Journal of the Bangladesh Society of Anaesthesiologists https://www.banglajol.info/index.php/JBSA Official journal of the Bangladesh Society of Anaesthesiologists. Bangladesh Society of Anaesthesiologists en-US Journal of the Bangladesh Society of Anaesthesiologists 2220-8992 Burnout syndrome – A professional hazards of Anaesthesiologists https://www.banglajol.info/index.php/JBSA/article/view/47584 <p>Abstract Not Available</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 1-3</p> Md Mozaffer Hossain ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 1 3 10.3329/jbsa.v28i1.47584 Recovery of Cognitive Function in Adults: A Comparison of Sevoflurane And Halothane Anaesthesia https://www.banglajol.info/index.php/JBSA/article/view/47585 <p><strong>Background: </strong>Among the recovery phases, patient achieve their cognitive and psychomotor skills in intermediate phase. Rapid clearance drug like Sevoflurane has beneficial effect on early cognitive recovery which allows early mobilization and reduce post operative complication but Halothane with delayed recovery profile is still commonly used in our country.</p> <p><strong>Objective: </strong>So the study was done to compare the post operative cognitive recovery in adult patients receiving sevoflurane and halothane anaesthesia and with a view to increase the use of sevoflurane over halothane.</p> <p><strong>Settings and study design: </strong>This prospective randomized comparative study was done in Anaesthesia, analgesia and intensive care medicine department of BSMMU Hospital between September 2009 to June 2011. A total 60 patients[30 in sevoflurane group (Group-S) and 30 in halothane group(Group-H)]of either sex, 18-50 years, ASA-I and II, elective surgery under general anaesthesia, lasting more than 1 hour and remaining 24 hours after surgery were the study population. Cognitive recovery was assessed using Bangla adaptation mini-mental state examination (BAMSE) and paper pencil test-Trail making test part- A (TMT-A) one day prior to surgery (baseline value) and 30 minutes after recovery then at hourly interval up to 3.5 hours postoperatively and compared.</p> <p><strong>Results: </strong>Emergence time was significantly shorter in Group-S compared to Group-H (10.85 min &amp; 15.13 min respectively, P&lt;0.001). The mean BAMSE score Group-S was 29 at baseline and demonstrated no change at the end of the observation, while the Group-H experienced a fall and rise in BAMSE score. Time taken by the patients of Group-S to complete (TMT-A) at 30 minutes after recovery was significantly less (40.9 sec. Vs 55.8 sec, P &lt;0.001) than patients of Group-H. And no significant difference was observed between groups at 1.5 hrs, 2.5 hrs and 3.5 hrs.</p> <p><strong>Conclusion: </strong>So the study concludes that adult patient of sevoflurane group experienced an early post operative cognitive recovery than halothane group. Though sevoflurane is costly, considering the benefits of patients in terms of early cognitive recovery that causes less postoperative complications and shorter hospital stay, sevoflurane should be used instead of halothane</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 5-11</p> Shamima Akter Suraya Akter Mohammad Sofiuddin Rehnuma Tasnim Abdullah Masum Dilip Kumar Bhowmick Md Abdul Hye ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 5 11 10.3329/jbsa.v28i1.47585 Microalbuminuria: A Predictor of Outcome in Critically ill Patients in Intensive Care Units https://www.banglajol.info/index.php/JBSA/article/view/47586 <p><strong>Background: </strong>Diffuse endothelial dysfunction in physical, chemical or infectious insult to the host leads to an increase in systemic capillary permeability. The renal component manifests as Microalbuminuria. The degree of Microalbuminuria correlates with the severity of the acute insult and the quantification of which may serve to predict outcome in critically ill patients.</p> <p><strong>Objectives: </strong>To evaluate whether the degree of Microalbuminuria could predict outcome in critically ill patients or not.</p> <p><strong>Settings and Study design: </strong>This cohort study was carried out in the 20 bed mixed Medical-Surgical Intensive Care Unit of Dhaka Medical College Hospital. A total 60 patients were purposively recruited for this study. In our study, we included all adult critically ill patients aged 18 years or more admitted in ICU after fulfilling the criteria of critically ill patients and who stayed for more than 24 hours. Patients with pregnancy, menstruation, anuria, macroscopic haematuria, pre-existing kidney disease, were excluded. Spot urine samples were collected by ICU nurses at 24 hrs of admission, for the quantification of Albumin Creatinine Ratio, which was referred to as ACR. The outcome of the patient was classified as death and discharge/ survival. Maximum follow up was done for 15 days. Patients discharged within this 15 days, were considered as survival.