Abstract: Introduction: Colonoscopy may be a mildly painful procedure requiring conscious sedation. Though propofol may be a widely used anesthetic in day-care procedures thanks to its rapid onset and quick recovery features a drawback of requiring resuscitation maneuvers more often than the traditional methods. Dexmedetomidine, a newly introduced, highly selective α2 adrenergic receptor agonist possessing hypnotic, sedative, anxiolytic, sympatholytic, and analgesic properties with impressive margin of safety, must be explored to be used in conscious sedation for colonoscopy procedure among Bangladeshi population. Objective: To find out the comparison between propofol and dexmedetomidine for conscious sedation in patients undergoing outpatient colonoscopy. Materials and Methods: A prospective randomized comparative study was conducted on patients aged between 25 and 60 years with the American Society of Anesthesiologist physical status classes I and II posted for colonoscopy under monitored anesthesia Dept. LABAID Specialized Hospital, Dhanmondi, Dhaka, Bangladesh from January 2018 to December 2019. Study group was randomly divided into two groups and administered propofol and dexmedetomidine. The primary outcome variable was assessments of sedation scores between the two groups. Secondary outcome variables were pain score assessments, hemodynamic comparisons, and adverse events among the two groups. Appropriate statistical tests were applied to compare the findings. Results: After comparisons between the two groups, we found that...................
Abstract: Raised levels of D-dimer have been noted in patients with COVID-19. The existing evidence emplies that the highest levels of D-dimer in the critically ill Covid-19 patient shows a linear relationship between the D-dimer measurement and the severity of the disease. However, that should also mean a patient on the road to recovery would have decrease in pro-thrombotic state and hence lower D-dimer readings. This study hypothesized that D-dimer trend would start to return towards normal as patients recovered from this illness. The present study included 43 patients with COVID-19 infection treated in the ICU at Khoula Hospital, Muscat, Oman from 10th May to 5th August 2020. Six readings of D-dimer were taken from the time of admission of Covid-19 npatient to their discharge from the ICU or demise. The data was statistically analyzed using generalized linear model, paired ‘t’ test and Wilcoxon Signet Ranks test. D-dimer demonstrated a statistically significant difference by the value of 4 μg/ml in patients who were eventually extubated compared to those who died while in the ICU, despite that, as a trend over time was insignificant. In conclusion, this study suggests that D-dimer would be noteworthy in assessing severity as a single time-point, however not as a prognostic value in evaluating improvement of critically ill patients of COVID-19.
Abstract: COVID-19 is most well-known for causing respiratory pathology. It can also result in other organ involvement. These include thrombotic complications like myocardial infarction and stroke. Cardiac arrhythmias, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, pancreatitis, neurologic disorders including demyelination, endocrine issues like hyperglycemia and ketosis have been reported. Individually and in combination, these can add to mortality and morbidity. This review is primarily focussing on the potential life threatening problems that physicians can encounter during the course of COVID 19 patients’ stay in intensive care unit. Electronic literature search was done to study COVD-19 and its pathophysiology, different organ involvement other than lungs, ICU management and mortality. The search engines used to conduct the electronic literature searches were PubMed, PubMed Central, Google Scholar and CAS. A combination of keywords was used to make the searches such as COVID-19 AND (Pathology OR Pathophysiology OR Complications OR Organ failure OR Intensive care OR Risk factors OR Mortality).The articles published in English language between the years 2019 and 2020 were considered in the review. Few cross references of previous years were also reviewed and included. The findings of these studies were synthesized into a narrative review.
Abstract: COVID-19 associated Multisystem inflammatory syndrome in adults (MIS-A) can present with varied cardiac manifestations like ST segment changes, wall motion abnormalities, arrythmias and valvular abnormalities. Although the CDC has released criteria for diagnosis in July 2020, there is still a lack of clarity due to the varied presentation of cases and overlap of symptoms with other common disease conditions. A delay in diagnosis due to time taken to rule out other conditions can delay appropriate treatment. We present a case of an adult male who presented with fever, chest discomfort and abdominal symptoms with a history of previous COVID-19 infection. His vitals were stable without any signs of cardiac failure. We tested for COVID-19 antigen, antibody, and inflammatory markers. ECG and CT-chest and abdomen showed ST-T changes and a significant pericardial effusion. Though there were no cardiac symptoms, he was monitored with serial Troponin T and transthoracic ECHO cardiography which helped us to pick up deterioration of cardiac function. An immediate coronary angiogram was done which was normal. He was treated with corticosteroids, diuretics and colchicine and with daily monitoring his cardiac function improved. The pathophysiology of MIS-A is currently not well understood and a pericardial effusion without any significant cardiac symptoms as a presentation of MIS-A has not been reported previously. A multi-disciplinary approach and a high index of suspicion was required along with vigilant monitoring in an intensive care setup to recognise and treat this patient who had a good recovery with supportive care.
