Dr.ninadini Shrestha | Tribhuvan University (IOM) (original) (raw)
Papers by Dr.ninadini Shrestha
Journal of Nepalese Society of Critical Care Medicine
Background and aims: Mannitol is commonly used to reduce elevated intracranial pressure (ICP) in ... more Background and aims: Mannitol is commonly used to reduce elevated intracranial pressure (ICP) in patients with traumatic brain injury, intracranial hemorrhage and acute cerebrovascular accident. Optic nerve sheath diameter (ONSD) has high sensitivity and specificity in diagnosing raised ICP. This study aims to evaluate effect of Mannitol on ONSD in patients with raised ICP. Methods: This was a prospective cohort observational study of adult patients receiving osmotherapy for increased ICP admitted to the ICU. Baseline ONSD (T1) was recorded bilaterally followed by administration of Mannitol. ONSD was remeasured bilaterally at 30 (T2), 60 (T3) and 120 (T4) minutes after completion of administration of mannitol. Peak inspiratory pressures and PEEP were recorded for patients on mechanical ventilation. Results: Of the 40 patients included in the study, the mean age of patients was 54.03 ±19.15 years. Among them 26 were mechanically ventilated. Compared to the baseline values of 6.1 ± 0....
Grande Medical Journal, 2020
Journal of Nepal Health Research Council, Jul 4, 2018
Takayasu's arteritis is a well known yet rare form of large vessel vasculitis. 1 This inflamm... more Takayasu's arteritis is a well known yet rare form of large vessel vasculitis. 1 This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. 2 Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. 1 We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management.
Journal of Institute of Medicine, 2020
IntroductionPostoperative sore throat (POST) has a reported incidence of up to 62% following gene... more IntroductionPostoperative 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.MethodsThe 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.ResultsThe overall incidence of...
A patient can present with persistent pain even after vertebral compression fracture augmentation... more A patient can present with persistent pain even after vertebral compression fracture augmentation procedures. We report a case of a patient of carcinoma breast with L1 vertebral metastasis and fracture for which vertebroplasty was performed abroad. The patient had severe pain even after the procedure and multiple therapies. The patient’s pain was finally relieved with radiofrequency ablation of target medial branch, which highlights the importance of facet joint as source of pain generator in such group of patients. Key words : Compression fracture, facet joint
Journal of Chitwan Medical College, 2020
Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Combi... more Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Combined Spinal Epidural Anaesthesia (CSEA) technique and Continuous epidural anaesthesia both have been extensively used in elective gynaecological surgeries. This prospective cross-sectional comparative study was designed to compare the quality of anaesthesia between CSEA and Epidural anaesthesia. Methods: Sixty-four patients between age group 15- 65 years of ASA grade I, II were randomly divided into 2 groups. Group A patients received CSEA using “double needle double interspace technique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block with catheter using 10 ml of 0.5% plain bupivacaine. In all patients, subsequent dosage of 2 ml per unblocked segment 0.5% plain bupivacaine was administered through the epidural catheter to achieve a block up to T4-5. Mean was calculated using t-test, median with Mann Whitney U test and Ch...
Nepal Medical College Journal, 2020
Infective etiologies are the first differentials that come to the mind in clinical conditions pre... more Infective etiologies are the first differentials that come to the mind in clinical conditions presenting with diarrhea associated with encephalopathy. We report a case of a 21 year old lady diagnosed as acute infective gastroenteritis and treated for the same only to manifest itself later as encephalopathy leading to a diagnostic dilemma. The clinical manifestations had started from abdominal cramps, bloody diarrhea followed by altered sensorium. A detailed history later revealed the use of the roots of Abrus precatorius for the treatment of sub-fertility was the missing piece of the diagnostic puzzle. Only after confirmation of the herb did the temporal sequence of events seemed logical. The patient was successfully managed for toxic acute disseminated encephalomyelitis (ADEM). Abrus precatorius is a commonly used herb used in traditional medicinal practice in many cultures. Various aspects of its toxicity can mimic other more commonly encountered medical ailments.
