Journal of the Bangladesh Society of Anaesthesiologists最新文献

{"title":"Challenges and Difficulties of Spinal Anesthesia in a Patient with Traumatic Thoracolumber Scoliosis","authors":"Tasnuva Tanzil, S. Khatoon, Satyajit Dhar, Akm Samsul Alam","doi":"10.3329/jbsa.v34i1.67576","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67576","url":null,"abstract":"We report an interesting and challenging case of traumatic thoracolumber scoliosis presenting with closefracture of right patella planned for open reduction and internal fixation (ORIF) under regional anesthesia.However, spinal anesthesia was not successful even with the use of intra operative fluoroscopy or ultrasoundguidance. We have in view to show the importance of proper review of preoperative x-ray of dorsolumberspine scoliosis and careful physical examination of back of the patients by the anesthesiologist to administeran effective and safe spinal anesthesia in such patients in low resource setting for successful & safe spinalanesthesia.\u0000JBSA 2021; 34(1): 54-56","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74590469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Short-term Outcomes of COVID-19 Patients in a Dedicated Intensive Care Unit of Bangladesh: A Single Centre Experience","authors":"S. A. Al Momen, A. Akhter, Md Mazharul Anwar, C. S. Karmakar, Md Harun Ur Rashid, R. Sultana, Abul Khayer Nazrul","doi":"10.3329/jbsa.v34i1.67566","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67566","url":null,"abstract":"Introduction: The COVID-19 pandemic emerged as a major public health crisis and was confirmed to havespread to Bangladesh since March 2020. A large number of hospitalized patients with COVID-19 pneumoniarequire intensive care for respiratory support due to hypoxic respiratory failure. Bangladesh is greatlyfacing multiple challenges to combat the surging pandemic due to lack of experiences and insufficientmedical resources. Reports describing patients admitted to the ICU with COVID-19 in Bangladesh are verylimited. Objective of this study was to determine the clinical characteristics and outcomes of the COVID-19patients admitted at the dedicated intensive care unit of Kurmitola General Hospital, Dhaka for bettercharacterization of COVID-19 infection in critically ill patients in a resource limited setting.\u0000Materials and Methods: All the RT-PCR confirmed COVID-19 patients aged >15 years who had beenadmitted to the dedicated COVID intensive care unit of Kurmitola General Hospital, Dhaka from April2020 to October 2020 were included in this retrospective cross-sectional study. The protocol was approvedby the Ethical and Scientific Committee of the institute. The demographic, clinical and treatment data ofall participants were collected and evaluated and mode of treatments were compared between survivorand non-survivor groups. The statistical analysis was carried out using the Statistical Package for SocialSciences version 22.0 for Windows (SPSS Inc., Chicago, Illinois, USA).\u0000Results: A total of 294 critically ill COVID-19 patients were admitted to the ICU of Kurmitola generalhospital between April, 2020 to October, 2020. The mean (±SD) age of the patients was 57.4 (±13.1) years,male participants were predominant (71.1%), 74.5% patients had positive contact history, commonpresenting problems were fever (94.5%), cough (83.6%), dyspnoea (80.9%), diarrhoea (60.2%) and chestpain (42.8%). Frequency of different associated co-morbidities like hypertension (49.3%), diabetes mellitus(50.3%), cardiac diseases (34.0%), renal diseases (17.7%), bronchial asthma (33.3%), COPD (40.1%), CVD(24.1%) and obesity (24.1%) were high. The mean (±SD) length of ICU stay of the patients was 7.0 (±4.1)days; 11.6% patients required mechanical ventilation; 63.6% of ICU patients died and 36.4% recovered inthe specified time period. HFNC was provided to 62.6% patients in survivor group and 56.1% in nonsurvivorgroup, 31% of non-survivor patients required non-invasive ventilator support. Requirement ofmechanical ventilation was significantly higher among the non-survivor group (18.7%) than survivorgroup (p <o.oo1). Use of convalescent plasma therapy was significantly higher in survivor group (29.0%)than the non-survivor group (18.7%) (p=0.043). No significant differences regarding anti-viral, monoclonalantibody and anticoagulant therapy were observed between both groups.