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Introduction: The pneumoperitoneum created during laparoscopic surgery has numerous effects on the patient ranging from respiratory to hemodynamics. The two common methods of ventilator are volume control and pressure control. The volume control method has been commonly used during general anesthesia. Pressure control method has been used in intensive care unit for improving the respiratory mechanics. Objective: The study aims to compare the effects of pressure control to volume control ventilation in patients undergoing laparoscopic surgery. The hypothesis of the study is that pressure control method improves the respiratory mechanics by decreasing the peak airway pressure and increasing the lung compliance. Methodology: The total of 100 patients who underwent laparoscopic surgery were undertaken for this study. The 50 in each group (PCV and VCV) were allotted randomly. As per predicted body weight, the tidal volume was adjusted to 8 ml/kg, for both the modes of ventilation, peep 5 mm of Hg with fio2 of 100% and I:E-1:2,. The variations in peak airway pressure, mean airway pressure, lung compliance, SPO2 and hemodynamic parameters were observed at baseline (T1), at pneumoperitoneum (T2), after 10 minutes of pneumoperitonium (T3) and at 20 minutes after pneumoperitonium (T4). Results: The pressure control group on comparison to volume control mode group showed significant decrease in peak airway pressure while increase in mean airway pressure and increase in lung compliance at different points of pneumoperitoneum. However there was no significant change in hemodynamics between the two groups in patient undergoing laparoscopic surgery. Conclusion: We conclude that respiratory mechanics improve when the patient is on pressure control ventilation in compared to volume control method of ventilation. Whereas there is no difference in hemodynamic parameters between the two methods.

Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe COVID pneumonia. The study compares the use methylprednisolone and dexamethasone as an adjuvant steroid therapy in severe COVID-19 pneumonia. Methods: Prospective comparative study including total of 190 COVID-19 severe pneumonia cases admitted in intensive care unit with 93 patients randomly allocated to receive dexamethasone 6 mg and 97 patients allocated to receive methylprednisolone 1mg/kg in two divided doses both by intravenous route for 7 days. Mortality was compared as primary objective while oxygenation parameters and inflammatory markers, need for invasive mechanical ventilation, duration of ventilation, length of ICU-stay, incidence of multiorgan failure were assessed as secondary variables. Results: At day zero, the patient in methylprednisolone group had significantly lower PaO2/FIO2 ratio (258.3950.36 vs 285.1868.62, P=0.002). At day seven, methylprednisolone significantly improved PaO2/FIO2 ratio (266.5260.73 vs 244.8175.36, P=0.029) and there was substantial decrease in inflammatory markers CRP, Ferritin (P

Introduction: Subglottic secretion drainage reduces the incidence of ventilator associated pneumonia (VAP). The efficacy of Continuous subglottic secretion drainage (CSSD) over Intermittent subglottic secretion drainage (ISSD) for prevention of VAP is unknown. Objectives: Compare the efficacy of CSSD and ISSD in terms of incidence of VAP, mortality, duration of mechanical ventilation, length of ICU stay and incidence of reintubation. Methodology: This was a prospective comparative study conducted at Birat Medical College and Teaching Hospital. A total number of 80 intubated patients for at least 48 hours duration were included. Continuous and intermittent endotracheal suctioning techniques were compared for prevention of VAP and secondary outcomes in terms of length of mechanical ventilation, length of ICU stay, multiorgan failure, reintubation and mortality rate. Results: The incidence of VAP was 15% and 22.5 % in CSSD group while it was 17.5% and 27.5% in ISSD group in first 48 hours and 96 hours of mechanical ventilation respectively.The length of mechanical ventilation was significantly less in continuous group (4.78 ± 2.50 days) than in intermittent group (7.18 ± 2.09 days) with p value of 0.023. The patients with CSSD had significantly shorter ICU stay (5.49 ± 3.16 days) as compared to the patients with ISSD (8.46 ± 2.06 days). The incidence of reintubation was significantly higher in intermittent group patients (p value 0.024). Patients in both the group had comparable incidence of multiorgan failure, spontaneous breathing trial and mortality rate. Conclusion: The incidences of VAP and mortality were comparable in CSSD and ISSD. However CSSD significantly decreased the duration of mechanical ventilation, length of ICU stay and incidence of reintubation..

