ANAESTHESIA, PAIN & INTENSIVE CARE A Quarterly, International Journal of Anesthesiology, Pain Management, Intensive Care & Resuscitation An official publication of PSA (Pakistan Society of Anesthesiologists) and PARES (Pakistan Resuscitation Society) Vol. 20, No. 4 October - December 2016 Patron-in-Chief: Fares Chedid Statistician Brig. M. Salim. SI(M) Consultant Neonatologist Irum Abid Professor of Anesthesiology Tawam Hospital, Al Ain, Shamail Alam [email protected] Abu Dhabi (UAE) [email protected] Patron: Editorial Board: Aliya Ahmed (Pakistan) Syed Tipu Sultan Zahid Akhtar Rao Chancellor, Malir University of Science and Professor of Anesthesiology, Arshad Taqi (Pakistan) Technology, Malir, Karachi Trauma Centre, Civil Hospital Arzu Irban (Turkey) [email protected] Karachi (Pakistan) Ashish Sinhas (USA) Editor-in-Chief: [email protected] Dario Galante (Italy) Tariq Hayat Khan Eugenio Martínez Hurtado (Spain) Consultant Anesthesiologist & Pain Specialist Assistant Editors: Fazal Hameed Khan (Pakistan) [email protected] Ashish Kulshrestha (India) Gauhar Afshan (Pakistan) [email protected] Hideaki Tsuchida (Japan) Editors: Fauzia Anis Khan Logan Danielson (USA) Joseph D. Tobias (USA) Senior Editor [email protected] Kenneth Candido (USA) Rashed A. Hasan (USA) Professor of Anesthesiology, Pranav Bansal (India) Aga Khan University, Karachi (Pakistan) [email protected] Rudin Domi (Albania) [email protected] Saeid Safari (Iran) Richa Saroa (India) Senthil Gopala Krishna (USA) Sukhminder Jit Singh Bajwa [email protected] Professor of Anesthesiology, Shahab Naqvi (Pakistan) Faisal Jafar (UK) S. K. Malhotra (India) Gian Sagar Medical College & Hospital, Patiala, [email protected] Punjab, (India) Shiv Kumar Singh (UK) [email protected] Zahid Furqan (Pakistan) Somchai Amornyotin (Thailand) [email protected] Yasuhiro Morimoto (Japan) Associate Editors: AKM Akhtruzzaman (Bangladesh) [email protected] ‘Anaesthesia, Pain & Intensive Care’ is indexed by PakMediNet, Medlip. Index Medicus (EMR), EBSCO, Index Copernicus, Embase, EMCare, UDL (Malaysia), DOAJ, Web Mèdica Acreditada Quality Program (WMA), WMA Google Search. Listed with: National Library of Medicine Catalogue NLM ID: 101313795 [Serial]; HINARI portal. Registered by Pakistan Medical & Dental Council (PM&DC). Recognized by Higher Education Commission (HEC) Permission granted by District Magistrate Islamabad for publication. General Information: The journal is published on quarterly basis, in the months of March, June, September and December every year. Please direct inquiries regarding subscriptions, single copies and back issues, changes of addresses, and other correspondence to the Publications Office. Advertising inquiries should also be sent to the same address. See us at FACE BOOK, Twitter, Linked in and Medpedia Cover Picture: Failed back surgery syndrome - All articles represent the opinions of the authors and do not reflect A growing challenge (Designed by: Dr. Tariq H. Khan) official policy of the journal. This work is licensed under a Creative Commons Regional Office (Pakistan): Dept of Anaesthesia and Attribution-NonCommercial 3.0 Unported License. Pain