Background: With the advent of anesthesia, surgery is no longer a race against the clock and surgeons. Many studies in the past have demonstrated limited knowledge among patients about various aspects of anesthesia.Objectives: To assess the awareness and concern of elective surgical patients towards anesthesia.Methodology: A cross-sectional questionnaire survey was conducted over two months’ period in adult patients of age eighteen years and above. Two hundred surgical patients accessing services at the pre-anesthesia check-up clinic were interviewed using 12 questions assessing demographic characteristics, educational status and their knowledge about anesthesia.Results: Out of 200 patients, only 32% knew that anesthesiologists provide anesthesia. It was found that 63% didn’t have any knowledge about the types of anesthesia. The most common fear among the participants about anesthesia was the fear of pain during surgery.Conclusion: The study showed poor knowledge of patients regarding anesthesia.

Background Sciatic nerve block used for various surgeries below knee and for maintenance of analgesia demonstrates wide variability regarding its bifurcation into tibial and common peroneal nerves, frequently accounting for incomplete nerve blocks. Objective To determine the variation of sciatic nerve bifurcation among Nepalese volunteers. Method This cross sectional study was conducted in the Department of Anesthesiology of Kathmandu Medical College Teaching Hospital from March to May 2019, where 110 healthy volunteers underwent ultrasonography of sciatic nerve starting from popliteal fossa to its bifurcation. The distance between the bifurcation of sciatic nerve from popliteal crease and depth of the nerve at that point from the skin were measured. Result The mean distance at which sciatic nerve bifurcated from the popliteal crease was 5.42 ± 1.37 cm. Most commonly, the sciatic nerve bifurcated at a distance of 5-7 cm from the popliteal crease in 110 limbs (50.45%). However, in 80 limbs (36.69%), the bifurcation was found at less than 5 cm from the popliteal crease. The depth of the nerve from the skin at the point of bifurcation was 1.72 ± 0.54 cm, with results showing it was deeper in females compared to males (p value < 0.001). Conclusion This study showed that though the distance of sciatic nerve bifurcation from the popliteal crease in our study group was coherent with the published literature of 5-12 cm; many volunteers also had this bifurcation at distances less than 5 cm. Females showed nerves to be deeper at the point of bifurcation than males.

Introduction: Dexmedetomidine has been frequently used in regional anaesthesia to improve the quality of blocks. Addition of dexmedetomidine to local anaesthetics has been shown to hasten the onset of both sensory and motor blocks and also prolong the duration of analgesia. The objective of this prospective comparative study was to assess the change in characteristics of infraclavicular brachial plexus block after adding Inj. Dexmedetomidine to 2% Lignocaine with Adrenaline. Methods: Sixty-six patients, scheduled for upper limb surgeries under ultrasound guided infraclavicular brachial plexus block were randomly allocated to two groups. Group LS received Inj. Lignocaine 2% with Adrenaline, 7mg/kg diluted to 30 ml with saline and Group LD received Inj. Dexmedetomidine 0.75 mcg/kg in addition to Inj. Lignocaine 2% with Adrenaline, 7mg/kg again diluted to a total volume of 30 ml. The parameters studied were: onset of sensory and motor blocks and duration of analgesia. Results: Sixty patients completed the study. The demographic variables and motor block were similar between both groups. The mean time to onset of sensory block was significantly faster in Group LD compared to Group LS (9.80±4.85 min vs 12.30±3.97 min, p=0.033). The duration of analgesia was also found to be prolonged in Group LD compared to Group LS (286.73±55.38 min vs 226.53±41.19 min, p < 0.001). Conclusion: Addition of 0.75 mcg/kg of Dexmedetomidine to 2% Lignocaine with Adrenaline hastens the onset of sensory block and prolongs the duration of analgesia in ultrasound guided and peripheral nerve stimulator guided infraclavicular block.

This is a case series of six obstetric patients who had post-dural puncture headache, resistant to conservative treatment. The onset of post-dural headache in our series on average was on the 34th hour of the procedure. After confirmation of the diagnosis with a typical history of presentation and examination, the patients underwent pharmacological treatment. Post-dural puncture headache, in our series, not relieved by pharmacological treatment underwent epidural blood patch after persistent headache in an average of 5 days post-dural puncture. All patients receiving this therapy had a complete cure of headache at the earliest - from 45 minutes to as late as 11 hours post procedure. Epidural autologous blood instillation in an average of 10 to 11 ml completely relieved the ailment in the primary blood patch. Epidural blood patch is still considered gold standard therapy in persistent post-dural puncture headache.

Background: Increasing the cross sectional area (CSA) of the left internal jugular vein facilitates cannulation and decreases complications. But, the literature is sparse regarding the methods to increase the cross sectional area of the left internal jugular vein.Objective: To assess the changes that occur in cross sectional area of left internal jugular vein after application of different levels of positive end expiratory pressure and compare the findings with right internal jugular vein.Methodology: Sixty-four patients were included. Antero posterior diameter, transverse diameter and cross sectional area of left and right internal jugular vein was measured using two-dimensional ultrasound before the induction of anesthesia and after intubation at positive end expiratory pressure of 0, 5, 10 and 15 cm H2O. Result: The increase in positive end expiratory pressure was associated with increase in cross sectional area, anteroposterior and transverse diameter of left internal jugular vein. At 10 cmH2 Opositive end expiratory pressure, left internal jugular vein cross sectional area increased significantly by 22.8% that is 1.34±0.53cm2(P value< 0.05). The right internal jugular vein is significantly larger than left at baseline and at all levels of studied positive end expiratory pressure. The percentage increase of cross sectional area for both internal jugular veins was similar.Conclusion: The left internal jugular vein cross sectional area increment has direct relationship with increment of positive end expiratory levels at studied points. However, above 10 cm H2O of positive end expiratory pressure, there was only non significant increase (P value > 0.05).