Journal of Kathmandu Medical College, 2020
Background: Spinal anesthesia is the preferred technique of anesthesia employed for caesarean sec... more Background: Spinal anesthesia is the preferred technique of anesthesia employed for caesarean sections. However, it is very often complicated by hypotension. Different drugs and techniques have been used to prevent the hypotension induced by spinal anesthesia. In this study, the effect of ondansetron on the prevention of hypotension after spinal anesthesia was evaluated. Objectives: To determine the effect of prophylactic ondansetron on prevention of spinal induced hypotension in elective caesarean section. Methodology: Eighty-six parturients planned for elective caesarean deliveries were randomized into two groups of 43 each. Group O received Ondansetron 4 mg (4 ml) and Group S received Normal Saline (4 ml) intravenously 10 minutes prior to spinal anesthesia. Blood pressure, heart rate, phenylephrine requirements, occurrence of nausea and vomiting and APGAR scores of neonates were compared between the groups. Hemodynamic data was analyzed using Student’s t-test for intergroup compa...
Oxford Medical Case Reports, 2020
Peripheral route for administration of vasopressors is often opted due to resource limitations or... more Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.
Toxicology Reports, 2020
Nitrobenzene can cause life threatening methaemoglobinemia. Its management includes the use of in... more Nitrobenzene can cause life threatening methaemoglobinemia. Its management includes the use of intravenous methylene blue to reduce the iron moiety from its ferric to ferrous state. Due to unavailability of intravenous preparation, enteral methylene blue was used in our case. This case report is to highlight that even oral preparations can be successfully used in a resource limited setting where often intravenous preparations are unavailable.
Anesthesia & Analgesia, 2020
REFERENCES 1. Barrington MJ, Seah GJ, Gotmaker R, Lim D, Byrne K. Quality of recovery after breas... more REFERENCES 1. Barrington MJ, Seah GJ, Gotmaker R, Lim D, Byrne K. Quality of recovery after breast surgery: a multicenter randomized clinical trial comparing pectoral nerves interfascial plane (pectoral nerves II) block with surgical infiltration. Anesth Analg. 2020;130:1559–1567. 2. Maniker RB, Johnson RL, Tran DQ. Interfacial plane blocks for breast surgery: which surgery to block, and which block to choose? Anesth Analg. 2020;130:1556–1558. 3. Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative breast analgesia: a qualitative review of anatomy and regional techniques. Reg Anesth Pain Med. 2017;42:609–631. 4. Thallaj AK, Al Harbi MK, Alzahrani TA, El-Tallawy SN, Alsaif AA, Alnajjar M. Ultrasound imaging accurately identifies the intercostobrachial nerve. Saudi Med J. 2015;36:1241–1244. 5. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61–65.
Radiology Case Reports, 2020
Gall bladder (GB) perforation can be misdiagnosed as any other more common cause of acute abdomen... more Gall bladder (GB) perforation can be misdiagnosed as any other more common cause of acute abdomen. We present a case of a 72-year-female who had presented to the emergency department with an acute abdomen. The clinical presentation and the biochemical markers had pointed towards acute pancreatitis. However, the ultrasonographic examination of the abdomen and the pelvis suggested GB perforation which was confirmed by the multislice computerized tomography scan. Following this the patient underwent open cholecystectomy and was successfully managed. The invaluable contributions from the radiological modalities led to the successful management of the patient.
Anaesthesia, Pain & Intensive Care, 2020
Pain is one of the most common symptoms of patients visiting the hospital. The prevalence of chro... more Pain is one of the most common symptoms of patients visiting the hospital. The prevalence of chronic pain is estimated to be around 30%. Pain management service is a separate service provided by healthcare institutions to manage such chronic pain and has become essential service in most of the countries. Nepal has also started to provide services for patients with chronic pain through pain management clinics.
