Journal of the Bangladesh Society of Anaesthesiologists最新文献

{"title":"Effectiveness of Transversus Abdominis Plane Block as part of a Multimodal Analgesia to Reduce Opioid Consumption among Total Abdominal Hysterectomy Patients: A Randomized Control Trial","authors":"Md Ali Haider, Rabeya Begum, Md. Sirajul Islam, M. N. Islam, Subrata Mondal, Md Gishan Hossain, Md Jahid Iqbal","doi":"10.3329/jbsa.v33i1.67477","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67477","url":null,"abstract":"Background:Generally patients after total abdominal hysterectomy have suffered from moderate tosevere postoperative pain. Multimodal approach are using to reduce this pain.\u0000Objective:The purpose of the present study was to observe the effectiveness of transversus abdominisplane block as part of amultimodal analgesia to reduce opioid consumption among total hysterectomypatients.\u0000Methodology:This randomized control trial was conducted in Department of Anaesthesia, Analgesia,Palliative and Intensive Care Medicine of Dhaka Medical College and Hospital, Dhaka, Bangladeshfrom March 2016 to September 2018 for a period two years and six months. Women planned for anelective total abdominal hysterectomy under general anesthesia were selected as study population.Participants were selected and randomly divided into two groups designed as group I and group II.Patient of both group were given general anesthesia. Group I patient received 20 ml 0.25% bupivacaineand group II patient received 20 ml normal saline as placebo. Then dressing was done. The TAP blockwas performed after taking all aseptic precaution in the flank palpated between the 12th rib (Costalmargin) and the iliac crest. After confirmation of correct position, 20 ml 0.25% bupivacaine was given togroup I patient and 20 ml normal saline was given to group II patient within the fascial layer whichwas confirmed by ultrasound.\u0000Result:A total number of 40 patients were recruited for this study and were equally divided into twogroups. Thus 20 patients were in the group I and the rest 20 patients were in group II. The mean age ofgroup I were 53.08 ±4.25 and group II were 51.5±4.97 (p= 0.286).In this study 5(25.0%) patients hadnausea in group I and 8(40.0%) in group II, 3(15%) patients had vomiting in group I and 4(20.0%) ingroup II (p>0.05). The mean first analgesic demand was 8.39±1.85 hours in group I and 1.59±0.21 hoursin Group II (p=0.001).The mean total morphine consumption was 14.78±3.56 in group I and 26.30±5.9in group II (p<0.05).\u0000Conclusion:TAP block effectively reduced the total postoperative morphine consumption.\u0000JBSA 2020; 33(1): 16-21","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85449765","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 between High and Low Rapid Shallow Breathing Indexes with Weaning of Patients in Prolonged Mechanical Ventilation","authors":"Md. Sirajul Islam, Md Ali Haider, Uzzwal Kumar Mallick, M. Asaduzzaman, Md Gisan Hossain, Kazi Eshika Raka, Mohammad Safayat Kamal","doi":"10.3329/jbsa.v33i1.67476","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67476","url":null,"abstract":"Background: The rapid shallow breathing indexe is crucial considering the weaning of patients inprolonged mechanical ventilation.\u0000Objective: The purpose of the present study was to compare the high and low rapid shallow breathingindexes with weaning of patients in prolonged mechanical ventilation.\u0000Methodology: This cohort study was conducted in the Department of Anesthesia, Pain Palliative &Intensive Care Unit of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2014 toDecember 2015 for a period of two (02) years. Patients of ICU on mechanical ventilation more than 48hours with the age of 18 to 60 years were included in this study. Standard weaning criteria was consideredas resolution of the primary cause of respiratory failure, state of alertness, cooperation, response tocommands and Glasgow coma scale (GCS) scores ³9. Primary and daily setting of ventilators and thedecision to weaning of the patient was made by the ICU consultants. RSBI was then measured. Thedecision of weaning was not influenced by the RSBI. After measuring RSBI, patients was separatedfrom mechanical ventilator and given T-piece trial (1 to 4 hours) and finally extubated as per advice ofICU consultant and observed for 48 hours. The patients were divided in two groups low RSBI £105breath/min/L and high RSBI >105breath/min/L. These patients were prospectively followed up to 48hours in ICU and HDU.