Browsing by Author "Acharya, SP"
Now showing 1 - 6 of 6
Results Per Page
Sort Options
Publication A case of left atrial myxoma: Anaesthetic management(Kathmandu University, 2006) Pradhan, B; Acharya, SPLeft Atrial Myxomas are notorious for their varied presentations. We describe one such case which initially presented with hemiparesis and seizures and was diagnosed as cerebral infarction and treated accordingly and decompression craniotomy with hinge flap was done for raised ICP and impending brain herniation. The main cause was a left atrial myxoma, which was diagnosed only in follow up. The myxoma has embolised to give rise to cerebral infarction. The LA myxoma was then successfully operated under general anaesthesia and Cardiopulmonary bypass (CPB). Key words: Hemiparesis, Cerebral infarction, Left Atrial (LA) MyxomaPublication Application of “the Sequential Organ Failure Assessment (SOFA) score” in predicting outcome in ICU patients with SIRS(Kathmandu University, 2007) Acharya, SP; Pradhan, B; Marhatta, MNAbst ract Background: Various scoring systems have been developed to prioritize patient admission and management in ICU. The objective of this prospective, observational cohort study was to evaluate application of one such system, the Sequential Organ Failure Assessment (SOFA) Score in predicting outcome in ICU patients with SIRS. Patients and Methods: Fifty patients admitted to a six bed multidisciplinary ICU with SIRS were consecutively enrolled in the study and SOFA scores were calculated at zero hour, after 48 hrs, and after 96 hrs and patients followed till discharge from hospital. Results: When compared to outcome, the non survivors had high initial, mean and highest SOFA scores as compared to survivors. (p value = 0.002, <0.001, <0.001 respectively). Delta SOFA was not significantly associated with outcome. (p value= 0.117). The initial SOFA score > 11 predicted a mortality of 90%. (OR 23.72, 95%CI2.68- 209.78, p=0.004). Similarly, mean SOFA score of > 7 predicted a mortality of 73.9% (OR 22.7, 95%CI 5.0 – 103.5, p<0.001) and high SOFA score > 11 predicted a mortality of 87.5% (OR 32.66, 95%CI 5.82-183.179, p< 0.001). Area under receiver operating characteristic (ROC) curve for mean SOFA was 0.825, for high SOFA was 0.817 and for initial SOFA was 0.708. Thus mean, high and initial SOFA scores were helpful in predicting between the survivors and the non survivors. Conclusion: The SOFA scoring system is useful in predicting outcomes in ICU and thus help in proper utilization of ICU resources. Key words: Sequential Organ Failure Assessment (SOFA) Score, Systemic Inflammatory Response Syndrome (SIRS), Intensive Care Unit (ICU).Publication Arthroscopic Debridement for Mucoid Degeneration of Anterior Cruciate Ligament - A Single Institution Experience from Nepal(Kathmandu University, 2023) Shrestha, R; Khadka, SK; Maharjan, S; Basi, A; Dahal, A; Chaudhary, A; Acharya, SP; Malla, MABSTRACT Background Mucoid degeneration of anterior cruciate ligament is characterized by infiltration of mucoid-like material scattered throughout the anterior cruciate ligament substance. It is an uncommon condition, but previously, underdiagnosed or often misdiagnosed as an anterior cruciate ligament tear. Objective To present our early experiences with mucoid degeneration of anterior cruciate ligament in last five years in terms of clinical presentation and the outcomes of arthroscopic management. Method This was a retrospective descriptive cross-sectional study on patient who received arthroscopic debridement for mucoid degeneration of anterior cruciate ligament in Dhulikhel Hospital over five years period (2017 May to 2022 April). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale that has been translated and validated to be used in local (Nepali) language and context was used for evaluation of outcome evaluation. Result Twenty-one patients of mean age 44.21 years, predominantly females (18), were managed in five years period. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 16.33±10.47 with a range of 0 to 36 (11.57 to 21.09 at 95% confidence interval). The mean Western Ontario and McMaster Universities Osteoarthritis Index score converted on a scale of 0 to 100 was 17. Thirteen patients had isolated Mucoid degeneration of anterior cruciate ligament whereas nine others had associated either meniscal tear or chondral lesions. Conclusion Mucoid degeneration of anterior cruciate ligament could be a cause of knee pain in middle-aged patients and arthroscopic debridement can improve the patient’s symptoms and provide a good functional outcome. KEY WORDS Anterior cruciate ligament, Arthroscopy, Debridement, Mucoid degeneration, WOMACPublication Comparison of hemodynamics and LMA insertion conditions using combination of Ketamine-Propofol, Fentanyl-Propofol