Efficacy of Low‑dose Suxamethonium in Reducing Induction Dose of Propofol for Laryngeal Mask Airway Insertion in Nigerian Adults

Background: Propofol is commonly used as a sole induction agent during laryngeal mask airway (LMA)  insertion, and additional doses are often required with systemic consequences. Objective: Our study evaluated the effect of 0.1 mg/kg suxamethonium on the dose of induction of propofol when used during insertion of LMA. Methodology: Eighty patients aged between 18 and 60 years were included in this prospective study. Patients undergoing elective  procedures under general anaesthesia with LMA and spontaneous ventilation were randomized into two groups. Patients in both groups were induced with an initial dose of 2.5 mg/kg of propofol; the control group (group P) and the second group (group S) received 5 ml of normal saline and 0.1 mg/kg of suxamethonium made up to 5 ml, respectively. The need for additional doses of propofol following  insertion of LMA was then assessed based on insertion conditions (ease of insertion, severity of airway response in terms of coughing, gagging, laryngospasm, and patient movement). The total dose of propofol required before successful insertion was recorded, as well as the incidence and duration of apnea post-induction. The pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed at 0, 1, 3 and 5 min after insertion of LMA for each group. Results: The total dose of propofol required for successful LMA insertion was significantly lower in group S (2.82 ± 0.39 mg/kg) compared to group P (3.13 ± 0.49 mg/kg), P = 0.002. Haemodynamic parameters (SBP, DBP, MAP, PR, and SpO2) were well-controlled post-LMA insertion and were comparable between the two groups. Furthermore, no incidence of hypotension or bradycardia requiring intervention was observed at different time intervals, throughout the study period, in both groups. Conclusion: The dose of propofol is lesser when low‑dose suxamethonium (0.1 mg/kg) precedes its use for induction during LMA insertion, and there is a reduction in the duration of apnea; however, it causes a higher apnea incidence. Vital signs were similar in the two study groups

Psycho-behavioral responses of Nigerian health workers to an initial human-to-human transmission of the coronavirus disease

Previous pandemics have had significant impact on psychological well-being of front-line health care workers. Issues such as fear of contracting the disease, high workload as a result of high numbers of infected cases, increased job stress and unavailability of personal protective equipment have been implicated in development of psychological distress in this subset of individuals. The aim of the present paper is to describe psychobehavioral responses of health care workers and potential predictors of emotional response at onset of COVID-19 outbreak in Nigeria. Cross-sectional web-based survey and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) were administered anonymously to 444 respondents comprising various categories of frontline healthcare workers. Stepwise multiple linear regression was used to determine predictors of anxiety scores. Participants were mostly young adults (mean age 38 years), females (57%), living with a partner (78.2%) and medical doctors (56.8%). Restrictions in clinical activities and use of hand sanitizers were commonest precautionary behaviors. Commonest emotional responses were anger and despair (27.0% and 25.7%), respectively. About 42.8% had clinically significant anxiety symptoms with highest burden among nurses. Perception of likelihood of 2nd wave (p=0.03), self-preparedness (p=0.04), gender (p=0.01) and cadre (p=0.02) were significant predictors of emotional response of anxiety. Study findings highlighted diverse psychological reactions of health care workers with a large proportion screening positive for significant anxiety symptoms. This has implications for planning a comprehensive psychosocial response to COVID-19 pandemic and for future pandemics among frontline health care workers in lowresource settings.gold open acces

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effect of topical bupivacaine on post-tonsillectomy pain relief in children

Tonsillectomy is a common surgery performed in paediatric otorhinolaryngology and is usually accompanied by considerable postoperative pain. Earlier literature has shown the use of topical bupivacaine for post-tonsillectomy pain relief to be promising. This study was conducted to evaluate the efficacy of topical bupivacaine application on post-tonsillectomy pain relief. Fifty consenting patients scheduled for tonsillectomy that met the inclusion criteria were enrolled in the study and assigned into two groups of 25 patients each. Group B had their tonsillar fossa packed with 0.5% bupivacaine soaked gauze for 5 minutes while Group S had normal saline. Pain intensity was measured at 1, 2, 4, 12 and 24 hours postoperatively, using the Faces Pain Scale- Revised (FPS-R). Mean scores for groups B and S at 1, 2, 4, 8, 12, 24 hours were 1.96±1.17, 2.40±0.82, 2.8±1.0, 2.88±1.17, 3.08±0.99, and 3.04±1.02 and 3.36±1.38, 4.72±1.62, 3.92±1.35, 3.76±1.45, 4.00±1.41, 3.38±0.98 respectively. The difference was significant at 1 and 2 hours only (P≤0.05). Post-tonsillectomy pain was reduced in the first two hours by application of bupivacaine soaked gauze.</jats:p

Psycho-behavioral responses of Nigerian health workers to an initial human-to-human transmission of the coronavirus disease

Previous pandemics have had significant impact on psychological well-being of front-line health care workers. Issues such as fear of contracting the disease, high workload as a result of high numbers of infected cases, increased job stress and unavailability of personal protective equipment have been implicated in development of psychological distress in this subset of individuals. The aim of the present paper is to describe psychobehavioral responses of health care workers and potential predictors of emotional response at onset of COVID-19 outbreak in Nigeria. Cross-sectional web-based survey and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) were administered anonymously to 444 respondents comprising various categories of frontline healthcare workers. Stepwise multiple linear regression was used to determine predictors of anxiety scores. Participants were mostly young adults (mean age 38 years), females (57%), living with a partner (78.2%) and medical doctors (56.8%). Restrictions in clinical activities and use of hand sanitizers were commonest precautionary behaviors. Commonest emotional responses were anger and despair (27.0% and 25.7%), respectively. About 42.8% had clinically significant anxiety symptoms with highest burden among nurses. Perception of likelihood of 2nd wave (p=0.03), self-preparedness (p=0.04), gender (p=0.01) and cadre (p=0.02) were significant predictors of emotional response of anxiety. Study findings highlighted diverse psychological reactions of health care workers with a large proportion screening positive for significant anxiety symptoms. This has implications for planning a comprehensive psychosocial response to COVID-19 pandemic and for future pandemics among frontline health care workers in lowresource settings.</jats:p