Journal of the Bangladesh Society of Anaesthesiologists最新文献

{"title":"Comparison of Intravenous Ketamine and Midazolam Premedication on Emergence Agitation (EA) in Children following Tonsillectomy with or without Adenoidectomy under General Anaesthesia","authors":"A. Maruf, Mozaffer Hossain, R. Ershad, S. Nazrina, M. Kamal","doi":"10.3329/jbsa.v33i2.67525","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67525","url":null,"abstract":"Background: Management of emergence agitation (EA) following tonsillectomy with or without adenoidectomy under general anaesthesia in children has been a major challenge for anaesthesiologists.Several medications have been investigated in an attempt to reduce the occurrence and severity of EA.\u0000Objectives: The purpose of this study is to determine the effect of premedication with intravenousmidazolam and ketamine on EA following tonsillectomy with or without adenoidectomy under generalanaesthesia in children.\u0000Study design: Randomised clinical study.\u0000Methods: Sixty children of both sex, American Society of Anaesthesiologists (ASA) physical status I & IIage 5 to 12 years scheduled to undergo elective tonsillectomy with or without adenoidectomy were randomlyassigned into two groups. Patients in group K (n=30) received premedication of intravenous ketamine0.25 mg/kg body weight in 5 ml total volume and in group M (n=30) received premedication 0.1 mg/kgbody weight intravenous midazolam in 5 ml total volume. After completion of surgery patients weretransferred to recovery. Incidences and severity of EA(Paediatric Anaesthesia Emergence Delirium Scale),pain score (Wong-Baker FACES Pain scale) and postoperative nausea and vomiting (PONV) were assessedat admission in the recovery (T0) and in the post anaesthesia care unit (PACU) at 5 min (T5), at 15 min(T15) and at 30 min (T30).\u0000Results: Incidences of EA in Group K remained significantly lower than Group M at admission to therecovery and in the PACU at 5 min and 15 min (P<0.05). Severity of EA was significantly lower patientsin Group K than Group M at admission in recovery and in PACU at 5 minute and 15 minute (P<0.05).There were no significant differences in pain scores between two groups. Regarding PONV there was nosignificant difference between two groups.\u0000Conclusion: Premedication with ketamine was more effective than midazolam in the prevention of EAfollowing tonsillectomy with or without adenoidectomy in pediatric patients under general anaesthesia.\u0000JBSA 2020; 33(2): 55-61","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83240854","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":"Minimizing Stress Responses at Intubation","authors":"M. K. Basu","doi":"10.3329/jbsa.v33i2.67523","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67523","url":null,"abstract":"Abstract not available. \u0000JBSA 2020; 33(2): 46-47","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78318509","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":"Efficacy of pregabalin in attenuation of laryngoscopy and intubation reflex-A comparison with gabapentin","authors":"Muhammad Mamun Ur Rashid, Hasan Ali Talukder, Moinul Hossain Chowdhury, Shukha Ranjan Das, Mozaffer Hossain, Taneem Mohammad, N. Ara","doi":"10.3329/jbsa.v33i2.67531","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67531","url":null,"abstract":"Backgrounds: Direct laryngoscopy and tracheal intubation are noxious stimuli that can provokeundesirable responses in the cardiovascular, respiratory and other physiologic system. These physiologicalchanges are well tolerated by healthy individuals. However, these changes may be detrimental or evenfatal in patients with coronary artery disease, hypertension, cerebrovascular disease, intracranialaneurysm, valvular heart disease.Many pharmacological techniques were introduced and evaluated either in the premedication or duringinduction to attenuate the hemodynamic pressor response to laryngoscopy and tracheal intubation, butresults were controversial. A drug that has analgesic properties, opioid sparing effects, possibly reducesopioid tolerance, relieves anxiety and is not associated with adverse effect would be an attractive adjuvant.Gabamimetic drug like gabapentin have been successfully used as oral premedication to attenuate pressorresponse during airway instrumentation, to decrease the preoperative anxiety and to reduce perioperativefentanyl consumption.In contrast, newer generation Gabamimetic drug pregabalin is effective in preventingneuropathic component of acute nociceptive pain of surgery and is several times more potent thangabapentin. Pregabalin is being used as oral premedicant in some studies but very few comparativestudies with gabapentin is present at time. So, there is a need to study the effectiveness of oral pregabalinin attenuating the hemodynamic response to laryngoscopy and intubation. If pregabalin is established asoral premedicant then it will bring a great benefit to peri-operative period with minimal cost.