RESUMO
BACKGROUND: Despite overwhelming evidence in favour of a relaxed fasting protocol, the traditional practice of keeping patients nil per oral from midnight before the day of surgery for all elective operations still appears to hold sway in many practices. METHODS: A prospective study to evaluate the pattern of preoperative fasting among patients undergoing elective general surgical operations in the Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was conducted between June and December 2020. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 24, and presented as descriptive statistics in the form of frequencies and percentages. RESULTS: The mean prescribed fasting duration was 11.2 ± 2.4 hours. The mean actual fasting duration of 17.6 ± 13.1 hours was significantly longer than the mean prescribed fasting duration (p= <0.001). Eighty-nine percent of patients fasted for >12 hours before their surgical operations. Bowel surgeries had the longest actual fasting duration of 34.9 ± 27.5 hours, while ventral hernia repairs and superficial mass excisions had the shortest duration of 13.5 ± 0.7 hours. Surgeries performed after noon had the longest actual fasting duration compared to those performed before noon (21.5 ± 18.7 hours vs. 15.6 ± 8.6 hours). Ninety percent of respondents reported hunger score of>4 while fasting. CONCLUSION: Preoperative fasting duration in our surgical unit remains long and conventional. The potential implications of this practice on patients' physiological status and surgical outcomes are strong enough to motivate a change.
CONTEXTE: Malgré les preuves accablantes en faveur d'un protocole de jeûne assoupli, la pratique traditionnelle consistant à maintenir les patients à jeun par voie orale à partir de minuit avant le jour de l'intervention chirurgicale pour toutes les opérations non urgentes semble toujours avoir cours dans de nombreux cabinets. MÉTHODES: Une étude prospective visant à évaluer le modèle de jeûne préopératoire chez les patients subissant des opérations chirurgicales générales non urgentes dans le département de chirurgie, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, a été menée entre juin et décembre 2020. Les données obtenues ont été analysées à l'aide du logiciel IBM SPSS Statistics for Windows, version 24, et présentées sous forme de statistiques descriptives sous forme de fréquences et de pourcentages. RÉSULTATS: La durée moyenne de jeûne prescrite était de 11,2 ± 2,4 heures. La durée moyenne du jeûne effectif de 17,6 ± 13,1 heures était significativement plus longue que la durée moyenne du jeûne prescrit (p= <0,001). Quatre-vingt-neuf pour cent des patients sont restés à jeun pendant plus de 12 heures avant leur intervention chirurgicale. Les opérations de l'intestin ont eu la durée de jeûne réelle la plus longue, soit 34,9 ± 27,5 heures, tandis que les réparations de hernies ventrales et les excisions de masses superficielles ont eu la durée la plus courte, soit 13,5 ± 0,7 heures. Les interventions chirurgicales réalisées après midi ont eu la durée de jeûne réelle la plus longue par rapport à celles réalisées avant midi (21,5 ± 18,7 heures contre 15,6 ± 8,6 heures). Quatre-vingt-dix pour cent des personnes interrogées ont signalé une sensation de faim >4 pendant le jeûne. CONCLUSION: La durée du jeûne préopératoire dans notre unité chirurgicale reste longue et conventionnelle. Les implications potentielles de cette pratique sur l'état physiologique des patients et les résultats chirurgicaux sont suffisamment fortes pour motiver un changement. Mots-clés: American Society of Anaesthesiologists (ASA), Score de faim, Nil Per Oral (NPO), Jeûne de nuit, Jeûne prolongé, Protocole de jeûne traditionnel.
Assuntos
Jejum , Hospitais de Ensino , Humanos , Nigéria , Estudos Prospectivos , UniversidadesRESUMO
BACKGROUND: Open-heart surgery started at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria, 5 years ago through partnership with foreign partners. This paper reviewed the difficulties facing the development of paediatric cardiac anaesthesia, the pattern, and the outcome of cases managed. METHODS: A review of the infrastructure, equipment, manpower and operational setup for open-heart surgery at OAUTHC was done. A retrospective study of all patients that were operated on from April 2016 to March 2021 was performed. Extracted data were analysed with Statistical Packages for the Social Scientists using descriptive statistics. RESULTS: A total of 102 patients had open-heart surgeries during the period under review by the various teams in a shared facility of the hospital's main theatre. Challenges with manpower, infrastructure, and supplies were major limitations to service delivery. Most of the patients (75.5%) were aged < 5 years. The commonest procedures performed were ventricular septal defect closure (31.4%), total correction of tetralogy of Fallot (26.5%), and atrial septal defect closure (9.8%). Fast-tracked anaesthesia was used always except where it was contraindicated. Most (76.7%) of the cases were extubated within 24 hours after surgery; the mean (SD) duration of ventilation in the ICU was 0.99 (1.2) days and the average length of ICU stay was 3 days. The overall mortality rate was 20.6%. CONCLUSION: Numerous challenges confront the provision of sustainable paediatric cardiac anaesthesia services in resource-constrained settings like ours. Much can be achieved with appropriate investment in material and manpower, and partnership with experienced teams.
