Emergency Caesarean section in a patient with known sickle-cell disease and myasthenia gravis

A 33-year-old patient with known sickle-cell disease (SS) booked for antenatal care at the Lagos University Teaching Hospital at six weeks gestational age. She had been diagnosed with myasthenia gravis three years prior to presentation and placed on oral anticholinesterase and steroid therapy, but her compliance was poor. She had had an operative delivery six years previously, under a general anaesthesia relaxant technique. It had been complicated by delayed emergence and residual muscle weakness, necessitating postoperative ICU admission for mechanical ventilation. In the index pregnancy, she had an emergency Caesarean section with bilateral tubal ligation under a combined spinal-epidural technique. A level of sensory block of T6 was achieved with 2.8 mL of 0.5% hyperbaric bupivacaine administered intrathecally. Towards the end of surgery, analgesia was supplemented through the epidural catheter with injection of 25 μg fentanyl in 6 mL of 0.25% plain bupivacaine. Supplemental oxygen was administered via a Hudson mask at 4 L/min. A live male baby with Apgar scores of 9 and 10 at one and five minutes, respectively, was delivered. The intraoperative period was uneventful. Postoperatively, she was managed in the high care unit. Postoperative analgesia was achieved via the epidural catheter with 6 mL of 0.125% bupivacaine and 2 μg/mL fentanyl four hourly for 48 hours. Subsequent recovery was uneventful. She was discharged to the postnatal ward on the fourth day postsurgery, and home with her baby 10 days later.Keywords: Caesarean section, myasthenia gravis, epidural, sickle-cell diseas

Aetiology and treatment outcome of severe traumatic brain injuries in neurosurgical center with inadequate facilities

Background: Severe traumatic brain injury (TBI) is a major challenge to the patient, the relatives, the care givers, and the society in general. The primary and secondary injuries, and the high metabolism are formidable stages of the injury, each capable of taking the life of the patient. The objectives were to determine the etiology and outcome in severe traumatic brain injuries patients.Methods: This was a prospective study on patients with severe traumatic brain injury patients managed in our center from August 2010 to December 2014. Patients were resuscitated in accident and emergency unit using Advanced Trauma Life Support protocols. Those with Glasgow Coma scale scores ≤8 were included in the study.Data were collected with structured proforma which was component of our prospective data bank that was approved by our ethics committee, and were analyzed with Environmental Performance Index info 7 softwareResults: One hundred and ten patients were studied. Males were 86. The mean age Was 31.43 years. Ninety six were involved in road traffic accident. Seventy seven patients had favorable outcome.Conclusion: The commonest etiology was road traffic accident.Seventy seven patients had favorable outcome.Keywords: etiology, outcome, severe traumatic brain injur

Pain on Propofol Injection: The Gender Differences in Pain Perception

Background: Injection pain, which distresses patients, is a major disadvantage of propofol as an induction agent. Lignocaine pretreatment is the most popular method for reducing this pain but this drug alone cannot eliminate the problem. The aim of this study was to investigate the gender differences in pain perception/responses, and the analgesic effect of lignocaine and metoclopramide combination, compared with lignocaine alone, during propofol injection in an adult Nigerian population at the Lagos University Teaching Hospital (LUTH).Methods: A total of seventy patients were studied, comprising twenty-seven men (38.57%) and forty-three women (61.43%). Thirty-five patients in each group; who came in for various elective surgical procedures under intravenous general anesthesia were randomly assigned to two different groups, A or B. The effectiveness of a combination of i.v lignocaine 20mg/ i.v metoclopramide 10mg ( group A, n=35) when mixed with i.v propofol 2.0mg/kg in reducing pain on injection at induction of anesthesia was compared with i.v lignocaine 20mg alone mixed with i.v propofol 2.0mg/kg into a dorsal hand vein (group B, n=35). During a ten-second pause, after the first 25% of the calculated propofol dose (mixed with study drugs), the patients were asked standard questions regarding pain on injection before induction of anaesthesia. The incidence and intensity of pain were assessed using a four point Verbal Rating Scale 0 to 3 during propofol injection. Thereafter, the induction of anesthesia was continued and completed with the remainder of the calculated propofol dose and endotracheal intubation facilitated with 0.1mg/kg pancuronium in the two groups. In all other respects, except for the type of surgery, the patients had the same treatment.Results: With regard to incidence of pain on injection, the difference between the two groups was statistically significant (P<0.05) using the Chi-square test. There was no statistical difference in Verbal Pain Response (intensity) (P>0.05) Female patients had statistically significant greater pain responses/perception than men in both groups (P< 0.05).Conclusion: A lignocaine/metoclopramide combination was more effective than lignocaine alone for reducing pain on injection of propofol, and in addition, women had significant greater pain perception than men.Keyword: propofol injection pain, gender differences, pain perception, lignocaine, metoclopramide

