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)

Aim: To determine the effect of placebo vs intravenous lignocaine pre-intubation on hemodynamic responses during direct laryngoscopy. Study design: Randomized control trial Place and duration of study: Department of Anaesthesia, Indus Hospital, Karachi from 1st March 2017 to 31st August 2017. Methodology: One hundred and twenty patients were included and divided into two groups. In one group, lignocaine arm (1.5mg/kg I/V lignocaine) was given while placebo arm was given (6ml normal saline pre-intubation) in group two. In both groups after arrival at the operation theatre, base-line parameters like the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure was measured non-and later hemodynamic assessment was done before giving lignocaine, prior and post intubation and after 3,5 and 10 minutes of intubation. Results: Fifty six (46.15%) were male while 64 (53.85%) were females. No patients were found to have asthma, COPD, ischemic heart disease, TB, CHF, Cushing syndrome, phenochromcytoma, and drug allergy. No significant association was found between the two groups when comparing the gender, BMI, comorbids, ASA grade and Mallampati grade. The systolic blood pressure at 3,5 and 10 minutes was significant in the two groups, while diastolic was not significantly associated. The pulse rate at3 and 10 minutes was found to have a significant association while at 5 minutes was insignificant. MAP showed no significant association between the two groups. Conclusion: Hemodynamic stability is only affected in terms of systolic blood pressure, while other parameters are not significantly affected. Keywords: Lignocaine, Hymodynamic changes, Laryngoscopy

Aim: To observe the effectiveness of sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia in local population Study design: Descriptive cross-sectional study Place and duration of study: Department of Anesthesia, The Indus Hospital, Karachi from 11th March 2013 to 15th March 2014. Methodology: One hundred and fourteen patients with elective operations like wound debridement of foot, amputation of toes were included. After 15 minutes of giving the block, and at the time of incision, the patient was asked about his/her pain level by showing the pain scale. If the patient points at level 0, the surgery was proceed and the block was termed as effective. Results: Most of the patients were between 51-70 years of age and mean age was 58.83±9.21 years. There were 73(64.04%) males and 41(35.96%) females. Seventy four (64.91%) were in ASA-III, 32(28.07%) were in ASAIV and 8(7.02%) were in ASAV. The pain was not reported in 103(90.35%) patients while 11(9.6%) had pain in which 4 patients had mild pain, 5 moderate and 2 had severe pain. Block was effective in 103(90.35%) cases and ineffective in 11(9.65%) cases. Conclusion: Sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia be taken as an anaesthesia method for surgeries below the knee as well as for the control of the post-operative pain specifically in patients where spinal anaesthesia is not favorable Keywords: Below knee surgery, Sciatic nerve block, Popliteal nerve block

Aim: To determine the hemodynamic response during insertion of laryngeal mask airway versus conventional intubation. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesia, Jinnah Postgraduate Medical Centre, Karachi from 9th June 2016 to 10th December 2016. Methodology: One hundred and fifty-eight patients were enrolled, and they were divided in two groups; Group A (laryngeal mask airway) and patients falling in group B (conventional method). Baseline haemodynamic parameters were noted, and all patients were induced with propofol 2mg.kg 1. In group B, succinylcholine 1.5mg.kg-1 was used to facilitate intubation. After induction appropriate size endotracheal tube or laryngeal mask airway were inserted for airway control. For first five minutes after intervention, analgesics and any other stimulation were avoided, in order to prevent any haemodynamic alteration. All airway interventions were done by anaesthesiologist who had more than 5 years post fellowship experience. Mean arterial pressures were recorded. Initial haemodynamic parameters were measured when the patient enter the operating room and then second reading taken just after induction of anaesthesia, third reading recorded one minute and fourth reading 5 minutes after the intervention (i.e., after passing either endotracheal tube or laryngeal mask airway). Results: The average mean arterial pressure during process of intubation of patients in Group laryngeal mask airway group was 105.21±5.90 while in conventional group the average mean arterial pressure was 102.21±4.29 with P-value=0.001. Conclusion: Intubation through intubating laryngeal mask airway is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic tracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious. Keywords: Intubating laryngeal mask airway, Conventional laryngoscopy, Hemodynamic responses, Airway morbidity,