Introduction: Delirium is underdiagnosed especially in ICU. In a study done in the Netherlands investigators found not only ICU nurses but also intensivists had difficulty in diagnosing delirium. With the impact that delirium has on patients’ health, its monitoring and detection should be considered an integral part of patient care in critical care medicine, Knowledge and attitude are one of the primary unmet needs regarding early detection and treatment of delirium. Since nurses are the first line assessors in any ward we would like to carry out this cross-sectional survey on a group of nurses. Objective: To assess the nurses’ knowledge about delirium & to compare the knowledge between those that have worked in ICU or critical care to those who haven’t. Methodology: This was a cross-sectional survey carried out at Birat medical college and teaching hospital. Here all nurses were requested to fill a questionnaire that consisted of 15 questions. A time-frame of 1 week was taken to gather the data. Results: We collected data from 124 nurses, who had varying educational degrees, Eighty-four were currently working in an ICU and 32.5% of those not working had previously worked in an ICU. Over all knowledge level for nurses was poor where 94 of 124 nurses had less than 50% scores. About 27% of those who had worked in an ICU setting had good knowledge compared to 17.5% of those who had not. Conclusion: Training regarding delirium is required to increase identification and adequate management to decrease morbidity due to delirium.

Background: Epidemiological data on critically ill patients is crucial for understanding resource utilisation, gaps in quality of care and for supporting surveillance of endemic or emerging diseases. We report the epidemiology of critically ill patients from 17 intensive care units (ICUs) in Nepal using an established and standardised ICU registry. Methods: The ICU registry data is collected prospectively and includes data on case mix, severity, organ support and outcomes. We conducted a retrospective observational study with all adult (≥18 years) critically ill patients admitted to 17 ICUs in Nepal between September 2019 and September 2022. We report on case mix, treatment received, severity of illness, standardised mortality rates (SMR), discharge outcomes and ICU service activity. Descriptive statistics were used to report the findings. Results: Of the 18603 unique admissions, 14% were operative, with 35% emergency surgeries. Patients’ median age was 57 (IQR 40-71) and 59% were male. Hypertension and diabetes were common comorbidities and pneumonia accounted for 26% of all admissions. During the ICU stay, 39% of patients received mechanical ventilation, 29% received vasoactive medication and 10% received renal replacement therapy. The median predicted risk of death was 0.1 (IQR 0.1-0.3) using APACHE II and 0.2 (IQR 0.1-0.4) using eTropICS. The median SMR was 0.7 (IQR 0.5-0.8) and 0.8 (IQR 0.6-1.4) using eTropICS and APACHE II, respectively. Median length of stay was 4 days (IQR 2-7). Eighteen percent died in the ICU; of those alive at discharge, 12% went home, 84% went to another department and 3% went to another hospital. COVID-19 was the most common notifiable disease reported (12% of all admissions). Median ICU turnover was 9% (IQR 6-14) with bed capacity ranging from 43-278. Conclusions: These findings should guide forecasting and service planning to ensure ICUs can optimally care for critically ill patients in Nepal.

No abstract available.

Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia. Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI > 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups. Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study. Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI > 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value. Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001). Conclusion : This study demonstrates that baseline PI of > 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of < 3.5.

