Journal of Society of Anesthesiologists of Nepal <p align="center"><img src="/ojs/public/site/images/jsanorg/Picture1.png"></p> <p align="justify">Journal of Society of Anesthesiologists of Nepal (JSAN) is an official publication of the <a href=""> <u>Society of Anesthesiologists of Nepal (SAN)</u> </a> .</p> <p align="justify">It is an indexed, peer-reviewed, open access medical journal that is published with the aim of highlighting the scientific advances in the field of anaesthesia, intensive care, pain medicine and allied sciences. Open access is funded by the Society of Anesthesiologists of Nepal.</p> <p>The journal provides a platform for anesthesiologists, intensivists and pain practitioners to share their views, finding of their scientific research, and experiences.</p> Society of Anesthesiologists of Nepal (SAN) en-US Journal of Society of Anesthesiologists of Nepal 2362-1281 <p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="CC-BY-4.0" href="" target="_blank">Creative Commons Attribution License</a> (CC BY-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> Original Article Hemodynamic changes during orotracheal intubation using Airtraq video laryngoscope and direct laryngoscope: A randomized comparative study <p><strong>Introduction</strong><strong>:</strong>&nbsp;Direct laryngoscopy is associated with sympathetic stimulation and altered hemodynamics. A long intubation time may result in a greater&nbsp;in stress response. Alternative techniques using video laryngoscopes have been developed that do not require direct vocal cord visualization&nbsp;and may decrease the hemodynamic response. This study aimed&nbsp;to compare the difference between hemodynamic changes and intubation time with Airtraq video laryngoscope and conventionl Macintosh direct laryngoscope.</p> <p><strong>Methods</strong><strong>:</strong>&nbsp;A prospective randomized comparative study was conducted&nbsp;involving 100 adult patients&nbsp;who were undergoing elective surgeries under general anesthesia and endotracheal intubation. The patients were randomly assigned to group V (Video laryngoscope) or&nbsp;group D (Direct laryngoscope). In addition to the baseline vitals and vitals at various time intervals, intubation time was also recorded.&nbsp;We considered a difference in Heart Rate and Mean Arterial pressure of 20% to be clinically significant and statistical significance was p-value &lt;0.05.</p> <p><strong>Results</strong><strong>:</strong>&nbsp;Significant difference was found in heart rates immediately after laryngoscopy (110.40 vs. 105.02 beats/minute; p&lt;0.01) and 1 minute after intubation (109.30 vs. 106.20 beats/minute; p&lt;0.01) with attenuation seen in video laryngoscopy group. Blood pressures were similar in both the groups&nbsp;at all times. Time for intubation was prolonged in video laryngoscopy group than that for direct laryngoscopy group (26.54 vs. 22.80 seconds; p&lt;0.05). There were no adverse events associated with either of the techniques.&nbsp;</p> <p><strong>Conclusions</strong><strong>:</strong>&nbsp;The&nbsp;Airtraq video laryngoscopy resulted in lesser change in heart rate and longer intubation time. However, clinical impact of such a difference seemed to be insignificant.</p> Sarobar Upadhyaya Laxmi Pathak ##submission.copyrightStatement## 2019-06-05 2019-06-05 e272 e272 10.3126/jsan.v6i1.24299 Efficacy of dexmedetomidine in attenuating hemodynamic and airway responses during extubation: a randomized double-blind study <p><strong>Introduction</strong>: Tracheal extubation causes significant hemodynamic changes and airway irritation. During smooth extubation there is an absence of straining, movement, coughing, breath holding, laryngospasm and minimal change in hemodynamic. Purpose of this study was to test the efficacy of dexmedetomidine in attenuating hemodynamic and airway responses during extubation.</p> <p><strong>Methods</strong>: Eighty ASA-PS I and II patients, receiving general anesthesia, were included in this randomized double-blinded study. Ten minutes before the end of anesthesia, Group D (Dexmedetomidine group) (n=40) received Inj. Dexmedetomidine 0.5mcg/kg and Group N (Normal Saline group) (n=40) received 10 ml normal saline over 10 mins. We recorded heart rate and mean&nbsp;arterial blood pressure prior to the drug administration till 10 mins after extubation. We also monitored the incidence of cough during extubation. Any possible side effects of study drugs were recorded.</p> <p><strong>Result</strong>: Age, gender, physical status, weight, duration of surgery, baseline heart rate and mean arterial pressure were comparable between the groups. There was a statistically significant difference (p &lt; 0.05) in heart rate and mean arterial pressure between the groups after 5 mins of study drug administration and then throughout the study period. Using a four point scale for coughing during extubation, 10% of Group D and 50% of Group N had minimal cough, 22.5% of Group N and 2.5% of Group D had moderate cough.</p> <p><strong>Conclusion</strong>: Finding suggests that IV dexmedetomidine before extubation significantly attenuates hemodynamic and airway responses during extubation.</p> Kripa Pradhan Pradip Raj Vaidya ##submission.copyrightStatement## 2019-08-10 2019-08-10 e273 e273 10.3126/jsan.v6i1.25065 Pediatric Lung isolation in a limited resource setup: A case report <p><strong>Rationale</strong>: Pediatric lung isolation is a great challenge to anesthesiologists. Despite various advances in techniques and equipment in lung isolation, most of the sophisticated devices are unavailable in remote setups. Blind techniques have been used, but they have a low success rate. <strong>Patient concerns</strong>: Here we report a case of a five-year-old male child who had cough and fever for one month. CT scan of the chest revealed right-sided empyema thoracis for which decortication was planned under general anesthesia with one lung ventilation. Double lumen tube for this patient was not commercially available and we did not have a pediatric fiberoptic bronchoscope, which would fit inside the endotracheal tube necessary for the patient. <strong>Interventions</strong>: After anesthesia induction, an adult fiberoptic bronchoscope was used as an aid for insertion of bougie into the left mainstem bronchus followed by railroading the endotracheal tube over the bougie for lung isolation. <strong>Outcomes</strong>: Surgery then proceeded in the left lateral position with a right thoracotomy under a quiet surgical field. <strong>Conclusion</strong>: In the case of unavailability of pediatric fiberoptic bronchoscope, an adult fiberoptic bronchoscope and a bougie can aid in successful lung isolation in pediatric patients.</p> Pankaj Baral Jagat Narayan Prasad Sabin Bhandari Pratistha Thapa ##submission.copyrightStatement## 2019-07-04 2019-07-04 e270 e270 10.3126/jsan.v6i1.24686 Establishing pain service in Dharan: overcoming the inertia Balkrishna Bhattarai ##submission.copyrightStatement## 2019-05-18 2019-05-18 e268 e268 10.3126/jsan.v6i1.24099