Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Childbirth has been recognised as the most painful experience known to women. This study aimed at... more Childbirth has been recognised as the most painful experience known to women. This study aimed at studying the efficacy and safety of the single shot spinal analgesia for pain relief in labour. One hundred and twelve parturients in labour were randomized into two groups of 55 paturients each. Group B received 2.5 mg of spinal plain bupivacaine only while Group BF had 2.5 mg plain bupivacaine with 25 gg of fentanyl. Onset of sensory block, time to achieve maximum sensory block, duration of sensory and motor block and the level of block were recorded. The need for oxytocin augmentation, instrumental delivery, neonatal Apgar scores and umbilical artery blood pH were recorded. The numeric rating pain scores for groups B and BF were significantly reduced from a mean prespinal score of 8.17 +/- 0.96 cm and 8.30 +/- 0.23 cm respectively to a mean post-spinal pain score of 0.23 +/- 0.45 cm and 0.09 +/- 0.47 cm respectively, p = 0.000. The mean duration of analgesia in Group B was 61.60 +/- ...
The purpose of this study was to evaluate the role of needle diameter of the same tip configurati... more The purpose of this study was to evaluate the role of needle diameter of the same tip configuration in the causation of Post Dural Puncture Headache (PDPH). This prospective, single blind, randomised study compares the incidence of PDPH from two spinal needles (Becton Dickinson Whitacre sizes 25 G and 26 G needles) in obstetric patients. One hundred women undergoing elective and emergency Caesarean delivery under spinal anaesthesia were recruited. Each of the patients was interviewed using a standard questionnaire and reviewed until the seventh day postoperative. Both intraoperative and postoperative complications that occur were promptly treated. There was no significant difference in the number of attempts at insertion in both groups, although a shorter time was achieved in group25. PDPH occurred in 6.0% of those in group25. There was no difference in the insertion characteristics between the two needles.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur ... more Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur in drug administration. We report three cases of such errors. The anaesthetic record of 3 patients who had errors in drug administration and discussion of the relevant literature. Through the years in anaesthetic practice at the University of Port Harcourt Teaching Hospital (UPTH), our Pharmacy has always supplied standard ketamine hydrochloride in a dark brown bottle containing 10 mls of the 5% solution. Suxamethonium chloride on the other hand was always supplied in a 2 ml clear glass ampoule. A change in this known packaging without prior notification resulted in near misses, all of which had the potential for serious morbidity. A strict adherence to standard procedure is necessary to minimize the risk, since there is no substitute for vigilance if morbidity and mortality is to be prevented.
Hypotension is common during spinal anesthesia in pregnant patients. Patient positioning can affe... more Hypotension is common during spinal anesthesia in pregnant patients. Patient positioning can affect the spread of local anesthetic, which can, in turn, affect the speed of onset of sensory block and the hemodynamic effects of the spinal anesthetic. Despite fluid loading, left uterine displacement, and the use of vasopressors, the incidence of hypotension during cesarean section under spinal anesthesia remains at 30% to 90%. Studies of various maternal positions have yielded conflicting results regarding hemodynamic stability and block spread. This randomized study was undertaken to determine whether induction of spinal anesthesia in the lateral or sitting position for cesarean section (CS) would lead to less hypotension. One hundred healthy parturients with normal pregnancies undergoing elective CS were randomized to the lateral position (group L) or sitting position (group S). All patients were premedicated with 50mg IV ranitidine given 1 hour preoperatively. Baseline vital signs were recorded with the patient supine with 15-degree lateral tilt. After infusion of 0.9% saline 20mL/kg over 15 minutes, the patient was placed in the left lateral or sitting position. Plain 0.5% bupivacaine, 2 or 2.4mL depending on patient height (<1.65 or Z1.65m, respectively), was injected over 10 to 15 seconds. The patient was then immediately returned to the supine position with lateral tilt. Hypotension that did not respond to rapid infusion of 250mL 0.9% saline was treated with IV ephedrine 5mg. Severity of hypotension was determined by the value of the lowest systolic and mean arterial pressure (MAP) obtained and the frequency of systolic blood pressure (SBP)<90mm Hg. The primary outcome was the lowest recorded SBP. Secondary outcomes were lowest MAP, incidence and onset of hypotension, lowest heart rate, ephedrine use, upper sensory level, time to sensory level of T6, and neonatal outcomes. Each group included 50 patients, and the