Minimally invasive Coronary ArteryWe discussed the procedure with the patient, who was enthusiastic and well-motivated to accept the technique.On the day prior to the elective surgery, a thoracic epidural catheter was inserted at the T1 and T2 level under local anesthesia using an 18-gauge. Tuohy needle with the patient in sitting position. The epidural space was identified by hanging-drop technique. The catheter was directed cephaled and advanced 3cm into the epidural space. The block level was tested by a test dose of 3ml Lignocaine (2%).On the day of surgery, early in the morning the patient was pre-medicated with 7.5 mg Midazolam orally. At 8:30am in the operating room, 10 ml of 0.25% Bupivacaine + 5 ml of 1% Lignocaine was administered through the epidural catheter as a bolus and the level of block was tested by pin-prick discrimination. The upper level of block was C6 and the lower level was T10. After skin incision weinfused a solution of 25ml 0.5% Bupivacaine + 25ml distilled water + 50µg Fentanyl by syringe pump at the rate of 5ml per hour. The patient breathed 5 litres of oxygen per minute using a face mask.The patient was continuously monitored by Intra Arterial Blood Pressure (IABP), CVP, ECG, pulse oxymetry, ETCO 2 , and ABCT. The maximum
Background: Management of partial epilepsy is an important issue in the field of neurology. Objective: The purpose of the present study was to collect additional clinical data on efficacy and safety of sustained release sodium valproate chrono formulation as first-line monotherapy in patients newly or recently diagnosed with partial epilepsy in Bangladesh under daily practice condition.
Methodology:This open-label, multicenter, non-controlled, prospective, observational study enrolled adults and children ? 6 years newly diagnosed with partial epilepsy with or without secondary generalization between March 2010 and February 2011. Patients were treated with sustained release sodium valproate. Primary evaluation criterion was the remission rate i.e. proportion of seizure-free patients at 6 months. Secondary evaluation criteria included retention rate at 6 months, remission rate at 1 and 3 months, investigator's global clinical impression rating, safety profile assessment. Results: A total of 185 adults and 115 children with mean 4.4 months duration of epilepsy were included. At inclusion the mean daily valproate dose in children was 329 mg and 568 mg in adults. The mean treatment duration in both children and adults was 5.5 months. At the end of 6 months 74.7% of the patients were seizure-free (children and adults; 79.1% vs 71.9%). The number of seizure free patients at 1 month was 109 (36.3%) and 175 (58.3%) at month 3. The treatment retention rate at 6 months was 87.3% with small higher trend in adults than children (88.6% vs. 85.2%). Among the patients 9.3% experienced side effects like drowsiness and weight gain. No severe adverse event was reported. Conclusion: Sodium valproate sustained release formulation is effective for the first-line treatment of partial epilepsy in both adults and children with acceptable tolerability. [J Natl Inst Neurosci Bangladesh 2015;1(1): 2-4]
Patients undergoing CABG surgery have abnormal cardiovascular physiology and are commonly associated with multivessels disease, have compromised ventricular function and are often associated with other co morbid conditions. Aim of the study was to compare the peroperative hemodynamic effect in CABG surgery before aortic cannulation of two anesthetic techniques, e.g. TIVA (propofol-fentanyl) vs conventional (N20-halothane). 40 patients scheduled for CABG surgery were allocated in double blind, randomized study. Patients were divided into two groups. In group A patients were maintained anaesthesia with TIVA (Propofol-fentanyl) technique and in group B patients conventional (N20-halothane) technique. Hemodynamic parameters were taken at different stages in peroperative period upto the time of aortic cannulation. Hemodynamic supports were manipulated in a systematic approach. Hemodynamic status was evaluated and compared on the basis of support requirements between the groups. No significant changes of all the hemodynamic parameters were observed at induction, intubation, skin incision, sternotomy and then in maintenance phase (mean of 15 minutes interval) upto aortic cannulation in both groups. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.3-8
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