\u0000Result: A total of 117 patients were included in this study. The mean age was found 35.42±13.66 yearswith range from 18 to 60 years. The mean mechanical ventilation was found 9.6±6.4 days in low RSBIgroup and 8.6±4.5 days in high RSBI group (p>0.05). The association between RSBI and success inweaning of the patients was recorded. In low RSBI group 94.6% patient’s sustained extubation (success)and high RSBI group 76.0% patients’ sustained extubation. Success was significantly higher in patientswith low RSBI group (p=0.001). The association between RSBI and weaning failure of the patients wasmeasured. In high RSBI group failure was 6(24.0%) and success was 19(76.0%). On the other hand inlow RSBI group failure was found 5(5.4%) and success was 87(94.6%) (p=0.011).\u0000Conclusion: In conclusion significant association is found between high and low rapid shallow breathingindexes with weaning of patients in prolonged mechanical ventilation.\u0000JBSA 2020; 33(1): 10-15","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"267 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83001258","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":"Fentanyl - Based Cardiac Anesthesia Provides Higher Recovery Compared with Morphine in Elective CABG Surgery Patients","authors":"Hasan Amk, A. Niaz, A. S, Haider Mz, Kabir Maam, Nine Smaz, K. A, Hasan Ms","doi":"10.3329/jbsa.v33i1.67479","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67479","url":null,"abstract":"Background : High-dose opioid anesthesia during cardiac surgery has been the mainstay of cardiacanesthesia for decades due to its ability to preserve hemodynamic stability and attenuate hormonal andmetabolic response to surgical stress. The hypothesis of this study is that the use of fentanyl as part of abalanced anesthetic would lead to improved patient health status and recovery during the first 3 daysafter cardiac surgery with CPB compared with morphine. Quality of recovery was assessed using theQoR-40 questionnaire administered preoperatively and daily on postoperative days 1–3. Hemodynamicvariables, duration of tracheal intubation, organ morbidities, intensive care unit (ICU) and hospitallength of stay were evaluated.\u0000Methods: This comparative randomized double blind study was conducted in the department ofcardiothoracic vascular anaesthesia and critical care of Apollo Hospitals,Dhaka on 100 patientsundergoing elective CABG. Study period was (January-July), 2019. The study was approved by theinstitutional review board, and informed consent was obtained from all subjects. One hundred patientspresenting for elective CABG surgery, between the ages of 18 and 79, were enrolled in the study. Exclusioncriteria included (1) concurrent valvular surgery or the presence of valvular disease, (2) reoperativeprocedures, (3) unstable angina or elevated cardiac enzymes within 48 hours of surgery, (4) morphine orfentanyl allergy, (5) the need for an intra-aortic balloon pump or inotropic agents preoperatively, (6)psychiatric or central nervous system disturbances precluding completion of the QoR-40.\u0000Results: Compared with patients given morphine, those receiving fentanyl had higher global QoR-40scores on postoperative days 1 (174.8 vs 162.5, P 0.001), 2 (175 vs 166.1, P 0.001), and 3 (178.1 vs 167.3,P 0.001). Differences between the groups were observed in the QoR-40 dimensions of emotional state,physical comfort, and pain . Postoperative visual analog scale pain scores, use of pain medication in theICU and surgical ward, and postoperative febrile reactions were reduced significantly in the fentanylgroup . No differences between the groups were noted in duration of tracheal intubation,ICU and hospitallength of stay, or postoperativecomplications.\u0000Conclusion: Continuous intravenous infusions of fentanyl have been used to provide intraoperativeanalgesia also give good-to-excellent postoperative analgesia furthermore early extubation and the qualityof postoperative recovery in cardiac surgical patients can be enhanced when fentanyl is used as part of abalanced anesthetic.