Browsing by Author "Shrestha, Anil"
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Publication Awake Throughout Craniotomy: Initial Experience and the Anaesthetic Challenges(Institute of Medicine, 2019) Shakya, Bigen M; Acharya, Binita; Shrestha, Gentle S; Shrestha, Anil; Sedain, Gopal; Shrestha, NinadiniABSTRACT Awake throughout technique for craniotomy demands very careful titration of drugs for sedation. It does not utilize any airway devices. The success depends on experience of anesthesiologist, good team work and meticulous planning. This is the first case of awake throughout craniotomy in our institute. Keywords: Awake throughout, craniotomy, outcomePublication Clinical Characteristics and Hematologic Profile of Children Admitted to a Tertiary Hospital with Dengue Virus Infection: A Cross-sectional Study(Rapti Academy of Health Sciences (RAHS), 2025) Chand, Bharat; Thakuri, Pushpa Chand; Shrestha, Anil; Poudel, DrishtiAbstract: Introduction: Dengue is an arboviral disease spread by mosquitoes, predominantly affecting tropical and subtropical regions. In Nepal, dengue cases have highest burden in the Bagmati region, including Kathmandu. Clinically, dengue manifests with asymptomatic to severe infection characterized by systemic symptoms. This study aims to identify the clinical characteristics and hematologic profile of children admitted with dengue fever in a tertiary hospital in Kathmandu. Methods: A cross-sectional study was carried out at Nepal APF Hospital, a tertiary care facility in Kathmandu, Nepal. Enumerative sampling was used to gather secondary data of 49 children under the age of 18 who were hospitalized with positive dengue tests (NS1 antigen or IgM antibody positive) between September 2022 and November 2024. Dengue was categorized as per the 2009 WHO classification. Descriptive statistics and Kruskal-Wallis test was performed. Results: Majority of the patients (77.5%) had dengue without warning signs, 20.41% had warning signs and only 2.04% had severe dengue. All the patients had fever when they first arrived. Headache (57.1%), Arthralgia/Myalgia (53.1%), Nausea and Vomiting (24.5%) and Cough (22.4%), were common clinical characteristics. Abdominal pain (p-value <0.05) and epistaxis (p-value <0.05) was significantly associated with severity of dengue infection. There was a sharp rise in incidence of dengue cases in the month of September. Majority of children admitted had Leukopenia (69.4%) and thrombocytopenia (57.1%). 83.7% of children were Non-Structural protein 1 (NS1) positive and 32.7% were IgM positive whereas none were IgG positive. Conclusion: Fever is the most common sign of a dengue infection. Leucopenia and thrombocytopenia are the most prevalent test findings. Children are especially susceptible to dengue during the monsoon season. It is critical to be aware of these clinical and laboratory markers to diagnose and manage denguePublication 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 intubationPublication Drug Induced Sleep Endoscopy for Obstructive Sleep Apnea Syndrome: An Initial Experience in a Tertiary Level Centre(Institute of Medicine, 2019) Parajuli, Bashu D; Mandal, Lokendra; Koirala, Megha; Bhattarai, Amit S; Neupane, Yogesh; Shrestha, AnilABSTRACT Drug induced sleep endoscopy (DISE) is a technique of performing endoscopy of the upper airway after inducing sleep by the use of anaesthetic agents in patients suffering from obstructive sleep apnea syndrome (OSAS). The main purpose of DISE is to detect the obstruction or collapse at one or more location in the upper airway, both for the successful diagnosis and management of OSAS. Here we discuss a case of OSAS who underwent DISE under novel anaesthetic agents midazolam and dexmedetomidine. Keywords: Dexmedetomidine, drug induced sleep endoscopy, obstructive sleep apnea syndrome, propofolPublication Interrater Variability among Anaesthesiologists Using American Society of Anesthesiologists Physical Status Classification System(Nepal Health Research Council, 2023) Bhattarai, Amit Sharma; Bista, Navindra Raj; Basnet, Madindra Bahadur; Joshi, Deepak Raj; Shrestha, AnilAbstract Background: The American Society of Anaesthesiologists Physical Status classification is deployed by the anaesthesiologists worldwide to classify operative surgical patients. Many studies have found moderate degree of interrater variability among anaesthesiologists. The general objective of the study was to find out interrater variability among Nepalese anesthesiologists using this classification system in Nepal. The specific objectives of the study were to find out the correctness of assignment and inter-rater variability among anaesthesiologists based on their experience. Methods: Ten clinical cases were distributed among 130 registered anaesthesiologist practitioners of Nepal after validation with the experts. Respondents were asked to assign each of ten cases to a specific physical status class. Anaesthesiologists were classified to two classes based on clinical experience as having more or less than five years of experience. Results: We found substantial agreement among < 5 year’s (0.66) and > 5 year’s experience group (0.753) and among