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Journal of Clinical Images and Medical Case Reports
Introduction: Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare tumor that affects almost excl... more Introduction: Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare tumor that affects almost exclusively adolescents and young males
INDIAN JOURNAL OF APPLIED RESEARCH, May 1, 2023
Background Postoperative Nausea and vomiting (PONV) are two of the common adverse events in the p... more Background Postoperative Nausea and vomiting (PONV) are two of the common adverse events in the postoperative period. Though there has been advances in the eld of medicine and surgery, PONV still continues to be a problem with evidence revealing high incidence rates of 20-30% in non-high-risk groups and up to 70% in high-risk groups. This is the rst clinical audit of PONV at Nepal Mediciti Hospital after the implementation of departmental PONV pathway. This audit assessed incidence of PONV Methods in the rst twenty-four hours in all post operative patients undergoing elective surgery under anesthesia over a year period between Jan 1, 2022, to Dec 31, 2022, by reviewing the medical records. Out of 4022 patients 28 (0.7%) had all 4 ris Results k factors. 1122 (27.9%) had 3 risk factors. 1392 (34.6%) had 2 risk factors. 1094 (27.2%) had only one risk factor and 386 patients (9.6%) had no risk factors. 2912 (72.4 %) patients received Perioperative PONV prophylaxis. 1110 (27.6%) patients didn't receive perioperative PONV prophylaxis. 168 patients vomited whereas 3854 patients had no vomiting. 3716 (92.4 %) didn't have nausea and 306 (7.6%) patients had nausea. There was a call for management for PONV in 2.7% of the patients. 2% of the patients said that PONV interfered with daily activities. Overall, 27% patients didn't receive prophylaxis. Conclusion Our ndings indicate that PONV management remains a signicant target for improved clinical practice. Despite the extensive evidence base, strategies such as risk stratication, reduction of baseline risk and rational antiemetic prescription can be improved, especially in high-risk patients
International Journal of Surgery Case Reports
Magna Scientia Advanced Research and Reviews
Laparoscopic surgeries have become popular and are now widely used in gynecological procedures du... more Laparoscopic surgeries have become popular and are now widely used in gynecological procedures due to their minimally invasive nature. CO2 is used to create the pneumoperitoneum to facilitate the laparoscopic surgery. Pneumoperitoneum and different positions used can have adverse effects on hemodynamics. Most of the system of the human body are affected including Cardiovascular and pulmonary system leading to various complications. Complications include vascular and bowel injury during pneumoperitoneum access, subcutaneous emphysema, pneumothorax, pneumomediastinum, CO2 embolism and others. Understanding the underlying hemodynamic changes is crucial to tailor the patient's individual needs. Anesthesiologists play a critical role in managing these challenges by closely and vigilantly monitoring hemodynamics, utilizing appropriate anesthetic techniques, and promptly identifying and addressing potential complications. This paper aims to provide a comprehensive review of the effects...
Nepal Mediciti Medical Journal
We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein... more We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein the patient declined general anesthesia. Instead, we successfully administered anesthesia using ultrasound-guided supraclavicular and suprascapular nerve blocks, combined with continuous perineural brachial plexus block. The surgical procedure was successfully completed within six hours, and no complications were encountered.
Journal of Advances in Internal Medicine, 2021
Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinas... more Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinastatin is a serine proteases inhibitor that reduces inflammation by suppressing the infiltration of neutrophils and elastase release and inflammatory mediators that help improve clinical symptoms and reduce mortality. This study aims to evaluate the clinical utility of Ulinastatin. Methods: Fifty-two patients admitted to ICU with acute pancreatitis were divided into; Ulinastatin group who received a 3 to 5 days course of 200,000IU, and Control Group who didn’t receive ulinastatin. Pearson's Chi-square and Fisher's exact test were used and a p-value < 0.05 was considered statistically significant. Results: Mean age was lower among the Ulinastatin group at 43 years (p-Value 0.014) and Hepatic dysfunction was more among this group (p-value 0.04). Among new onset of organ dysfunction, only CVS dysfunction was significant among the Control group ( p-value 0.044) while respiratory fu...
