NepMed Repository :: Browsing by Author "Maharjan, SK"

Browsing by Author "Maharjan, SK"

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A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: Insertion characteristics and complications
(Kathmandu University, 2003) Tabedar, S; Maharjan, SK; Shrestha, BR; Shrestha, BM
Objective: The study was designed to compare the insertion characteristics and incidence of PDPH between 25 gauge Quincke needle and 26 gauge Eldor needle for spinal anaesthesia in elective c/s. Method: 60 pregnant women (aged 19-35yrs and weighing 58 –67kg) undergoing elective caesarean section were randomized into group A (Quincke spinal needle group) or group B (Eldor spinal needle group). Spinal anaesthesia was performed with 2.9 ml 0.5% heavy bupivacaine using 25 gauge Quincke spinal needle in group A and 26 Gauge Eldor spinal needle in group B. Onset, time of first identification of backflow of CSF, number of attempts, level of sensory and motor blockade, failure of anaesthesia, inadequate anaesthesia and incidence of PDPH were recorded. Result: Quincke spinal needle was found easy at insertion, first attempt was successful in 90% of cases, whereas Eldor spinal needle was successful at first attempt in only 60% of cases. Early identification of CSF was seen in Eldor spinal needle group in 3.5 seconds vs. 5.2 seconds in Quincke spinal needle group. Blood mixed CSF was seen in 8 Quincke spinal needle group vs. none in Eldor spinal needle group. Onset was similar between both groups i.e. in 6 minutes. Failure of anaesthesia was none in Eldor spinal needle group vs. 2 in quincke spinal needle group. Height of sensory block achieved was T4 level in 26 parturients,T6 in 1 ,T8 in 1 and no anaesthesia at all in another 2 parturient as compared to T4 level in 29 and T3 in 1 parturient in Eldor spinal needle group. The degree of motor block with the use of Bromage criteria showed a motor score of 1or 2 in 26 parturients in Quincke spinal needle group vs. same in all cases in Eldor spinal needle group. The total incidence of PDPH was 8.3 %( 5 out of 60 parturient) which occurred all in Quincke spinal needle group. 2 parturient who developed severe PDPH required epidural blood patch. Conclusion: 26 gauge Eldor spinal needle was found to be better than 25 gauge Quincke spinal needle for caesarian sections to decrease the incidence of PDPH, though not all insertion characteristics were in favour of the Eldor needle. Key Words: Anaesthetic technique, spinal; equipment, spinal needles; complications, headache.
A comparison of haemodynamic responses with pethidine vs. butorphanol in open cholecystectomy cases
(Kathmandu University, 2004) Tabedar, S; Maharjan, SK; Shrestha, BR; Shrestha, S
Objective: The present study was undertaken to compare the haemodynamic responses with pethidine vs. Butorphanol intraoperatively in open cholecystectomy cases in KMCTH. Method: In this randomized study, all together 40 patients undergoing routine cholecystectomy surgery were included. Group A received Pethidine 1mg/kg and Group B received Butorphanol 0.04mg/kg intraoperatively. Heart rate and blood pressure were recorded before injection of the drug, after injection, before intubation, after intubation, before skin incision, after incision, before extubation and after extubation Data analysis was done using independent sample “t” test. Result: Our study showed no statistical significance in haemodynamic responses with either pethidine or Butorphanol in open cholecystectomy cases. Conclusion: Both drugs appear equally good analgesics in our study. Key words: analgesics, pethidine, Butorphanol, haemodynamic responses, surgery, cholecystectomy.
Anaesthesia for cleft lip surgery – a challenge in rural Nepal
(Kathmandu University, 2004) Maharjan, SK
Cleft lip and palate is quite common in Nepalese population residing in hilly areas and interior of the country. Nepalese doctors with limited resources and fund and International aided team of fully equipped doctors from developed world conduct operative procedures in the centre or district hospital setup quite frequently. But very few patients will come to the hospital for treatment as it is not an emergency for them. Anaesthesia for cleft lip and palate surgery carries a high risk and difficulty in airway management. Associated congenital anomalies further complicate the management. Still a team of Nepalese physicians are providing this service in a field. How to provide safe anaesthesia was a main concern for an anaesthesiologist with a limited supply. During the last three years we have anaesthetized safely four hundred children aged between 2 months to 14 years. The team worked at an altitude ranging from 100 feet to 10,000 feet of Nepal in a temporary erected operation room of the village. Most of the operations were conducted under total Ketamine anaesthesia and general anaesthesia with halothane. In our context we found Ketamine anaesthesia was safe and effective anaesthetic technique in simple clefts in children more than 2 years. This technique reduces the cost by minimizing the supply to be carried in the field. Key words: cleft lip, cleft palate, ketamine, rural area, difficult intubation.
