ABSTRACT
Objective: using plain bupivacaine with dexamethasone in spinal anesthesia is a new technique in total hip replacement operation. It provide good sensory and motor block with less complication. Dexamethasone is a potent corticosteroid drug was mixed with bupivacaine. This study was done to compare the incidence of side effects of spinal anesthesia, the duration of both sensory and motor block following administration of heavy bupivacaine alone with administration of plain bupivacaine mixed with dexamethasone. Materials and Methods: 100 patients whose ages between 40 &90 years and weight between 70 &110 KG and American society of anesthesia (ASA) 2/3/4 who underwent total hip replacement under spinal anesthesia were randomly allocated into 2 groups by sealed envelope method, each group with 50 patients. First group received 15 mg heavy spinal bupivacaine alone while the second group received 15 mg heavy bupivacaine mixed with dexamethasone. Results: The duration of both sensory and motor block was longer in dexamethasone group in comparison to control group (p<0.001). The incidence of hypotension, breadycardia and shivering was less in dexamethasone group. Conclusion: Dexamethasone when mixed with plain bupivacaine prolong the duration of sensory and motor block and reduce the incidence of hypotension, Breadycardia and shivering.

ABSTRACT
Introduction: Eclampsia, a major neurological complication of pre-eclampsia, is defined by a convulsive manifestation and /or consciousness disorder occurring in a preeclampsia context and cannot be attributed to a pre-existing neurological problem. Pre‐eclampsia is a leading cause of maternal morbidity and mortality. Substandard care is often present and many deaths are preventable. Objective: To assess the peculiarities of anesthesia-resuscitation and the prognostic factors of morbidity and mortality of eclampsia. Materials and Methods: This is a retrospective, descriptive and analytical study of all patients admitted for eclampsia from January to December, 2020 in the intensive care unit of the Department of Anaesthesia, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh. All patients admitted to resuscitation for management of eclampsia were included. The diagnosis of eclampsia was based on the occurrence of peripartum seizures in a woman whose history and examination revealed no other cause for the convulsion. All patients with eclampsia were treated according to the management protocol, namely: stabilization (peripheral venous catheter, oxygen therapy, Guedel cannula, lateral safety position, standard monitoring), administration of 4gSMgO4 in 20 minutes then 1g/h for 48h, control of arterial hypertension/Nicardipine, childbirth by the quickest method, admission for resuscitation. All patients had blood samples analyzed for: azotemia, creatinine, blood count with platelet count, hemostasis balance (TP and INR, TCA), bilirubinemia and liver aminotransferases. Results: We collected 51 cases of eclampsia for 4550 deliveries in the study. The average age of the patients was 22.23 years. Primiparity was found in 28 patients (54.9%). Antenatal consultations were effective in 4 patients (7.8%). Consciousness was clear at admission in 42 patients (82.36%) and for one patient a Glasgow score <8 was reported (1.96%). Severe hypertension was ........

ABSTRACT
Introduction: The study of mortality allows for the monitoring and review of therapeutic measures in a health facility. Maternal death is a major concern in the world and constitutes a social tragedy. We present a study on the etiologies of maternal death in the mother and child health center in the Zinder region. Methodology: This was a retrospective, descriptive study covering three years from January 1st, 2017 to December, 31st, 2019. The study was carried out at the mother and child health center in the Zinder region, the main regional referral site for obstetrics and gynecology. The objective was to determine the etiologies and epidemiological profile of deceased parturients. Patients admitted directly or evacuated from other health facilities and who died according to the definition of maternal death were included. Accidental and incidental deaths and those that did not meet the WHO framework were excluded. Data were collected from the admission register, the maternal death audit report and the patient file. The variables studied were epidemiological data, causes of death, mode of transport and length of stay of the patient. Results: A total of three hundred and ninety-seven (397) files were retained out of 13874 admissions, including 7606 live births. The mortality rate was 2.86% and the maternal mortality ratio was 5219.56 per 100,000 live births. The average age was 26 years with extremes of 15 and 45 years. The 25-29 year old age group was the most affected with 23.92% (n=95). Large multiparous women (6-13 parities) were the majority with 28.21% (n=135). Most patients (87.15) were evacuated and transported medically in 92.77%. They were from rural areas in 72.83% (305). More than half, 81.86% (n=325) were uneducated. The pregnancy was not monitored in 84.39% (n=335 cases). Management was immediate, in less than one hour in 70.78% (281 cases) of patients. It was provided by the midwife alone in 34.50% (137 cases) versus 26.44% (105 cases) by the ..........

ABSTRACT
Introduction: The study of mortality makes it possible to control and revise therapeutic measures in a health facility. Maternal death is a major concern in the world, it is a social tragedy. We present a study on maternal death at the Mother Child Health Center in the Zinder region. Methodology: The study was a retrospective, descriptive study covering eleven months from January 1st to November 30th, 2017. Study conducted at the mother and child health center in the Zinder region, the main regional reference point for obstetric gynecology. The objective was to determine the epidemiological profile of deceased parturients. Patients admitted directly or evacuated from other health facilities and who died as a result of maternity were included. Patients who died outside the gestational setting were excluded. Data was collected from the admission register, the maternal death audit report and the patient record. The variables studied were epidemiological data, type of anesthesia, ASA class, cause of death, mode of transport. Results: A total of 10090 patients admitted were studied, one hundred and sixteen (116) women died (1.14%) and 3030 deliveries was conducted, of which 2635 were live births. The average age was 26.28 years with extremes of 15 years and 42 years. The 21 to 30 age group was the most affected with 31.89% (n = 37). Large multiparas (5 to 13 parities) were in the majority with 46.55% (n = 54). Transportation was unsafe at 86.20% (n = 100) and 68.96% (n = 80) was more than 50 km from the site of care. Almost all, 99.13% (n = 115) were uneducated and unprofessional. NPC was not achieved in 98.27% (n = 114) of the cases. Anesthesia was performed in 23.27% (n = 27) of the patients including 19.82% general anesthesia and 03.44% spinal anesthesia. The ASA I class represented 14.81% (n = 04), ASA II 74.07% (n = 20) and 11.11% for the other classes. The midwife was the caregiver in 87.93% (n = 103) of the cases. Delayed treatment was the leading cause of .......

