Journal Issue: Volume: 12, No 2, Issue 46, APRIL-JUNE, 2014
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Volume
Number
Issue Date
2014
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Safety Profile and Patient Satisfaction of the Routine use of Propofol in Gastrointestinal Endoscopy
(Kathmandu University, 2014) Gurung, RB; Purbe, B; Malla, B; Dhungel, A; Yogol, S; Poudel, A; Kunwor, K; Byanju, S
ABSTRACT
Backgroud
Routine use of sedation in upper gastrointestinal endoscopy is uncommon
in Nepal. There is no study on use of propofol sedation in routine endoscopy
examination in Nepal. This study was conducted in order to assess the
patient satisfaction and safety profile in patient undergoing routine upper
GI endoscopic examination on outpatients.
Objective
To study safety profile and patient satisfaction of use of propofol in patients
undergoing upper GI endoscopy.
Method
A prospective, observational study was conducted in the endoscopy unit
of Dhulikhel hospital, Kathmandu University Hospital from July 2011 to
2012 July. Patients who were referred to upper GI endoscopy were offered
to sedation under propofol. Informed consent was taken after explaining
side effects, advantages and risk-benefit to the clients. The propofol was
administered by the endoscopy nurse under guidance and supervision of
the endoscopy performing physician.
Data were collected and analyzed using SPSS version 16.0 with 0.05 level
of significance.
Result
Total of 203 patients included in the study. Among 203 patients, 21. 2% were
males and 78.8% were females; 83.7% were of less than of 60 years age
and 16.3% above 60 years of age. The mean total dose of propofol required
was 136.08 ± 48.82 mg. Total of 29.1 % of cases required O2 administration
during the procedure time due to transient drop in O2 saturation. Total of
4.4% of cases required fluid administration due to transient fall in blood
pressure. Total of 68.0% of cases were completely sedated; 28.6% had minor
restless and 3.4% showed agitation during induction period of propofol
sedation. Total of 99.5% of patients reported pleasant experience while
0.5% reported unpleasant. Among 203 respondents, 98.5% responded
they would prefer to do the procedure under propofol sedation in the
future; 1.5% responded they did not want sedations in the future.
Conclusion
Upper GI endoscopy can safely be performed under propofol sedation
administered by registered trained nurse under the supervision of
endoscopist.
KEY WORD
Endoscopy, patient safety, patient satisfaction, propofol sedation
Measurement of Right Atrial Volume and Diameters in Healthy Nepalese with Normal Echocardiogram
(Kathmandu University, 2014) Karki, DB; Pant, S; Yadava, SK; Vaidya, A; Neupane, DK; Joshi, S
ABSTRACT
Background
The size of right atrium is expected to be different in diverse healthy ethnic groups. It
is important to know the normal size of right atrium in our healthy population.
Objective
The study aimed to find out the normal values of right atrial volume, right atrial short
axis diameter and right atrial long axis diameter in healthy Nepalese population with
normal echocardiographic findings. It also looked at correlations between right atrial
dimensions and the right atrial volume.
Method
Verbal consent was taken from all the participants. One hundred participants
between the age of 18 and 60 years with normal echocardiographic findings and
without any chronic disease were included in this study. Right atrial volume was
measured by using area length method. Right atrial short axis diameter and Right
atrial long axis diameter were measured in the four chamber view.
Result
The mean right atrial volume was 23.64±5.36 ml (range 11.30 - 40.00 ml).The range
of right atrial short axis diameter and right atrial long axis diameter were 1.34-3.80
cm and 2.4-4.7 cm respectively.
Conclusion
The size of right atrium in the Nepalese population is smaller compared to western
population. Male right atrial volume size is greater than female in Nepalese
population similar to western population. The findings of normal value of right atrial
volume and right atrial diameter in Nepalese population will help the physician to
assess patients with various conditions affecting the right atrium.
KEY WORDS
Nepalese population, right atrial short axis diameter, right atrial long axis diameter,
right atrial volume.
Incidence and Risk Factors of Surgical Site Infection Following Cesarean Section at Dhulikhel Hospital
(Kathmandu University, 2014) Shrestha, S; Shrestha, R; Shrestha, B; Dongol, A
ABSTRACT
Background
Cesarean Section (CS) is one of the most commonly performed surgical procedures
in obstetrical and gynecological department. Surgical site infection (SSI) after a
cesarean section increases maternal morbidity prolongs hospital stay and medical
costs.
Objective
The aim of this study was to find out the incidence and associated risk factors of
surgical site infection among cesarean section cases.
Method
A prospective, descriptive study was conducted at Dhulikhel Hospital, department
of Obstetrics and Gynaecology from July 2013 to June 2014. Total of 648 women
who underwent surgical procedure for delivery during study period were included
in the study. Data was collected from patient using structred pro forma and
examination of wound till discharge was done. Data was compared in terms of
presence of surgical site infection and study variables. Wound was evaluated for
the development of SSI on third day, and fifth post-operative day, and on the day
of discharge.
Results
Total of 648 cases were studied. The mean age was 24±4.18. Among the studied
cases 92% were literate and 8% were illiterate. Antenatal clinic was attended by
97.7%. The incidence rate of surgical site infection was 82 (12.6%). SSI was found
to be common in women who had rupture of membrane before surgery (p=0.020),
who underwent emergency surgery (p=0.0004), and the women who had vertical
skin incision (p=0.0001) and interrupted skin suturing (p=0.0001) during surgery.
Conclusion
Surgical site infection following caesarean section is common. Various modifiable
risk factors were observed in this study. Development of SSI is related to multi-
factorial rather than one factor. Development and strict implementation of protocol
by all the health care professionals could be effective to minimize and prevent the
infection rate after caesarean section.
KEY WORDS
Caesarean section, maternal infection, surgical site infection
Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal
(Kathmandu University, 2014) Thapa, P; Chakraborty, PK; Khattri, JB; Ramesh, K; Sharma, P
ABSTRACT
Background
Delirium affects a significant proportion of critically ill patients admitted in hospital.
It is associated with various adverse outcomes. Despite its enormous prognostic
significance it tends to be underdiagnosed. There is a dearth of studies on risk
factors of delirium in our setting.
Objectives
The main objectives of this study was to find out the prevalence, rate of non
recognition and risk factors associated with delirium in hospitalized critically ill
patients.
Methods
A hospital based cross-sectional study was carried out. Data was collected using
a predesigned semi-structured proforma and Intensive care delirium screening
checklist was used to screen for delirium in patients admitted in various wards of
Manipal teaching hospital, Pokhara, Nepal.
Results
Ninety five cases were included in the analysis. The mean age of study group
was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not
recognized by treating physician in about one third of cases. Odds ratio (OR) was
statistically significantly increased in patients with history of stroke (OR=4.484 95%
CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR=
4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766),
nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s
catheter (OR=12.000 95% CI= 3.072;46.877).
Conclusion
About 16% of critically ill patients were found to be delirious. In about one third of
the cases delirium was not recognized. Both patient related and iatrogenic factors
may increase the risk of delirium in hospitalized critically ill patients.
KEY WORDS
Critical care, delirium, non-recognition