![Research paper thumbnail of Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report [Response to Letter]](https://attachments.academia-assets.com/88751501/thumbnails/1.jpg)
](Local and Regional Anesthesia, 2020
We appreciate their effort and knowledge with which they have raised their concerns regarding the... more We appreciate their effort and knowledge with which they have raised their concerns regarding the case report. Firstly, the patient had an American Society of Anesthesiologists, Physical Status (ASA PS) class I status as mentioned in the case description. Thus, it goes without mentioning that the patient was a non-smoking healthy individual with no known co-morbidities, no alcohol use and a body mass index within normal ranges. 1 To add, he had undergone a pre-anaesthetic assessment before surgery with investigations as per the institutional practice which included a complete blood count (including a platelet count, prothrombin time and international normalized ratio for cases planned under regional anaesthesia), serum sodium, potassium, urea and creatinine levels. All of these parameters were within normal ranges. For the surgery, the patient was put in right lateral position with a padded support below the left elbow with the shoulder abducted at 90 degrees for the entire duration of the surgery which as mentioned in the report was 130 minutes. There were no episodes of hypotension or hypoxemia in the pre-, intra-or the post-operative periods. Hence, no pre-or intra-operative risk factors for neuropathy was present in the patient. 2 As they have mentioned in their letter, the tourniquet can cause a reversible block distal to it. Also, a more appropriate method of determining the adequate pressure would have been by measuring the limb occlusion pressure rather than using 250 mm of Mercury pressure. 3 However, we think that it is unlikely for the tourniquet to have caused the delayed recovery in this case since the block had persisted even above the site of its application (C5 to T1 dermatomes) till week three. 4 Secondly, as pointed out and as we have mentioned in the discussion of the case report, an early nerve conduction study (before three to four weeks) may be normal. 5 By week three after the administration of the block, the patient had started to develop paresthesia. He was advised for a repeat nerve conduction test by the neurologist but he declined to it. He had made a valid point that the clinical management would not change with the results of the test and had opted to wait for a few more weeks. By the sixth week, the patient had recovered sensation of the entire upper limb with partial recovery of the motor functions.
Journal of Institute of Medicine Nepal, 2019
The tumor of brain near or within the eloquent brain regions like motor and language cortex requi... more The tumor of brain near or within the eloquent brain regions like motor and language cortex requires excision of tumor and at the same time preservation of the functional area. To achieve the second goal the awake craniotomy is being practiced where the aim is to make the patient awake during resection of tumor so that the motor and speech function can be constantly monitored. We present the anaesthetic management of a case of craniotomy for low grade oligodendroma in frontal region with the awake throughout technique.
Journal of Nepal Medical Association, 2015
Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory ... more Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management. Keywords: anaesthetic management; takayasu’s arteritis.
Journal of Advances in Internal Medicine, 2019
Background and Aims: Use of point-of-care ultrasound (POCUS) in acute care setting has rapidly in... more Background and Aims: Use of point-of-care ultrasound (POCUS) in acute care setting has rapidly increased and has potentials to guide patient management. This survey study aims to explore the usefulness of a one-day workshop and to elicit the perceived barriers for effective use of POCUS. Methods: A total of 169 doctors who had attended one day Acute Care Ultrasound workshop were approached through email. Online link to access the survey created using Google forms was sent. The survey contained questions related to the details about the participants, feedback about the workshop, whether the workshop has helped to change the practice of the participants, availability of ultrasound machine during the daily practice and the perceived barriers for use of POCUS. Results: A total of 41 responses were obtained. Majority of the participants had anaesthesiology as the base specialty followed by general practice. Most of them had ICU as their predominant working place, followed by emergency ro...