Comparative study between bupivacaine heavy vs pethidine intrathecally to study early haemodynamic changes and postoperative analgesia in patients undergoing caesarean section
(Kathmandu University, 2007) Shrestha, BR; Maharjan, SK; Thapa, C
Objective: To study early hemodynamic changes and duration of postoperative analgesia between two study groups of intrathecal pethidine and bupivacaine heavy in patients undergoing caesarean section. Methodology: Total number of 60 patients of ASA I and II, undergoing caesarean section were enrolled in the study. All the patients were divided into two groups: Pethidine and Bupivacaine heavy. The dose of pethidine for subarachnoid block was 1mg/kg and in Bupivacaine group 2.2ml of 0.5% bupivacaine heavy was given intrathecally. Heart rate and blood pressure of all the patients were recorded before subarachnoid block. After giving spinal anesthesia, the heart rate and blood pressure were monitored and recorded in different time intervals. The duration of postoperative analgesia in all patients was recorded in postoperative ward. The APGAR Scores of the babies were recorded in 1and 5 minutes after delivery. The data were statistically compared using independent sample t-test. Conclusion: The hemodynamic parameters (HR & BP) were compared in different time intervals. The difference in heart rate and blood pressure at different time intervals in the two study groups were statistically insignificant as (p > 0.05). The total duration of postoperative analgesia in patients receiving sole intrathecal pethidine was 8 hours and 30 minutes. Where as, in Bupivacaine group the duration was 2 hrs and 36 minutes. This has been found statistically significant (p<0.05).
Do we have to hyperventilate during laparoscopic surgery?
(Kathmandu University, 2007) Maharjan, SK; Shrestha, BR
Maharjan SK1, Shrestha BR 2 1&2 Department of Anaesthesiology and Intensive care, Kathmandu medical college Teaching Hospital, Sinamangal, Kathmandu
Epidural anaesthesia and analgesia
(Kathmandu University, 2004) Maharjan, SK; Shrestha, BM
Objective Among various methods of providing analgesia during surgery for e.g., parenteral opiates and NSAIDS, epidural anaesthesia and analgesia seem to have beneficial efficacy and less side effect profiles. Methods This study was conducted in 153 patients coming for operation at KMCTH between August 2003 to August 2004. Patients were divided in two groups, one group were operated under sole epidural anaesthesia and the other group received a combination of either general anaesthesia or spinal anaesthesia. Results 39 (25.5%) patients underwent sole lumbar epidurals, 36 (23.5%) patients received a combination with spinal (CSE) and 78 (51.0%) were under Combination with general anaesthesia. The patients were interviewed among whom it was found that satisfactory analgesia was reported by 75 cases and 73 cases reported excellent analgesia. Patchy anaesthesia observed in 5 cases who underwent sole epidural anaesthesia. Discussion & Conclusion Patients undergoing major surgery with epidural anaesthesia and analgesia had stable cardiovascular parameters, minimal neuroendocrine response, less respiratory complications including SIRS and sepsis, lower incidence of thromboembolic events, less blood loss, reduced hospital stay and better pain control.
Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy
(Kathmandu University, 2009) Maharjan, SK; Shrestha, S
Abstract Purpose: to study the analgesic efficacy of intraperitoneal and periportal injection of bupivacaine following laparoscopic cholecystectomy. Materials and methods: 40 patients undergoing laparoscopic cholecystectomy were randomized into two groups of 20 each. Group A (study group) received 40 ml of intraperitoneal injection of 0.25% bupivacaine and 20 ml of same concentration in 4 ports, 5 ml each at the end of surgery. Group B (control) received no treatment. Post operative patient monitoring and pain assessment was done by another doctor blinded to the procedure using VAS score at 1,2,3,6,9 and 24 hours after surgery. Pethidine 50 mg intramuscular was given as rescue analgesic when demanded by patient within first 24 hours. Results: when VAS score was analyzed in the two groups, the study group had less scores compared to control group though it was statistically not significant (p>0.05). The rescue analgesic requirement was significantly less in study group (p<0.00). Conclusion: Intraperitoneal and periportal injection of bupivacaine is effective in decreasing pain after laparoscopic cholecystectomy. Key words: Laparoscopic surgery, intraperitoneal bupivacaine, analgesia, VAS score
Painless delivery – a short experience
(Kathmandu University, 2003) Maharjan, SK; Karki, CB
