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An Audit of Perioperative Use of Tramadol in Children in a Specialized Children Hospital
Ahmed Haroun Mahmoud,
Mohamed Hanafi Mahmoud,
Abdulaleem Alatassi,
Mohamed Ibrahim Emam,
Ahmed Mahran Hamada,
Marwan Hadaki,
Zainab Alzayer,
Badar Alhasani,
Abdulrahman Aljamous,
Husam I. Ardah
Issue:
Volume 8, Issue 2, December 2020
Pages:
30-36
Received:
24 May 2020
Accepted:
8 June 2020
Published:
16 June 2020
DOI:
10.11648/j.ijacm.20200802.11
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Abstract: Background: Tramadol is widely used worldwide to treat moderate to severe pain in children. There are growing concerns regarding the safety of tramadol use in children in recent years when the US FDA (Food and Drug Administration) issued a safety announcement that restricts tramadol use in children less than 18 years old to treat pain after tonsillectomy and adenoidectomy. After this FDA announcement, our hospital stopped using tramadol in children less than 18 years old. Objective: we planned to audit our experience in the use of intravenous tramadol in children for postoperative pain management in recovery area. Methods: Institutional Review Board (IRB) waived written informed consent. After getting the IRB approval, we reviewed the anesthesia records of 16130 patients between the years 2015 and 2017. We looked for patients who received tramadol postoperatively in PACU (post-anesthesia care unit). We looked for postoperative complications or adverse events in the form of apnea, hypopnea, bradycardia, postoperative nausea and vomiting, prolonged stay in recovery, unplanned admission, or admission after discharge within 48 hours. Statistical analysis was done using Wilcoxon scores for variables, Wilcoxon 2 sample test, calculated odd's Ratio and 95% confidence interval and P-values where P values less than 0.05 were considered significant. Results: Seven patients desaturated out of 430 patients. They needed oxygen support in the form of simple facemask or nasal cannula but no one needed positive pressure ventilation. No one developed apnea or bradycardia or needed naloxone administration. There was no readmission after discharge from the hospital. There was only one unplanned admission due to a surgical cause. The average duration of stay in the PACU was 86 minutes. Almost all (418) patients stayed more than 45 min (97.2%). Ninety-two patients had PONV (postoperative nausea and vomiting) (21.39%). There was positive correlation between PONV and total tramadol dose, while a comparison of the Pearson correlations showed that duration of the procedure was the best predictor of PACU duration with an R-value of 0.188 which was highly significant at the P<0.0001. Conclusion: Tramadol does not cause respiratory depression in children, especially when given in a controlled and monitored setup in the operating room and recovery area however Still, Tramadol needs to be studied more in pediatric anesthesia and analgesia and more comparative data is required to determine the safety of available opioids in this setting.
Abstract: Background: Tramadol is widely used worldwide to treat moderate to severe pain in children. There are growing concerns regarding the safety of tramadol use in children in recent years when the US FDA (Food and Drug Administration) issued a safety announcement that restricts tramadol use in children less than 18 years old to treat pain after tonsill...
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Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases
Jose Correa,
Henry Cortes,
Patricia Abella,
Alberto Quevedo,
Olga Correa
Issue:
Volume 8, Issue 2, December 2020
Pages:
37-41
Received:
25 July 2020
Accepted:
7 August 2020
Published:
13 August 2020
DOI:
10.11648/j.ijacm.20200802.12
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Abstract: Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP blocks in acute pain management, using local anesthetics for their realization, but the true mechanism of action of this block has not yet been determined due to a paucity of evidence of the technique, so the role of ESPB in chronic pain management is limited. Even more, there are no studies using neurolytic techniques in the ESPB. Method: We describe the successful application of the neurolytic substance phenol in 2 female patients with severe pain due to breast cancer where the previous management of the analgesic medications, did not achieved an adequate pain control. Result: The neurolytic-ESPB produced an extensive multidermatomal sensory block, allowing the reduce of the previous total oral opioid requirement for prolonged periods of time after the neurolytic procedure, and reducing, in consequent, the related side effects, improving the quality of life of our patients. Conclusion: The true mechanism of ESPB has not yet been determined, and there is a paucity of evidence of its role in the management of chronic pain with this technique. This balance between effectiveness and safety in all areas of chronic pain, mainly with patients with refractive cancer-pain, where multimodal techniques are chosen, must follow the criteria of evidence-based medicine.
Abstract: Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP block...
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Simulation Based Training in Basic Life Support for Medical and Non-medical Personnel in Resource Limited Settings
Christopher Nyirenda,
Samuel Phiri,
Boniface Kawimbe
Issue:
Volume 8, Issue 2, December 2020
Pages:
42-46
Received:
1 July 2020
Accepted:
16 July 2020
Published:
20 August 2020
DOI:
10.11648/j.ijacm.20200802.13
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Abstract: Medical and non-medical personnel commonly encounter victims of life threatening injuries inflicted by various causes in diverse settings. More than 90% of global deaths and disability adjusted life-years (DALYs) lost because of injuries reportedly occur in low-income and middle-income countries (LMICs). The degree of readiness and competence to manage victims of accidents is likely to vary among individual care givers for knowledge, skill and confidence which would also depend on their training status. It would thus be justified that training in basic life support and other emergency clinical skills be administered to enhance competences in resuscitating the accident victims. Whatever the scale of a mass casualty incident, the first response will be carried out by members of the local community-not just health care staff and designated emergency workers, but also many ordinary citizens. Therefore, both medical and non-medical personnel should be targeted to receive training in basic life support (BLS). In medical training, the traditional (didactic) approach has been suggested to be an efficient and well-experienced training method while with the advances in technology the use of simulation-based medical training (SBMT) is increasing since SBMT provides a safe and supportive educational setting, so that students can improve their performance without causing adverse clinical outcomes. Similarly, the use of simulation based training in BLS would not only reduce the procedural associated risks but also benefit more participants from the public domain than would be the case if the training was conducted on human subjects. Compared with the developed world set-up simulation based training in resource constrained settings may not be that well established. This paper will therefore seek to examine the role of medical simulation as a necessary advancement and supplementary method of training in basic life support for medical and non-medical personnel in resource limited settings.
Abstract: Medical and non-medical personnel commonly encounter victims of life threatening injuries inflicted by various causes in diverse settings. More than 90% of global deaths and disability adjusted life-years (DALYs) lost because of injuries reportedly occur in low-income and middle-income countries (LMICs). The degree of readiness and competence to ma...
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Assessment of Knowledge and Awareness of Acute Physiology and Chronic Health Evaluation (APACHE) II Tool Among Intensive Care Nurses in a Tertiary Institution
Christie Omolola Adamsloladams28@gmail.com,
Esther Joseph,
Ekele Peter Ekele,
Elizabeth Ifeyinwa Rasong,
Daniel Ebenezer Obi
Issue:
Volume 8, Issue 2, December 2020
Pages:
47-54
Received:
16 July 2020
Accepted:
29 July 2020
Published:
25 August 2020
DOI:
10.11648/j.ijacm.20200802.14
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Abstract: Background: This study is aimed at assessing the adequate knowledge and awareness of the trained Intensive Care Nurses working at the University of Abuja Teaching Hospital (UATH) on Acute Physiology and Chronic Health Evaluation (APACHE) II prognostic tool on patients who are being referred for intensive medical and nursing care from other departments of the hospital for cardiac and thoracic support, also for invasive and non-invasive procedures. This tool is an instrument of interest that is used in predicting the severity and prognosis of critical conditions such as severe trauma, and severe sepsis. The prognostic tool was first founded at George Washington University Medical Center in 1981. The acute physiological score was complex initially because it uses 34 physiological parameters, afterward a simple 12 parameter APACHE II system was invented in 1985 and it is widely applied in assessing the severity of diseases in the Intensive Care Unit. The same was published in 1985 and it remains useful for research, quality control, and clinical applications for patients admitted into the Intensive Care Unit within 24 hours. This study was a cross-sectional survey that used a structured electronic survey questionnaire to collect ethnography qualitative data. A total of 72 (98%) (n=72) of the respondents are trained intensive care nurses and 2 (2%) had no training in intensive care nursing. 27 (36%) of the respondents work in the intensive care unit, 10 (14%) works in the Post Basic Intensive Training School, 14 (19%) works in Post-Operative Recovery Room, while 23 (31%) of the respondent works in other departments of the hospital. And all these trained intensive care nurses had their training across different schools in Nigeria. In conclusion, the study showed that a larger number of the trained intensive care nurse in UATH who had their training across various schools in Nigeria do not have optimal knowledge and awareness of the utilization of this tool, and it is very important for nurses to have the background knowledge and for proper use of this prognostic tool. Therefore, there is a need for training and re-training for the Intensive Care Nurses across the board. Also, this tool should be inculcated into the Post Basic Critical Care Training Nursing Schools, curriculum across all the Post Basic Critical Care Nursing Training Schools in Nigeria.
Abstract: Background: This study is aimed at assessing the adequate knowledge and awareness of the trained Intensive Care Nurses working at the University of Abuja Teaching Hospital (UATH) on Acute Physiology and Chronic Health Evaluation (APACHE) II prognostic tool on patients who are being referred for intensive medical and nursing care from other departme...
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Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey
Neha Rawat,
Jijo Francis,
Goverdhan Dutt Puri,
Amarjyoti Hazarika,
Naveen Naik,
Kulbhusan Saini
Issue:
Volume 8, Issue 2, December 2020
Pages:
55-61
Received:
15 August 2020
Accepted:
27 August 2020
Published:
3 September 2020
DOI:
10.11648/j.ijacm.20200802.15
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Abstract: INTRODUCTION: PPE for contact protection is an integral component of the management of critically ill COVID-19 patients. It causes restrictions in mobility and impaired touch perception. This is further impaired by additional standard barrier precautions taken for sterility. In an era where the point of care ultrasound (POCUS) has become an everyday practice, ultrasound guidance is recommended to overcome some of these difficulties. OBJECTIVE: The objective was to find and evaluate the techniques practiced, the difficulties faced and complications while performing a central venous catheter and arterial cannula insertion. MATERIALS AND METHODS: The study was conducted through an online survey. The questionnaire included questions about the practices followed, the problems faced, and complications during performing such procedures. RESULT: 66.66% of the Senior residents and 16.6% of the Consultants attempted the CVC insertions. Arterial cannulation was attempted by 78.37% senior residents and 14.42% Consultants. Majority of intensivists used USG for CVC insertions (86.48%) and for arterial cannulation (81%). The various difficulties faced were impaired vision due to fogging (100%), impaired body movement. 66% complained of suboptimal patient positioning and 33% complained of difficulty in communication during CVC insertion. We found that there were no immediate complications. CONCLUSION: To access central and arterial cannulation in a COVID ICU, Senior intensivist should perform the procedure using USG guided techniques so as to improve success rate and minimize complication amidst difficulties like fogging of vision and improper procedural positioning. Standardized equipment for “standard” maximal barrier precautions should be available before performing these procedures in addition to PPE.
Abstract: INTRODUCTION: PPE for contact protection is an integral component of the management of critically ill COVID-19 patients. It causes restrictions in mobility and impaired touch perception. This is further impaired by additional standard barrier precautions taken for sterility. In an era where the point of care ultrasound (POCUS) has become an everyda...
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Prevalence of Different Severities of Hypoxia in COVID-19 Patients Admitted in Critical Care Unit
Shamim Kausar,
Syeda Rida-e-Zehra,
Anum Latif,
Samar Abbas Jafferi,
Syeda Namayah Fatima Hussain,
Syeda Nazish Azim,
Farah Naz,
Irfan Ahsan,
Pirih Bhatti
Issue:
Volume 8, Issue 2, December 2020
Pages:
62-64
Received:
20 September 2020
Accepted:
30 September 2020
Published:
13 October 2020
DOI:
10.11648/j.ijacm.20200802.16
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Abstract: In 2020 Corona Virus Disease 2019 (COVID-19) infection hit the world as pandemic. The most common and life threatening complication was various severity of respiratory failure. So we decided to conduct a study to determine the prevalence of different severities of hypoxia in COVID-19 infection. The study was a cross sectional prospective observational study on 50 participants. The study was conducted in COVID Intensive care unit (ICU) of Liaquat National Hospital and Medical College and COVID ICU of National Medical Centre Karachi, Pakistan. All patients with PO2 to FiO2 (PF) ratio less than 300, smokers and non-smokers were included in the study. PF ratio of 300 to 200 was considered as mild, 200 to 100 as Moderate and less than 100 considered as severe hypoxia. Admitting PO2 from an Arterial Blood Gas (ABG) sample and FIO2 was noted. Prevalence of hypoxia severities were graded, need of mechanical ventilation and mortality of each group was determined. 42 (84%) of patients had severe while 8 patients 16% had moderate hypoxia. None of the patient admitted in critical care had mild hypoxia. In severely hypoxic patients mortality rate was 28.6% and in moderately hypoxic group it was 50%. Severe hypoxia effected most of the COVID-19 infected patients admitted in critical care, which may be the cause of poor outcomes in critically ill COVID-19 patients.
Abstract: In 2020 Corona Virus Disease 2019 (COVID-19) infection hit the world as pandemic. The most common and life threatening complication was various severity of respiratory failure. So we decided to conduct a study to determine the prevalence of different severities of hypoxia in COVID-19 infection. The study was a cross sectional prospective observatio...
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A Unique Case Report of Bilateral Rectus Sheath Block as a Sole Anaesthetic Technique for Umbilical Hernia Repair
Issue:
Volume 8, Issue 2, December 2020
Pages:
65-67
Received:
16 September 2020
Accepted:
28 September 2020
Published:
21 October 2020
DOI:
10.11648/j.ijacm.20200802.17
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Abstract: Background: Rectus sheath block has been traditionally used to provide analgesia for anterior abdominal wall surgeries, as it spares the visceral pain component. It’s been used efficiently for intraoperative, post-operative analgesia, providing stable hemodynamic. The emergence of ultrasound has potentially increased the rate of success, while avoiding complications like bleeding, peritoneal puncture, visceral injury. Objective: The author successfully used bilateral rectus sheath block for anesthesia of umbilical hernia repair about which very sparsely is described in literature. The use of ultrasound has increased the accuracy while decreasing the rate of complications. Also complications associated with general anesthesia and central neruaxial block can be avoided. Method: Obstructed umbilical hernia repair and ventral hernia repair were performed under sole ultrasound guided rectus sheath block. 5ml of 2% xylocard and 10ml of 0.75% ropivacaine was deposited on each side between rectus abdominis muscle and posterior rectus sheath. Both were high risk cases and some length of bowel handling was also involved. Yet the patients were comfortable with minimal supplemental analgesics and did not complain of any pain. Conclusion: Bilateral rectus sheath block can provide adequate anesthesia for abdominal hernia surgeries involving some bowel handling if supplemented by intravenous analgesics in high-risk cases. Thus avoiding general anesthesia and central neuraxial blockade.
Abstract: Background: Rectus sheath block has been traditionally used to provide analgesia for anterior abdominal wall surgeries, as it spares the visceral pain component. It’s been used efficiently for intraoperative, post-operative analgesia, providing stable hemodynamic. The emergence of ultrasound has potentially increased the rate of success, while avoi...
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Effect of Different Concentrations of Intraperitoneal Bupivacaine on Postoperative Outcome in Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery
Mohammed Adel Hegazy,
Hosam Hamed,
Mohamed Said Salim,
Mohamed Abdelraoof,
Ahmed Mohamed Farid,
Hani Taman
Issue:
Volume 8, Issue 2, December 2020
Pages:
68-73
Received:
20 October 2020
Accepted:
2 November 2020
Published:
9 November 2020
DOI:
10.11648/j.ijacm.20200802.18
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Abstract: Introduction: Regional analgesic techniques with infiltration of local anesthetic represent a cornerstone in modern postoperative pain management strategies after laparoscopic surgery. If used in a right concentration, it could help in attenuation of postoperative pain with better pulmonary performance and less morbidity. Aim: to compare the effect of different concentrations of intraperitoneal bupivacaine to obtain proper pain relief after laparoscopic bariatric surgery and evaluating its effect on pulmonary functions. Patients and methods: One hundred and twenty morbidly obese patients were included in this study. Patients were divided into three group. Group (A) patients received 50 ml bupivacaine 0.25% into the coelomic cavity. Group (B) patients receive 50 ml bupivacaine 0.125% into the coelomic cavity. Group (C) control group (n=36): patients receive 50 ml of normal saline into the coelomic cavity. VAS score and pulmonary function study were examined before and at regular intervals after surgery. Total analgesic requirements and time to first analgesic rescue was recorded. Results: VAS in group (A) was significantly lower than group (C) 2 hours after surgery and lower in group (A) compared with group (B&C) at 4 and 6 hours postoperative. Postoperative morphine consumption was lower in group (A) during the first 24 hours when compared to group (B & C) respectively. Both FVC and FEV1 were higher in group (A) compared to group (B&C) at 6hours postoperative. Conclusion: intraperitoneal injection of bupivacaine 0.25% is an efficient method of decreasing the postoperative pain with better preservation of pulmonary functions in morbidly obese patients undergoing laparoscopic bariatric surgery.
Abstract: Introduction: Regional analgesic techniques with infiltration of local anesthetic represent a cornerstone in modern postoperative pain management strategies after laparoscopic surgery. If used in a right concentration, it could help in attenuation of postoperative pain with better pulmonary performance and less morbidity. Aim: to compare the effect...