Oxford Medical Case Reports, 2020
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2020
Pre-designed self administered questionnaire was used to collect information on pain management p... more Pre-designed self administered questionnaire was used to collect information on pain management practice and perceived barriers. The practice questionnaire consisted of close-ended questions and the barrier questionnaire was in the form of 5-point Likert scale. For each item, frequency of scales 1, 2 and 3 were combined as negative
Journal of Nepalese Society of Critical Care Medicine
Background and aims: Mannitol is commonly used to reduce elevated intracranial pressure (ICP) in ... more Background and aims: Mannitol is commonly used to reduce elevated intracranial pressure (ICP) in patients with traumatic brain injury, intracranial hemorrhage and acute cerebrovascular accident. Optic nerve sheath diameter (ONSD) has high sensitivity and specificity in diagnosing raised ICP. This study aims to evaluate effect of Mannitol on ONSD in patients with raised ICP. Methods: This was a prospective cohort observational study of adult patients receiving osmotherapy for increased ICP admitted to the ICU. Baseline ONSD (T1) was recorded bilaterally followed by administration of Mannitol. ONSD was remeasured bilaterally at 30 (T2), 60 (T3) and 120 (T4) minutes after completion of administration of mannitol. Peak inspiratory pressures and PEEP were recorded for patients on mechanical ventilation. Results: Of the 40 patients included in the study, the mean age of patients was 54.03 ±19.15 years. Among them 26 were mechanically ventilated. Compared to the baseline values of 6.1 ± 0....
Grande Medical Journal, 2020
Journal of Nepal Health Research Council, Jul 4, 2018
Takayasu's arteritis is a well known yet rare form of large vessel vasculitis. 1 This inflamm... more Takayasu's arteritis is a well known yet rare form of large vessel vasculitis. 1 This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. 2 Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. 1 We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management.
Journal of Institute of Medicine, 2020
IntroductionPostoperative sore throat (POST) has a reported incidence of up to 62% following gene... more IntroductionPostoperative 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.MethodsThe 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.ResultsThe overall incidence of...
A patient can present with persistent pain even after vertebral compression fracture augmentation... more A patient can present with persistent pain even after vertebral compression fracture augmentation procedures. We report a case of a patient of carcinoma breast with L1 vertebral metastasis and fracture for which vertebroplasty was performed abroad. The patient had severe pain even after the procedure and multiple therapies. The patient’s pain was finally relieved with radiofrequency ablation of target medial branch, which highlights the importance of facet joint as source of pain generator in such group of patients. Key words : Compression fracture, facet joint
Journal of Chitwan Medical College, 2020
Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Combi... more Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Combined Spinal Epidural Anaesthesia (CSEA) technique and Continuous epidural anaesthesia both have been extensively used in elective gynaecological surgeries. This prospective cross-sectional comparative study was designed to compare the quality of anaesthesia between CSEA and Epidural anaesthesia. Methods: Sixty-four patients between age group 15- 65 years of ASA grade I, II were randomly divided into 2 groups. Group A patients received CSEA using “double needle double interspace technique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block with catheter using 10 ml of 0.5% plain bupivacaine. In all patients, subsequent dosage of 2 ml per unblocked segment 0.5% plain bupivacaine was administered through the epidural catheter to achieve a block up to T4-5. Mean was calculated using t-test, median with Mann Whitney U test and Ch...
Nepal Medical College Journal, 2020
Infective etiologies are the first differentials that come to the mind in clinical conditions pre... more Infective etiologies are the first differentials that come to the mind in clinical conditions presenting with diarrhea associated with encephalopathy. We report a case of a 21 year old lady diagnosed as acute infective gastroenteritis and treated for the same only to manifest itself later as encephalopathy leading to a diagnostic dilemma. The clinical manifestations had started from abdominal cramps, bloody diarrhea followed by altered sensorium. A detailed history later revealed the use of the roots of Abrus precatorius for the treatment of sub-fertility was the missing piece of the diagnostic puzzle. Only after confirmation of the herb did the temporal sequence of events seemed logical. The patient was successfully managed for toxic acute disseminated encephalomyelitis (ADEM). Abrus precatorius is a commonly used herb used in traditional medicinal practice in many cultures. Various aspects of its toxicity can mimic other more commonly encountered medical ailments.