\u0000Conclusion: This retrospective cross-sectional study represented the clinical characteristics and treatmentoutcome","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74867304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchial Blocker Provides Hemodynamic stability for One Lung Ventilation in Right Video-Assisted Thoracoscopic Surgery: An Observational Study","authors":"F. Kalam, Suraya Akter, Md Pervez Altaf Hussain","doi":"10.3329/jbsa.v34i1.67570","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67570","url":null,"abstract":"Background: Double lumen endotracheal tubes (DLT) and bronchial Blockers (BB) have been both beenused for lung isolation in video-assisted thoracic surgery (VATS) with some inherent demerits.\u0000Objective: The aim of this study was to observe the quality of lung deflation of a bronchial blocker forone lung ventilation & the hemodynamic stability in video-assisted thoracic surgery(VATS).\u0000Materials & methods: A total forty adult patients have been assigned to observe the effects & hemodynamicstability of BB who undergoing VATS procedure for mediastinal mass surgery. Correct placement ofairway was confirmed by fiber optic bronchoscopy. The variables assessed were: 1. Time required forcorrect placement of device, 2. Time taken for lung collapse, 3. Quality of Lung collapse, 4. Number oftimes of airway mal-positioned, 5. Changes of blood pressure and heart rate at baseline (T1) and immediatebefore (T2) and after (T3) intubation and one minute after (T4) intubation, 6. Number of patients withhypoxemia (Spo2 <90%) during one lung ventilation, and 7. Post-operative complication like hoarsenessof voice, sore throat and lung infection.\u0000Result: Results were observed for MAP & HR at T1, T2, T3 &T4. It was shown that HR decreasedafter induction than the baseline (T1) & came near baseline one min after intubation(T4). Just afterintubation at T3, HR increased from the baseline & immediate before induction (T1&T2). MAP wasalso increased at T3 than T1 & T2. Time taken for right lung collapse with BB was (4.76±0.61) similarand comparable to other studies. Total 36 patients were achieved total collapse of the lung and incidenceof device malposition was observed in case of 5 patients. On the other hand, hypoxaemia was observedin case of 1 patient.\u0000Conclusion: Result showed that BB could be a better and effective alternative in VATS Procedureconsidering a longer time to achieve complete lung collapse with minimum hemodynamic changes andwith minimum post-operative complications.\u0000JBSA 2021; 34(1): 38-42","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73160082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Critically Ill COVID-19 Patients After Getting Convalescent Plasma (CP) in ICU of DMCH","authors":"Ferdous Rahman, Md. Tariqul Islam, M. Ashrafuzzaman, Tofazzel Hossain, Benzir Shafi, A. Ahmed","doi":"10.3329/jbsa.v34i1.67567","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67567","url":null,"abstract":"There are no approved specific antiviral agents or vaccines against COVID-19 till now. In this study, 10critically ill patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200mL of convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibodytiters above 1:160 was transfused to the patients as an addition to maximal supportive care and antiviralagents. The aim of this study is to see the outcome of CP transfusion. It was possible to reduce oxygensupport (step down) of 40%(04) patients, 10% (01) patient’s parameters was unchanged and 50% (05)patients were need more oxygen support (step up) after getting CP which correlate with incrementalresponse of lymphocyte counts and detrimental response of biochemical parameters of inflammation.70%(07)patients of total who received mechanical ventilation, after treatment with CP, 30%(03) patients wereweaned from mechanical ventilation to high-flow nasal cannula, and 10%(01) patient discontinued highflownasal cannula to NRM.No severe adverse effects were observed. This study showed CP therapy waswell tolerated and could potentially improve the clinical outcomes through neutralizing viremia in criticalCOVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needsfurther investigation in larger well-controlled trials.