Birat Journal of Health Sciences
Introduction: We preferred general anesthesia over spinal anesthesia for day care surgeries in ou... more Introduction: We preferred general anesthesia over spinal anesthesia for day care surgeries in our center. During COVID-19 pandemic, we planned subarachnoid blocks for daycare surgeries, to minimize aerosol generation and to reduce virus transmission risk to health care professions. Objectives: This study intended to compare time of discharge after subarachnoid block with general anesthesia in day care surgeries. We compare time to achieve post-anesthetic discharge score (PADS) equal to or more than nine; need for overnight hospitalization; and complications. Methodology: A retrospective analysis of cases posted for elective daycare surgery in our institute during COVID-19 pandemic from April 2020 to July 2020 were identified. We compared time to discharge home in patients who received general anesthesia and spinal anesthesia. Normality of distribution was determined using Two sample Kolmogorov-Smirnov Tes. Student t test was used for normally distributed data, Mann-Whitney U tes...
Journal of Advances in Internal Medicine, 2021
Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinas... more Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinastatin is a serine proteases inhibitor that reduces inflammation by suppressing the infiltration of neutrophils and elastase release and inflammatory mediators that help improve clinical symptoms and reduce mortality. This study aims to evaluate the clinical utility of Ulinastatin. Methods: Fifty-two patients admitted to ICU with acute pancreatitis were divided into; Ulinastatin group who received a 3 to 5 days course of 200,000IU, and Control Group who didn’t receive ulinastatin. Pearson's Chi-square and Fisher's exact test were used and a p-value < 0.05 was considered statistically significant. Results: Mean age was lower among the Ulinastatin group at 43 years (p-Value 0.014) and Hepatic dysfunction was more among this group (p-value 0.04). Among new onset of organ dysfunction, only CVS dysfunction was significant among the Control group ( p-value 0.044) while respiratory fu...
The management of Post-Dural Puncture Headache; a prospect from a low and middle-income country: ... more The management of Post-Dural Puncture Headache; a prospect from a low and middle-income country: A viewpoint.
Journal of Clinical Images and Medical Case Reports
Introduction: Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare tumor that affects almost excl... more Introduction: Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare tumor that affects almost exclusively adolescents and young males
INDIAN JOURNAL OF APPLIED RESEARCH, May 1, 2023
Background Postoperative Nausea and vomiting (PONV) are two of the common adverse events in the p... more Background Postoperative Nausea and vomiting (PONV) are two of the common adverse events in the postoperative period. Though there has been advances in the eld of medicine and surgery, PONV still continues to be a problem with evidence revealing high incidence rates of 20-30% in non-high-risk groups and up to 70% in high-risk groups. This is the rst clinical audit of PONV at Nepal Mediciti Hospital after the implementation of departmental PONV pathway. This audit assessed incidence of PONV Methods in the rst twenty-four hours in all post operative patients undergoing elective surgery under anesthesia over a year period between Jan 1, 2022, to Dec 31, 2022, by reviewing the medical records. Out of 4022 patients 28 (0.7%) had all 4 ris Results k factors. 1122 (27.9%) had 3 risk factors. 1392 (34.6%) had 2 risk factors. 1094 (27.2%) had only one risk factor and 386 patients (9.6%) had no risk factors. 2912 (72.4 %) patients received Perioperative PONV prophylaxis. 1110 (27.6%) patients didn't receive perioperative PONV prophylaxis. 168 patients vomited whereas 3854 patients had no vomiting. 3716 (92.4 %) didn't have nausea and 306 (7.6%) patients had nausea. There was a call for management for PONV in 2.7% of the patients. 2% of the patients said that PONV interfered with daily activities. Overall, 27% patients didn't receive prophylaxis. Conclusion Our ndings indicate that PONV management remains a signicant target for improved clinical practice. Despite the extensive evidence base, strategies such as risk stratication, reduction of baseline risk and rational antiemetic prescription can be improved, especially in high-risk patients
International Journal of Surgery Case Reports
Magna Scientia Advanced Research and Reviews
Laparoscopic surgeries have become popular and are now widely used in gynecological procedures du... more Laparoscopic surgeries have become popular and are now widely used in gynecological procedures due to their minimally invasive nature. CO2 is used to create the pneumoperitoneum to facilitate the laparoscopic surgery. Pneumoperitoneum and different positions used can have adverse effects on hemodynamics. Most of the system of the human body are affected including Cardiovascular and pulmonary system leading to various complications. Complications include vascular and bowel injury during pneumoperitoneum access, subcutaneous emphysema, pneumothorax, pneumomediastinum, CO2 embolism and others. Understanding the underlying hemodynamic changes is crucial to tailor the patient's individual needs. Anesthesiologists play a critical role in managing these challenges by closely and vigilantly monitoring hemodynamics, utilizing appropriate anesthetic techniques, and promptly identifying and addressing potential complications. This paper aims to provide a comprehensive review of the effects...
