Antiemetic prophylaxis with promethazine or ondansetron in major gynaecological surgery

Background: Postoperative nausea and vomiting remain a significant cause of morbidity among patients undergoing general anaesthesia. The optimal strategy for prevention, however, remains controversial. This study evaluated the efficacy of ondansetron 8 mg compared with promethazine 25 mg or placebo for the prevention of nausea and vomiting in patients undergoing elective major gynaecological surgery.Methods: Seventy-five patients received intravenous injection of the study medication (ondansetron-25, promethazine-25 or placebo-25) immediately before the induction of anaesthesia. Nausea and vomiting were assessed over a 24-hour postoperative period.Results: Nausea occurred in 20%, 40% and 72% of the promethazine, ondansetron and placebo groups respectively (p = 0.001). The overall incidence of vomiting was 12%, 16%, and 60% (p = 0.000) for promethazine, ondansetron and the placebo respectively. Postoperative drowsiness was prominent in the promethazine group. There was no significant difference in effectiveness between promethazine and ondansetron.Conclusions: Promethazine 25 mg was significantly more effective than ondansetron 8 mg in the prevention of postoperative nausea and vomiting. Promethazine is inexpensive and the cost of drugs is of importance in developing African countries. Drowsiness was a significant side-effect with promethazine, and this will be a disadvantage in ambulatory surgery

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

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

The assessment of C-Reactive Protein (CRP) during anaesthesia and elective surgery among Nigerians

No Abstract. NQJHM Vol. 8 (1) 1998: pp. 22-2

The Period of Operation and Perioperative Blood Glucose Concentration in Children any Change from the last two Decades?

Glucose is the metabolic fuel for most tissues in the body while other substrates such as lactate and ketone bodies become important during starvation. The metabolic changes during starvation function to preserve glucose and the limited reserves of glycogen in the liver for use by the brain and the erythrocytes, liver glycogen therefore is largely intended for maintenance of blood glucose concentrations in between meals.(1) Inadequate glycogen stores and immature enzyme systems in neonates and infants when exposed to prolonged fasting periods may predispose to hypoglycaemia preoperatively. Hyperglycaemia may also occur particularly when these infants are given intravenous glucose.(2) In a developing country several factors combine to cause delay in starting surgery. it extends the fasting period and may adversely affect the blood glucose levels in children. This was a prospective observational study of preoperative blood glucose levels in 90 consecutive ASA 1 and 2 children aged 1-12 years scheduled for various elective surgeries. All the children were premedicated 1-2h before surgery with oral promethazine. Demographic data as well as duration of fast was obtained, blood glucose level was estimated by One touch glucometer (Life Scan Inc. USA) immediately after induction. The mean age of the children was 4.1±2.6 yr and the mean weight was 15.9±6.2 kg. The mean duration of preoperative fast was 13.1±4.2 h (5-23) h. The incidence of hypoglycaemia was 13.3%. Duration of fast did not significantly correlate with the occurrence of hypoglycaemia (p=0.41). There was a significant difference between the mean fasting blood glucose concentration of children who had morning surgery (4.7±1.2)mmoUL and those who had afternoon surgery (4.4±1.1) mmoi/L (p=0.02). This study has shown that fasting blood glucose was significantly influenced by period of surgery; children operated in the morning had significantly higher blood glucose levels than those operated in the afternoon.Keywords: perioperative hyperglycaemia; hypoglycaemia; blood glucose; operatio

Paediatric admission into the Intensive Care Unit of the Lagos University Teaching Hospital

