Middle cerebral artery stroke following massive hornet sting: a case report

Hornet stings are frequently encountered in practice in Nepal. Majority of patients sustain minor illness. However, complications like anaphylactic shock and the rare acute kidney injury, multiple organ dysfunction and acute myocardial infarction have been reported. Ischemic stroke following hornet stings has been reported infrequently in scientific publications. We report a case of fatal   right Middle Cerebral artery territory ischemic stroke and acute kidney injury in a 40-year farmer

The story of critical care in Asia: a narrative review

Background Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia. Main body Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off through collaboration across groups. Sepsis, increasingly aggravated by multidrug resistance, contributes to a significant burden of critical illness, while epidemics and pandemics continue to haunt the continent intermittently. In particular, the coronavirus disease 2019 (COVID-19) has highlighted the central role of critical care in pandemic response. Accessibility to critical care is affected by lack of ICU beds and high costs, and quality of critical care is affected by limited capability for investigations and treatment in low- and middle-income countries. Meanwhile, there are clear cultural differences across countries, with considerable variations in end-of-life care. Demand for critical care will rise across the continent due to ageing populations and rising comorbidity burdens. Even as countries respond by increasing critical care capacity, the critical care community must continue to focus on training for ICU healthcare workers, processes anchored on evidence-based medicine, technology guided by feasibility and impact, research applicable to Asian and local settings, and rallying of governments for support for the specialty. Conclusions Critical care in Asia has progressed through the years, but multiple challenges remain. These challenges should be addressed through a collaborative approach across disciplines, ICUs, hospitals, societies, governments, and countries

Transorbital sonographic evaluation of normal optic nerve sheath diameter in healthy Nepalese adults

Background: Sonographic evaluation of optic nerve sheath diameter (ONSD) is increasingly being used as a non-invasive technique for detecting raised intracranial pressure. Aims: The aim of this study is to find out the normal ONSD in healthy Nepalese adults. Settings and Design: It is a cross-sectional observational study. Subjects and Methods: ONSD was measured 3 mm behind the globe using 6–13 MHz linear probe. Subjects were examined in the supine position with their eyes closed and in neutral position. Transducer was placed horizontally and in each eye, an average of three readings were documented. Statistical Analysis Used: Data were represented as mean and standard deviation. Paired t-test was used to compare ONSD between the right and left eye. Independent t-test was used to compare ONSD between males and females. Pearson correlation coefficient was used to assess the correlation between age and ONSD. Results: Eighty-eight healthy subjects above 18 years of age were enrolled in the study. The median ONSD was 4.1 mm with 95% of subjects in the range of 3.1–4.6 mm. There was no significant difference in ONSD measurement between males and females (P = 0.09) and between the right and left eye (P = 0.72). There was no relationship between ONSD and age ( R2=0.06, P = 0.55). Conclusions: The range for normal ONSD in healthy adult Nepalese subjects is 3.1–4.6 mm with no significant relationship with gender, age and side of the body

Anaesthetic Management of Patients with Takayasu’s Arteritis for Open Cholecystectomy: a Report of Two Cases

Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management. Keywords: anaesthetic management; takayasu’s arteritis

Ultrasound of the diaphragm in severe hypokalemia induced diaphragmatic dysfunction

Severe hypokalemia presents with significant muscle weakness and involvement of respiratory muscles. Bedside ultrasonography of the diaphragm is emerging as a noninvasive bedside tool for diagnosis and followup of diaphragmatic dysfunction due to various causes. Here, we present a case of diaphragmatic dysfunction due to severe hypokalemia. The patient presented with acute onset quadriparesis that rapidly improved with correction of hypokalemia. The clinical and laboratory parameters correlated well with the findings of diaphragm ultrasound, both initially and after correction of hypokalemia

Use of Gabapentin, Esmolol, or Their Combination to Attenuate Haemodynamic Response to Laryngoscopy and Intubation Corresponding Author

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