-
The Effect of Tetracaine Gel in Male Patients with Indwelling Catheterization on Agitation and Urethral Irritation During Recovery from General Anesthesia
Luo Xiaoting,
Fu Huan,
Li Shengnan,
Wei Yao,
Liang Yu
Issue:
Volume 11, Issue 2, December 2023
Pages:
62-65
Received:
29 June 2023
Accepted:
13 July 2023
Published:
24 July 2023
Abstract: Objective: To observe the effect of tetracaine mucilage applied to male patients with indwelling urinary catheter on agitation and urethral irritation during recovery from general anesthesia. Methods: A total of 60 male patients who were scheduled to undergo thoracoscopic radical resection of lung cancer under general anesthesia in our hospital from January 2022 to May 2022 were selected and randomly divided into two groups according to the random number table method, 30 cases/group. Control group: lubricate the anterior end of the catheter and urethral mucosa with liquid paraffin oil after general anesthesia double-lumen bronchial intubation; experimental group: use 1-2 g tetracaine gel to fully lubricate the anterior end of the catheter and urethral mucosa, and then the two groups All patients underwent conventional catheterization. The Ricker sedation-agitation score (SAS) scale was used to evaluate the agitation of the two groups of patients during the recovery period, and the degree of urethral stimulation in the two groups of patients during the recovery period was also recorded. Results: Compared with the control group, the incidence of agitation during recovery and the degree of urethral irritation in the experimental group were significantly reduced, and the difference was statistically significant (P < 0.05). Conclusion: Tetracaine gel applied to male patients with indwelling catheter after general anesthesia can significantly reduce agitation and urethral irritation during recovery from general anesthesia.
Abstract: Objective: To observe the effect of tetracaine mucilage applied to male patients with indwelling urinary catheter on agitation and urethral irritation during recovery from general anesthesia. Methods: A total of 60 male patients who were scheduled to undergo thoracoscopic radical resection of lung cancer under general anesthesia in our hospital fro...
Show More
-
Pediatric Anesthesiology Practice Evolution in Benin, from the Study Research Realized in 2010 and 2020
Akodjenou Joseph,
Ahounou Ernest,
Lalèyè Yasmine,
Zoumenou Eugène,
Gbénou Séraphin Antoine,
Fiogbé Michel Armand,
Veyckemans Francis
Issue:
Volume 11, Issue 2, December 2023
Pages:
66-68
Received:
2 June 2023
Accepted:
10 July 2023
Published:
31 July 2023
Abstract: Introduction: This is a literature review on pediatric anesthesiology practice from 2010 to 2020 in two reference teaching hospitals of Cotonou: National University Hospital Centre (CNHU), and Lagoon--Mother and Child Hospital Centre (CHUMEL). Objective: To highlight the advances in pediatric anesthesia in Benin through the work carried out in 2010 and those of 2020 in the two reference hospitals in southern Benin. Patients and Methods: Data concerning the sociodemographic profile of patients, epidemiologic profile, human resources, infrastructures, equipment, medications and caregiving are examined. In this study, the work carried out in 2010 was compared to those in 2020. Results: The study carried out in 2010 included 512 children under 15 years, for a year’s duration; when in 2020, 345 children were included, all of which had surgery in a five months period. Equipment and Human ressources had improved with the creation of a pediatric critical care unit. The new monitoring material, anesthetic medications, and regional anesthesia technics were not practiced in 2010. Conclusion: This work shows that the practice of pediatric anesthesia in 2020 in the two reference hospitals in Benin, compared to previous years, is becoming increasingly satisfactory, even if anesthesia safety is not yet optimal.
Abstract: Introduction: This is a literature review on pediatric anesthesiology practice from 2010 to 2020 in two reference teaching hospitals of Cotonou: National University Hospital Centre (CNHU), and Lagoon--Mother and Child Hospital Centre (CHUMEL). Objective: To highlight the advances in pediatric anesthesia in Benin through the work carried out in 2010...
