Shivering during regional anesthesia is a common problem and is distressing for patients with variety of complications. Therefore this study was conducted to compare the efficacy, potency, hemodynamic effects and side effects of tramadol with that of meperidine for the control of shivering during Spinal Anaesthesia. Sixty patients of ASA physical status I or II, aged 18 to 65 years, undergoing routine surgery under spinal anaesthesia and developed shivering intraoperatively were randomly allocated to receive 0.5 mg/kg meperidine intravenously (Group A, n=30) or 0.5 mg/kg tramadol intravenously (Group B, n=30). Treatment that stopped shivering was considered to have been successful. The response rate was 100 % in both the groups. The time that elapsed from treatment to the time shivering ceased was 5.37±2.20 minutes for meperidine group and 5.87±2.92 minutes for tramadol group (p>0.05). The number of patients who assessed treatment efficacy as no, partial or marked improvement was 0, 2 and 28 for meperidine group and 0, 3 and 27 for tramadol group (p>0.05). Only two patients receiving meperidine developed pruritis and both the grops were similar in terms of Haemodynamic response. The result of this study concluded that tramadol (0.5 mg/kg) is as effective as meperidine (0.5 mg/kg) for treating post anaesthetic shivering with high safety profile.

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Background: Urticaria is a short-lived swelling of skin and mucosa due to plasma leakage by immune and non immune mediated activation and released of mediators from mast cell and basophil. Autoimmune urticaria tends to have a high itch and wheal score than other type of urticaria. Its diagnosis is practically relied upon clinical suspicion and autologous serum skin test. Autologous serum skin test (ASST) is the simple and cost effective test to differentiate autoimmune urticaria from the bulk of chronic urticaria patients. Objective: To compare the features of chronic urticaria in patients having positive versus negative autologous serum skin test (ASST).Materials and methods: Cross-sectional hospital based study was conducted among 90 chronic urticaria patients (CIU) attending the outpatient dermatology department of Nepalgunj Medical College, Nepalgunj, during one year period. The study was conducted after ethical approval from the institutional committee. The patients were diagnosed on the basis of the appearance of continuous or recurrent hives with or without angioedema for more than 6 weeks. Patients who suffered from either acute urticaria or urticarial vasculitis or physical urticaria or other systemic diseases known to cause urticaria were excluded. Standard tools and techniques were used to prepare antilogous serum and injection of the serum and interpretation of the result. The test result was Interpreted as positive and negative autologous serum skin test.Results: ASST was positive in 42% of the patients and negative in 58% of the patients. The ASST-positive patients had a higher mean urticaria activity score and median duration of wheals in comparison with the ASST-negative patients. Wheals lasted for significantly longer duration in patients with positive ASST. Patients with positive ASST had more frequent attacks which was statistically significant compared to the ASST-negative group. The mean urticaria activity score was significantly higher in the ASST-positive patients than that in the ASST-negative patients.Conclusions: Autologous serum skin test may be a useful screening test for autoimmune urticaria and may be used as a simple and cost-effective test for the classification of chronic urticaria.JNGMC Vol. 12 No. 2 December 2014, page: 6-10

Introduction: Postoperative nausea and vomiting are frequent complications after laparoscopic cholecystectomy. Several risk factors have been associated with postoperative nausea and vomiting. This study aimed to find out the prevalence of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anaesthesia in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the patients undergoing laparoscopic cholecystectomy under general anaesthesia at a tertiary care centre from 1 July 2021 to 30 April 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 050-077/078). Convenience sampling was done. All the patients received antiemetic prophylaxis with ondansetron. The general anaesthetic technique was standardised in all the patients. They were followed up 24 hours after surgery for an episode of nausea and vomiting. Point estimate and 95% Confidence Interval were calculated. Results: Among 200 patients, postoperative nausea and vomiting were seen in 28 (14%) (9.19-18.81, 95% Confidence Interval). Among them, 7 (25%) of the patients experienced post-operative vomiting as well. Conclusions: The prevalence of postoperative nausea and vomiting among patients undergoing laparoscopic cholecystectomy in our study was lower when compared to other studies conducted in similar settings.

Shivering is a common and distressing problem after spinal anaesthesia which occurs due to heat loss and core to peripheral redistribution of body heat, resulting in reduction of core body temperature. Post anaesthetic shivering has deleterious metabolic and cardiovascular effect which should ideally be prevented by pharmacological methods that are economically and practically feasible in all settings compared to many physical methods. Therefore, this study was conducted using a centrally acting analgesic, oral Tramadol hydrochloride prophylactically for the prevention of perianaesthetic shivering after spinal anaesthesia. This prospective observational study was carried out in 106 patients of ASA I or II, aged 15 to 70 yrs of age undergoing lower limb or lower abdominal surgery under spinal anaesthesia. Postanaesthetic shivering was evaluated during the surgery. Shivering was observed in 11 (10.4%) patients and among them 2 (1.9%) patients had grade 1, 6 (5.7%) patients had grade 2, 2 (1.9%) patients had grade 3 and 1 (0.9%) patients had grade 4 type of shivering. Sedation was observed in 19 (17.9%) patients. The result of this study concluded that oral tramadol is very safe and superior to various drugs studied till date and can be used prophylactically as a part of premedication for the prevention of postanaesthetic shivering in patients undergoing surgery under spinal anaesthesia.