all raters (0.736). The mean score of the group with less than 5 years of experience was more. There was no significant difference between the mean score (p = 0.595). Overall mean score for the both groups was 5.66 with SD 1.66. There was no significant difference between the groups. Conclusions: The study shows that there is very less variation among registered practising anaesthesiologists of Nepal using American Society of Anesthesiologists Physical Status classification system. Keywords: ASA-PS; interrater; variability.Publication Knowledge and Attitude about Labor Epidural Analgesia among Pregnant Women Attending Antenatal Clinic(Nepal Health Research Council, 2023) Parajuli, Bashu Dev; Koirala, Megha; Joshi, Pankaj; Katuwal, Neeta; Shrestha, Amit; Singh, Shreejana; Rawal, Suniti; Shrestha, AnilAbstract Background: Labour pain is one of the most painful experiences that a woman faces in her lifetime. There are various options for labour pain management. Epidural analgesia is the gold standard method for pain management during labour. In developing and under-developed countries there are many challenges to provide this service, a very important one being knowledge about epidural analgesia among the parturients and the physicians. Methods: A prospective cross-sectional study was carried out among 384 pregnant women attending Antenatal clinic of a tertiary level teaching hospital using pretested structured questionnaire prepared by a team of anaesthesiologists and obstetricians. Non-probability purposive sampling technique was used. The data was analysed by using SPSS version 20.0. Descriptive and inferential statistical methods were used for analysis. Results: Of the 384 pregnant women, only 29.4% had knowledge about some form of labour analgesia techniques and only 16% of the participants were aware of labour epidural analgesia. Also, only 6.2% were aware that epidural service is available at our hospital. Regarding acceptance, only 42.4% were willing to use epidural analgesia in their present pregnancy. Conclusions: The present study findings revealed that a significant number of participants had very limited knowledge about labour epidural analgesia and were also unaware of the availability of the service in our hospital. Educational programs need to be provided to all the pregnant women for enhancement of knowledge and awareness about epidural labour analgesia to increase its acceptability among them. Keywords: Acceptance; awareness; knowledge; labour analgesia.Publication Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal(Nepal Paediatric Society (JNPS), 2021) Basnet, Sangita; Shrestha, Dhruba; Amatya, Puja; Sharma, Arun; Bajracharya, Binod Lal; Shrestha, Anil; Shrestha, Sudeep; Rajchal, Pramila; Kafle, Raju; Shrestha, Devendra; Puri, Sangeeta; Bhatta, Anwesh; Pathak, Om Krishna; Shrestha, ShrijanaAbstract: Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal. Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources. Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources. Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.Publication Nutritional Status of Children Under Five Years in a Tertiary Care Center: A Cross-Sectional Study(Nepal APF Hospital, 2025) Chand, Bharat; Poudel, Drishti; Shrestha, Anil; Thakuri, Pushpa Chand; Thapa, Madhu; Shahi, AnitaAbstract: Introduction: Malnutrition remains a leading cause of under-five mortality globally and in Nepal, with significant rates of stunting, wasting, and underweight. Despite national progress, child nutrition challenges persist, especially among vulnerable groups in hospital settings. This study assesses the nutritional status of under-five children attending a tertiary care center in Nepal. Methods: This descriptive cross-sectional study was conducted among 260 under-five children attending the Pediatric Department of Nepal APF Hospital, Kathmandu, from February to June 2025 after ethical approval. Data were collected through face-to-face interviews with caregivers and anthropometric measurements. Nutritional status was assessed using WHO standards. Descriptive statistics, chi-square test, and logistic regression were used for analysis. Results: Among 260 children under five years, the overall prevalence of malnutrition was 30%, including 10% stunted, 11.2% wasted, and 15.4% underweight. Malnutrition was significantly associated with the child’s age (p < 0.001), with children below 24 months more likely to be malnourished. Father's education level also showed a significant association (p = 0.005), where lower paternal education correlated with higher malnutrition rates. No significant associations were observed with maternal, environmental, or child-rearing characteristics. Conclusion: The present study found a notable burden of malnutrition among under-five children visiting a tertiary care center in Kathmandu with younger age and father’s education significantly associated with malnutrition. Targeted early-life nutritional interventions and improved parental education can help to improve the nutritional status of under five children.Publication Perception and Willingness Regarding Organ Transplantation/donation among Medical Students