Introduction: Arrhythmias are not uncommon after Coronary Artery Bypass Graft (CABG) surgery. There is increasing evidence that Magnesium, the important intracellular cation plays a crucial role in preventing and terminating cardiac arrhythmias. Objectives: The aim of this study was to establish the role of peroperative use of intravenous Magnesium in reducing the incidence of per and postoperative arrhythmias in CABG surgery. Materials and methods: A total sixty (Group-I 30 and Group-II 30) patients of both sexes and different ages undergoing conventional CABG surgery under general anesthesia in CMH Dhaka from January 2009 to December 2011 were selected randomly. After induction, Group-I received 2 gm of Magnesium in 100 ml normal saline intravenously over a period of 30 minutes and Group-II received no Magnesium. Parameters recorded per and postoperatively were- aortic cross clamp time, Cardio Pulmonary Bypass (CPB) time, total surgery time, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and blood sample were collected on arrival to Cardiac Intensive Care Unit (CICU) and after 6, 12, and 24 hours. Results were expressed as mean ± SD (Standard Deviation) or in frequencies (percentage) as applicable. The results were analyzed by Student’s ‘t’ test. Results: Magnesium levels were significantly (p<0.05) low in Group-II patients than that of Group-I. In Group-II patients, the fluctuations of HR, SBP and DBP were significantly (p<0.05) more than that of Group-I. In Group-I patients incidence of arrhythmias were significantly (p<0.05) less than that of Group-II. Conclusion: Low serum Magnesium levels are a frequent finding after conventional CABG surgery. This acute loss of Magnesium has been suggested as an etiology of many per and postoperative arrhythmias. This study revealed that peroperative administration of Magnesium provided a significant reduction in arrhythmias per and postoperatively. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18739 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 105-114

Background: The major cause of sympatho-adrenal response to tracheal intubation is due to thestimulation of supraglottic region by tissue irritation induced by direct laryngoscopy. Direct laryngoscopyby activating proprioceptors, induces arterial hypertension, tachycardia and increased catecholamineconcentrationproportional to the intensity of stimulus exerted against the base of the tongue. Incardiac compromised patient, use of endotracheal tube (ETT) is associated with various hemodynamiccomplications, which are minimally affected during ProSeal laryngeal mask airway (PLMA) use. Objective: This prospective study was conducted with the objective of demonstrating the advantages ofPLMA over ETT in the patients undergoing laparoscopic cholecystectomy surgeries. Methodology: This prospective, interventional study was carried out in 60 patients who underwentlaparoscopic cholecystectomy surgeries. Patients were randomized in equal numbers to either ETTgroup or PLMA group, and various hemodynamic changes were observed at different time points. Results: Patients in PLMA group had mean systolic blood pressure 134.785±03.765 mm Hg comparedto the patients of ETT group 146.675±05.764 mmHg. Pulse rate in the PLMA group was less (94.267 ±05.678per min) (P < 0.05) compared to ETT group (115.34±10.236).Thus, hemodynamic changes weresignificantly lower (P < 0.05) in PLMA than in ETT group. The incidence of adverse events was alsolower in PLMA group. Conclusion: PLMA offers advantages over the ETT in airway management in the patients undergoinglaparoscopic cholecystectomy surgeries in cardiac compromise patients. JBSA 2018; 31(1): 38-44