Nepal Mediciti Medical Journal
We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein... more We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein the patient declined general anesthesia. Instead, we successfully administered anesthesia using ultrasound-guided supraclavicular and suprascapular nerve blocks, combined with continuous perineural brachial plexus block. The surgical procedure was successfully completed within six hours, and no complications were encountered.
Journal of Advances in Internal Medicine, 2021
Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinas... more Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinastatin is a serine proteases inhibitor that reduces inflammation by suppressing the infiltration of neutrophils and elastase release and inflammatory mediators that help improve clinical symptoms and reduce mortality. This study aims to evaluate the clinical utility of Ulinastatin. Methods: Fifty-two patients admitted to ICU with acute pancreatitis were divided into; Ulinastatin group who received a 3 to 5 days course of 200,000IU, and Control Group who didn’t receive ulinastatin. Pearson's Chi-square and Fisher's exact test were used and a p-value < 0.05 was considered statistically significant. Results: Mean age was lower among the Ulinastatin group at 43 years (p-Value 0.014) and Hepatic dysfunction was more among this group (p-value 0.04). Among new onset of organ dysfunction, only CVS dysfunction was significant among the Control group ( p-value 0.044) while respiratory fu...
Birat Journal of Health Sciences
Introduction: We preferred general anesthesia over spinal anesthesia for day care surgeries in ou... more Introduction: We preferred general anesthesia over spinal anesthesia for day care surgeries in our center. During COVID-19 pandemic, we planned subarachnoid blocks for daycare surgeries, to minimize aerosol generation and to reduce virus transmission risk to health care professions. Objectives: This study intended to compare time of discharge after subarachnoid block with general anesthesia in day care surgeries. We compare time to achieve post-anesthetic discharge score (PADS) equal to or more than nine; need for overnight hospitalization; and complications. Methodology: A retrospective analysis of cases posted for elective daycare surgery in our institute during COVID-19 pandemic from April 2020 to July 2020 were identified. We compared time to discharge home in patients who received general anesthesia and spinal anesthesia. Normality of distribution was determined using Two sample Kolmogorov-Smirnov Tes. Student t test was used for normally distributed data, Mann-Whitney U tes...
Journal of Advances in Internal Medicine, 2021
Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinas... more Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinastatin is a serine proteases inhibitor that reduces inflammation by suppressing the infiltration of neutrophils and elastase release and inflammatory mediators that help improve clinical symptoms and reduce mortality. This study aims to evaluate the clinical utility of Ulinastatin. Methods: Fifty-two patients admitted to ICU with acute pancreatitis were divided into; Ulinastatin group who received a 3 to 5 days course of 200,000IU, and Control Group who didn’t receive ulinastatin. Pearson's Chi-square and Fisher's exact test were used and a p-value < 0.05 was considered statistically significant. Results: Mean age was lower among the Ulinastatin group at 43 years (p-Value 0.014) and Hepatic dysfunction was more among this group (p-value 0.04). Among new onset of organ dysfunction, only CVS dysfunction was significant among the Control group ( p-value 0.044) while respiratory fu...
The management of Post-Dural Puncture Headache; a prospect from a low and middle-income country: ... more The management of Post-Dural Puncture Headache; a prospect from a low and middle-income country: A viewpoint.