposed for total abdominal hysterectomy conducted under general anaesthesia, the intraoperative and postoperative monitoring and considerations.

Challenges In The Anesthetic Management Of Peripartum Cardiomyopathy Undergoing Emergency Ceserean Section

Peripartum cardiomyopathy (PPCM) is an unusual form of dilated cardiomyopathy which manifests as acute heart failure in the last trimester of pregnancy or early postpartum period. Choice of anaesthesia is based on the urgency of lower segment caesarean section and severity of PPCM. Here we report a 31year old female G3P2L2 36weeks + 2days diagnosed as Peripartum Cardiomyopathy came with complaints of leaking per vagina was taken up for emergency caesarean section under general anaesthesia. In this case report, we discuss the anaesthetic management of a case of PPCM posted for emergency caesarean section with intra-operative event of desaturation. Anaesthetic management was directed towards optimization of desaturation, myocardial contractility, preload and after load. No adverse events or complications were observed.

Comparative-study-of-etomidate-and-propofol-for-induction-of-general-anesthesia-in-elderly-patients

Introduction: An ideal induction agent for general anesthesia should have hemodynamic stability, minimal respiratory side effect and rapid recovery. Presently etomidate and propofol are popular rapid acting inducing agents. Material and methods: After obtaining informed written consent from patients this prospective, randomized, double blind study was conducted in 100 patients of ASA grade 3 and 4 posted for elective surgeries under general anaesthesia. They were divided into two groups of 50 in each group based on random number as group A and group B. The patients in Group A given Inj. Propofol and the patients in Group B received Inj. Etomidate. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and spo2 were monitored continuously and recorded. Incidence and degree of pain of myoclonic movements were recorded. Demographic variables such as age,Result: gender, weight and ASA grade were comparable no significant difference existed between both the groups.Baseline mean heart rate, mean systolic blood pressure and mean diastolic blood pressure were comparable in both the Groups. (P>0.05)Significant (P<0.05) fall in mean systolic blood pressure, mean diastolic pressure and mean arterial pressure was observed immediately after induction, at 2, 5, 10 minutes up to 30 minutes in group A (propofol) compare to group B (etomidate). After then no significant difference seen in mean systolic pressure, mean diastolic pressure and mean arterial pressure. Etomidate was found ideal for its hemodynamic stability when compared to PropofolConclusion: along with less incidence of pain on injection, the only drawback being high incidence of myoclonus elderly patient.

Immediately sequential bilateral cataract surgery in Down syndrome

The exponential increase in world population and average human lifespan is expected to result in geriatric population globally. The problem of preventable blindness due to cataract will increase manifold. Simultaneous Bilateral cataract surgery (SBCS) is a viable option in such subset of patients. Despite faster visual recovery, economic benefits to patients and health care providers, decreased risk of complications associated with General anaesthesia, there is significant resistance in accepting SBCS as a routine procedure. Bilateral endophthalmitis is the main deterrent in performing ISBCS. This case highlights successful ISBCS in 36 years old female patient with Down抯 syndrome.

Metabolic Effects of Carbon Dioxide Insufflation During Laparoscopic Surgery: Changes in pH, Arterial Partial Pressure of Carbon Dioxide (PaCO2) And End Tidal Carbon Dioxide (ETCO2)

Background: Laparoscopy involves inspecting the abdomen and pelvis using an endoscope. Carbon dioxide (CO2) is the gas that is commonly used to insufflate the abdomen so as to facilitate the surgical view. Aim: The present study was under taken to determine the Metabolic effects of carbon dioxide insufflation during laparoscopic surgery. Methods: An observational study on 50 patients above 18 years of age with physical status of American Society of Anaesthesiologists (ASA) Class I and II after obtaining approval from institutional ethical committee and consent of the patient was conducted in the Postgraduate Department of Anaesthesiology and Critical Care, Government Medical College Srinagar. Results: There was a progressive decrease in the pH during pneumoperitoneum in keeping with the hypercarbia. An increase towards baseline was observed during recovery but pH was still significantly lower than baseline 15 minutes into recovery (p<0.118). The Pco2 increased after 15 mins Co2 insufflation & peaked at 30 mins with mean & SD 42.82,2.775 & 46.16,2.909 respectively which was statically significant. Etco2 also increased after 15 mins of Co2 insufflation & peaked at 30 mins with mean 41.56 & 44.50 respectively which was statically significant. Similarly, Hco3 decreased over period of time with peak decrease at 30 mins of Co2 insufflation with mean 23.70, SD 1.919 & range 19-27. Conclusion: Co2 insufflation does bring metabolic changes in Ph, Pco2, Etco2 & HCO3 but with proper monitoring & management laparoscopic procedure can be safely performed.

