Implantation of an IOL at the time of cataract extraction under combined systemic ketamine and peribulbar lidocaine anesthesia appeared to be well tolerated and produced significant visual improvement in pediatric patients in Nepal. Primary posterior capsulotomy and AV helped prevent visual axis opacification without a significant increase in complications.

Aim: A cross sectional study was carried out on 78 screened cataract patients of two screening camps in Kathmandu valley, Nepal, to assess the willingness to pay for cataract surgery. Methods: A non-probability sampling technique with open ended and close ended questionnaires was used.Results: The average age of patients was 68.8 years. The ratio of men and women was 0.9:1. 42.3% (33) of patients were willing to pay for cataract surgery. Among them 48.5% (16) of people were willing to pay less than $13 and 51.5% (17) were willing to pay more than $13. The mean was $2.3 (SD $15.5) per case. Patients with bilateral cataract were more willing to pay than unilateral cases. Poverty (44.4%, 20) was the main barrier for unwillingness to pay for cataract surgery. Other reasons were the lack of family support (28.9%, 13), lack of knowledge of surgery and belief that it was an unnecessary procedure (15.6%, seven), and waiting for a free surgical service (11.1%, five). Conclusion: This study clearly indicates that although there was awareness of the availability of treatment and services provided within the reach, people are not willing to pay for the surgery and use the facility primarily because of poverty. Hence, to change patients' attitudes, a more holistic approach is needed, keeping in view the cultural, social, and economic background of the society. W orldwide, 16 million people are blind because of cataracts and the burden of blindness is higher in developing countries 1 and Nepal is no exception. 2Cataract surgery has become one of the most common cost effective ambulatory elective surgical procedures as a result of increased technology and anaesthesia costing less than $20. However, in many parts of the world, people are still in darkness, unable to utilise this technology.Many studies show the magnitude of cataract prevalence in the community 4 5 including a few studies published from Nepal, 6 7 but no study has been carried out in this country to assess the willingness to pay for this sight giving procedure. Hence this study was carried out for the first time in Nepal to determine patients' willingness to pay for cataract surgery. PATIENTS AND METHODSA total of 78 cataract cases were selected from 705 examined from two screening eye camps of Kathmandu valley, Nepal (Sankhu Village Development Committee and Bhaktapur Municipality). All selected cases had vision less than 6/60 in one or both eyes. These two places are within half an hour drive with good transport links from Kathmandu city. Kathmandu city has all the facilities of excellent eye surgical services and the people of these two localities can easily access them. A non-probability sampling technique was used for sampling. The study design was cross sectional study containing both open ended and close ended questionnaires. Pretest was done in same types of communities. Local data enumerators were selected and trained at Tilganga Eye Centre. Willingness of patients was divided into two categories: willing to pay less than $13 and more than $13. Maximu...

Background: Fear of operation, injections, physicians and peculiar operation theatre environment where children are separated from their parents prior to anesthesia invariably produce traumatic experiences in tender mind of young children. Midazolam and Ketamine are useful for oral premedication in children to allay anxiety, allow separation from parents and to ensure smooth induction.Methodology: It was a prospective, randomized, double-blinded and comparative study conducted in 80 children of ASA I and II aged 1-6years undergoing elective ophthalmological procedures under general anesthesia. Children were randomized and divided into two groups, K received 4mg/kg of Ketamine and MK received 0.2mg/kg of Midazolam+2mg/kg of Ketamine peroral. Sedation level, ease of parental separation and ease of mask acceptance were evaluated within 20-30 minutes on a 4-point scale. The time to achieve modified Aldrete score of ≥9 was also noted.Results: Two groups were identical regarding age, sex, weight and ASA status. In sedation score, 31(77.5%) children in group K and 35(87.5%) children in group MK were awake, calm and quite (score3)(p=0.50). In parental separation score, 34(85%) children in group MK and 25(62.5%) children in group K have good separation, awake and calm (score2) (p=0.04). In mask acceptance score, 34(85%) children in group MK and 17(42.5%) children in group K were calm, awake, cooperative, accepting Mask (score1)(p=0.001). Time of recovery in group K was 17.92}6.50min whereas in group MK was 17.80}4.059min(p=0.91).Conclusion: Ketamine 4mg/kg and combination of Midazolam 0.2mg/kg with Ketamine 2mg/kg are equally effective but low dose combination is safe and superior. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 66-73

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