NepMed Repository :: Browsing by Author "Shrestha, Bibhush"

Browsing by Author "Shrestha, Bibhush"

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Comparison of EuroSCORE II with EuroSCORE in Cardiac Surgical Patients in a Tertiary Level Teaching Hospital in Nepal
(Institute of Medicine, 2020) Pradhan, Bishwas; Bastola, Priska; Basnet, Madindra B; Shrestha, Bibhush; Sigdel, Shailendra; Gurung, Arjun
ABSTRACT Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Its relevance has been validated in European, Asian countries and also in Nepal. Its limitations led to development of EuroSCORE II. This study was carried out to compare EuroSCORE II with EuroSCORE in Nepalese cardiac surgical patients. Methods: A retrospective analytical cohort study of 3 years duration in 972 adult cardiac surgeries was conducted. Scores obtained from EuroSCORE (Logistic and Additive) and EuroSCORE II was compared with the observed mortality. Calibration was calculated by Hosmer- Lemeshow (H-L) test (Chi Square test) and discrimination by calculating the area under the curve (AUC) of receiver operating characteristics (ROC) curve. Results: Observed mortality was 4.11%. EuroSCORE additive, logistic and EuroSCORE II predicted mortality were 4.32%, 4.55% and 2.13% respectively. H-L chi square calculation for EuroSCORE additive model could not hold as all observed and expected frequencies match exactly. Hence it can be considered as a good fit. EuroSCORE logistic model (H-L, Chi-square 7.743, p<0.001) and EuroSCORE II (H-L, Chi-square 11.631, p = 0.168) also showed good fit i.e. both can predict mortality satisfactorily. AUC of ROC curve of EuroSCORE additive, logistic and EuroSCORE II were 0.632, 0.636 and 0.616 respectively, which showed fair discrimination power. Conclusion: Mortality prediction of adult cardiac surgical patients by EuroSCORE (additive and logistic) and EuroSCORE II was satisfactory. Keywords: Additive, cardiac surgical, EuroSCORE, logistic
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 D
ABSTRACT 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
Nepal’s First Laser Bronchoscopy: A Case Report
(Institute of Medicine, 2021) Sapkota, Ranjan; Shrestha, Bibhush
ABSTRACT Light Amplification by Stimulated Emission of Radiation (Laser) is an essential tool for a thoracic surgeon in the management of tracheobronchial lesions: alone or on combination with other modalities of treatment. Post-tracheostomy tracheal stenosis (PTTS) is a well-known entity and often a challenging problem to manage. Here we report a successful use of endotracheal Laser, yet unreported in available English Literature from Nepal, in a 24 year man with PTTS after a protracted hospital stay for traumatic brain injury. The use of Laser bronchoscopy in such cases is safe and feasible, alone or in combination with tracheal dilatation. Keywords: Bronchoscopy, dilatation, post-tracheostomy tracheal stenosis, laser
Surgical Management of Post-Intubation Tracheal Injuries: A Single-Center Experience from Nepal
(Institute of Medicine, 2022) Sapkota, Ranjan; Shrestha, Bibhush; Sharma, Aakriti
ABSTRACT Introduction: Despite various improvements in technology and patient care, tracheal intubation and tracheostomy still result in significant tracheal injuries like stenosis and airway fistula. Pressure necrosis by the inflated balloon is the commonest culprit. Post-intubation tracheal stenosis is a major indication for tracheal resection and anastomosis. This study was done to find out the indications and results of surgery for post-intubation tracheal lesions. Methods: It was a descriptive observational study of patients with post-intubation tracheal lesions managed in Manmohan Cardiothoracic Vascular and Transplant Center over a period of 20 years (2001 to 2021). Results: Twenty five patients were treated for post-intubation tracheal lesions. Four had isolated tracheo-esophageal fistula (TEF); eighteen had an isolated tracheal stenosis and three had both. Most had a tracheal resection and end-end anastomosis (REEA) via a cervical approach, resecting an average of 2.7 cm of tracheal length. The average size of stenotic lumen was 4.32 mm. There were no operative deaths. Two patients expired within a month of surgery: one due to fatal restenosis and the other due to sepsis. There were a few immediate and a few long-term complications. The average follow-up period was 5 years. Conclusion: Among the various post-intubation lesions, tracheal stenosis is the commonest indications for surgery. The management is challenging but safe and feasible, with a multidisciplinary team approach. Keywords: Endotracheal intubation, resection and anastomosis, tracheal stenosis, tracheostomy, tracheo-esophageal fistula

Browsing by Author "Shrestha, Bibhush"

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