groups were similar in demographic characteristics. Anesthetic and surgical times were similar for the 2 groups as were the 1and 5-minute Apgar scores. Baseline SBP, MAP, and heart rate were similar for the 2 groups. Hypotension developed in 17 patients (34%) in group L compared with 28 (56%) in group S (P=0.027). Mean times to the first episode of hypotension were 11.8±10.7 minutes in group L versus 9.8±8.2 minutes in group S (P=0.5). Lowest mean SBP was similar (group L: 99.2±8.9mm Hg; group S: 95.4±12.3mm Hg; P=0.08). The lowest MAP was 72.9±11.2mm Hg in group L compared with 68.2±9.6mm Hg in group S (P=0.02). The groups did not differ in the frequency of SBP<90mm Hg, heart rate, use of ephedrine, or blood loss. Onset time for sensory and motor block was longer in group L compared with group S (5.1±2.7 vs. 3.4±1.6min; P<0.0001). The cephalad spread of the block was higher in group S than in group L, with some group S patients developing a block to the cervical dermatomes; no patient in group L had cervical spread. The median upper sensory level at the end of surgery was T5 and T4 in group L and S, respectively (P=0.0001). Bromage scores at the end of surgery were comparable in the 2 groups. The incidence of complications did not differ between the groups, and no episodes of bradycardia occurred. Compared with the sitting position, induction of spinal anesthesia in the lateral position led to a lower block level, slower onset of anesthesia, lower incidence of hypotension, and a higher value for the lowest recorded MAP. The lateral position offers more stable blood pressure and may be preferred if hemodynamic stability is desired during spinal anesthesia with plain bupivacaine.
Nigerian Quarterly Journal of Hospital Medicine, 2009
Localisation of the epidural space is one of the key steps in the provision of epidural analgesia... more Localisation of the epidural space is one of the key steps in the provision of epidural analgesia during childbirth. Many ingenious devices have been designed to improve the success of the puncture procedure. A clinical experience with a modified Macintosh epidural balloon in the localisation of the epidural space is described. Fifty ASA Class I-II consecutive parturients requesting pain relief in labour were enrolled in this prospectively randomized study. They were allocated to receive either air (LORA) or epidural balloon (EB) to assist in the identification of the epidural space. The end-point for the EB was marked by the collapse of the balloon while this was depended on the loss of resistance felt on the syringe plunger in the LORA. The primary outcome was ease of epidural space identification and adequate pain relief between the two groups. There were no statistical differences in age, height, weight, gestational age, gravidity and parity between the two groups. Twenty-two women in the EB group had a successful localisation at first attempt as compared to 14 women in the LORA group (p &lt; 0.0126). The time taken to localise the epidural space was less in the EB than the LORA, (p &lt; 0.0001). There were more Accidental Dural Punctures and failed blocks in the LORA group. The overall quality of block was better in the EB group. The epidural space was identified more often at the first attempt, and more swiftly, with the epidural balloon.
International Journal of Obstetric Anesthesia, 2013
Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of lo... more Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of local anaesthetic, maternal position may affect the speed of onset of sensory block and thus the haemodynamic effects. The aim of this study was to determine whether inducing spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position would result in less hypotension compared with the sitting position. One hundred American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomised to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S). Using the L3-4 interspace, patients received intrathecal plain bupivacaine, 10mg or 12 mg according to their height, after which they were placed immediately in the supine position with left uterine displacement. Maternal blood pressure was measured every minute for 10 min, every three min for 20 min and 5-minutely thereafter. Hypotension was defined as a fall in systolic blood pressure &gt;20% or a value &lt;90 mmHg. There was no difference in the lowest recorded systolic blood pressure in Group L (99.2±8.9 mmHg) compared with Group S (95.4±12.3 mmHg, P=0.081). However, the lowest recorded mean arterial pressure was greater in Group L (72.9±11.2 mmHg) than in Group S (68.2±9.6 mmHg; P=0.025). The incidence of hypotension was lower in Group L (17/50, 34%) than in Group S (28/50, 56%; P=0.027). Onset of hypotension was similar between groups. Hypotension occurred less frequently when spinal anaesthesia for caesarean using plain bupivacaine was induced with patients in the lateral compared with the sitting position. Values for the lowest recorded mean arterial pressure were greater but values for the lowest recorded systolic blood pressure were similar for patients in the lateral position group.
