Single Dose of Dexamethasone for Prevention of Nausea and Vomiting After Major Gynaecological Surgery

BACKGROUND: Post-operative nausea and vomiting (PONV) is a common complications following general anaesthesia and is a leading cause of morbidity following surgery . The mainstay of management them is by the use of antiemetic.METHOD: It was a randomized double blind placebo controlled study. The sample size was calculated as 90 from previous study with 10% attrition to make the 100. They were randomly divided into two groups; group Breceived dexamethasone prophylactically at induction while group A received placebo also at induction. All patients had balanced general anaesthesia and were taken to the recovery room postoperatively whereincidences of postoperative nausea and vomiting were recorded. Patients with incidences of nausea and vomiting were treated with 10mg metoclopramide intravenously while postoperative complications thatmay be associated with dexamethasone prophylaxis were also noted.RESULTS: The groups were comparable with respect to demographic characteristics. More patients in group A(placebo group)) had incidence of nausea than group B (dexamethasone group) with p value of 0.01 and also more patients in group A had vomiting than group B with p value of 0.02; which was significant. The duration of stay in the recovery room for both groups A and B were however comparable with no statistical difference.CONCLUSION: Dexamethasone when given prophylactically at induction reduces incidence of postoperative nausea and vomiting after  gynaecological surgeries.KEYWORDS: Postoperative nausea (PONV), Dexamethasone, prophylaxis, gynaecology

Intrathecal tramadol versus intrathecal fentanyl for visceral pain control during bupivacaine subarachnoid block for open appendicectomy

Context: Profound side.effects following intrathecal use of local anesthetics as the sole drugs of choice make spinal anesthesia for open  appendicectomy uncommon.Aim: The aim of this study was to evaluate the effectiveness of  intra-operative analgesia produced by intrathecal tramadol and fentanyl during bupivacaine spinal anesthesia for open appendicectomy.Settings and Design: A prospective randomized study was performed.Materials and Methods: A total of 186 American Society of  Anesthesiologists 1 or 11 patients scheduled for emergency open  appendicectomy were analyzed. Group FB (n = 62) received intrathecal fentanyl 25 µg plus 3 ml of 0.5% hyperbaric bupivacaine, Group SB (n = 62) received 0.5 ml normal saline plus 3 ml of 0.5% hyperbaric  bupivacaine and Group TB (n = 62) received intrathecal tramadol 25 mg plus 3 ml of 0.5% hyperbaric bupivacaine. Visual analog scale scores and frequency of subjective symptoms among patients in the three groups formed the primary outcome measure of this study.Results: Effective intraoperative sensory block was achieved in 100% of patients in group FB and TB while 29 (46.8%)patients in group SB had ineffective sensory block (P = 0.0001). The pain free period was significantly longer in patients inGroup FB than Group SB and TB. Mean time for Group FB with regard to first analgesic request was 304.73 ± 67.91 min,Group SB was 146.59 ± 36.62 and Group TB was 238.39 ± 61.28 min. Incidence of complications were comparableamong the three groups.Conclusion: This study showed that intrathecal tramadol (25 mg) can safely replace intrathecal fentanyl (25 ƒÊg) in themanagement of visceral pain and discomfort during subarachnoid block for appendicectomy.Key words: Analgesia, appendicectomy, intrathecal opioid, spinal anaesthesi