\u0000Objectives: To compare the efficacy of pregabalin and gabapentin in attenuation of laryngoscopy andintubation reflex (HTN & Tachycardia).\u0000Methods: This is hospital based randomized double-blind control study. Eighty patients, classified by (ASA)physical status category I-II, were randomized by card method in two groups of 40 patients each. The patientswere randomly allocated to receive oral Pregabalin 150mg (Group A) and Gabapentin 600mg tablet (Group B)1 hour prior to surgery. Before administration of the oral premedication, each patient’s baseline heart rate,systolic and diastolic blood pressure, mean arterial pressure and oxygen saturation were recorded by ananesthesiologist who was not enrolled into the study about the occurrence. In addition, to measure anxietyand sedation Ramsay Sedation Score was completed for each patient. All measurements were repeated beforeinduction. Grade 2 patient was selected. Systolic, diastolic and mean arterial blood pressure (SAP, DAP,MAP) and heart rate (HR), oxygen saturation (Spo2) was recorded after administration of IV anesthetics,immediately after intubation and cuff inflation, and 1, 3, 5 and 10 minutes after intubation. After trachealextubation the patients were monitored for 24 about the occurrence of any side effects, such as nausea,vomiting, dizziness, blurred vision, respira","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75509066","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":"Successful Anaesthetic Management of a Patient with Post Burn Contracture and Difficult Airway: A Case Report","authors":"Mushfiqur Rahman, M. Rahman","doi":"10.3329/jbsa.v33i2.67532","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67532","url":null,"abstract":"The Anaesthetic management of patients with post burn contracture release poses many problems toanaesthesiologist. Airway management in such cases is still challenging to anaesthesiologist as thecontracture and deformity due to fibrous tissue resulting in non-alignment of oral, pharyngeal andlaryngeal planes, makes laryngoscopy and endotracheal intubation very difficult or impossible and thiscan result in many life threatening and serious complications. We report the successful airway managementof a patient with restricted neck extension and fixed flexion deformity by Laryngeal mask airway (LMA)followed by endotracheal intubation.\u0000JBSA 2020; 33(2): 107-110","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74076630","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":"Haemodynamic Changes & Complications between Unilateral and Bilateral Spinal Anesthesia in Elderly Type-2 Diabetic Patient Undergoing Hemiarthoplasty – A Comparative Study","authors":"Ferdous Ali, I. Khalilullah, A. Jabbar, M. Hasan, M. Rahman","doi":"10.3329/jbsa.v33i2.67526","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67526","url":null,"abstract":"Background: During spinal anesthesia, extend of sympathetic blockade causes hemodynamic instability,such as hypotension and bradycardia.It can lead to develop cardiac arrest in some cases. Elderly patientdo not compensate these haemodynamic change easily because of aging process leads some physiologicalchanges in all system especially on cardio vascular system e.g; decreased elasticity of vessels, decreasedvascular and myocardial compliance and also decreased autonomic responsiveness. It is hypothesizedthat unilateral spinal anesthesia restrict the spread of hyperbaric bupivacaine to one side only (dependentside) thus sparing the opposite sympathetic chain and hence would cause less haemodynamic changes.\u0000Materials & Methods: This cross sectional study, took place in the department of Anaesthesiology andSICU, BIRDEM General Hospital, Shahbag, Dhaka. A total 60 elderly (age-60 to 80 years), ASA grade IIand III, type-2 Diabetic patients scheduled for hemiarthoplasty were enrolled in this study. Patients weredivided into two groups U & A, 30 patients in each. Subarachnoid (spinal) anaesthesia was performed inall patients with 0.5% hyperbaric bupivacaine intrathecally, at L3 - L4 interspinous spaces, with 25GQuinke’s spinal needle. Patients of group U were kept in lateral decubitus position which was maintainedfor 15 minutes after injecting bupivacaine and patients of group B were kept in supine position. Changesof BP, pulse and development of any complication was recorded in 5 minute interval after spinal anesthesia.All the informations were recorded in preformed data collection sheet.