During the early and intermediate post anesthesia recovery period, the use of the cascade cough technique is a very effective maneuver to promote airway clearance of thick secretions. Teach patients to take a slow, deep breath, hold their breath for 2 seconds, then perform a series of coughs from the beginning to the end of expiration, followed by breathing slowly and resting. This technique is most effective when performed in a sitting position. Adequate pain management and splinting of incision facilitate coughing. In the case where the patient is unable to sit in a chair or upright in bed place the patient in a side-lying position with hips and knees flexed, or in a semi-Fowler position with the head and arms supported with pillows and the knees flexed. These alternative positions lessen abdominal tension and still permit complete movement of the diaphragm, improving the effectiveness of the cough.