IntroductionOvarian neoplastic and nontineoplastic lesions form a pelvic mass and cause gynaecological problems. Therefore, proper recognization and classification is important for appropriate therapy.ObjectiveTo study the morphological patiern and classify the neoplastic and nontineoplastic ovarian lesions in terms of age and size.MethodologyA retrospective study conducted at Sriram Diagnostic Clinic, Biratnagar, Nepal and Birat Medical College, Tankisinwari, Morang, Nepal during a period of March 2012 to February 2016. All abdominal hysterectomy specimens with bilateral or unilateral salpingo-oophorectomy and all ovarian surgeries presenting with either solid or cystic ovarian lesions were included in the study for histopathological analysis. Normal appearing ovaries on gross and microscopic examination were excluded from the study.ResultsA total of 522 cases were studied. Out of which 329 (63%) were non-neoplastic and 193 (37%) were neoplastic. Follicular cysts comprised of 112 (34%) cases, and it was the most common non neoplastic lesion. The age of patients with non-neoplastic lesions and neoplastic lesions varied from 16-54 years and 13-72 years respectively. Size of nonneoplastic and neoplastic lesions varied from 2-12 cm and 2- 19 cm respectively. Among the 193 neoplastic ovarian lesions, 181 (94 %) were benign, as well as 4 (2%) were borderline and 8 (4 %) were malignant. Mature cystic teratoma was the commonest benign tumor followed by Serous cystadenoma. Serous cystadenocarcinoma was the commonest occurring malignant tumor followed by Mucinouscystadenocarcinoma.ConclusionVarying types of both non neoplastic and neoplastic ovarian lesion were seen. Among the non-neoplastic and neoplastic lesion, the most commonly encountered lesion was follicular cyst and mature cystic teratoma respectively.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, Page: 168-174

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

Background : Emergence agitation is a distressful phenomenon associated with inhalational agents such as Sevoflurane in short surgical procedures. Various drugs have been used in the past but some come at the cost of increased complications. We aim to study the effects of ketamine alone and ketamine with midazolam on emergence agitation and their effects on recovery and discharge times.Methods: We conducted a prospective randomized controlled trial among 94 patients aged two to ten years presenting for ophthalmic surgeries in which 45 patients were allocated to each group: group K (Ketamine) and group KM (Ketamine with Midazolam). Group K received Ketamine 0.3 mg/kg IV and Group KM received Ketamine 0.3 mg/kg IV and Midazolam 0.03 mg/kg IV. Intraoperatively heart rate and post-operatively emergence agitation, recovery times, discharge times were studied.Results: Demographic variables were comparable between the two groups. Median Pediatric Anesthesia Emergence Delirium (PAED) score of 6 with IQR (4-6) in group K was comparable to the median score of 5 with IQR (4-6) in group KM. The mean recovery time of 22}4.82 min in group K was significantly lower compared to the mean time of 25.75}3.32 min in group KM. Mean time to discharge of 67}11 min from the hospital in group K was significantly shorter compared to that in group KM (108}18 mins).Conclusion: We concluded from our study that ketamine alone is as effective as ketamine with midazolam in reducing the emergence agitation following Sevoflurane anesthesia for ophthalmic surgery. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 57-65

Intoduction: The problem with induction during anaesthesia is decrease in blood pressure, apnea which could be detrimental to patient. Co-induction and autocoinduction are one of the modalities that are developed to overcome hypotension during induction. The study was carried out to observe heart rate, blood pressure response and propofol consumption following midazolam as co-induction or propofol autocoiniduction for propofol induction. Methods: This study was a conducted in 52 patients of ASA I and ASA II undergoing elective surgical procedures with general anesthesia. Patients were randomly allocated and group P received 0.5 mg/ kg of propofol and group M received 0.04 mg/ kg of midazolam intravenously as autocoindution and coinduction respectively. Results: The two groups were identical regarding age, weight, ASA status and base line vitals. This study showed that there was significant difference between 2 groups in terms of blood pressure. Decrease in blood pressure from baseline is more in Midazolam group compared to propofol.  In terms of Heart Rate there was no statistically significant between two groups at any time of observation. Decrease in HR from baseline was almost similar in both groups. Consumption of Propofol was not statistically significant different between two groups. Propofol group required 8% lesser Propofol than Midazolam group. Conclusions: Our study concluded that blood pressure was decreased significantly in Midazolam group compared to Propofol group but heart rate was decreased almost similar in both groups and was not statistically significant. Consumption of Propofol was not statistically significant but Propofol group had 8 % lesser Propofol consumption than Midazolam group.

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