Background: Total intravenous anaesthesia (TIVA) is a technique of anaesthesia which has become w... more Background: Total intravenous anaesthesia (TIVA) is a technique of anaesthesia which has become widely popular in the developed world with the availability of computerized infusion devices and appropriate drugs making its use easy and safe for the practitioner, and acceptable, tolerable and cost-effective for the patient. Such infusion devices and new drugs are not readily available in the developing world, although in Nigeria today, infusion devices may be obtained through medical equipment companies now established in the country, and opioids are available through the National Agency for Food, Drug, Administration and Control (NAFDAC). Aim: This paper aims to discuss TIVA giving insights into its practice in a developing economy without the use of sophisticated equipment and drugs, in order to encourage practitioners to use the technique. Method: At the 1st South-South regional anaesthesia conference in Calabar in July 2004, a symposium on TIVA in a developing economy was held as part of the conference. This review utilized literature from relevant texts and that obtained through Medline search. Results: This paper discusses TIVA highlighting aspects of its use in the developed world, and presenting its rather peculiar practice in our environment without the use of sophisticated equipment and opioid analgesics. Conclusion: TIVA is a unique technique of anaesthesia which is easy to master. It is cost-effective and safe. Hence, it is possible to use what is available in the developing environment to obtain what is necessary. Keywords : Anaesthesia, Total intravenous, Developing countries Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 81-86
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Childbirth has been recognised as the most painful experience known to women. This study aimed at... more Childbirth has been recognised as the most painful experience known to women. This study aimed at studying the efficacy and safety of the single shot spinal analgesia for pain relief in labour. One hundred and twelve parturients in labour were randomized into two groups of 55 paturients each. Group B received 2.5 mg of spinal plain bupivacaine only while Group BF had 2.5 mg plain bupivacaine with 25 gg of fentanyl. Onset of sensory block, time to achieve maximum sensory block, duration of sensory and motor block and the level of block were recorded. The need for oxytocin augmentation, instrumental delivery, neonatal Apgar scores and umbilical artery blood pH were recorded. The numeric rating pain scores for groups B and BF were significantly reduced from a mean prespinal score of 8.17 +/- 0.96 cm and 8.30 +/- 0.23 cm respectively to a mean post-spinal pain score of 0.23 +/- 0.45 cm and 0.09 +/- 0.47 cm respectively, p = 0.000. The mean duration of analgesia in Group B was 61.60 +/- ...
The purpose of this study was to evaluate the role of needle diameter of the same tip configurati... more The purpose of this study was to evaluate the role of needle diameter of the same tip configuration in the causation of Post Dural Puncture Headache (PDPH). This prospective, single blind, randomised study compares the incidence of PDPH from two spinal needles (Becton Dickinson Whitacre sizes 25 G and 26 G needles) in obstetric patients. One hundred women undergoing elective and emergency Caesarean delivery under spinal anaesthesia were recruited. Each of the patients was interviewed using a standard questionnaire and reviewed until the seventh day postoperative. Both intraoperative and postoperative complications that occur were promptly treated. There was no significant difference in the number of attempts at insertion in both groups, although a shorter time was achieved in group25. PDPH occurred in 6.0% of those in group25. There was no difference in the insertion characteristics between the two needles.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur ... more Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur in drug administration. We report three cases of such errors. The anaesthetic record of 3 patients who had errors in drug administration and discussion of the relevant literature. Through the years in anaesthetic practice at the University of Port Harcourt Teaching Hospital (UPTH), our Pharmacy has always supplied standard ketamine hydrochloride in a dark brown bottle containing 10 mls of the 5% solution. Suxamethonium chloride on the other hand was always supplied in a 2 ml clear glass ampoule. A change in this known packaging without prior notification resulted in near misses, all of which had the potential for serious morbidity. A strict adherence to standard procedure is necessary to minimize the risk, since there is no substitute for vigilance if morbidity and mortality is to be prevented.
