Analgesia in patients with or without single-shot lamina thoracic paravertebral block following breast cancer surgery in a Nigerian hospital

Background: In this pilot study, we evaluated the postoperative analgesic effect of the new lamina thoracic paravertebral block using a single-shot technique for major breast cancer surgery.Methods: A retrospective observational design was used to compare data involving 16 consecutive ASA 1 and 2 female patients who had unilateral modified radical mastectomy with axillary clearance under general anaesthesia with paravertebral block and 15 others without block between 13/03/2014 to 12/05/2015. We compared the time to the first request for analgesic, total analgesic (opioid and non-opioid) consumption (in mg) and postoperative pain scores over 72 h between the two groups.Results: One patient was excluded from the cohort due to block failure. The median time to first request for analgesic was 43 h (25.2-73.0 h) in the block group versus 2 h (1.0-2.5 h), p=0001. The pain scores was significantly lower at all measurement points among the block patients compared with the no-block group until 24 h postoperatively. No patient in the block group required analgesic within 24 h after surgery. The total consumption of pentazocine was nil (block group) vs. 154.0±74.2 (range 90-300) mg, p=0.0000001.Conclusions: Single-shot lamina paravertebral block provided prolonged postoperative analgesia and reduced opioid and non-opioid consumption

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

Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Although stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.</p> <p>Methods</p> <p>A hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.</p> <p>Results</p> <p>There were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.</p> <p>Conclusion</p> <p>Awareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.</p

Single‑shot lamina technique of paravertebral block as an adjunct to general anesthesia for modified radical mastectomy

Thoracic paravertebral block can be employed as an alternative or an adjunct to general anesthesia (GA) for breast cancer surgery. There is no report of this new lamina technique for catheter placement in our environment. In low‑resource settings, potent opioids are lacking and the extended postoperative analgesia it provides makes this regional block an invaluable addition to an anesthetist’s armamentarium. We describe this single‑shot, but titratable technique used as an adjunct to GA for modified radical mastectomy with axillary dissection for breast cancer. The total intraoperative opioid analgesic 50 mg pethidine was received at induction. The patient’s vital signs remained stable throughout surgery that lasted 115 min. Pain score charted every 10 min in the postanesthesia care unit using the verbal rating scale was 0. The time to the first request for rescue analgesic was 18 h after surgery for which paracetamol 1 g was adequate.Key words: Adjunct, anesthesia, breast surgery, paravertebra

Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy

Ambrose Rukewe,1 Oludolapo O Afuwape,2 Austin Ugheoke,3 Akinola A Fatiregun4 1Department of Anaesthesia &amp; Critical Care, Faculty of Medicine, University of Botswana, Gaborone, Botswana; 2Department of Surgery, College of&nbsp;Medicine,&nbsp;3Department of Anaesthesia, University College Hospital, Ibadan, 4World Health Organisation, Akure, Ondo State, Nigeria Abstract: We describe the use of single-shot lamina thoracic paravertebral block (TPVB) with sedation for a 56-year-old female patient who had modified radical mastectomy with axillary clearance. Two years ago, she suffered vocal cord palsy post thyroidectomy, which was managed with tracheostomy. The tracheostomy tube was removed 8&nbsp;months later, leaving the patient with persistent hoarseness of voice and left vocal cord palsy. She declined general anesthesia and consented for TPVB. The surgery lasted 95&nbsp;minutes and was successfully completed with TPVB. Her vital signs were stable during the operation. She had low pain scores, minimal opioid use, early alimentation, and no postoperative nausea and vomiting and was discharged early. We present the anesthetic management of this case in our setting, where TPVB under ultrasound guidance and modern drug-delivery systems for sedation are unavailable. Keywords: anesthesia, breast surgery, lamina, paravertebral, low resourc

INFLUENCE OF SMOKING ON RESPIRATORY SYMPTOMS AND LUNG FUNCTION INDICES IN SAWMILL WORKERS IN BENIN CITY, NIGERIA.

