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Biomedical subjects

Y Adu-Gyamfi

Publications and source records attributed to Y Adu-Gyamfi.

17 recordsLinked to original sources
PubMed1999

Intubation via LMA in pediatric patients with difficult airways.

PURPOSE: To report two cases of successful tracheal intubation in difficult pediatric airways using a conventional laryngeal mask airway (LMA) with an extended polyvinyl chloride (PVC) tube after laryngeal assessment with a fibreoptic device. CLINICAL FEATURES: Two cases, Dandy-Walker and Pierre Robin syndromes, were scheduled for surgery. They were premedicated with 0.5 mg x kg(-1) promethazine p.o. 90 min before surgery. Both patients arrived in the operating room sedated, with dry mouth, and without evidence of increased intracranial tension or airway obstruction. Inhalational induction with isoflurane 0.5-3% was commenced. Conventional tracheal intubation was impossible in both cases. In each an LMA was inserted to maintain ventilation, anesthesia, and to facilitate intubation. Fibreoptic bronchoscopy was used to assess the larynx, followed by blind intubation via the LMA using extended PVC tracheal tube (TT). Anesthesia was maintained during intubation using Mapleson F anesthesia circuit attached to a connector with fibreoptic bronchoscope adapter. CONCLUSION: This report describes the assessment of the airway with fibreoptic bronchoscopy after LMA insertion facilitated blind tracheal intubation in two children with difficult airways.

Anesthesia, Inhalation↗
PubMed1993

Use of a tourniquet in patients with sickle-cell disease.

Fifteen patients, 13 male and two female, known to be carrying the sickle-cell gene (12 HbSS and 3 HbAS), who were undergoing operations requiring a bloodless field, were included in the study. Of the 12 with HbSS, seven had haemoglobin A1 component of between 11 and 27%, three had fetal haemoglobin ranging from 5.7 to 29% and the remaining two had increased haemoglobin A2 concentrations suggesting a beta non-thalassaemia combination. All had a tourniquet applied to the appropriate limb and were given general anaesthesia with moderate hyperventilation throughout the procedure. The tourniquet inflation time was 61.7 +/- 27.5 min. The mean PaO2 remained above 200 mmHg, mean PaCO2 was less than 37 mmHg, and pH ranged between 7.40 and 7.45. There were no clinically important changes in BP or ECG. All patients made uneventful recoveries and none developed sickle-cell crises. It is suggested that it is safe to use tourniquet in patients with sickle-cell disease provided optimum acid-base status and oxygenation are maintained throughout the procedure.

Adolescent↗
PubMed1992

Flumazenil reversal of midazolam sedation for dental procedures.

The efficacy of flumazenil in the reversal of midazolam sedation was assessed in double-blind placebo controlled study. Thirty patients undergoing oral surgical procedures were included. Flumazenil administration was followed by immediate rise of the CNS functions scores to almost the baseline awake values. Compared to control group, patients were significantly more oriented and had better comprehension up to 15 minutes, more alert for 30 minutes and had better memory function up to 60 minutes. Peripheral oxygen saturation was significantly higher up to 15 minutes. Flumazenil allows better utilization and higher turn over rate where space and nursing resources are scarce.

Adult↗
PubMed1991

Anaesthetic-induced ventricular tachyarrhythmia in Jervell and Lange-Nielsen syndrome.

A four-year-old deaf girl with a history of convulsions developed polymorphous ventricular tachycardia during induction of anaesthesia. The arrhythmia reverted to sinus rhythm spontaneously. Post-anaesthetic ECG showed marked prolongation of the QTc interval (570-690 msec). Deafness and prolonged QTc interval in association with microcytic-hypochromic anaemia confirmed the diagnosis of the Jervell and Lange-Nielsen syndrome. This case report highlights the potentially lethal complication of halothane anaesthesia in patients with long QTc interval syndrome.

Anesthesia, Inhalation↗
PubMed1990

Congenital lobar emphysema.

This paper reviews three cases of congenital lobar emphysema from Saudi Arabia, seen over a period of three years. All were boys aged 2.5, 7 and 8 months, and recurrent attacks of chest infection, which started during the early neonatal period, were the main presentation. In all cases, diagnosis was confirmed by chest x-ray. Two of them had a lobectomy and made a good recovery. Operation was refused in the third. The clinicopathological features, diagnosis and management are discussed. An outline of the anaesthetic management is also discussed briefly.

Anesthesia, Inhalation↗
PubMed1986

Epidural ketamine for postoperative analgesia.

Thirty-four patients of ASA physical status I or II scheduled for gall bladder surgery were studied in a comparative prospective trial to evaluate the efficacy of epidural and intramuscular ketamine for postoperative pain relief. They were divided randomly into three groups. Group I (11 patients) received 30 mg intramuscular ketamine. Group II (10 patients) and Group III (13 patients) received 10 and 30 mg ketamine in 10 ml saline respectively, through epidural catheters. Pain was evaluated every two hours for the first 24 hours post-operatively by using a linear analogue pain scale from 0-10. Ketamine was given on the patient's request and whenever the pain score exceeded three. Ketamine produced analgesia in all patients studied. The reduction of pain score after two and four hours in Group I and III was significant when compared to Group II. Seven patients (54 per cent) in Group III did not require further analgesia after the initial injection. However, following 10 mg epidural ketamine or 30 mg IM ketamine, post-operative pain was more frequent. Four patients who received epidural ketamine complained of transient burning pain in the back during injection. No patient developed respiratory depression, psychic disturbance, cardiovascular instability, bladder dysfunction or neurologic deficit. It is concluded that 30 mg epidural ketamine is a safe and effective method for postoperative analgesia.

Adult↗
PubMed1986

Plasma cholinesterase in pregnancy--effect of enzyme activity on the duration of action of succinylcholine.

The duration of action of succinylcholine, 1 mg/kg and plasma cholinesterase activity were compared in 25 pregnant women undergoing cesarean section and 25 non-pregnant women undergoing elective surgery. Neuromuscular activity was assessed by observation of thumb adduction, following stimulation of the ulnar nerve at the wrist. The duration of action of succinylcholine was significantly longer and enzyme levels significantly lower in the pregnant women. Monitoring of neuromuscular function is recommended when succinylcholine is used in pregnant women.

Adult↗
PubMed1985

Atracurium for short surgical procedures: a comparison with succinylcholine.

A comparison was made between atracurium and succinylcholine in 40 patients undergoing short gynaecological procedures of 30 minutes or less. Good intubating conditions were produced in 76.7 +/- 39.3 seconds (mean +/- S.D.) with succinylcholine 1 mg . kg-1 and 198 +/- 84 seconds with atracurium 400 micrograms . kg-1. Muscle relaxation was maintained with the initial dose of atracurium or with repeated boluses of succinylcholine. The mean time of surgery was 17.65 +/- 5.3 minutes in the atracurium group and 15.2 +/- 4.6 minutes in the succinylcholine group. Residual neuromuscular block with atracurium was reversed with neostigmine 0.036 mg . kg-1 and atropine 0.018 mg . kg-1. Recovery of neuromuscular function following reversal, assessed by return of all responses to train-of-four stimulation occurred in 5.05 +/- 4.6 minutes in the atracurium group but half the above doses of neostigmine and atropine were repeated in three patients. We conclude that a single dose of atracurium 400 micrograms . kg-1 is suitable for intubation and maintainance of muscle relaxation for short surgical procedures. However, the onset of action is slow, compared to succinylcholine. Residual neuromuscular block can be antagonised with standard doses of neostigmine, less than 20 minutes after the initial dose of relaxant. Atracurium appears to be a suitable alternative for short procedures where succinylcholine is unsuitable or contraindicated.

Adolescent↗
PubMed1983

Anaesthesia with continuous thiopentone infusion, epidural morphine and relaxant.

Twenty-three patients undergoing surgery below T.6 dermatome were anaesthetized with epidural morphine 20 mg in 15 ml of saline, thiopentone drip 0.04-0.1 mg/kg/min. and pancuronium 0.1 mg/kg. The patients had satisfactory analgesia intra-operatively. Post-operative analgesia lasted for varying periods ranging from 13 hours to 24 hours and above. The cardiovascular system was stable. Post-epidural morphine complications of respiratory depression (three patients), urinary retention (one patient) and pruritus (one patient) were seen and they were managed successfully.

