Browsing by Author "Marhatta, MN"
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Publication Application of “the Sequential Organ Failure Assessment (SOFA) score” in predicting outcome in ICU patients with SIRS(Kathmandu University, 2007) Acharya, SP; Pradhan, B; Marhatta, MNAbst ract Background: Various scoring systems have been developed to prioritize patient admission and management in ICU. The objective of this prospective, observational cohort study was to evaluate application of one such system, the Sequential Organ Failure Assessment (SOFA) Score in predicting outcome in ICU patients with SIRS. Patients and Methods: Fifty patients admitted to a six bed multidisciplinary ICU with SIRS were consecutively enrolled in the study and SOFA scores were calculated at zero hour, after 48 hrs, and after 96 hrs and patients followed till discharge from hospital. Results: When compared to outcome, the non survivors had high initial, mean and highest SOFA scores as compared to survivors. (p value = 0.002, <0.001, <0.001 respectively). Delta SOFA was not significantly associated with outcome. (p value= 0.117). The initial SOFA score > 11 predicted a mortality of 90%. (OR 23.72, 95%CI2.68- 209.78, p=0.004). Similarly, mean SOFA score of > 7 predicted a mortality of 73.9% (OR 22.7, 95%CI 5.0 – 103.5, p<0.001) and high SOFA score > 11 predicted a mortality of 87.5% (OR 32.66, 95%CI 5.82-183.179, p< 0.001). Area under receiver operating characteristic (ROC) curve for mean SOFA was 0.825, for high SOFA was 0.817 and for initial SOFA was 0.708. Thus mean, high and initial SOFA scores were helpful in predicting between the survivors and the non survivors. Conclusion: The SOFA scoring system is useful in predicting outcomes in ICU and thus help in proper utilization of ICU resources. Key words: Sequential Organ Failure Assessment (SOFA) Score, Systemic Inflammatory Response Syndrome (SIRS), Intensive Care Unit (ICU).Publication Comparison of hemodynamics and LMA insertion conditions using combination of Ketamine-Propofol, Fentanyl-Propofol or Saline-Propofol(Institute of Medicine, 2017) Koirala, M; Acharya, SP; Pradhan, B; Marhatta, MN; Bhattarai, AS; Parajuli, BDAbstract Introduction: Laryngeal Mask Airway(LMA) insertion requires a certain depth of anaesthesia to blunt the airway reflexes. Propofol alone causes undesirable hemodynamics effects and suboptimal LMA insertion condition. So this study was designed to compare the hemodynamics and insertion conditions when Ketamine or Fentanyl was combined with Propofol for induction. Methods: In this study, sixty ASA PSI(American Society of Anesthesiologists Physical Status) patients undergoing various surgical procedures under LMA were assigned to three groups; Group K, Group F and Group S who received 0.5 mg/kg of Ketamine, 1 μg/kg Fentanyl and Normal saline respectively before receiving Propofol 2.5 mg/kg after which LMA insertion was done. Arterial blood pressure and heart rate were measured at various intervals. LMA insertion conditions were graded under different parameters to calculate LMA insertion summation score. Result: Significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MAP) was seen between Gr K and Gr S after successful LMA insertion and after 2 mins of insertion. Significant difference in SBP was seen in between Group K and Group F (p=0.01) after successful LMA insertion. The median summed score describing the LMA insertion condition was significantly better in Ketamine [7.0 (6.0-7.5)] and Fentanyl [7.0 (6.0-7.0)] in comparison to Saline [ 8.5 (8.0-11.0)] Conclusion: During LMA insertion, adding Ketamine to Propofol provides stable hemodynamics in comparison to using Propofol. Addition of either Ketamine or Fentanyl to Propofol provides equally good conditions during LMA insertion than using Propofol alone. Key words: Fentanyl, Ketamine, LMA, PropofolPublication Unexplained apnoea and loss of consciousness during sub arachnoid block for caesarean section(Kathmandu University, 2009) Acharya, SP; Marhatta, MN; Amatya, RAbstract Sub arachnoid block (SAB) is often perceived safe by many anesthesiologists and other faculties but is also not completely safe choice especially in pregnant females, as the incidence of complications and local anaesthetic agent toxicity is high in these groups of patients. Here we present four such cases out of the seventeen patients over a period of six months, who developed apnea and transient loss of consciousness after spinal anesthesia for lower segment caesarean section. Typically all these patients after spinal anesthesia developed difficulty in breathing, became apnoea and had loss of consciousness for about a minute or two. The apnea was relieved with bag and mask ventilation following which the patient regained consciousness and start breathing normally. The rest of the procedure was uneventful. We presented these cases with aim of sharing similar experiences, and to aware about the possibility of such events as these events do occur frequently but case reports and literatures are unavailable. Key words: Apnoea, loss of consciousness, lower segment caesarean section (LSCS), Sub arachnoid block (SAB).Publication Use of Gabapentin, Esmolol or Their Combination to Attenuate Haemodynamic Response to Laryngoscopy and Intubation(Kathmandu University, 2011) Shrestha, GS; Marhatta, MN; Amatya, RABSTRACT Background Laryngoscopy and intubation increases blood pressure and heart rate. Objective The study aims to investigate the effect and safety of gabapentin, esmolol or their combination on the haemodynamic response to laryngoscopy and intubation. Methods A total of 72 patients undergoing elective surgery were randomly allocated to one of the four groups. First study drug was administered orally as gabapentin 1200mg or placebo. Second study drug was administered intravenously as esmolol 1.5mg/ kg or normal saline. Heart rate, rate pressure product, systolic blood pressure and mean arterial pressure were recorded at baseline and at zero, one, three and five minutes after tracheal intubation. Results Baseline values were compared with the values at various time intervals within the same group. In group PE (placebo, esmolol), there was significant decrease in heart rate and rate pressure product at five minutes. In group GN (gabapentin, normal saline), there was significant decrease in systolic blood pressure and mean arterial pressure at five minutes. In group GE (gabapentin, esmolol), there was significant decrease in heart rate at zero, three and five minutes. Systolic blood pressure, mean arterial pressure and rate pressure product was significantly lower at three and five minutes. In group PN (placebo, normal saline), there was significant increase in heart rate at zero, one, three and five minutes; systolic blood pressure at zero and one minutes; mean arterial pressure at zero and one minutes & rate pressure product at zero, one and three minutes. In group GN (gabapentin, normal saline), there was significant increase in heart rate at zero, one and three minutes & rate pressure product at zero, one and three minutes. In group PE (placebo, esmolol), there was significant increase in systolic blood pressure at zero and one minutes & mean arterial pressure at zero and one minutes. However, in group GE (gabapentin, esmolol) none of the variables showed statistically significant increase at any time. Inter-group comparison was made for each time point. At zero minute, there was significant difference in heart rate between groups PN and GE, GN and PE & GN and GE Significant difference was also noted in rate pressure product between PN and GE at zero minute. At one minute there was difference in heart rate between PN and PE, PN and GE, GN and PE & between GN and GE. Significant difference was observed in rate pressure product between PN and PE & between PN and GE at one minute. No significant side effects of the study drugs were observed. Conclusions Combination of gabapentin and esmolol in this study design is safe and better attenuates both the pressor and tachycardic response to laryngoscopy and intubation, than either agent alone. KEYWORDS attenuation of haemodynamic response, Esmolol, Gabapentin, laryngoscopy and intubation