Patterns of Paediatric Dental Treatment Under General Anaesthesia: A Retrospective Study

ABSTRACT@#This retrospective study aimed to evaluate patterns of comprehensive dental treatment under general anaesthesia (GA) for healthy children in Universiti Teknologi MARA, Malaysia. The treatment records of healthy paediatric patients who received dental treatment under GA from February 2017 to January 2021 were reviewed. The patients were divided into two groups: (1) less than 6 years old and (2) 6 to 16 years old. Patients’ characteristics were summarised using descriptive statistics while an independent t-test was applied to investigate the influence of “age group” on treatment duration, number of procedures and use of various restorative materials. A total of 125 paediatric patients (67 boys and 58 girls) were included. The patients’ mean age at the time they underwent GA was 5.77 ± 1.94 years old and the average duration of dental treatment was 62.58 minutes. There was a significant difference in the duration of treatment between the two age groups (p < 0.05). Tooth extraction was the most dental procedure performed (63.31%). The 6 to 16 years old group had a significantly shorter treatment duration (p < 0.05). However, no significant differences were found in all procedures (extraction, restoration, preventive and pulp therapy) and the utilisation of composite, glass ionomer cement (GIC) and compomer in both groups. The use of stainless steel crown (SSC) restorations was significantly higher in the less than six years old group (p < 0.05). Most of the dental procedures performed under GA on healthy children were extraction procedures. Children less than six years of old had a longer treatment duration under GA. Composite restorations and SSC were more frequently used in primary dentition.

Difficult and failed intubation in Caesarean general anaesthesia: a four-year retrospective review

INTRODUCTION@#General anaesthesia is associated with higher maternal morbidity and mortality when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for Caesarean delivery at a high-volume obstetric hospital in Singapore.@*METHODS@#All parturients who underwent Caesarean delivery under general anaesthesia from 2013 to 2016 were identified and their medical records were reviewed to extract pertinent data. Difficult intubation was defined as 'requiring more than one attempt at intubation or documented as such, based on the opinion of the anaesthetist'. A failed intubation was defined as 'inability to intubate the trachea, with subsequent abandonment of intubation as a means of airway management'.@*RESULTS@#Records of 660 Caesarean sections under general anaesthesia were extracted. The mean age of the parturients was 32.1 ± 5.5 years and the median body mass index was 27.5 (interquartile range 24.6-31.1) kg/m2. Rapid sequence induction with cricoid pressure was employed for all patients, with thiopentone and succinylcholine being administered for 91.2% and 98.1% of patients, respectively. There were 33 difficult intubations among 660 patients, yielding an incidence of 5.0%. Junior trainees performed about 90% of all intubations and 28 (84.8%) out of 33 difficult intubations. Repeat intubations were performed by senior residents/fellows (57.1%) and consultants (14.3%). No instance of failed intubation was reported.@*CONCLUSION@#The local incidence of difficult obstetric intubation was one in 20. No failure of intubation was observed.

Complete dental management of an Autism and Intellectual disability patient under general anaesthesia: A case report

@#Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and the presence of restricted interests and repetitive behaviours. Comorbidities following ASD, such as seizure, intellectual disability, and sensory impairment worsen patients’ ability to care for themselves. We present the case of a 22-year-old man with autism, intellectual disability and visual impairment who had recurrent pain in his upper and lower left posterior teeth that had cavities. On the first visit, the patient was observed and had panoramic x-ray. Clinical examination could not be done properly due to lack of patient cooperation. Restoration, pulp capping, tooth extraction, and odontectomy were planned under general anaesthesia.

Use of a Combined Anaesthetic Technique and Minimally Invasive Hemodynamic Monitoring in a Primigravid with Uncorrected Tetralogy of Fallot for Caesarean Section

@#<p style="text-align: justify;">Tetralogy of Fallot (TOF) in pregnancy is a rare occurrence which poses a high risk for detrimental effects on both mother and fetus. This paper reports a 21-year-old primigravid diagnosed with uncorrected TOF who had a successful caesarean section at 32 weeks of gestation. To address the hemodynamic challenges, the anaesthetic management involved the use of a minimally invasive hemodynamic monitor, controlled mechanical ventilation and a combined technique of intravenous anaesthesia using remifentanil and lumbar epidural anaesthesia using levobupivacaine.</p>