Journal of Kathmandu Medical College, 2020
Background: Spinal anesthesia is the preferred technique of anesthesia employed for caesarean sec... more Background: Spinal anesthesia is the preferred technique of anesthesia employed for caesarean sections. However, it is very often complicated by hypotension. Different drugs and techniques have been used to prevent the hypotension induced by spinal anesthesia. In this study, the effect of ondansetron on the prevention of hypotension after spinal anesthesia was evaluated. Objectives: To determine the effect of prophylactic ondansetron on prevention of spinal induced hypotension in elective caesarean section. Methodology: Eighty-six parturients planned for elective caesarean deliveries were randomized into two groups of 43 each. Group O received Ondansetron 4 mg (4 ml) and Group S received Normal Saline (4 ml) intravenously 10 minutes prior to spinal anesthesia. Blood pressure, heart rate, phenylephrine requirements, occurrence of nausea and vomiting and APGAR scores of neonates were compared between the groups. Hemodynamic data was analyzed using Student’s t-test for intergroup compa...
Oxford Medical Case Reports, 2020
Peripheral route for administration of vasopressors is often opted due to resource limitations or... more Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.
Toxicology Reports, 2020
Nitrobenzene can cause life threatening methaemoglobinemia. Its management includes the use of in... more Nitrobenzene can cause life threatening methaemoglobinemia. Its management includes the use of intravenous methylene blue to reduce the iron moiety from its ferric to ferrous state. Due to unavailability of intravenous preparation, enteral methylene blue was used in our case. This case report is to highlight that even oral preparations can be successfully used in a resource limited setting where often intravenous preparations are unavailable.
Anesthesia & Analgesia, 2020
REFERENCES 1. Barrington MJ, Seah GJ, Gotmaker R, Lim D, Byrne K. Quality of recovery after breas... more REFERENCES 1. Barrington MJ, Seah GJ, Gotmaker R, Lim D, Byrne K. Quality of recovery after breast surgery: a multicenter randomized clinical trial comparing pectoral nerves interfascial plane (pectoral nerves II) block with surgical infiltration. Anesth Analg. 2020;130:1559–1567. 2. Maniker RB, Johnson RL, Tran DQ. Interfacial plane blocks for breast surgery: which surgery to block, and which block to choose? Anesth Analg. 2020;130:1556–1558. 3. Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative breast analgesia: a qualitative review of anatomy and regional techniques. Reg Anesth Pain Med. 2017;42:609–631. 4. Thallaj AK, Al Harbi MK, Alzahrani TA, El-Tallawy SN, Alsaif AA, Alnajjar M. Ultrasound imaging accurately identifies the intercostobrachial nerve. Saudi Med J. 2015;36:1241–1244. 5. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61–65.
Radiology Case Reports, 2020
Gall bladder (GB) perforation can be misdiagnosed as any other more common cause of acute abdomen... more Gall bladder (GB) perforation can be misdiagnosed as any other more common cause of acute abdomen. We present a case of a 72-year-female who had presented to the emergency department with an acute abdomen. The clinical presentation and the biochemical markers had pointed towards acute pancreatitis. However, the ultrasonographic examination of the abdomen and the pelvis suggested GB perforation which was confirmed by the multislice computerized tomography scan. Following this the patient underwent open cholecystectomy and was successfully managed. The invaluable contributions from the radiological modalities led to the successful management of the patient.
Anaesthesia, Pain & Intensive Care, 2020
Pain is one of the most common symptoms of patients visiting the hospital. The prevalence of chro... more Pain is one of the most common symptoms of patients visiting the hospital. The prevalence of chronic pain is estimated to be around 30%. Pain management service is a separate service provided by healthcare institutions to manage such chronic pain and has become essential service in most of the countries. Nepal has also started to provide services for patients with chronic pain through pain management clinics.
