It is a common observation that following spinal anaesthesia, the penis usually elongates. The aim of this study was to determine the degree of change in penile length following spinal anaesthesia. Consecutive urosurgical patients undergoing spinal anaesthesia were recruited for this study. Those who received general anaesthesia or incomplete spinal blocked were also excluded. The flaccid length of the penis was measured before and after the administration of spinal anaesthesia. Penile length 15 minutes post-spinal anaesthesia was measured and recorded. The change in length was tested for statistical significant difference, the age of patient; diagnosis and type of surgery were also recorded. Forty three patients completed the study. Benign prostatic hypertrophy constituted 41.9% of the surgical indications. While 53.5% of the patients were ASA I, 39.5% and 7.0% of them were ASA II and III respectively. While the mean initial penile length was 12.1 ± 0.53 cm and the mean final length was 15.7 ± 0.53 cm, the mean maximal change in penile length was 3.6±1.5 cm; p<0.0001. There was no statistical correlation between age and mean differential change in length of penis (r= -0.2842, p=0.43). It was therefore concluded that there was a significant change in penile length (tumescence) following successful spinal anaesthesia.
Background: Obstructive sleep apnea (OSA), the most important and treatable form of sleep disordered breathing is common in significant proportion of general population, and also in pregnant women. Method: our study including 1000 population based study and was question wear based. During the periods of apnea there is fall in oxygen saturation because of collapse of upper airways. In pregnant females, this process I.e. exaggerated by hormonal influence. Result: There is significant literature demonstrating adverse effects of maternal and fetal outcome, and, treatment of OSA has demonstrated remarkable improvement in the maternal and fetal well being. Conclusion: So keeping public health in view, the article emphasizes basic concepts addressing this issue and management strategies for better maternal and fetal outcome.
The ideal intraoperative intravenous fluid in paediatric anaesthesia and surgery is still debatable. This is essential to overcome physiological changes to maintain safety and wellbeing of the patient. A new isotonic “balanced solution” (Sterofundin ® ISO) has been introduced to replace existing intraoperative fluid of choice (Ringer’s Lactate). The study aimed to observe any changes in electrolytes and acid base after infusion of each study solutions and to evaluate any post infusion electrolytes and acid base differences between both study solutions. The double blinded randomized control trial involved 141 paediatric patients who were subjected to minor surgical procedure of less than 3 hours were randomized into Ringer’s Lactate or Sterofundin ® ISO group. The electrolytes and acid base parameters were assessed at pre-infusion and post-infusion time. There were significant difference in glucose, potassium (K+) and chloride (Cl-) level between pre-infusion and post-infusion values with those given Ringer’s Lactate. There were also significant different in pH, base excess, glucose, Calcium (Ca2+), Chloride (Cl) and lactate level between pre-infusion and post-infusion values with Sterofundin ® ISO. When comparing the mean difference (pre-infusion and post-infusion) between Ringer’s Lactate and Sterofundin ® ISO, calcium (Ca2+) is the only electrtolyte which found to be significant (P=0.015) with the values of (Means±SD 0.005±0.07) mmol/L and (Means±SD 0.02±0.06) mmol/L respectively. Both study solutions showed variable effects of electrolytes and acid base parameters and no fluid was found to be superior in paediatric surgical patients underwent minor surgery of less than three hours.
Background: Surgery is accompanied by postoperative pulmonary functions impairment especially in the prone position. There is evidence suggested that using low tidal volume during general anesthesia may decrease post-operative lung injury. This study aimed to evaluate the effect of low tidal volume on lung functions during mechanical ventilation for general anesthesia while patients lying in the prone position. Methods: A prospective clinical trial was performed on 88 patients ASA I&II scheduled for elective surgery while patients lying prone and were randomly assigned to either protective ventilation group A with tidal volume; 5-7 ml/kg, 10 cm H2O positive end expiratory pressure (PEEP) with recruitment maneuver (RM) or conventional group B with Tidal Volume; 10-12 ml/kg, without both PEEP and RM. The primary efficacy variables were assessed by pulmonary function tests, performed before surgery, and 6, 12 and 24 hours postoperatively. Results: Improvement of lung functions were found in the first post-operative 6 and 12 hours in the low tidal volume group and significant difference was found in all parameters P value 0.001 except PaO2/FIO2 ratio P value 0.4. After 24 hours there were significant difference in the FVC, predicted FEV1 and FVC and FEV1/FVC ratio being higher in the low tidal volume group with P value 0.001. Patients in both groups showed similar rates of postoperative chest complications without significant difference. Conclusion: lung protective ventilation improved lung functions in the first post-operative 24 hours. There was no significant postoperative chest complications difference between the two groups.