Introduction: Stroke is life threatening & debilitating neurological disease, defined as focal neurological deficit of sudden onset lasting >24 hours & vascular in origin. Significant association between ischemic type of stroke with carotid artery disease seen, more prevalent with carotid artery stenosis. Objectives: This study was done to show association between extracranial carotid artery disease & cerebrovascular accidents (CVAs) with the help of Color Doppler Sonography (CDS). The association between carotid artery disease with associated risk factors were also assessed. Methodology: In this ethically approved prospective study, carotid CDS was done in 79 consecutive patients with diagnosis of acute ischemic stroke (AIS). The various parameters studied included peak systolic velocity (PSV) of internal carotid artery (ICA) & common carotid artery (CCA), ICA/CCA PSV ratio & plaque characteristics. The data collected was analyzed with appropriate statistical test of significance was calculated. Results: Total 79 patients with AIS included out of which 53 were males & 26 were females. The most common presenting complains were hemiparesis (30.4%) & most commonly associated risk factors included hypertension (62.02%). Right sided strokes were most common (44.3%) & middle cerebral artery was most commonly involved vascular territory. Significant stenosis (≥50%) of carotid artery was seen in 27 patients with ICA most common site (45.8%) for plaque formation. Bilateral carotid artery involvement (52.1%) with hypoechoic echotexture of atheromatous plaques (46.6%) was most responsible for significant stenosis & increased intima media thickness. Increased value of PSV & EDV was seen in the stenotic area in the proportion of stenosis with increased PSV ICA/CCA ratio of more than three indicates >60% stenosis. Conclusion: The present study showed well documented role of carotid doppler in detection of site & extent of carotid artery stenosis due to atheromatous plaques of various characteristics playing critical role in thromboembolic phenomenon responsible for development of stroke.

Introduction: Dexmedetomidine has an ideal pharmacodynamic profile for attenuation of stress response during general anesthesia for laparoscopic cholecystectomy. Since, the value of dexmedetomidine as a single premedication dose remains largely unexplored, this study compared dexmedetomidine in 0.5μg/kg and 1μg/kg dose for laparoscopic cholecystectomy under general anesthesia. Objectives: The primary objective of this study was to compare dexmedetomidine in a single premedication dose of 0.5μg/kg and 1μg/kg in terms of hemodynamic (heart rate and mean arterial pressure) changes to critical incidences such as laryngoscopy, endotracheal intubation, pneumoperitoneum and extubation. The secondary objectives were to compare induction dose of propofol required, sedation scores in the immediate post anesthesia period and adverse events such as bradycardia and hypotension. Methodology: This was a prospective double blind study. Ninety-two patients aged 18-55 years of either gender of American Society of Anesthesiologists physical status I-II were randomly allocated into two groups to receive either Dexmedetomidine 1μg/kg or 0.5μg/kg slowly IV over 10 minutes as a premedication before induction. Heart rate, Mean arterial pressure, induction dose of propofol, sedation scores, and adverse events were compared. Results: The patient characteristics, Fentanyl consumption, duration of surgery and anesthesia in both groups were comparable. There was comparable attenuation of hemodynamics in both groups during laryngoscopy and intubation. Dexmedetomidine in 1μg/kg compared to 0.5μg/kg had significantly better attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum. After 40 minutes, there was no attenuation in either group. The post anesthesia sedation scores were comparable. The induction dose of propofol was significantly less and the incidence of bradycardia was significantly higher with dexmedetomidine 1μg/kg. Conclusion This study demonstrates that a premedication dose of Dexmedetomidine in 1μg/kg compared to 0.5μg/kg has significantly betier attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum.

Introduction: Knowledge and awareness of sepsis among various health care professionals is essential for prompt diagnosis and appropriate initial resuscitation and management of patient with sepsis. Objective: To assess and compare the knowledge and awareness of sepsis among health care professionals working at Birat Medical College and Teaching Hospital. Methodology This was a questionnaire-based survey with comparative study in 200 health care professionals conducted at Birat Medical College and Teaching Hospital from July– September, 2019. Questions were designed to assess the knowledge on diagnosis, initial resuscitation and management of sepsis. The knowledge level of the participants was assessed with scoring system as good, average and poor which was finally compared between the various health care professionals. Result Out of 200, only 180 health care professionals were included for statistical analysis. While assessing the knowledge on diagnosis of sepsis, 55.6% consultant doctors, 42.8% medical officers and 21.5% nursing/paramedics answered correctly on an average. Similarly, 51.7 % consultant doctors, 33.7% medical officers and 26.6% nursing/ paramedics gave correct answers while assessing knowledge on initial resuscitation and management. The nursing/paramedics had comparatively lower knowledge level on sepsis than the doctors. Around 31.7%, 51.2% and 17% of health care professionals working in Emergency, ICU and Anesthesiology departments had good, average and poor knowledge on sepsis respectively as compared to 14.2%, 28.5% and 57.1% of participants working in other departments. Conclusion: The nursing/paramedics had lower knowledge level on sepsis as compared to the doctors while health care professionals working in Emergency,ICU and Anesthesiology departments had better knowledge on sepsis as compared to staffs working in other departments.