Show More
-
A Case of Pseudocholinesterase Deficiency in Patient Underwent General Anesthesia with Flexible Bronchoscopy
Issue:
Volume 11, Issue 2, December 2023
Pages:
69-71
Received:
9 July 2023
Accepted:
25 July 2023
Published:
31 July 2023
Abstract: Pseudocholinesterase deficiency is a rare clinical condition primarily associated with genetic alterations, but it can also be caused by certain diseases and medication factors. Patients with this condition experience significantly prolonged muscle paralysis when succinylcholine or mivacurium is used during general anesthesia, due to the decreased enzyme levels. The diagnosis of pseudocholinesterase deficiency is typically made after the administration of succinylcholine or mivacurium. Inquiring about the patient's family history is also crucial for proper diagnosis and intervention. Here, we report a case of a rare pseudocholinesterase deficiency patient who experienced delayed recovery following general anesthesia for flexible bronchoscopy. The patient was a healthy 67-year-old male with no history of liver or kidney dysfunction or other diseases. The plan was to perform painless flexible bronchoscopy, and after the procedure, the patient exhibited delayed recovery. Throughout the process, electrocardiographic monitoring showed normal blood pressure, heart rate, and oxygen saturation. After ruling out other factors that could cause delayed emergence, including central nervous system issues and electrolyte imbalances, it was found that succinylcholine, a depolarizing muscle relaxant, had been used. There was a high suspicion of pseudocholinesterase deficiency in the patient. Pseudocholinesterase enzyme activity testing was performed, and the patient was continued on mechanical ventilatory support. After 220 minutes from the completion of the procedure, the patient regained spontaneous breathing and full consciousness, and the endotracheal tube was removed. This article presents a case of delayed recovery in a patient with pseudocholinesterase deficiency following painless flexible bronchoscopy. It also summarizes the causes, clinical manifestations, diagnosis, and treatment of pseudocholinesterase deficiency-related delayed emergence. It is hoped that this article will contribute to timely recognition and management of such cases, thereby preventing any potential adverse outcomes for patients. Furthermore, since pseudocholinesterase deficiency is relatively rare, further research is needed to confirm the effectiveness of the preventive and therapeutic measures mentioned in this article.
Abstract: Pseudocholinesterase deficiency is a rare clinical condition primarily associated with genetic alterations, but it can also be caused by certain diseases and medication factors. Patients with this condition experience significantly prolonged muscle paralysis when succinylcholine or mivacurium is used during general anesthesia, due to the decreased ...
Show More
-
An Unexpected Case of Difficulty in Weaning from Cardiopulmonary Bypass
Min Xu,
Meng Dai,
Xuejie Li,
Xiao Wang
Issue:
Volume 11, Issue 2, December 2023
Pages:
72-75
Received:
26 June 2023
Accepted:
26 July 2023
Published:
5 August 2023
Abstract: Cardiopulmonary bypass is typically required for coronary artery bypass surgery, valve repair or replacement, congenital heart defect correction and cardiovascular operation. However, difficulty in weaning from cardiopulmonary bypass can increase mortality, which makes difficulties for the physicians. The cause of difficult weaning should be found, but sometimes it is difficult. The assessment by transesophageal echocardiography plays a central role in diagnosing and managing the cardiac operations patients. The early principal goal is the assessment of any findings that indicate a structural problem, which may require immediate surgical intervention. Herein, we presented a case of difficulty in weaning from cardiopulmonary bypass. A 53-year-old woman was admitted to our hospital due to fatigue and lower limb edema. The patient planned to undergo tricuspid bioprosthetic valve replacement under cardiopulmonary bypass due to the dysfunction of the tricuspid mechanical valve and the anticoagulant drugs being ineffective. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. Abnormal tricuspid regurgitation displayed by transesophageal echocardiography. After reopening the right atrium for testing, it was found that the mitral valve was occluded by gauze. Removing the gauze from the right atrium, it was successfully separated from cardiopulmonary bypass. Transesophageal echocardiography is important to accurately understand the clinical course of such complications.
Abstract: Cardiopulmonary bypass is typically required for coronary artery bypass surgery, valve repair or replacement, congenital heart defect correction and cardiovascular operation. However, difficulty in weaning from cardiopulmonary bypass can increase mortality, which makes difficulties for the physicians. The cause of difficult weaning should be found,...
