Pub Date : 2023-12-22DOI: 10.3126/nmcj.v25i4.60875
S. Acharya, Sabin Bhandari, Sushmita Bhandari
Spinal anaesthesia using hyperbaric bupivacaine is the most popular method for caesarean section. Adjuvents like fentanyl which enhances the sensory block and provide stable haemodynamics are usually premixed with bupivacaine in a single syringe. Fentanyl when added to hyperbaric bupivacaine, decreases the density of solution to extent of 0.0006 which alters the spread of local anesthetics in CSF. If we inject both the drugs separately in different syringe, it may minimize the effect of the changes in densities and PH of both the drugs and produce their maximum effect with minimal haemodynamic alteration. Therefore this study was conducted to see the quality of sensory block and haemodynamic response by sequential intrathecal administration of fentanyl and hyperbaric bupivacaine in two different syringe for patients undergoing caesarian section. This interventional study was carried out in Seventy nine Patients undergoing caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine 9mg (1.8 ml) and fentanyl 20 mcg in two different syringe administered sequentially. Out of 79 parturients only 22 (27.85%) had hypotension requiring vasopressor treatment during caesarean section and maximum amount of vasopressor used was 15 mg of mephentermine. The mean level of maximum sensory block after 20 mins of spinal anaesthesia was T2 in 20 (25.32%) patients, T3 in 19 (24.05%) patients, T4 in 32 (40.51%) patients, T5 in 1 (1.27%) patient and T6 in 7 (8.86%) Patients. Intraoperative quality of surgical anaesthesia was very satisfactory to the patients. Only 6 (7.59%) patients had mild discomfort whithout requirement of any medical treatment. The result of this study concluded that separate intrathecal injection of fentanyl and hyperbaric bupivacaine provides better haemodynamic stability, improves quality of surgical anaethesia allowing it to work at higher levels in the spinal cord with minimal other side effects in patient undergoing caesarean section.
{"title":"Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section","authors":"S. Acharya, Sabin Bhandari, Sushmita Bhandari","doi":"10.3126/nmcj.v25i4.60875","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60875","url":null,"abstract":"Spinal anaesthesia using hyperbaric bupivacaine is the most popular method for caesarean section. Adjuvents like fentanyl which enhances the sensory block and provide stable haemodynamics are usually premixed with bupivacaine in a single syringe. Fentanyl when added to hyperbaric bupivacaine, decreases the density of solution to extent of 0.0006 which alters the spread of local anesthetics in CSF. If we inject both the drugs separately in different syringe, it may minimize the effect of the changes in densities and PH of both the drugs and produce their maximum effect with minimal haemodynamic alteration. Therefore this study was conducted to see the quality of sensory block and haemodynamic response by sequential intrathecal administration of fentanyl and hyperbaric bupivacaine in two different syringe for patients undergoing caesarian section. This interventional study was carried out in Seventy nine Patients undergoing caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine 9mg (1.8 ml) and fentanyl 20 mcg in two different syringe administered sequentially. Out of 79 parturients only 22 (27.85%) had hypotension requiring vasopressor treatment during caesarean section and maximum amount of vasopressor used was 15 mg of mephentermine. The mean level of maximum sensory block after 20 mins of spinal anaesthesia was T2 in 20 (25.32%) patients, T3 in 19 (24.05%) patients, T4 in 32 (40.51%) patients, T5 in 1 (1.27%) patient and T6 in 7 (8.86%) Patients. Intraoperative quality of surgical anaesthesia was very satisfactory to the patients. Only 6 (7.59%) patients had mild discomfort whithout requirement of any medical treatment. The result of this study concluded that separate intrathecal injection of fentanyl and hyperbaric bupivacaine provides better haemodynamic stability, improves quality of surgical anaethesia allowing it to work at higher levels in the spinal cord with minimal other side effects in patient undergoing caesarean section.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"81 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.3126/nmcj.v25i4.60876
C. Lama, Rabita Kharbuja, Deepika Karki, S. Dhungel
Assessments are powerful tools for bringing on the achievement of educational goals and one of the tools for bringing it rightly is “item analysis.” Multiple - Choice Questions (MCQs) are one of the most common methods of assessing the knowledge capabilities of undergraduate and postgraduate medical students. The main objective of this study was to analyze the quality of MCQs and to assess the relationships of items having good difficulty and discrimination indices with their distracter efficiency. After getting an ethical approval from Institutional Review Committee of Nepal Medical College Teaching Hospital a cross – sectional study was conducted over a period of one year from January 2022 to December 2022 in the Department of Human Anatomy of Nepal Medical College. The difficulty index (DIF I), discrimination index (DI) and distracter efficiency (DE) were calculated and analyzed. The results obtained revealed that the mean and standard deviation of DIF I, DI and DE were 56.75±22.6, 0.3±0.2 and 43.24±25.66 respectively. The items analyzed were neither too easy and nor too difficult (DIF I = 62.8%). The majority of items fulfilled the criteria of acceptable difficulty and good discrimination index and the maximum number of items were found to have 2 NFDs (DE = 33.33 %). The present study was hence undertaken as it assists to evaluate the MCQ items to discern its effectiveness in assessing the knowledge of students as well as it plays a vital role in developing a question bank having valid MCQs.
{"title":"Study on item analysis of multiple – choice questions amongst the undergraduate dental students","authors":"C. Lama, Rabita Kharbuja, Deepika Karki, S. Dhungel","doi":"10.3126/nmcj.v25i4.60876","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60876","url":null,"abstract":"Assessments are powerful tools for bringing on the achievement of educational goals and one of the tools for bringing it rightly is “item analysis.” Multiple - Choice Questions (MCQs) are one of the most common methods of assessing the knowledge capabilities of undergraduate and postgraduate medical students. The main objective of this study was to analyze the quality of MCQs and to assess the relationships of items having good difficulty and discrimination indices with their distracter efficiency. After getting an ethical approval from Institutional Review Committee of Nepal Medical College Teaching Hospital a cross – sectional study was conducted over a period of one year from January 2022 to December 2022 in the Department of Human Anatomy of Nepal Medical College. The difficulty index (DIF I), discrimination index (DI) and distracter efficiency (DE) were calculated and analyzed. The results obtained revealed that the mean and standard deviation of DIF I, DI and DE were 56.75±22.6, 0.3±0.2 and 43.24±25.66 respectively. The items analyzed were neither too easy and nor too difficult (DIF I = 62.8%). The majority of items fulfilled the criteria of acceptable difficulty and good discrimination index and the maximum number of items were found to have 2 NFDs (DE = 33.33 %). The present study was hence undertaken as it assists to evaluate the MCQ items to discern its effectiveness in assessing the knowledge of students as well as it plays a vital role in developing a question bank having valid MCQs.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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