Objective: To compare mean time required to request for first analgesia post-operatively in functional endoscopic sinus surgeries (FESS) by using pre-emptive paracetamol versus intra-operative paracetamol. Study Design: Comparative Observational Study. Sampling Technique: Non probable, consecutive sampling Place & Duartion: This Study was conducted in the Department of Anesthesiology, Sindh employee’s social security hospital landhi Karachi, From June, 2018 to January, 2019. Materials and Methods: In this study 64 patients of both genders included. 36 patients were male and 28 were females. They were aged between 18 and 70 years. This study was conducted from June, 2018 to January, 2019. Patients were distributed into two different groups, Group-1 (pre-emptive paracetamol) and Group-2 (intra-operative paracetamol). 32 patients were included in each group. In Group-1 (pre-emptive paracetamol), patients received 1 Gm. I/V paracetamol, 15 minutes prior to induction of general anesthesia and in Group-2 (intra-operative paracetamol), patients received 1gm. I/V paracetamol just before removal of endotracheal tube. Post-operatively patients were observed in Post-Anesthesia Care Unit (PACU) with standard monitoring. Time for first request for analgesia in minutes was noted. Result: SPSS 16 version used for statistical analysis. Chi squire test applied. Mean age of in pre-emptive paracetamol group (group-1) was 51.53 + 18.90 years and mean age of patients in intra-operative paracetamol group, was 50.43 + 19.10 years (p-value 0.819). Mean weight of patients in pre-emptive paracetamol was 66.65 + 10.74 kg and mean weight of the patients in intra-operative paracetamol was 67.71 + 10.78 kg. (P-value was 0.694). ASA status 1 was found in 36 (56.30%) patients and ASA status II was found in 28 (43.80%) patients. Mean time required for first analgesia in pre-emptive paracetamol group was 192.90 + 8.70 minutes and mean time required for first analgesia in intra-operative paracetamol group was 163.93 + 13.57 minutes and p-value found < 0.001 (significant). Conclusion: Significant variance was observed in the mean time required to request for first analgesia post-operatively in functional endoscopic sinus surgeries (FESS) by using pre-emptive paracetamol versus intra-operative paracetamol. Keywords: pre-emptive versus intraoperative paracetamol, functional endoscopic sinus surgeries, time required to request for first analgesia post-operatively.

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

Aim: To compare the frequency of hypotension between phenylephrine and ephedrine groups after spinal anesthesia for cesarean delivery. Study design: Single-blind randomized clinical study Place and duration of study: Department of Anesthesia, Pain Management and Surgical ICU Civil Hospital, Karachi from 1st January 2019 to 30th June 2019. Methodology: All patients with age between 18 to 35 years having weight range 50kg to70kg with American Society of Anesthesiologist (ASA) physical classification of I and II with Singleton Pregnancy assessed on ultrasound and gestational age 37 to 42 weeks assessed on previous dating scan were enrolled. Results: The mean age was 26.48±3.05 years, mean weight was 60.07±5.10 Kg, mean height 1.53±0.05m and mean BMI was 27.37±5.01 Kg/m2 respectively. Hypotension was found in 13(17.10%) patients. Comparison of hypotension with pehenylephrine and ephedrine shows that frequency of hypotension was found lower (15.4%) in patients who used pehenylephrine as compared to the patients who used ephiderine (p=0.006). Conclusion: Significant difference was observed in hypotension between phenylephrine and ephedrine groups after spinal anesthesia for cesarean delivery. Keywords: Hypotension, cesarean delivery, phenylephrine and ephedrine groups, spinal anesthesia