Journal of Society of Anesthesiologists of Nepal 2019-07-05T02:00:53+00:00 Dr Apurb Sharma and Dr Achyut Sharma Open Journal Systems <p>The official journal of the Society of Anesthesiologists of Nepal (SAN). Also available at <a title="JSAN" href="" target="_blank" rel="noopener"></a></p> Hemodynamic changes during orotracheal intubation using Airtraq video laryngoscope and direct laryngoscope: A randomized comparative study 2019-06-19T08:27:07+00:00 Sarobar Upadhyaya Laxmi Pathak <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> 2019-06-01T00:57:28+00:00 ##submission.copyrightStatement## Pediatric Lung isolation in a limited resource setup: a case report 2019-07-05T02:00:53+00:00 Pankaj Baral Jagat Narayan Prasad Sabin Bhandari Pratistha Thapa <p><strong>Rationale</strong>: Pediatric lung isolation is a great challenge to an anesthesiologist. 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.&nbsp;<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 chest revealed right sided empyema thoracis for which decortication was planned under general anaesthesia with one lung ventilation. Double lumen tube for this patient was not commercially available and we did not have a paediatric fiberoptic bronchoscope, which would fit inside the endotracheal tube necessary for the patient.&nbsp;<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 rail roading the endotracheal tube over the bougie for lung isolation.&nbsp;<strong>Outcomes</strong>: Surgery then proceeded in left lateral position with a right thoracotomy under a quiet surgical field.&nbsp;<strong>Conclusion</strong>: In case of unavailability of paediatric fiberoptic bronchoscope, an adult fiberoptic bronchoscope and a bougie can aid in successful lung isolation in paediatric patients.</p> 2019-07-05T02:00:49+00:00 ##submission.copyrightStatement## Establishing pain service in Dharan, Nepal: overcoming the inertia 2019-06-19T08:27:07+00:00 Balkrishna Bhattarai <p>The author describes the initial days of establishing pain management services in the eastern part of Nepal.</p> 2019-05-18T02:50:23+00:00 ##submission.copyrightStatement##