Introduction: Electrolyte and hemoglobin measurement are the integral part of management of critically ill patient. There can be a wide variation in the electrolyte and hemoglobin measurement in critically ill patient between arterial blood gas analyzer and central laboratory auto analyzer. Objective: To compare the electrolytes (sodium, potassium and chloride) and hemoglobin level measured by arterial blood gas analyzer and laboratory analyzer. Methodology: This was a prospective cross-sectional comparative study comparing the electrolytes (sodium, potassium and chloride) and hemoglobin measurement between arterial blood gas analyzer and laboratory auto analyzer. The study included 124 paired blood samples from the patient admitted in intensive care unit of Birat Medical College Teaching Hospital in two months duration. The arterial sample and venous sample for electrolytes and hemoglobin measurement were taken simultaneously or not more than one hour apart and analysis was done by arterial blood gas analyzer and central laboratory auto analyzer accordingly. The values of electrolytes and hemoglobin measured by two different analyzers were finally compared for variation. Result: The mean difference calculated for sodium potassium and chloride in ABG machine and Auto-analyzers were 0.57 mmol/l.-0.04mmol/l and 1.71mmol/l respectively. These data were within the acceptable range of United States Clinical Laboratory Improvement Amendments(USCLIA). The mean difference derived for hemoglobin in ABG and Auto-analyzers was 0.16g/dl which was not consistent with the range of United States Clinical Laboratory Improvement Amendments (USCLIA) Conclusion: The measurement of electrolyte namely sodium, potassium and chloride in ABG machines and Auto-analyzers of central lab were comparable while hemoglobin was not comparable under the USCLIA guidelines.

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points. Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

DOI: https://doi.org/10.3126/bjhs.v4i1.23949 Introduction: It is essential that all the medical professionals should have adequate skill for basic life support (BLS) for better outcome of cardiac arrest patients. The objective of the study is to assess the knowledge and awareness of BLS among the medical doctors, nursing staffs and health care paramedics working in Birat Medical College and Teaching Hospital, Biratnagar. Methodology: A three-month duration observational questionnaire-based survey was conducted at Birat Medical College and Teaching Hospital, Biratnagar to assess the knowledge, awareness of basic life support among the medical doctors, nursing staffs and health care paramedics. A total of ten questions were designed to assess the knowledge and awareness regarding BLS skill. Three questions were designed to assess the previous experiences on cardiac arrest situation and BLS training. Similarly, two additional questions were added to assess the self-grading of BLS knowledge which included poor, below average, good and excellent. Result: It was observed that only 14% participants had previous BLS training. Surprisingly, 76% of the participants had encountered cardiac arrest situation in their clinical practice but they were managing those cases with limited knowledge on BLS. The correct answer to the self-structured questionnaire were ticked by less than 50% of participants and majority of the participants came below average on self-grading of the knowledge and awareness suggesting the need of easy accessibility of BLS training centers in the eastern part of Nepal. Conclusion: This study revealed that the knowledge and awareness of basic life support skills among the various staffs was mostly below average to poor. Significant amount of cost effective BLS trainings must be conducted so as to develop competent staffs by various training centers Keywords: Awareness, basic life support, cardiopulmonary resuscitation, knowledge

Central venous catheterization is one of the common procedures used for gaining vascular access for various indications. Sometimes, the catheter can take unusual course inside the vein that can lead to erroneous pressure measurement, increase the risk of thrombosis or trauma to the vessel. Any resistance during insertion of the guide wire or catheter and absence of blood aspiration are some alarming signs that help to detect malposition at the earliest moment. We report a case of coiling of the shaft of the central venous catheter inside left sublacvian vein in a patient with head injury. Technical expertise, sound knowledge of anatomical landmarks and use of real time ultrasound can minimize malposition of the catheter. We suggest at any moment if there is resistance during insertion of guide wire or catheter or if there is absence of blood aspiration from any of the lumen, the catheter should be removed immediately suspecting malposition.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 87-90

