Background: Hypertension has been reported as the most prevalent comorbidity in patients with corona virusdisease 2019 (COVID-19) .Since hypertension is exceedingly frequent in the elderly and older people appear tobe at particular risk of being infected with SARS-COV-2 virus and of experiencing severe forms andcomplications of COVID-19. Objective : This retrospective study aim to compare the outcomes in COVID-19 infected patients with orwithout hypertension. Method : Atotal 180 hospitalized patients with laboratory confirmed COVID-19 were included. The medicalrecord including clinical feature, history of hypertension were included in this study. This study wasconducted in COVID-19 ICUof Bangabandhu Sheikh Mujib Medical University from August 2020 to January2021.Informationwere obtained frommedical record including clinical features, complication,treatments andclinical outcome were extracted for the analysis. Results: There were 180 patients selected for this study. 50(27.8%) patients had 51-60 years ,79(43.5%)patients had61-70 years and 27(15%) patients had 71-80 years.This study showed that 71.7% patients washypertensive and 29.3% patients was non-hypertensive. In total 180 patients, mortality rate was 65.1% inhypertensive patientsand mortality rate was41.1% in non-hypertensivepatients.Among them patientscomorbidity was 50% Diabetes mellitus,14% Bronchial asthma,14% patients Ischemic heart disease, 11%Chronic Kidney disease ,6% hypothyroidism and 5% cerebrovascular disease. Conclusion: This study concluded that hypertension does not affect the outcome of COVID-19. Compared withthe group of survivors and non-surviving COVID-19 patients with hypertension, most of the patients were olderand had more comorbidity. JBSA 2021; 34 (2) : 44-48

Background: The safety of regional anaesthesia become more pronounced by the use of ultrasound andnerve stimulator. Supraclavicular nerve blocks known as ‘spinal of the arm’ are the most attractiveupper extremity blocks to perform in our practice. In this study less experienced hands try to found thebest approach for upper extremity block. Objective: To comparethe success rate when Ultrasound addedwith Peripheral nerve stimulator insupraclavicular brachial plexus block. Methods: After IRB approval and written consents from patients, total 66 patients divided into twogroups,Group USNS had supraclavicular block guided by both ultrasound and Nerve stimulator. Onthe other hand Group BNS had this block by only Nerve stimulator. All the equipments kept ready andmaintaining sterility a mixture of 0.5% Bupivacaine and 2% plain Lignocaine were prepared. The amountinjected according to the body weight without crossing the toxic dose (2mg/Kg 0.5% Bupivacaine, 5mg/Kg 2% Lignocaine). Total volumes were 25-30ml for every patient.The sensory block was assessed byobservers who unaware of the technique for every 2 minutes till the onset of block and every 10 minutesthereafter for 30 minutes. Any failure in establishing the block was converted to GA. The sensorydermatomes were assessed by alcohol swab. The motor blocks were evaluated by the same observer ineach jointfor every 2 minutes till onset than 10, 20 & at the end of 30 minutes.Successful block wasconsidered if no supplementation or conversion to general anaesthesia required. Results: In all demographic variables and ASA Class, there was no differences in between the USNSgroup and BNS group.In group USNS block execution time was significantly higher(P<0.05). The timerequired for both sensory and motor block was statistically significantly less in Group USNS comparedto Group BNS (P value < 0.05). Regarding quality of motor block, at wrist joint statistical significancepresent between two groups ( p value < 0.05 ). The duration of analgesia is significantly lower in GroupBNS than Group USNS (P value is 0.012).In Group USNS, only one (3.03%) patient neededsupplementation. But in Group BNS 7 (21.21%) patients needed supplementation. According to thedefinition, these cases were regarded as failed case. The success rate is significantly higher in GroupUSNS (P value is 0.024). Conclusion: Combined use of ultrasound and peripheral nerve stimulator increases success rate thanperipheral nerve stimulator alone in supraclavicular brachial plexus block. This combined method alsoreduces block execution time, early onset of both sensory and motor block, improve quality of sensory andmotor block and less incidence of complications. JBSA 2018; 31(2): 54-61

