Comparison of 0.3mg/kg, 0.6mg/kg and 1.0mg/kg succinylcholine in producing acceptable intubating conditions among adult patients at the Jos University Teaching Hospital

Background: Succinylcholine at 1.0 mg/kg usually provides acceptable tracheal intubation condition within 60 seconds. The return of respiratory function following this dose is not quick enough to prevent oxyhaemoglobin desaturation when ventilation is not assisted. This randomized, double blind study was conducted to investigate if smaller doses of succinylcholine can provide acceptable intubating conditions.Methods: 180 patients, aged 18-65 years were randomly assigned to three groups A, B or C to receive 0.3, 0.6, or 1.0 mg/kg succinylcholine respectively. Anaesthesia was induced in all patients with 2μg/kg fentanyl and 2 mg/kg propofol. Following induction, they received the appropriate dose of succinylcholine according to allocated group. Tracheal intubation was performed 60 seconds later. A blinded investigator performed laryngoscopy and graded the intubating conditions.Results: Intubating conditions were acceptable in 91.7%, 96.7%, and 96.7% after in group A, B and C respectively. There was no significant difference between group A and B (p=0.235) and between group A and C (p=0.235). Group B and C equally showed no significant difference (p=1.00).Conclusions: The use of 0.3mg/kg and 0.6 mg/kg succinylcholine can produce acceptable intubating conditions after 60 seconds following administration. We therefore recommend that 0.6mg/kg of succinylcholine may be administered to patients in order to achieve acceptable tracheal intubation.Keywords: succinylcholine, tracheal intubatio

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

The African Surgical OutcomeS-2 (ASOS-2) Pilot Trial, a mixed-methods implementation study

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. The working hypothesis is that patients die as a result of failure to rescue following complications in the postoperative period. The African Surgical OutcomeS-2 (ASOS-2) Trial plans to test the efficacy of increased postoperative surveillance in high risk patients for decreasing perioperative morbidity and mortality. This pilot trial aimed i) to evaluate the adequacy of data produced by the data collection strategies of the ASOS-2 Trial, ii) to evaluate the fidelity of implementation of the increased postoperative surveillance intervention, and iii) to understand the acceptability, appropriateness and feasibility of the intervention and the trial processes.Methods: The ASOS-2 Pilot Trial was a mixed-methods (quantitative-qualitative) implementation study focusing on the intervention arm of the proposed ASOS-2 Trial. The intervention is increased postoperative surveillance for high-risk surgical patients. The intervention protocol was implemented at all sites for a seven-day period. A post pilot trial survey was used to collect data on the implementation outcomes.Results: 803 patients were recruited from 16 hospitals in eight African countries. The sampling and data collection strategies provided 98% complete data collection. Seventy-three percent of respondents believed that they truly provided increased postoperative surveillance to high risk patients. In reality 83/125 (66%) of high-risk patients received some form of increased postoperative surveillance. However, the individual components of the increased postoperative surveillance intervention were implemented in less than 50% of high-risk patients (excepting increasing nursing observations). The components most frequently unavailable were the ability to provide care in a higher care ward (32.1%) and assigning the patient to a bed in view of the nurses’ station (28.4%). Failure to comply with available components of the intervention ranged from 27.5% to 54.3%. The post pilot survey had a response rate of 30/40 (75%). In Likert scale questions about acceptability, appropriateness, and feasibility of the ASOS-2 intervention, 63% to 87% of respondents indicated agreement. Respondents reported barriers related to resources, trial processes, teamwork and communication as reasons for disagreement.Conclusions: The proposed ASOS-2 Trial appears to be appropriate, acceptable and feasible in Africa. This pilot trial provides support for the proposed ASOS-2 Trial. It emphasises the need for establishing trial site teams which address the needs of all stakeholders during the trial. A concerted effort must be made to help participating hospitals to increase compliance with all the components of the proposed intervention of ‘increased postoperative surveillance’ during the ASOS-2 Trial.Keywords: Trial, cluster randomised, Trial, pilot, Implementation science, Mixed methods, Mortality, Surger

Book of Abstract

No Abstract

Selected abstracts presented at the 4th scientific conference of critical care society of Nigeria held at Carlton Gate Xclusive Hotel, Ibadan, from 18th to 20th July 2018

No Abstract

Selected Abstracts From The 5th Annual Meeting And Scientific Conference of The Critical Care Society Of Nigeria: Lagos 2019

No Abstract

Awake craniotomy for intracranial lesions: An audit of the anaesthetists’ initial experience at the University College Hospital, Ibadan

Background: Awake craniotomy (AC) is an attractive ‘minimally invasive’ anaesthetic technique for intracranial surgical procedures. There is dearth of information on the feasibility of this technique from developing countries. Material and methods: This is a prospective descriptive study on all the patients who had AC for intracranial surgery over a 2-year period in a developing country. The data regarding their demographics, preoperative, intraoperative and postoperative anaesthetic events and any intraoperative complications were recorded. Results: There were 18 patients, 11 (61.1%) males, mean age of 47.5 years (SD = 14.71). Propofol and Fentanyl were the sole agents providing conscious sedation during these surgical cases, while 0.25% Plain Bupivacaine and 1% Lidocaine with Adrenaline (1:200,000) were used for operative site anaesthesia. Most of the tumours, 7 (38.9%), were found in the parietal region of the brain; 9 (50.1%) patients had between 5 and 10 mm midline shift on brain MRI/CT Scan; metastatic tumours, 8 (44.4%), were the commonest lesions, and 13 (72.2%) had GCS of 15/15 prior to surgery. Hypertension and tachycardia, 3 cases (16.7%) in each, were the commonest intraoperative complications. All the patients successfully underwent the AC and none was admitted into the Intensive Care Unit postoperatively. At a mean follow-up of six months 10 (55.6%) patients were alive, 6 (33.3%) dead, and 2 (11.0%) of unknown status. Conclusions: This audit showed AC to be a well-tolerated procedure with low rate of complications in our practice, an encouraging prospect for the feasibility of AC for intracranial surgical procedures in developing countries

Evaluation of surgical resident staff knowledge of cancer pain: Assessment and treatment

Objective: Inadequate knowledge and expertise are major contributing factors to poor pain management in the cancer patient. This study was carried out to evaluate the effect of formal teaching on pain management on the current practice of the resident surgeons at the University College Hospital (UCH). Ibadan. Method: Resident surgeons at different levels of their 4-year program responded to a questionnaire, which requested them to state their management of a hypothetical patient who had severe cancer pain and also asked questions on other issues relating to cancer pain therapy. Results: Sixteen resident doctors responded to the questionnaire. Mean number of years spent in residency was 2.1. More than 80% of the respondents had adequate knowledge of just taking the basic history of pain. Less than 50% indicated the need to seek information about associated symptoms, previous pain history, and the psychosocial history of the patient. Only 37% would examine the patient. On the general knowledge section, 11 (68%) of the respondents recommended parenteral opioids while only 9 prescribed oral opioids. Ten (69.5%) respondents prescribed NSAIDS in addition to opioids. All the resident doctors knew oral, IM and IV routes for analgesic therapy. The most common side effect of opioid analgesia listed was addiction. To the question of unrelieved pain, only 2 residents treated the patient appropriately. Conclusion: It is concluded that the resident's knowledge of cancer pain management id deficient and that the College should adopt a workshop approach to cancer pain management. KEY WORDS: Cancer pain management, Resident staff [Nig J Clinical Practice Vol.5(1) 2002: 10-13

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