Perception of Nurses about Palliative Care: Experience from South-West Nigeria

Background: Nurses play a major role all over the world in the palliative care team.Aim: The aim of this study was to investigate the knowledge and attitude of nurses toward palliative care in a tertiary level hospital in Nigeria. Subjects and Methods: Setting: This cross-sectional questionnaire-based study was carried out among nurses at a tertiary health care facility inAdo-Ekiti, South-West Nigeria. Design: A cross-sectional questionnaire-based study was carried out. The questionnaire sought information about the sociodemographic profile of respondents, their knowledge of definition and philosophy of palliative care among other things. Descriptive statistics was used to obtain the general characteristics of the study participants, while Chi-square was used to determine the association between categorical variables. A two-sided P < 0.05 was considered as significant.Results: A total of 100 questionnaires were returned with a female preponderance among the respondents with F: M ratio of 9:1. Regarding the definition of palliative care, 71.8% (48/66) of the respondents  understood palliative care to be about pain medicine, 55% (33/60) thought it to be geriatric medicine, while 90.2% (83/92) felt palliative care is about the active care of the dying. Exactly 80.5% (66/82) respondents agreedthat palliative care recognizes dying as a normal process while 84.1% (74/88) respondents were of the opinion that all dying patients would require palliative care. The use of morphine would improve the quality of life of patients according to 68.9% (42/61) of respondents.Conclusion: There are gaps in the knowledge of healthcare workers in the area of palliative care and this call for a review of the current nursing curriculum and practice guidelines in Nigeria.Keywords: End of life, Nursesf attitude, Pain management, Palliative car

B-Lynch Suture-Uterine Artery Ligation in Severe Postpartum Haemorrhage: First Experience at a New Tertiary Institution in Nigeria

Postpartum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical methods have been used to arrest bleeding but none has been uniformly successful. Experience withcombined B-Lynch suture(Brace suture) and bilateral uterine artery  devascularisation procedure is limited in southwestern Nigeria as there is dearth of data on it and most times (especially in our center) hysterectomy is done to secure haemostasis in severe postpartum haemorrhage which could as well, in well selected cases, respond to the procedures being described. A combined B-Lynch suture and bilateral ligation of the uterine vessels(the first experience in the centre of study) was done in the case reported below which was successful and effective with no complications. This is thus highly recommended as alternative to obstetric hysterectomy especially in well selected primipara. (B-Lynch, uterine artery ligation, postpartum haemorrhage, Nigeria

Antioxidant activities and phenolic contents of the methanol extracts of the stems of Acokanthera oppositifolia and Adenia gummifera

Abstract Background Acokanthera oppositifolia Lam (family: Apocynaceae) is a shrub or small tree with white latex, and the leaves of this plant are used in the form of a snuff to treat headaches and in infusions for abdominal pains and convulsions and septicaemia. Adenia gummifera Harv of the family Passifloraceae is a distinctive woody climber whose infusions are used as emetics and are said to help with some forms of depression. Lipid peroxidation has gained more importance today because of its involvement in pathogenesis of many diseases. Free radicals are the main agents in lipid peroxidation. Antioxidants thus play an important role of protecting the human body against damage by the free radicals. Plants containing phenolic compounds have been reported to possess strong antioxidant properties. Methods The antioxidant activities and phenolic contents of the methanol extracts of the stems of Acokanthera oppositifolia and Adenia gummifera were evaluated using in vitro standard procedures. Spectrophotometry was the basis for the determinations of total phenol, total flavonoids, flavonols, and proanthocyanidins. Tannins, quercetin and catechin equivalents were used for these parameters. The antioxidant activities of the stem extract of Acokanthera oppositifolia were determined by the 2,2'-azinobis-3- ethylbenzothiazoline-6-sulfonic acid (ABTS), 1,1-Diphenyl-2-picrylhydrazyl (DPPH), and ferrous reducing antioxidant property (FRAP) methods. Results The results from this study showed that the antioxidant activities of the stem extract of Acokanthera oppositifolia as determined by the 1,1-Diphenyl-2-picrylhydrazyl (DPPH), and ferrous reducing antioxidant property (FRAP) methods, were higher than that of Adenia gummifera. The levels of total phenols and flavonols for A. oppositifolia were also higher. On the other hand, the stem extract of Adenia gummifera had higher level of total flavonoids and proanthocyanidins than that of Acokanthera oppositifolia. The 2, 2'-azinobis-3- ethylbenzothiazoline-6-sulfonic acid (ABTS) activities of the 2 plant extracts were similar and comparable to that of BHT. Conclusion Thus, the present results indicate clearly that the extracts of Acokanthera oppositifolia and Adenia gummifera possess antioxidant properties and could serve as free radical inhibitors or scavengers, acting possibly as primary antioxidants. This study has to some extent validated the medicinal potential of the stems of Acokanthera oppositifolia and Adenia gummifera.</p

