Background: EF is an important measurement in determining how well the heart is pumping out blood and in diagnosing as well as tracking the heart failure (HF). Normal EF varies at 55% to 70%, while EF 40% to 55% may indicate damage perhaps from previous heart attack, but may not indicate HF. However, measurement under 40% may show evidence of HF or cardiomyopathy and patient with EF< 35% may be at the risk of life threatening irregular heartbeats. Such patients are considered to be at high risk for anaesthesia as life threatening irregular heartbeats lead to sudden cardiac arrest and sudden death.Objectives: The aim of this study was to find out the characteristics of patients, identifying of the risk factors, better understanding of pathophysiology, pre-operative optimization of the patients, uses of stable drugs & anesthetic techniques, reduces intraoperative or early postoperative complications & perioperative morbidity, mortality.Methods: In this retrospective study we described our experiences of 236 cases of very low ejection fraction (20% - 35%) from 1st July 2014 - 30th June 2017. We reviewed their medical history and noted age, sex, type of operation & anesthesia, pattern of operation either elective or emergency, preoperative investigation and preparation, as well as details of anaesthetic management, were also recorded.Results: General anaesthesia was performed in 176 (74.58%) cases and rest of 60(25.42%) cases were regional where spinal 42(17.80%) cases & epidural 18(7.62%) cases. The age of the patients were in the range of 20 to 70 years, with majority of the patients were in 60 to 69 years age group. The majority of the patients about 46.19% were in LVEF 26 - 30% group, 36.01% patients were in 31 - 35% group and rest of 17.80% patients were in 20 - 25% group. Average duration of operation incase of general anesthesia 66.5(±2.28SD) min and incase of regional 44.2(±3.25SD) min. The mortality rate only 1.27%.Conclusions: Preoperative patient optimization, intraoperative haemodynamic stability and postoperative care have contributed to the success of very low ejection fraction patients in our hospital.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 114-120

Background: Renal transplantation is the preferred treatment for end stage renal disease. Patients undergoing renal transplant surgery have several high risk features like cardiovascular diseases, diabetes mellitus and need for haemodyalysis. Renal transplant anaesthesia requires a thorough understanding of the metabolic and systemic abnormalities in end stage renal disease, familiarity with transplant medicine and expertise in managing and optimizing these patients for the best possible outcome. The aim of this study was to find out the characteristics of patients, causes of ESRD, anaesthetic management and the impact of pre-existing diseases on intraoperative or early postoperative complications of the recipients.Methods: In this retrospective study we described our experiences of 124 cases of living transplants from November 2004 – December 2016. We reviewed their medical history and noted age, sex, blood groups, causes of ESRD and history of dialysis. Preoperative investigation and preparation, as well as details of anaesthetic management, were also recorded.Results: General anaesthesia was performed in almost 97% of patients and for the rest of them, combined epidural and general anesthesia were done. The age of the patients was in the range of 15 – 65 years, with the majority of 30 - 39 years group. The mean of surgery duration was 4.5 (±1.20SD) hours. The most significant point during surgery is keeping the mean arterial pressure > 90mm Hg.Conclusions: Preoperative patient optimization, intraoperative haemodynamic stability and postoperative care of renal transplant patients have contributed to the success of renal transplant programmed in our hospital.Birdem Med J 2018; 8(2): 167-171

Background: Functional endoscopic sinus surgery (FESS) requires effective control of bleeding for better visibility of the operating field and reduced risk of injury to the optic nerve or the internal carotid artery. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Objectives: Our study is undertaken to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS). Methods: Sixty (60) patients 20 – 50 years of age, ASA I/II scheduled for FESS were randomly assigned to two equal groups of 30 patients each. Patients of group D received dexmedetomidine 1µg/kg over 10 min before induction of anesthesia followed by 0.4 – 0.8 µg/kg/hr infusion during maintenance and group E received esmolol loading dose 1mg/kg was infused over one min followed by 0.4 – 0.8 mg/kg/hr infusion during maintenance to maintain mean arterial blood pressure (MAP) between (55 – 65 mmHg). The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP, HR); intraoperative fentanyl consumption and total recovery from anesthesia (Aldrete’s score ≥9) were recorded. Sedation score was determined at 10, 20, 30, 40 & 60 min after tracheal extubation and time to first analgesic demand was also recorded. Results:In both group D and group E reached the desired MAP (55–65 mmHg) with no inter group difference in MAP or HR. Mean intraoperative fentanyl consumption was significantly lower in group D than group E. Recovery time to achieved Aldrete’s score ≥9 were significantly lower in group E compared with group D.The sedation score were significantly lower in group E compared with group D at 10 minutes, 20 minutes and 30 minutes postoperatively. Time to first analgesic demand was significantly longer in group D. Conclusion: The result of this study showed that both dexmedetomidine and esmolol can be used as agents for controlled hypotension and are effective in providing ideal surgical field during FESS. But dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect. Bangladesh J Otorhinolaryngol; April 2018; 24(1): 37-49

Introduction: Laparoscopic cholecystectomy remains the standardtreatment for cholelithiasis. Everincreasing number of patients with myriad of medical illness is being treated by this technique. However,significant concern prevails among the surgical community regarding its safety in patients with cardiacco-morbidity. Patients with diabetes, significant cardiac dysfunction and multiple co-morbidities wereprospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopiccholecystectomy was performed. Results: Patient demographics, details of peri-operative management and post-operative complicationswere studied.Between July 2014 and January 2018, 32 patients (M:F=24:08) with mean age of 55 years(range 36–78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy.Of these, 24 patients were in NYHA class-II, while 8 belonged to class-III. Left ventricular ejection fraction,as recorded by transthoracic echocardiography, was20–30% in 08 (25%) patients and 30–40% in the rest24(75%). In addition, 21 (71%) patients had regional wall motion abnormalities, 11 (34%) patients hadcardiomyopathy while 09 (39%)patients had prior cardiac interventions. Following laparoscopiccholecystectomy, hypertension (21), tachyarrhythmia(4) and bradycardia (2) were the commonest eventsencountered.Two patients required dopamine in the immediate postoperative period but all other patientsmade an uneventful recovery. Conclusion: With appropriate cardiological support, laparoscopic cholecystectomy may be safely performedin patients with significant cardiac dysfunction. JBSA 2020; 33(2): 78-84