Aim: To evaluate the efficacy of oral Theophylline for the management of post dural puncture headache (PDPH). Material and Method: Forty patients with PDPH, whose surgeries were done under spinal anaesthesia, were selected randomly and divided into two groups of 20 each. One group to receive conservative treatment and the other group Theophylline (400 mg) only orally. Intensity of headache was analysed using a visual analogue scale (VAS) of pain. Assessment was done immediately before (0 h) and at 8, 16 and 24th hr of drug administration. Result: Significantly better relief of PDPH was found in Theophylline (9.3±5.7) than the conservative group (56.7 ±10.2) (p<0.001). Recurrence of headache was found in 2 patients (10 %) at 16th hr and 2 (10%) at 24th hr in the Theophylline group compared to 12 (60%) and 14 (70%) patients respectively in the other group. Conclusion: The study concludes that Theophylline in the management of post dural puncture headache may be considered the best choice over the conventional approach. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18292 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.114-118

Background:Cleft lip with or without palate is one of the common congenital malformations.Aim:To evaluate the per-operative complications of anesthesia, a comparative study was conducted in children using the endotracheal tubes available in the Institute so that the complications can be averted in future procedures.Materials and Methods:The rural population of Tripura, India.Result:Awareness was generated and the incidence of repair surgeries of cleft lip and palate was thus increased considerably in Dr. B. R. Ambedkar Memorial Teaching Hospital, Agartala, Tripura.Conclusion:The RAE tube has been found to be the choicest one and at a minimal risk for maintaining patients’ patent airway and other related complications.

Aim:The aim of this study is to compare the effectiveness, hemodynamic changes and duration of sedation and analgesia between combinations of fortwin-phenergan-midazolam (FPM) and ketamine - midazolam (KM) along with local anesthesia for the surgeries done under the umbrella of monitored anesthesia care.Materials and Methods:A total of 50 patients undergoing surgeries as tympanoplasty, septoplasty, lip repair, dacrocystectomy and cataract under local anesthesia, randomly received either intravenous (IV) fortwin 0.3 mg/kg over 1 min followed by IV midazolam 0.04 mg/kg plus IV phenergan 12.5 mg (Group FPM) or IV ketamine 0.3 mg/kg over 1 min plus IV midazolam 0.04 mg/kg (Group KM). Sedation was titrated to Ramsay sedation score (RSS) of 3. Patients’ mean arterial pressure (MAP), heart rate (HR), saturation peripheral pulse, duration of sedation and need for intraoperative rescue sedation/analgesic were recorded and compared. Satisfaction of patients (using a 1-7 point Likert verbal rating scale) and readiness for discharge towards (time to Aldrete score of 10) were also determined.Result:Group KM had significant rise in HR (20-25%) and MAP (25-30%) from 30 min after the bolus dose given until the end of the surgery in contrast to Group FPM. The target sedation level (RSS ≥ 3) was higher in Group FPM (n = 23 [92%]) as compared with Group KM (n = 12 [48%]). Time until need for rescue sedation was 66.96 ± 17.19 min in FPM and 32.80 ± 8.90 min in KM group. The patient satisfaction (Likert scale) is more with the FPM group (6.12 ± 0.83 vs. 4.40 ± 1.20).Conclusion:We found that the combination of FPM is superior to the KM combination as per the hemodynamic changes, duration of analgesia, patients’ satisfaction and efficacy of the drugs are concerned.

Background: Stress responses caused by noxious stimuli during laryngoscopy and tracheal intubation can incite harmful effects, especially in neurosurgical patients. Among various drug regimens and techniques tried for obtunding such consequences, dexmedetomidine, an α-2 receptor agonist mediating its action through α-2A receptors located in locus coeruleus, inhibits noradrenaline release thus decreases such sympathetic activity. Aim and Objective: To evaluate the effect of a single preoperative dose of dexmedetomidine 1 μg/kg slow infusion on hemodynamic responses to laryngoscopy and tracheal intubation. Materials and Methods: Sixty patients randomized into two groups of 30 each of age range 20–60 years, the American Society of Anesthesiologists physical Status I and II posted for planned neurosurgical procedures, to receive dexmedetomidine (Group D): 1 μg/kg diluted with 0.9% saline to a total volume of 20 mL, control Group (C): 20 ml 0.9% normal saline, both infused intravenously over 10 min, 3 min before induction. Changes in heart rate (HR), systolic, diastolic, mean arterial pressure (MAP), and any side effect associated with the drug during the study of 20 min of intubation, were observed and statistically analyzed. Results: Insignificant difference (P > 0.05) in demographic criteria. In comparison to the baseline (BL) value, during laryngoscopy, a fall in mean HR by 12.1% in dexmedetomidine group and a rise of 28.39% in control group, reduction in mean systolic blood pressure value 11.40% in dexmedetomidine group, a rise by 19.50% in control group (P < 0.05), a fall in mean diastolic blood pressure by 11.19% in dexmedetomidine, in control group a rise of 16.97%, the difference is statistically significant (P < 0.0001), rise in the mean MAP value in the control group to 18.12% above the BL value but in Group D, it was reduced by 11.29% (P < 0.05). Conclusion: Infusion of dexmedetomidine, in attenuation of hemodynamic response to laryngoscopy and tracheal intubation, is a safe and effective protective method.