Eventration of the diaphragm – case reports and review of the literature

Eventration of the diaphragm can have varied symptomatology. We present three cases that presented with features suggestive of gastric outlet obstruction, productive cough of acute onset, and traumatic diaphragmatic rupture respectively. They were successfully treated with plication of affected hemidiaphragm. We also reviewed existing literature on the subject with presentation of our findings.Keywords: Eventration, Hemidiaphragm, Syndromes, Plicatio

<b>Comparative study of trace element levels in some local vegetable varieties and irrigation waters from different locations in Ilorin, Nigeria</b>

The level of heavy metals in two varieties of vegetables harvested during the dry and wet seasons from seven different locations in Ilorin, Nigeria, were determined. The correlation between the level of metals in the vegetables and the irrigation water was also studied. Vegetables harvested during the dry season were found to contain higher level of toxic metals. Low water quality, accumulation of particulate after rainless period and nearness of some vegetable gardens to major and well travelled roads appeared to be the major contributory factors. <i>Amaranthus hybridus</i> seemed to have higher metal accumulation capacity compared to <i>Corchorus olitorius mannii</i>

The efficacy of dexamethasone/bupivacaine combination versus plain bupivacaine only for caudal block in paediatric herniotomy:- a comparative study.

Background : The duration of caudal anaesthesia in pediatrics surgery have been prolonged with different adjunct, however, they were associated with untoward adverse effects.Objective: We compared the efficacy of caudal dexamethasone/bupivacaine combination with caudal bupivacaine only for postoperative herniotomy pain.Method : This was a randomized controlled trial in 84 children, aged 1-5 years with American Society of Anesthesiologists physical status (ASA) 1-11scheduled for elective unilateral herniotomy under general anaesthesia. They were assigned to received either 0.25% bupivacaine 1ml/kg, (group B) or a mixture of dexamethasone (0.1mg/kg) with 0.25% bupivacaine 1ml/kg, (group BD). Postoperative pain was assessed using a ModifiedObjective :&nbsp; Pain Scale (MOPS) score. Rescue analgesia (oral ibuprofen 5 mg/kg) was administered when MOPS was ≥4.Results : The mean MOPS was significantly higher in group B than group BD at 2, 6, and 8 hours after surgery; 4.10 ±1.1 versus 2.88 ±0.5, (p =0.001), 3.2 ±1.3 versus 2.60 ±0.9, (p = 0.002), and3.74 ±0.8 versus 2.1 ±1.1, (p =0.004) respectively. The mean time to first analgesic requirement was significantly longer in group BD than group B 478.17 ±27.64 versus 183.67 ±28.43 minutes, (p =0.001). The mean dose of total ibuprofen consumed was significantly higher in group B, 228.82 ±26.26 mg than group BD, 151.90 ±14.91mg, p =0.001.Conclusion: It's concluded that the addition of 0.1mg/kg dexamethasone to 1ml/kg bupivacaine 0.25% during caudal block significantly prolonged the duration of analgesia, reduced the postoperative pain scores, and the total dose of ibuprofen consumed in the first 24 hours postsurgery

A comparative study of the incidence and severity of sore throat after insertion of the laryngeal mask airway and endotracheal tube

BackgroundPostoperative sore throat is a common and unpleasant complication following airway insertion during general anaesthesia.ObjectiveWe compared the incidence and severity of sore throat following passage of two airway devices.MethodsFollowing ethical committee approval, patients were randomly allocated by blind balloting into one of two groups; Group ETT (n=45) had endotracheal tube insertion and group cLMA (n=45) had classic laryngeal mask airway insertion. Induction of anaesthesia was achieved with propofol 2.5 mg/kg and fentanyl 1.5μg/kg., followed by pancuronium 0.1mg/kg, after test ventilation. Introduction of airway device was done 3 minutes after administration of muscle relaxant. The incidence of dryness of the throat, hoarseness of voice, cough and severity of sore throat was accessed using visual analogue scale, on the 1st and 2nd postoperative days.ResultsThe incidence of sore throat was comparable between the two groups on both 1st and 2nd postoperative days, (p =0.371, p =0.668) respectively. On 1st postoperative day, incidence of cough and hoarseness were significantly more in the ETT group than in the LMA group, (p =0.001, p =0.026) respectively. While on 2nd postoperative day, the incidence of cough and hoarseness were comparable, (p =0.147, p =0.571) respectively.ConclusionThe incidence of sore throat following the use of the classic laryngeal mask airway and endotracheal tube were similar. However, on 1st postoperative day, the development of cough and hoarseness of the voice was significantly more following endotracheal tube insertion