Oral Health-related Quality of Life Impact in Children and Children With Special Needs Undergoing Dental Treatment Under General Anaesthesia – An Institutional Study

@#Introduction: Numerous studies have examined both the effect of caries and dental care under general anaesthesia affecting children and children with special needs, but there is still scant information on the relationship between both classes. Thus this project is aimed i) to compare oral health-related quality of life in children and children with special needs undergoing dental care under general anaesthesia (GA) and ii) To compare the impact on oral health-related quality of life in children and children with special needs. Methods: Forty-six children (25 normal children, 21 children with special needs) are recruited. Participating parents completed a brief version of the Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS) before the treatment and subsequent follow-up appointments (4 weeks to 8 weeks). Oral symptoms, social health, psychology, functional limitation, and family effect ratings, the mean, standard deviations, and statistical differences between groups were analysed. Results: 52.2% of both parent groups rated the oral health status of their children as low before GA, and it improved considerably, with 69.6% of parents rating post-operatively as healthy. The most recorded impacts at baseline were pain, discomfort, often annoyed and angry among children and parents feeling guilty and upset due to the condition of the child. Conclusion: Oral rehabilitation under GA leads to the immediate improvement of oral health, mental, and social quality among the children in both groups. However, for parents of children with special needs, despite the effort to eradicate dental-related issues, the overall quality of life shows no significant improvements.

The Extent of Parents Acceptance with Regard to Usage of General Anaesthesia for Their Children during Dental Procedure in Riyadh City

Investigators have begun to assess the parental acceptance on General Anaesthesia (GA) in pediatric dentistry. Patient satisfaction and knowledge has an essential role in determining the utilization of the healthcare services. Physiologic and functional outcomes can affect completion of the treatment process that is one of the Factors that influence parental decision for seeking care. METHODSIn this survey, a structured self-administered and close ended questionnaire, was used to assess parents’ acceptance for dental treatments under general anaesthesia for their child. Parents whose children were going to undergo dental treatments in Riyadh Elm University, were approached with this questionnaire. All parents fulfilling inclusion criteria were explained about the purpose of the study and a total of 452 parents provided informed consent during the aforementioned period was included in the survey. RESULTSA total of 452 parents of the children participated in the study. The educational level of the parents was found to be significantly associated with the effectiveness of the comprehensive dental care for their child under GA. Child age showed significant association with the parental refusal of dental treatment under GA. Educational level of the parents and residence were found to be significantly associated with the perception that the dental treatment under GA is indicated for a specific class of patients. (P < 0.05) CONCLUSIONSEducation level of parent’s have important role in knowlage and awareness to treat their children under GA. Regular dental check up is important. Educating parents about oral health and diseases is important to increase the awareness about prevention rather than intervention.

Anesthesia- patient’s apprehension, concerns, and counseling

Introduction: To allay anxiety and resolve the patient’s apprehension regarding general anesthesia through counseling. Patients presenting to PAC were asked to participate in a 2-way conversation meant to evaluate and study his apprehension, concerns in relation to anesthesia, and subsequently, a counseling session was given to answer his doubts and resolve his fear. Material and Methods: In the study, it was found the fear of death was the greatest concern. The other major concerns were fear of paralysis and heart attack. Results: The level of fear decreased as the severity of surgery decreased. For major surgery, the fear of death differed significantly with age, especially with increasing age came a lessened fear of death. Counseling by anesthesia provider regarding the fear that the patient reported help to reduce the anxiety. It allows for a more personalized approach towards the patient. It helps anesthesia provider to tailor the informed consent process. Conclusion: In general, the study increases awareness regarding anesthesia among patient and their relatives.

Effect of dexamethasone with granisetron or ondansetron for prevention of post-operative nausea vomiting in patients undergoing laparoscopic gynaecological surgery

Background: Post-operative nausea and vomiting (PONV) is generally self-limiting, associated with high level of patient dissatisfaction and may delay hospital discharge. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors and variety of antiemetic drug available in market. With this issue we aim to compare the effectiveness of dexamethasone with granisetron or ondansetron in patients undergoing laparoscopic gynaecological surgery.Methods: 120 patients were registered in this prospective, randomized double blind study. Group I (n=60) received ondansetron 4 mg intravenously (IV)+dexamethasone 8mg I/V or II (n=60) received granisetron 1 mg IV+dexamethasone 8 mg I/V prior to anaesthesia. Post-operative data of PONV was recorded at pre-defined intervals.Results: The majority of the patients were of the age group 20-25 years (55.83%). The mean score of Group I subjects was 0.30±0.72 and that of Group II was 0.20±0.57 (p=0.43).  There are 3.33% of patients in group-I having vomiting episodes, and 1.67% of patients in group-II having vomiting episodes, none of the patients developed 2nd episodes of vomiting in either group. Thus it appears that dexamethasone in combination with ondansetron and granisetron is effective in decreasing the number of episodes of PONV. The occurrence of sickness episodes within 24 hours of surgery revealed no significant different in both groups. Haemodynamic variables showed no significant difference recorded in postoperative care unit between the study groups. The most common complaint was headache 16.67% in both groups.  Conclusions: Dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg showed no significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.

A comparative study of various types of intravenous fluids on the changes during induction of general anaesthesia

Background: The induction and endotracheal intubation is the most risky and initial process of general anaesthesia. Without induction and endotracheal tube placement one cannot imagine the general anaesthesia. Propofol and fentanyl are the commonly used drugs for induction of general anaesthesia. These drugs produce hypotension and other cardiorespiratory disturbances. These hazardous and sometimes fatal effects can be reduced and eliminated by preloading the patients with colloid or crystalloid solutions.Methods: We selected 90 patients who visited our hospital in the last 2 years from June 2017 to May 2019. All the investigations and pre-anaesthetic check-up was done routinely. These patients had to undergo different surgical procedures under general anaesthesia. The induction of anaesthesia was done with propofol and fentanyl. These patients were divided in three groups A, B and C. Group A patients did not receive any preloading. Group B was given colloids (3.5% gelatins) and group C received crystalloids (Ringer’s lactate solution). The haemodynamic changes were noted and analysed statistically.Results: The study showed that IV fluids given before induction of general anaesthesia blunts the adverse cardiovascular response.Conclusions: We concluded that preload with fluids whether colloids or crystalloids are beneficial to counter the detrimental effects of propofol and fentanyl for induction of general anaesthesia. The preload fluids stabilise the patient haemodynamically. When compared the two, colloids were better to blunt the cardiovascular changes.

Evaluation of Midazolam as an Intravenous Induction Agent for General Anaesthesia-Comparision with Thiopentone

Introduction: Midazolam, a water-soluble benzodiazepine, isnon-irritant on intravenous injection and has a shorter durationof action than diazepam. In this research, we evaluated theinduction time achieved with midazolam and compared withthiopentone. We also observed the hemodynamic effectsfollowing induction with midazolam and thiopentone. In thecurrent study, we also studied undesirable or unwanted effectsof the two drugs.Material and methods: The present study was conductedat Civil Hospital, Aizawl Mizoram in thedepartmentofAnaesthesiology and Critical Care. The study was conductedbetween November 2018 to October 2019. A clinical studywas carried out in hundred patients with a physical status ofASA I and ASA II patients, patients between 20-50 years ofage and weight 45-70 kg were selected and were divided intotwo groups each group consisting of fifty patients. Group A– Midazolam (0.2mg/kg) and Group B – Thiopentone (5mg/kg). A routine preanaesthetic check-up was carried out beforethe operation. The procedure of anaesthesia to be given wasexplained to the patients and written informed consent wastaken accordingly.Results: The mean age (in years) of the midazolam group was35.54 ± 8.5 and it was 34.06 ± 10.2 in the thiopentone group.We found a statistically significant difference of weight,spontaneous closure of eye, Loss of lid reflex between boththe groups. Patient Good acceptance was good in 16 (66.67%)participants in midazolam and 8 (33.33%) participants in thethiopentone group.Conclusion: We conclude that midazolam is a satisfactorysubstitute to thiopentone.

Postoperative Hypotension as a Complication of General Anaesthesia After Dialysis - A Retrospective Study