ABSTRACT
Introduction: Propofol, a popular intravenous anesthetic, is now on the trade. It's a common tool for both starting and keeping anesthesia going. Antiemetic and anticonvulsant properties and the speed of induction and recovery are its primary benefits. Intubation without a muscle relaxant, day surgery, and the installation of a laryngeal mask airway has all been effective using this technique. Injection discomfort, dosage-dependent hypotension, and severe bradycardia are the primary drawbacks of the drug's use. Objectives: Researchers set out to see how much of a difference complete intravenous anesthesia with Propofol made in mean systolic function roughly equivalent to balanced anesthesia (Thiopentone; Isoflurane; Nitrousoxide). Results: Multicentered based randomized quasi-experimental prospective study was performed in Kushtia Medical College Hospital, Kushtia, Bangladesh, from January 2019 to December 2020. In our study, out of 60 cases (30 in each group), 70 %(n=21) in Group-A and 63.33%(n=19) in Group-B were between 12-30 years of age while 30%(n=9) in Group-A and 36.67%(n=11) in Group-B were between 31-60 years of age, mean±SD was calculated as 27.90±8.91 and 29.8±8.49 years respectively. 60 %(n=18) in Group-A and 53.33%(n=16) in Group-B were male while 40%(n=12) in Group-A and 46.67%(n=14) in Group-B were females. Comparison of mean hemodynamic changes using Propofol as total intravenous anesthesia with balanced anesthesia technique (thiopentone isoflurane-nitrous oxide) shows that heart rate after intubation in Group-A was 83.4±2.36 and 90.36±1.95 in Group-B, the p-value was 0.001 while meaning arterial pressure in Group-A was recorded as 78.6±2.25 and in Group-B 89.43±1.73, the p-value was 0.000. Conclusion: A substantial improvement in supportive care is seen in surgical interventions when using Propofol as a complete intravenous anesthetic vs. balanced anesthesia (thiopentone-isoflurane-nitrous oxide).

ABSTRACT
Background: Spinal anaesthesia consists of inserting a spinal needle into the subarachnoid space and, when a free flow of cerebrospinal fluid (CSF) is obtained, injection of a solution of local anaesthetic directly into the CSF. In Paediatric Patients Spinal Anaesthesia is used for subumbilical surgeries but still there is a concern about its safety & feasibility. Objective: To assess the spinal anaesthesia in paediatric patients of district level hospital, Tangail, Bangladesh. Materials and Methods: In this prospective study was conducted in the Dept. of Anaesthesia, Sheikh Hasina Medical College Hospital, Tangail, Bangladesh from January to June 2021. 32 paediatric patients of aged 2-10 years were included undergoing sub umbilical surgery. Under all aseptic precautions and sedation, subarachnoid block was given with 27g quineke needle through L3-L4 or L4-L5 subarachnoid space & hyperbaric 0.5%. Bupivacaine was administered according to the weight of children. The dose of Bupivacaine used was 0.1ml\kg for child (<5kg), 0.08ml\kg (5-15kg), 0.06ml\kg (>15kg). Demographic data, vital parameters, sensory –motor block characteristics & complications were noted. Results: The mean and standard deviation of age is 5.17+2.83 (2-10) years and Mean Weight (Kg) 15.23+7.43 (7.8-23). Out of the 32 cases, 24 were males whereas the remaining 8 were females. In this study indication of high perception RIH 10 (31.25%), Fracture shaft of femur 4 (12.5%), LIH 4 (12.5%), Umbilical Polyp 2 (6.25%), Distal Hypospadias 5 (15.62%), Re-Circumcision 2 (6.25%), Undescended testicle 3 (9.37%), Appendicitis 1 (3.12%) and Mucous Cyst 1 (3.12%). In our study common SA Herniotomy 14 (43.75%), Circumcision 2 (6.25%), Urethroplasty 5(15.62%), Excision polyp 2(6.25%), Orchiopexy 3(9.37%), Ortho surgery 4 (12.5%), Mucous Cyst Excision 1 (3.12%). There was no significant change in vital parameters. Mean peak sensory level was T 6.20 ±1.20 (T4- T8). Mean sensory level at the end of surgery was T8.11±1.4

ABSTRACT
Kidney infarction is a rare diagnostic condition because it is often underestimated. It occurs most often in patients with cardiovascular terrain. Most often, the clinical symptomatology of renal infarction initially simulates a picture of febrile renal colic or not, the radiological examinations of which requested are based on the first-line ultrasound. The abdominopelvic scanner without injection being used more and more in front of a painful abdominal symptomatology. In some cases, it is desirable to complete the scan by injecting contrast product, especially in the event of an unconfirmed lithiasis obstacle. Early management of renal infarction with thrombolysis or curative-dose anticoagulation (heparin therapy) may improve complete and permanent restoration of renal function. Indeed, the early diagnosis of a renal infarction is made in less than 30% of patients; it is a critical problem that requires rapid management to save the vital prognosis and the function of the kidney.