Biomedical subjects

O T Kushimo

Publications and source records attributed to O T Kushimo.

8 recordsLinked to original sources

PubMed2006

Comparison of suxamethonium and priming with atracurium for rapid sequence orotracheal intubation in a Nigerian adult population.

OBJECTIVE: To compare suxamethonium with atracurium using the priming principle, for rapid sequence orotracheal intubation assessing onset time, time to successful laryngoscopy and intubation and quality of intubating conditions. PATIENTS AND METHODS: A prospective double-blind, randomised study was performed in 90 ASA physical status I and II patients aged between 18 and 64 years undergoing elective surgery requiring endotracheal intubation between October 2002 and June 2003 in a university teaching hospital . All patients were premedicated with 5-10mg oral diazepam and randomly assigned to one of two groups to receive either suxamethonium as a bolus dose (group A) or atracurium (priming with 0.05 mg/kg followed by 0.55 mg/kg after induction of anaesthesia) (group B). In both groups, the trachea was intubated when there was maximal muscle relaxation, determined clinically by jaw muscle relaxation. Muscle paralysis using a PNS, quality of intubating conditions, and occurrence of muscle weakness due to the priming dose of atracurium, time to laryngoscopy and onset time were all noted. RESULTS: Onset time was 87.1 +/- 25.60s and 135.8 +/- 46.23s in groups A and B respectively (P < 0.05). Group A had a laryngoscopy time of 73.6 +/- 25.22s compared to 107.7 +/- 41.32s in group B (P < 0.05). Intubating conditions were significantly better in group A compared to group B (P < 0.05). The frequency of muscle weakness from the priming dose of atracurium was 6.6%. CONCLUSION: Atracurium, using the priming principle, is an option in our environment for modified rapid sequence induction when suxamethonium is contraindicated.

Adult↗

PubMed2006

Knowledge, attitude and practices of Nigerian anaesthetists in HIV infected surgical patients: a survey.

In the light of increasing prevalence of the human immunodeficiency virus (HIV), anaesthetists are likely to see more patients with this virus in their practice. This study evaluated, using a questionnaire format, the knowledge, attitude and practices of anaesthetists in the management of HIV infected surgical patients. The questionnaire sought demographic information, the knowledge of risks involved as well as attitude and practices. One hundred (66.7%) out of 150 questionnaires distributed amongst members of the Nigerian Society of Anaesthetists were completed and returned. Fifty-five per cent (55%) of the respondents confirmed their willingness to be screened but only 45% had had a personal HIV screening test. Even though 23% of all the respondents will transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of consultants will routinely wear gloves whilst only 12(70.5%) of the senior house officers will routinely glove for venepuncture despite the availability of gloves. Other precautionary facilities such as goggles, sharp disposal bins, routine screening of all surgical patients were more available in private than in government hospitals. Ninety- six per-cent of all respondents will initiate an action after a needle stick injury whilst 4% will ignore. General Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by 43% of respondents whilst 22% of respondents would choose regional technique. However, only 85% of respondents were willing to anaesthetise an infected patient. This study suggested a dearth of knowledge and perception of risks of HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater education is highly recommended. Rigorous infection control policy is imperative and hospital authorities must ensure availability of protective facilities.

Adult↗

PubMed2005

Is ephedrine infusion more effective at preventing hypotension than traditional prehydration during spinal anaesthesia for caesarean section in African parturients?

