Biomedical subjects

S K Maharjan

Publications and source records attributed to S K Maharjan.

6 recordsLinked to original sources

PubMedDate not supplied

A comparison of haemodynamic response with pethidine vs. butorphanol in open cholecystectomy cases.

OBJECTIVE: The present study was undertaken to compare the haemodynamic responses with pethidine vs. Butorphanol intraoperatively in open cholecystectomy cases in KMCTH. METHOD: In this randomized study, all together 40 patients undergoing routine cholecystectomy surgery were included. Group A received Pethidine 1 mg/kg and Group B received Butorphanol 0.04 mg/kg intraoperatively. Heart rate and blood pressure were recorded before injection of the drug, after injection, before intubation, after intubation, before skin incision, after incision, before extubation and after extubation data analysis was done using independent sample t test. RESULT: Our study showed no statistical significance in haemodynamic responses with either pethidine or Butorphanol in open cholecystectomy cases. CONCLUSION: Both drugs appear equally good analgesics in our study.

Adjuvants, Anesthesia↗

PubMedDate not supplied

Painless delivery--a short experience.

PURPOSE: To determine efficacy and safety a randomized comparison of continuous infusion versus intermittent injection of epidural bupivacaine for labor analgesia was performed in the Maternity Hospital, Thapathali Kathmandu. METHODS: Twenty healthy parturient received a loading dose of 10 ml of epidural 0.1% bupivacaine with 25 mg of pethidine. They were then randomized to receive continuous infusion of 0.1% bupivacaine 10 ml/hour with the help of infusion pump or intermittent injection of 0.1% bupivacaine 10 ml hourly. For breakthrough pain 10 ml of 0.1% bupivacaine top ups given in both groups. The two groups were compared for analgesic efficacy, mode of delivery, patient assessment of analgesia, motor block and other complications. Data analyzed in Pentium III version with SPSS and statistical significance test is done with independent samples t-test. RESULTS: The 10 patients in each group were comparable in age but not in parity. Analgesic efficacy was excellent in 10 cases and comfortable in another 10 cases [excellent/comfortable 6:4 with infusion and 4:6 with intermittent injection]. There were no statistically significant differences between groups in pain scores or duration of active first or second stage of labor. Fifteen women had spontaneous vaginal deliveries, one caesarian section (infusion group) and four instrumental deliveries (intermittent injection group). Four women in the infusion group had hypotension and motor block, but none in the intermittent injection group. APGAR scores in both groups were 7-8/10 at 1 minute and 9-10/10 at 5 minutes. CONCLUSION: Both continuous infusion and intermittent injection of low dose bupivacaine are very good methods of relieving labor pain in our context. Analgesic efficacy was similar in both groups and there was no prolongation of second stage of labor.

Adult↗

PubMedDate not supplied

Three in one block for unilateral knee arthrotomy in an old lady.

An old lady having septic arthritis of right knee joint underwent arthrotomy under three in one block for femoral, obturator and lateral cutaneous nerve of thigh in inguinal region, with catheter in situ. She was a case of chronic obstructive airway disease with ischaemic heart disease, so operation and postoperative pain management was planned under regional block. Anaesthesia was started by giving regional block with 0.25% bupivacaine at first and maintained with intermittent injection of 0.125% bupivacaine. The patient was pain free and comfortable though out the perioperative period.

Aged↗

PubMedDate not supplied

Supraclavicular brachial plexus block with and without dexamethasone - a comparative study.

UNLABELLED: To compare the analgesic efficacy of local aesthetic with and without dexamethasone in supraclavicular brachial plexus block. METHODS: Forty patients undergoing arm, forearm and hand surgeries were randomly selected. The forty patients were divided in two groups of 20 each. In-group one, a brachial plexus block was done with 40-50 ml of local anaesthetic with 1:200,000 adrenaline and in the other group the block was performed with the same amount of local anaesthetics with dexamethasone. The onset of action and duration of analgesia in the two groups were compared and any complications of the procedure were noted. Statistical analysis was done using the independent sample t-test. RESULTS: The two groups were comparable in respect to age, sex, and weight. There was significant faster onset of action and prolonged duration of analgesia in the dexamethasone group than in the other group. There were no complications. CONCLUSION: Addition of dexamethasone for brachial plexus block significantly prolongs the duration of analgesia without any unwanted effects.

Adolescent↗

PubMedDate not supplied

A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: insertion characteristics and complications.

OBJECTIVE: The study was designed to compare the insertion characteristics and incidence of PDPH between 25 gauge Quincke needle and 26 gauge Eldor needle for spinal anaesthesia in elective c/s. METHOD: 60 pregnant women (aged 19-35 yrs and weighing 58 -67 kg) undergoing elective caesarean section were randomized into group A (Quincke spinal needle group) or group B (Eldor spinal needle group). Spinal anaesthesia was performed with 2.9 ml 0.5% heavy bupivacaine using 25 gauge Quincke spinal needle in group A and 26 Gauge Eldor spinal needle in group B. Onset, time of first identification of backflow of CSF, number of attempts, level of sensory and motor blockade, failure of anaesthesia, inadequate anaesthesia and incidence of PDPH were recorded. RESULT: Quincke spinal needle was found easy at insertion, first attempt was successful in 90% of cases, whereas Eldor spinal needle was successful at first attempt in only 60% of cases. Early identification of CSF was seen in Eldor spinal needle group in 3.5 seconds vs. 5.2 seconds in Quincke spinal needle group. Blood mixed CSF was seen in 8 Quincke spinal needle group vs. none in Eldor spinal needle group. Onset was similar between both groups i.e. in 6 minutes. Failure of anaesthesia was none in Eldor spinal needle group vs. 2 in quincke spinal needle group. Height of sensory block achieved was T4 level in 26 parturients,T6 in 1 ,T8 in 1 and no anaesthesia at all in another 2 parturient as compared to T4 level in 29 and T3 in 1 parturient in Eldor spinal needle group. The degree of motor block with the use of Bromage criteria showed a motor score of 1 or 2 in 26 parturients in Quincke spinal needle group vs. same in all cases in Eldor spinal needle group. The total incidence of PDPH was 8.3 % (5 out of 60 parturient) which occurred all in Quincke spinal needle group. 2 parturient who developed severe PDPH required epidural blood patch. CONCLUSION: 26 gauge Eldor spinal needle was found to be better than 25 gauge Quincke spinal needle for caesarian sections to decrease the incidence of PDPH, though not all insertion characteristics were in favour of the Eldor needle.

Adult↗

PubMedDate not supplied

Propranolol is effective in decreasing stress response due to airway manipulation and CO2 pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

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.

Adrenergic beta-Antagonists↗