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> Moonwalk in Cardiac anesthesia platform in Nepal <p>This editorial presents a short picture of the development of cardiac anesthesia and its current status in Nepal.&nbsp;</p> Bishwas Pradhan ##submission.copyrightStatement## 2019-03-15 2019-03-15 5 1 1 3 Adding moments to history of Anesthesia of Nepal: Truth or fiction? <p>This article describes about a person who might have served as anesthesia provider during 1930s at the Bir Hospital, Kathmandu, Nepal. However, concrete evidence of the person’s work as an anesthesia provider has not been found yet. &nbsp;</p> Apurb Sharma ##submission.copyrightStatement## 2019-03-15 2019-03-15 5 1 4 6 Comparison of endotracheal tube cuff inflation techniques by stethoscope and just seal method in patients undergoing surgeries under general anesthesia <p><strong>Background</strong>: Overinflation of the endotracheal tube cuff affects tracheal mucosa blood supply that causes postoperative complications like cough, sore throat and hoarseness. There is no standard cuff inflation technique that produces appropriate cuff pressure. The aim of this study was to find out better technique of cuff inflation that will produce adequate pressure with limited complication using stethoscope guided and just seal.</p> <p><strong>Methods</strong>: This was prospective, randomized single blinded study of 100 American Society of Anesthesiologists Physical Status (ASA PS)&nbsp;I and II patients of 18-65 years undergoing elective surgery under general anesthesia requiring endotracheal intubation. Group J (n=50) received just seal method of tracheal cuff inflation where air was introduced into cuff until audible leak at mouth disappeared and Group S (n=50) received stethoscope-guided tracheal cuff inflation where air was introduced into cuff until harsh breath sound changed to soft while listening with stethoscope bell over the thyroid cartilage. Volume of air in endotracheal tube cuff, cuff pressure following inflation and post-operative sore throat, hoarseness and cough at 24 hour were assessed.</p> <p><strong>Results</strong>: Demographic details, mean volume of air in cuff, mean cuff pressure and incidence of postoperative adverse effects like sore throat, hoarseness and cough at 24 hours between the groups were comparable. &nbsp;&nbsp;</p> <p><strong>Conclusion</strong>: Both the stethoscope guided and just seal cuff inflation techniques were equally effective in producing adequate cuff pressure of 20-30 cmH<sub>2</sub>O with limited complication.</p> Mona Rajbhandari Nagendra Bahadur K.C Bhuban Raj Kunwar Bindu Laxmi Shah ##submission.copyrightStatement## 2019-03-15 2019-03-15 5 1 Single dose versus multiple dose antibiotics in laparoscopic cholecystectomy: A prospective comparative single blind study <p><strong>Introduction: </strong>There is a controversy on single dose or multiple doses of prophylactic antibiotics for prevention of surgical site infection during laparoscopic cholecystectomy in a developing country setting.<strong>&nbsp;</strong>The objective of this study was to compare single versus multiple doses of prophylactic antibiotics in terms of surgical site infection in laparoscopic cholecystectomy patients.</p> <p><strong>Methods: </strong>This was a prospective, comparative, randomized study was conducted in a medical college hospital. Two hundred consecutive patients with symptomatic cholelithiasis planned for routine laparoscopic cholecystectomy were enrolled in the study. Patients were randomly divided in a Single dose (SD) group and multiple dose (MD) group. SD group were given injection ceftriaxone (1gm) before induction of anesthesia and MD group received ceftriaxone (1gm) before induction of anesthesia and continued a total of 3 doses postoperatively for next 24 hours.</p> <p><strong>Results: </strong>A total of 200 patients were studied, of which 100 were in single dose (SD group) and another 100 in multiple dose (MD group). The mean age of patients with symptomatic cholelithiasis was 41.76 ± 13.38 years with minimum of 16 years and maximum of 73 years. Of the total patients, 4 patients in single dose (SD) group and 3 patients in multiple dose (MD) group developed surgical site infection of various severity which was not statistically significant. (p=0.500).</p> <p><strong>Conclusion: </strong>There is no difference in terms of surgical site infection in patients taking either single or multiple doses of antibiotics in laparoscopic cholecystectomy in a medical college setting in Nepal.</p> Ashok Koirala Dipendra Thakur Sunit Agrawal Bhuwan Lal Chaudhary ##submission.copyrightStatement## 2019-03-15 2019-03-15 5 1 Combination of caudal epidural steroids with oral gabapentin for radicular low back pain: a prospective observational study <p><strong>Introduction:</strong> The physical, socioeconomic and psychological burden of low back pain is enormous.The poor socioeconomic condition and geographical constrains confines people to limited health facilities. The objective of the study was to evaluate whether combination of caudal epidural steroids with local anaesthetics and gabapentin is effective for radicular low back pain in the rural Nepal setting.</p> <p><strong>Methods:</strong> It was a prospective observational study including 300 patients with radicular low back pain done over a period of 6 months (13/4/2016 to 30/10/2016). All participants received caudal epidural steroid injection (6ml 2% Xylocaine with adrenaline plus Depomedroxy steroid 80mg plus 12 ml distilled water) and 200 mg gabapentin daily for three months. All patients were followed up for three months and were evaluated.</p> <p><strong>Results:</strong> Mean age of presentation was 41.21 years (SD +_ 11.02) with majority of farmers (42.31%).&nbsp; Mean Numerical Rating Scale at the baseline was 8.01(SD+_1.00) and at the first follow up was 3.98 (SD+_0.83) (p &lt;0.001). Mean Oswestry Disability Index at baseline was7.85 (SD+_0.98) and at the first follow up was 4.04 (SD+_0.80) (p &lt;0.001). Straight Leg Raising Test at baseline was less than 70° in 84.7% which improved to more than 70° in 87.9% of the patients (p-value &lt;0.001).</p> <p><strong>Conclusion:</strong> Caudal epidural steroids combined with gabapentin is safe, economical and technically less demanding. This treatment modality can be used with good outcomes in the rural areas with limited diagnostic and therapeutic facilities.</p> Grisuna Singh Binod Thapa Kiran Gurung Nirmal Kumar Gyawali ##submission.copyrightStatement## 2019-03-15 2019-03-15 5 1 Case Report: Anesthetic management of a patient with sickle cell disease for Pericardiectomy. <strong>:</strong> santosh sharma parajuli ##submission.copyrightStatement## 2019-03-15 2019-03-15 5 1 PRB Stick to facilitate stabilization of ultrasound probe and prevent work-related musculoskeletal disorder <p>The authors propose a stabilizing aid to support arm of anesthesiologist during ultrasound guided procedures in the operating room.</p> Prajjwal Raj Bhattarai Ashim Regmi ##submission.copyrightStatement## 2019-03-15 2019-03-15 5 1