Introduction: Spinal anaesthesia has been widely used for urological operations because it permits early recognition of symptoms caused by overhydration, transurethral resection of prostate syndrome and bladder perforation. Short acting spinal anaesthesia may help to prevent complications associated with delayed immobilization. Our study was undertaken to examine whether adding 25?g fentanyl to bupivacaine would intensify sensory and motor block without prolonging recovery time.Materials and Methods: Ninety American Society of Anaesthesiologists physical status I and II scheduled for elective urological procedures were studied in a double-blinded, randomized prospective manner. Random allocation was done as , Group I (n=30) receiving intrathecal bupivacaine 12.5 mg; Group II (n=30) bupivacaine 10 mg with 25 ?g of fentanyl; and Group III (n=30), bupivacaine 5 mg with 25 ?g of fentanyl. Assessment of sensory, motor block and duration of sensory analgesia was done.Result: There was statistically significant difference regarding total duration of motor block, time for two-segment regression and duration of sensory analgesia between each pair of groups. The duration of motor block, time for two segment regression and duration of sensory analgesia was found to be longest in Group II and shortest in Group III. There were no significant differences in the incidence of complications.Conclusion: Addition of 25 ?g fentanyl to 5 mg bupivacaine resulted in short-acting motor block whereas with 10 mg of bupivacaine, it increased the intensity and duration of motor block, prolonged sensory analgesia and two segment regression time.Journal of Society of Anesthesiologists 2014 1(1): 18-21

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 room and operating room. The workshop was found to be helpful by most of the participants. Majority of the participants (20 participants; 49%) had ultrasound machine sometimes available during their daily practice. Only 20% (8 participants) had ultrasound machine always available during their clinical practice. Similarly, 46% (19 participants) considered lack of access to ultrasound machine as a barrier for application of POCUS. Significant number of participants considered lack of supervision and guidance (18 participants; 44%) and lack of knowledge and skills (13 participants; 32%) as the barriers. Conclusions: Majority of the participants found the one-day workshop helpful. Doctors from various specialty, working in acute care setting had participated in the survey. Limited access to ultrasound machine, together with lack of adequate knowledge and skills were perceived as major barriers for effective use of point-of-care ultrasound.

Background: Laryngeal mask airway insertion requires a certain depth of anesthesia that blunts the airway reflexes. We compared the effectiveness of the trapezius squeezing test with that of the jaw thrust test as clinical indicators of adequate condition for laryngeal mask airway insertion in adults under propofol anesthesia.Methods: In this randomized study, seventy adult patients undergoing surgery with general anesthesia maintained with laryngeal mask airway were randomly allocated to the group T (trapezius squeezing, n = 35) or the group J (jaw thrust, n = 35). The laryngeal mask airway was inserted immediately after the loss of response to trapezius squeezing or jaw thrust.  We recorded successful and unsuccessful attempts. An unsuccessful attempt was defined as development of coughing, SPO2 < 90%, body movements during or within one minute of laryngeal mask airway insertion and failed insertion of laryngeal mask airway. Preparation time for laryngeal mask airway insertion, blood pressure, and heart rate were recorded.Results: The incidence of successful attempts was significantly higher in the group T than in the group J (p-value = 0.002). The time taken for preparation and insertion of laryngeal mask airway, arterial blood pressure and heart rate were comparable in both the groups.Conclusion: This study has demonstrated that the trapezius squeezing test is a superior indicator of an adequate condition for laryngeal mask airway insertion compared to the jaw thrust test in adults.

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia; however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient's records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia,

Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. There is increasing burden of these diseases especially when it comes to a developing country like Nepal. The survey was done to determine the prevalence of Rheumatic heart disease and its burden. Methods: A Community based cross sectional study was done as a part of a demographic survey conducted among the residents of Mathagadi VDC of Palpa district. Cardiac auscultation and transthoracic echocardiography were performed. Abnormal findings on auscultation (murmurs, abnormal heart sounds) were further evaluated with the help of screening echocardiography by Cardiologist. Results: Out of total 2795 people screened, 37 individuals were found to have RHD, confirmed with a 2D echocardiographic findings. Mitral regurgitation was found to be the predominant lesion with 13 cases. Conclusion: The study revealed a large of proportion of cardiovascular diseases in Mathagadi VDC. It became clear that due to lack of proper health services, a large of number of cases may be either undiagnosed or under treated.

Background: Sepsis has been one of the most important conditions for morbidity and mortality of Intensive care unit (ICU) patients. Antibiotics remain one of the major combating factors for it. Indiscriminate antimicrobial usage and poor prescription practices have contributed to the development of multidrug resistant (MDR) organisms. Therefore, the current study was designed to evaluate the spectrum, and susceptibility patterns of pathogens isolated from patients admitted to our Cardiothoracic and Vascular Intensive care unit. Materials and Methods: The study was conducted in Cardiothoracic and Vascular ICU of a tertiary care teaching hospital from February 2019 to March 2021. Samples (blood, urine, wound swab, tracheal aspirate, and central venous catheter tip) for culture were taken from all the patients in Sepsis admitted in Cardiothoracic and Vascular ICU above 18 years of age during the study period. The culture reports (microbiological profile and their susceptibility pattern) were collected and data collection of all enrolled patients was done. Results: Out of the total 128 samples studied 75 (58.5%) were culture positive. The predominant organisms isolated were Gram negative organisms (Klebsiella, Pseudomonas, Acinetobacter, followed by E. coli). The highest prevalence of microbial growth was found in tracheal aspirate (46.8%), followed by blood (21.8%). Antibiotic susceptibility results showed the highest sensitivity of those common pathogens towards higher antibiotics only (especially Polymyxin B and Colistin). Conclusion: The emergence of

Introduction European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Its relevance has been validated in European, Asian countries and also in Nepal. Its limitations led to development of EuroSCORE II. This study was carried out to compare EuroSCORE II with EuroSCORE in Nepalese cardiac surgical patients. MethodsA retrospective analytical cohort study of 3 years duration in 972 adult cardiac surgeries was conducted. Scores obtained from EuroSCORE (Logistic and Additive) and EuroSCORE II was compared with the observed mortality. Calibration was calculated by Hosmer- Lemeshow (H-L) test (Chi Square test) and discrimination by calculating the area under the curve (AUC) of receiver operating characteristics (ROC) curve. ResultsObserved mortality was 4.11%. EuroSCORE additive, logistic and EuroSCORE II predicted mortality were 4.32%, 4.55% and 2.13% respectively. H-L chi square calculation for EuroSCORE additive model could not hold as all observed and expected frequencies match exactly. Hence it can be considered as a good fit. EuroSCORE logistic model (H-L, Chi-square 7.743, p<0.001) and EuroSCORE II (H-L, Chi-square 11.631, p = 0.168) also showed good fit i.e. both can predict mortality satisfactorily. AUC of ROC curve of EuroSCORE additive, logistic and EuroSCORE II were 0.632, 0.636 and 0.616 respectively, which showed fair discrimination power. ConclusionMortality prediction of adult cardiac surgical patients by EuroSCORE (additive and logistic) and EuroSCORE II was satisfactory.