Introduction: Dexmedetomidine and midazolam are frequently used to maintain sedation in mechanically ventilated patient in intensive care unit. The study compared dexmedetomidine and midazolam infusion in mechanically ventilated patient in terms providing effective sedation. Methods: This was one year prospec­tive comparative study conducted in 130 mechanically ventilated patients who were randomly divided in two groups receiving either dexmedetomidine or midazolam infusion for sedation. Sedation level was assessed by Riker Sedation-Agitation Scale with the aim of maintaining target sedation score of 3 to 4. The two drugs were compared in terms of sedation level in first 24 hours, time required to achieve target sedation level, hemody­namic changes and adverse effects including ICU delirium. The outcome was measured in terms of duration of mechanical ventilation, length of ICU stays and ICU mortality. Results: Both dexmedetomidine and midazolam achieved target sedation level in a comparable time duration. The median sedation level for both the drugs was 4 and 3 in initial 4 and 24 hours respectively. Dexmedetomidne produced significant decrease in blood pressure and heart rate (P=0.044 and P=0.007 respectively). Patients treated with dexmedetomidine had less incidence of ICU delirium (odds ratio=2.669, P=0.029).Dexmedetomidine infusion had significantly shorter duration mechanical ventilation (4.10 ± 2.05 vs. 5.15 ± 2.44, P=0.011), early discharge from ICU (6.05 ± 2.02 vs. 7.48 ± 2.42, p=0.001). ICU mortality was comparable between the groups. Conclusion: Dexmedetomidine and midazolam both were equally effective in maintaining sedation in Critically ill patient. Compared to midazolam, dexmedetomidine could be a preferred sedative in ICU in terms of early removal from mechanical ventilation, early discharge from ICU and less incidence of delirium.

Introduction: The aim of the study was to carry out the comparative study of variations in blood glucose levels intra operatively in patients undergoing surgical procedures in Spinal Anesthesia and General Anesthesia by capillary blood glucose level.Objective: To compare intra operative blood glucose level in Spinal and General Anesthesia.Methodology: Sixty non diabetic patients (30 in each group) aged between 20 – 60 years belonging to ASA I and ASA II status were enrolled for this prospective comparative study. Capillary blood glucose was measured preoperatively and thereafter at 15 minutes interval after incision in Spinal Anesthesia and after induction of General Anesthesia till one hour of surgery. For statistical analysis paired sample t – test was used for comparing mean of quantitative data. Difference was considered statistically significant if p < 0.05.Results: Blood sugar level was well controlled in patients receiving spinal anesthesia. General anesthesia produced more increase in blood sugar level compared to base line value which was statistically significant (P

Introduction: Outpatient anesthesia for the minor day care surgical procedures requires a safe anesthesia and anesthetic agents. For this purpose two study solutions propofol with ketamine (ketofol) and propofol were compared. The comparison of the both agents were assessed, evaluated and discussed in this study. Methodology: This is prospective study of 100 adult patients of both sex aged between 18-60 years with ASA physical status class I and II who were operated in the Birat Medical College teaching hospital. This study was started after approval from the ethical committee of the hospital and after written and informed consent from all participants. All patients were randomly divided into two groups. Group A (n=50) received ketamine with propofol and Group B (n=50) propofol after intravenous sedation with 2 mg of midazolam and 1 mg of butorphanol. The main aim of this study was comparison of onset of sedation, respiratory and cardiac adverse events, level of sedation using Ramsey sedation scale, requirement of sedatives, recovery time, average cost of the sedatives and postoperative complications between the two groups. All collected data are analyzed using MS Excel office 2007 and for the data analysis IBM SPSS software was used. Results: In the both groups patients were comfortable with the either anesthetic agents. Onset of anesthesia was faster in Group A. Intraoperative sedation was measured using Ramsay sedation scale and was comparable. Recovery from sedation was assessed with AVPU scale and patient was shifted to postoperative room after the verbal response. Postoperative complications seen were nausea vomiting, severe pain, ketamine induced psychotomimetic effects and all of these were treated well and discharged on the same day from the hospital. Conclusion: The combination of ketamine and propofol for the sedation in minor surgical procedures has more advantages than the propofol alone. The combination is cost effective, has better sedation and hemodynamic stability, quick recovery and fewer side effects in the post operative room. Birat Journal of Health Sciences Vol.2/No.3/Issue 4/Sep- Dec 2017, Page: 287- 291