No Abstract. NQJHM Vol. 8 (1) 1998: pp. 52-5

Medical Students\' Perception Of Undergraduate Training in Anaesthesia

Background: Modern teaching methods emphasize feed-back from students on all aspects of any course. This study was done to assess students\' perception of their posting in anaesthesia and to permit them suggest ways it can be more rewarding. Methodology: A structured questionnaire was voluntarily and anonymously filled by 56 students at the end of their 6-week posting in anaesthesia which comprised lectures, demonstrations, theatre and intensive care unit(ICU) sessions. Results: Mean age of the students was 24.09 ± 2.83yrs. Cardiopulmonary Resuscitation was the most popular topic (23.2%), while Breathing Systems was the most difficult to understand (28.6%) and Oxygen Therapy the most boring (12.5%). Suggestions to improve lectures included improved audiovisuals (25%) and reduced duration of lectures (17.9%). To improve learning during theatre sessions, 44.7% suggested step-by-step explanation of procedures while 41.1% suggested permitting students to carry out procedures e.g. cannulation, maintenance of a patent airway, and endotracheal intubation. Prior to their posting, 26.8% had limited knowledge of anaesthesia while 21.5% thought it was irrelevant. Forty-eight students (85.7 %) changed their impression of anaesthesia in a positive direction after their posting. At the end, 76.7% found the specialty challenging. Thirteen students (23.2%) would consider anaesthesia for postgraduate training.80.3% rated the posting as good. Conclusion: The variable response of the students has given insight into areas requiring adjustments to lecture topics and techniques of teaching. This will assist in imparting the vital knowledge and skills that are peculiar to our specialty. This would go a long way in changing the perception of anaesthesia thereby encouraging more students to consider postgraduate training in anaesthesia. NQJHM Vol. 16 (3) 2006: pp. 106-10

Resuscitation Guideline 2000: What is the level of Awareness and Knowledge in Practicing Anaesthestists?

BACKGROUND: Cardiopulmonary resuscitation was officially instituted in 1960. In 1992, the American Heart Association released the first set of resuscitation guidelines. Following a general consensus by experts drawn from various resuscitation councils worldwide, a new set of evidence based guidelines was released in August 2000. New guidelines were released in November 2005. PURPOSE: To determine the level of awareness and knowledge of the 2000 ‘Resuscitation Guidelines\' on the management of cardiopulmonary resuscitation among Nigerian Anaesthetists. METHOD: This was an unannounced, cross-sectional assessment using anonymous self-administered questionnaires. A structured questionnaire based on the UK interpretation of the Resuscitation Guidelines 2000 was sent to 10 teaching hospitals in Nigeria that offer Anaesthesia residency training and the questionnaire was also administered at an annual Anaesthetists\' gathering. Level of awareness of the guidelines and current management of cardiopulmonary resuscitation was assessed. RESULTS: 94 anaesthetists, 64 (68.1%) male; 30 (31.9%) female, from 13 hospitals in Nigeria responded (response rate 71.8%). Average age and post graduation years were 37.1+5.1 and 11.7+7.2 years respectively. 39.2%+17.2 was the average score obtained. 14.9% were aware of the resuscitation guidelines 2000 with consultants exhibiting greater awareness (

Prevalence and predictive factors of birth traumas in neonates presenting to the children emergency center of a tertiary center in Southwest, Nigeria

Background: Although the majority of birth injuries are minor and often unreported, occasionally birth injuries may be so severe as to be fatal or leave the child with a permanent disability or even death.Objective: This study aimed to document the patterns and predictive factors of birth injuries in neonates presenting at the emergency center of a tertiary hospital in South west, Nigeria. Patients And Methods: This was a cross-sectional study of neonates who presented at the Olikoye Ransome-Kuti Children Emergency Center of the Lagos University Teaching Hospital between October and December 2016. All neonates admitted for treatment at the center for any clinical condition were included in the study after initial review or resuscitation/treatment for their primary complaint, and consent was obtained from their caregivers. The babies were examined by at least a senior resident and any abnormality documented. Any underlining medical conditions such as asphyxia and neonatal sepsis were properly investigated and treated. Statistical analyses were performed by chi-square, student's t-test, using SPSS version 20.0. P ≤ 0.05 was considered statistically significant. Results: A total of 134 neonates were reviewed during the study period with majority, 84 (62.7%), being males. The mean age at presentation was 65.2 ± 89.2 h (median 24 h). Caput succedaneum (22.2%) and subconjunctival hemorrhage (22.2%) were the most frequent injuries observed, while cranial nerve injury the least. One patient had multiple injuries (cranial nerve injury with fractures humerus). Conclusions: Overall prevalence and pattern of birth injuries in neonates presenting at our emergency center was consistent with various studies from other centers. Parity of the mother, significant maternal medical history, duration of labor, mode of delivery, and skill of attending personnel at delivery were significant factors associated with birth injurie