Nigeria is naturally blessed with both savannah and tropical rainforests vegetation and these offer a wide distribution of plants believed to possesses secondary metabolites which are responsible for treating or curing various diseases. Several researches have been carried out in order to explore and identify the chemical compositions responsible for various pharmacological activities in Nigerian medicinal plants. This paper discussed the meaning and historical development of medicinal plants. A brief account of phytochemicals (alkaloids and flavonoids) were also given. The plants presented in this paper confirmed the pharmacological activities of these plants and includes; anticonvulsant, antioxidant, antibacterial, anxiolytic, antiinflammatory, antiulcer, anticancer, antiplasmodial, antitrypanosomal, antithypoid, antitumor, antileishmanial, antidiarrhoeal, antidiabetic, antituberculosis, analgesic as well as others.
Ascorbic acid modulates the central nervous system either physiologically or pharmacologically, and has been proposed to function as a neuromodulator. The effect of ascorbic acid (AA, vitamin C) on some physiological parameters, onset and duration of anaesthesia following propofol anaesthesia was evaluated in goats. A total of 24 goats divided into four groups, comprising five goats each in groups I and II, and seven goats each in groups III and IV were used for the experiment. Groups I and II served as control for AA (200 mg/kg) and propofol (5 mg/kg) intravenous treatments, respectively; while groups III and IV received AA at 200 mg/kg and 300 mg/kg, respectively before propofol anaesthesia. The result showed that AA significantly (P < 0.05) decreased the onset of anaesthesia and increased the duration of propofol anaesthesia in goats. AA (300 mg/kg) induced a decrease (P < 0.05) in respiratory rate during anaesthesia, but there were no significant changes in heart rate and rectal temperature in the groups. In conclusion, AA potentiated the effect of propofol – induced anaesthesia in goats without alteration in heart rate and rectal temperature.
The ideal supraglottic airway device must have high airway seal pressures during spontaneous and positive pressure ventilation also low resistance to the flow of gases. This study compared the utility of I-Gel with Baska Mask during general anesthesia in obese patients undergoing elective ambulatory surgeries. The study was conducted on sixty obese patients with body mass index (BMI) of ≥ 25 and ≤ 40 kg.m 2 , ASA I, II, III, 18-60 years old of either sex scheduled for short duration (<3 hr). I-gel was successfully inserted in 25 patients on the first attempt and in 2 patients on the second attempt (overall success rate = 90%). Baska mask was successfully inserted in 27 patients on the first attempt and in 2 patients on the second attempt (overall success rate = 96.97%). Successful insertion time was significantly shorter in the I-gel group. Oropharyngeal sealing pressure (OSP) was significantly higher following Baska mask insertion. Intra- and postoperative airway morbidity rates were not significantly different between both groups. So Concluded that both I-gel and Baska mask are suitable for ventilation in obese patients, but Baska mask gave a better laryngeal seal.