The study was done to assess the influence of smoking on respiratory symptoms and respiratory function in sawmill workers in Benin City. 150 sawmill workers who were all males and aged between 18 and 50 years, and had been in continuous employment in sawmill factories for a minimum of one year were studied. They were selected by a two - stage random sampling process from sawmills in Benin City. These were compared to 150 age and sex matched controls in order to determine the effect of sawdust exposure on the respiratory system. Questionnaire was used to elicit morbidity patterns and anthropometric measurements were also made. Respiratory rates, Peak Expiratory Flow Rates and Blood Pressures were measured in both groups. Respiratory symptoms were more common among sawmill workers compared to the controls. Smoking by some of these workers further aggravated their respiratory symptoms. Although blood pressure was similar in both groups, Respiratory rates were higher and Peak Flow Rates were lower in the sawmill workers compared to the controls (20.83 ± 2.02 cycles/minute and 516.72 ± 38.48 L/minute for the sawmill workers; 15.45 ± 1.23 cycles/minute and 575.37 ± 27.34 L/minute for the controls, respectively). Less than 5% of the sawmill workers wore protective devices/clothing, and health and safety standards were neither practiced nor enforced. The findings suggest that respiratory symptoms especially sputum production and chest pain are common in sawmill workers. Respiratory function is compromised in these workers

Micro-Albuminuria In Adolescent/Young Adult Offsprings Of Hypertensive Nigerian Adults - A Preliminary Report

Objectives: To determine the prevalence of micro-albuminuria in adolescent/young adult offsprings of Nigeria hypertensive adults. Background: On the premise that micro-albuminuria is a predictor of early stage hypertensive disease and the fact that heredity plays an important role in the aetiology of essential hypertension, the prevalence of micro-albuminuria in children of hypertensive adults was assessed. Setting: Medical wards of the University of Benin Teaching Hospital, Benin City. Subjects: Normotensive, non-diabetic, non-obese adolescents/young adult offsprings of known adult hypertensives, receiving in-patient care. Controls had similar characteristics but born to normotensive adults. Design: Prospective, cross-sectional involving 42 subjects and 50 controls. Results: Mean age of the 42 study subjects (24 males and 18 females) was 17.95+0.52years (range 13 – 24 years). Eight (19.0-%) had microalbuminuria as compared to 4(8.0%) in controls. Five (62.5%) of the micro-albuminuric subjects had fathers who were hypertensive while none had maternal history of hypertension. The incidence of microalbuminuria in subjects with positive paternal history of hypertension was 21.1% as against 0.0% in those with positive maternal history of hypertension. Parental history of diabetes mellitus did not enhance the risk of micro-albuminuria. Similarly, combined morbidities of hypertension and diabetes mellitus in either parents or both were unassociated with increased incidence of micro-albuminuria. Mean duration of paternal hypertension of 9.20± 2.09 years did not vary from 8.90±1.13years in the parents of those who were micro-albuminuria negative. Conclusion: Microalbuminuria could be a predictor of early phase adolescent hypertensive disease and such may have more relevance in offsprings of Nigerians at risk of hypertensive fathers. Recommendation: Longitudinal and more detailed work employing timed urine sample is advocated to further examine these relationships. Key Words: Micro-albuminuria, Adolescents, Parental essential hypertension, Africans. Nigerian Journal of Clinical Practice Vol. 7(2) 2004: 60-6

37-41Experimental Investigation of the Effect of Emulsifier Concentration on the Properties of Olechemical Oil Based Cutting Fluid

Abstract Experimental investigation of the effect of emulsifier concentration on the properties of olechemical-oil -based cutting fluid was studied. It was observed that as the emulsifier concentration increases from 2% to 8%, the kinematic viscosity increased. However, for emulsifier concentration of 10%, the kinematic viscosity started decreasing for all the temperature range used, although an increase was observed with increase in temperature. On the other hand, other properties such as thermal conductivity, pH value, flash and fire points increased as the concentration of the emulsifier was raised. However, microbial growth decreased as the pH value increased