Background: The majority of patients admitted in hospital for elective surgery experience anxiety preoperatively which can adversely influence the surgical procedure as well as the patient’s recovery. Reduction of anxiety and fear during preoperative period in patients of elective surgery is an essential surgical preparation. Benzodiazepines are the most commonly used drugs for this purpose. Materials and Methods: The study was carried out in a series of 60 consecutive, randomly selected patients, aged 18-60 years, admitted for elective surgery under General Anaesthesia, in Combined Military Hospital, Chattogram during the period September 2021 to February 2022. Patients who received Clonazepam or Bromazepam as preoperative medication were included in the study. Anxiety was scored using VAS (Visual Analogue Scale), sedation was scored by using Ramsay Sedation Scale and anterograde amnesia by asking preoperative events after 24 hours of premedication. Results: While evaluating mean anxiety reduction, mean reduction is not significantly different between the two groups (P value 0.856). Sedation level was more achieved with Clonazepam but that was not statistically significant (mean 2.13 vs mean 2.0, P value 0.557). In the Clonazepam group, greater percentage of patients could not recall preoperative events but that was not statistically significant (average 51.10% vs 39.99%, P value>0.05). Incidence of adverse effects was more in the Bromazepam group (16.66% vs 6.66%). Conclusion: The standard administration of Clonazepam and Bromazepam before operation provides patients with a moderate reduction of periprocedural anxiety. Clonazepam produces more amnesia, sedation and less adverse effects.. Therefore, this study favors routine use of Clonazepam as premedication to reduce anxiety before surgery. KYAMC Journal Vol. 13, No. 03, October 2022: 139-144

This randomized clinical trial compares midazolam and dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects, and adverse effects of both the drugs in elective Caesarian section under spinal anaesthesia. The study included 60 ASA grade-I patients between age 20- and 40-years undergoing elective Caesarean sections under subarachnoid anaesthesia, from January 2022 to June 2022. Patients were randomly allocated to one of the two groups: midazolam group (Group-I, n=30), who received midazolam in a single dose of 0.10mg/kg and Dexmedetomidine group (Group-II, n=30), who received dexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5-minute intervals until arousal of the patient. The onset of sedation i.e., time from IV (intravenous) injection of Midazolam or Dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e., time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5-point ‘Likert verbal rating scale’. There was no significant difference of mean blood pressure and mean heart rate between the two groups at different time intervals (P>0.05). Time of onset of sedation was significantly delayed in dexmedetomidine group (P<0.05). Duration of sedation was comparable between the two groups (P>0.05). Incidence of peroperative complications were comparable between the two groups (P>0.05). Haemodynamic effects and adverse effects of two drugs were comparable. Therefore, it is recommended that either midazolam or dexmedetomidine can be used for sedation in single dose technique during subarachnoid block for Caesarean section. CBMJ 2023 January: Vol. 12 No. 01 P: 99-106

Background: Regional anaesthesia has become an important anaesthetic technique now a days. Pharmacologically induced tranquility improves acceptance of regional technique. Objective: To compare Fentanyl and Fenofol (Fentanyl+Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal(subarachnoid) anaesthesia. Materials and Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I or II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Fenofol group (Group FP, n=30), who received Fenofol in a single dose of Fentanyl-0.5mcg/kg+Propofol-0.5mg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Fentanyl or Fenofol to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’ Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (P>0.05). Time of onset of sedation and the arousal time i.e. duration of sedation was comparable between the two groups (P>0.05). Significant percentage of patients required O2 supplementation in Fenofol group due to hypoventilation (66.66% vs 10%, P<0.001). Pain in arm during drug administration was significantly more with Fenofol (46.66% vs 6.66%, P<0.001). Conclusion: As a significantly higher percentage of patients required O2 supplementation during sedation with Fenofol and pain in arm during drug administration was significantly more in Fenofol group, it is recommended that Fentanyl is a better choice than Fenofol for sedation in single dose technique during subarachnoid block for Caesarean section. KYAMC Journal Vol. 13, No. 04, January 2023: 234-239

Background: Regional anaesthesia has become an important anaesthetic technique now a days. Theuse of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remainawake during surgery. Pharmacologically induced tranquility improves acceptance of regionaltechnique. This study compares Clonazepam and Dexmedetomidine in terms of onset and recovery ofsedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during electiveCaesarian section under spinal anaesthesia. Materials and Methods: This randomized clinical trial included 60 ASA (American Society ofAnaesthesiologists) grade I patients between age 20-40 years undergoing elective Caesarean sectionsunder Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients wererandomly allocated to one of two groups: Clonazepam group (Group C, n=30), who received Clonazepamin a single dose of 0.015mg/kg and Dexmedetomidine group (Group D, n=30), who receivedDexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting ahyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameterswere documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv(intravenous) injection of Clonazepam or Dexmedetomidine to closure of eye lids (OAA/S score of 3) andthe arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient isawake clinically) were noted. Any complication during operation was documented. The patient’ssatisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’ Results: There was no significant difference of mean blood pressure and mean heart rate between thetwo groups at different time intervals (P>0.05). Time of onset of sedation was significantly delayed inDexmedetomidine group (P<0.05). Duration of sedation was comparable between the two groups (Pvalue 0.326). Incidence of peroperative complications were comparable between the two groups (P>0.05). Conclusion: Although onset of sedation was significantly delayed in Dexmedetomidine group,duration of sedation was not significantly different between Clonazepam and Dexmedetomidine insingle dose technique for sedation during Caesarean section. Haemodynamic effects and adverse effectsof two drugs were comparable. Thus it is recommended that either Clonazepam or Dexmedetomidinecan be used for sedation during subarachnoid block for Caesarean section. JBSA 2022; 35 (2) : 30-36

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. Objective: This study compares Ketofol (Ketamine+Propofol) and Fenofol (Fentanyl+ Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia. Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I or II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period of January 2022 to June 2022. Patients were randomly allocated to one of two groups: Ketofol group (Group KP, n=30), who received Ketofol in a single dose of 0.5mg/kg (Ketamine- 0.5mg/kg+Propofol-0.5mg/kg) and Fenofol group (Group FP, n=30), who received Fenofol in a single dose of Fentanyl-0.5mcg/kg+Propofol-0.5mg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Ketofol or Fenofol to closure of eye lids and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. Patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups (P>0.05). Time of onset of sedation was comparable between the two groups (P>0.05). Duration of sedation was significantly less in Fenofol group (p value=<0.001). Significant percentage of patients required oxygen supplementation after sedation with Fenofol due to hypoventilation (66.66% vs 10%, p value <0.001). Incidence of nausea and vomiting was significantly more with Fenofol (46.66% vs 10%, p value >0.001). Conclusion: The study showed that the arousal time i.e. duration of sedation was significantly more with Ketofol than Fenofol which is beneficial for the patient in single dose technique for sedation. Fenofol was associated with significantly high incidence of nausea, vomiting. Moreover, significantly higher percentage of patients required O2 supplementation due to hypoventilation during sedation with Fenofol. Thus it is recommended that Ketofol is a better choice than Fenofol for sedation in single dose technique during subarachnoid block for Caesarean section.  J Rang Med Col. March 2023; Vol. 8, No. 2:20-26

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. Objective: This study compares Fentanyl and Ketofol (Ketamine+Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia. Materials and method: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients between age 20-40 years undergoing elective Caesarean sections under subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Ketofol group (Group KP, n=30), who received Ketofol in a single dose of 0.5mg/kg (Ketamine-0.5mg/kg+ Propofol-0.5mg/kg). Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Fentanyl or Ketofol to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (p>0.05). Time of onset of sedation was significantly less with Ketofol than Fentanyl (p<0.05). The arousal time i.e. duration of sedation was significantly longer with Ketofol than Fentanyl (p<0.05). Fentanyl was associated with high incidence of some adverse effects like nausea, vomiting than Ketofol (46.66% vs 16.70%, p<0.05). Pain in arm during drug administration was significantly more with Ketofol (33.33% vs 6.66%, p<0.05). Significant percentage of patients was satisfied with Ketofol than Fentanyl (66.66% vs 20%, p<0.001). Conclusion: The study showed that the time to reach effective sedation was less with Ketofol than Fentanyl and the arousal time i.e. duration of sedation was significantly longer with Ketofol which is beneficial for the patient in single dose technique for sedation. Although incidence of pain in arm was more with Ketofol, Fentanyl was associated with high incidence of some adverse effects like nausea and vomiting. Thus it is recommended that Ketofol is a better choice than Fentanyl for sedation in single dose technique during subarachnoid block for Caesarean section. Delta Med Col J. Jul 2020;8(2): 67-74

Background: Cerebral palsy (CP) is one of the most common causes of chronic childhood disability. To know the aetiopathogenesis, severity and prognosis of CP, neuroimaging is an important modality of investigation. Objective: This study was done to observe the findings in CT scan of brain in children with CP. Materials and Methods: This is a cross-sectional descriptive study. One hundred and ten patients who were clinically diagnosed as cerebral palsy were enrolled in the study. After selection of the subjects, demographic and clinical characteristics were recorded. All other comorbidities including visual and hearing impairments were identified. CT scan of brain was done in all children and reporting had been done by a single qualified radiologist. Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). Seven types of CP were found in the study group. Among them quadriplegic CP were the most common (39.1%). History of perinatal asphyxia was found in 81.8% children. Cognitive delay was found in 90% children, speech delay was found in 88.2% children, visual impairment was found in 35.5% children and hearing impairment in 31.8% cases. Epilepsy was found in 44.4% among studied subjects. Most common finding on CT scan of brain was cerebral atrophy (62.7%), followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). Abnormal CT scan findings were found in 88.2% of study population. Conclusion: This study showed that most common type of CP was quadriplegic CP. Maximum children had abnormal CT scan findings. Most common CT scan finding was cerebral atrophy. J Enam Med Col 2021; 11(1): 18-23

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal(subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery.Pharmacologically induced tranquility improves acceptance of regional technique. Objective: This study compares Ketofol (Ketamine + Propofol) and Dexmedetomidine in terms of onset and recovery ofsedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesariansection under spinal anaesthesia. Materials and Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists)grade I and II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoidanaesthesia during the period January 2022 to June 2022. Patients were randomly allocatedto one of two groups:Ketofol group (Group KP, n=30), who received Ketofol in a single dose of 0.5mg/kg (Ketamine-0.5mg/ kg+Propofol-0.5mg/kg) and Dexmedetomidine group (Group D, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg.Spinal anaesthesiawas conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinalneedle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset ofsedation i.e. time from iv (intravenous) injection of Ketofol or Dexmedetomidine to closure of eye lids (OAA/S score of3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awakeclinically) were noted. Any complication during operation was documented. Patient’s satisfaction with the sedation wasassessed by the 5 point ‘Likert verbal rating scale’. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups indifferent time intervals (P>0.05). Time of onset of sedation was significantly delayed in Dexmedetomidine group(P<0.001). The arousal time i.e. duration of sedation was comparable between the two groups (P>0.05). Ketofol wasassociated with significantly higher incidence of some adverse effects like pain in arm during drug administration thanDexmedetomidine (33.33% vs 10%, P<0.05). Satisfaction with sedation was comparable between the two groups(66.66% vs 86.66%, P value 0.136). Conclusion: As duration of sedation was comparable between the two drugs but adverse effects was less withDexmedetomidine, it is recommended that Dexmedetomidine is a better choice than Ketofol for sedation in single dosetechnique during Subarachnoid block for Caesarean section. Bangladesh Crit Care J March 2023; 11 (1): 13-18