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

Comparison of the findings of DN4 questionnaire with physician’s diagnosis of pain.

Comparison of the findings of DN4 questionnaire with physician’s diagnosis of pain.</p

Demographic information.

ObjectiveThis study aimed to translate the DN4 questionnaire into Nepalese version and assess its psychometric properties: diagnostic accuracy, internal consistency, and test-retest reliability.MethodsAn observational study was conducted in a tertiary level teaching hospital of Kathmandu, Nepal. We included 166 patients with chronic pain visiting a pain clinic over a period of one year. The Nepalese version of the DN4 questionnaire was used for detecting signs and symptoms of neuropathic pain. The English version of the questionnaire was translated into Nepali in accordance with the standard guideline with the help of linguistic experts. The patients who met the inclusion criteria were examined and interviewed twice in an interval of two weeks. The association between the index test and the reference test was analyzed using Chi-square test. Diagnostic accuracy was assessed using sensitivity, specificity, Youden’s index, and positive and negative predictive values. We calculated internal consistency using Cronbach’s alpha (∝), and test-retest reliability using Cohen’s kappa and Intra-class correlation coefficient (ICC).ResultsThe study showed a significant association between the result of DN4 questionnaire and the gold standard (physician’s diagnosis) (pConclusionsThe Nepalese version of DN4 questionnaire is a valid and reliable tool for the identification of signs and symptoms of neuropathic pain. This can be used for screening neuropathic pain signs and symptoms in clinical as well as research settings.</div

Test-retest reliability of the pain assessment at baseline and at follow-up using DN4 questionnaire.

Test-retest reliability of the pain assessment at baseline and at follow-up using DN4 questionnaire.</p

Study questionnaire in Nepalese version.

ObjectiveThis study aimed to translate the DN4 questionnaire into Nepalese version and assess its psychometric properties: diagnostic accuracy, internal consistency, and test-retest reliability.MethodsAn observational study was conducted in a tertiary level teaching hospital of Kathmandu, Nepal. We included 166 patients with chronic pain visiting a pain clinic over a period of one year. The Nepalese version of the DN4 questionnaire was used for detecting signs and symptoms of neuropathic pain. The English version of the questionnaire was translated into Nepali in accordance with the standard guideline with the help of linguistic experts. The patients who met the inclusion criteria were examined and interviewed twice in an interval of two weeks. The association between the index test and the reference test was analyzed using Chi-square test. Diagnostic accuracy was assessed using sensitivity, specificity, Youden’s index, and positive and negative predictive values. We calculated internal consistency using Cronbach’s alpha (∝), and test-retest reliability using Cohen’s kappa and Intra-class correlation coefficient (ICC).ResultsThe study showed a significant association between the result of DN4 questionnaire and the gold standard (physician’s diagnosis) (pConclusionsThe Nepalese version of DN4 questionnaire is a valid and reliable tool for the identification of signs and symptoms of neuropathic pain. This can be used for screening neuropathic pain signs and symptoms in clinical as well as research settings.</div

Diagnostic values of the DN4 questionnaire for the discrimination of neuropathic pain signs and symptoms.

Diagnostic values of the DN4 questionnaire for the discrimination of neuropathic pain signs and symptoms.</p

Participant flow diagram.

ObjectiveThis study aimed to translate the DN4 questionnaire into Nepalese version and assess its psychometric properties: diagnostic accuracy, internal consistency, and test-retest reliability.MethodsAn observational study was conducted in a tertiary level teaching hospital of Kathmandu, Nepal. We included 166 patients with chronic pain visiting a pain clinic over a period of one year. The Nepalese version of the DN4 questionnaire was used for detecting signs and symptoms of neuropathic pain. The English version of the questionnaire was translated into Nepali in accordance with the standard guideline with the help of linguistic experts. The patients who met the inclusion criteria were examined and interviewed twice in an interval of two weeks. The association between the index test and the reference test was analyzed using Chi-square test. Diagnostic accuracy was assessed using sensitivity, specificity, Youden’s index, and positive and negative predictive values. We calculated internal consistency using Cronbach’s alpha (∝), and test-retest reliability using Cohen’s kappa and Intra-class correlation coefficient (ICC).ResultsThe study showed a significant association between the result of DN4 questionnaire and the gold standard (physician’s diagnosis) (pConclusionsThe Nepalese version of DN4 questionnaire is a valid and reliable tool for the identification of signs and symptoms of neuropathic pain. This can be used for screening neuropathic pain signs and symptoms in clinical as well as research settings.</div

Internal consistency.

ObjectiveThis study aimed to translate the DN4 questionnaire into Nepalese version and assess its psychometric properties: diagnostic accuracy, internal consistency, and test-retest reliability.MethodsAn observational study was conducted in a tertiary level teaching hospital of Kathmandu, Nepal. We included 166 patients with chronic pain visiting a pain clinic over a period of one year. The Nepalese version of the DN4 questionnaire was used for detecting signs and symptoms of neuropathic pain. The English version of the questionnaire was translated into Nepali in accordance with the standard guideline with the help of linguistic experts. The patients who met the inclusion criteria were examined and interviewed twice in an interval of two weeks. The association between the index test and the reference test was analyzed using Chi-square test. Diagnostic accuracy was assessed using sensitivity, specificity, Youden’s index, and positive and negative predictive values. We calculated internal consistency using Cronbach’s alpha (∝), and test-retest reliability using Cohen’s kappa and Intra-class correlation coefficient (ICC).ResultsThe study showed a significant association between the result of DN4 questionnaire and the gold standard (physician’s diagnosis) (pConclusionsThe Nepalese version of DN4 questionnaire is a valid and reliable tool for the identification of signs and symptoms of neuropathic pain. This can be used for screening neuropathic pain signs and symptoms in clinical as well as research settings.</div

Frequency of pain signs and symptoms based on DN4 questionnaire.

Frequency of pain signs and symptoms based on DN4 questionnaire.</p

COSMIN Checklist.

ObjectiveThis study aimed to translate the DN4 questionnaire into Nepalese version and assess its psychometric properties: diagnostic accuracy, internal consistency, and test-retest reliability.MethodsAn observational study was conducted in a tertiary level teaching hospital of Kathmandu, Nepal. We included 166 patients with chronic pain visiting a pain clinic over a period of one year. The Nepalese version of the DN4 questionnaire was used for detecting signs and symptoms of neuropathic pain. The English version of the questionnaire was translated into Nepali in accordance with the standard guideline with the help of linguistic experts. The patients who met the inclusion criteria were examined and interviewed twice in an interval of two weeks. The association between the index test and the reference test was analyzed using Chi-square test. Diagnostic accuracy was assessed using sensitivity, specificity, Youden’s index, and positive and negative predictive values. We calculated internal consistency using Cronbach’s alpha (∝), and test-retest reliability using Cohen’s kappa and Intra-class correlation coefficient (ICC).ResultsThe study showed a significant association between the result of DN4 questionnaire and the gold standard (physician’s diagnosis) (pConclusionsThe Nepalese version of DN4 questionnaire is a valid and reliable tool for the identification of signs and symptoms of neuropathic pain. This can be used for screening neuropathic pain signs and symptoms in clinical as well as research settings.</div