Manual In-Line Stabilization of the Cervical Spine Increases the Rate of Difficult Oro-Tracheal Intubation in Adults - A Randomized Controlled Trial

Background: Patients with traumatic brain injury present with loss of consciousness andsuspected cervical fracture. The aim of this study was to determine the rate of difficult orotracheal intubation in surgical patients undergoing various procedures when manual in-line neck immobilization technique was applied. Methods: This was a randomized prospective study at the Lagos University Teaching Hospital. A total of 100 patients were enrolled into the study and were allocated into 2 groups of either Manual In-Line Stabilization (MILS) or Early Morning Sniffing position (EMSP) techniques during intubation. Successful or unsuccessful intubations within 30secs, as well as time to successful intubation were the outcome measures. Results: The mean ± SD intubation time for successful intubation was similar in both groups (MILS=17.9±7.7 seconds, EMSP=14.6±6.6 seconds (p=0.359)).There were more failed intubations in the MILS group (27%) and (2%) in the EMSP group (p=0.001). Conclusion: The study showed that patients who had MILS had more failed intubations than those that were intubated with the EMSP technique. With this level of failed intubations there is need for provision of difficult airway laryngoscopic adjuncts for patients with diagnosed cervical fracture and uncleared cervical injury who require orotracheal intubation.Key Words: Manual inline stabilization, Cervical spine injury, Orotracheal intubation, Difficult intubatio

Allergic Rhinitis and its Associated Co-Morbidities at Bugando Medical Centre in Northwestern Tanzania; A Prospective Review of 190 Cases.

Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (χ2 = 28.691, P = 0.000). Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P < 0.05). Strong perfume odors affect female than males (χ2 = 4.583, P = 0.032). In this study family history of allergic rhinitis was not a significant risk factor (P =0.423). The majority of patients (68.8%) were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 - 28 days). Most patients (98.4%) had satisfactory results at discharge. The study shows that allergic rhinitis is common in our settings representing 14.7% of all otorhinolaryngology and commonly affecting children and adolescent. Sufferers seek medical services due to co-morbidities of which combination of surgical and medical treatment was needed. High index of suspicions in diagnosing allergic rhinitis and early treatment is recommended

An Audit Of Perioperative Cardiac Arrest At Lagos University Teaching Hospital

Objective: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. Materials and Methods: All perioperative cardiac arrests in adults that occurred in a one year period(January 2003 to December 2003) at the Lagos University Teaching Hospital were prospectively studied. All patients less than16 years and cardiac arrests occurring outside the direct supervision of the anaesthetists were excluded. Study variables included demographic data, ASA score, urgency of surgery, surgical procedure, aetiology, time and duration of arrest, cardiac arrest rhythm, management as well as immediate outcome and survival to hospital discharge. Results Thirteen cardiac arrests occurred in 2147 cases (incidence of 6 per 1000). The mean age of patients was 30.23 ± 11.06 years. Ten patients had an ASA score greater than 3. Hypovolaemia was responsible for arrests in 9 patients. Two arrests occurred at induction, 7 intraoperatively and 4 postoperatively. Seven patients had non- VF/VT rhythms. Cardiopulmonary resuscitation was instituted immediately. The mean duration of arrest was 25.66 ± 13.34 minutes. Drug and defibrillator therapy were inadequate. Immediate survival occurred in 5 patients (38.46%). Factors associated with significant difference in recovery from a cardiac arrest were type of surgery (p=0.043) and duration of resuscitation (p=0.022) Conclusion: Majority of cardiac arrests were due to hypovolaemia from massive blood loss. There is a need for the provision of adequate banked blood as well as improvement in training in the management of in-hospital cardiac arrest to ensure a better outcome. Keywords: Witnessed cardiac arrest; cardiopulmonary resuscitation, outcome Nigerian Journal of Clinical Practice Vol. 10 (3) 2007 pp. 188-19

An Audit of Anaesthesia Record-keeping at the Lagos University Teaching Hospital

Background: The anaesthetic record documents how individual patients respond to surgery and anaesthesia. It is an essential part of patients’ medical records. We conducted an audit cycle of anaesthetic records to determine accuracy and completeness of records and any effects on record-keeping after feedback. Patients and Methods: All anaesthetic record charts filled for elective and emergency surgeries over a one month period were prospectively and anonymously scrutinised for completeness of records. A re-audit of 100 charts was performed after feedback of results to the department to determine any improvement in documentation. Results: One hundred anaesthetic charts were studied in each audit. 6% of anaesthetic charts were completely filled in both audits. The only variables to be recorded 100% in both audits were the patient’s name and type of airway device inserted in patients that had general anaesthesia. There was an improvement in records of all demographic data but only weight recorded a significant improvement from 31% to 47% (p=0.02). Preoperative clinical data that recorded significant improvement in the re-audit were Pre-operative history (51% to 91%