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
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
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: The majority of patients admitted to the 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 at the preoperative period in patients of elective surgery is essential for surgical preparation. Benzodiazepines are the most commonly used drugs for this purpose. Materials and Methods: The study was carried out on a series of 60 consecutivepatients, 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 receiving bromazepam or lorazepam as preoperative medication were selected. Anxiety was scored using VAS (Visual Analogue Scale), sedation was scored by using the Ramsay Sedation scale and anterograde amnesia by asking about preoperative events after 24 hours of premedication. Results: While evaluating mean anxiety reduction only, mean reduction is greater in the lorazepam group compared to that of bromazepam. Sedation level was less achieved with bromazepam. In the lorazepam group, a greater number of patients could not recall preoperative events but incidence of adverse effects was significantly more in this group. Conclusion: The standard administration of bromazepam before the procedure provides patients with a moderate reduction of periprocedural anxiety. Premedication of lorazepam is associated with a high incidence of adverse effects. Therefore, this study does not support the routine use of lorazepam as premedication to reduce anxiety before surgery. Bangladesh Crit Care J September 2022; 10(2): 110-115
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
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