Browsing by Author "Gautam, B"
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Publication Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy(Kathmandu University, 2008) Gautam, B; Shrestha, BR; Lama, P; Rai, SAbstract Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the ef cacies of Ondansetron-Dexamethasone combination with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under general anaesthesia. Materials and methods: Hundred and fty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective, randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were assessed at six, 12 and 24 hrs post operation. Complete response was de ned as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to rst analgesia demand, amount of Meperidine consumption, adverse event(s) and duration of hospital stay were recorded. Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Signi cantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the rst six hrs (P=0.023 versus O & 0.008 versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD (P=0.032). Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV after laparoscopic cholecystectomy. Dexamethasone alone is signi cantly less effective in preventing early vomiting compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as compared with combination therapy. Key words: Antiemetic prophylaxis; Dexamethasone; laparoscopic cholecystectomy; Ondansetron; postoperative nausea and vomiting (PONV)Publication Cardiac arrest during laparoscopic cholecystectomy under general anaesthesia: A study into four cases(Kathmandu University, 2009) Gautam, B; Shrestha, BRAbstract Laparoscopic cholecystectomy (LapChole) has virtually superseded the more conventional open abdomen approach for the surgical treatment of symptomatic cholelithiasis. LapChole is however not a risk free procedure and serious, potentially fatal intra-operative complications can occur. Here we present case reports of four patients who suffered from intra-operative cardiac arrest during LapChole. All four recovered without residual morbidity and three of them underwent successful surgery in the same setting. No definite cause could be identified in any of the patients. We outline several possible mechanisms that could have been involved and discuss these events in face of published reports describing similar incidences. We infer that the creation of carbon-dioxide (CO2) pneumoperitoneum was involved in the causation of the cardiac arrest because all four incidences occurred within minutes thereafter. Although rare, such complications can be fatal and are thus demanding to the anaesthesiologist. Key words: Anaesthetic complications; carbon-dioxide pneumoperitoneum (CP); cardiac arrest; general anaesthesia; laparoscopic cholecystectomyPublication Globozoospermia(Kathmandu University, 2023) Bhattarai, L; Gautam, B; Raut, BB; Chettri, SABSTRACT Male infertility may be due to low sperm concentration, poor sperm motility, or abnormal morphology. Among the factors involved in male infertility, there is a rare morphology disorder called “Globozoospermia”. This condition is primarily characterized by the presence of round-headed spermatozoa, absence of acrosomal cap and cytoskeleton defects around the nucleus. The morphological characteristics of globozoospermia are formed during spermiogenesis. We report here a case of male infertility due to morphological disorder Globozoospermia. Assessment of semen by observing macroscopic and microscopic parameters are not sufficient for sperm analysis. In present case, macroscopic and microscopic assessment was within normal range. Morphological assessment showed 80% of spermatozoa with round head and absence of acrosomal cap. The absence of acrosome makes fertilization impossible since these sperm are unable to bind to the zona pellucida. By using Intracytoplasmic Sperm Injection (ICSI), conception is possible; however, the fertilization rate remains very low. KEY WORDS Globozoospermia, Male infertility, MorphologyPublication Prevalence of Fibularis Tertius: Insights from a Surface Anatomical Study(Kathmandu University, 2025) Shrestha, S; Mansur, DI; Shrestha, P; Maskey, S; Shrestha, M; Kunwar, A; Poudel, B; Dahal, P; Gautam, BABSTRACT Background The fibularis tertius muscle, a variant muscle in the crural compartment of the leg, is thought to have evolved in humans in response to the development of bipedalism. Acting as both an ankle dorsiflexor and foot everter, it plays a crucial role in enabling efficient terrestrial locomotion, especially in mid-foot biomechanical stabilization. The origin and insertion of this muscle have been reported to exhibit significant variation. Objective The aim is to determine the prevalence of this muscle by conducting a surface anatomical examination of the foot among pre-clinical sciences students at Kathmandu University School of Medical Sciences. Method Each participant’s fibularis tertius muscle (FTM) was assessed on both feet using a standardized surface palpation technique based on protocols that Tixa and Kendall had validated. To ensure accuracy, each foot was subjected to two separate evaluations by qualified evaluators that lasted 120 seconds each. During dorsiflexion and eversion, muscles were identified using sequential palpation techniques. Visibility was categorized into three graded responses (G1–G3) according to muscle activation. SPSS version 23 was used to analyze the data. While the Chi-square test evaluated sex-based associations, with statistical significance set at p < 0.05, descriptive statistics summarized prevalence. Result A total of 226 students (54.42% males, 45.58% females; mean age 20.8 ± 1.88 years) participated in the study. The fibularis tertius muscle had a prevalence of 95.58%, with a similar gender distribution. It was bilateral in 187 participants and unilateral in 29, mostly on the right foot. Multivariable logistic regression revealed no significant association between fibularis tertius presence and body mass index, with both crude and adjusted odds ratios (0.83 and 0.89, respectively) and p-values exceeding 0.05. Conclusion The fibularis tertius muscle is essential for ankle stability, reducing injury risk and aiding recovery during high-impact activities. Its absence increases instability and recurrent sprains. Understanding the anatomy of fibularis tertius muscle is crucial for surgical planning, tendon repair, and rehabilitation, influencing diagnosis, treatment, and injury prevention. KEY WORDS Anatomy, Bilateral traits, Fibularis