Management, AKUH, Karachi. Ph: +92-21-34864631/4331 Subscription Rates: Subscription Rates: The rates for a one-year subscription of the Journal are Pak Rupees 1000 for subscribers in APICARE HQ: Pakistan, Pak Rupees 3500 for institutions in Pakistan, Pak Rupees 60-A, Nazim-ud-Din Road, F-8/4, Islamabad (Pakistan) 3500 (US$ 35) for subscribers from SAARC countries and Pak Rupees E-mail: [email protected], [email protected] 5500 (US$ 55) from elsewhere. www.apicareonline.com Ph: +92 321 514 9709 Published by: Dr. Tariq H. Khan PAKISTAN SOCIETY OF ANAESTHESIOLOGISTS PSA LAHORE CHAPTER 2015-2016 CENTRE, CABINET 2016-2018 Patron Prof. Attiya Sakhi Patron Prof. S. Tipu Sultan President Prof. Khalid Bashir President Dr. Abdul Malik Organizing Secretary Dr. Jodat Saleem President Elect Dr. Fayyaz Qureshi Vice President Prof. Khalid Siddiqui President Immediate Past Maj. Gen. Shahab Naqvi Vice Presidents Dr. Leena Aziz – Islamabad Brig. Asif Gul Kayani General Secretary Dr. Iftikhar Ali Awan – Punjab Prof. Khalid Bashir Finance Secretary Dr. Mudassar Aslam – Sindh Prof. Safia Zafar Siddiqui Joint Secretary Dr. Ali Sabtain Haider – Baluchistan Dr. Jamil Baloch Scientific Committee Dr. Arshad Taqi – Khyber Pakhtunkhwa Dr. Kashif Anwar Dr. Khawer Ali General Secretary Prof. Nur-ul-Haq Dr. Jodat Saleem Information Secretary Dr. M. Kashif Iqbal Dr. Liaqat Ali Treasurer Dr. Zia Akhtar Dr. Farooq Atique Executive Members Dr. Khalid Siddiqui – Islamabad Prof. Iqbal Memon Maj. Gen. Amjad Iqbal – Punjab Prof. Salman Waris Executive Committee Co-ordinator Dr. Ashraf Zia Dr. Taifurul Islam Dr. M. Younas – Sindh Prof. Samina Ismail Dr. Abdul Qayyum Dr. Asiya Taqi Dr. Hamid Raza DR. Syed Millat Hussain Dr. Abrar Shafique – Baluchistan Dr. Amjad Ali Dr. Waseem Ismat Dr. Almas Iqbal Dr. Sabeha Shujaat Dr. Zia Haider Dr. Khalid Buland – Khyber Pakhtunkhwa Dr. Mujahid ul Islam Dr. Sardar Ali Dr. Ansar Ali Dr. Irfan Butt PSA KARACHI CHAPTER CURRENT CABINET (2016-2017) PSA MULTAN CHAPTER 2015-2016 Patron Prof. S. Tipu Sultan President Prof. Dr. Salman Waris President Prof. Naveed Masood Sr. Vice President Dr. M.Yousuf Bandesha President Elect Dr. Zahid Akhtar Rao Vice President Dr. Nadeem Ahmad Khan Vice President Dr. Amin Khuwaja Lady Vice President Dr. Youmna Kamran Gen. Secretary Dr. M. Hamid Ali Gen. Secretary Dr. Rana Altaf Ahmad Joint Secretary Dr. Nadeem Naqvi Finance Secretary Dr. Aftab Haider Treasurer Dr. Dillo Raja Press Secretary Dr. Rana Khawar Latif Joint Secretary Dr. Munir Ahmad Ch. Executive Members 1. Dr. Akhtar Waheed Khan 14. Dr. Aliya Ahmed 2. Dr. Akhtar Aziz Khan 15. Dr. Zia Akhtar Executive Members 3. Prof. Saeeda Haider 16. Dr. Amin Suleman 1. Dr. Mohammad Nasir 4. Prof. Younis Khatri 17. Dr. Nadeem Munir 2. Dr. Jamil Malik 12. Dr. Cynthia Naghmana 5. Prof. Fauzia Anis Khan 18. Dr. Muhammad Hamid 3. Dr. Asma Samee 13. Dr. Rana Muhammd Arshad 6. Prof. Sadqa Aftab 19. Dr. Shabbir Jumani 4. Dr. Col. M. Ishaq 14. Dr. Muhammad Saeed 7. Prof. Nur ul Haque 20. Dr. Sohail Hai 5. Dr. Rao Liaquat Ali 15. Dr. Ahmad Fuad Khawani 8. Prof. Gauhar Afshan 21. Dr. M. Kashif Iqbal 6. Dr. Sohail Kazmi 16. Dr. Shahab Khakwani 9. Prof. Rehana