Central corneal thickness changes following manual small incision cataract surgery

Olufisayo Temitayo Aribaba,1 Olusesan Adetunji Adenekan,1 Adeola Olukorede Onakoya,1 Adekunle Rotimi-Samuel,1 John Olutola Olatosi,2 Kareem Olatunbosun Musa,1 Akinyele Oyedele Oyefeso,1 Folashade Bolanle Akinsola11Guinness Eye Centre, Lagos University Teaching Hospital, 2Department of Anaesthesia, College of Medicine, University of Lagos, Lagos, NigeriaAim: To determine changes in post-cataract surgery central corneal thickness (CCT) at Lagos University Teaching Hospital by assessing the time it takes for the cornea to return to its preoperative thickness value.Methods: This study is a prospective, hospital-based open within-patient controlled study with the unoperated eye controlling for the operated one.Results: Two hundred patients with 400 eyes were analyzed, with bilateral mature cataract in 47.0%. All the patients had manual small incision cataract surgery with posterior chamber intraocular lens implant. There is an increase in mean baseline CCT from 520.6±20.3 µm by 76.9 µm (597.9±30.4 µm) 24 hours after cataract surgery followed by relative reduction in the mean CCT to 555.2±24.7 µm and 525.1±19.7 µm at 2 weeks and 12 weeks, respectively. Increase in mean CCT in the unoperated and contralateral eyes were recorded in this study.Conclusion: There was a transient increase in corneal thickness following cataract surgery with subsequent decrease to preoperative thickness by 12th and fourth week in the operated and unoperated eyes, respectively. Corneal manipulations during cataract surgery must be minimal to reduce visual rehabilitation time to barest minimum. Postoperative refraction will be better at eighth week to 12th week considering the time it takes for the CCT to return to its stable preoperative values.Keywords: post-cataract surgery visual rehabilitation, pachymetry, recovery time, unoperated ey

Knowledge of Australian primary education providers towards dental avulsion injuries: a cross-sectional study

Background/aim The aim of this study was to evaluate the knowledge of school professionals regarding the emergency management of dental avulsion. Methods This cross‐sectional study utilised a self‐administered, pilot‐tested questionnaire for school staff from primary schools. Descriptive statistics were used for the analysis – the prevalence and univariate associations between a categorical outcome and the variables under consideration, were evaluated using Pearson’s Chi‐squared test. Results This survey yielded a response rate of 43.5% (n = 313). Approximately 60% of participants held valid first‐aid certificates and 23% had received avulsion advice previously. Over 80% of participants expressed an unwillingness to replant an avulsed tooth, and over 90% believed that there should be greater awareness in this area. This unwillingness to replant was influenced by respondents’ age (x2 = 8.13 df = 3, P = 0.043) and receiving advice previously (x2 = 13.15, df = 1, P < 0.001). Under‐preparedness was related to years of experience (x2 = 15.03, df = 5, P = 0.010), first‐aid training (x2 = 6.41, df = 1, P = 0.011) and receiving advice previously (x2 = 43.47, df = 1, P < 0.001). It was also evident that first‐aid training positively influenced appropriate dental referral in the management pathway (x2 = 10.49, df = 1, P = 0.001). Conclusion This study suggests that there is an inadequate level of knowledge on the appropriate management of dental avulsion injuries amongst primary school professionals in Australia