Background: Involving patient in decision making for their care can enhance satisfaction and promote health outcomes in particular in the nursing fields. As The World Health Organization Principles of Perinatal Care has recommended that care should involve women in decision making. This principle strongly endorses for improving effective perinatal care. Decision making regard to treatment options is a concept that has increased widespread appeals to healthcare providers and users in recent year. Evidently, patient involvement in decision making has not always been implemented in clinical practice in particular during intrapartum period. Objective: The aim of this study was to investigate the involvement of women in decision making on episiotomy procedure during labor. Methods: A descriptive quantitative approach was conducted using self-administered survey questionnaires in two government hospitals, Bangkok, Thailand. Participating hospitals were identified by convenience and remained anonymous. The Participant, eligible women included those who have reached 37 to 42 weeks of gestation, experienced vaginal birth, have a live baby, and admitted in the postpartum units. An appropriate sample size was assigned based on a 95 percent confidence level. A sample size was drawn from two hospitals based on a binomial probability distribution. There were 400 postpartum women participated in this study. Anonymous patient’s data were analyzed using frequencies and percentages. Results: The results revealed that 80% of all women experienced episiotomy. The finding demonstrated that decision making on having this procedure made by health care providers and relatives 73.8%, 3.2%, respectively. 23% of them had a chance to make a decision on having episiotomy. There were 23.8% of women received information about risks and benefits of episiotomy procedure and 76.2% did not get information. Conclusion: The findings of this study demonstrated that women have less opportunity to make a decision on having episiotomy during labor and received less information about this procedure. Therefore, health care providers should be clearly discussed about risks and benefits of episiotomy before performing the procedure. The factors influencing patient involvement in decision making should be investigated to promote good experiences of women during delivery and increase satisfaction toward their care.
The primary objective was to compare oropharyngeal leak pressures of streamlined liner of pharyngeal airway (SLIPATM) and Baska mask at different head and neck positions. Assessing the fiberoptic view of glottis and ventilation score of both devices in different positions were the secondary objectives. Sixty patients ASA I-II, 18-60 years of either sex scheduled for short ambulatory surgery were included. Patients were randomly assigned in a 1:1 ratio to either the SLIPATM or the Baska mask group. The effect of various head and neck positions was evaluated. Neutral position was maintained first then the patient was repositioned in the following positions: maximal extension, maximal flexion, and maximal rotation to the left. In each position, peak airway pressure and oropharyngeal leak pressure were noted. The ventilation score was assessed and fibreoptic views were noted. In both groups, oropharyngeal leak pressures and peak airway pressure were significantly higher with flexion. The fiberoptic score frequently decreased in flexion but with no effect on the ventilation. In comparison between the two devices, there was no significant change in the fibreoptic view of the glottis at different neck positions. So we concluded that, effective ventilation is possible with both Baska mask and SLIPATM with the head in neutral, flexion, extension, and lateral rotation positions. But care should be taken with extreme flexion and the airway pressures need to be monitored. Baska mask has a better margin of safety than SLIPATM due to better airway sealing pressures.
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a common cause of intensive care unit (ICU) admission due to respiratory failure which often necessitates mechanical ventilation (MV). This study evaluated the rapid shallow breathing index (RSBI) as a predicator of ventilatory support necessity in patients admitted with acute exacerbation of COPD. This study was conducted on 100 acute COPD exacerbation patients who admitted to the critical care department at Alexandria main university hospital. All enrolled patients (n=80) were subjected on admission to RSBI measurement on admission and every 30 minutes for the first 2 hours. The RSBI cutoff value that discriminated best between the need for noninvasive and invasive MV using the Receiver Operating Characteristic (ROC) was > 241 breath/minute/Liter, it showed a sensitivity of 88.33% and a specificity of 100%. RSBI may be a good predictor of ventilatory support necessity in acute exacerbation of COPD.
Background: Perioperative laboratory investigations should be obtained for specific indications based on the patient history, physical examination, co morbidities and the type of surgery. A test is likely to be indicated only if it can correctly identify abnormalities and will change the diagnosis, the management plan, or the patient’s outcome. Routine laboratory investigation before surgery is rampant. It seldom however changes the anaesthetic care plan or influence outcome. This research sought to find out the practice of preoperative laboratory testing at the Komfo Anokye Teaching Hospital (K. A. T. H). Methodology: This was a prospective, cross sectional study of patients undergoing elective surgery at K. A. T. H from 1st to 31st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient’s folder before an elective surgical procedure. Close and open ended questionnaire was developed and answered by reviewing patient’s folders during the pre-anaesthesia assessment. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22. Results: The average age of patients studied was 50 years. Complete blood count (CBC) is the most ordered laboratory investigation at KATH (98.8%). Every patient had at least four (4) laboratory investigations done. At the time of preoperative assessment by the anaesthetist, laboratory investigations had already been ordered by the surgical team in almost all the patients studied (98.8%). The anaesthetists ordered investigations in only 1.2% of the patients. When tests ordered were compared to the Canadian Anesthesiology Society (CAS) guidelines, it was found that 54.4% of renal function test ordered had no indication, as was the case with serum electrolytes 40.4%, coagulation studies 39.9% and complete blood count 23.9%. Conclusion: A lot of laboratory investigations requested for patients undergoing surgery at K. A. T. H have no clinical indication. Members of the surgical team are responsible for ordering the laboratory investigations. Complete blood count is the most frequently ordered investigation.
Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.
General anaesthesia is a balance between the amount of anaesthetic drug(s) administered and the state of arousal of the patient. Different patients may need variable doses of anaesthetics to reach and maintain a surgical level of anaesthesia. Even though lack of autonomic response suggests sufficient analgesia during surgery, there is no such clear clinical sign for the assessment of the depth and sedation of anaesthesia especially in a paralysed patient. Bispectra index (BIS) monitors the depth of anaesthesia and helps the anaesthetist to deliver the minimal dose of anaesthetic agent required to achieve an adequate hypnotic state. In this study conducted at the Komfo Anokye Teaching Hospital, patients undergoing general anaesthesia received intravenous propofol and remifentanil under BIS monitor as the sole anaeshetic. At the end of the surgery the total amount of propofol and remifentanil consumed and the time it took for the patients to open the eye and respond to verbal commands were noted. Propofol consumption was calculated to beat an averagerate of 5.44mg/kg/h and remifentanil at 13.68ug/kg/h to maintain a surgical level of anaesthesia. The mean time from stopping the anaesthetic agents until the patients opened the eyes and responded to verbal commands were 2.20 minutes and 2.70 minutes respectively. The study found that Propofol and remifentanil infusions at a rate of 5.44mg/kg/h and 13.68ug/kg/h respectively, under BIS monitor, effectively controls intraoperative responses and allow for rapid emergence from anaesthesia in a Ghanaian population.
This research was conducted considering the fact that today, there are still very few studies comparing Sevoflurane or Target Controlled Infusion using Propofol in term of serum lactate accumulation during general anaesthesia. There were 92 patients aged 18-65 years old, classified under ASA I, were involved in this prospective study. They were divided into 2 groups and this study was done in a double-blind manner. Patients received either Sevoflurane inhalational or Propofol infusion using Marsh model (target plasma concentration of 5 mcg/ml) during operation. All the patients received anaesthesia in a standard practice and blood samples were taken at every hour until completion of operation. The blood samples were tested for acid-base values and lactate level. There are significant differences in the mean values of serum lactate levels at 1st, 2nd, 3rd and 4th hour of surgery within propofol and sevoflurane group with p value of < 0.05. Nevertheless, when comparing differences in the mean values of serum lactate levels between propofol and sevoflurane group showed no significant difference of serum lactate change with p=0.186. In conclusion, our study shows that short term anaesthesia with sevoflurane is associated with an increase blood lactate levels more than lactate levels observed during high dose propofol anaesthesia.
