Background: Maternal hemodynamic changes are common during spinal anesthesia for cesarean delivery. Many agents are used for treating hypotension. In this study we compared the effi cacy of ephedrine and phenylephrine in preventing and treating hypotension in spinal anesthesia for cesarean section and their effect on fetal outcome. Materials and Methods: A total of 100 ASA Grade I patients undergoing elective cesarean section under spinal anesthesia with a normal singleton pregnancy beyond 36 weeks gestation were randomly allocated into two groups of 50 each. Group I received prophylactic bolus dose of ephedrine 10 mg IV at the time of intrathecal block with rescue boluses of 5 mg. Group II received prophylactic bolus dose of phenylephrine 100 g IV at the time of intrathecal block with rescue boluses of 50 g. Hemodynamic variables like blood pressure and heart rate was recorded every 2 minutes up to delivery of baby and then after every 5 minutes. Neonatal outcome was assessed using Apgar score at 1 and 5 minutes and neonatal umbilical cord blood pH values. Results: There was no difference found in managing hypotension between two groups. Incidence of bradycardia was higher in phenylephrine group. The differences in umbilical cord pH, Apgar score, and birth weight between two groups were found statistically insignifi cant. Conclusion: Phenylephrine and ephedrine are equally effi cient in managing hypotension during spinal anesthesia for elective cesarean delivery. There was no difference between two vasopressors in the incidence of true fetal acidosis. Neonatal outcome remains equally good in both the groups.

Objective: Postanaesthetic shivering is a recognised complication of general and regional anaesthesia. Pharmacological and nonpharmacological methods have been used to prevent shivering. This study was conducted to determine the efficacy of ketamine when compared with pethidine and placebo for the prevention of postanaesthetic shivering.Design: A randomised, double-blind study was conducted.Setting and subjects: This study was conducted on 90 American Society of Anesthesiologists (ASA) I and II patients of both genders, aged 18-70 years, who were to undergo surgery under general anaesthesia. Patients were randomised into three equal groups: Group S received a saline placebo, Group P received pethidine 20 mg and Group K received ketamine 0.5 mg/ kg. The study medication was given within 20 minutes of the estimated end of surgery.Outcome measures: Haemodynamic parameters were noted before, during and after anaesthesia. Tympanic temperature was recorded during the intraoperative period, on arrival in the recovery room (T0) and subsequently at 10 minutes (T10), 20 minutes (T20) and 30 minutes (T30). Shivering was graded on a four-point scale. Pain was assessed and recorded by means of a visual analogue scale. Any untoward side-effects were also noted. Results:The demographic profile of the patients was similar. The number of patients shivering at T0 and subsequently at T10 and T20 was significantly less in Group K and Group P than in Group S (p-value < 0.005). However, there was no difference between Group P and Group K (p-value > 0.005). Thirty minutes after the end of the anaesthetic, there was no difference between the groups (p-value > 0.005). Haemodynamic parameters were similar throughout. The incidence of adverse effects was similar. Conclusion:Ketamine was found to be as effective as pethidine in preventing postanaesthetic shivering without increasing the risk of side-effects.