Browsing by Author "Pradhan, Bishwas"
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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 Comparison of Ultrasonography with Cole’s Formula to Determine Appropriate Endotracheal Tube Size in Pediatric Population(Institute of Medicine, 2022) Shaheed, Asadh M; Shrestha, Bibhush; Pradhan, Bishwas; Shrestha, Anil; Parajuli, Bashu DABSTRACT Introduction: Recently, ultrasonography (USG) has gained popularity in perioperative airway management . One of the commonest method to select endotracheal tube in pediatric patients is Cole’s formula. Our study was conducted to assess if there was a measurable difference in the appropriateness of the endotracheal tubes as selected by the two methods. Methods: The study group included 68 children scheduled for elective surgeries under general anesthesia with endotracheal intubation in an randomized prospective manner. The size of endotracheal tube was calculated using Cole’s formula in group A. In group B, ultrasound was done to measure the subglottic transverse diameter at the level of cricoid to find the largest outer diameter of tube . Results: Ultrasonography group measuring the subglottic diameter was found to have more appropriately sized tubes than age-based Cole's formula (76.5% Vs 58.8% p=0.007). The pressure equilibrated measured (13.2 ± 5.2 cm of H2O in age based group and 17 ± 4.5 cm of H2O in ultrasonography group) was statistically significant (p= 0.002). Also the incidence of selecting an inappropriately small sized ET tube was lower in the ultrasound group (5.9% Vs 35.3%).There were no significant differences in the number of intubation attempts and mean time required for intubation between the two groups. Conclusion: Ultrasonographic method is a suitable alternative tool in predicting the size of uncuffed endotracheal tube in pediatric population than age-based Cole’s formula. Keywords: Age-based formula, cricoid ring, pediatric, subglottic diameter, tracheal intubation