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
Background: Laparoscopic surgery is among the routinely performed surgeries. However, it leads to hemodynamic instability with potentially harmful consequences. Dexmedetomidine is found to provide good hemodynamic stability required during laparoscopy when performed under general anesthesia. The aim of the study was to assess the efficacy of dexmedetomidine in attenuation of hemodynamic responses. Method: A prospective comparative study was conducted at a tertiary care center, Kolhapur including a total of 60 patients between 18-60 years and belonging to Grade I and II as per American society of Anesthesiologists (ASA) who underwent laparoscopic surgeries under general anesthesia. All the patients were equally randomized and infused with either dexmedetomidine (Group D) or 0.9% saline (Group S) and baseline hemodynamics were recorded prior to the administration of general anesthesia. Post-operative requirement of analgesia (within 24 hours) and the recovery time were recorded. Outcomes of both the groups were compared by Chi square and a P-value <0.05 was considered significant. Result: No significant difference was found in preoperative heart rate and Mean Arterial Pressure (MAP) in both the groups (P= 0.8994; P= 0.5643, respectively). Post intubation, heart rate and MAP were significantly lower throughout the surgery, in group D (P<0.05). Requirement of isoflurane and incidence of hypertension were significantly higher in group S (P= 0.0031) whereas the requirement of post-operative analgesia were significantly less group D (P=0.0015; P=1.51e-08 respectively). Conclusion: Perioperative IV dexmedetomidine is very useful in stabilizing haemodynamics in patients undergoing laparoscopic surgeries under general anesthesia.

ABSTRACT
Poisoning due to deliberate self-harm with the leaves or seeds of pink or yellow oleander results in significant morbidity and mortality. A wide variety of symptoms like nausea, vomiting, bradyarrhythmias and tachyarrhythmias occur following ingestion. Usually more cases will be seen in suburban parts of India and South Asia. We present an unusual case of poisoning by the ingestion of oleander leaves manifested with refractory bradycardia at tertiary care.

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Objectives: There are so many in-vitro and in-vivo studies proved the hepatoprotective and antiviral effect of silymarin and derivatives. Number of antiviral activities of Silymarin and derivatives has shown against liver and non-liver pathogens, it indicates potential broad spectrum antiviral. In addition, considering the poly-pharmacological activity of silymarin and derivatives towards multiple host cell targets, such as cell innate immunity and inflammation, oxidative stress production, and autophagy, which are all cell physiological processes that are known to be elicited or subverted by many viral infections, these natural products are likely to exert their antiviral activities by modulating the cellular environment in addition to any potential direct antiviral function(s) against a specific viral protein. Highly contagious SARS-CoV-2 causes high grade fever with joint pain and lethal organ injuries. The infection of COVID-19 across world has led to a global health emergency. COVID-19 disease caused by the severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) has affected nearly all the continents with around 1.52 million confirmed cases worldwide. Methods: In the present research an attempt had been made to find new COVID-19 main protease inhibitor by molecular docking approach. Grid based docking approach has been selected to find out the binding using AutoDock software. The two-dimensional structure of was converted into 3-D structure and optimized with 3D geometry. Results: Silibinin, are extracts obtained from the medicinal plant milk thistle (Silybum marianum) and have conventionally been used for the treatment of liver diseases. It is major constituent of Silymarin. Recent studies reported its significant in anti-neoplastic effects in a diversity of in vitro and in vivo cancer models, including skin, breast, lung, colon, bladder, prostate and kidney carcinomas. The Silibinin was docked and the binding energy was found to be -7.92 kcal/mol. .....

ABSTRACT
Introduction: Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. Pediatric patients differ in their drug requirements because of their smaller body size, differences in body composition and handling capacity of drugs. Usually dosages are based on body weight, because it correlates so intimately with body water compartments. Objective: To find out the Intra-Operative & Post-Operative Complications in Pediatric Anesthesia. Materials & Methods: The present study was conducted in the Department of Anaesthesiology, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh during from April 2020 to March 2021. It included 83 pediatric patients of both gender. Parents were informed regarding the study and written consent was obtained. Ethical clearance was taken from institutional ethical committee. General information such as name, age, sex, ASA status, technique of anesthesia and complications were recorded. Results: The prospective study was conducted to identify anesthesia-related complications in pediatric patients. The present study was conducted on 83 pediatric patients of both genders. Factors such as conscious state, colour, respiration, pulse and blood pressure were also assessed. Age group 1 month- 1 year had 12 males and 18 females. 1-5 years had 10 males and 15 females, 6-10 years had 11 males and 15 females and 11-18 years had 01 males and 01 females. The difference was non- significant (P-0.5). Patients had ASA I (72), ASA 2 (17), ASA 3 (5), ASA 4 (1) and ASA 5 (1) Status. The difference was significant (p-0.05). Type of anesthesia was general anesthesia (50), general anesthesia with caudal block (14), subarachnoid block (1) and general anesthesia with local anesthesia (18). The Difference was significant (p-0.01). Common intra- operative complications were bradycardia (3), tachycardia (2), hypotension (2), cardiac arrest (2), ...............

ABSTRACT
Guillain-Barré syndrome (GBS) is a complicated degenerative neurological disorder which can be acute or chronic in nature. It is an acquired condition which is characterized by progressive, symmetrical, proximal and distal tingling and weakness. Muscle stretch reflexes are decreased to absent and loss of sensation is common. These patients present a substantial anaesthetic risk because of autonomic dysfunction. We report a case of 51 year old female with Guillain-Barré syndrome (GBS) undergoing total hip replacement managed under general anaesthesia and ultrasound guided erector spinae plane block given for post operative pain relief.

ABSTRACT
Background: Spinal anaesthesia is a preferred mode of anaesthesia for lower limb orthopedic surgery but limited duration of action remains a concern. Different adjuvants have been used intrathecally to prolong the duration of SAB .A quest for searching newer and safer adjuvant to local anaesthetic agents is always there as these orthopaedic procedures are associated with moderate to severe pain postoperatively. Aim: We compare the efficacy of intrathecal dexmedetomidine, fentanyl and nalbuphine for block characteristics and post operative analgesia in orthopedic surgeries. Material & Methods: 130 American Society of Anaesthesiologist 1and II patients undergoing lower limb orthopedic surgery requiring SAB were allocated randomly to four groups of 30 each to receive intrathecal dexmedetomidine 0.5mcg Group 1, fentanyl 25mcg Group 2, nalbuphine 0.4mg Group 3 and normal saline Group 4, added to 0.5% Isobaric levobupivacaine 12.5mg to make total volume 3 ml in each group. We assesed block characteristics, postoperative pain scores, time to use of first analgesic, 24 hour analgesic consumption, and additional analgesic consumption. Results: Onset of Motor blockade was fastest (8.67mins) in dexmedetomidine group (9.13mins) in fentanyl group, (10.07mins) in nalbuphine group and (12.18mins) in control group. Significant prolongation of time for need of first rescue analgesic was seen with the use of dexmedetomidine (485.35mins).Total 24 hours tramadol consumption was 196.42mg in dexmedetomidine group, 200mg in fentanyl group, 253.84mg in nalbuphine group and 222.72mg in control group. Conclusion: Dexmedetomidine as an adjuvant to 0.5% levobupivacaine seems to be a better alternative to fentanyl and nalbuphine.