The routine prophylactic administration of an uterotonic agent is an integralpart of active management of the third stage of labor, helping to prevent postpartum haemorrhage (PPH). The two mostwidely used uterotonic agents are: ergometrine-oxytocin (Syntometrine ®) (a combination of oxytocin, 5 internationalunits (iu) and ergometrine, 0.5 mg) and oxytocin, (Syntocinon ®) 10 international units (iu). Objective: To compare theefficacy and safety of intravenous oxytocin, with intramuscularly syntometrine in the management of third stage of labor.Study design: Experimental study. Setting: Department of obstetrics and gynaecology Combined Military HospitalPeshawar. Period: Over one year period from March 2005 to March 2006. Methods: A total 200 women havingsingleton pregnancy and vaginal delivery admitted in maternity ward were divided in two treatment groups by simplerandom sampling using random number tables, 100 patients received 2 ml Syntometrine, (a combination of oxytocin,5iu and ergometrine meleate 0.5mg) intramuscularly and 100 patients received 10iu of intravenous syntocinon at thedelivery of anterior shoulder of the fetus. Results: The use of intravenous oxytocin,, was associated with a reductionin postpartum blood loss (P<0.001) but there was no difference in the risk of post partum hemorrhage, in the need forrepeated oxytocin injections and the drop in peripartum hemoglobin level between the two groups, and need for bloodtransfusion. There was also no difference in the risk of prolonged third stage, or manual removal placenta. The useof syntometrine was associated with a higher risk of hypertension (RR 2.39, 95% Cl 1.00-5.70) other side effects weremild in nature with no differences between the two groups. Conclusions: There are no important clinical differencesin the effectiveness of intramuscular syntometrine and. Intravenous oxytocin for the prevention of post partum bloodloss. Intravenous oxytocin is less likely to cause hypertension and other side effect profiles are low

Objective: To assess the outcome of end to side Ileo-Ascending Colic anastomosis in patients undergoing emergency and elective Ileo-Caecal resection in non-malignant cases. Study Design: Cross Sectional Descriptive study. Setting: Department of Surgery at Fauji Foundation Hospital Rawalpindi. Period: January, 2018 to December, 2020. Material & Methods: A Total of 40 patients with ileo-caecal benign pathology presenting with generalized peritonitis and intestinal obstruction were studied. All patients underwent laparotomy either in emergency or as planned procedure. After dealing with the primary pathology an end to side ileo-ascending colic anastomosis was performed in all cases. Cases of ileo-caecal disease that required an ileostomy or underwent ileo-transverse colic anastomosis were excluded from the study. Anastomosis was performed in conventional two layers with vicryl 3/0. Variables studied were; indication for surgery, per-operative findings and post-operative complications like anastomotic leakage, surgical site infection, burst abdomen and systemic sepsis. Data was analyzed on SPSS (v 26). Results: There were 30 females (75%) and 10 male patients (25%). Age range was 18-72 years with mean age 43.62 years. Common clinical indication of surgery was intestinal obstruction 11 cases (27.5%) followed by generalized peritonitis 10 cases (25%) and trauma 9 cases (22.5%). Post-operative diagnosis in most patients was ileo-caecal tuberculosis 14 cases (35%) followed by trauma to ileo-caecal region 9 cases (22.5%). Anastomotic leakage occurred in 1 patient (2.5%) who underwent second look laparotomy and re-anastomosis. Surgical site infection occurred in 3 cases (7.5%). There was one fatality (2.5%) due to uncontrolled systemic sepsis. Conclusion: An end to side ileo- ascending colic anastomosis in conventional two layers is a safe and reliable procedure after emergency or planned ileo-caecal resection. It saves the patient from ileostomy, preserves colonic length and avoids formation of blind loop.