tertius, Muscle anatomy, Prevalence, Unilateral traitsPublication Spinal anaesthesia for laparoscopic cholecystectomy: A feasibility and safety study(Kathmandu University, 2009) Gautam, BAbstract Background: Regional anaesthetic techniques have benefited those patients undergoing laparoscopic surgeries that are deemed high risk to receive general anaesthesia (GA). But spinal anaesthesia (SA) has not been routinely employed as the sole technique for laparoscopic cholecystectomy (LC). Objective: This study was conducted to uncover feasibility and safety of SA for conducting LC. Materials and methods: Twelve American Society of Anaesthesiologists' physical status I or II patients undergoing elective LC received SA using 4 ml of 0.5% hyperbaric Bupivacaine mixed with 0.15 mg Morphine. Peri-operative preparations and management were all standardised, with other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. LC was performed with CO2 pneumoperitoneum maintained at an intra-abdominal pressure of less than 10 mm Hg and with minimal operating table tilt. Peri-operative events, operative difficulty, hospital stay and patient satisfaction were studied. Results: Spinal anaesthesia was adequate for surgery in all but one patient. Intraoperatively, two out of four patients who experienced right shoulder pain received Fentanyl. Two patients were given Midazolam for anxiety and one was given Ephedrine for hypotension. Operative difficulty scores were minimal and surgery in one patient was converted to open cholecystectomy. Postoperatively, pain scores were minimal and no patient demanded opioid. One patient required antiemetic for vomiting and one patient each suffered headache and urinary retention. 11 patients were discharged within 48 hours of surgery and patient satisfaction scores were very good. Conclusion: Spinal anaesthesia with Morphine-mixed hyperbaric Bupivacaine is adequate and safe for elective LC in otherwise healthy patients and minimises postoperative pain and opioid use. Success and safety of this technique, however, necessitates knowledgeable patient, gentle surgical procedure, and co-operation among patient and members of the perioperative care team. Key words: Hyperbaric Bupivacaine; intrathecal Morphine; laparoscopic cholecystectomy; spinal anaesthesia.Publication Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery(Kathmandu University, 2020) Gautam, B; Piya, B; Karki, DABSTRACT Background Caudal block is the most common anaesthetic technique employed in children for managing perioperative pain of inguino-scrotal surgery. However, despite using long- acting local anaesthetics, caudal analgesia lasts relatively shorter. Dexmedetomidine, an alpha-2 agonist, augments local anaesthetic action. Objective To assess the analgesic effect of caudal Dexmedetomidine. Method This is a randomized, double-blinded study conducted on otherwise healthy children (one to five years) undergoing elective inguino-scrotal surgery. General anaesthesia was administered and a laryngeal mask airway was inserted for assisting ventilation. The caudal block was applied using 0.8 milliliters/kilogram drug volume comprising either two milligrams/kilogram Bupivacaine in group A (n=42) or two milligrams/ kilogram Bupivacaine mixed with 0.75 micrograms/kilogram Dexmedetomidine in group B (n=42). Intraoperatively, inhaled Halothane, intravenous Fentanyl, fluids, and ventilation were titrated to maintain monitored hemodynamic variables within 15% from baseline values. The primary endpoint comprised the duration of analgesia, defined by a time when postoperative pain score (face, legs, activity, cry, consolability; FLACC scale) reached four out of ten. Perioperative events were studied for 24 hours. Student’s t-test and Chi-square test were used for analysis, with p-value less than 0.05 considered as significant. Result Demographic, surgical, and anaesthetic characteristics were similar between the groups. Duration of analgesia was significantly prolonged in group B (group B, 413±101 minutes; group A, 204±40 minutes). The intraoperative requirement for supplement Fentanyl was significantly reduced in group B. Adverse events were comparable between the groups. Conclusion Dexmedetomidine prolongs the duration of analgesia when mixed with caudal Bupivacaine, without increasing adverse events. KEY WORDS Adjuncts, Analgesia, Caudal block, Children, Dexmedetomidine, PaediatricPublication Thresholds for Spinal Anaesthesia-induced Hypotension During Caesarean Section(Kathmandu University, 2021) Gautam, B; Bhattarai, AABSTRACT Background Spinal anaesthesia is the current standard for caesarean section. Hypotension, a common complication, potentially results in adverse foetal and maternal outcomes. However, hypotension-defining criteria are varied. Objective To identify the blood pressure thresholds for spinal anaesthesia-induced hypotension during caesarean section. Method This is a retrospective cohort study of spinal anaesthesia-induced hypotension that occurred till baby-delivery during caesarean section. Reports on intraoperative hypotension, collected previously from January to December 2019, were reviewed to identify the hypotension-defining thresholds. The thresholds were categorized into systolic blood pressure (SBP) of 80, 90 or 100 mmHg, mean arterial pressure (MAP) of 60, 65 or 70 mmHg, combinations, and others. Parturient and anaesthesia characteristics, and associated hypotensive symptoms were also recorded for descriptive analysis. Result Spinal anaesthesia-induced hypotension was identified in 129 (11.5%) cases among 1116 caesarean sections. Altogether, 12 hypotension-defining thresholds were employed. Thresholds of SBP 90, MAP 60, and SBP 80 mmHg were used in 53 (41%), 28 (21.7%), and 21 (16.2%) cases respectively. Mean maternal age was 28 (±4.22) years and 87 (67.4%) cases underwent emergency surgery. Median sensory blockade level was T4. Nausea-vomiting, bradycardia, and tachycardia were associated during five (3.8%), six (4.6%), and 15 (11.6%) hypotensive incidents respectively. Two cases had unrecordable blood pressure but there was no maternal mortality. Conclusion Systolic blood pressure of 90 mmHg and mean arterial pressure of 60 mmHg included the most common thresholds for spinal anaesthesia-induced hypotension during caesarean section. Identifying the safe and clinically relevant hypotension-defining criteria needs further investigation. KEY WORDS Caesarean section, Criteria, Definition, Hypotension, Spinal anaesthesia, Threshold