Show More
-
Electric Pulp Testing Evaluation of Dental Anesthesia After 660-nm Laser-Photoiomodulation Therapy: Results of a Double-Blind Randomized, Placebo-Controlled Clinical Trial
Arash Ebrahimi,
Iman Sokouti Emamzade Hashemi,
Mohsen Ramazani
Issue:
Volume 11, Issue 2, December 2023
Pages:
76-81
Received:
30 June 2023
Accepted:
24 July 2023
Published:
5 August 2023
Abstract: Background: For many years, injection of chemical solutions of anesthesia are well-known conventional method in dental practice. To date, various complications have known to be caused by this injection as well as the high extent of anxiety and fear that have shown to be related with this procedure. By the most recently, introduction of photobiomodulation therapy (PBMT) in the field of laser dentistry, many efforts have been made to evaluate the state of PBMT- anesthesia on different laser parameters. Objectives: This double blinded randomized clinical trial aims at evaluating the efficacy of PBMT with 660nm diode laser on elevation of post-treatment electric pulp testing (EPT) scores representing as an anesthesia, in contralateral healthy premolars. Methods and Materials: 19 participants have included in this study according to the inclusion criteria. Each participant had two caries-free healthy contralateral maxillary first premolars, of which one was chosen randomly to be treated with sham (placebo) irradiation or laser treatment (Diode laser, 660nm, 200 mW, 12 J/cm2, 30s). The EPT scores were evaluated two minutes before the laser/placebo treatment and right after the treatment. Results: 14 out of 19 (73.68%) sites which received laser treatment, showed more than 20% increase in EPT value, while in the placebo group 11 out of 19 (57.89%) sites that were treated with sham irradiation showed less than 20% change in EPT values after treatment. Therefore, there was a significant difference in EPT responses between the laser and placebo treatment groups (fisher’s exact=0.106, p-value=0.047). Besides, the regression coefficients of post and pre-treatment EPT scores of laser and placebo treatment groups were 0.4 (p-value=0.008) and 0.98 (p-value=0.008), respectively. No gender differences were found regarding the EPT responses. Conclusion: The diode laser, 660nm PBMT with the given protocol can effectively induce a pulpal anesthesia, while further studies should elucidate the precise mechanism of its action and the capacity for its clinical applicability in dental practice.
Abstract: Background: For many years, injection of chemical solutions of anesthesia are well-known conventional method in dental practice. To date, various complications have known to be caused by this injection as well as the high extent of anxiety and fear that have shown to be related with this procedure. By the most recently, introduction of photobiomodu...
Show More
-
Possible Mechanisms of Rebound Pain After Peripheral Nerve Block Subsides and Preventive Therapy Measures
Issue:
Volume 11, Issue 2, December 2023
Pages:
82-87
Received:
17 July 2023
Accepted:
1 August 2023
Published:
10 August 2023
Abstract: Peripheral nerve block can enhance the analgesic impact for the duration of and after the operation, which is conducive to the early recuperation of useful workouts and bodily features after the operation, and enhance the relief of the patients. With the development and improvement of nerve block positioning technology, nerve block has grow to be greater and greater specific and safe, and has obtained greater and extra interest in the improvement of anaesthesia. However, rebound pain (RP) can also occur after the nerve block subsides. If RP occurs, it may also limit affected person delight in the much less extreme cases, and in the greater extreme cases, it may additionally have an effect on the patients' postoperative recovery, extend the medical institution stay, and make bigger the burden of clinical care. The pathogenesis of RP is nonetheless unclear, and it is now not nicely understood, and RP is frequently overlooked through clinical personnel in medical work. Preventing and treating RP is of top notch magnitude in enhancing postoperative restoration of sufferers present process peripheral nerve block anaesthesia. At present, there is nevertheless a lack of consensus on the prevention and remedy of RP. In latest years, pupils at domestic and overseas have performed a lot of lookup on RP, put ahead various conjectures on its pathogenesis, and supplied many preventive and healing measures, which include drug intervention, nerve stimulation, psychological intervention, etc., which supply greater theoretical groundwork for medical work. In this paper, we generally evaluation the prevention and therapy of RP from the elements of mechanism and intervention methods, and grant reference for the prevention and remedy of RP after nerve block cessation.
