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> Avoiding plagiarism in academic writing <p>Recently, our national newspapers were filled with sensational news on plagiarism. The culprit article was retracted by the journal and the authors were blacklisted for scientific misconduct.</p> <p>With the rising pressure to publish scientific articles for academic promotion and recognition, the chances of submitting a plagiarized article for publication is extremely high. However, a completely plagiarized text as seen in the newspaper is rare. Most of the times authors tend to copy one sentence from a paper and another sentence from a similar paper to express their ideas as it is extremely easy to copy and paste from the internet. Sometimes, authors think that citing the original text actually removes the chance of one’s text being called plagiarized. So, what actually at the Journal of Society of Anesthesiologists of Nepal is considered to be plagiarism?</p> Apurb Sharma ##submission.copyrightStatement## 2018-08-04 2018-08-04 4 2 47 48 Pain practice in Nepal thirty years ago: A practitioner's Quest <p align="justify">The article describes the initial days of the authors pain practice in Nepal.</p> Bal Bahadur Swar ##submission.copyrightStatement## 2018-08-04 2018-08-04 4 2 49 53 Individualizing hyperosmolar therapy for management of intracranial hypertension <p>Intracranial hypertension is a major cause of morbidity and mortality in patients with brain injury. If not appropriately treated, it can precipitate brain ischemia, brain herniation and death. Hyperosmolar therapy remains the main armamentarium for management of raised intracranial pressure, especially in patients with diffuse lesions and where surgical options are not applicable. Substantial amount of studies have tried to explore the superiority of hypertonic saline or mannitol over the other. Due to significant heterogeneity in the pathophysiology of patients, variation in treatment threshold, method of drug administration and drug concentration, substantial evidence is lacking to support one agent over other. Hypertonic saline may be more effective than mannitol for lowering raised intracranial pressure. Well designed novel trials need to try to find the answer. Clinical, pathophysiological and biochemical data should be incorporated at bedside while individualizing selection of hyperosmolar therapy, with the aim to improve outcome and minimize harm.</p> Gentle Sunder Shrestha ##submission.copyrightStatement## 2018-08-06 2018-08-06 4 2 54 56 Effects of ketamine and ketamine with midazolam on emergence agitation in children following sevoflurane anesthesia <p>Background: <br>Emergence agitation is a distressful phenomenon<br>associated with inhalational agents such as <br>Sevoflurane in short surgical procedures. Various <br>drugs have been used in the past but some come at<br>the cost of increased complications. We aim to study<br>the effects of ketamine alone and ketamine with<br>midazolam on emergence agitation and their effects<br>on recovery and discharge times.</p> <p>Methods: <br>We conducted a prospective randomized controlled<br> trial among 94 patients aged two to ten years <br>presenting for ophthalmic surgeries in which 45 <br>patients were allocated to each group: group K <br>(Ketamine) and group KM (Ketamine with <br>Midazolam). Group K received Ketamine 0.3 mg/kg<br>IV and Group KM received Ketamine 0.3 mg/kg IV<br>and Midazolam 0.03 mg/kg IV. Intraoperatively heart<br>rate and post-operatively emergence agitation,<br> recovery times, discharge times were studied.</p> <p>Results: <br>Demographic variables were comparable between<br>the two groups. Median Pediatric Anesthesia<br> Emergence Delirium score of 6 with IQR (4-6)<br>in group K was comparable to the median score of 5<br>with IQR (4-6) in group KM. The mean recovery time <br>of 22±4.82 min in group K was significantly lower<br>compared to the mean time of 25.75±3.32 min in<br> group KM. Mean time to discharge of 67±11 min <br>from the hospital in group K was significantly shorter <br>compared to that in group KM (108±18 mins).</p> <p>Conclusion: <br>We concluded from our study that ketamine alone is <br>as effective as ketamine with midazolam in reducing <br>the emergence agitation following Sevoflurane<br> anesthesia for ophthalmic surgery.</p> Achyut Sharma Resham Bahadur Rana ##submission.copyrightStatement## 2018-08-06 2018-08-06 4 2 57 65 Ketamine with Midazolam and Ketamine alone as oral premedication in children <p>BACKROUND: Fear of operation, injections, physicians and peculiar operation theatre environment where children are separated from their parents prior to anaesthesia invariably produce traumatic experiences in tender mind of young children. Midazolam and Ketamine are useful Jay Prakash Thakur Resham Bahadur Rana Abhay Pokharel ##submission.copyrightStatement## 2018-08-14 2018-08-14 4 2 66 73 Intrathecal Magnesium Sulfate as Analgesic and Anaesthetic Adjunct to Bupivacaine in Patients Undergoing Lower Extremity Orthopaedic Surgery <p><strong>Background</strong></p> <p>Subarachnoid block is a popular mode of anesthesia for lower limb surgeries. Studies of Magnesium Sulfate (MgS0<sub>4</sub> ) as an adjuvant to intrathecal local anaesthetic&nbsp; are limited. The objective&nbsp; was to find out the analgesic and anaesthetic&nbsp; effect of intrathecal MgS0<sub>4</sub> added to bupivacaine for spinal anaesthesia in patients undergoing lower extremity orthopaedic surgery.