Background: Among the various options of treatment of ischemic heart disease coronary artery bypass grafting (CABG) remains one of the standard modes of revascularization. Coronary artery bypass grafting can be done with or without using cardiopulmonary bypass (CPB). This study was to compare postoperative early (up to 1 month) outcome of intact versus open pleura after off pump coronary artery bypass grafting (OPCAB). Methods: In this study, sixty patients aged 18-70 years admitted in Department of Cardiac Surgery, NICVD who underwent OPCAB were selected for the study sample and divided into two groups. Groups I (n=30) consist of the patients who underwent OPCAB with pleurotomy and Group II (n=30) consists of patients who underwent OPCAB with intact pleura. Outcome of patients including Forced expiratory volume in first second (FEV1) & Forced vital capacity were evaluated. Results: Patients having OPCAB with intact pleura showed lower incidence of atelectasis and pleural Effusion in 2nd postoperative & 5th postoperative day (p<0.05). Lower amount of chest tube drainage and transfusion requirement were observed in group II patients than Group I (530.00 ± 28.97 vs. 485.96±38.62; p<0.05 and 611.23±99.22 vs. 577.93±135.38, p>0.05, respectively). Moreover, higher duration of ventilation were noted in group I (7.50 ± 2.22 vs. 6.30±2.32, p<0.05). Beside these, total duration of ICU stay & hospital stay were significantly higher in patients OPCAB with open pleura (p<0.05). Conclusion: Keeping the pleura intact during OPCAB is significantly associated with low rate of atelectasis and pleural effusion. Clinically, it decreases postoperative amount of blood loss and significantly lowers ICU stay, mechanical ventilation time and hospital stay. Therefore, it can be concluded that intact pleura during OPCAB improves postoperative pulmonary outcomes. Cardiovasc. j. 2021; 13(2): 112-119

Background: Postoperative atrial fibrillation (POAF) often occurs in patients after coronary artery bypass graft surgery (CABG), both conventional and off pump ranges from 11% to 40%. Although often transient, self-limited, and benign, it may be associated with increased postoperative morbidity. The prevention of POAF has been associated with improved postoperative outcomes in terms of reduced medical treatment, laboratory tests, shorter nursing time, and hospital stay, even when uncomplicated. The present study was conducted to find out the effect of omega polyunsaturated fatty acid on the prevention of POAF after off pump CABG. Method: This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Sher-E-Bangla Nagar, Dhaka, between September 2017 and August 2018. Total 100 patients with sinus rhythm admitted for OPCAB were included in this study, and they were divided into two groups, Group A, 50 patients having omega-3 PUFA in the preoperative and postoperative period up to the fifth postoperative day (POD) and Group B, 50 patients not having omega-3 PUFA in the preoperative and postoperative period up to the fifth POD. Findings were compared between two groups preoperatively, postoperatively, up to 5 days, at discharge, and at one month after discharge. Results: Postoperative AF was significantly higher in group B in comparison to group A up to 5th POD. AF was present in a few patients during discharge and one month after discharge, but the differences were statistically not significant between groups. Total ICU stay was similar between the two groups, but the postoperative hospital stay was shorter in Group A, and the mean difference was statistically significant. Conclusion: This study concluded that perioperative oral omega-3 polyunsaturated fatty acid intake reduces the incidence of postoperative atrial fibrillation in patients undergoing off pump coronary artery bypass graft surgery. University Heart Journal 2022; 18(1): 36-43

Background: The timing of cholecystectomy for acute cholecystitis has been debated with most studies favoring early cholecystectomy. However, most surgeons in Bangladesh prefer to delay surgery in the acute phase. The study aimed to compare between early Laparoscopic Cholecystectomy (LC) with that of delayed laparoscopic cholecystectomy in the management of acute calculus cholecystitis. Materials and methods: This quasi-experimental study included a total of 74 patients with a diagnosis of acute calculous cholecystitis as per Tokyo guideline from the Surgery Department, Chittagong Medical College Hospital, during August 2019 to July 2020. Thirty-seven patients underwent early cholecystectomy (Within 7 days of onset of symptoms) and 37 patients underwent elective or delayed cholecystectomy (After a gap of 6-8 weeks from the acute attack). Peroperative events, postoperative complications, length of hospital stay and days needed to return to full activity were compared between two groups. Results: Both early and delayed groups were similar in-terms of their baseline demographic and clinical characteristics. Significantly higher number of patients in the early group had difficult Callot’s triangle dissection (59.4% vs. 27.1%, p<0.01) and lower number of patients had difficult gallbladder bed dissection (5.4% vs. 37.8%, p<0.001) than the delayed group. The proportion of the patients required conversion to open surgery was 10.8% and 6.1%, respectively in early and delayed group (p=0.691). Total hospital stay was shorter in the early surgery group than the delayed surgery group (6.05±0.52 vs. 12.03±1.46 days, p=0.001). Wound infection, duration of hospital stays following surgery, and days need to return to full activity after surgery was similar between two groups. Conclusion: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system. IAHS Medical Journal Vol 5(2), Dec 2022; 11-14