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Background: Upper abdominal surgery (like- hepatobiliary surgery, gastrectomy, esophagectomy, hepatictomy, and whipples operations that involve large surgical incisions) lead to severe postoperative pain that lead to higher doses of opoids use in post-operative period as a result incidence of unwanted side effect and respiratory complication increase hospital stay and morbidity. To reduce the use of opioids clonidine can be used as a multimodal analgesic approach. It is reported that clonidine 150mcg intravenous (I/V) produce a similar analgesic effect to morphine 5mg in patient after orthopedic surgery. Because of its dose, route, and surgical variation it is very much important to specify the dose for upper abdominal surgery. Material and methods: After considering the inclusion and exclusion criteria the patients were randomized to receive Group: A (2mcg/kg oral clonidine) and Group: B (4mcg/kg oral clonidine), one hour (60minutes) before surgery as an oral premedication. All groups were compared for preoperative analgesic, sedation and anxiety level along with changes of heart rate and mean arterial pressure prior to premedication and post-operative periods as follows VAS (visual analogue score) pain scores. Result: The post-operative pain measured on VAS showed Group A expressed highest VAS at 6thpost-operative hour Group –B showed highest VAS at 14th post-operative hour. So it is very clear to us that pethedine requirement of Group B (4mcg/kg oral clonidine) is less than Group A (2mcg/kg oral clonidine). The oral premedication with clonidine at 2 microgram per kg or 4 microgram per kg for postoperative analgesia and hemodynamic stability of elective upper abdominal surgery patients. Conclusion: As a part of multimodal analgesic approach, 4mcg/kg oral clonidine premedication is effective to perioperative pain control and keep stable the haemodynamic in upper abdominal surgery J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 131-135

Background: Emergency tracheostomy is the commonest surgical intervention performed as lifesaving procedure by ENT surgeons on patients in emergency room of ENT and ICU. Several operative and postoperative complications have been reported after tracheostomy including fatal hemorrhage. Massive subcutaneous neck emphysema occurred because ventilation started at the time when the hemorrhage was not completely managed and the tracheal tube was not fully secured. Objective: This study was conducted to compare haemorrhage and surgical emphysema as complication of emergency tracheostomy among patients admitted in Department of ENT and Head-Neck Surgery in Dhaka Medical College & Hospital. Methods and Materials: This was a Cross Sectional Study conducted in the ENT and Head- Neck Surgery Department, Dhaka Medical College Hospital from July 2015 to June 2016. A total of 90 patients were included who fulfilled the selection criteria. Non probability convenient sampling was used to collect data. Statistical analysis was done by SPSS version 21. Results: Mean± SD of the study subjects was 49.84±17.4 years with most patients belonged to 40-79 years age group. 28.9% patients had habit of smoking and betel nut chewing. (48.9%) patients suffered from Ca larynx. Out of 90 tracheostomy patients, 40(44.4%) patients had had different complications including haemorrhage (13.3%), surgical emphysema (10%), haemorrhage with surgical emphysema (6.7%), tube blockage (3.3%), wound infection (3.3%) and injury to local tissue (2.2%). Haemorrhage occurs from anterior jugular vein, middle thyroid veins and thyroid gland and included peroperative haemorrhage (7.8%), immediate post- operative haemorrhage

Background: Laparoscopic cholecystectomy has emerged as a popular alternative to traditional open cholecystectomy in the management of cholelithiasis. It has several advantages .Pneumoperitoneum and trendelenburg positioning causes release of stress hormones and ultimately changes in hemodynamic parameters. Stretching of peritoneum, abdominal wall associated with postoperative pain. So maintenance of haemodynamic stability, immediate postoperative pain control continues to be a major challenge for the anaesthesiologists. Methods: Sample was selected by non-probability sampling technique in two groups distributed as- Group-L (Laparoscopic cholecystectomy, n=30) and Group-O (opencholecystectomy, n=30). Detailed history taking, physical examination and routine lab investigations were done. Approval of the study was obtained by the local Ethical Committee. Post-operative complications, postoperative pain, frequency and pattern of cardiovascular complications, frequency and pattern of respiratory complications were evaluated and compared between thegroups Result: In both groups female were predominant. In this study haemodynamic status (Heart rate, SBP, DBP, MBP) in different phases of anaesthesia, surgery and postoperative follow-up (at 4th hour, 8th hour, and 12th hour) has been observed. Conclusion: This study confirms the feasibility and safety of laparoscopic cholecystectomy is better than open technique in terms of attenuation of better haemodynamic stability, better postoperative pain control and less requirement of analgesia. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 184-189