Abstract: Peripheral nerve block can enhance the analgesic impact for the duration of and after the operation, which is conducive to the early recuperation of useful workouts and bodily features after the operation, and enhance the relief of the patients. With the development and improvement of nerve block positioning technology, nerve block has grow to be g...
Show More
-
Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study
Anne-Marie Githaiga,
Wangari Waweru-Siika,
Mohamed Jeilan,
Idris Chikophe,
Vitalis Mung’ayi
Issue:
Volume 11, Issue 2, December 2023
Pages:
88-97
Received:
17 August 2023
Accepted:
13 September 2023
Published:
25 September 2023
Abstract: Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed. Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa. Methodology: A prospective observational study which recruited non-intubated septic patients who were hypotensive [mean arterial pressure less than 65 mm Hg], requiring fluid resuscitation. Focused Cardiac Ultrasound [FoCUS] was used to measure IVCCI followed immediately by a PLR manoeuvre for comparison. Patients were classified as fluid responders if they had an IVCCI ≥ 50% and/or an increase of 10% in pulse pressure following a PLR. The correlation between IVCCI and PLR on each patient in predicting fluid responsiveness was then assessed. Results: 38 patients satisfied the inclusion criteria. McNemar’s test yielded a p=0.039 indicating that PLR test and IVCCI are not equivalent in predicting fluid responsiveness in non-intubated septic patients. A Cohen’s Kappa of 0.283 signified only a “fair” correlation between the two. An IVCCI cut-off of 30% would have resulted in a near- perfect agreement as evidenced by a Cohen’s Kappa value of 0.93. A cut off between 30-40% would give a Cohen’ Kappa of 0.81 with a strong level of agreement. Conclusion: The PLR test and IVCCI test have a fair correlation and are not identical in predicting fluid responsiveness in non-intubated spontaneously breathing septic patients.
Abstract: Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilis...
Show More
-
Determining the Disability Status of Adult Patients Post General Intensive Care Unit Discharge using the World Health Organization Disability Assessment Schedule 2.0
Khadija Ahmed,
Vitalis Mung’ayi
Issue:
Volume 11, Issue 2, December 2023
Pages:
98-105
Received:
20 August 2023
Accepted:
18 September 2023
Published:
8 October 2023
Abstract: Background: Critical care has evolved throughout the years since the polio outbreak when the first intensive care unit (ICU) was set up in the United States of America (USA). There is an increasing number of survivors of critical illness. The survivors have been shown to have prolonged physical, cognitive and psychological impairments. There is a paucity of current information on the status of these patients post ICU in Africa. Objectives: To measure the disability status of adult patients post general Intensive Care Unit (ICU) discharge using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. To determine the factors associated with the degree of disability. Methodology: This was a cross-sectional analytical study. Patients admitted to Aga Khan University Hospital, Nairobi, (AKUHN) ICU, were on mechanical ventilation for more than forty-eight hours and survived to hospital discharge were contacted by telephone. Once they were found to be alive and consented for the study, the WHODAS 2.0 questionnaire was used. The level of disability was measured using the WHODAS 2.0 which has 12 items, where each item was scored between 0 and 4; and the total score was displayed as a percentage. Factors associated with the degree of disability were retrieved from the patients’ files. Data analysis was done using SPSS version 2.0. Results: 92 patients were enrolled into the study where 62.6% (n=57) were females. The disability status in our respondents was as follows; n=26 (28.6%) of them had no disability, n=26 (28.6%) mild disability and n=22 (24.2%) had moderate disability, n=17 (18.7%) of the patients reported severe disability while no participant had complete disability. Median age of 60 years and length of ICU stay were found to be associated with moderate to severe disability. Other factors like; duration of mechanical ventilation, number of comorbid, use of muscle relaxant/steroids, admission diagnosis was not found to be statistically significant in relation to degree of disability. Conclusion: In this study, 57.2% of patients had no disability to mild disability while 42.8% were found to have moderate to severe disability. Patients who were found to have moderate to severe disability had longer ICU stay and were in the older population.