Abstract: Background and Aim: Comparison of the efficacy of epidural labour analgesia and programmed labour analgesia in controlling labour pain. Objectives: Primary objectives are VAS score, vitals and any untoward effects. Effect on ambulation, APGAR score and incidence of intervention as secondary objectives. Methods: A total of 80 parturients in active labour were allocated into two equal groups by using random allocation software.Group (G1) was given epidural injection of 15 ml of ropivacaine 0.2% with 2mcg/ml fentanyl. Top up was given with same dose regimen in graded manner.Group (G2) was given programmed labour analgesia with Inj. Pentazocine 6mg IV+Inj. Diazepam 2mg IV+Inj. Tramadol 1mg/kg deep i.m and thereafter Inj. Drotaverine 40mg IV half hourly (maximum of 3 doses). Inj. Ketamine 0.25-0.5 mg/kg IV was given as resque analgesia. Quality of pain relief was assessed with VAS score. Results: Labour analgesia was better in epidural group (G1) with VAS decreased significantly at 5 min (p <.00001). It was<3 till end of delivery in group (G1).In Group (G2) VAS was mostly>3 and they required resque analgesia with ketamine. There were no significant changes in hemodynamics. Side effects were mild without needing any intervention.There was no effect on ambulation in group (G1). Local anaesthetics were needed for episiotomy in all cases in group (G2). No adverse effects were seen on neonate in either group. Conclusion: Epidural labour analgesia with 0.2% ropivacaine plus fentanyl 2mcg/ml is better for labour analgesia in terms of VAS score, safety profile and side effects. There was no increase in duration of labour with epidural labour analgesia.
Abstract: Coronavirus disease 2019 (COVID-19) is primarily a respiratory tract disease but involves other organ systems too, especially gastrointestinal system. Acute pancreatitis is one of the manifestations of COVID-19, as pancreatic gland also expresses the angiotensin-converting enzyme 2 receptors. We present two cases, where none of them presented with symptoms of pancreatitis on admission. Our first patient presented with severe acute respiratory distress syndrome secondary to COVID-19 and during her stay necrotizing pancreatitis was incidentally detected on CT scan. Our second patient presented as an acute fatty liver of pregnancy and was incidentally found to be COVID-19 positive and later developed symptoms of acute pancreatitis.
Comparison of Quality of Labor Analgesia by NPRS Score Upon Single Dose Intrathecal Labor Analgesia Between Bupivacaine With Adjuvants (Fentanyl And Dexmedetomidine) And Bupivacaine With Adjuvants (Fentanyl And Morphine): A Randomized Comparative Double Blind Study
Dr. Gian Chauhan, Dr. Kartik Syal, Dr. Rajeev Sood, Dr. Geetika Gupta Syal, Dr. Sanjay Rathod, Dr. Rajeev Bansal, Dr. Manoj Maitan, Dr. AnshitAbhi Pathania, Dr. Anu Shree Bansal, Dr. Madhav Verma , D
EAS J Anesthesiol Crit Care, 2020; 2(5):160-164
Background: Intrathecal analgesics using (ITA) local anesthetics and adjuvants like narcotics are safe and effective alternative to epidural anesthesia. The objective of the study is toassess and compare quality of labor analgesia through NPRS Score upon single dose ITA between bupivacaine with adjuvants (fentanyl and dexmedetomidine) and bupivacaine with adjuvants (fentanyl and morphine).Material & Methods: The present study was a prospective, randomized and double blinded controlled study.120 parturients allocated into two equal groups (G-D& G-M) of 60 patients using block Randomization Technique. Group G-D received Bupivaciane, Fentanyl &Dexmedetomedine while G-Mreceived Bupivaciane, Fentanyl & Morphine. Quality of analgesia was assessed through NPRS Scale and and analyzed using Epi Info V7.Results:. Difference in mean NPRS score between both Group(G-D) and Group(G-M)was found to be non- significant at baseline as well as at various time interval till 5 hours. At 0 minutesi.e.the mean NPRS was comparable (p>.05) in both the groups, (8.65±0.48 inGroup(G-M)and 8.58±0.49 inGroup(G-D)respectively).After 3 minutes Itdecreased to 3.03±0.18 in Group(G-M)and 3.10 ± 0.35 minutes inGroup(G-D)respectively,however itremained less than 5 (3.05±0.229 inGroup(G-M)and 3.12±0.331 inGroup(G-D) respectively till 4 hoursof intrathecal injection. Further itincreased to 4.75±0.50 inGroup(G-M)and 5.00 ± 0.00 inGroup(G-D)respectivelybut the mean NPRS was comparable (p>.05) in both the groups. Conclusion: we found that intrathecallabour analgesia is an effective and safe mode of analgesia. The mean NPRS score remained less than 5 in both the groups till 4.5 hours and was comparable throughout.