Nebulized magnesium versus ketamine for prevention of postoperative sore throat in patients for general anaesthesia

Background: Sore throat is a common post-operative complaint which can cause significant distress and morbidity. We tested and compared the efficacy of nebulized Magnesium and Ketamine on the incidence and severity of sore throat within the first 24 hours after general anaesthesia.Objective: To compare the incidence and severity of post-operative sore throat at 2, 4, 8, 12 and 24 hours after extubation following pre-induction administration of nebulized Magnesium and Ketamine.Method: In this randomized controlled trial, 99 adult ASA I and II patients between the ages of 16 – 65 years were administered  nebulized Ketamine 50 mg, Magnesium Sulphate 250 mg or saline for ten minutes prior to induction of general anaesthesia and orotracheal intubation. Incidence and severity of post-operative sore throat were assessed at 2, 4, 8, 12 and 24 hours post extubation.Result: The incidence of sore throat at 4, 8, 12 and 24 hours post tracheal extubation were significantly lower in the Magnesium  (18.2%, 12.1%, 0, 0; p = 0.009, 0.006, <0.0001, 0.003) and Ketamine group (24.2%, 12.1%, 6.1%, 0; p = 0.041, 0.006, 0.001, 0.003) compared with the saline group (48.5%, 42.4%, 39.4%, 24.2%). Patients also had significantly less severe sore throat at 4 and 8 hours post  extubation in both Magnesium and Ketamine groups (p = 0.0 11, 0.041).Conclusion: Pre-induction nebulization of Ketamine or Magnesium can decrease the incidence and severity of sore throat in the first 24 hours after anaesthesia. Keywords: Nebulize, Sore throat, Magnesium, Ketamin

Range of mouth opening among three major ethnic groups in Nigeria

Background: Maximum mouth opening (MMO) is an important parameter in the assessment of several clinical situations and its measured value isdocumented to have racial, gender, age and anthropometric variation.Objective: To determine the maximal mouth opening and its predictors among the different major ethnic groups in Nigeria.Methods: Study subjects were 449 adults (232 males, 215 females), age range 18-74 years from the three major ethnic groups in Nigeria. MMO measurements and anthropometric parameters were recorded. Data analysis was done using SPSS Version 22 and variables subjected to univariate analysis to determine association and a linear regression model was performed to determine variables that could predict maximum mouth opening with pvalue set at < 0.05.Result: The overall mean MMO across the ethnic groups was 49.33 ± 7.91mm. Mean MMO for the Yoruba ethnic group, 53.06 ± 6.27 mm was found to be significantly higher than values obtained for Hausa tribe 52.77 ± 8.06 mm and Igbo tribe 47.59 ± 8.61 mm (p=<0.001). Age, weight and height were observed to correlate significantly with MMO. A multivariate linear regression model revealed that age and height were independent predictors of maximum mouth opening across the ethnic groups.Conclusion: There is ethnic variation in MMO among the 3 major ethnic groups in Nigeria with mean MMO values of 53.96 (± 6.27 mm), 52.77 (± 8.06mm) and 47.59 (± 8.61 mm) for the Yoruba, Hausa and Igbo ethnic groups respectively. Age and height are important predictors of MMO

Inappropriate Intensive Care Unit admissions: Nigerian doctors’ perception and attitude

Background: Nonclinical factors are said to influence decisions to admit patients into the Intensive Care Unit (ICU). We therefore assessed the perception and attitude of Nigerian doctors working in the ICU about inappropriate admissions and request for admission in the setting of a full ICU.Methods: An anonymous, self‑administered questionnaire survey was carried out among doctors working in the ICU of 17 University Teaching Hospitals, in Nigeria. A score of 0 (least usual reason) to 5 (most usual reason) was ascribed to some factors that can influence ICU admission. In addition, each of the 4 possible actions in the setting of a full ICU was graded from 0 (least likely) to 5 (most likely). The result was analyzed as appropriate.Results: Sixty‑four doctors participated in the survey. Inappropriate admissions were acknowledged by 96% of respondents. Perceived reasons included pressure from superiors (93.7%), referring clinicians (89.1%), and hospital management (87.5%). If confronted with request for admission in the setting of a full ICU, respondents will arrange for the discharge of fit ICU patients to the ward (95.3%), transfer patients not receiving acute care to high dependency unit or recovery room (70.3%), or create additional ICU beds (42.2%). Chi‑square test showed a significant difference between single and married respondents with regard to clinical doubt (P = 0.01) and pressure from referring clinician (P = 0.02) as reasons for inappropriate admission. Respondents’ gender, marital status, professional activity, and number of ICU admissions per year did not affect possible steps in the setting of a full ICU.Conclusion: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is necessary to determine the impact of such admissions on ICU efficiency.Keywords: Intensive care, patient admission, perception, resource allocatio

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran