Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. MethodsIn this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middleincome countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42•4% vs 44•2%; absolute difference -1•69 [-9•58 to 6•11] p=0•67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H 2 O; p=0•0011). ICU mortality was higher in MICs than in HICs (30•5% vs 19•9%; p=0•0004; adjusted effect 16•41% [95% CI 9•52-23•52]; p<0•0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0•80 [95% CI 0•75-0•86]; p<0•0001).Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status.

Background: Successful insertion of Laryngeal Mask Airway (LMA) requires sufficient depth of anesthesia and depression of airway reflexes to avoid gagging, coughing and laryngeal spasm. The LMA is popular because it is easy to insert and it provides a secure airway for the patients who breathe spontaneously. Indeed, the intravent LMA instruction manual specifically recommends propofol for induction of anesthesia during LMA insertion. As a matter of fact Propofol and LMA insertion has become synonymous. However, there are some problems related to the use of propofol, for example, relatively high cost. This observational study was conducted to compare efficacy and safety of propofol and thiopentone -midazolam in smooth insertion of LMA and the hemodynamic changes over time in both groups. Methods: The study was done in the Department of Anesthesiology, Chittagong Medical College from July, 2012 to December, 2013. All the patients scheduled for elective surgical procedures under general anesthesia fulfilling the inclusion criteria, were the study population. Data was analyzed by computer based software SPSS-21. Results: Overall LMA insertion condition was improved better by the use of midazolam with thiopentone sodium (Group B) than propofol (Group A). The drug regime used in group A (Propofol) was expensive than group B (midazolam with thiopentone sodium) with indifferent hemodynamic stability in both groups. Mean ages of patients were 32.43 years ± SD- 10.67 years in group A and 33.5 years ± SD- 10.63 years in group B. Conclusion: In the perspective of our study, for smooth insertion of LMA midazolam-thiopentone sodium regime is cheaper and can be effectively and safely used over propofol regime. Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 38-41

Background: Adding narcotics to local anesthetic is very effective in prolonging the analgesic effects. The aim of this study is to evaluation the efficacy and safety of fentanyl as an adjuvant with bupivacaine-lignocaine in supraclavicular block. Methods: This analytical study was carried out in the department of anesthesiology in Chittagong Medical College Hospital in collaboration with the department of orthopedic surgery over a period of 22 months starting from January 2012 to December 2014. A total 130 adult patients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected for upper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groups of 65 patients in each. Group- C was received Distilled water 2ml and Group-F was received fentanyl 2ml (100 g) in 38ml of bupivacaine and lignocaine with adrenaline (Total volume of 40ml). Results: The mean onset of sensory & motor block was 10.49±0.75 min & 9.41±0.76 min in group-C and 7.60±3.711min & 9.23±5.114min in group-F. The duration of analgesia in group-C was 3.81±0.88 hrs and in group-F was 8.62±1.747 hrs. Conclusion: There was significantly prolonged duration of analgesia and better onset of sensory and motor block in fentanyl group without any unwanted effects. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 31-35

Background: The most vital element in providing functional respiration is the airway and the major responsibility of the anesthetist is to provide respiration for the patient through a patent airway and adequate ventilation. The use of Laryngeal Mask Airway (LMA) is well established in anesthetic practice. The LMA is an innovative airway management device intended as an alternative airway to face mask use and being used in millions of patients for routine and emergency procedures. LMA obviates the need for tracheal intubation during anesthesia. The efficacy of thiopentone can be altered by midazolam or succinylcholine in combination. We used thiopentone sodium (5mg/kg) and midazolam (0.05mg/kg) as induction agent in group A (Control group) and thiopentone sodium (5mg/kg) and succinylcholine (0.25mg/kg) in group B for LMA. This randomized trial was conducted to compare the effectiveness of midazolam and succinylcholine added with thiopentone in smooth insertion of LMA. Materials and methods: The study was done in the Department of Anesthesiology, Chittagong Medical College from July 2013 to December 2014. All the patients scheduled for elective surgical procedures under general anesthesia fulfilling the inclusion criteria, were the study population. Data was analyzed by computer based software SPSS-17. Results: Mean age of patients were 33.50 years ± SD- 10.629 years in group A and 32.22 years ± SD- 9.192 years in group B. In all patients (42) from group A, LMA was successfully inserted after first attempt and in group B 36 (85.71%) patients required single attempt. The overall insertion condition of LMA was excellent in 21 (50%) patients in group A and in 13 (30.95%) patients in group B. Conclusion: In the perspective of our study, midazolamthiopentone sodium is more effective and safe to use in smooth insertion of LMA. JCMCTA 2018 ; 29 (1) : 17-22

Background: This prospective, randomized, double-blinded study wasundertaken to compare the effectiveness and side effects of intravenous Ondansetron and Nalbuphine in the reduction of intrathecal Fentanyl-induced pruritus in obstetric patients of Chittagong Medical College Hospital. Materials and methods : This study was done in CMCH during the period August 2012 to January 2014. One hundred and thirty women of ASA status I or II undergone caesarean section by spinal anesthesia using Inj. Bupivacaine 10 mg and Inj. Fentanyl 15 μgm was randomly allocated in two groups, by simple random method. The patients received Nalbuphine 4mg or Ondansetron 8mg as intravenous injection in respective of groups, immediately after the baby was delivered and umbilical cord was clamped. Onset of pruritus, the degree of pruritus, four-point rating score for nausea and vomiting were assessed and recorded as per case record form and preserved for analysis. All statistical analysis was performed using SPSS® software package version SPSS-16 (SPSS, Chicago, Illinois, USA) for windows XP. pvalue was considered statistically significant when it was less than 0.05(p£0.05). Results : Intravenous Ondansetron was more effective in reducing the incidence of fentanyl-induced pruritus than Nalbuphine. Pruritus was mild and relatively short duration in most patients. Patients remained hemodynamically stable after using both Ondansetron and Nalbuphine. Conclusion: Ondansetron is more effective and cheaper than Nalbuphine in reducing the intrathecal Fentanyl induced pruritus during cesarean delivery and safely used as an alternative to expensive drug Inj. Naloxone. JCMCTA 2017 ; 28 (1) : 45 - 51