or Saline-Propofol(Institute of Medicine, 2017) Koirala, M; Acharya, SP; Pradhan, B; Marhatta, MN; Bhattarai, AS; Parajuli, BDAbstract Introduction: Laryngeal Mask Airway(LMA) insertion requires a certain depth of anaesthesia to blunt the airway reflexes. Propofol alone causes undesirable hemodynamics effects and suboptimal LMA insertion condition. So this study was designed to compare the hemodynamics and insertion conditions when Ketamine or Fentanyl was combined with Propofol for induction. Methods: In this study, sixty ASA PSI(American Society of Anesthesiologists Physical Status) patients undergoing various surgical procedures under LMA were assigned to three groups; Group K, Group F and Group S who received 0.5 mg/kg of Ketamine, 1 μg/kg Fentanyl and Normal saline respectively before receiving Propofol 2.5 mg/kg after which LMA insertion was done. Arterial blood pressure and heart rate were measured at various intervals. LMA insertion conditions were graded under different parameters to calculate LMA insertion summation score. Result: Significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MAP) was seen between Gr K and Gr S after successful LMA insertion and after 2 mins of insertion. Significant difference in SBP was seen in between Group K and Group F (p=0.01) after successful LMA insertion. The median summed score describing the LMA insertion condition was significantly better in Ketamine [7.0 (6.0-7.5)] and Fentanyl [7.0 (6.0-7.0)] in comparison to Saline [ 8.5 (8.0-11.0)] Conclusion: During LMA insertion, adding Ketamine to Propofol provides stable hemodynamics in comparison to using Propofol. Addition of either Ketamine or Fentanyl to Propofol provides equally good conditions during LMA insertion than using Propofol alone. Key words: Fentanyl, Ketamine, LMA, PropofolPublication Feasibility study of acute thrombolytic therapy for stroke in a tertiary care center in Nepal(Institute of Medicine, 2018) Pradhan, S; Shrestha, PS; Acharya, SP; Prasad, PNAbstract Introduction: Early thrombolysis is the recommended therapy for acute ischemic stroke (AIS). In a developing country like Nepal, many factors contribute to the delay in performing prompt thrombolysis. This was a feasibility study to assess the determinants of pre-hospital delay for patients diagnosed with AIS. Methods: From 16th July to 16th September 2017, patients diagnosed with AIS in the emergency department (ED) were identified and a structured interview with the patient or next of kin was performed. Various pre-hospital time intervals and possible factors resulting in delay were assessed. Results: A total of 58 AIS patients were studied. Only 12% of the total patients underwent thrombolysis. The mean delay (+/-sd) from symptom onset to first contact with a medical personnel was 6.74 (+/- 7.84) hours. The mean (+/-sd) total arrival delay to ED was 15.78 (+/-17.48) hours. The mean (+/-sd) delay in dispatch to delivery time was 9.12 (+/-15.57) hours. Ten patients (17%) arrived to our ED within 3 hours of onset of symptoms, and 14 (24%) arrived within 4.5 hours of onset of symptoms. Fifty percent of those who presented on time for thrombolysis underwent the therapy. Conclusions: This study shows that there are major obstacles before we are able to provide adequate thrombolysis services for AIS. There remain plenty of areas where the government, the hospital and public health services need immediate addressing. Key words: feasibility, ischaemic stroke, pre-hospital delay, thrombolysisPublication Unexplained apnoea and loss of consciousness during sub arachnoid block for caesarean section(Kathmandu University, 2009) Acharya, SP; Marhatta, MN; Amatya, RAbstract Sub arachnoid block (SAB) is often perceived safe by many anesthesiologists and other faculties but is also not completely safe choice especially in pregnant females, as the incidence of complications and local anaesthetic agent toxicity is high in these groups of patients. Here we present four such cases out of the seventeen patients over a period of six months, who developed apnea and transient loss of consciousness after spinal anesthesia for lower segment caesarean section. Typically all these patients after spinal anesthesia developed difficulty in breathing, became apnoea and had loss of consciousness for about a minute or two. The apnea was relieved with bag and mask ventilation following which the patient regained consciousness and start breathing normally. The rest of the procedure was uneventful. We presented these cases with aim of sharing similar experiences, and to aware about the possibility of such events as these events do occur frequently but case reports and literatures are unavailable. Key words: Apnoea, loss of consciousness, lower segment caesarean section (LSCS), Sub arachnoid block (SAB).