The outcome of anaesthesia related cardiac arrest in a

Background: Anaesthesia related cardiac arrest is undesirable, and different attempts have been made to reduce the mortality associated with it through continuous specialist training, and provision of state of art equipment, combined with rigorous research. Patients and methods: We determined the outcome of all cardiac arrests that occurred within 24 h of a surgical procedure and anaesthesia from January 2013 to May 2014. Results: There were nine anaesthesia related cardiac arrest in 4229 cases, (incidence of 21.28 per 10,000), with a mortality of 7/4229; (16.55 per 10,000). There were 60 perioperative cardiac arrests (incidence of 141.88 per 10,000), with a mortality of 55/4229 (130.05 per 10,000). There was return of spontaneous circulation in 34 (56.67%) cases, among them only 7 (20.59%) survived to hospital discharge. The independent determinant of perioperative mortality was the duration of cardiac arrest ⩾ 5 min (RR 10.50, 95% CI 2.721–40.519, p < 0.001), cardiac arrest in the absence of a witness (RR 9.56, 95% CI 2.486–36.752, p < 0.001), nonstandard time of cardiac arrest (RR 3.2, 95% CI 1.792–5.714, p < 0.001), ASA physical status ⩾ III (RR 2.017, 95% CI 1.190–3.417, p = 0.017), and emergency surger (RR 2.17, 95% CI 1.151–4.049, p = 0.011). Conclusion: Anaesthesia related cardiac arrest and mortality were linked to cardiovascular depression from halothane overdose in our institution. The burden can be reduced by improving on establishing standard monitoring in the perioperative period, and a team approach to patients care

Complications and outcomes following central neuraxial anesthesia in a sub-Saharan Tertiary Hospital: The legal implication

Background: Complications following central neuraxial anesthesia have led to litigations and claims in developed nations, however, the incidence of litigation is low in our environment. Anesthetist practicing in Nigeria need to be aware that such complications are not uncommon. Aim and objective: To determine central neuraxial anesthesia related complications and the legal implications. Method: This was a prospective observational study conducted in 821 patients scheduled for surgery under central neuraxial anesthesia from February 2012 to January 2013. The choice of anesthesia depended on the indication and the duration of surgery. Results: The observed complications of central neuraxial anesthesia, which may result in litigation included inadvertent high block (22.4%), paresthesia during needle placement (6.2%), inadequate block (3%), failed block (1.2%), and postdural puncture headache (1.15%). Others were seizure (0.1%), meningism (0.1%), persistent pain in the lower limb for 48 hours (0.1%), back pain (0.7%) and cardiac arrest (0.49%); three of the four cardiac arrest died. There was, however, no report of litigation or claim in this study. Conclusion: We have demonstrated that complications, which may result in litigation and claim following central neuraxial anesthesia is not a rare occurrence in our institution. However, there was no record of litigation or claim in our review. Anesthetist in Nigeria need to be aware of the legal implication of such complications. When performing blocks, well recognized complications should be discussed before obtaining consent. If any untoward effect occurs, a detailed note of the findings and treatment should be documented for future reference

Does Electroconvulsive therapy aggravate the rise in potassium and creatine kinase following suxamethonium administration?