</p> <p><strong>Results: </strong>Patients were divided into two groups, Group-I: subjects (exposed): Patients having Microalbuminuria. Group-II: control (unexposed): Patients having no Microalbuminuria. In this study, Relative Risk was calculated for risk measurement and to assess the strength of association between the patients having Microalbuminuria and outcome and the calculated relative risk was 2.08. It indicates that the presence of Microalbuminuria is a risk factor for the critically ill patients. Chi-square test was used to compare categorical outcomes and for hypothesis testing. The test statisticis11.94 and p=&lt;0.001.So, our study result supports the hypothesis that Microalbuminuria predicts the outcome in critically ill patients.</p> <p><strong>Conclusion: </strong>It was observed that the presence of Microalbuminuria at 24 hours of ICU admission is a predictor of poor outcome in critically ill patients. Absence of Microalbuminuria at 24hrs of admission may help to predict survival in the ICU. So the study concludes that the Microalbuminuria would provide a rapid, simple, inexpensive bedside test to identify patients who may benefit from appropriate early therapeutic strategies. It may prevent further capillary leak and hence the onset of multi organ failure and death.</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 12-18</p> Suraya Akter Shamima Akter Md Shahjahan Miah AKM Habibullah Bahar Md Mozaffer Hossain Md Abdur Rahman ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 12 18 10.3329/jbsa.v28i1.47586 Use of Ketamine-Propofol ‘Ketofol’ versus Ketamine- Midazolam for Procedural Sedation and Analgesia https://www.banglajol.info/index.php/JBSA/article/view/47587 <p><strong>Background: </strong>Procedural sedation and analgesia (PSA) is useful technique for unpleasant surgical, diagnostic and interventional procedures while maintaining cardiorespiratory function. Unfortunately, at this time no single agent available that complete PSA successfully, so combinations of different drugs used at varying does to achieve the desired goal.</p> <p><strong>Objectives: </strong>The purpose of this study is to observe the effectiveness of combination of ketamine and propofol (Ketofol) in comparison with ketamine midazolam combination in patients undergoing procedural sedation and analgesia (PSA) for short elective and emergency surgeries.</p> <p><strong>Methods: </strong>One hundred patient of both sex, ASA grade I &amp; II, age 18 to 50 years were scheduled to undergo different short surgical procedures (less than 1 hour) were randomly assigned into 2 groups. In Group KP (n=50) recieved Ketamine &amp; Propofol (1:1) and Group KM (n=50) received Ketamine and midazolam at the discretion of the anaesthesiologist by using titrated aliquots for completion of the procedure. All perioperative vital parameters, events, complications, recovery status, and cost of sedation regimen were recorded and subsequently analyzed.</p> <p><strong>Results: </strong>The two groups were fairly comparable regarding demographic and preoperative data. Group KP remain more stable than Group KM haemodynamicaly; heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure were significantly higher in Group KM than Group KP during procedure at 5, 10, 15, 20 and 25 minutes (p&lt;0.01). Recovery time was 19.71±7.58 (mean±SD) minutes in Group KP and 32.25±8.91 (mean±SD) minutes in Group KM which was significantly higher (P&lt;0.01). Cost (taka) of sedation regimen was significantly higher in Group KP than Group KM (P&lt;0.01). Regarding sedition related side effects; incidences of hypertension (systolic BP more than 30% of baseline record) was found 1(2%) in Group KP and 5(10%) was found in Group KM and difference was statistically significant (P&lt;0.01). Other notable side effects were desaturation (SpO2 less than 93 %), airway misalignment, vomiting and agitation were almost similar and differences between two groups were statistically not significant.</p> <p><strong>Conclusion: </strong>Combination of ketamine and propofol ((ketofol) appeared to be a safe and efficacious during procedural sedation and analgesia regarding haemodynamic stability and short recovery period in comparison with ketamine midazolam combination for short surgical procedures.