\u0000Result: Compared with group U, group B showed statistically significant increase inheart rate at 10 minafter spinal anesthesia (p<0.05).Systolic BP was significantly lower in group B compared to group U in allrecorded time interval except at 60 minute.Diastolic blood pressure was significantly lower in group Bcompared to group U at 15, 30 and 45 minute reading. Regarding maen arterial pressure we found it wasreduced significantly in group B compared to group U in all the recorded time except at 60 minute(p<0.05). Present study showed none of the patients in the unilateral group experienced vomiting; onlytwo patients noticed nausea. In the bilateral group, seven patients had nausea and three of them experiencedepisodes of vomiting (p = 0.02). In group U, no case found hypotensive, only single developed bradycardia.In Group B 7 patients experienced hypotensions and 4 patients had bradycardia.\u0000Conclusion: This study showed that the unilateral spinal anesthesia reduces the incidence and severityof hypotension, bradycardia and other complication in elderly type-2 diabetic patients. So unilateralspinal anaesthesia is more benifecial for elderly type-2 diabetic patient in hemiarthoplasty.\u0000JBSA 2020; 33(2): 62-68","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83302623","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":"Different doses of Dexmedetomidine in attenuating the pressor response to laryngoscopy in controlled hypertensive patient under general anesthesia","authors":"Rumana Afroz, Rabeya Begum, Mahin Muntakim, Taneem Mohammad, Subrata Mondal, Mohammad Jahid Iqbal, Md Ali Haider, M. Kabir","doi":"10.3329/jbsa.v33i2.67527","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67527","url":null,"abstract":"Background: Laryngoscopic manipulation and endotracheal intubation are always a matter of concernwhich capable of producing tachycardia, arrhythmias and hypertension which is generally well tolerated inhealthy patient. In Hypertensive patient cardiovascular response to laryngoscopy and intubation is exaggerated.\u0000Aims: To assess the effectiveness in attenuation of haemodynamic responses to laryngoscopy andendotracheal intubation with different doses of intravenous dexmedetomidine in controlled hypertensivepatients with no adverse effects.\u0000Methods: This prospective Randomized controlled trial was carried out with 60 patients belonging toAmerican Society of Anesthesiologists (ASA) Physical Status II posted for elective general anaesthesia.Patients were randomly divided into three groups with fixed card sampling, where, patients who receivedIV dexmedetomidine 0.5 μg/kg diluted to 50 ml with normal saline as infusion over 10 min was consideredas group A, patients who received IV dexmedetomidine 0.75 μg/kg diluted to 50 ml with normal salinewas considered as group B and patients who received IV dexmedetomidine 1 μg/kg diluted to 50 ml withnormal saline was considered as group C. The primary outcome measures were haemodynamic responseat 1, 3 and 5 min after intubation. The secondary outcome measures were to note down any adverseeffects associated with drugs.\u0000Result: The groups were well matched for their demographic data . Male to female ratio was 1:1 in allthree group. The mean height, weight and BMI were almost similar among three groups. In this studybaseline readings of SBP, DBP, MAP and HR were almost similar in all three groups and statistically notsignificant. Maximum intubation response was seen at 1 min post intubation in all the three groups. Themean SBP of group A varied from 144.8±8.4 mmHg to 118.5±4.4 mmHg that of group B varied from134.8±4.1 to 122.0±4.2 mmHg and then group C varied from 126.5±15.5 mmHg to 103.8±8.4 mmHgduring different evaluation period (p<0.05). The mean DBP of group A varied from 91.8±7.6 mmHg to72.4±5.8 mmHg that of group B varied from 81.3±5.2 to 70.3±2.5 mmHg and then group C varied from80.9±6.7 mmHg to 63.4±2.4 mmHg during different evaluation period (p<0.05). The mean MAP of groupA varied from 109.0±5.6 mmHg to 87.5±4.4 mmHg that of group B varied from 98.7±2.5 to 86.3±3.4mmHg and then group C varied from 95.5±9.2 mmHg to 76.5±3.4 mmHg during different evaluationperiod (p<0.05). The mean heart rate of group A varied from 94.5±12.7 bpm to 75.2±10.5 bpm that ofgroup B varied from 87.3±8.3 to 75.0±6.6 bpm and then group C varied from 81.1±7.2 bpm to 66.2±8.1bpm during different evaluation period (p<0.05).\u0000Conclusion: Dexmedetomidine in doses of 0.75 μg/kg was more effective compared to 0.05 μg/kg and1μg/kg in attenuating haemodynamic response to laryngoscopy and endotracheal intubation withoutproducing adverse effects in control hypertensive patients.\u0000JBSA 2020; 33(2): 69-77","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79797727","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":"Laparoscopic Cholecystectomy in High Risk Cardiac Patient with DM","authors":"Md. Mushfiqur Rahman, Shafiul Alam Shaheen, Mahbubul Hasan Munir, K. Sardar, Md Abdus Salam Khan, A. Chowdhury, M. Rahman, Shamiron Kumar Mondal, Taposh Kumar Mitra","doi":"10.3329/jbsa.v33i2.67528","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67528","url":null,"abstract":"Introduction: Laparoscopic cholecystectomy remains the standardtreatment for cholelithiasis. Everincreasing number of patients with myriad of medical illness is being treated by this technique. However,significant concern prevails among the surgical community regarding its safety in patients with cardiacco-morbidity. Patients with diabetes, significant cardiac dysfunction and multiple co-morbidities wereprospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopiccholecystectomy was performed.