BACKGROUND: Hypotension following spinal anaesthesia for caesarean section may result in maternal nausea and vomiting and decreased uteroplacental blood flow with possible fetal acidaemia. Numerous methods have been tried to minimise hypotension. In developing countries where resources are limited, this study aimed to compare a standard infusion of ephedrine with traditional prehydration to prevent spinal hypotension. METHOD: Sixty patients for elective caesarean section were randomly allocated to group 1: 1 L 0.9% saline before spinal block, and group 2: infusion of ephedrine 30 mg in 1 L of 0.9% saline after spinal block, titrated to maternal systolic pressure. Spinal anaesthesia was achieved with 2.5 mL of 0.5% heavy bupivacaine in the L3/L4 interspace. RESULTS: Systolic pressure decreased 5 min after spinal block. Group 2 had higher mean values of systolic pressure throughout most of the study period than group 1 (P < 0.05). Hypotension occurred in 70% of patients in group 1 and 40% of patients in group 2 (P = 0.037). Severe hypotension occurred in 40% of group 1 and 13.3% of group 2 (P = 0.039). Nausea was the most common side effect of hypotension, occurring in 39.4% of all hypotensive patients. Other complications, including hypertension, tachycardia and bradycardia were similar in the two groups. Neonatal outcome was similar in the two groups and median Apgar scores at one and five minutes were 8. CONCLUSION: Prophylactic ephedrine given by standard infusion set was more effective than crystalloid prehydration in the prevention of hypotension during spinal anaesthesia for elective caesarean section.

Adult↗

PubMed2004

Cardiovascular changes during halothane induction in children.

OBJECTIVES: The incidence of bradycardia and myocardial depression following halothane induction in children is well documented. Bradycardia leads to reduced cardiac output, which can result in compromised organ perfusion. Halothane may sometimes induce arrhythmia. There is at present no study in this sub-region on the cardiovascular changes of halothane induction in children. This study was designed to investigate the cardiovascular changes and incidence of arrhythmias following halothane induction. PATIENTS AND METHODS: Ninety ASA I - II children aged 6 months to 12 years were studied. Premedication with oral promethazine 1mg/kg was given to all patients above the age of one year. Anaesthesia was achieved with incremental halothane up to 3% in 33% oxygen and nitrous oxide. Halothane induction led to a significant drop in SBP, DBP and MAP in all patients at the end of induction. (p < 0.005). Heart rate values were significantly less postinduction in children older than one year (p < 0.05). Arrhythmias occurred in 3.3% of all patients. No patient experienced bradycardia. Other complications included hypotension (8.8% ) and mild laryngeal spasm (2.2% ). RESULTS: Halothane induction in children results in significant reduction in heart rate and blood pressure. Bradyarrhthmias are uncommon with promethazine premedication.

Anesthesia, Inhalation↗

PubMed1991

Dose requirements of atracurium in paediatric intensive care patients.

The dose requirements of atracurium were determined in 12 children who required an infusion of atracurium to facilitate mechanical ventilation in the intensive care unit. The mean duration of infusion was 98 h (range 36-284 h) during which an increasing dose requirement was observed in all patients. The mean infusion rate was 1.60 (SEM 0.08) mg kg-1 h-1, and in seven patients a mean infusion rate of 1.72 (0.15) mg kg-1 h-1 was observed at 72 h. These rates are greater than those reported previously in adults. Cessation of neuromuscular block occurred promptly upon discontinuing the infusion. No side effects were observed which could be attributed to the infusion of atracurium.

Adolescent↗

PubMedDate not supplied

Prediction of difficult laryngoscopy in a population of Nigerian obstetric patients.

Difficulty in the maintenance of the airway during obstetric anaesthesia is a major contributory factor in anaesthetic related morbidity and mortality. There is an eightfold increase in the incidence of failed intubation in obstetrics. This is attributable to the physiological changes in pregnancy. Eighty consecutive obstetric patients, over a one year period who required general anaesthesia for caesarian section were evaluated using five bedside tests viz: Mallampati test, Thyrometal distance, Sterno-mental distance, Horizontal length of the Mandible and Inter-incisor gap. Eight patients had difficult laryngoscopy (10%). Mallampati test had a sensitivity, specificity and positive predictive value of 87.1%, 99.6% and 70% respectively. The values obtained for the Thyro-mental distance were 62.5%, 93.1% and 50% respectively. The other tests were not able to predict intubation difficulty significantly. When all tests were combined, sensitivity, specificity and positive predictive were values 100%, 36.1% and 14.8%. The combination of Mallampati and Thyro-mental distance had values of 100%, 93.1% and 61.5%--sensitivity, specificity and positive predictive value. Mallampati can be used as the sole predictor of difficult intubation in Nigerian obstetric patients.

