Browsing by Author "Malla, Sadikshya Shah"
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Publication Caudal Dexmedetomidine versus Fentanyl with Bupivacaine in Decreasing Post-Operative Pain in Pediatric Inguinoscrotal Surgery : A Comparative Study(Institute of Medicine, 2023) Gyawali, Nirman P; Shrestha, Reshma; Bhattarai, Krishna P; Malla, Sadikshya ShahABSTRACT Introduction: Despite various advancements in postoperative analgesia in children, about half of post-surgical children still experience pain. Opioids like fentanyl are used as an adjunct leading to a lower dose of caudal local anesthetics but have many side effects. Administration of caudal dexmedetomidine with local anesthetics was shown to prolong postoperative analgesia and sedation in children. This study was conducted to compare the effects of caudally administered fentanyl and dexmedetomidine in children undergoing inguinoscrotal surgery. Methods: This was a comparative clinical study in which 152 patients were included. Patients were divided into two groups to receive a caudal block, each having 76 cases. Group A and Group B received single-dose caudal analgesia using fentanyl (1mcg/kg) and dexmedetomidine (1mcg/kg) with 0.25% bupivacaine(0.75ml/kg), respectively. The analgesic effect of the caudal block was evaluated using the FLACC score and sedation using the RSS score. The statistical significance was evaluated using independent t test using confidence interval of 95% (p value<0.05). Results: The study showed no statistical significance in the demographic and operative variables between the two groups. The duration of analgesia (p value<0.001) and both the FLACC (p value=0.001) and RSS score (p value=0.004) only at 30 min postoperative values were statistically significant between the groups. The only side effect that showed statistical significance was vomiting (p value=0.03) seen in fentanyl group. Conclusion: Dexmedetomidine can thus be used safely in children along with bupivacaine in routine inguinoscrotal surgery with additional benefits of prolonged analgesia and decreased side effects. Keywords: Bupivacaine; fentanyl; dexmedetomidine; postoperative analgesiaPublication Clinical Profile, Immediate Outcome and Predictors of Poor Outcome of Children in Pediatric Intensive Care Unit with Sepsis(Institute of Medicine, Tribhuvan University, 2024) Poudel, Bulu Wagley; Shrestha, Pun Narayan; Shrestha, Sanjeet Kumar; Malla, Sadikshya Shah; Rayamajhi, AjitAbstract: Introduction Sepsis remains a major cause of death in children with death rate ranging from 5% in developed countries to 35% in developing countries. However, data on the predictive factors for poor outcome particularly in developing countries, remain limited. So this study aims to evaluate the clinical profile, immediate outcome and factors associated with poor outcome of the children with sepsis. Methods This retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at Kanti Children Hospital, Kathmandu. Medical records of patients aged 30 days to 14 years, diagnosed with sepsis based on clinical and laboratory parameters and admitted to the PICU between April 2024 to September 2024 were analyzed. The clinical features, outcome in the form of discharge or death during the hospital stay and factors effecting the poor outcome were tabulated and the data analysis was done by SPSS version 21. Results The total number of patient enrolled in the study were 53. The mean age of the patient was (3.49±0.183) yrs. Among them 31/53(58 %) were male and 22/53(42%) were female. Among them 42/53(79.25%) were Hindus 5/53(9.43%) were Muslims 4/53(7.54%) Buddhist and 2/53 (3.77%) Christian. The most common presenting symptom was fever observed in 50/53(94.4%) of cases. The mortality rate for sepsis was (14/53)26.41% which is statistically significant. Predictors of poor outcome included were the need for dialysis (p=0.016), the presence of Central Nervous System disease (p=0.001), the use of mechanical ventilation (p=0.00), the use of ionotropic support (p=0.010) and elevated D-dimer levels (p=0.036). Conclusion Fever was the most common symptom of sepsis with a mortality rate of 26.41%. Key predictors of poor outcome included the need of dialysis, presence of CNS disease, mechanical ventilation, the use of ionotropic support and elevated D-dimer level.