Background: Shivering is commonly observed as a complication after Regional Anesthesia. Pethidine has been thought as a standard for prevention and treatment of shivering but it is not without side effects. Studies showed that dexamethasone also has promising effect with fewer side effects even though there are controversies. Objective: To compare the effect of prophylactic dexamethasone and pethidine on prevention of post-spinal anesthesia shivering for patients who underwent transurethral resection of the prostate (TURP) at Dagmawi Minilik second hospital from October 26 to January 24/2020. Methods: An institutional-based prospective cohort study was conducted on 64 patients who fulfilled inclusion criteria and underwent TURP. A convenient sampling technique was used to recruit study participants. Independent sample t-test statistics and Mann-Whitney U test were used for quantitative data that was distributed normally and none normally respectively. A Chi-square test was used to compare differences in categorical data. P-value <0.05 was considered as statistically significant. Result: The incidence and severity of shivering was comparable between pethidine and dexamethasone group (p value > 0.05). There was no statistically significant difference in the meantime to the first onset of shivering between dexamethasone (65 min) and pethidine (81 min) group (p = 0.23).The median consumption of total antishivering medication was comparable between dexamethasone (54.2 mg of tramadol) and pethidine (68.8 mg of tramadol) group (p = 0.21). Conclusion: Dexamethasone (4 mg) is equally effective as pethidine (25 mg) that of standard antishivering drugs. The use of dexamethasone (4 mg) as an alternative of pethidine as a prophylaxis for the prevention of shivering for patients undergoing TURP procedures under spinal anesthesia. Highlights:

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Introduction: Unexpected cardiac arrest during the intraoperative period contributes to higher morbidity and mortality. All patients undergoing surgery and anesthesia have a risk of having a cardiorespiratory event perioperatively. Presentation of case: A 70 years old female (Gravida 7, Para 7) patient having an elective transvaginal hysterectomy under spinal anesthesia. After 1 hour and 25 minute, the patient had sudden intraoperative cardiac arrest noted with loss of carotid pulse, undetectable blood pressure, and chaotic irregular deflection with decrement of amplitude on ECG. Immediate resuscitation was done with chest compression, endotracheal intubation, and epinephrine administration. The patient extubated in the operation room and wean after a day from vasopressor support in the intensive care unit then patient discharged safely after a week. Discussion: Intraoperative cardiac arrest is a very infrequent and unanticipated adverse event following noncardiac surgery. Urgent surgeries, lower American Society of Anesthesiologists (ASA) physical status, and trauma are major contributors to this unwanted event. 4 ''H'' and 4 ''T'' mnemonics are well-known reversible causes of cardiac arrest. Deterioration in hemodynamic status during surgery is an indicator of an upcoming cardiac arrest. Conclusion: Patients with low risk score for perioperative cardiac event might develop a sudden intraoperative cardiac arrest. Preparation for resuscitation at any time of surgery is very important in the management of sudden and unexpected cardiopulmonary arrest during surgery. Highlights