\u0000Results: Patient demographics, details of peri-operative management and post-operative complicationswere studied.Between July 2014 and January 2018, 32 patients (M:F=24:08) with mean age of 55 years(range 36–78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy.Of these, 24 patients were in NYHA class-II, while 8 belonged to class-III. Left ventricular ejection fraction,as recorded by transthoracic echocardiography, was20–30% in 08 (25%) patients and 30–40% in the rest24(75%). In addition, 21 (71%) patients had regional wall motion abnormalities, 11 (34%) patients hadcardiomyopathy while 09 (39%)patients had prior cardiac interventions. Following laparoscopiccholecystectomy, hypertension (21), tachyarrhythmia(4) and bradycardia (2) were the commonest eventsencountered.Two patients required dopamine in the immediate postoperative period but all other patientsmade an uneventful recovery.\u0000Conclusion: With appropriate cardiological support, laparoscopic cholecystectomy may be safely performedin patients with significant cardiac dysfunction.\u0000JBSA 2020; 33(2): 78-84","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"C-22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85092765","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 poisoning patient admitted in the ICU of the largest tertiary care government hospital in Dhaka, Bangladesh","authors":"S. K. Sarker, M. Salim, A.K. Ahmed, Mousume Mahjaben, Benozir Sofi Tumpa","doi":"10.3329/jbsa.v33i2.67529","DOIUrl":"https://doi.org/10.3329/jbsa.v33i2.67529","url":null,"abstract":"Background: Acute poisoning is a common chief complaint leading to emergency department visits andhospital admissions in developing countries such as Bangladesh.\u0000Aim: To study the demographic and clinical profiles of patients admitted to the ICU with acute poisoningand to study the factors that predict their mortality.\u0000Methodology: This observational study recruited all eligible 74 poisoning patients admitted in theintensive care unit from 1st July 2019 to 30th June 2020. This study is conducted in the Intensive CareUnit of Dhaka Medical College Hospital, Dhaka, Bangladesh.\u0000Result: Total 74 poisoning patients were admitted in the intensive care unit, of them female (55.54%)was more than male(44.59% ). Among the patients 67( 90.54 %) patient were Muslims and 43(58.10%)were married. The highest incidence of poisoning 28 (37.83%) were observed in the age group 11 to 20year and the mean age was 23.74 years. The majority of poisoning cases was suicidal intension(87.83%),accidental was 6.75% and homicidal or street poisoning was 5.40%.The most common type of poisoningwas organophosphorus compound (52.70%) followed by Drug overdose (16.21%), Paraquat poisoning(9.45%), rat killer( 5.4%),Insecticide poisoning (4.05%),Corrosive poisoning (2.74%).The most commonroute of poisoning was ingetion. Mechanical ventilation required 52.70% patients, majority of patientsrequired shorter period (1 to 5 days) of mechanical ventilation and mean duration of mechanical ventilationis 6.33 days . 83% patient were shifted /dischared from the ICU within 1 to 5 days. Mean duration was8.13 day in case of mechanical ventilated patients, but in non-ventilated patients, ICU stay was much lessthan ventilated patients. In this study, the mortality rate was 31% .\u0000Conclusion: Early ICU admission and appropriate management of patients after ingestion of poisonousagent results in reduced morbidity and mortality.\u0000JBSA 2020; 33(2): 85-91","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78670353","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 Granisetron and Dexamethasone in management of post operative nausea and vomiting (PONV) in laparoscopic gynaecological surgery","authors":"Kawser Begum, Rezwanur Rahman, Akm Habibullah, Md Younus Ali, K. Ibrahim, D. Banik","doi":"10.3329/jbsa.v33i1.67480","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67480","url":null,"abstract":"Background: Postoperative nausea and vomiting (PONV) is a common problem. It is more common inlaparoscopic surgery than in open surgery and following laparoscopic gynaecological surgery. PONVcauses patient discomfort and can prolong the time of hospital discharge.It causes potential hospitalburden and loss of unanticipated working time both for the patients and doctors. Management of thisproblem based on prevention rather than treatment. Various antiemetic drugs including steroids areeffective in the prevention of PONV but which one is better still now a debateable one. On the basis of thisfact there were numerous research, articles, analysis and publication work done all over the world.