Objective: The design of present study was to explore and compare different aspects of fentanyl and DEX when used as adjuvants to hyperbaric bupivacaine in neurexial anesthesia in cases of cesarean sections. Study Design: Randomized Single Blinded study. Setting: Department of Anesthesia, QAMC, Bahawalpur. Period: January, 2019 to December, 2019. Material & Methods: They were divided in three groups, each group consists of 35 patients having the name of group BN, group BF and group BD. Patients in group BN was given the injection bupivacaine alone, group BF, administered injection bupivacaine along with fentanyl 25 mg and group BD given DEX 10 mg with bupivacaine intrathecally between L4 and L5 intervertebral disc. Scrutiny of onset of sensory block to T5, along with time required to attain Bromage O scale (motor block). Regression of sensory block (recovery of sensory function) and time required to reach Bromage 3 scale (recovery of motor function) were also recorded. Hemodynamic parameters such as heart rate, systolic and mean arterial pressures along with Ramsay sedation score were also taken into account. Results: Similar demographic profile has been observed in all groups. All three groups differ in terms of onset of sensory and motor block with p value 0.00 when BN was compared with Group BD and BF. Statistically significant results also observed between group BF and group BD with group BD showing shortest time required for initiation of sensory block (p value .04)  and time to reach Bromage O scale (p value .02) . The duration for regression of four sensory segments shows the statistical significance (P 0.000) when all three groups were compared, however, no difference found between BF (175+12.85 min) and BD (171.88 + 12.33 min) which showed a P-value of 0.240. The time required to reach Bromage 3 score was statistically significant between all three groups (p value 0.00) and was also statistically significant between group BF and group BD (p value 0.00) with longest time taken by BD group to reach BROMAGE 3 scale. Both two research groups showed same degree of sedation and comfort for patient. Conclusion: Hyperbaric bupivacaine, in conjunction with dexmedetomidine and fentanyl produced satisfactory results in terms of faster sensory and motor block onset and prolonged time to take in regression of sensory and motor block in comparison to bupivacaine alone. Dexmedetomidine was better among the two adjuncts. Both adjuvants produce same degree of sedation and comfort for patient and relieved apprehension.

Objective: To assess the impact of fast track extubation versus late extubation in cardiac surgery patients being operated in Bahawal Victoria hospital, Bahawalpur, Pakistan. Methods: This analytical cross-sectional study was conducted in department of cardiac surgery, Bahawal Victoria Hospital, Bahawalpur, from March 2018 to March 2020. All patients who underwent cardiac surgical procedures were consecutively enrolled. Fast-track extubation (FTE) and delayed extubation (DE) in these patients were recorded. Moreover, information regarding baseline and clinical characteristics was collected and outcome like reintubations, hospital stay, and mortality were observed. Results: Of 86 patients, FTE was successful in 70 (80.14%) patients, while DE was observed in 16 (18.6%) patients. High dose inotropes 6 (37.50%) and increase drain output 5 (31.25%) were the most common cause of FTE failure among 16 patients. NYHA class was found to be significantly higher in DE group as compared to FTE group (pvalue 0.002). The mean ventilation time in FTE group was significantly higher as compared to DE group, i.e., 2.7±1.6 hours vs. 6.5±4.4 hours respectively (p-value 0.001). While, inotropic support (p-value 0.047), drain volume at 4 hours (p-value 0.039), and drain at the time of removal (p-value 0.002) were significantly lower in FTE group as compared to DE group. There was a single reintubation (1.16%) and mortality (1.16%). Conclusion:FTE is a safer technique in planned cardiac surgical procedures resulting in least morbidity and mortality.

Objective: To compare the hemodynamics changes, intraoperative awareness and postoperative delirium after combined administration of dexmedetomidine plus propofol versus propofol alone in cardiac surgical patients. Study Design: Randomized Clinical Trial. Setting: Cardiac Center, Bahawal Victoria Hospital, Bahawalpur. Period: 1st December 2018 to January 2020. Material & Methods: Sixty-two (62) patients who underwent different cardiac surgical procedures were included in the study. Patients were randomly divided in group 1 {Dexmedetomidine (DEX) +Propofol} and group 2 {propofol alone}. Induction in group 1 was done by loading dose of DEX (0.7 microgram/kg) while induction in group 2 was done by Lignocaine 1.5 mg/kg. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) were recorded at different time intervals. Intraoperative awareness and post-operative delirium was also assessed. Results: All hemodynamic parameters (HR, SAP, DAP, MAP) were statistically significant lower in group 1 in comparison to group 2 at different intervals indicating a more stable hemodynamic profile in group 1. End tidal CO2, pH, and peak airway pressures were not statistically significant between both groups. Intra-operative awareness was diagnosed in 1 (3.2%) patients in group 1 and in 5 (16.1%) patients in group 2 (p-value 0.08). Delirium was diagnosed in 3 (9.6%) patients in group 1 and in only 1 (3.2%) patients in group 2 (p-value 0.30). Conclusion: Combined administration of DEX and propofol produces more stable hemodynamics, less intraoperative awareness but more incidence of delirium as compared to propofol alone in cardiac surgical patients.