Browsing by Author "Shrestha, Ninadini"
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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 Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit(Institute of Medicine, 2019) Shrestha, Pramesh S; Marhatta, Moda N; Acharya, Subhash P; Shrestha, NinadiniABSTRACT Introduction Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room. Keywords: Complications, intensive care unit, percutaneous tracheostomy, surgical tracheostomyPublication Effect of Preoperative Nebulized Ketamine on Incidence and Severity of Postoperative Sore Throat in Patient Undergoing General Anaesthesia with Endotracheal Intubation(Institute of Medicine, 2020) Bhatta, Prajjwol D; Shakya, Bigen M; Bista, Navindra R; Marhatta, Moda N; Shrestha, NinadiniABSTRACT Introduction: Postoperative sore throat (POST) has a reported incidence of up to 62% following general anaesthesia. POST was rated by patients as the eighth most undesirable outcome in the postoperative period. The objective of this study was to compare the incidence and severity of postoperative sore throat after saline and ketamine nebulization in patients undergoing general anaesthesia with endotracheal intubation. Methods: The study was prospective double blinded randomized controlled trial . One hundred patients belonging to American Society of Anesthesiologists physical status I–II undergoing surgery under general anaesthesia with endotracheal intubation were randomized into two groups; group Saline (S) received nebulization with 5 ml of normal saline and group Ketamine (K) received nebulization with 1 ml of ketamine of concentration 50 mg/ml mixed with 4 ml saline. POST was assessed at zero hour, two hour, four hour, six hour, eight hour and 24 hour. Results: The overall incidence of POST was 28%. Twenty two (44%) patients in group S and six (12%) patients in group K had postoperative sore throat at some point of the study. The POST was significantly reduced in group K at zero hour 3(6%), two hour 3(6%), four hour 4(8%), six hour 5(10%) and eight hour 3(6%) with p value <0.05 . The severity of POST was also significantly decreased in group K at zero hour, two hour, four hour, six hour, eight hour with p value <0.05. Conclusion: Preoperative nebulization with ketamine reduces the incidence and severity of POST after general anaesthesia with endotracheal intubation. Keywords: Endotracheal intubation, ketamine nebulization, post-operative sore throat