\u0000JBSA 2021; 34(1): 20-25","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88943453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-demoghraphic Profile and Outcome of Critically Ill COVID 19 Patient Admitted in the ICU of a Tertiary Care Government Hospital in Dhaka, Bangladesh","authors":"Mozaffer Hossain, S. K. Sarker, M. Salim, A. Rahman, Syed Tarik Reza, Mohammad Mohsin","doi":"10.3329/jbsa.v34i1.67565","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67565","url":null,"abstract":"Background & objectives: First outbreak of corona virus disease (COVID-19) started in Wuhan, Chinaat December 2019and since then, it spread globally but information about critically ill patients withCOVID-19 is still limited. The characteristic clinical observations and outcomes of this disease (COVID-19) have been reported from different countries. So, it is important to know the demographic profile andoverall outcome of COVID-19 patients. We aimed to describe the clinic-demographic characteristics andoutcome of critically ill COVID-19 patients admitted into the intensive care unit of Dhaka MedicalCollege Hospital.\u0000Methods:This prospective observational study was carried out in the COVID non-surgical IntensiveCare Unit (ICU) of Dhaka Medical College Hospital, Dhaka, Bangladesh from 2nd May to 31stDecember2020.Out of 549 suspected cases, 392 patients were found RT-PCR for COVID-19 positive and157 were diagnosed as COVID patients clinically and from HRCT of chest but RT-PCR negative includedin this study. After admission in ICU, all patients had been treated according to ICU protocol. Durationof ICU stay, data collection regarding demographic, clinical and laboratory parameters, managementand outcome of COVID-19 patients admitted in the ICU were done. Patient outcomes were recorded asdeath or survival (transferred or discharged).\u0000Results:A total of 549 patients (male 415, female 134, mean age 57.10 years) with RT-PCR for COVID-19 positive 392 and 199 clinically diagnosed covid-19 but RT-PCR negative were enrolled in this study.Regarding COVI-19 related symptoms, 98.54%(541) respiratory distress, 79.96 % (n=439) cough, 62.84%(n=345) history of fever,10.2 % (n=56) anosmia and 5.28% (n=29), lose motion. Diabetes mellitus (DM)and Hypertension was the most common co-morbidity (64.89%), Hypertension(HTN)56.46% was thesecond most common co-morbidity..For improvementof oxygenation of COVID patient, we treated 5.46%(n=30) by Non Re-breather Mask, 51.91% (n= 285) by High Flow Nasal Cannula (HFNC),14.20%(n=78)bynon invasive mechanical ventilation(BiPAP) and28.41% (n= 156) by Invasive Mechanical Ventilation.Mean duration of ICU stay were 12.33days and range of ICU staywere 1-30 days. Among 549 COVIDpatient,36.24% (n=199) were transferred to the isolation ward or discharged at home and 63.75 % (n=350)were died.\u0000Conclusion: This study showed the overall demographic and clinical features of critically ill COVID-19patients, admitted in the covid non-surgical ICU of Dhaka Medical College Hospital, the largest tertiarycare hospital in Bangladesh. As it was a single centered study, we need more study with multi centerapproach to know the detail demographic profile and outcome of COVID-19 patients.\u0000JBSA 2021; 34(1): 5-11","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75232453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenge and Role of Anesthesiologists in the COVID-19 Pandemic – Bangladesh Perspective","authors":"D. Banik","doi":"10.3329/jbsa.v34i1.67564","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67564","url":null,"abstract":"Abstract not available\u0000JBSA 2021; 34(1): 1-4","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85012739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Haemodynamic Stability of Etomidate versus Propofol for Induction of Anaesthesia in Patients undergoing Coronary Artery Bypass Graft Surgery","authors":"M. M. Hossain, M. Alam, Suraya Akter, Md Pervez Altaf Hussain","doi":"10.3329/jbsa.v34i1.67571","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67571","url":null,"abstract":"Background: Maintenance of hemodynamic stability during induction and obtundation of intubationstress response are the prime consideration of general anaesthesia.\u0000Aims: The purpose of the study is to compare the hemodynamic effects of etomidate and propofol duringinduction and intubation in patients undergoing Coronary Artery Bypass Graft Surgery(CABG).\u0000Materials and Methods: This prospective, double-blind randomized clinical trial, total eighty patientswere randomly allocated and divided into two groups based on the induction agent used for anaesthesia(etomidate group or E group) and (propofol group or P group). Heart rate(HR), Mean Arteriolar Bloodpressure(MAP), Cardiac Output (CO) & Cardiac Index(CI) were recorded at preoperative Baseline(T1), atpremedication(T2), at induction(T3), at intubation (T4), 1 min after induction(T5), 3 min after induction(T6),5 min after induction(T7). The use of vasopressors was also recorded, required for both the groups.