Browsing by Author "Shrestha, Saurav"
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Publication Rocuronium-Induced Anaphylactic Shock during Elective Septoplasty: A Case Report Authors(Nepal APF Hospital, 2025) Bajracharya, Nitendra Raj; Shrestha, Saurav; Dangol, Shova; Paudel, Rabi; Bishwokarma, Pushkar; Shrestha, Surendra ManAbstract: Introduction : Perioperative anaphylaxis is a rare but potentially fatal complication during anesthesia. Among muscle relaxants, rocuronium is a leading cause of intraoperative anaphylaxis. Early recognition and prompt management are crucial to reduce morbidity and mortality. Case presentation: We report a 14-year-old female with a medical history of Hashimoto’s thyroiditis and dissociative disorder scheduled for elective septoplasty. Following induction with midazolam, fentanyl, propofol, rocuronium, and tracheal intubation, the patient developed severe hypotension, tachycardia, generalized rash, lip swelling, and increased airway pressure, suggestive of Grade III anaphylaxis suspected to be secondary to rocuronium. Immediate management with intravenous epinephrine boluses (300 mcg ×2), fluid resuscitation (2 Litres Normal Saline), hydrocortisone, ketamine, and initiation of an epinephrine infusion (0.1 mcg/kg/min) was done and surgery was postponed. The patient was transferred to the ICU for close monitoring. Epinephrine infusion was tapered off and trachea was extubated the next day, and discharged to the ward on the third day without neurological or respiratory sequelae. Conclusion: This case emphasizes on the importance of early recognition of rocuronium-induced anaphylaxis, rapid administration of epinephrine and aggressive supportive care. The incidence of such reactions remains low, but the high fatality rate necessitates preparedness during anesthesia.Publication Scar among Bacillus Calmette-Guérin Vaccinated Children Presenting to an Immunisation Clinic at a Tertiary Hospital in Nepal: An Observational Study(Nepal Medical Association, 2025) Dhakal, Ajaya Kumar; KC, Divya; Shrestha, Barsha; Shrestha, Devendra; Neupane, Nischal; Acharya, Sharda; Shrestha, SauravAbstract Introduction: Bacillus Calmette-Guérin vaccination is associated with the development of scarring at the vaccination site in most children within 12 weeks of vaccination. However, due to various factors, some children do not develop scars. The aim of the study was to determine the prevalence of scar failure and the differences in clinical characteristics between scar-positive and scar-negative children. Methods: This observational cross-section study was conducted between 12 September 2022 and 15 April 2024 on children attending a vaccination clinic at a tertiary care hospital for 12 or 15-month vaccination. A purposive sampling method was used, and 386 children were enrolled in the study. During medical history, information was collected on Bacillus Clamettte-Guérin vaccination, child and maternal clinical profiles, and hospitalisations for respiratory tract infections in children. Results: Among 386 infants, prevalence of BCG scar was 341 (88.34%; 95% CI: 91.81%-91.37%). Vaccination was confirmed in 94.82% by history and card. The median scar size was 4mm (IQR: 2,5 mm) transversely and 3 mm (IQR: 2,5) vertically. Thirty-two (8.30%) infants required hospital admission for respiratory infections; none received anti-tubercular treatment. Conclusions: The BCG scar formation was higher compare to the scar failure. The scar failure was comparable to other studies.