Abstract: Background: Critical care has evolved throughout the years since the polio outbreak when the first intensive care unit (ICU) was set up in the United States of America (USA). There is an increasing number of survivors of critical illness. The survivors have been shown to have prolonged physical, cognitive and psychological impairments. There is a p...
Show More
-
Research Article
Inventory of the Practice of Sedation Procedural Analgesia in Digestive Endoscopy: Case of Hospitals in the City of Kinshasa
Jean de Dieu Muamba*,
Wilfrid Mbombo,
Christian Nantulu,
Gibency Mfulani,
Raphael Mubunda,
Didier Kandongo,
Eric Landu,
Didier Mayemba,
Arthur Isamba,
Etienne Ngombe,
Ivan Ebondo,
Gabriel Makeya,
Augustin Bananga,
Sylvain Kabudisa,
Gauthier Ngiay,
Antoine Tshimpi,
Alex Ngalala,
Berthe Barahiga
Issue:
Volume 11, Issue 2, December 2023
Pages:
106-114
Received:
10 July 2023
Accepted:
26 September 2023
Published:
21 November 2023
Abstract: Objective: This study was conducted to take stock of the practice of procedural analgesia sedation in digestive endoscopy in Kinshasa hospitals. Methods: This is a cross-sectional study from 06/01/2021 to 06/30/2022 in three Kinshasa hospitals in patients who received sedation analgesia for digestive endoscopy. Socio demographic, preoperative, postoperative variables and complications were sought, analyzed with SPSS 23.0 for <0.05. Results: Four hundred and seven patients were selected; the mean age was 48.069 years (range 2 to 90). The M/F sex ratio was 1.04. The pre-anaesthetic consultation was done the same day in 41.5%, the comorbidities were: arterial hypertension (27%), obesity (4.9%), diabetes (4.2%) and heart disease (3.2%). Pre-anesthetic examinations were prescribed in 70.3%, pre-anesthetic fasting was respected in 95.8%. Mallampati's grade was I (69.8%), II (23.1%) and III (7.1%). ASA classes I and II accounted for 89.7%. Pre oxygenation was done in 96.6% of patients. The products used were: propofol (98.8% for an average dose of 228.11 mg), midazolam (5.4% average dose of 1.53mg), ketamine (4.2% the average dose of 9.6mg), fentanyl (32.7% mean dose of 38.66μg), sufentanil (9.2% mean dose of 3.86μg) and haloperidol (7.6%). The endoscopy performed was high (56.8%), low (25.3%) and combined (16.5%). The procedure performed was: exploration/biopsy (53.8%), exploration (23.3%), removal of the foreign body (3.4%) and haemostasis (3.2%). Complications were present in 47.7% (desaturation, cough, arterial hypotension, bradycardia, tachycardia, arterial hypertension, spasm and apnea). The high total doses of the products (fentanyl, midazolam and ketamine) were associated with complications but in multivariate analysis, persisted: the grade of Mallampati III, the ASA class IV, the duration of the procedures greater than or equal to ten minutes, endoscopy combined and the junior anesthesiologist. Conclusion: Procedural analgesia sedation in Kinshasa is increasingly practiced in gastrointestinal endoscopies. It is provided by anesthesiologists who use the same products cited in the literature but with a relatively high rate of complications.
Abstract: Objective: This study was conducted to take stock of the practice of procedural analgesia sedation in digestive endoscopy in Kinshasa hospitals. Methods: This is a cross-sectional study from 06/01/2021 to 06/30/2022 in three Kinshasa hospitals in patients who received sedation analgesia for digestive endoscopy. Socio demographic, preoperative, post...
Show More
-
Case Report
Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report
Agwu Nnanna Uchechukwu,
Asudo Felicia,
Adeyemi William Osebequin
Issue:
Volume 11, Issue 2, December 2023
Pages:
115-118
Received:
31 October 2023
Accepted:
23 November 2023
Published:
6 December 2023
Abstract: Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises.
Abstract: Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as ...
Show More