Background: Widespread epidemics of malaria, yellow fever, meningitis and Tuberculosis across the Sub-Saharan African in the 1990s were largely attributed to poor surveillance systems which were neither able to detect communicable diseases on time nor build up an effective response. Effective communicable disease control relies on effective response systems which are dependent upon effective disease surveillance. Integrated Disease Surveillance and Response strategy (IDSR) was adopted by the AFRO members of the World Health Organization (WHO) to improve surveillance activities. Objective: This study was conducted to assess IDSR implementation in selected Health Facilities of Dawuro zone. Settings and Design: Dawuro zone is located in Southwestern Ethiopia. It shares borders with the Gamo-Gofa zone in south, Wolayta zone in the east, Konta Special district in the west, Oromia region in North, Hadya and Kambata Tembaro Zones in North east. Based on the 2006 census, it has a population of 590,090. A cross-sectional facility based descriptive study was conducted. Materials and Methods: An interviewer administered questionnaire of an adapted from the WHO Protocol for the Assessment of National Communicable Disease Surveillance and Response systems was used. Data analysis was carried out using SPSS version 21. Results: All of the health facilities (38%) have any case definition for the priority diseases. About 43% of the health facilities had electricity. Only seven percent has standby generators, which were functional. All health centers had calculators and stationery available for data management while 36% had computers and but 28% have printers available. No form of data analysis was available in 93% of the health centers, analysis of data were however available in all 14 Health centers studied. A reporting system was available in 92% of health centers. There was no feedback from the region to the district health offices and Health centers, nor was there feedback from the national to the zone level. Conclusion and recommendation: The implementation of IDSR in Dawuro zone is moderate. Resources are insufficient and although some structures are present on ground like the presence of reporting mechanism, feedback is low from the higher to lower levels. Standard case definitions are not used in all health facilities for all priority diseases. Standard case definitions should be made available and used in all health facilities.
Background and purpose: The main and the most known complication of intravenous regional anesthesia (IVRA) is systemic toxicity due to local anesthetics that occurs following the accidental tourniquet release immediately after injection. This study aims to evaluate the effect of adding ketamine to lower dose of lidocaine on reducing the dose and side effects of lidocaine. Materials and Methods: In this randomized clinical trial, 60 patients undergoing the surgery of upper limb below the elbow under IVRA were randomly divided into two groups. In group 1 (control group), 40 ml lidocaine 0.5% (200 mg) and in group 2 (intervention group), 40 ml lidocaine 0.25% (100 mg) plus 40 mg of ketamine 0.1% injected intravenously. Outcomes included postoperative pain at 15, 30 and 60 minutes after surgery. The pain of the patients was assessed by using the Visual Analogue Scale (VAS Score). Results: Both groups were comparable in demographic and surgical parameters. The average pain based on the VAS score at 15, 30 and 60 minutes after surgery was similar in both groups and there was no significant difference between the two groups (p> 0.05). Moreover, postoperative complications including unconsciousness, restlessness, dizziness, nausea, vomiting, tinnitus, seizure, delirium and hallucination had no significant differences (p> 0.05). Conclusion: Results of this study showed that the addition of ketamine to lower dose of lidocaine in patients receiving IVRA significantly reduced postoperative pain, and reduces the likelihood of systemic toxicity with lidocaine without causing significant adverse effects.
Background.Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia.Aim of the Work.The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects.Patient and Methods.Sixty adult patients of both sexes, divided into three.Group Creceived 2.5 mL bupivacaine and 0.5 mL saline 0.9%.Group Areceived 2.5 mL bupivacaine and 0.5 mL midazolam.Group Breceived 2.5 mL bupivacaine and 0.5 mL magnesium sulphate.Results.As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C.Conclusions.These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.
Objective. The aim of this study was to evaluate the arterial to end-tidal partial pressure gradient of carbon dioxide according to age in the supine position during general anesthesia. Methods. From January 2001 to December 2013, we evaluated 596 patients aged ≥16 years who underwent general anesthesia in the supine position. The anesthetic charts of these 596 patients, all classified as American Society of Anesthesiologists physical status I or II, were retrospectively reviewed to investigate the accuracy of PaCO2 and ETCO2. Results. The a-ETCO2 was 3.0 ± 2.1 mmHg for patients aged 16 to <65 years and 4.1±3.1 mmHg for patients ≥65 years. The a-ETCO2 was 2.4±3.1 mmHg for patients aged 16 to 25 years, 3.1±2.2 mmHg for patients aged 26 to 35 years, 3.0±2.2 mmHg for patients aged 36 to 45 years, 3.4±2.0 mmHg for patients aged 46 to 55 years, 3.2±2.0 mmHg for patients aged 56 to 64 years, 4.3±3.2 mmHg for patients aged 65 to 74 years, and 3.7±2.8 mmHg for patients aged 75 to 84 years. Conclusion. The arterial to end-tidal partial pressure gradient of carbon dioxide tended to increase with increasing age.