Objective: To determine the effective dose of intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Design: A randomized, double-blinded dose finding study. Place and Duration: The study was carried out in Combined Military Hospital Gujranwala from March 2009 to March 2010. Methodology: Total patients were 80 full term women who were randomly allocated into four groups and were given Ringer lactate 10 ml per kg body weight intravenously. One minute after the spinal injection, patients were given saline control or ephedrine 0.1mg per kg body weight, 0.25mg per kg body weight, or 0.4mg per kg body weight for 30 seconds. The study period started at the time of spinal injection and continued for 15 minutes. Systolic arterial pressure and heart rate were recorded at 1-minintervals. Side effects like hypotension, hypertension, tachycardia, bradycardia, nausea and vomiting were also recorded. Total rescue ephedrine and total dose of used ephedrine in all groups were measured. Neonates were assessed by APGAR score. Results: There was less incidence of hypotension in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group as compared with ephedrine 0.1mgper kg body weight and the control group, 5(25%),13(65%) vs. 16(80%), 18 (90%) respectively. Systolic arterial pressure (SAP) in the first 15 min after the spinal injection was statistically significant greater in the 0.4mg per kg body weight group compared with other groups (P <0.001). Reactive hypertension occurred in 9(45%) in the 0.4mg per kg group, compared with control group, 0(0%), ephedrine 0.1 mg, 1(5%) andephedrine 0.25 mg 3(15%) patients. The Heart rate in the first 15 minutes in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group was statistically significant higher than those of ephedrine 0.1mg per kg body weight and control group (P<0.001). The incidence of tachycardia was more in ephedrine 0.4 mg per kg body weight and 0.25 mg per kg body weight groups as compared to ephedrine 0.1mg perkg body weight and the control group, 9 (45%), 6 (30%) vs. 3 (15%), 2 (10%) respectively. There were significant decrease in total doses of rescue ephedrine required in the ephedrine0.4mg per kg body weight group as compared to other three groups. Total doses of used ephedrine in all groups were similar. Conclusion: We conclude that although ephedrine 0.25 mg per kg body weight reduces the hypotension but the smallest effective dose of ephedrine to reduce the incidence of hypotension significantly was 0.4mg per kg body weight.

To determine the effect of speed of hyperbaric bupivacaine (0.75%) injection on clinical characteristics of spinal anaesthesia in elderly patients undergoing lower limb orthopaedic surgeries. Study Design: Prospective, randomized, double-blind study. Setting: This study was conducted in the operating theatre of Fauji Foundation Hospital, Rawalpindi. Period: August 2018 - March 2019. Materials and Methods: 60 elderly patients undergoing lower limb orthopaedic surgery were randomized into two groups based on injection rate (fast and slow). 1.5 ml of 0.75% hyperbaric bupivacaine was injected over 5 seconds (fast group) and 50 seconds (slow group). Study was undertaken after taking permission from institutional ethical review committee. Level of sensory block, motor block, and systolic blood pressure were recorded at pre-specified intervals. Incidences of hypotensive episode, nausea, phenylephrine and antiemetic use were also documented. Results: Our study did not reveal any difference in maximum level of sensory block attained (fast = median T4, interquartile range [T4–T6] vs slow = T4 [T4–T6], P = 0.77). There was no difference in mean time (minutes) to reach T10 sensory level (fast = 2.5 ± 1.2 vs slow = 2.2 ± 0.8, P = 0.27); maximum sensory level (fast = 4.2 ± 1.5 vs slow = 3.8 ± 1.2, P = 0.26) and maximum motor block level (min) (fast = 5.9 ± 1.4 vs slow = 5.7 ± 1.2, P = 0.56). The rate of hypotension (fast = 8/30 vs slow = 4/30, P = 0.33), nausea (fast = 5/30 vs slow = 3/30, P = 0.99) and phenylephrine use (fast = 5/30 vs slow = 3/30, P = 0.71) and antiemetic requirement (fast = 1/30 vs slow = 2/30, P = 0.99) was also alike. Conclusion: There is no effect of injection speed of intrathecal (0.75%) bupivacaine on the clinical features of spinal anaesthesia in older patients undergoing lower limb orthopedic surgery.

Objective: To compare the result of the combination of hyperbaric bupivacaine plus fentanyl with hyperbaric bupivacaine alone in patients undergoing caesarean section in spinal anaesthesia. Study Design: Comparative, cross-sectional study. Place and Duration of Study: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi Pakistan, from Dec 2017 to Jun 2018. Methodology: After consulting the institutional ethical review committees a total of 60 females between ages 18-40 years were enrolled for caesarean section delivery. They were divided into two groups. The study group (n=30) received a subarachnoid injection of 0.5% hyperbaric bupivacaine (10mg) 2ml with 25ug of fentanyl 0.5ml and control group (n=30) was injected 0.5% hyperbaric bupivacaine 12.5mg (2.5 ml) only. Pain experienced during the procedure was assessed by using 10-point visual analogue scoring method. The mean duration of analgesia, mean arterial blood pressure and heart rate after surgery were compared between two groups. Results: The mean duration of analgesia was 206.5/min ± 6.4 in the study group and it was 163.6min ± 7.2 in the control group (p=0.001). Mean arterial BP after surgery was 92.3mmHg ± 3.8 in the study group and 88.7mmHg ± 4.1 in the control group (p=0.001). The mean heart rate recorded after surgery was 75.2/min ± 5.2 in the study group and it was 70.4/min ± 6.1 in the control group (p=0.001). Conclusions: The mean duration of analgesia was significantly longer in the study group when compared with the control group with better mean arterial blood pressure and heart rate response after Caesarean section.