of Maharajgunj Medical Campus: A Cross-sectional Study(Nepal Health Research Council, 2024) Bhattarai, Amit Sharma; Adhikari, Bidur; Joshi, Deepak Raj; Yadav, Alisha; Joshi, Pankaj; Parajuli, Bashu Dev; Koirala, Megha; Karki, Kushal Jung; Subedi, Krishna Prasad; Shrestha, Gentle Sunder; Shrestha, Anil; Singh, ShreejanaBackground: Organ transplant is the procedure of replacing a failing or damaged organ with a functioning one. Positive attitude and awareness about donation are a must for donor organs to be available. This study explored the level of knowledge, perception and willingness regarding organ donation among medical students in Nepal. Methods: A descriptive cross-sectional study was conducted with 180 medical students using a self-administered questionnaire. Descriptive statistics were used, and Pearson correlation was applied to examine the relationship between knowledge and perception of organ transplantation. Independent samples t-test and ANOVA was used to compare scores among year of study and gender. Results: Results indicated that 86.1% of participants were aware of the need for organ donation, and 83.3% knew that both living and deceased individuals could be donors. While 93.9% believed in the need for effective laws, 72.8% perceived risks for donors. However, only 74.4% were willing to donate their organs, though 91.7% expressed willingness to promote organ donation among friends and family. Participants showed a positive perception towards organ donation. Conclusions: Despite a high level of awareness and knowledge regarding organ donation, participants exhibited a lower level of willingness to donate organs. Perceived risks for donors and a lack of robust laws and regulations presented significant barriers. Nevertheless, an inclination to promote organ donation was observed. This underlines the need for enhanced education and policy reform to increase organ donation rates. Keywords: Awareness; knowledge; organ donation; organ transplantation; perception.Publication Separate Consent for Anesthetic Practice: Need of the Moment(Institute of Medicine, 2020) Shrestha, Anil; Shrestha, Gentle S; Pradhan, Saurabh; Joshi, PankajABSTRACT Decades of refinement and modifications have led the modern anaesthetic practice to be conducted so smoothly and safely, that sometimes we take for granted the enormous amount of risks involved with it. Furthermore, with the evolution of monitoring techniques, and discovery of safer drugs, anesthesia has facilitated the conduction of complex surgeries on sicker patients, and older patients. The expansion to critical care and pain management services has added another dimension to this field, with anesthesiologists not just working as facilitators for another procedure, but acting as primary physicians. Anesthesiologists are among the few clinicians, who are involved in patient morbidity and mortality in their daily routine. With the ever-changing ethical and legal background, the significance of obtaining a separate consent for anesthesia needs to be timely evaluated. In this review, we have discussed the significance of a separate consent for anesthesia and highlight its various aspects. Keywords: Anesthetic practice, separate consentPublication Ultrasound versus Chest X-ray for Confirmation of Central Venous Catheter Tip Position: A comparative study(Institute of Medicine, Tribhuvan University, 2025) Mandal, Lokendra Narayan; Bhattarai, Amit Sharma; Parajuli, Bashu Dev; Acharya, Subhash Prasad; Shrestha, AnilAbstract: Introduction Malposition of central venous catheter (CVC) tip is common after central vein cannulation. Chest radiography is the standard method for confirmation, but ultrasound is gaining popularity for bedside localization, placement confirmation, and complication detection. CVC insertion is frequently performed for various medical purposes. While both chest radiography and ultrasound are used to confirm tip position, ultrasound is radiation-free and faster. Real-time ultrasound during insertion reduces attemptsto catheterisation and complications like pneumothorax. However, radiographic confirmation remains the gold standard. This study aimed to evaluate the accuracy and speed of ultrasound compared to chest X-ray for confirming CVC tip position. Methods A total of 109 patients (aged 15–65 years) who underwent CVC insertion via the right internal jugular vein were enrolled. Written informed consent was obtained from patients or family members. Sonographic confirmation was done using a bubble study, while chest X-ray was used for radiographic confirmation. Sensitivity, specificity, predictive values, interrater reliability, and percent agreement between the two methods were assessed. The mean confirmation times were also compared. Results Ultrasound showed 91.6% sensitivity, 96.91% specificity, 78.57% positive predictive value, and 98.95% negative predictive value. Interrater reliability (k = 0.82) and percent agreement (96.3%) were high. Ultrasound confirmed placement 88.29 minutes earlier than chest X-ray. Conclusion Ultrasound confirmation using a saline flush method is accurate and significantly faster than chest radiography for CVC tip verification.