Background: Potassium and creatine kinase levels increase after the administration of suxamethonium. This rise may be exaggerated by the combination of suxamethonium fasciculation and the modified tonic/clonic convulsion induced by electroconvulsive therapy. This study compared the magnitude of increase in potassium and creatine kinase levels after electroconvulsive therapy and surgery using suxamethonium.Methods: A total of 40 patients were studied; electroconvulsive therapy (ECT), n=20 and surgery (Control), n=20. Intravenous sodium thiopentone (5mg/kg) and suxamethonium (1.5mg/kg) were administered. The changes in potassium and creatine kinase levels were assessed at presuxamethonium, 1 and 3 minutes after fasciculation in Control group and ECTinduced seizure activity in the ECT group. Our hypothesis was that a significant increase occurs in the mean potassium and creatine kinase levels after suxamethonium administration during electroconvulsive therapy.Results: Both groups exhibited a rise in potassium concentration after administration of suxamethonium. The mean increase was significantly higher in the ECT group than in the Control group; at 1 minute; ECT (0.71 ±SEM 0.24) versus control (0.28 ±SEM 0.19) mmol/L, p =0.003, and at 3 minutes; ECT (0.35 ±SEM 0.23) versus control (0.20 ±SEM 0.15), p =0.044. The mean increase in the creatine kinase concentration was significantly higher in the ECT group (34.11 ±SEM 10.76) than in the Control group (19.71 ±SEM 6.32) IU/L, p = 0.023, at 3 minutes.Conclusion: The creatine and potassium concentrations following suxamethonium administration were significantly higher in the electroconvulsive therapy group than in the control group.Keywords: ECT, surgery, creatine kinase, potassiu

How safe is sedated upper gastrointestinal endoscopy in a sub-Saharan teaching hospital?

Background: Upper gastrointestinal endoscopy may induce autonomic reactions, with transient changes in haemodynamics and oxygen saturation. We audited the changes in cardiovascular parameters and oxygen saturation during sedated endoscopy.Patients and Methods: A prospective observational study of 110 consecutive patients scheduled for upper gastrointestinal endoscopy under conscious sedation. The sedative agent, duration of endoscopy, heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SPO2) were recorded, while the rate pressure product (RPP) was computed. The patient's preoperative anxiety, pain score and discomfort score during the procedure was recorded on a modified visual analogue scale (VAS) rated from 1-10.Results: Atotal of 110 patients were studied: 69(62.7%) received IV midazolam, and 41(37.3%) had IV pentazocine. The mean HR and RPP increased significantly at all times during the study period from presedation values, p &lt;0.0001. However, the mean HR, SBP and RPP were comparable between midazolam and pentazocine groups. The maximum HR, SBP, RPP in the midazolam group was 155 bpm, 189 mmHg, and 23.35 mmHg/bpm respectively compared to the pentazocine group with 151 bpm, 174mmHg, and 24.71 mmHg/bpm respectively, p &lt;0.05.Oxygen desaturation (SPO2 ≤ 94%w)as noted in 15 patients (13.6%); midazolam (8.2%) versus pentazocine (5.5%), p =0.82. The lowest SPO2 in midazolam group was 92% versus 93% in pentazocine group. The post endoscopy ECG changes included sinus tachycardia in (12), ST segment elevation (5) and T wave inversion (8) in all patients. The number of patients with pain (VAS &gt;7) during endoscopy was comparable: midazolam (26) versus pentazocine (20), p = 0.25.Conclusion: Sedationwith either midazolam or pentazocine during endoscopy had similar effects on cardiovascular parameters and oxygen saturation. However, severe pain with VAS &gt;7 was not uncommon.Keywords: Upper gastrointestinal Endoscopy, midazolam, pentazocine, cardiorespiratory changes, Pain, anxiety score, discomfort scor

The agreement of point-of-care and standard laboratory electrolyte and glucose analysis in critically ill patients in a sub-Saharan tertiary teaching hospital

Background: The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients.Objective: This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients.Methods: The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with ISTAT Abbot Analyzer unit with parallel blood specimens (n=30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000.Results: There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good pc = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (pc) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (pc) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (pc) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (pc) = 0.0796, mean difference of 13.8 and 95%  limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (pc) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L.Conclusion: The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.Keywords: Point of care testing, Bland and Altman, concordance, electrolytes, IC