CONTEXTE: La chirurgie à cÅur ouvert a commencé au complexe hospitalier universitaire Obafemi Awolowo (OAUTHC) Ile-Ife, au Nigeria, il y a 5 ans grâce à un partenariat avec des partenaires étrangers. Cet article a passé en revue les difficultés rencontrées dans le développement de l'anesthésie cardiaque pédiatrique, le schéma et l'issue des cas pris en charge. MÉTHODES: Un examen de l'infrastructure, de l'équipement, de la main-d'Åuvre et de la configuration opérationnelle pour la chirurgie à cÅur ouvert à l'OAUTHC a été effectué. Une étude rétrospective de tous les patients opérés d'avril 2016 à mars 2021 a été réalisée. Les données extraites ont été analysées avec des progiciels statistiques pour les spécialistes des sciences sociales à l'aide de statistiques descriptives. RÉSULTATS: Au total, 102 patients ont été opérés à cÅur ouvert au cours de la période étudiée par les différentes équipes dans une salle commune du bloc opératoire principal de l'hôpital. Les défis liés à la main-d'Åuvre, à l'infrastructure et aux fournitures constituaient des obstacles majeurs à la prestation de services. La plupart des patients (75.5%) étaient âgés de < 5 ans. Les gestes les plus fréquemment pratiqués étaient la fermeture de la communication interventriculaire (31.4%), la correction totale de la tétralogie de Fallot (26.5 %) et la fermeture de la communication interauriculaire (9.8%). L'anesthésie accélérée a toujours été utilisée sauf en cas de contre-indication. La plupart (76.7%) des cas ont été extubés dans les 24 heures suivant la chirurgie ; la durée moyenne (ET) de la ventilation en USI était de 0.99 (1.2) jours et la durée moyenne de séjour en USI était de 3 jours. Le taux de mortalité global était de 20.6%. CONCLUSION: De nombreux défis font face à la prestation de services durables d'anesthésie cardiaque pédiatrique dans des contextes aux ressources limitées comme le nôtre. Beaucoup peut être réalisé avec un investissement approprié en matériel et en main-d'Åuvre, et un partenariat avec des équipes expérimentées. MOTS-CLÉS: Pédiatrie, Anesthésie, Chirurgie Cardiaque, Nigéria, Pays en Développement.
Assuntos
Anestesia em Procedimentos Cardíacos , Anestesia , Criança , Pré-Escolar , Hospitais de Ensino , Humanos , Nigéria , Estudos Retrospectivos , UniversidadesRESUMO
BACKGROUND: Pain is a public health problem requiring serious attention. One major barrier to the provision of quality pain treatment in many countries is lack of training for healthcare workers. The aim of this study was to evaluate the impact of pain education on the knowledge and attitude of healthcare workers, and opioid utilization in a university teaching hospital. METHODS: Pain management workshops were conducted for healthcare workers over a 12-month period. The modified "Knowledge and Attitudes Survey Regarding Pain" questionnaire was administered to participants pre- and post- training for each of the workshops. The total mark by each participant was entered into the Statistical Package for Social Sciences (SPSS) software version 16 software for windows (SPSS Inc., Chicago, Illinois, USA) for comparison of means for pre- and post-test. Changes in opioid utilization were evaluated. RESULTS: The pre-test and post-test questionnaires were filled by 715 and 700 participants respectively. The mean post-test score was significantly higher than the pre-test score (68% versus 49% respectively, p = 0.00001). The doctors scored significantly higher than the other groups (p < 0.0001) in the pre-test. The mean post-test scores were significantly higher than the corresponding mean pre-test scores for the various groups (p < 0.0001). Sustained increase (up to 60.4%) in total morphine utilization was observed during the training. CONCLUSION: There is a wide knowledge gap requiring regular training and re-training to achieve improved pain management and opioid utilization among healthcare workers. Inclusion of robust pain curricula in medical training programs will significantly improve pain management.
Assuntos
Analgésicos Opioides/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Manejo da Dor/métodos , Dor/tratamento farmacológico , Competência Profissional , Adulto , Avaliação Educacional , Feminino , Hospitais de Ensino , Humanos , Capacitação em Serviço , Masculino , Pessoa de Meia-Idade , Nigéria , Avaliação de Programas e Projetos de Saúde , Inquéritos e QuestionáriosRESUMO
Neuropathic pain responds poorly to common analgesics that effectively control nociceptive pain because its pathophysiology is different and it is usually associated with co-morbidities such as sleep disturbance, depression and anxiety. Patients with this chronic pain are sometimes left with neurolysis as the last resort. A 65-year-old male multiply-injured retiree presented with disabling pain following traumatic brachial plexus injury sustained from road traffic accident 5 years earlier. Other injuries resolved with therapy except the chronic severe burning and electrifying pain (VAS score 9) in the paralyzed left upper limb associated with allodynia and insomnia which was unresponsive to conventional analgesics. PainDETECT score was 29. A test supraclavicular block with 0.25% Bupivacaine was done, followed by chemical neurolysis one month later. He was placed on oral Gabapentin. The pain score a week post injection was 3 and has remained same 18 months post injection. Patient's level of satisfaction on 5 point Likert scale was 5. Chronic neuropathic pain following traumatic brachial plexus injury could be successfully managed by chemical neurolysis and oral gabapentin.