Browsing by Author "Koirala, M"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Publication Effect of Dexmedetomidine with Ropivacaine in Supraclavicular Brachial Plexus Block(Kathmandu University, 2019) Sharma, S; Shrestha, A; Koirala, MABSTRACT Background Brachial plexus block is popular choice for upper limb surgeries and offers good and relatively safe anesthesia. Among various approaches supraclavicular approach is the most consistent method for anaesthesia and postoperative pain management in surgery below the elbow joint. Many drugs are used as adjuvants in brachial plexus block for faster onset, denser block and for prolongation of postoperative analgesia. Dexmedetomidine also has been shown to prolong the sensory and motor duration when added as an adjuvant to local anaesthetic in nerve blocks. Objective To assess the effect of adding dexmedetomidine to ropivacaine in brachial block. Method Sixty patients, planned for upper limb surgeries under ultrasound guided brachial block were randomly allocated into two groups. Group RS (n=30) received 30 ml of 0.5% Ropivacaine + 1 ml Normal Saline and Group RD (n=30) received 30 ml of 0.5% Ropivacaine + 0.75 mcg/kg Dexmedetomidine diluted to 1 ml solution. The onset time to sensory and motor blockade were recorded. The duration of sensory and motor block and duration of analgesia were recorded. Result The mean time to onset of sensory block (12.60±2.67 min Vs 22.17±2.81 min) and motor block (14.20±3.22 min Vs 22.53±3.97) in Group RD was significantly faster in Group RD than Group RS. The mean duration of sensory block (838.70±164.11 min Vs 670.20±145.16 min), motor block (804.16±148.71 min Vs 594.93±53.89 min) and duration of analgesia (1193.80±223.11 min Vs 828.23±136.30 min) were significantly longer in Group RD compared to Group RS. The incidence of side effects in both groups were comparable. Conclusion From this study, it can be concluded that addition of Dexmedetomidine 0.75 mcg/ kg to 0.5% Ropivacaine results in early onset of sensory and motor blockade, prolongation of duration of sensory and motor blockade and duration of analgesia postoperatively without any significant side effects. KEY WORDS Analgesia, Brachial plexus block, Dexmedetomidine, Motor block, Ropivacaine, Sensory blockPublication Functional Status of Senior Citizens of a Metropolitan City in Morang(Kathmandu University, 2022) Koirala, P; Shrestha, S; Koirala, MABSTRACT Background Functional abilities start to decelerate after the age of 70 and causes need for assistance to do their basic activities of daily living (BADL) as well as instrumental activities of daily living (IADL). Objective To find out the functional status of senior citizens of a Metropolitan city in Morang. Method A descriptive cross-sectional study was carried out at Biratnagar Metropolitan City among 254 senior citizens receiving old age allowance using cluster sampling technique. Data were collected through face to face interview and measuring height and weight by researcher herself for the period of four weeks. Basic activities of daily living and instrumental activities of daily living were assessed using Katz Index of Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living tool with some modifications. Chi square test was used to assess the association between variables. Result About 48.4% and 90.6% of senior citizens had dependency in Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living respectively. The most common dependency for Basic Activities of Daily Living and Instrumental Activities of Daily Living was control of urination and defecation (31.9%) and using telephones (75.2%) respectively. Basic activities of daily living was significantly associated with age (p=0.0017), sex (p=0.013), literacy status (p=0.001), years of smoking (p=0.0029), social participation (0.0029) and history of fall within 1 year (p=0.038). Likewise Instrumental Activities of Daily Living was significantly associated with age (p=0.03), sex (p=0.035), literacy status (p=0.002), exercise (p=0.033) and social participation (p= 0.001). Conclusion It is concluded that about half of the senior citizens are dependent in Basic Activities of Daily Living and almost all of them are dependent in Instrumental Activities of Daily Living. So senior citizen clubs/ groups are suggested to be strengthened which may be effective in promoting independence, extending an active and healthy ageing. KEY WORDS Basic activities of daily living , Functional status, Instrumental activities of daily living, Senior citizensPublication Ischemic Stroke as a Manifestation of Cholesterol Embolization Syndrome Following Percutaneous Coronary Intervention(Kathmandu University, 2021) Ghimire, B; Khanal, K; Bajracharya, A; Koirala, MABSTRACT Cholesterol embolization syndrome (CES) is one of the major, yet under- diagnosed cause of morbidity and mortality following invasive coronary interventions. The major risk factors are elderly, male, atherosclerotic disease, anticoagulation and femoral access route. This multisystem disease affects skin, kidney, brain, eye and gastrointestinal tract. Only few cases of cholesterol embolization syndrome manifesting as an ischemic stroke are reported. We present a case of an elderly man, admitted to our ICU after percutaneous coronary intervention (PCI) who developed neurological deficits along with skin changes and renal failure. cholesterol embolization syndrome was suspected based upon the presence of cardiovascular risk factors, invasive cardiovascular intervention and clinical signs. The diagnosis of ischemic stroke made through plain MRI brain, revealed multiple areas of lacunar infarcts. He was treated with intermittent hemodialysis, statins and anti-platelet agents. On follow up, skin lesions and renal functions were improved; but slurring of speech and paresis persisted. KEY WORDS Cholesterol embolization syndrome, Ischemic stroke, Percutaneous coronary interventionPublication Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible?(Kathmandu University, 2022) Koirala, M; Shakya, BM; Parajuli, B; Ghimire, BABSTRACT Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation used during intraoperative period have been postulated to cause temporary spasm of the coronary vessels leading to decrease supply to the myocardium and precipitating myocardial infraction in non-obstructive coronary arteries (MINOCA). As an anaesthesiologists, we should be aware that even a dose as small as 25 mcg epinephrine infiltrated along with local anaesthetic in the subcutaneous plane may be responsible for coronary vessel spasm and thus myocardial infraction in non- obstructive coronary arteries. We report a case of 45 years old female with papillary carcinoma of thyroid who developed features of non-ST elevation myocardial infarction 5 minutes after the subcutaneous infiltration of 5 ml of 2% Xylocaine with 1:200000 Epinephrine. Patient was managed for acute Myocardial Infarction. Coronary angiogram done the next day revealed normal coronary arteries, hence the diagnosis Myocardial infraction in non-obstructive coronary arteries was made. KEY WORDS Acute myocardial infraction, Epinephrine, Local anaesthetics