A four year old girl was diagnosed as a case of mid muscular Ventricular Septal Defect (VSD) since early infancy. She had history of failure to thrive (FTT) and recurrent chest infection or pneumonia. As her pulmonary artery pressure was almost normal she was planned for device closure on elective basis once device and technology would be available in cardiac centre of combined Military Hospital (CMH) Dhaka. Finally it was done on 21st August 2005 and patient was discharged after 72 hours observation period. Echocardiography on next morning showed complete occlusion of defect with no residual shunt. (J Bangladesh Coll Phys Surg 2007; 25 : 161-163)

Nowadays, laparoscopic surgeries are being performed under subarachnoid block (SAB) safely. Aims: This study was to compare the arterial and end-tidal carbon dioxide (CO2) tension changes during spinal and general anaesthesia (GA) in CO2 pneumoperitoneum for upper abdominal laparoscopic surgeries. Settings and Design: This was a prospective randomized comparative clinical study. Materials and Methods: Eighty patients posted for upper abdominal laparoscopic surgeries were randomly allocated to two groups either to receive standard GA or lumbar SAB. Results: The demographic profiles of both the groups were comparable. The PaCO2 was increased gradually and sustained at its peaks within 20±4.37 minutes in both the groups. The mean±SD revealed to be higher in Group B (41.5500±2.1315) than Group A (40.8460±2.1136), but the difference between the two was not statistically significant (P=0.6142). There was a gradual increase in ETCO2 over the initial 10±2.07 minutes and reached a plateau within 20±5.74 minutes in both the groups and declined faster after deflation of pneumoperitoneum in SAB group. The mean±SD was found to be higher in Group B (33.923±1.642) than Group A (33.408±1.772), but it was also not statistically significant (P=0.4492). The difference of the arterial blood pH between the groups was not statistically significant. Three (7.5%) patients developed transient urinary retention and 2 (5%) patients suffered from post-dural puncture headache in SAB group. Conclusions: Arterial and end-tidal CO2 tension changes during upper abdominal laparoscopic surgery under SAB remain within physiological limit and comparable to the CO2 tensions under GA. However, per-operative complications in SAB are greater, while it is lesser in postoperative period in comparison to GA. SAB may be adopted in ASA physical status I patients with proper preoperative counselling. J Bangladesh Coll Phys Surg 2019; 37(1): 13-18

DOI: http://dx.doi.org/10.3329/jafmc.v8i1.13533 JAFMC Vol.8(1) 2012 pp.15-19

Atrial septal defect (ASD) and patent ductus arteriosus (PDA) are commonly encountered problems and constitute about 20% of all congenital heart lesions. Association of these two conditions in a single patient is not very uncommon. Both these conditions can be treated by placing intracardiac devices. Double interventional closure of Atrial Septal Defect (secundum type) and Patent Ductus Arteriosus was performed in single sitting in a 12 year-old girl in Catheterization Laboratory of CMH Dhaka. This is the first ever-reported double interventional closure of two separate diseases in a single patient in single setting, which led writing this report. (J Bangladesh Coll Phys Surg 2006; 24: 34-37)

BACKGROUND: Hyperbaric bupivacaine has been the gold standard drug for the safe conduct of spinal anaesthesia. It offers duration of 1.5 to 2.5 hours of anaesthesia and analgesia, various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. clonidine, an α 2 adrenergic agonist is new neuraxial adjuvant gaining popularity. AIM: The purpose of this study was to compare the efficacy of sensory and motor block, degree of postoperative analgesia, and adverse effects of clonidine and fentanyl used intrathecally with hyperbaric bupivacaine for spinal anaesthesia. SETTINGS AND DESIGN: the study was conducted in prospective, double blind manner, included 60 ASA class I and II patients undergoing lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia after approval from hospital ethics committee with written and informed consent of patients. MATERIALS AND METHODS: the patients were randomly allocated into two groups (30 patients each), group C received hyperbaric bupivacaine 15mg with clonidine 1µg. kg-1 and group F received hyperbaric bupivacaine15mg with fentanyl 25µg. This randomized study was conducted to compare the effects with regards to, Onset and duration of block, degree of post-operative analgesia (evaluated by VAS scale) and side effects associated with the drugs were recorded. RESULTS: Patients in group C had significantly longer sensory and motor block times than group F. The mean onset of sensory block in group C was 136.67sec and in group F was 138.33 sec. The mean onset of motor block in group C was 200.00sec and in group F was 206.67 sec. There were no differences with respect to the onset of block .The mean duration of sensory block in group C was 343.67min and in group F was 250.83min. CONCLUSIONS: There were no differences in the onset of sensory and motor blockade. The duration of analgesia, two segment regressions, and recovery of motor blockade were prolonged when clonidine 1µg.kg-1 was used as an additive to intrathecal hyperbaric bupivacaine compared to fentanyl 25µg for spinal anaesthesia, with side effects like bradycardia, hypotension and pruritus which did not require any treatment. Mild sedation was associated with intrathecal administration of clonidine 1µg.kg-1 which did not require any treatment. KEYWORDS: α 2 adrenorecepor agonist, bupivacaine, clonidine, fentanyl, spinal anaesthesia. INTRODUCTION: Hyperbaric bupivacaine has been the gold standard drug for the safe conduct of spinal anaesthesia. 1 It offers duration of 1.5 to 2.5 hours of anaesthesia and analgesia. Discovery of various spinal receptors like α 2-adrenergic, cholinergic, opioid, NMDA, GABA,