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade. Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique. Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique. Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually. Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition. Birat Journal of Health Sciences Vol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

Background: Acute poisoning is a common health-care problem requiring admission in the intensive care unit (ICU) in the developing countries. The study was conducted to assess the epidemiological parameters of acute poisoning and factors affecting clinical course and outcome of the patients in ICU in the eastern part of Nepal. Methodology: This was a prospective observational study conducted at ICU of tertiary care hospital in the eastern part of Nepal for the duration of 2 years. All the acute poisoning cases admitted in the ICU were studied for epidemiological profiles, poisoning characteristics, and various clinical factors affecting the outcome of the patients. Results: Eighty-five patients with acute poisoning were included in the study. Suicidal attempt leading to acute poisoning was seen in majority of the young population. Majority of the poisoning was due to the organophosphorous compounds (43.5%). Patients with organophosphorous poisoning had a significantly longer duration of ICU stay (P = 0.020). The survival of the patients was significantly affected by age, duration of presentation to the hospital, Glasgow Coma Scale, Sequential Organ Failure Assessment score, need for mechanical ventilation, duration of ICU stay, hepatic failure, coagulopathy, and need for vasoactive drugs (P < 0.05). The independent predictors of mortality observed in the study were age, delayed presentation to the hospital, hepatic failure, and need for mechanical ventilation. Conclusion: Organophosphorous poisoning was the most common acute poisoning in young population leading to the ICU admission. Older age, delayed initiation of the resuscitative measures, need for mechanical ventilation, and hepatic failure significantly affected the mortality.

Introduction Cleft lip and palate deformity is the most common congenital birth defect caused by complex genetic and environmental factors. Pre-operative management of these patients is always challenging and anesthesia has a great role for the surgery. Objective The aim of this study is to evaluate the outcomes including pre-operative election of cases, intra-operative and post-operative complications in pediatric patients. Methodology This is retrospective study conducted on cleft lip and palate repair patients between the ages of 3 months to 12 years, operated under general anesthesia during last six years at Morang Co-operative Hospital, Biratnagar, Nepal. Total 570 patients were assessed with preoperative, intra-operative and post-operative parameters, complications and managements. The MS Excel office and SPSS software was used to analyze the data. Results Among 570 patients about one third came from the high mountain and hilly region and the rest from the Tarai. The maximum travel _me to reach the hospital was 2 days. The percentage of cancellation was 22.13% and was mainly due to the respiratory problems. Among 570 patients 352(61.75%) were males. While classifying the cases, 202 cases were presented with only cleft lip, 325 cleft lip and palate combined and 43 patients with isolated cleft palate. Narcotics were not used for analgesia and analgesia maintained with other measures. There was no intra and post-operative death and none of the patient received intra-operative blood transfusion. Conclusion Cleft lip and palate surgery in pediatric patients is possible in any hospitals when trained man power and proper operating and post-operative setup is available. Anesthesia for cleft lip and palate is challenging associated with several complications requiring continuous and vigilant anesthetic supervision and management for the better outcome. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 127-133

Background: Intubating oral airways are widely used during fibreoptic orotracheal intubationin order to improve the bronchoscopic visualisation of the glottis and facilitate the procedure. This study compares the visualisation of the glottic opening with bronchoscope using Berman or Ovassapian intubating airway.Methods: We conducted a randomised comparative prospective study one hundred twenty patients with no clinical indicators of the difficult airway. The two oral intubating Berman and Ovassapian airways were compared during fibreoptic endotracheal intubation in anaesthetized patients. The bronchoscopic view, bronchoscopic time, and the total time for intubation were compared.Result: The bronchoscopic view was significantly better with Berman intubating airway (unobstructed view 74%) as compared to the Ovassapian airway (unobstructed 38.4%) (p-value 0.002). The Berman airway provided a significantly shorter duration for visualisation of the vocal cord and intubation of trachea in comparison to the Ovassapian airway.Conclusion: Berman airway provided a better bronchoscopic view as well as shorter bronchoscopic and intubation time as compared to the Ovassapian airway.