Prevention of postanesthetic shivering under subarachnoid block for cesarean section: A randomized, controlled study comparing tramadol versus ondansetron.

BACKGROUND: Shivering is a frequent undesirable event in patients undergoing cesarean delivery under spinal anesthesia. Postanesthetic shivering has a multitude of deleterious effects and different methods have been used to prevent it. We therefore compare the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. AIM: Comparison of the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. SUBJECT AND METHODS: This is a prospective, double-blind, placebo-controlled, randomized study. The patients (n = 109) were randomly allocated to three groups according to the study drugs, namely tramadol 50 mg group (Group T), ondansetron 4 mg group (Group O), and saline 4 ml group (Group S) using envelope randomization. Statistical analyses were done using Statistical Package for Social Sciences 20.0. RESULTS: A total of 100 patients completed the study (33 in Group S, 33 in Group T, and 34 in Group O). The three groups were comparable with respect to demographic characteristics. Shivering was observed in 16 (48.5%) of the patients in Group S; 13 (39.4%) patients in Group T, and in only 2 (5.9%) patients in Group O. The differences in incidence of shivering were statistically significant between Groups O and S (P = 0.000) and Groups O and T (P = 0.001) but not between Groups T and S (P = 0.460). The differences across the groups were not statistically significant in terms of incidence of intraoperative hypotension, bradycardia, and the cumulative amount of ephedrine consumed. CONCLUSION: This study demonstrated that ondansetron is superior to tramadol in preventing shivering under spinal anesthesia in women undergoing cesarean section.

Pattern of admission and outcome of patients admitted into the Intensive Care Unit of University of Nigeria Teaching Hospital Enugu: A 5-year review.

OBJECTIVE: The objective was to determine the pattern of admission and outcome of patients in the Intensive Care Unit (ICU) of University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. MATERIALS AND METHODS: A retrospective review of all patients admitted into the general ICU at UNTH from 2008 to 2012. Data were collected from the ICU admission and discharge registers, and data analysis was done using Microsoft Excel 2007. RESULTS: A total of 766 patients were admitted during the period, consisting of 501 (65.4%) males and 265 (34.6%) females. Ages ranged from 1-day to 89 years with a mean age of 38.2±18.2 years. The most common cases admitted were neurosurgical patients of which there were 316 (41.2%). Patients admitted as a result of critical incidents in anesthesia formed the lowest number of cases admitted 10 (1.3%). Of the 316 neurosurgical cases, 224 (70.9%) were due to severe traumatic brain injury (TBI). An overall admission of 92.4% (207) was for severe TBI due to motor-vehicular accident (MVA). The average length of stay was <24 h to 72 days with a mean of 4.9±3.2 days. A total of 16.7% (128) patients received invasive mechanical ventilation during their stay in ICU. Only 15% (34 patients) of all the cases of severe TBI patients received invasive mechanical ventilation. Mortality rate was 34.6% in this study. CONCLUSION: The highest number of admissions into the ICU was for severe TBI following MVA. Developing a viable trauma team and separately equipped neurosurgical ICU with adequately trained and motivated staff will help improve the outcome of patients.

Right colon interposition in corrosive esophageal long segment stricture: our local experience.

BACKGROUND: Aim of our study is to highlight technical details in pedicled right colon interposition locally in cases of long segment corrosive esophageal stricture. Lesion results from cicatrization of burns wound inflicted by chemicals. Restoration of swallowing is of paramount importance. MATERIALS AND METHODS: It was a retrospective study involving adult and adolescent patients who had surgery because of corrosive esophageal stricture between January 2001 and December 2010. Hospital records were reviewed for age, sex, radiological findings, detail of anesthesia, operative procedure, and follow up. The steps which included mobilization of colon with intact marginal blood supply, safeguarding the middle colic artery that forms the pedicle, and doing three anastomoses that were leak proof were ascertained. RESULT: There were 12 males (70.5%) and six females (29.4%) and age ranged from 14 to 45 years. Caustic soda caused the problem among 10 (58.8%) patients while liquid acid battery was involved in three (17.6%) patients. The rest were distributed equally between native concoction and unknown substance. All were done under general anesthesia and mean duration of the procedure was 306.8 ± 54.6 min with an average intra operative blood loss of 823.1 ± 428.5 m. Sixteen (94.1%) had successful pedicle isolation and 15 (82.3%) patients had neither dysphagia nor reflux at follow-up. CONCLUSION: Securing a pedicled right colon based on middle colic artery was a critical step. This surgical technique should be used to restore swallowing among patients with long segment esophageal stricture.