Local and Regional Anesthesia, 2020
We appreciate their effort and knowledge with which they have raised their concerns regarding the... more We appreciate their effort and knowledge with which they have raised their concerns regarding the case report. Firstly, the patient had an American Society of Anesthesiologists, Physical Status (ASA PS) class I status as mentioned in the case description. Thus, it goes without mentioning that the patient was a non-smoking healthy individual with no known co-morbidities, no alcohol use and a body mass index within normal ranges. 1 To add, he had undergone a pre-anaesthetic assessment before surgery with investigations as per the institutional practice which included a complete blood count (including a platelet count, prothrombin time and international normalized ratio for cases planned under regional anaesthesia), serum sodium, potassium, urea and creatinine levels. All of these parameters were within normal ranges. For the surgery, the patient was put in right lateral position with a padded support below the left elbow with the shoulder abducted at 90 degrees for the entire duration of the surgery which as mentioned in the report was 130 minutes. There were no episodes of hypotension or hypoxemia in the pre-, intra-or the post-operative periods. Hence, no pre-or intra-operative risk factors for neuropathy was present in the patient. 2 As they have mentioned in their letter, the tourniquet can cause a reversible block distal to it. Also, a more appropriate method of determining the adequate pressure would have been by measuring the limb occlusion pressure rather than using 250 mm of Mercury pressure. 3 However, we think that it is unlikely for the tourniquet to have caused the delayed recovery in this case since the block had persisted even above the site of its application (C5 to T1 dermatomes) till week three. 4 Secondly, as pointed out and as we have mentioned in the discussion of the case report, an early nerve conduction study (before three to four weeks) may be normal. 5 By week three after the administration of the block, the patient had started to develop paresthesia. He was advised for a repeat nerve conduction test by the neurologist but he declined to it. He had made a valid point that the clinical management would not change with the results of the test and had opted to wait for a few more weeks. By the sixth week, the patient had recovered sensation of the entire upper limb with partial recovery of the motor functions.
Journal of Institute of Medicine Nepal, 2019
The tumor of brain near or within the eloquent brain regions like motor and language cortex requi... more The tumor of brain near or within the eloquent brain regions like motor and language cortex requires excision of tumor and at the same time preservation of the functional area. To achieve the second goal the awake craniotomy is being practiced where the aim is to make the patient awake during resection of tumor so that the motor and speech function can be constantly monitored. We present the anaesthetic management of a case of craniotomy for low grade oligodendroma in frontal region with the awake throughout technique.
Journal of Nepal Medical Association, 2015
Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory ... more Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management. Keywords: anaesthetic management; takayasu’s arteritis.
Journal of Advances in Internal Medicine, 2019
Background and Aims: Use of point-of-care ultrasound (POCUS) in acute care setting has rapidly in... more Background and Aims: Use of point-of-care ultrasound (POCUS) in acute care setting has rapidly increased and has potentials to guide patient management. This survey study aims to explore the usefulness of a one-day workshop and to elicit the perceived barriers for effective use of POCUS. Methods: A total of 169 doctors who had attended one day Acute Care Ultrasound workshop were approached through email. Online link to access the survey created using Google forms was sent. The survey contained questions related to the details about the participants, feedback about the workshop, whether the workshop has helped to change the practice of the participants, availability of ultrasound machine during the daily practice and the perceived barriers for use of POCUS. Results: A total of 41 responses were obtained. Majority of the participants had anaesthesiology as the base specialty followed by general practice. Most of them had ICU as their predominant working place, followed by emergency ro...
Oxford Medical Case Reports, 2020
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2020
Pre-designed self administered questionnaire was used to collect information on pain management p... more Pre-designed self administered questionnaire was used to collect information on pain management practice and perceived barriers. The practice questionnaire consisted of close-ended questions and the barrier questionnaire was in the form of 5-point Likert scale. For each item, frequency of scales 1, 2 and 3 were combined as negative