Effect of routine preoperative fasting on residual gastric volume and acid in patients undergoing myomectomy.

BACKGROUND: Preoperative fasting of patients aims to reduce the residual gastric volume (RGV). The magnitude of this reduction is yet to be ascertained in the Nigerian population. AIM: To compare the RGV and pH of patients fasted for 6-12 h with those allowed oral intake of fluid up to 2 h preoperatively. SUBJECTS AND METHODS: This randomized study involved 90 American Society of Anesthesiologists physical status I-II patients booked for abdominal myomectomy under general anesthesia. The patients were randomized into three groups. Preoperative fasting from midnight (Group F, n = 30) was fasted from midnight to the operation time. Carbohydrate-rich drink group (Group C, n = 30) received 800 mL of oral carbohydrate solution in the evening before surgery (22:00 h). An additional 400 mL was given 2 h before anesthesia. Placebo drink group (Group P, n = 30) received water in the same protocol as Group C. The Student's t-test was used to analyze RGV and pH postoperative satisfaction and postoperative nausea and vomiting (PONV) were compared on a visual analog scale. RESULTS: The RGV and pH were similar for all groups (P = 0.45 and 0.90, respectively). Antiemetic consumption and PONV scores were lower in Group C compared with Groups F and P (P = 0.01). Patients' in Group C had higher satisfaction (P < 0.001). CONCLUSION: Preoperative carbohydrate or water intake up to 2 h before surgery is safe with better satisfaction when compared to overnight fasting.

TRANSMIGRATION OF INTRA-UTERINE DEVICE, EXPLORATORY LAPAROTOMY, RETRIEVAL AND REPAIR OF PERFORATED UTERUS.

BACKGROUND: Perforation of the uterus following transmigration of Intra-uterine devise (IUD) is an uncommon finding of insertion of IUD. There is associated increased risk of accidental pregnancy,morbidity and mortality. AIM: To report a rare clinical condition in which there was uterine perforation following migration of IUD and to increase awareness of this condition in our environment. CASE REPORT: A 37 year old para 6⁺° woman (all alive) who presented with a ten day history of lower abdominal pains following IUD insertion. Examination revealed tenderness in the suprapubic region and non-visualization of IUD thread per vaginam. Pelvic USS showed an empty uterine cavity while an abdominopelvic x-ray following tracer IUD insertion showed the IUD to be outside the uterine cavity. She had an exploratory laparotomy for retrieval of transmigrated IUD and repair of perforated uterus. CONCLUSION: Transmigrated IUD with uterine perforation is distressing uncommmon clinical condition, and it is reported with the hope of increasing the awareness and possibly prevent this avoidable uncommon complication.

The Efficacy of Chewing Gum on Postoperative Ileus Following Cesarean Section in Enugu; South East Nigeria: A Randomized Controlled Clinical Trial

Background: Postoperative ileus (POI) is a common complication following caesarean section. It impairs patients comfort; delays wound healing and prolong duration of hospital stay. Several methods have been used in the management of this condition with varying efficacy. Chewing gum postoperatively is a recent concept in the western world being advocated as a cost effective and comfortable management of POI.Aim: The aim was to evaluate the efficacy of gum­chewing in reducing POI following caesarean section in Enugu.Materials and Methods: One hundred and eighty women booked for elective caesarean section were randomized into gum­chewing group (n = 90) or control group (n = 90) The subjects chewed sugarless gum three times daily from 6 h postoperatively until the first passage of flatus. Each chewing session lasted 30 min. Elective cesarean section was carried out with a Pfannenstiel incision. Groups were compared primarily for time to first bowel sound, and first flatus.Secondary endpoints of comparison were time of operation to first defecation, and patient satisfaction concerning postoperative gum chewing. The Student's t­test and Pearson Chi­square test and multiple linear regression were used for statistical analysis.Results: The groups were comparable in age, body mass index (BMI) and duration of surgery. The mean time to first bowel sounds (21.9 ± 8.0 vs. 26.1 ± 10.0), mean time to first flatus (24.8 ± 6.4 vs. 30.0 ± 10.0) and mean time to defecation (30.7 ± 5.9 vs. 40.0 ± 9.0) were significantly reduced in patients that chewed gum compared with controls.P =0.02, 0.01, and 0.01, respectively. Patients were satisfied with gum chewing and no side­effect was recorded.Previous surgery and duration of surgery were predictors on duration of POI, while age, BMI and parity had no effect.Conclusion: Gum­chewing has a beneficial effect on early return of bowel function following cesarean section and should be included in the postoperative management protocol

The efficacy of chewing gum on postoperative ileus following cesarean section in Enugu, South East Nigeria: A randomized controlled clinical trial.

BACKGROUND: Postoperative ileus (POI) is a common complication following caesarean section. It impairs patients comfort; delays wound healing and prolong duration of hospital stay. Several methods have been used in the management of this condition with varying efficacy. Chewing gum postoperatively is a recent concept in the western world being advocated as a cost effective and comfortable management of POI. AIM: The aim was to evaluate the efficacy of gum-chewing in reducing POI following caesarean section in Enugu. MATERIALS AND METHODS: One hundred and eighty women booked for elective caesarean section were randomized into gum-chewing group (n = 90) or control group (n = 90) The subjects chewed sugarless gum three times daily from 6 h postoperatively until the first passage of flatus. Each chewing session lasted 30 min. Elective cesarean section was carried out with a Pfannenstiel incision. Groups were compared primarily for time to first bowel sound, and first flatus. Secondary endpoints of comparison were time of operation to first defecation, and patient satisfaction concerning postoperative gum chewing. The Student's t-test and Pearson Chi-square test and multiple linear regression were used for statistical analysis. RESULTS: The groups were comparable in age, body mass index (BMI) and duration of surgery. The mean time to first bowel sounds (21.9 ± 8.0 vs. 26.1 ± 10.0), mean time to first flatus (24.8 ± 6.4 vs. 30.0 ± 10.0) and mean time to defecation (30.7 ± 5.9 vs. 40.0 ± 9.0) were significantly reduced in patients that chewed gum compared with controls. P =0.02, 0.01, and 0.01, respectively. Patients were satisfied with gum chewing and no side-effect was recorded. Previous surgery and duration of surgery were predictors on duration of POI, while age, BMI and parity had no effect. CONCLUSION: Gum-chewing has a beneficial effect on early return of bowel function following cesarean section and should be included in the postoperative management protocol.

Anaesthetic management of a super morbidly obese patient for total abdominal hysterectomy: a few more lessons to learn.

BACKGROUND: The prevalence of obesity is on the upward trend world-wide. This epidemic has challenging implications for anaesthetists, following the anthropometric changes associated with the disease. OBJECTIVE: To highlight some of the challenges, the management and the lessons learnt during the management of this patient. METHODS: This is a case report of a 52-year old super morbidly obese, diabetic, and hypertensive patient that presented for total abdominal hysterectomy. Surgery was carried out under a single-shot spinal anaesthesia with bupivacaine/fentanyl. RESULTS: Under bupivacaine/fentanyl anaesthesia, she became very drowsy and had moderate to severe respiratory depression. She was arousable but had an obstructive sleep apnoea. Surgery was carried out successfully CONCLUSION: A better understanding of the pathophysiology and complications that accompany obesity is needed to manage an obese patient under anaesthesia.