Spinal Anaesthesia for Appendectomy: Experience at the University of Benin Teaching Hospital (UBTH), Benin-city, Edo State, Nigeria

Background: Appendectomy is the commonest surgical emergency in our hospital. Spinal anaesthesia is one of the anaesthetic techniques for appendectomy; it is simple and safe in experienced hands. We determined the use of spinal anaesthesia for appendectomy and outcome in our centre.Patients and Methods: This was a retrospective study of all cases of appendectomy performed from April 2007 to September 2009 (thirty months), cases that had spinal anaesthesia were further analysed. Information such as patients&#8217; age, gender, ASA physical health status, PCV, urinalysis, anaesthetic technique, surgery duration, supplemental analgesics, intra-operative complications, and outcome, were obtained from anaesthetic and theatre records.Results: Five hundred and thirty-three cases of appendectomy were performed, of which 105 (19.7%) patients received spinal anaesthesia while majority (80.1%) of the cases were done under general anaesthesia and 1 (0.2%) patient had epidural anaesthesia. Eighty-four (80%) of the patients who had spinal anaesthesia had intrathecal administration of a combination of 0.5% hyperbaric bupivacaine and an opioid (25&#956;g Fentanyl or 10mg Pethidine), while 21 (20%) had intrathecal administration of 0.5% hyperbaric bupivacaine without opioid. Of the patients who received spinal anaesthesia, 72 (68.6%) had adequate anaesthesia intra-operatively, 25 (23.8%) patients required supplemental analgesics, while 7.6% cases were converted to general anaesthesia. Complications in the intra-operative period such as hypotension, shivering, high block and itching were managed effectively.Conclusion: The study revealed that use of a combination of 0.5% hyperbaric bupivacaine and an opioid provided effective anaesthesia for appendectomy. We recommend an increasing use of spinal anaesthesia for appendectomy

Crystalloid Preload Plus Crystalloid Coload for Management of Hypotension During Subarachnoid Block for Emergency Caesarean Section

Background: Maternal hypotension following spinal anaesthesia remains a persistent major clinical burden. Several physical methods, fluid loading, dose adjustments, addition of opioids or vasopressors have been tried alone or in combinations but with controversial findings.Purpose: To determine whether crystalloid coloading will enhance control of maternal hypotension  provided by crystalloid preloading during spinal anaesthesia.Patients and Methods: Women in preload group (PL, n=25) received 15ml/kg normal saline within 15 minutes before induction of spinal anaesthesia, then had  maintenance infusion of 20ml/kg normal saline for the next one hour. Those in coload group (CL, n=25) received 15ml/kg normal saline within 15 minutes following  induction of spinal anaesthesia, then had maintenance infusion of 20ml/kg normal saline for the next one hour. The parturients in combined preloadcoload group (BL) received 15ml/kg normal saline within 15 minutes before spinal anaesthesia and 15ml/kg normal saline within 15 minutes following induction of spinal anesthesia,   then had maintenance infusion of 5ml/kg normal saline over one hour. Maternal hypotension, total rescue fluid, neonatal outcome and ephedrine used were  documented.Results: Incidence of hypotension was significantly higher among patients in preload group 15(60%) and coload group 18(75%) compared to combined group 4  (16.7%) (p=0.0001). The mean dose of ephedrine administered following hypotension was significantly higher in coload group (15.2 ± 3.2 mg) and preload group (12.3 ± 1.4 mg) compared to combined group (3.1 ± 0.9 mg) (P=0.0001). Neonatal outcome was similar in the three groups.Conclusion: Combined crystalloid preload-coload is a better prophylactic method of managing spinal-induced hypotension than crystalloid preload or coload alone in women undergoing caesarean section under subarachnoid block.Keywords: caesarean section, hypotension, preload, preload-coload, spinal anaesthesia