Current Issue : April - June Volume : 2018 Issue Number : 2 Articles : 6 Articles
Background. Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal\ntechnique for establishing and maintaining safe cuff pressures (20ââ?¬â??30cmH2O) is the cuff pressure manometer, but this is not widely\navailable, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia\nproviders commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the\nefficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Methods. This was a randomized clinical\ntrial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study\nparticipants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon\npalpation. The pressures measured were recorded. Results. One hundred seventy-eight patients were analyzed. 66.3% (59/89) of\npatients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot\nballoon palpation method. This was statistically significant. Conclusion.The loss of resistance syringe method was superior to pilot\nballoon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation....
Background.Drugs are often prescribed, dispensed, and administered by the same person during anaesthesia, and this may increase\nthe risk of drug error. Objectives. To assess the frequency of drug administration errors by anaesthetists, the drugs commonly\ninvolved, and the effects of such errors. Method. A questionnaire-based study was carried out among participants at an annual\nconference of Nigerian anaesthetists. Sixty-six of the 80 participants returned the completed questionnaire. The respondents\ncomprised 1 nurse anaesthetist, 34 resident doctors, 3 doctors with diploma in anaesthesia, and 28 consultant anaesthetists. The\ncollated data on drug errors, the effect of such errors on patients, and formulated protocols to prevent future occurrence were\nsubjected to descriptive analysis using Microsoft Excel. Result. Drug error was reported by 71.21% and witnessed by 22.72% of the\nrespondents.Most of the drug errors occurred during general anaesthesia (90.3%) for emergency procedures (51.61%), and muscle\nrelaxants were most commonly involved (58.06%). Conclusion. Drug errors are common among anaesthetists in Nigeria and their\nincidence is greater during general anaesthesia for emergency procedures, largely as a result of ampoule swaps due to similarities\nin ampoule design and packaging. Guidelines on their prevention should be developed by all health institutions....
Introduction.The pain after thyroid surgery is considered of moderate intensity and short duration. Most trials showed significant\nreduction in pain intensity and severity of pain in patients for whom bilateral superficial cervical plexus block (BSCPB) was done.\nObjective. To assess the postoperative analgesic effect of BSCPB for thyroid surgery. Methods. Sixty six euthyroid patients were\nrecruited and assigned to two groups (33 patients each). Group 1 BSCPB and Group 2 standard analgesia. The unpaired Studentââ?¬â?¢s\nt-test and Mannââ?¬â??Whitney test were used for comparison. Statistical significance was stated at p value < 0.05. Results.The median\npostoperative pain score (NRS) was 3 in the BSCPB group and 5 in the control group (p 0.002). There was also statistically\nsignificant difference at 6th, 12th, and 24th hour showing a lower median pain score in the BSCPB group compared to the control\ngroup. The median time was (360 minutes) in the treatment group and (180 minutes) in the control group (p 0.0006). The\nmedian tramadol consumption within 24 hours is 0mg in the BSCPB group compared to 100mg in the control group (p 0.001).\nConclusion and Recommendation. BSCPB done for thyroidectomy under general anesthesia decreases the postoperative pain\nscore, total analgesia consumption, and time to first analgesia request....
Background. Caesarean delivery can be associated with considerable postoperative pain. While the benefits of transversus\nabdominis plane (TAP) and ilioinguinal-iliohypogastric (II-IH) nerve blocks on pain after caesarean delivery via Pfannenstiel\nincision have been demonstrated, no enough investigations on the comparison of these blocks on pain after caesarean delivery\nhave been conducted in our setup. Method. An institutional-based prospective observational cohort study was conducted to\ncompare the analgesic efficacy of those blocks. We observed 102 postoperative parturients. The outcome measure was the severity\nof pain measured using a numeric rating scale. Result. Twenty-four hours after surgery, the NRS score at rest was (0.90 �± 0.80)\nversus (0.67 �± 0.58) and at movement (1.2 �± 1.07) versus (0.88 �± 0.76) for the TAP and II-IH groups, respectively. Twenty-four\nhours after surgery, the mean tramadol consumption was (55.45 �± 30.51) versus (37.27 �± 27.09) mg in TAP and II-IH groups,\nrespectively (p 0.009). The mean first analgesic requirement time was also prolonged in the II-IH group. Conclusion and\nRecommendations. There was no statically significant difference between TAP and II-IH blocks regarding postoperative pain\nscore, but the II-IH block significantly reduced the total tramadol consumption and prolonged the time to first analgesic request\nthan TAP. Thus, we recommend the II-IH nerve block....
Objective. To summarise the evidence for use of intravenous magnesium for analgesic effect in caesarean section patients.\nBackground. Postcaesarean pain requires effective analgesia. Magnesium, an N-methyl-D-aspartate receptor antagonist and\ncalcium-channel blocker, has previously been investigated for its analgesic properties. Methods. A systematic search was\nconducted of PubMed, Scopus, MEDLINE, Cochrane Library, and Google Scholar databases for randomised-control trials\ncomparing intravenous magnesium to placebo with analgesic outcomes in caesarean patients. Results. Ten trials met inclusion\ncriteria. Seven were qualitatively compared after exclusion of three for unclear bias risk. Four trials were conducted with general\nanaesthesia, while three utilised neuraxial anaesthesia. Five of seven trials resulted in decreased analgesic requirement postoperatively\nand four of seven resulted in lower serial visual analogue scale scores. Conclusions. Adjunct analgesic agents are utilised\nto improve analgesic outcomes and minimise opioid side effects. Preoperative intravenous magnesium may decrease total\npostcaesarean rescue analgesia consumption with few side effects; however, small sample size and heterogeneity of methodology\nin included trials restricts the ability to draw strong conclusions. Therefore, given the apparent safety and efficacy of magnesium,\nits role as an adjunct analgesic in caesarean section patients should be further investigated with the most current anaesthetic\ntechniques....
Introduction. Several studies suggest that preoperative anaemia (PA) is associated with adverse postoperative outcomes, but little\nis known about these outcomes in the Central Region of Ghana. This study aims to determine the prevalence of PA among\nnoncardiac surgical patients and its implications for their postoperative outcomes. Methods. This study was designed as an\nobservational study; data including demographics and clinical and laboratory results were collected from the patientsââ?¬â?¢ records and\nthrough interviews. Results. A total of 893 inpatient surgical cases undergoing elective and emergency operations, aged 15 years\nand above with mean age of 44.2 Ã?± 17.0 yrs, were enrolled. The prevalence of PA was 54.3%, mostly microcytic with or without\nhypochromia (57.2%). The prevalence was higher in females than males (p ââ?°Â¤ 0.001). Preoperative anaemia was significantly\nassociated with prolonged length of hospital stay (OR: 2.12 (95% CI: 1.49ââ?¬â??3.10)). Allogeneic blood transfusion significantly\nprolonged the length of hospital stay (OR 4.48 (95% CI: 2.67ââ?¬â??7.51)). 15.5% of the anaemic patients received oral iron supplements\ncompared to 2.2% of nonanaemic patients (p ââ?°Â¤ 0.001). Conclusion. Preoperative anaemia is common among noncardiac surgical\npatients. It is independently and significantly associated with prolonged hospital stay leading to the use of increased healthcare\nresources. It is also the main predictor for perioperative allogeneic blood transfusions and the use of haematinics....
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