\u0000JBSA 2020; 33(1): 28-35","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85503600","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":"Anesthetic management of an emergency caesarian delivery in a 61 year 8 month old Primigravid patient with 33+ wks pregnancy (IVF, twin) with Diabetes Mellitus with Hypertension with Hypothyroidism and Mild aortic stenosis","authors":"W. Mahmood, SM Ali, M. Islam, Dr. Rabindra Das, Basudeb Das, Tasmia Khan","doi":"10.3329/jbsa.v33i1.67481","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67481","url":null,"abstract":"Physiologic changes of pregnancy uniquely influence anesthesia for caesarian delivery. Aging is also anuniversal and progressive physiological phenomenon clinically characterized by degenerative changesin both the structure and the functional capacity of organs and tissues. For an anesthesiologist the casebecomes more challenging when the patient has multiple comorbidities such as Diabetes Mellitus,Hypertension, Hypothyroidism and Mild Aortic stenosis. We report an emergency caesarian delivery inthe case of a 61 year 8 month old woman who was diagnosed as 33+wks Pregnancy (IVF, TWIN) withDM (Insulin) with Hypothyroidism on medication with Hypertension on medication with Mild aorticstenosis. Emergency caesarian delivery of this patient was necessary due to oligohydramnios with laborpain and fetal distress. The delivery was successfully performed under SAB and patient recovered withoutany complication.\u0000JBSA 2020; 33(1): 43-45","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84080756","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":"Ultra-sound: A New Armament in Anesthesia","authors":"Md. Azharul Islam","doi":"10.3329/jbsa.v33i1.67474","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67474","url":null,"abstract":"Abstract not available\u0000JBSA 2020; 33(1): 1\u0000 ","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78642666","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":"Comparative Study between Bronchial Blocker and Left Double Lumen Endotracheal Tube for One Lung Ventilation in Right Video-Assisted Thoracoscopic Surgery","authors":"F. Kalam, Md Pervez Altaf Hossain, Masud Ahmed, Abdullah Masum","doi":"10.3329/jbsa.v33i1.67478","DOIUrl":"https://doi.org/10.3329/jbsa.v33i1.67478","url":null,"abstract":"Background: Double lumen endotracheal tubes (DLT) and bronchial Blockers (BB) have both beenused for lung isolation in video-assisted thoracic surgery (VATS) with some inherent demerits.Thoughnot well studied is widely thought that DLT provides faster and better quality of lung collapse.\u0000Objective: The aim of this study was to compare the quality of lung deflation of a left sided double lumenendotracheal tube with a broncheal blocker for one lung ventilation in video-assisted thoracic surgery.\u0000Materials methods: A total forty adult patients have been assigned to either DLT or BB group whoundergoing VATS procedure for mediastenal mass surgery. Correct placement of airway was confirmed byfiber optic bronchoscopy. The variables assessed were: 1. Time required for correct placement of device, 2.Time taken for lung collapse, 3. Quality of Lung collapse, 4. Number of times of airway mal-positioned, 5.Changes of blood pressure and heart rate at baseline (T1) and immediate before (T2) and after (T3) intubationand one minute after (T4) intubation, 6. Number of patients with hypoxemia (Spo2 <90%) during one lungventilation, and7.Post-operative complication like hoarseness of voice, sore throat and lung infection.\u0000Result: The time required to place the device in correct position was similar between two groups. Timetaken for right lung collapse in DLT was faster than BB group, DLT (2.46 ± 0.85) BB (4.76 ± 0.61) P (<0.05). HR was similar and comparable at T1, T2,T4 between groups &was significantly high at T3 inDLT (88.24 ± 7.42) than BB group (78.56 ± 9.06) and p value (=0.00007) was significant. Mean arterialpressure (MAP) were comparable between groups at T1, T2, T4, but at T3 was higher in DLT (99.36 ±9.62) than BB (92.15+6.47) and the result was statistically significant (P= 0.0084).\u0000Conclusion: Result showed that BB could be a better and effective alternative of DLT in VATS Procedureconsidering a longer time to achieve complete lung collapse with minimum hemodynamic changes andwith minimum post-operative complication.