Hypotension is common during spinal anesthesia in pregnant patients. Patient positioning can affe... more Hypotension is common during spinal anesthesia in pregnant patients. Patient positioning can affect the spread of local anesthetic, which can, in turn, affect the speed of onset of sensory block and the hemodynamic effects of the spinal anesthetic. Despite fluid loading, left uterine displacement, and the use of vasopressors, the incidence of hypotension during cesarean section under spinal anesthesia remains at 30% to 90%. Studies of various maternal positions have yielded conflicting results regarding hemodynamic stability and block spread. This randomized study was undertaken to determine whether induction of spinal anesthesia in the lateral or sitting position for cesarean section (CS) would lead to less hypotension. One hundred healthy parturients with normal pregnancies undergoing elective CS were randomized to the lateral position (group L) or sitting position (group S). All patients were premedicated with 50mg IV ranitidine given 1 hour preoperatively. Baseline vital signs were recorded with the patient supine with 15-degree lateral tilt. After infusion of 0.9% saline 20mL/kg over 15 minutes, the patient was placed in the left lateral or sitting position. Plain 0.5% bupivacaine, 2 or 2.4mL depending on patient height (<1.65 or Z1.65m, respectively), was injected over 10 to 15 seconds. The patient was then immediately returned to the supine position with lateral tilt. Hypotension that did not respond to rapid infusion of 250mL 0.9% saline was treated with IV ephedrine 5mg. Severity of hypotension was determined by the value of the lowest systolic and mean arterial pressure (MAP) obtained and the frequency of systolic blood pressure (SBP)<90mm Hg. The primary outcome was the lowest recorded SBP. Secondary outcomes were lowest MAP, incidence and onset of hypotension, lowest heart rate, ephedrine use, upper sensory level, time to sensory level of T6, and neonatal outcomes. Each group included 50 patients, and the groups were similar in demographic characteristics. Anesthetic and surgical times were similar for the 2 groups as were the 1and 5-minute Apgar scores. Baseline SBP, MAP, and heart rate were similar for the 2 groups. Hypotension developed in 17 patients (34%) in group L compared with 28 (56%) in group S (P=0.027). Mean times to the first episode of hypotension were 11.8±10.7 minutes in group L versus 9.8±8.2 minutes in group S (P=0.5). Lowest mean SBP was similar (group L: 99.2±8.9mm Hg; group S: 95.4±12.3mm Hg; P=0.08). The lowest MAP was 72.9±11.2mm Hg in group L compared with 68.2±9.6mm Hg in group S (P=0.02). The groups did not differ in the frequency of SBP<90mm Hg, heart rate, use of ephedrine, or blood loss. Onset time for sensory and motor block was longer in group L compared with group S (5.1±2.7 vs. 3.4±1.6min; P<0.0001). The cephalad spread of the block was higher in group S than in group L, with some group S patients developing a block to the cervical dermatomes; no patient in group L had cervical spread. The median upper sensory level at the end of surgery was T5 and T4 in group L and S, respectively (P=0.0001). Bromage scores at the end of surgery were comparable in the 2 groups. The incidence of complications did not differ between the groups, and no episodes of bradycardia occurred. Compared with the sitting position, induction of spinal anesthesia in the lateral position led to a lower block level, slower onset of anesthesia, lower incidence of hypotension, and a higher value for the lowest recorded MAP. The lateral position offers more stable blood pressure and may be preferred if hemodynamic stability is desired during spinal anesthesia with plain bupivacaine.