\u0000Results: Before induction, there was no significant difference in hemodynamics between the groups (p>.05). At induction, intubation & up to 5 min after induction thereafter all the hemodynamic parameterswere significantly different from baseline value in both groups (p < .001). During the comparison betweentwo group, it was noted that, in P group, propofol caused pronounced reduction of HR, MAP, CO & CI incomparison to E group, at induction(T3), at intubation (T4), 1 min after induction(T5), 3 min afterinduction(T6). The use of vasopressors was also in higher incidences in P group than E group.\u0000Conclusion: This study confirms that Etomidate provides a stable hemodynamic condition in contextwith propofol during induction, intubation & immediate post induction period and this hemodynamicstability can improve the clinical outcomes in patients undergoing CABG.\u0000JBSA 2021; 34(1): 43-49","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86295874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Ventilator Associated Respiratory Tract Infections (VARTI) by Common Anaerobic and Atypical Bacteria among the Patients of ICU of a Tertiary Care Hospital in Bangladesh","authors":"S. Alam, Taneem Mohammad, Moinul Hassan Chowdhury, M. Jamal, Abbasi Naser, Mohammad Ashrafuzzaman, S. Shamsuzzaman","doi":"10.3329/jbsa.v34i1.67569","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67569","url":null,"abstract":"Background and aim of the study:Ventilator-associated respiratory tract infection (VARTI)is theleading cause of higher mortalityand morbidity in ICU compared to non-ICU patients. Thisarticlereveals etiology of VARTI by commonanaerobic and atypical bacteria in ICU of Dhaka Medical College.\u0000Materials and Methodology: This is a cross-sectionalstudy where 200 endotracheal aspirate (ETA)samples were taken from clinically suspected patients of VARTI. After proper screening,bacteria were identified by PCR as because anaerobic and atypical bacteria cannot be easily grown inconventional culture media.\u0000Result: Sixty three (31.5%) samples were found to have VARTI. Among the common atypicalbacteriacausing, M. pneumoniae was found in 4 (6.35%) and L. pneumophila in 2 (3.17%) of the 63 samples. Insearch of the anaerobic bacteria causing VARTI,Peptostreptococcus was detected in 3 (4.76%) whileFusobacterium nucleatum andPrevotella melaninogenicawere detected in 2 (3.17%) each of the 63 samples.\u0000Conclusion: Anaerobic and atypical bacteria are implicated in VARTI in ICU although at a relative lowrate.\u0000JBSA 2021; 34(1): 32-37","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73874584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Convalescent Plasma Therapy in Critically Ill COVID-19 Patients: Early Experience from a Dedicated ICU of Bangladesh","authors":"S. A. Al Momen, A. Akhter, Md. Harun Ur Rashid, R. Sultana, Md Zahedul Islam","doi":"10.3329/jbsa.v34i1.67568","DOIUrl":"https://doi.org/10.3329/jbsa.v34i1.67568","url":null,"abstract":"Introduction: The management of severe or critical COVID-19 patients in the ICU includes supportivecare as well as repurposed drugs and revival of old strategies like human convalescent plasma therapy(CPT) in the absence of specific therapy against SARS-CoV-2 virus. CPT appears to be an attractivetreatment option as passive antibody transfer, but efficacy remains controversial.\u0000Objectives: To determine the effectiveness of convalescent plasma therapy in management of criticallyillCOVID-19 patients admitted at the dedicated intensive care unit of Kurmitola General Hospital, Dhaka.\u0000Study Method: All patients admitted in the ICU of Kurmitola General Hospital, Dhaka from 1st May to30th September 2020 were included in this retrospective observational cohort study. The protocolwasapproved by the Ethical and Scientific Committee of the hospital. The clinical and treatment data ofall participants were collected; and the association of CPT and mortality benefit was observed betweenthe patients who received plasma therapy during ICU stay and who didn’t. The statistical analysis wasperformed using the Windows based statistical software package SPSS version 25.