Adolescent↗
PubMed1975

Althesin and pancuronium in chronic liver disease.

In 32 patients with chronic liver disease, undergoing major abdominal surgery, anaesthesia was induced with either Althesin (alphaxalone and alphadolone acetate) or thiopentone, and maintained with nitrous oxide, oxygen and increments of either pethidine or fentanyl. The patients were ventilated artificially to maintain PaCO, values in the normal range. Pancuronium bromide was used as the muscle relaxant. Liver function tests at 24 hr and 5 day after surgery showed only minor changes compared with findings before operation. There was no significant difference between the Althesin and thiopentone groups. In two patients with severe obstructive jaundice there was difficulty in reversing the effects of pancuronium, but "pancuronium resistance" was observed in all patients. It is concluded that the anaesthetic sequence described, with either Althesin or thiopentone induction, is satisfactory with respect to changes in liver function in patients with chronic liver disease undergoing major surgery.

Adolescent↗
PubMedDate not supplied

The effect of supplemental oxygen in sedated and unsedated patients undergoing upper gastrointestinal endoscopy.

A total of 212 patients undergoing elective upper gastrointestinal endoscopy were prospectively studied. They were randomly assigned to one of four treatment groups: (I) sedation with no supplemental oxygen; (II) no sedation and no oxygen supplementation; (III) sedation and supplemental oxygen; and (IV) no sedation but supplemental oxygen. Oxygen desaturation occurred in all the groups except group IV and was worsened by sedation. Supplemental oxygen corrected the desaturation in the sedated patients and minimized the associated haemodynamic changes. The duration of the endoscopy procedure was shortest in patients who were sedated and given supplemental oxygen. It can be concluded that during conscious sedation for upper gastro-intestinal endoscopy, supplemental oxygen should be given and continued during the postendoscopy period to prevent oxygen desaturation.

Adult↗
PubMedDate not supplied

Epidural morphine plus bupivacaine for relief of post-operative pain following Harrington rod insertion for correction of idiopathic scoliosis.

The aim of this study was to assess the efficacy of epidural morphine plus bupivacaine for post-operative pain control following Harrington rod insertion. In 22 scoliotic patients, studied prospectively, the epidural catheter was positioned under direct vision, intra-operatively before wound closure. Post-operatively, the patients received 2 mg morphine in 4 ml of 0.25% bupivacaine through the epidural catheter whenever they complained of pain. The pain score was assessed before and after every injection, using the Visual Analogue Pain Scale, and side-effects were monitored. All patients had adequate pain relief following analgesic administration. The mean (+/- SD) pre-injection pain score decreased from 2.5 +/- 0.15 on the first post-operative day to 0.7 +/- 0.2 by the fourth day. The side-effects, including nausea, vomiting and pruritus, were minimal. It is concluded that morphine, in 0.25% bupivacaine administered through an intra-operatively placed epidural catheter, provides a safe and effective post-operative analgesia in patients undergoing Harrington rod insertion for idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

The Gulf War: the experience of a department of anesthesiology in the management of Scud missile casualties.

BACKGROUND: The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated. OBJECTIVE: To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management. METHODS: On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel. RESULTS: There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed. The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately. CONCLUSION: The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.

Adult↗
PubMedDate not supplied

Evaluation of an intensive care unit in a teaching hospital in Saudi Arabia.

Intensive Care Units (ICU) in general hospitals have become a standard requirement in tertiary care centres. However, the appropriateness of their use is not widely known. We have used the Therapeutic Intervention Scoring System (TISS) to evaluate a multidisciplinary ICU in a teaching hospital in Saudi Arabia. The average occupancy rate was 79%, the nurse: patient ratio was 1:1.4, duration of stay 4.1 +/- 3.5 days, and mortality was 1.4%. The distribution of severity of illness was as follows: Classes I & II, 82%, and Classes III & IV, 18%. The average TISS points were: daily per patient 15.1 +/- 2.7 (range 11.5-21.7), total per day 125.6 +/- 38.2 (range 35-211), and patient points per nurse was 21.1. We conclude that, although less than 20% of patients required unique ICU services, the use of our ICU was appropriate to the current medical and manpower training needs of the community it was designed to serve, but the basis of nurses' complaints of overwork remains to be determined.

Hospitals, Teaching↗