Nigerian Quarterly Journal of Hospital Medicine, 2009
Localisation of the epidural space is one of the key steps in the provision of epidural analgesia... more Localisation of the epidural space is one of the key steps in the provision of epidural analgesia during childbirth. Many ingenious devices have been designed to improve the success of the puncture procedure. A clinical experience with a modified Macintosh epidural balloon in the localisation of the epidural space is described. Fifty ASA Class I-II consecutive parturients requesting pain relief in labour were enrolled in this prospectively randomized study. They were allocated to receive either air (LORA) or epidural balloon (EB) to assist in the identification of the epidural space. The end-point for the EB was marked by the collapse of the balloon while this was depended on the loss of resistance felt on the syringe plunger in the LORA. The primary outcome was ease of epidural space identification and adequate pain relief between the two groups. There were no statistical differences in age, height, weight, gestational age, gravidity and parity between the two groups. Twenty-two women in the EB group had a successful localisation at first attempt as compared to 14 women in the LORA group (p &lt; 0.0126). The time taken to localise the epidural space was less in the EB than the LORA, (p &lt; 0.0001). There were more Accidental Dural Punctures and failed blocks in the LORA group. The overall quality of block was better in the EB group. The epidural space was identified more often at the first attempt, and more swiftly, with the epidural balloon.
International Journal of Obstetric Anesthesia, 2013
Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of lo... more Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of local anaesthetic, maternal position may affect the speed of onset of sensory block and thus the haemodynamic effects. The aim of this study was to determine whether inducing spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position would result in less hypotension compared with the sitting position. One hundred American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomised to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S). Using the L3-4 interspace, patients received intrathecal plain bupivacaine, 10mg or 12 mg according to their height, after which they were placed immediately in the supine position with left uterine displacement. Maternal blood pressure was measured every minute for 10 min, every three min for 20 min and 5-minutely thereafter. Hypotension was defined as a fall in systolic blood pressure &gt;20% or a value &lt;90 mmHg. There was no difference in the lowest recorded systolic blood pressure in Group L (99.2±8.9 mmHg) compared with Group S (95.4±12.3 mmHg, P=0.081). However, the lowest recorded mean arterial pressure was greater in Group L (72.9±11.2 mmHg) than in Group S (68.2±9.6 mmHg; P=0.025). The incidence of hypotension was lower in Group L (17/50, 34%) than in Group S (28/50, 56%; P=0.027). Onset of hypotension was similar between groups. Hypotension occurred less frequently when spinal anaesthesia for caesarean using plain bupivacaine was induced with patients in the lateral compared with the sitting position. Values for the lowest recorded mean arterial pressure were greater but values for the lowest recorded systolic blood pressure were similar for patients in the lateral position group.
Background: Total intravenous anaesthesia (TIVA) is a technique of anaesthesia which has become w... more Background: Total intravenous anaesthesia (TIVA) is a technique of anaesthesia which has become widely popular in the developed world with the availability of computerized infusion devices and appropriate drugs making its use easy and safe for the practitioner, and acceptable, tolerable and cost-effective for the patient. Such infusion devices and new drugs are not readily available in the developing world, although in Nigeria today, infusion devices may be obtained through medical equipment companies now established in the country, and opioids are available through the National Agency for Food, Drug, Administration and Control (NAFDAC). Aim: This paper aims to discuss TIVA giving insights into its practice in a developing economy without the use of sophisticated equipment and drugs, in order to encourage practitioners to use the technique. Method: At the 1st South-South regional anaesthesia conference in Calabar in July 2004, a symposium on TIVA in a developing economy was held as part of the conference. This review utilized literature from relevant texts and that obtained through Medline search. Results: This paper discusses TIVA highlighting aspects of its use in the developed world, and presenting its rather peculiar practice in our environment without the use of sophisticated equipment and opioid analgesics. Conclusion: TIVA is a unique technique of anaesthesia which is easy to master. It is cost-effective and safe. Hence, it is possible to use what is available in the developing environment to obtain what is necessary. Keywords : Anaesthesia, Total intravenous, Developing countries Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 81-86
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