Introduction: In present medical scenario relating to therenal failure patients in order to enhance the quality of lifeof such individuals the best modality is the dialysis. Thisprocedure itself involves lot of risk & can complicate themedical condition. The patients experiencing renal collapseare at more risk for increased metabolic & heart related issuesthough they are on treatment of dialysis. Dialysis itself canlead to the condition where other systems are compromised.Study aimed to find out the haemodialysis-to-generalanaesthesia time interval and post-operative complications inhaemodialysis patients in order to better define a more optimalpre-anaesthetic waiting period.Material and Methods: A retrospective study was carriedon patients with end-stage renal disease managed by chronichaemodialysis. The time gap between the haemodialysis end& the introduction of general anaesthesia was calibrated fromthe records available from the inpatient & outpatient files. Theside effect after the end of anaesthesia post operatively wasrecorded in our databank. based on the available informationfrom the records document between the haemodialysis &general anaesthesia, the subjects were divided into threegroups: Group 1 interval >24 hours; Group 2 interval from7-23.9 hours; or Group 3 interval < 7 hours.Results: Demographic and illness scores were not differentbetween groups. The only difference in complications waspostoperative hypotension, which was more common inGroup 3 than either Group 1 or 2.Conclusion: The present study results suggest that it is prudentto put a time lag the elective & urgent induction of generalanaesthesia for major surgeries for about 7 hours subsequentto haemodialysis in order to minimize hypotension.

Potentiation of general anaesthetic activity of ketamine by memantine

Background: The study was done with the objective to evaluate synergistic activity of ketamine induced general anesthesia by memantine in wistar albino rats.Methods: The wistar albino rats of either sex were divided into four groups of five animals. Group 1 received ketamine 40 mg/kg, group 2 received ketamine 80 mg/kg, group 3 received ketamine 40 mg/kg along with memantine 10 mg/kg and group 4 received 80 mg of ketamine along with memantine 10 mg/kg to evaluate the synergistic activity of ketamine induced general anesthesia by memantine. The sleep latency time and duration of sleep were measured in all the groups.Results: The sleep latency time of group 4 is significantly decreased (p<0.001) compared to all other groups. The duration of sleep of group 4 is significantly increased (p<0.001) compared to group 1 and group 3, but less than that of group 1.Conclusions: Memantine possess synergistic activity of ketamine induced general anaesthesia.

Characteristics and Dental Treatments of Children under General Anaesthesia

@#The goal of this retrospective study was to determine the types of dental treatments provided to paediatric patients under general anaesthesia (GA) at the Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pulau Pinang, Malaysia. Records of the 113 patients under 18 years old who had undergone dental treatment under GA from November 2015 to February 2019 were retrieved and reviewed. The median age for subjects was six years old and the data were skewed to the left. Subjects were diagnosed with early childhood caries (n = 94) where total oral rehabilitation was performed for most subjects (n = 82). Higher number of deciduous teeth were extracted (n = 488) with average number per person of 5.5 as compared to permanent teeth (n = 43) with 2.9 average number per person. The leading cause of surgical cases was removal of supernumerary and impacted teeth. Tooth colour restoration and stainless-steel crowns were commonly used in restorative procedures. Although most of the patients were in the American Society of Anaesthesiology categories I and II, treatments were performed under GA because complete oral rehabilitation was required. In conclusion, dental treatment under GA is essential for providing complete oral rehabilitation in young patients, especially those with early childhood caries or medical and behavioural problems.

Comparison of the efficacy of combined epidural anesthesia with general anaesthesia alone to attenuate hemodynamic responses and perioperative analgesia in laparoscopic cholecystectomy patients

Background: The aim of the study was to compare the efficacy of combined GA-Epidural Anesthesia (CEGA) with GA alone to attenuate hemodynamic responses and perioperative analgesia.Method: Authors conducted a prospective, randomized, double blind study, in which 60 patients undergoing laparoscopic cholecystectomy. Group A received (n=30) received GA and Group B (n=30) received combined GA and Epidural Anaesthesia (CEGA). Authors analyzed the effect of combined epidural general anaesthesia as compared to plain general anaesthesia with regard to hemodynamic parameters (heart rate, systolic and diastolic blood pressure), intraoperative anaesthetic requirement (intraoperative requirement of propofol), recovery score and postoperative analgesia (VAS score).Results: Authors found significant decrease in the heart rate, systolic and diastolic blood pressure in response to stress response to pneumoperitoneum in combined epidural general anaesthesia (CEGA) group compared to plain general anaesthesia (GA) group. Total amount of propofol required intraoperatively was less in CEGA group than in GA group. Recovery score and pain score (VAS) score were also compared which were better in CEGA group than in GA group. There were no significant intraoperative and postoperative complications noted in both the groups.Conclusion: Authors concluded that the use of epidural along with general anaesthesia helps in attenuating hemodynamic changes due to stress response to pneumoperitoneum, which results in maintaining stable intraoperative and postoperative hemodynamics during laparoscopic cholecystectomy surgery. Combining epidural to general anaesthesia results in rapid recovery as compared to plain general anaesthesia and also helps in providing good postoperative analgesia.