Effect Of Different Anaesthetic Techniques On Neutrophil To Lymphocyte Ratio And Systemic Immune Inflammation Index In Patients Undergoing Laparoscopic Tubal Ligation - A Randomised Prospective Observational Study.

Following approval from ethical committee and written informed consent from the patients. The study subjects would be divided into two groups. Group G would receive general anaesthesia and group S would receive spinal anaesthesia. The patients would be randomly allocated to one of the two groups. All patients will be assessed preoperatively and informed both techniques of anaesthesia and their risks and benefits. The patients would be fasted according to current anaesthetic guidelines. Preoperative haemoglobin levels, total leukocyte counts, differential count, NLR and systemic immune inflammation index would be evaluated along with the other necessary routine investigations. On the day of surgery, IV access will be established and balanced salt solution will be commenced. All patients will be monitored using NIBP, SPo2 and ETCO2. Baseline hemodynamic parameters will be recorded. Patients allocated to group G would be induced with propofol 2mg/kg and muscle relaxation achieved with vecuronium 0.1mg/kg IV. Following ventilation with oxygen, air and sevoflurane for 3 minutes, the trachea would be intubated with size 7mm tracheal tube and anaesthesia would be maintained with oxygen and air mixture 1-2% sevoflurane titrated to maintained the hemodynamic parameters within 15-20% of basal readings. Additional muscle relaxation for top up would be administered using vecuronium 0.05mg/kg as needed. Following completion of surgery, patients would be extubated after antagonism of residual neuromuscular blockade using glycopyrrolate 0.01mg/kg and neostigmine 0.05 mg/kg. Patient allocated to the spinal anaesthesia group would receive 0.5% heavy bupivacaine at T10 interspace in the sitting position using a volume of 1.8 ml. ECG, NIBP and SPO2 would be monitored continuously throughout the procedure. Any decrease in blood pressure would be corrected immediately by the administration of phenylephrine 50 micrograms boluses to maintain the arterial blood pressure within 20% of a baseline values.