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Antibioprophylaxis in Paediatric Surgery at University Hospital Center of Brazzaville (Republic of Congo)
Marie Elombila,
Gilbert Fabrice Otiobanda,
Peggy Dahlia Leyono-Mawandza,
Christ Mayick Mpoy Emy Monkessa,
Gilles Niengo Ontsouta,
Carine Mboutol Mandavo,
Irene Ondima
Issue:
Volume 8, Issue 2, December 2020
Pages:
74-77
Received:
16 October 2020
Accepted:
5 November 2020
Published:
11 November 2020
DOI:
10.11648/j.ijacm.20200802.19
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Abstract: Aim: Evaluate the practice of antibioprophylaxis in paediatric surgery at University Hospital of Brazzaville. Materials and methods: The study was a retrospective, cross-sectional and descriptive, during 12-month (January to December 2013) conducted in the operating room of University Hospital of Brazzaville. All patients undergoing scheduled paediatric surgery were included in this study. The parameters analyzed were: ASA class, Alteimer class, duration of surgery, type of antibiotic administered, timing of administration and reinjection of antibiotic. Results: A total of 216 patients were analysed. The average age was 7.57±5.03 years. The ASA I was the most represented in 94.9% of cases. Anaesthesia was general in 89.9% of cases. Surgery was classified as Alteimer I in 68.1% of cases, Alteimer II and III in 26.9% and 5.1% of cases respectively. The indication for antibioprophylaxis was conformed in 54.1% of cases. The most commonly used antibiotics were cefuroxime in 42.3% of cases and ceftriaxone in 31.5% of cases. In 20.7% of cases the antibiotic was administered after the surgical incision. Antibiotic reinjections were not performed. The average duration of the surgery was 99.94±46.36 minutes. The overall compliance (indication, choice of molecule, injection-incision time and reinjections) was 47.1%. Conclusion: In almost half of the cases, antibioprophylaxis did not comply with the recommendations. Consensus between surgeons and anesthesiologists must be reached to develop national protocols for antibioprophylaxis in pediatric surgery.
Abstract: Aim: Evaluate the practice of antibioprophylaxis in paediatric surgery at University Hospital of Brazzaville. Materials and methods: The study was a retrospective, cross-sectional and descriptive, during 12-month (January to December 2013) conducted in the operating room of University Hospital of Brazzaville. All patients undergoing scheduled paedi...
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Use of Dexmedetomidine as a Local Adjuvant Infiltration Agent in Septorhinplasty: New Infiltration Formula
Mohamed Eslam Alshahawy,
Ahmed Zeina,
Mohamed Elsaid Abdelshaheed,
Ahmed Mohamed Farid
Issue:
Volume 8, Issue 2, December 2020
Pages:
78-83
Received:
29 October 2020
Accepted:
9 November 2020
Published:
19 November 2020
DOI:
10.11648/j.ijacm.20200802.20
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Abstract: Septorhinoplasty is a common cosmetic surgery nowadays. Local anaesthetic mixture with adrenaline was preferably used for obtaining bloodless surgical field and adequate perioperative analgesic strategy. Dexmedetomidine as a selective α2-agonist may be useful as an additive agent that helps in achieving a suitable surgical field and postoperative proper pain management. Patients and method: Eighty patients who were scheduled for elective septorhinoplasty umder general anesthesia were divided into two groups, each included 40 Patients. Group I: patient received local anaesthesia and adrenarline, group II: patient received the same as group I besides dexmedetomidine 100 µg. Heart rate, mean arterial blood pressure changes were monitored. Surgical and operative times were reported. The level of sedation and postoperative pain were evaluated by Ramsay Sedation Scale (RASS) and Visual Analogue Scale (VAS) respectively. The amount of analgesic requirement and the time till first analgesic requirement were also recorded. Surgeon and Patients' satisfaction with anesthesia were questioned one week after discharge. Results: Heart rate and mean arterial blood pressure were significantly decreased in group II compared with group I. RASS score was higher and VAS score and bleeding was lower in group II compared to group I. Surgeons and patients satisfaction was higher in group II compared to group I. Conclusion: In conclusion, supplementation of local anesthesia with dexmedetomidine produces an adequate level of intraoperative hemodynamic stability, conscious sedation, adequate analgesia, low postoperative analgesic requirements with extended pain free period and less bleeding in all patients. These effects are well obtained with high dose of dexmedetomedine.
Abstract: Septorhinoplasty is a common cosmetic surgery nowadays. Local anaesthetic mixture with adrenaline was preferably used for obtaining bloodless surgical field and adequate perioperative analgesic strategy. Dexmedetomidine as a selective α2-agonist may be useful as an additive agent that helps in achieving a suitable surgical field and postoperative p...
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