Adult↗

PubMedDate not supplied

A comparative study of the haemodynamic effects of atropine and glycopyrrolate at induction of anaesthesia in children.

BACKGROUND: Bradycardia following administration of halothane and suxamethonium in children leads to reduced cardiac output, which can be prevented with prophylactic anticholinergics. Anticholinergics may result in tachycardia and arrhythmias. This study was designed to compare haemodynamic changes and incidence of cardiac arrhythmias following intravenous atropine and glycopyrrolate. STUDY DESIGN: Ninety ASA I and II children between one month and twelve years were studied. Premedication was with oral promethazine 1mg/kg. Anaesthesia was achieved with 3 % halothane in 33 % oxygen and nitrous oxide. Patients were randomly allocated to receive atropine 0.01mg/kg (Group I) or glycopyrrolate 0.005mg/kg (Group II). Tracheal intubation was facilitated with suxamethonium 1.5mg/kg. RESULTS: Patients in Group I had a 35.7% rise in heart rate from baseline, compared to 22.5 % in Group II two minutes after anticholinergic administration (p=0.001). Following intubation, heart rate rose by 9.7 % and 13.2 % (p<0.05) in Groups I and II respectively. MAP rose similarly in both groups. Arrhythmia occurred in 44.4 % of patients in Group I and 11.1% in Group II (p=0.001) and were mainly sinus tachycardia. 2.2% of patients in Group I exhibited bigemini. No patient experienced bradycardia. Hypoxia occurred in 2.2 %, hypotension in 13.3% and mild laryngeal spasm in 0% of Group I and 11.1%, 4.4% and 4.4% of Group II respectively. CONCLUSION: The use of glycopyrrolate compared to atropine, offered better cardiovascular stability in Nigerian children. Arrhythmias occurred more in patients who had atropine and occurred most frequently after tracheal intubation.

Anesthesia, Inhalation↗

PubMedDate not supplied

Open comparative study of the efficacy, safety and tolerability of midazolam versus thiopental in induction and maintenance of anaesthesia.

In a multicentre study, 145 adult Nigerian patients presenting with diverse conditions (falling into ASA1 or ASA2 classification) for short surgical procedures (< 1 hour) were given either midazolam (0.15-0.20 mg/kg) or thiopentone (4-6 mg/kg) intravenously for induction of anaesthesia. Study population consisted of 58 male and 89 female patients with a mean age of 33.5 +/- 10.42 years. The primary efficacy criteria for induction of anaesthesia was induction time measured by the time of spontaneous closing of eyes and disappearance of palpebral reflexes following injection of trial drug. For maintenance of anaesthesia efficacy was assessed by the requirement of an additional dose of the anaesthetic agent either alone or in combination with other agents in addition to N20/O2 mixture. The secondary efficacy criteria was the degree of anterograde amnesia produced by trial drug, this was assessed by memory test. Safety was assessed by the frequency of the incidence of apnoea and cardio-stability measured by changes in the haemodynamic parameters (BP and pulse). Tolerability was evaluated by incidence of phlebitis or pain at the injection site. The standard efficacy population was all the 145 patients while only 100 patients were considered evaluable for maintenance efficacy. The mean induction time was 67.28 +/- 63.36 secs and 31.28 +/- 13.01 secs for the midazolam and thiopentone groups respectively. Anaesthesia was maintained with N20/O2 alone in 47% of patients in the midazolam group compared with 28.6% of patients in the thiopentone group. The degree of anterograde amnesia was significantly more pronounced in the midazolam group than in the thiopentone group (p = 0.000).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