Oesophageal atresia and tracheooesophageal fistula: a 12 years experience in a developing nation.

OBJECTIVE: To document our 12 years experience in the management of oesophageal atresia and tracheooesophageal fistula. METHOD: The study was carried out at the University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria between January 1997 and December 2008. The paediatric ward and theatre records of patients with oesophageal atresia and trachea oesophageal fistula were reviewed. The data extracted include: age at presentation, age at referral, reasons for delay referral (> 24 hrs from birth). Associated anomalies, Time interval from diagnosis to intervention, Operative procedure, and outcome. RESULT: Ten patients were studied, eight males and two females, ratio 4:1. They were all referred from outside the study centre. The average age at presentation was 5.3 days with a range of 2-12 days. The mean age at referral was 3.9 days. Two patients died before surgical intervention. The remaining eight that had surgery done, only one was discharged alive to surgical out patient but was lost to follow up. CONCLUSION: Delay in arriving at a diagnosis, late referral, associated congenital anomalies and comorbidities contributed to the poor out come. High index of suspicion, early diagnosis and referral, improved facilities and experience of the attending team will make for a favourable out come.

An overview on the use of the laryngeal mask airway amongst anaesthesia practitioners in a developing country.

BACKGROUND: The aim of this study is to provide an overview on the use of the Laryngeal Mask Airway (LMA) amongst anaesthesia practitioners in Nigeria MATERIALS AND METHODS: This is a multicentre questionnaire based study involving eight tertiary health care institutions in Nigeria. The questionnaires were administered to anaesthetists. They were standardised open- and close-ended questions which were completed in person. The questionnaire was subdivided into a set of questions which include: status of the anaesthetist; the routine use of LMA in general anaesthesia and as a device for airway management in difficult airway. Statistical analyses were done by simple percentages. RESULTS: The numbers of respondents were seventy; 38 were junior residents, 20 were senior residents and 12 were consultants. Sixty (85.7%) respondent had personally used LMA, while 10 had never used it and they were all junior residents. Classic LMA was most commonly used (88%), followed by intubating LMA (7.5%), and proseal LMA (4.5%). Most of the respondents (67.1%) have used LMA in difficult airway management while 10% of respondents had used it in airway management during cardiopulmonary resuscitation (CPR). The reason for not using LMA routinely for general anaesthesia was due to unavailability in 15.7% of respondents, inexperience in 8.6% and habitual in 30%. CONCLUSION: Airway management is a vital discipline in the specialty of anaesthesia. The use of LMA as an airway device in the practice of anaesthesia in our setting is inadequate. Training, re-training and continuous medical education of anaesthetists' very necessary to improve our practice.

Postoperative vomiting and fever following tonsillectomy in Enugu, Nigeria.

OBJECTIVE: To determine the incidence of postoperative vomiting and fever in patients that had tonsillectomy in our centre over a five year period. METHODS: The hospital records (case files) of patients that had tonsillectomy with or without adenoidectomy under general anaesthesia at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria from January 2004 to December 2008 were retrieved and analyzed. Patients that had an adenoidectomy only were excluded. The patients were of the American Society of Anesthesiologists (ASA) I to III status. RESULTS: There were fifty two (52) patients that had tonsillectomy and adenotonsillectomy under general anaesthesia during the period under review. Forty one (41) patients were between the ages of 1-13 years (78%) and eleven (11) patients between the ages of 18-62 years (12%). There were 32 males and 20 females. The average age for all the patients was 9.03 years. There were seven (7) patients with post operative vomiting (13.4%). These included four (4) patients in the paediatric population (9.75%) and three (3) in the adult population (27.2%). Twenty one (21) patients (40.3%) developed postoperative fever. There were no deaths The other significant morbidity was postoperative pain. CONCLUSION: The number of patients that had tonsillectomy in our center was small compared to other studies. The incidence of postoperative vomiting in this study is lower than that reported from Western World, showing possible racial variations, a trend that has been reported in some earlier studies in Black populations.

Emergency airway management with laryngeal mask airway.

When used correctly, laryngeal mask airway is a life saver. We report two cases wherein it was used for rescue airway management and as a ventilatory device during anesthesia. It is concluded that an anesthetist should be familiar with the use of this device.