Browsing by Author "Koirala, Megha"
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Publication Anaesthetic Management of Foreign Body Bronchus: Profile of Cases Appearing at Tribhuvan University Teaching Hospital: An Observational Study(Nepal Medical Association, 2025) Koirala, Megha; Parajuli, Bashu Dev; Joshi, Pankaj; Ghimire, Basanta; Bhattarai, Amit SharmaAbstract Introduction: Rigid bronchoscopy is the preferred method for extracting airway foreign bodies, as it allows grasping forceps to extract foreign bodies while maintaining ventilation through a side port. The main challenge to the Anesthesiologists is to maintain oxygenation and ventilation while sharing the common field with the surgeons. This study intends to evaluate our current practices, challenges, and intraoperative events to enhance patient safety during these procedures. Methods:This is a prospective observational study that included patients with suspected or confirmed bronchial foreign bodies who underwent rigid bronchoscopy from February 2023 to February 2025. Data were collected by the anesthesiologists using the structured proforma, covering the anesthetic technique, complications, and details of foreign bodies. SPSS version 22 was used for analysis. Results: A total of 41 rigid bronchoscopies were performed, including three repeat procedures. Intraoperative complications included desaturation in 29, vocal cord edema in 16, slipping of foreign body in 8, bradycardia and airway bleeding in 6 cases each. Postoperatively, 23 patients required mechanical ventilation, and one patient experienced cardiac arrest. During preoperative preparation, intravenous glycopyrrolate and steroids were used in 38 and 34 cases, respectively. For induction and maintenance, Intravenous anesthesia was the most common technique, with muscle relaxants used in 39 cases. Of the 41 bronchoscopies, 30 achieved successful foreign body removal, while five required thoracotomy referrals. Conclusions: Anesthetic management of rigid bronchoscopy requires careful planning, vigilant monitoring and collaboration. Deasturation is the most frequent complication during removal of a foreign body bronchus.Publication Comparison Between Hyperbaric Bupivacaine with and Without Fentanyl in Reducing Visceral Pain During Cesarean Delivery Under Spinal Anaesthesia(Nepal Health Research Council, 2025) Thapa, Rashmi; Paudyal, Pooja Pooja; Pradhan, Bishwas; Koirala, Megha; Parajuli, Bashu DevAbstract Background: Visceral pain occurred during cesarean delivery during spinal anesthesia can be decreased with a higher dose of bupivacaine. However, larger doses of bupivacaine increases the risk of high sensory block. We hypothesized that addition of fentanyl to bupivacaine intrathecally could intensifies the sensory block and improves the quality of intraoperative analgesia. The aim of this study is to compare incidence of visceral pain between hyperbaric bupivacaine with or without fentanyl during cesarean delivery under spinal anesthesia. Methods: In this prospective randomized controlled trial, 72 term parturient with ASA PS II undergoing cesarean delivery under spinal anesthesia were randomly distributed into two groups. Group B received 2.2ml (11mg) of 0.5% hyperbaric bupivacaine while Group BF received 2 ml (10mg) of 0.5% hyperbaric bupivacaine and 0.2ml (10µg) of fentanyl intrathecally. Incidence of intraoperative visceral pain, maternal hemodynamics, side effects and APGAR score were compared. Results: During exteriorization of uterus, 11% of parturient in Group BF and 44% parturient in Group B complained of intraoperative visceral pain with significant difference between two group (p=0.002). The intraoperative rescue analgesia was given in 22 % parturient in Group BF and 33% parturient in Group B (p= 0.29). Maternal vital parameters like blood pressure, heart rate, oxygen saturation and respiratory rate were comparable between two groups. APGAR score was similar in both groups. Conclusion: Addition of intrathecal fentanyl to hyperbaric bupivacaine was effective in reducing intraoperative visceral pain during cesarean delivery with stable maternal hemodynamics and without neonatal side effects. Keywords: Bupivacaine; cesarean delivery; fentanyl; spinal anesthesia; visceral painPublication Perception and Willingness Regarding Organ Transplantation/donation among Medical Students of Maharajgunj Medical Campus: A Cross-sectional Study(Nepal Health Research Council, 2024) Bhattarai, Amit Sharma; Adhikari, Bidur; Joshi, Deepak Raj; Yadav, Alisha; Joshi, Pankaj; Parajuli, Bashu Dev; Koirala, Megha; Karki, Kushal Jung; Subedi, Krishna Prasad; Shrestha, Gentle Sunder; Shrestha, Anil; Singh, ShreejanaBackground: Organ transplant is the procedure of replacing a failing or damaged organ with a functioning one. Positive attitude and awareness about donation are a must for donor organs to be available. This study explored the level of knowledge, perception and willingness regarding organ donation among medical students in Nepal. Methods: A descriptive cross-sectional study was conducted with 180 medical students using a self-administered questionnaire. Descriptive statistics were used, and Pearson correlation was applied to examine the relationship between knowledge and perception of organ transplantation. Independent samples t-test and ANOVA was used to compare scores among year of study and gender. Results: Results indicated that 86.1% of participants were aware of the need for organ donation, and 83.3% knew that both living and deceased individuals could be donors. While 93.9% believed in the need for effective laws, 72.8% perceived risks for donors. However, only 74.4% were willing to donate their organs, though 91.7% expressed willingness to promote organ donation among friends and family. Participants showed a positive perception towards organ donation. Conclusions: Despite a high level of awareness and knowledge regarding organ donation, participants exhibited a lower level of willingness to donate organs. Perceived risks for donors and a lack of robust laws and regulations presented significant barriers. Nevertheless, an inclination to promote organ donation was observed. This underlines the need for enhanced education and policy reform to increase organ donation rates. Keywords: Awareness; knowledge; organ donation; organ transplantation; perception.