Purpose: To determine efficacy and safety a randomized comparison of continuous infusion versus intermittent injection of epidural bupivacaine for labor analgesia was performed in the Maternity Hospital, Thapathali Kathmandu. Methods : Twenty healthy parturient received a loading dose of 10 ml of epidural 0.1% bupivacaine with 25 mg of pethidine. They were then randomized to receive continuous infusion of 0.1% bupivacaine 10 ml/hour with the help of infusion pump or intermittent injection of 0.1% bupivacaine 10 ml hourly. For breakthrough pain 10 ml of 0.1% bupivacaine top ups given in both groups. The two groups were compared for analgesic efficacy, mode of delivery, patient assessment of analgesia, motor block and other complications. Data analyzed in Pentium III version with SPSS and statistical significance test is done with independent samples t-test. Results: The 10 patients in each group were comparable in age but not in parity. Analgesic efficacy was excellent in 10 cases and comfortable in another 10 cases [excellent / comfortable 6:4 with infusion and 4:6 with intermittent injection]. There were no statistically significant differences between groups in pain scores or duration of active first or second stage of labor. Fifteen women had spontaneous vaginal deliveries, one caesarian section (infusion group) and four instrumental deliveries (intermittent injection group). Four women in the infusion group had hypotension and motor block, but none in the intermittent injection group. APGAR scores in both groups were 7-8/10 at 1 minute and 9- 10/10 at 5 minutes. Conclusion: Both continuous infusion and intermittent injection of low dose bupivacaine are very good methods of relieving labor pain in our context. Analgesic efficacy was similar in both groups and there was no prolongation of second stage of labor. Key words : painless delivery, parturient, bupivacaine, epidural analgesia.
Propranolol is effective in decreasing stress response due to airway manipulation and CO2 pneumoperitoneum in patients undergoing laparoscopic cholecystectomy
(Kathmandu University, 2005) Maharjan, SK
Purpose: to study the effect of Propranolol on hemodynamic response due to airway manipulation and carbon dioxide pneumoperitoneum on laparoscopic cholecystectomy cases. Methods: 63 patients undergoing laparoscopic cholecystectomy under general anaesthesia were randomly divided into 3 groups; group 1 received 1.0 mg of Propranolol, group 2 received 0.5 mg of Propranolol and group 3 received 1 ml saline 5 minutes before induction of anaesthesia. Haemodynamic parameters were recorded for every 5 minutes from basal to 5 minutes after extubation and analyzed. Results: Balanced anaesthesia used in our set up is effective in decreasing stress response due to airway manipulation (laryngoscopy and endotracheal intubation) but not effective in that due to CO2 pneumoperitoneum. Propranolol 1 mg 5 minutes before anaesthesia is effective in decreasing stress response due to airway manipulation and CO2 pneumoperitoneum in these groups of patients. Conclusion: Propranolol effectively blunts the stress response due to CO2 pneumoperitoneum during laparoscopic cholecystectomy. Key words: Propranolol, laparoscopy, stress response, CO2 pneumoperitoneum
Supraclavicular brachial plexus block with and without dexamethasone - A comparative study
(Kathmandu University, 2003) Shrestha, BR; Maharjan, SK; Tabedar, S
To compare the analgesic efficacy of local aesthetic with and without dexamethasone in supraclavicular brachial plexus block. Methods: Forty patients undergoing arm, forearm and hand surgeries were randomly selected. The forty patients were divided in two groups of 20 each. In-group one, a brachial plexus block was done with 40-50 ml of local anaesthetic with 1:200,000 adrenaline and in the other group the block was performed with the same amount of local anaesthetics with dexamethasone. The onset of action and duration of analgesia in the two groups were compared and any complications of the procedure were noted. Statistical analysis was done using the independent sample t-test. Results: The two groups were comparable in respect to age, sex, and weight. There was significant faster onset of action and prolonged duration of analgesia in the dexamethasone group than in the other group. There were no complications. Conclusion: Addition of dexamethasone for brachial plexus block significantly prolongs the duration of analgesia without any unwanted effects.
Three in one block for unilateral knee arthrotomy in an old lady
(Kathmandu University, 2003) Tabadar, S; Shrestha, BR; Maharjan, SK
An old lady having septic arthritis of right knee joint underwent arthrotomy under three in one block for femoral, obturator and lateral cutaneous nerve of thigh in inguinal region, with catheter in situ. She was a case of chronic obstructive airway disease with ischaemic heart disease, so operation and postoperative pain management was planned under regional block. Anaesthesia was started by giving regional block with 0.25% bupivacaine at first and maintained with intermittent injection of 0.125% bupivacaine. The patient was pain free and comfortable though out the perioperative period Key words: Aesthesia, Regional Anaesthesia technique – 3 in 1 block, Surgery- U/L knee Arthrotomy

Browsing by Author "Maharjan, SK"

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