Journal Issue: No 2, Issue 10, APRIL-JUNE, 2005
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Volume
Number
Issue Date
2005
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Propranolol is effective in decreasing stress response due to airway manipulation and CO2 pneumoperitoneum in patients undergoing laparoscopic cholecystectomy
(Kathmandu University, 2005) SK, Maharjan
Purpose: to study the effect of Propranolol on hemodynamic response due to airway manipulation and carbon
dioxide pneumoperitoneum on laparoscopic cholecystectomy cases. Methods: 63 patients undergoing laparoscopic
cholecystectomy under general anaesthesia were randomly divided into 3 groups; group 1 received 1.0 mg of
Propranolol, group 2 received 0.5 mg of Propranolol and group 3 received 1 ml saline 5 minutes before induction of
anaesthesia. Haemodynamic parameters were recorded for every 5 minutes from basal to 5 minutes after extubation
and analyzed. Results: Balanced anaesthesia used in our set up is effective in decreasing stress response due to
airway manipulation (laryngoscopy and endotracheal intubation) but not effective in that due to CO2
pneumoperitoneum. Propranolol 1 mg 5 minutes before anaesthesia is effective in decreasing stress response due to
airway manipulation and CO2 pneumoperitoneum in these groups of patients. Conclusion: Propranolol effectively
blunts the stress response due to CO2 pneumoperitoneum during laparoscopic cholecystectomy.
Key words: Propranolol, laparoscopy, stress response, CO2 pneumoperitoneum
A comparative study of pre-operative with operative diagnosis in acute abdomen
(Kathmandu University, 2005) RK, Chhetri; ML, Shrestha
In this observational study (from August 2000 to January 2001) 102 patients of all age group with non-traumatic
acute abdomen were studied to see the negative laparotomy rate and the diagnostic accuracy and predictive values of
different investigations in acute abdomen. The disease was most common in the age group 20-29 years with male
predominance. More than half of the acute abdomen was due to the acute appendicitis. Neutrophil leucocyte count
had the highest sensitivity (91.5%) while Plain X-ray abdomen showed the highest specificity (88.8%) and positive
predictive value (88.6%) in diagnosing acute abdomen. Urinalysis showed the highest negative predictive value
(93.3%). Overall diagnostic accuracy was 78.4%, which was statistically significant (P<0.05). Diagnostic accuracy
was highest in bowel obstruction (82.4%) and lowest in peritonitis due to viscus perforation (69.0%). Negative
laparotomy rate was 17.6% in the study, which was statistically significant (p<0.05). It was highest with peritonitis
due to viscus perforation (20.7%), and lowest in bowel obstruction (11.8%).
Key words: Acute abdomen, laparotomy.
Upper GI Endoscopy in Children- in an adult suite
(Kathmandu University, 2005) MR, Joshi; S K, Sharma; MR, Baral
Although Upper GI endoscopy is commonly performed in adults, paediatric endoscopy is not available in many of
our referral centres. The efficacy and safety of upper GI endoscopy in paediatric age group performed in adult suite
of Kathmandu Medical College is reviewed. Patients and Method: A retrospective study of endoscopies performed
on children aged up to 15 years in an adult endoscopy suite of Kathmandu medical college over last one year is
presented. All cases were the referred cases from paediatric unit for various problems. Results: Endoscopy in
paediatric group comprises only 6% of total upper GI endoscopies performed during the same year. Sex ratio was
almost equal. Most cases (87%) were performed under local anaesthetic and well tolerated by the patients. Recurrent
abdominal pain (RAP) was the commonest indication and among them one third of cases had significant positive
finding. Conclusion: Upper GI endoscopy is a useful diagnostic tool in children. Where specialized paediatric
endoscopy units are not feasible i.e. developing countries, endoscopic services to children can be safely provided in
adult endoscopy suite with or without sedation. Upper GI endoscopy is well tolerated by children even without
sedation.
Key words: Endoscopy, Recurrent abdominal pain.