The effect of intraoperative lidocaine infusion on opioid consumption and pain after totally extraperitoneal laparoscopic inguinal hernioplasty: a randomized controlled trial.

Background: As a component of multimodal analgesia, the administration of systemic lidocaine is a well-known technique. We aimed to evaluate the efficacy of lidocaine infusion on postoperative pain-related outcomes in patients undergoing totally extraperitoneal (TEP) laparoscopies inguinal hernioplasty.

Methods: In this randomized controlled double-blind study, we recruited 64 patients to receive either lidocaine 2% (intravenous bolus 1.

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial.

Background: As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy.

Butorphanol in Labour Analgesia.

Introduction: Labour is the process where uterine contractions lead to expulsion of product of conception through the vagina into the outer world. Labour pain is one of the most severe pains which has ever been evaluated and its fear is one of the reasons women wouldn't go for natural delivery. Delivery is a painful experience for all of the women except a few of them.

Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study.

Background: Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae.

Methods: The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections.

Effect of long term high altitude exposure on cardiovascular autonomic adjustment during rest and post-exercise recovery.

Background: Despite the successful adaptation to high altitude, some differences do occur due to long term exposure to the hypoxic environment. The effect of long term high altitude exposure on cardiac autonomic adjustment during basal and post-exercise recovery is less known. Thus we aimed to study the differences in basal cardiac autonomic adjustment and its response to exercise in highlanders and to compare it with lowlanders.

Prediction of Difficult Airway Among Patients Requiring Endotracheal Intubation in a Tertiary Care Hospital in Eastern Nepal.

Introduction: Various screening tests are done for predicting difficult laryngoscopy with variable diagnostic accuracy. Difficult laryngoscopy is being considered a surrogate indicator of difficult intubation, though it is not the exact measure of intubation difficulty. Our objectives were to find out the better predictor of difficult laryngoscopy amongst the routinely used tests and also to find the ability of difficult laryngoscopy to predict difficult intubation.

The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary Intensive Care Unit of a tertiary care center in Nepal.

Aim: C-reactive protein (CRP) is a commonly used biomarker of sepsis, the leading cause of mortality in Intensive Care Units (ICUs). However, sufficient data are still lacking to strongly recommend it in clinical practice. The present study is aimed to find out its reliability in diagnosing sepsis.

Intubation techniques: preferences of maxillofacial trauma surgeons.

Objective: To evaluate the clinical outcomes of alternative techniques of intubation in patients sustaining maxillofacial injuries, where nasotracheal intubation (NTI) is best avoided.

Material And Methods: Alternative techniques to standard naso-tracheal intubation like submental intubation, orotracheal intubation-retrotuberosity/retromolar and missing dentition were used and variables of clinical outcome recorded.

Results: Submental intubation provides an unobstructed intraoral surgical field, avoids intraoperative and postoperative complications of tracheostomy, and overcomes the disadvantages of NTI.

Premedication with oral alprazolam and melatonin combination: a comparison with either alone--a randomized controlled factorial trial.

We assessed if the addition of melatonin to alprazolam has superior premedication effects compared to either drug alone. A prospective, double blind placebo controlled trial randomly assigned 80 adult patients (ASA 1&2) with a Visual Analogue Score (VAS) for anxiety ≥ 3 to receive a tablet containing a combination of alprazolam 0.5 mg and melatonin 3 mg, alprazolam 0.

Intraoperative alcohol withdrawal syndrome: a coincidence or precipitation?

As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome (AWS) is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A 61-year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture.

Drug-Induced Ocular Hypertension and Angle-Closure Glaucoma.

The objective of this study was to review the available literature on the drugs causing ocular hypertension and glaucoma. Electronic literature search was carried out using the Web sites www.pubmed.

Nepalese patients' anxiety and concerns before surgery.

Study Objective: To determine the changes in anxiety level and need for information at three different time points before surgery.

Design: Prospective observational study.

Setting: Ward (T(1)), preoperative holding area (T(2)), and operating room (T(3)) of a university hospital.

Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case.

Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a 16-year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity. Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS.

Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore.

Context: Mechanical ventilation with positive end expiratory pressure (PEEP) is associated with unequal aeration of lungs in acute respiratory distress syndrome (ARDS) patients. Therefore, patients may develop asymmetric atelectasis and postural hypoxemia during lateral positioning.

Aims: To validate proposed lung infiltration score (LIS) based on chest x-ray to predict postural hypoxemia and lateralization of skin sores in ARDS patients.

Chronic pain and cost: an epidemiological study in the communities of Sunsari district of Nepal.

The purpose of the study was to find out the prevalence of chronic pain in economically active population and associated economic loss. This cross-sectional observational study was carried out in 3 VDCs of Sunsari District involving 1730 individuals of 15-64 years age group selected by multistage random sampling. Demographic data, absence or presence of pain, site, severity, duration and relieving measures, approximate expenditure in treating pain and number of days lost due to pain were noted using a preformed questionnaire.

Central neural blocks: a quality assessment of anaesthesia in gynaecological surgeries.

Quality of anaesthetic care can be improved only after identifying the factors contributing to patients' discomforts and dissatisfaction. The purpose of this prospective observational study was to assess the quality of central neural blocks in terms of physiological alterations and undesired events and to find out modifiable factors associated with patients' discomforts and dissatisfaction. Total 204 female patients (ASA I and II) undergoing gynaecological surgeries received either of the subarachnoid block (SAB), combined spinal epidural anaesthesia (CSEA) or lumbar epidural anaesthesia (LEA) depending on the nature of the procedure.