JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Apr 2011
Randomized Controlled Trial Comparative StudyUltrasound versus the landmark technique: a prospective randomized comparative study of internal jugular vein cannulation in an intensive care unit.
The aim of this study is to find out if an ultrasound technique has advantages over the conventional landmark technique. ⋯ Ultrasound improves success rate, minimizes cannulation time and complications during internal jugular vein cannulation. It can be employed as a rescue technique in cases of a failed landmark technique.
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JNMA J Nepal Med Assoc · Jan 2011
Randomized Controlled Trial Comparative StudyThe effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section.
The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fixed dose during caesarean section. ⋯ The bupivacaine dose was significantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fixed compared with the dose use.
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JNMA J Nepal Med Assoc · Jan 2011
Case ReportsTopical anaesthesia of the vocal cords by nebulized lignocaine inhalation to facilitate fibreoptic nasotracheal intubation in a head-size parotid tumour patient.
This case report describes a successful fibreoptic naso-tracheal intubation in a patient with difficult airway due to a nearly head-size right parotid swelling. Nasal fibreoptic intubation was performed by maintaining spontaneous breathing under propofol infusion at a dose of 25 mcg/kg/hour and topical anaesthesia of vocal cords by using oxygen (6 l/min) flow to nebulize 4% lignocaine from the side port of the fibreoptic bronchoscope. The topical anaesthesia was achieved by keeping the scope in close proximity of the vocal cords and in the centre of view of the scope. This case emphasizes the possibility of fibreoptic intubation in a sedated yet spontaneously breathing patient by allowing inhalation of nebulized lignocaine during fibreoptic intubation.
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JNMA J Nepal Med Assoc · Jan 2011
Case ReportsIntraoperative stereotactic navigation for reconstruction in zygomatic-orbital trauma.
Reconstruction of the maxillofacial skeleton after traumatic injury is not always straightforward because of its three dimensional complex anatomy and aesthetic significance. In case of zygomatic-orbital injury induced by trauma resulting in enophthalmos, the patient is affected on both function and cosmesis. ⋯ Navigation-guided open reduction of a zygomatic-orbital complex fractures with orbital floor reconstruction can be regarded as a valuable treatment option for this potentially complicated procedure. This case demonstrated the use of the non-ionizing, noncontact, navigation system in intraoperative procedure and clinical monitoring to identify the correct position and symmetry in complex orbital floor reconstruction.
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Pralidoxime are enzyme reactivator that are known to reactivate the phosphorylated acetylcholinesterase by binding to the organophosphorus molecule. The use of oximes in acute organophosphorus poisoning has been a controversial subjects for over two decades. This study was conducted with the objective to find out the estimation of serum cholinesterase and use of pralidoxime in organophosphorus poisoning. ⋯ The initial dose of Pralidoxime used was 1 gm followed by maintenance dose of 500mg 6 hourly, the doses prescribed were less than WHO recommended doses.