The Effects of Prophylactic Intravenous Lignocaine vs Vecuronium on Succinylcholine-Induced Fasciculation and Postoperative Myalgia in Patients Undergoing Elective Surgery at Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2022: Prospective Cohort Study.

Background: The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2% plain lignocaine hydrochloride is administered before induction. The aim of this study is to examine the effectiveness of defasciculation dosages of vecuronium bromide and 2% preservative-free plain lignocaine hydrochloride in decreasing succinylcholine-induced fasciculation and postoperative myalgia in patients undergoing elective surgery. Methods: A total of 110 participants were included in a prospective observational cohort study that was located in an institution. Patients were randomly assigned to (Group L) and (Group V) based on the prophylactic measures they received from the responsible anesthetist utilizing preservative-free 2% plain lignocaine and defasciculation dose of vecuronium bromide, respectively. We recorded, socio-demographic variables, fasciculation, postoperative myalgia, total number of analgesics administered following surgery in 48hrs, and kind of procedure. The descriptive data were compiled using descriptive statistics. Categorical and continuous data were evaluated, respectively, using chi-square statistics and the independent sample t-test. To compare the prevalence of fasciculation and myalgia across the various groups, the Fischer exact test was performed. A 0.05 p-value was deemed statistically significant. Results: This study found that the incidence of fasciculation in the groups receiving the defasciculation doses of vecuronium bromide and preservative-free 2% plain lignocaine hydrochloride was 14.6% and 20% (p-value 0.007), respectively. The rate of mild-to-moderate postoperative myalgia in the vecuronium bromide group was 23.7%, 30.9%, and 16.4% in the first, 24th, and 48th hours, respectively (p-value 0.001), as opposed to 0%, 37.3%, and 9.1%, respectively (p-value 0.008) in the group receiving preservative-free 2% plain lignocaine hydrochloride. Conclusion: Pretreatment with 2% plain lignocaine that is preservative-free is more efficient than vecuronium bromide at reducing the frequency and intensity of postoperative succinylcholine-induced myalgia, whereas defasciculation dose of vecuronium was more effective prevention of succinylcholine-induced fasciculation.

The practice of blood cross-match request and transfusion in surgical patients at Debre Markos comprehensive Specialized Hospital, Debre Markos, Ethiopia, 2021/2022. A prospective study.

Background: Blood transfusions play a great role to improve oxygen delivery to tissues for indicated surgical patients. Preoperative ordering of blood, especially in elective surgery, is often based on the worst-case assumptions, demanding large quantities of blood or overestimating the anticipated blood loss, of which little is ultimately used. This study aimed to assess the practices of blood requisite and transfusion in surgical patients. Method: An institutional-based prospective study was conducted from September to February 2021/2022, in Debre Markos comprehensive Specialized Hospital. Socio-demographic data like age, sex, ASA status, type of anesthesia, and type of surgeries were taken preoperatively. The number of cross-matched and transfused data were collected from patient charts throughout the perioperative periods. Efficacy of blood utilization was evaluated using the following indices like cross-match to transfusion ratio (C/T ratio), transfusion probability (%T), and transfusion index (TI); a ratio of 2.5 and below, A value of 30% and above, and values of 0.5 or more respectively were considered indicative of significant blood usage and this study is registered with a research unique identifying number of researchregistry7989 and reported in line with STROCSS 2021 guideline. Result: In all procedures, among cross-matched blood units 64.1% were unutilized. Depending on the urgency of the procedures about 77.7% of cross-matched blood units were not utilized in elective patients. In emergency procedures, the majority (64.3%) of cross-matched units were transfused. The overall blood transfusion indices result was C/T ratio, %T, and TI was 2.9, 33.5%, and 0.7, respectively. The overall blood transfusion indices for elective and emergency surgery are set respectively as follows C/T ratio (4.6 vs 1.5), %T (22 vs 78.8), and TI (0.4 vs 1.9). Among elective procedures, blood utilization was significant in orthopedic surgery with the value of C/T ratio 1.3, %T 66, and TI 1.4. In the rest of the elective procedures, blood transfusion indices were not significant. Conclusion: The overall blood utilization indices in emergency surgical patients were better than in elective and preoperative grouping, screening, and hold (GSH) is sufficient for elective surgical procedures to decrease wastage of valuable supplies.

Comparison of intravenous magnesium sulphate and lidocaine for attenuation of cardiovascular response to laryngoscopy and endotracheal intubation in elective surgical patients at Zewditu Memorial Hospital Addis Ababa, Ethiopia.

BACKGROUND: Laryngoscopy and endotracheal intubation are essential components of general anesthesia. But it is always associated with side effects called reflex cardiovascular responses. Many methods have been identified to attenuate these responses like intravenous lidocaine, deep inhalational anesthesia, vasodilators, intravenous magnesium sulphate even though therapeutic superiority remains understudied. METHODS: An institutional-based cohort study on 112 adult patients aged between 18-60 years was applied. 37 patients in the non-exposed group (Group N), 37 in the lidocaine group (Group L), and 38 in magnesium sulphate (Group M) were included. The hemodynamic parameters like heart rate, systolic, diastolic and mean arterial blood pressure at various time points up to 7 minutes post-intubation were recorded and the effect of both drugs to reduce hemodynamic responses was compared. Parametric data were analyzed using ANOVA and nonparametric data using the Kuruska-Wallis H rank test. P-value < 0.05 considered statistically significant. RESULTS: In all three groups, there was a statistically significant rise in heart rate and blood pressure from baseline. There was a statistically significant difference in mean heart rate throughout study minutes among the groups (p<0.001). However, there was no statistically significant difference in mean heart rate between Groups M and L at all post-intubation time intervals. In blood pressure at all three parameters there was statistically significant difference among groups at all-time points except no difference at 7th minutes in DBP. There was significantly lower blood pressure in group M compared to both groups. CONCLUSION: In conclusion, prophylactic administration of magnesium sulphate and lidocaine was effective in attenuating hemodynamic responses to the stress effect of laryngoscopy and intubation. But based on our finding prophylaxis of magnesium sulphate is associated with a more favorable hemodynamic response.