\u0000Objectives: Comparison of granisetron and dexamethasone to detect which one is better in managementof PONV after laparoscopic surgery.\u0000Method: The patient were selected after ethical committee approval. After informed written consent wehave selected 100 ASA- I & II patients undergoing general anaesthesia for laparoscopic gynaecologicalsurgery in a prospective double blind randomized study. Patients who had received opoids, NSAIDS,steroids or antiemetic agent before previous 4 weeks or who has known hypersensitivity to granisetron ordexamethasone. Patients were divided as group-A (granisetron) and Group-B(dexamethasone). 50 patientwere member of each group. Every patient got study drug during induction. Group-A got granisetron andgroup-B got dexamethasone for prevention of PONV. There were no differences in background factors orfactors related to anaesthesia, analgesics consumption, pain or side effects between groups. The data collectedin a fixed protocol form from the patient consented for the study. After collection of data were coded, edited,compiled and entered into computer system for analysis. The result will help to guide the anaesthesiologistspracticing in the third world countries like Bangladesh in the management of PONV.\u0000Results: The current study showed the intravenous injection of 8 mg dexamethasone, or 3 mg Granisetronhave similar effects on PONV prophylaxis in laparoscopic gynaecological surgery. These results of thecurrent study indicated that Dexamethasone is a suitable substitute for Granisetron.\u0000Conclusion: Dexamethasone and Granisetron are comparable in management of PONV. These drugsinjection before anesthesia induction have similar effects on nausea and vomiting prophylaxis afterlaparoscopic gynaecological surgery. Prophylactic use of dexamethasone should be routine to preventPONV because dexamethasone is cost effective than granisetron.\u0000JBSA 2020; 33(1): 36-42","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73051792","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":"Contribution of Regional anaesthesia on health economics: cost effectiveness of preemptive TAP block in Laparoscopic cholecystectomy","authors":"S. Azad, Mishuk Dutta, Nahida Parveen Nimmi, A. Badruddoza, S. Mitra, Azharul Islam, L. Aziz","doi":"10.3329/jbsa.v33i1.67475","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67475","url":null,"abstract":"Objective: Regional anaesthesia can play a vital role as a supplement of general anaesthesia inlaparoscopic cholecystectomy surgery. In this study we postulated that preemptive bilateral dualtransversus abdominis plane (BD - TAP) block has the potential to reduce the requirement of volatileanaesthetic, muscle relaxant, postoperative opioid demand and shortening of hospital stay in laparoscopiccholecystectomy surgery, ultimately total cost.\u0000Method: Total 40 patients ASA I - II undergoing laparoscopic cholecystectomy surgery were randomlyassigned into two equal groups of 20 patients each. All patients received preemptive IV Paracetamol (15mg/kg), IV Diclofenac (1 mg/kg) and BD - TAP block. Block was performed with bilateral Subcostal(medial to linea semilunaris) and lateral TAP injection with total 70 ml drug volume. Group A receiveda drug solution containing plain Bupivacaine 15 ml (0.1%), Lidocaine 35ml (1%), Dexamethasone 10mg. Group B received a total 70 ml normal saline injection. Maintenance of anaesthesia was accomplishedwith low flow anaesthesia (0.5 - 1.0 L/min) accompanied by BIS monitoring, maintaining BIS index 45- 55. All patients received Sevoflurane with N2O 60%. Muscle relaxation was guided by TOF monitoringand supplemental dose was adjusted by the TOF counting. Postoperative analgesia was maintainedwith IM pethidine in p.r.n dose and oral paracetamol in regular doses. Total opioid requirement, musclerelaxant and volatile anaesthetic used and duration of postoperative hospital stay were recorded.\u0000Result: BD - TAP block reduced the Sevoflurane requirement, group A 5.5 (± 0.05) ml/ hr and group B6.8 (± 0.9) ml/ hr (p < 0.05). It also reduced the requirement of Rocuronium in comparison to controlgroup, group A 49.5 (± 2.85) mg and in group B 58 (± 4.21) mg (p < 0.05). Postoperative pethidinerequirement, group A 135 (± 22.9) mg and group B 375 (± 46) mg (p < 0.05). It also facilitated rapidhospital discharge, group A 1.16 (± 0.5) days and group B 2.03 (± 0.5) days (p < 0.05).\u0000Conclusion: In this study it is demonstrated that preemptive (BD - TAP) block in laparoscopiccholecystectomy surgery is associated with reduced requirement of volatile anaesthetic, muscle relaxantand postoperative opioid consumption. It seems that regional anaesthesia has a big contribution inmodern health economics and national health policy should consider this issue.\u0000JBSA 2020; 33(1): 3-9","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73826862","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}