Objective: To analyze efficacy of intrathecal Dexmedetomidine as adjunct to hyperbaric Bupivacaine in terms of postoperative analgesia after caesarean section. Study Design & Setting: This randomized controlled trial was conducted at Department of Anesthesia, Rawal Institute of Health Sciences, Islamabad from20th, October 2018 to 20thApril 2019 after taking Ethical board approval from the Institute. (letter no RIHS-REC/030/18, dated, 18th October 2018). Methodology: Total n=120 patients having ASA status I, II undergoing elective cesarean section were randomly divided into 2groups (60 each) by lottery method. Group-A, was given hyperbaricBupivacaine (0.5%) 12mg alone and group-B, was given hyperbaricBupivacaine (0.5%) 12mg along with injection Dexmedetomidine 4ug in intrathecal space respectively. Patients were followed in postoperative period for onset of pain and requirement for rescue analgesia in first 6 hours. Results: There was statistically significant difference in mean onset of postoperative pain among both the groups-A and B (178.18 ± 12.51 versus 364.07± 35.58min respectively with p value 0.000), as well as, postoperative analgesic requirement, in first 6 hours, 39 (65.0 %) versus 31 (51.7 %) with p-value 0.000 respectively. However, on stratification, considering effect modifiers, like age (20-30 years and 30-40 year and previous history of cesarean section), there was statistically significant difference in mean onset of pain in both groups, but no significant difference was found regarding rescue analgesic requirement in both groups. Conclusion: Intrathecal Dexmedetomidine along with hyperbaric Bupivacaine was better than hyperbaric Bupivacaine alone in controlling postoperative pain in caesarean section.

Objective: To determine the lowest effective bolus dose of oxytocin to produce adequate uterine tone during elective caesarean delivery avoiding side effects. Study design and setting: A study was conducted at Rawal General and Dental Hospital, from 10th Oct, 2018 to 27th May, 2019. Methodology: Patients undergoing elective cesarean spinal delivery were randomly divided by computer generated numbers(n=155) into 5 groups A, B, C, D and E receiving 0.5, 1, 3, 5 and 10 units of injection oxytocin as bolus respectively after delivery of baby. Uterine contraction was assessed by gynecologist by manual palpation of uterus on a linear scale. Value of 8 was considered adequate and 8 inadequate uterine tone respectively. Heart rate, non-invasive blood pressure and oxygen saturation were noted before and after oxytocin bolus. All patients received oxytocin infusion. The primary outcome measure was the assessment of uterine tone at 2 minute of oxytocin bolus. The secondary outcome variables included shortness of breath, chest discomfort, top-up bolus administered, hemodynamic variables, epigastric discomfort and oxytocin related effects (tachycardia, epigastric discomfort and hypotension). Results: The use of 5 units oxytocin (group-D) showed most optimal uterine contractions, 61.3% in comparison to commonly used 10 units bolus dose (group-E) 48.4% with minimal side effects like, less tachycardia(12.9% versus 72.9%) and hypotension (12.9% versus 32.3%), no top-up bolus dose was required in 54.8% cases and no complain of epigastric discomfort was observed. Conclusion: Low doses of oxytocin are effective in terms of uterine contraction with minimal side effects

Objective: To compare the frequency of sore throat and cough after prophylactic Lignocaine versus Beclomethasone in adults undergoing tracheal intubation. Study Design: Prospective longitudinal study. Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun to Sep 2019. Methodology: A total of 180 patients of both gender scheduled for elective surgery under general anaesthesia with endo-tracheal intubation were recruited for this study. Ninety patients of Group-A received Lignocaine, while 90 patients of Group-B received Beclomethasone. After 24 hours of the procedure, sore throat and cough were assessed from both groups and noted. Results: The age range in this study was from 18 to 50 years, with a mean age of 34.22±5.31 years in Group -A while 36.57±7.22 years in Group-B. Sore throat was seen in 22(24.4%) patients in Lignocaine-Group (Group-A) as compared to 9(10.0%) patients in Beclomethasone-Group (Group-B) (p=0.010). Cough was seen in 18(20.0%) patients in the Lignocaine-Group as compared to 5(5.6%) patients in the Beclomethasone-Group (p=0.003). Conclusion: This study concluded that spraying Beclomethasone on the endotracheal tube reduces the frequency and severity of postoperative sore throat and cough in patients given general anaesthesia with endotracheal intubation.