\u0000JBSA 2020; 33(1): 22-27","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90604899","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 and Safety of Dexamethasone versus Fentanyl as an adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block","authors":"S. Hasan, A. Chowdhury, S. Khatoon, Kalyan Barua, A. S. Alam","doi":"10.3329/jbsa.v32i1.66547","DOIUrl":"https://doi.org/10.3329/jbsa.v32i1.66547","url":null,"abstract":"Background: Brachial plexus blockade is gaining popularity day by day for the upper extremity surgery.Increasing the duration of local anesthetic action by adding different adjuvant is often desirable toprolong the surgical anesthesia and analgesia. The aim of this study was to make a comparative evaluationof the efficacy and safety of dexamethasone and fentanyl as an adjuvant with bupivacaine-lignocaine insupraclavicular block.\u0000Material and methods: This comparative study was carried out in the departmentof anesthesiology in Chittagong Medical College Hospital in collaboration with the department oforthopedic surgery over a period of 22months starting from July, 2012 to April, 2014. A total 130 adultpatients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected forupper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groupsof 65 patients in each. Group- D was received dexamethasone 2ml (10mg) and Group-F was receivedfentanyl 2ml (100mg) in 38ml of bupivacaine and lignocaine with adrenaline (total volume of 40ml).\u0000Result: The mean onset of sensory&motor block was 7.72±1.949min & 8.75±2.008min in group-D and7.60±3.711min & 9.23±5.114min in group-F. Both the results in two group was not statistically significant(p>0.05).The duration of analgesia in group-D was 11.40±0.844hrs and in group-F was 8.62±1.747hrs.Theresults was significantly higher in group-D than group-F (p<0.05).\u0000Conclusion: There was significantlyprolonged duration of analgesia and better onset of sensory and motor block in dexamethasone groupthan in fentanyl group without any unwanted effects.\u0000JBSA 2019; 32(1): 10-17","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"226 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75671073","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":"Anaesthetic Challenge of Craniopagus Twin: A Case Report","authors":"Moumita Talukdar, Rebeka Sultana, Mozaffar Hossain, Subrata Mondal, S. S. Alam","doi":"10.3329/jbsa.v32i1.66551","DOIUrl":"https://doi.org/10.3329/jbsa.v32i1.66551","url":null,"abstract":"We describe the anaesthetic management of 2 years old Craniopagus twins for cerebral angiogram &embolization. Anesthetic management for Craniopagus twins is associated with unique concerns of crosscirculation, difficulty in mask ventilation, difficult access to airway and intubation due to angle betweenthe heads.Adequate preparation and teamwork is the keystone to the management of these patients.\u0000JBSA 2019; 32(1): 35-37","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76042365","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":"Use of Ultrasonography in Regional Anaesthesia: Bangladesh Perspective","authors":"Debasish Banik","doi":"10.3329/jbsa.v32i1.66545","DOIUrl":"https://doi.org/10.3329/jbsa.v32i1.66545","url":null,"abstract":"Abstract not available\u0000JBSA 2019; 32(1): 1-2","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"254 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73694834","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":"Caesarean Section in A Patient with Myasthenia Gravis: A Challenging Anaesthesia","authors":"Nahida Parveen Nimmi, Golam Ferdous Alam, S. Mitra, L. Aziz","doi":"10.3329/jbsa.v32i1.66552","DOIUrl":"https://doi.org/10.3329/jbsa.v32i1.66552","url":null,"abstract":"Myasthenia Gravis (MG) is an acquired, autoimmune disorder affecting neuromuscular junctionpresenting with easy fatigability, progressive weakness, diplopia, difficulty in speaking and swallowingand even ventilator failure in severe cases. During pregnancy the disease may go into remission or mayexacerbate at any time during first, second and third trimesters or postpartum period. We are reportinga case of a 32 years old primi gravida, a known case of MG, who underwent emergency caesarian sectiondue to postdated pregnancy. Both the mother and the baby were well managed in the perioperative period.\u0000JBSA 2019; 32(1): 38-41","PeriodicalId":17242,"journal":{"name":"Journal of the Bangladesh Society of Anaesthesiologists","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82642931","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}