Yasin 22. Dr. S. Farjad Sultan 7. Dr. Aatir Fayaz 17. Dr. Aushtar Abbas 10. Prof. Nighat Abbas 23. Dr. Mukesh Kumar 8. Dr. Muhammad Shahid 18. Dr. Ahsan Ullah Khan 11. Prof. Roohina Baloch 24. Dr. Ali Sarfaraz 9. Dr. M. Usman Mohsin 19. Dr. Anwaar Ahmad 12. Prof. Safia Zafar Siddiqui 25. Dr. Asim Masroor Rasheed 10. Dr. Masood Zafar 20. Dr. Haider Khan 13. Dr. Madiha Hashmi 11. Dr. Masood Afzal Khan PSA: OTHER BRANCHES • PSA RWP/Islamabad • PSA Quetta • PSA Peshawar • PSA Hyderabad • PSA Nawabshah • PSA Faisalabad Reviewers Dr. Bethania Delucien Zulfiqar Ahmed, M.B.,B.S. F.A.A.P. Dr Pallavi Lande-Marghade, MD, PDCC, Neuro MICU Staff Anesthesiologist FRCA Children’s Hospital of Michigan Consultant Cardiac Anaesthetist & Dr Mohammad Hamid Director of Research Intensivist Associate professor Assistant Professor of Anesthesiology Plot No. 5, Eknath Vihar, Aga Khan university, Karachi Wayne State University Shankar Nagar, Rajapeth, 3901 Beaubien Amravati (Maharashtra) Hameed Ullah Detroit, MI 48201-2196 India-444605 Associate Professor Aga Khan university, Karachi Shamsuddin Akhtar, MD Mohd Saif Khan Associate Professor, Assistant Professor and Critical care Shemila Abbasi Director of Medical Studies, Physician, Aga Khan University Hospital, Karachi Department of Anesthesiology Pondicherry Institute of Medical Sciences, 333 Cedar Street, TMP # 3 Pondicherry Area, India Ali Sarfraz Siddiqui Yale University School of Medicine Aga Khan University Hospital, Karachi New Haven, CT 06520 Mohd Saif Ghaus Anesthesiologist and Intensivist, Dr Nurul Haque M. Saif Siddiqui, MD Dr Ahmed Abanamy Hospital KSA Prof. Anaesthesia. K.M.D.C & Abbasi Associate Professor Shaheed Hospital. Director, Radiology Sedation and Mohjir Baloch Gen.Secretary. PSA Centre. Anesthesia Consultant in Chronic Pain Management University of Arkansas for Medical Sciences Frimley Park Hospital, Guildford, United Humaira Ahmad and Arkansas Children’s Hospital Kingdom Aziz Fatimah Hospital Faisalabad Division of Pediatric Anesthesiology and Pain Medicine Anuja Abayadeera Prof. Khalid Javid Siddiqi 1 Children’s Way, Slot 203 Senior Lecturer in Anaesthesiology, HOD Deptt. Of Anesthesiology, Critical Little Rock, AR 72202-3591 University of Colombo, Sri Lanka Care and Pain Management FMH College of Medicine and Dentistry Murlikrishna Kannan MD FRCA Mpoki Ulisubisya Lahore Anesthesiologist, Miami Beach Anesthesia Associates, Professor Ahmed Helmy Abdelsalam, Dr Rana Imran Sikander Miami Beach Fl Professor of Anesthesiology, Associate Professor PIMS. Islamabad Miami/Fort Lauderdale Area (USA) Cairo University Cairo (Egypt) Dr.Mohammad Azizur Rahman Said Abuhasna Professor Manar Elkholy Asst.Professor & Head,Respiratory P.O. Box 15258, Professor of Anesthesiology, Medicine, M H Samorita Medical College & Al Ain, Abu Dhabi, UAE Cairo University Cairo Hospital,Dhaka. Dario Galante, MD. (Italy) Mohamed Bakri Naeem Zubair Home Address: Viale Ofanto 221, 7121 Anesthesia Consultant, KFH, KSA Consultant Anaesthetist Foggia, Italy Associate professor of Anesthesia & Lakeridge Health Corporation Hospitals, Intensive care Dept of Anaesthesia and Pain Medicine, Lea Paola Fabbri M.D.