Browsing by Author "Maharjan, SK"
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Publication 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, BMObjective: 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.Publication A comparison of haemodynamic responses with pethidine vs. butorphanol in open cholecystectomy cases(Kathmandu University, 2004) Tabedar, S; Maharjan, SK; Shrestha, BR; Shrestha, SObjective: 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.Publication Anaesthesia for cleft lip surgery – a challenge in rural Nepal(Kathmandu University, 2004) Maharjan, SKCleft 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.Publication Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy(Kathmandu University, 2009) Maharjan, SK; Shrestha, SAbstract 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