\u0000Results: A total of 228 critically illCOVID-19 patients were admitted to the ICU of Kurmitola GeneralHospital in the specified time period. Among them, 160 (70%) were male and 68 (30%) females. Mean agewas 57.97 (95% CI 56.23-59.70) years. Important co-morbidities were obstructive airway diseases 160(70.17%), hypertension 117 (51.31%) and diabetes mellitus 103 (45.17%). Only 53 (23.25%) patients receivedCPT during ICU stay. The median day of receiving CPT from the day of symptom onset was 12 (IQR 10-14) days in the survivor group and 18 (IQR 16-19) days in the non-survivor group (p<0.0001). All-causeICU mortality was 29 (54.7%) in CPT group vs. 115 (65.7%) in Non-CPT group (p=0.146). The odds ratioof survival in CPT group was 0.757 (95% CI 0.528-1.085).\u0000Conclusion: This retrospective cross-sectional study suggested that the efficacy of use of convalescentplasma in critical or severe COVID-19 patients admitted to ICU is conflicting for mortality benefit.\u0000JBSA 2021; 34(1): 26-31","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87123461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Oral Clonidine & Oral Gabapentin in Attenuation of Haemodynamic Stress Response to Laparoscopic Cholecystectomy","authors":"Hasan Ali Talukder, Muhammad Mamun Ur Rashid, Md. Abdur Rahman, Shukha Ranjan Das, M. S. Mondol","doi":"10.3329/jbsa.v33i2.67524","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67524","url":null,"abstract":"Background: In laparoscopic surgery, Carbondioxide (CO2) is routinely used to create pneumoperitoneum.Elevated intra-abdominal pressure, due to pneumoperitoneum, and Carbondioxide (CO2) insufflationhave adverse effects on the cardiovascular system. Plasma level of catecholamines and vasopressin areincreased immediately after pneumoperitoneum. Increased catecholamine level activates the renin–angiotensin–aldosterone system, leading to characteristic hemodynamic alterations such as decreasedcardiac output, elevated arterial pressure and increased systemic/pulmonary vascular resistance. Variousdrugs have been used to attenuate these hemodynamic responses.\u0000Objectives: Purpose of this study was to evaluate the efficacy of oral Clonidine and oral Gabapentinpremedication in attenuation of haemodynamic stress responses to laparoscopic cholecystectomy.\u0000Setting & study design: This Placebo control study was conducted in Department of Anaesthesiologyand ICU, Dhaka Medical College Hospital from 1st March 2015 to 31st August 2015. Total 60 patients withASA grade I, II and planned for elective laparoscopic cholecystectomy were selected. Exclusion criteriawere patients with history of hypersensitivity to Clonidine, Gabapentin, and patients with chronic pain,history of cardiovascular, psychiatric disease, use of psychotropic drugs, pregnancy other comorbidcondition- CKD, COPD, IHD etc. Study subjects were allocated in to groups as placebo or control group(or Group P), gabapentin (300 mg) or Group G and clonidine (100 ìg) or Group C. Tested drugs were given75 to 90 minutes before surgery as oral premedication. All groups were compared for sedation, anxietylevel along with changes of haemodynamic status.\u0000Result: Majority of patients (40%) belongs to age 41 to 50 yrs. Out of 60 cases 55% were male and 45%were female. Male – female ratio was 1.22:1. A clear increase in sedation and a moderate decrease inanxiety were observed in both premedicated groups as compared with control groups. Preoperativeanxiolysis and sedation was higher in oral clonidine group as compared with Gabapentin group. Comparedwith group P, gabapentin & clonidine group showed statistically significant decrease in heart rate beforeinduction (98, 80, 74 beat/min respectively). The heart rate increased significantly immediately afterintubation in control group P, whereas no such changes were observed in group G and in group C (132,125, 112 beat/min respectively). After laparoscopy, the attenuation of mean arterial blood pressure inpremedicated group was statistically significant as to control group (Group P) and remained stabilizedduring intraoperative period. Study showed that premedication (Group C and G) patients werecomparatively well oriented and were able to obey commands than control (Group P) in the postoperativecare unit. Postoperative analgesic need was much less with gabapentin (Group G) and clonidine group(Group C) as compared with control (Group P).\u0000Conclusion: The gabapentin and clonid","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88781887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}