</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 19-28</p> Abdullah Al Maruf M Masudul Haque Md Mozaffer Hossain Sayeda Nazrina ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 19 28 10.3329/jbsa.v28i1.47587 Ultrasound guided truncal blocks for post operative analgesia – A study of 100 cases for the first time in Bangladesh https://www.banglajol.info/index.php/JBSA/article/view/47588 <p>Ultrasound guided (USG) nerve block techniques have been used for post operative analgesia for truncal operations to limit the perioperative use of NSAID and opioids. USG visualization offers safe blocks by optimal needle positioning, direct visualization of peripheral nerves and local anesthetic distribution. In Bangladesh, first ultrasound guided nerve block studies were started in the Dept. of Anesthesia, Analgesia and ICU of Bangladesh Medical College hospital. This Study has been carried out in the operation theatre and post operative room. Ultrasound guided Rectus sheath block, Subcostal TAP block, Classical TAP block, Ilio inguinal and Ilio hypogastric nerve block provide post operative analgesia of the abdominal wall. PEC 1, PEC 2 and Serratus Anterior plain block provide post operative analgesia for anterior chest wall. This study was done with 100 patients coming for abdominal surgeries and anterior chest wall surgeries. These blocks were given after induction and before giving incision in case of general anesthesia or after operation in case of spinal anesthesia. This study is an audit of ultrasound guided nerve blocks in terms of analgesia score, patient satisfaction, outcome of anesthesia and complications.</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 29-31</p> Khanum NA Muhit MSB Ahmed NC Haque LD Ibrahim KE Amin NF ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 29 31 10.3329/jbsa.v28i1.47588 Outside the Operating Theatre Anaesthesia https://www.banglajol.info/index.php/JBSA/article/view/47590 <p>Modern hospital practice has seen the role of the anaesthesiogist expand beyond the operating theatre complex. While the operating theatres have experienced staff, adequate equipment and monitors, providing anaesthesian outside this complex is challenging and requires expertise and skill.</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 32-38</p> M Khalilur Rahman Md Mushfiqur Rahman ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 32 38 10.3329/jbsa.v28i1.47590 Anaesthetic Management of a Patient with Down Syndrome VSD, ASD & PDA in Pediatric Cardiac Surgery Department, Dhaka Shishu Hospital https://www.banglajol.info/index.php/JBSA/article/view/47591 <p>Down syndrome or trisomy 21 is a condition where extra genetic material causes mental and physical delays and deficits. It affects 1 in every 650 babies. Abnormalities of the cardiovascular system are common in down syndrome. Approximately half of all infants born with down syndrome have a heart defect. The most common heart defects in down syndrome are the following: atrioventricular septal defect (45%), ventricular septal defect (35%), atrial septal defects (8%) and patent ductus arteriosus (7%), tetralogy of Fallots (4%). A Two years one-month-old baby was admitted in cardiac surgery department of Dhaka Shishu Hospital, with the diagnosis of Down syndrome with VSD,ASD&amp; PDA with moderate pulmonary arterial hypertension. Clinical examination revealed diastolic murmur over mitral area. The child was treated with face musk oxygen, diuretics and digoxin and was stabilized medically and then was selected for surgery. We used balanced anesthetic technique using oxygen, air, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB) with moderate hypothermia. Patient tolerated the whole procedure well and was ventilated electively for 4hrs in the intensive care unit. He was discharged on the 8thpostoperative day.</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 39-42</p> Mohammad Makbul Hossain Mohammed Iqbal KM Tarik KZ Haque Masumul Gani Chwowdhury KA Zaman MS Rahman ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 39 42 10.3329/jbsa.v28i1.47591 Brain Tumour Excision by Awake Craniotomy https://www.banglajol.info/index.php/JBSA/article/view/47589 <p>Awake craniotomy poses a unique challenge to anaesthesiologists, and its success is highly dependent on careful patient selection and the experience of the surgical and anaesthesia team. I report the pre-operative preparation and anaesthetic management for resection of an intra-cerebraltumour by awake craniotomy in a 40 years old male patient for the first time done at CMH Dhaka. The challenges of sedation and psychologicalcare throughout the procedure are discussed. I conclude that the procedure can be performedsafely.</p> <p>Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 43-45</p> M Masudul Haque ##submission.copyrightStatement## 2020-06-14 2020-06-14 28 1 43 45 10.3329/jbsa.v28i1.47589