Browsing by Author "Rai, S"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Publication Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy(Kathmandu University, 2008) Gautam, B; Shrestha, BR; Lama, P; Rai, SAbstract Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the ef cacies of Ondansetron-Dexamethasone combination with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under general anaesthesia. Materials and methods: Hundred and fty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective, randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were assessed at six, 12 and 24 hrs post operation. Complete response was de ned as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to rst analgesia demand, amount of Meperidine consumption, adverse event(s) and duration of hospital stay were recorded. Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Signi cantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the rst six hrs (P=0.023 versus O & 0.008 versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD (P=0.032). Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV after laparoscopic cholecystectomy. Dexamethasone alone is signi cantly less effective in preventing early vomiting compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as compared with combination therapy. Key words: Antiemetic prophylaxis; Dexamethasone; laparoscopic cholecystectomy; Ondansetron; postoperative nausea and vomiting (PONV)Publication Nutritional risk assessment in patient undergoing major gastrointestinal surgeries(Institute of Medicine, 2017) Paudel, P; Ghimire, S; Rai, S; Pradhan, GBN; Shrestha, S; Bhattachan, CLAbstract Introduction: Malnutrition is prevalent in surgical patients in the range of 20–50%, depending on the population studied and method employed to determine nutritional status. Malnutrition is associated with adverse clinical outcomes, slow healing, increase in infection and longer hospital stay. There are several methods to assess the nutritional status of surgical patients. However, none has been universally accepted and there is no consensus on the best system. The Nutritional Risk Screening score (NRS 2002) was developed based on the presupposition that the severity of malnutrition indicates increased nutritional requirements and need for nutritional support. It has received approval from the European Society for Parenteral and Enteral Nutrition for use in the hospital setting. It is easy to administer in daily clinical practice and offers satisfactory reliability and reproducibility. The aim of the present study was to identify nutritional risk in patients undergoing major gastrointestinal surgeries using NRS2002 and to determine possible associations with postoperative complications. Methods: This is a prospective study carried out in department of surgery, Nepal Medical College and Teaching Hospital from 1st August 2016 to 30th July 2017. All the major gastrointestinal surgeries performed during this period were included. The nutritional assessment was done by BMI, Serum protein /albumin and nutritional risk screening score (NRS 2002). Results: Sixty three patients who underwent major gastrointestinal surgery were included in this study. Sixty percent patients (n=38) were male, 68.8% had BMI within ideal range (18.5-25.9 kg/m2), 71.4% (n=45) patients underwent elective surgery and 68.2% (n=43) had malignancy. A total of 44.4% (n=28) of the patients were classified as being “at nutritional risk” and 47.6% (n=30) had postoperative complications. The mean NRS score was significantly higher among the patients who had complications compared to those who did not have complication (3.7± 1.2 vs 3± 1, p=0.016). Low serum albumin, BMI and absolute lymphocyte count correlated with presence of nutritional risk assessed by NRS 2002 and complications. Conclusions: NRS 2002 is simple and easy to apply in routine clinical practice for nutritional assessment. It correlates with postoperative complications. Serum albumin, BMI and absolute lymphocyte count are also simple tools for nutritional assessment of surgical patients and can be used in supplementation with NRS 2002 for better accuracy. Keywords: Albumin, Complications, Gastrointestinal surgery, Malnutrition, Nutritional risk screeningPublication Nutritional risk assessment in patient undergoing major gastrointestinal surgeries(Institute of Medicine, 2017) Paudel, P; Ghimire, S; Rai, S; Pradhan, GBN; Shrestha, S; Bhattachan, CLAbstract Introduction: Malnutrition is prevalent in surgical patients in the range of 20–50%, depending on the population studied and method employed to determine nutritional status. Malnutrition is associated with adverse clinical outcomes, slow healing, increase in infection and longer hospital stay. There are several methods to assess the nutritional status of surgical patients. However, none has been universally accepted and there is no consensus on the best system. The Nutritional Risk Screening score (NRS 2002) was developed based on the presupposition that the severity of malnutrition indicates increased nutritional requirements and need for nutritional support. It has received approval from the European Society for Parenteral and Enteral Nutrition for use in the hospital setting. It is easy to administer in daily clinical practice and offers satisfactory reliability and reproducibility. The aim of the present study was to identify nutritional risk in patients undergoing major gastrointestinal surgeries using NRS2002 and to determine possible associations with postoperative complications. Methods: This is a prospective study carried out in department of surgery, Nepal Medical College and Teaching Hospital from 1st August 2016 to 30th July 2017. All the major gastrointestinal surgeries performed during this period were included. The nutritional assessment was done by BMI, Serum protein /albumin and nutritional risk screening score (NRS 2002). Results: Sixty three patients who underwent major gastrointestinal surgery were included in this study. Sixty percent patients (n=38) were male, 68.8% had BMI within ideal range (18.5-25.9 kg/m2), 71.4% (n=45) patients underwent elective surgery and 68.2% (n=43) had malignancy. A total of 44.4% (n=28) of the patients were classified as being “at nutritional risk” and 47.6% (n=30) had postoperative complications. The mean NRS score was significantly higher among the patients who had complications compared to those who did not have complication (3.7± 1.2 vs 3± 1, p=0.016). Low serum albumin, BMI and absolute lymphocyte count correlated with presence of nutritional risk assessed by NRS 2002 and complications. Conclusions: NRS 2002 is simple and easy to apply in routine clinical practice for nutritional assessment. It correlates with postoperative complications. Serum albumin, BMI and absolute lymphocyte count are also simple tools for nutritional assessment of surgical patients and can be used in supplementation with NRS 2002 for better accuracy. Keywords: albumin, complicationnns, Gastrointesstinal surgery, malnutrition, nutritional risk screening