Background: Oral and maxillofacial surgical procedures present a unique set of problems for both the anaesthesists and the surgeons. Simultaneous access to the oral or nasal cavities and dental occlusion is required for the surgical treatment of some craniofacial deformities. Generally, airway is maintained by orotracheal or nasotracheal intubation and some instances by tracheostomy however, nasotracheal intubation is contraindicated in skull base or midface fracture. Tracheostomy has inherent complications ranging from surgical emphysema to disfiguration where as orotracheal route prevents free access to oral cavity. In these circumstances, submento-tracheal intubation may provide a better option to overcome these problems. Objective: The aim of this study was to evaluate outcome of conversion of orotracheal route to submentotracheal route for surgical correction of maxillofacial trauma & deformity and time required to change from oral to submental route, accidental extubation, postoperative complications, and the healing of intraoral and submental scars were evaluated. Patients and Methods: Method: A total of 23 patients were selected from maxillofacial department of BSMMU and other institutions from December 2007 to March 2011 to use this technique. After standard orotracheal intubation, a 2 cm incision was made lateral to the midline in the submentum and a blunt dissection opposite to the skin incision on the lingual aspect of the mandible provides access to the floor of the mouth, the orotracheal tube is disconnected and pulled through the floor of the mouth then to the submental incision, the tube is then sutured to the skin. Surgery was completed without interference from flexometallic endotracheal tube. Following surgery the sequence is reversed and the patients extubated in the conventional manner. Results The technique was used in 13 patients with multiple facial fractures & 10 patients with facial deformity. The mean age of the group was 30 (20-50) years .The submental orotracheal intubation was completed successfully in all patients. No accidental extubations or tube injuries occurred. The mean time required for intubation was 6 minutes. All patients were extubated in the operating theatre. The intraoral and submental accesses healed with minimal scarring in all patients .There were no incidence of intra- or postoperative complications related to submental intubation. Conclusions Submental intubation is a simple, safe, and predictable approach without significant morbidity that facilated safe airway and enhances meticulous surgical procedure of fractured skull base and midface. JBSA 2012; 25(1): 21-27

Background: General anaesthesia is used for breast cancer surgery. The downside of generalanaesthesia includes inadequate pain control and a high incidence of nausea and vomiting. Generalanaesthesia with intravenous dexmedetomidine or intercostal nerve block reduce the incidence ofpostoperative pain. Objective: To evaluate the effectiveness of intravenous dexmedetomidine compared to intercostal nerveblocks in patients undergoing simple mastectomy with axillary dissection under general anaesthesia.Methods:It was a single-blinded prospective randomized comparative study. This study was conductedat the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh MujibMedical University (BSMMU), Dhaka from March 2018 to March 2019. A total of 60 patients sufferingfrom breast cancer admitted in the Department of General Surgery of BSMMU Dhaka and scheduledfor simple mastectomy with axillary dissection, were enrolled in this study. Results: Age ,height andweight were almost identical between two groups. Duration of anaesthesia and surgery were almostsimilar between two groups. The mean heart rate, systolic blood pressure, diastolic blood pressure ,mean arterial pressure did not significantly fluctuate in subsequent baseline follow up and 15 minuteand at 160 minutes parameters were almost similar within two groups.Mean time to achieve adequateAldrete recovery score after extubation was almost similar between two groups. Postoperative sedationlevel was also similar between two groups. Majorty of the surgeon were satisfied about anaesthesiatechnique in both group A and group B. Mean time of rescue analgesic requirement in postoperativeperiod was satistically significant (p<0.05) between two group but it was clinically less significant(groupA= 112 minutes and groupB=141minutes. Conclusion: Intravenous dexmedetomidine may be an alternative to intercostal nerve blocks inpatients undergoing simple mastectomy with axillary dissection under general anaesthesia as itprovided stable intraoperative haemodynamics, reduced blood loss and analgesic requirement, smoothrecovery, postoperative sedation level and surgeon satisfaction as well as intercostal nerve blocks. JBSA 2021; 34 (2) : 24-35

Total thyroidectomy can safely be performed by bilateral superficial cervical plexus blockade which is a regional anesthetic technique to anaesthetize superficial branches of the anterior primary rami of cervical 3-5 spinal nerves. Conscious sedation with this anesthetic technique enhance safe and faster recovery compared to general anesthesia (GA) with endotracheal intubation which is traditionally employed technique for thyroidectomy. This randomized active control trial was conducted in the department of Anaesthesia, Analgesia and Intensive care medicine, Bangabandhu Sheikh Mujib Medical University from January to December 2018 to compare perioperative outcome between bilateral superficial cervical plexus blockade and GA technique during total thyroidectomy. Total 60 patients of American Society of Anesthesiol- ogists Classification grade I and II who were selected for thyroidectomy were randomly divided into Group-A(n=30) and Group-B (n=30). Group A received with 0.5% bupivacaine and 1% lignocaine; and group B received general anesthesia during total thyroidectomy. Heart rate, systolic blood pressure, diastolic blood pressure mean arterial blood pressure , oxygen satura- tion (SPO2) were recorded and compared between the groups. Operative site bleeding, surgeon’s satisfaction & post operative pain were measured with Boezaart Scoring system, Likert scale & visual analogue scale repectively; and compared between two groups. During induction, systolic and diastolic blood pressure were high in group B and reduced in group A which were statistically significant. Systolic and diastolic blood pressure was significantly reduced in Group-A in comparison to Group-B after 5 minutes, 30 minutes, 45 minutes and at the end of operation. Bilateral superficial cervical plexus blockade reduced pain more effective- ly than GA group & it was statistically significant. Mean value of bleeding score were also statis- tically significant in Group-A. Regarding surgeons’ satisfaction, there was no statistically signif- icant difference between the groups. Bilateral superficial cervical plexus block with conscious sedation provided better outcome in terms of perioperative hemodynamics, pain and surgical site bleeding compared to general anaesthesia. BSMMU J 2021; 14(4): 104-108