Background: Fentanyl-induced cough is a common difficulty encountered at induction of anesthesia. Various interventions both pharmacological and non-pharmacological have been used to prevent this side effect including dexamethasone and propofol. Aim: To compare the effectiveness of dexamethasone and propofol to prevent fentanyl-induced cough at the induction of general anesthesia. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesiology, Surgical ICU & Pain Management, Dow University of Health Sciences and Civil Hospital Karachi from 16th September 2011 to 15th March, 2012. Methodology: One hundred patients who underwent elective surgical procedure were selected. Patients were randomized in two groups of 50 patients each; Group D was given intravenous dexamethasone; whereas patients of group P received intravenous propofol as the premedication before induction. The main outcome measure was effectiveness of both drugs to prevent fentanyl-induced cough. Results: Majority of patients (40%) were between 20-30 years of age group with mean age was 35.80±10.14 years. Males were more than females. Intravenous dexamethasone was significantly effective (90%) than intravenous propofol (70%) [p=0.012]. Conclusion: Intravenous dexamethasone is effective in reducing fentanyl-induced cough in comparison to propofol. Keywords: Dexamethasone, Propofol, Fentanyl-induced cough (FIC)

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Objective: To compare the frequency of pain in patients undergoing elective lower limb surgery between valsalva maneuver versus control group during spinal anesthesia. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anesthesia, Dow University of Health Sciences, Civil Hospital, Karachi from 1st June 2018 to 30th November 2018. Methodology: All patients aged 25 to 50 years of either sex having ASA status I and II undergoing for surgery in sitting position under sub-arachnoid block through midline approach were taken as study participants. Randomization was done and divided in two groups; Group A were those who did not perform valsalva group B were those who perform valsalva. Puncture pain was assessed and measured by visual analogue scale in which 0 indicates no pain whereas, 10 is considered as most painful. Results: The mean age was 39.76±8.43 years. There were 31 (51.7%) males and 29 (48.3%) females with body mass index in 21 (35%) have ≤25 kg/m2 and 39 (65%) have >25kg/m2. Mean VAS score was 4.27±2.09 and showed a significant association of pain between groups (p<0.001). Conclusion: Pain was found significantly lower in patients undergoing elective lower limb surgery with valsalva maneuver during spinal anesthesia. Keywords: Pain, Elective lower limb surgery, Valsalva maneuver, Spinal anesthesia

Objective: To compare the effectiveness of preload verses coload of crystalloid during spinal anesthesia for cesarean delivery Study design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesia, Civil Hospital Karachi from 1st November 2017 to 30th April 2018. Methodology: Sixty patients with age in between 18 to 35 years irrespective of parity having ASA physical status I and II and gestational age 37 completed weeks underwent cesarean section under spinal anesthesia were enrolled. Patients were randomized into one of two groups (P or C). A decrease of systolic blood pressure by 20% or more from the baseline value was taken as hypotension. Results: The mean age, weight, height, BMI and gestational age of the patients was 29.5±4.83 years, 60.16±5.17 kg, 1.54±0.60 m, 27.04±5.07 kg/m2 and 38.13±1.07 weeks respectively. Efficacy was significantly higher 25 (83.3%) among patients in preload group as compared to coload group 17 (56.7%) [P=0.024]. Conclusion: Effectiveness of preload was found to be less than coload of crystalloid during spinal anesthesia for cesarean delivery Keywords: Crystalloid, Preload, Coload, Spinal anesthesia, Cesarean delivery

Aim: To determine the effect of huffing manoeuvre to preventing cough caused by intravenous administration of fentanyl during induction of anaesthesia. Study Design: Cross-sectional study Place and duration of study: General Anaesthesia Department, SICU and Pain Management, Civil Hospital Karachi from 1st June 2019 to 30th November 2019. Methodology: One hundred and sixty four patients meeting were enrolled. Every patient was taught to perform huffing manoeuvre by primary investigator visiting patient in ward at night before surgery. The act of huffing manoeuvre was lasts within 5 seconds. Any episode of cough within 60 seconds of fentanyl administration was classified as fentanyl induced cough. All patients were received Propofol (2mg/kg) for induction of anaesthesia. Results: The mean age was 46.42±8.92 years. Incidence of fentanyl induced cough was observed in 4.3% cases and huffing manoeuvre was effective in 95.7% cases. Conclusion: Huffing manoeuvre is an effecting method of reducing fentanyl induced cough in patients undergoing surgery, especially the manoeuvre prevents developing of severe fentanyl induced cough. Keywords: Fentanyl, Cough, Huffing manoeuvre, Analgesic opioids