</p> <p><strong>Methods</strong></p> <p>Sixty ASA I or II adult patients undergoing lower extremity orthopaedic surgery were randomly allocated in a double blinded fashion into two groups of thirty each. Group A received 3.0 ml of 0.5% hyperbaric bupivacaine with&nbsp; 0.15 ml of 50% MgSO<sub>4</sub>. Group B received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of NS. Onset of sensory and motor block as well as time to attain highest level of sensory block were recorded. Duration of sensory and motor block along with duration of spinal anaesthesia were also assessed. Any adverse effects were noted and treated.</p> <p><strong>Results</strong></p> <p>Duration of sensory and motor block along with duration of&nbsp;&nbsp; spinal anaesthesia were prolonged in patients of MgSO<sub>4 </sub>but were not statistically significant with p-value of 0.33, 0.23 and 0.68 respectively.&nbsp; Onset of anaesthesia, requirement of rescue analgesics, haemodynamic parameters and adverse effects were comparable between two groups.</p> <p><strong>Conclusion</strong></p> <p>In patients undergoing lower extremity orthopaedic surgery the addition of 75mg of MgSO<sub>4 </sub>to intrathecal bupivacaine did not prolong the duration of sensory block, spinal anaesthesia nor decreased postoperative analgesic consumption without any additional side effects.</p> <p>&nbsp;</p> <p>Keywords: Bupivacaine, Intrathecal Magnesium Sulfate, Spinal Anaesthesia</p> Prakash Maden Limbu Sindhu Khatiwada Birendra Prasad Sah Satyendra Narayan Singh Krishna Pokharel Rajiv Maharjan ##submission.copyrightStatement## 2018-08-17 2018-08-17 4 2 74 80 Postoperative analgesia with bilateral ilioinguinal and iliohypogastric nerve block in lower segment cesarean section <p>Background: Modern techniques incorporate regional anesthesia in pain management and it is the best and safest technique. It avoids the side effects that remain with the traditional use of opioids. Ilioinguinal and iliohypogastric (IIIH) nerve block can provide a satisfactory postoperative analgesia in patients with pfannenstiel incision made in cesarean patients.<strong></strong></p><p>Objective:<strong> </strong>To assess postoperative pain relief with ilioinguinal and iliohypogastric nerves block in patients undergoing lower segment cesarean section (LSCS).</p><p>Methods: It is a hospital based comparative study done in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke in a period of one year. Sixty patients were randomly allocated into the two groups: <strong>Group B:</strong> (n=30) received bilateral ilioinguinal and iliohypogastric nerve block with 20ml of 0.5% bupivacaine. <strong>Group NS:</strong> (n=30) received ilioinguinal and iliohypogastric nerve block with 20ml of 0.9% normal saline</p><p>Results:<strong> </strong>The mean effective duration of analgesia measured from the time of onset of spinal blockade to the time of request for analgesia was 264 Anjali Poudel Prashant Kumar Dutta ##submission.copyrightStatement## 2018-08-28 2018-08-28 4 2 81 86 Anesthetic management for a cesarean section in a parturient with huge vulvar and lower limbs elephantiasis: A case report <p>Elephantiasis is caused by accumulation of lymph in soft tissues due to long standing lymphatic obstruction.Elephantiasis of female external genitalia is very rare and its association with limb elephantiasis is also quite very rare.Elephantiasis in pregnancy poses difficulty for an anesthesiologist while providing neuraxial anesthesia to such a patient.So we report the anesthetic management of a primigravida patient with both vulvar and lower limbs elephantiasis posted for emergency cesarean section.</p> <p>&nbsp;</p> Surendra Kumar Sethi Kavita Jain Neena Jain Sohan Lal Yadav ##submission.copyrightStatement## 2018-08-06 2018-08-06 4 2 110 112 Coiling of central venous catheter inside left subclavian vein- a rare case report. <p>Central venous catheterization is one of the common procedure 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. We report a similar case of malposition; coiling of the catheter inside the subclavian vein. Technical expertise, sound knowledge of anatomical landmarks and use of real time ultrasound can minimize malposition of the catheter.</p> Lalit Kumar Rajbanshi Shambhu Bahadur Karki Batsalya Arjyal ##submission.copyrightStatement## 2018-08-17 2018-08-17 4 2 91 94 Ultrasound guided catheter placement for TeQuiLa block: a novel technique for post-operative analgesia for abdominal surgeries <p>Ultrasound guided abdominal plane blocks are being considered as effective measure for postoperative analgesia. Among these Quadratus Lumborum Block has been reported to provide adequate analgesia for abdominal surgeries. Placement of catheter for continuous infusion of localin these plane provide long term analgesia for abdominal surgery. More recently, a transmuscular quadratus lumborum block (TeQuiLa Block) was described by Borglum et al and we have tried to use catheter placement and local anesthetic infusion for the same.</p> Prajjwal Raj Bhattarai ##submission.copyrightStatement## 2018-08-17 2018-08-17 4 2 113 114 Changing goals in the management of breast carcinoma patients towards preservation of femineity and quality of life <p>Breast cancer is the commonest cancer in women worldwide. In the developing countries of Asia, the health care burden on account of breast cancer has been steadily mounting.</p> Soumi Pathak Ajay Kumar Bhargava ##submission.copyrightStatement## 2018-08-20 2018-08-20 4 2 115 117