Anaesthesia- Scholarly Publications

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    Open Access
    Evaluation of the accuracy of the Masimo Pronto compared to laboratory spectrophotometric method of intraoperative haemoglobin measurement
    (African Journals Online, 2019) Oguntuase, O. O; Adekola, O. O; Dada, O. I. O; Olatosi, J. O; Ogunleye, E. O
    Background: Transfusion decisions intra-operatively are generally guided by accurate blood loss estimation and intermittent invasive haemoglobin measurement. We investigated the accuracy of non- invasive intraoperative haemoglobin measurement using the Masimo Pronto (SpHb) as compared to laboratory spectrophotometry (tHb). Methods and Materials This was a cross sectional study of 110 adult patients undergoing surgery with a potential for blood loss of 500 ml and over under general anaesthesia. Haemoglobin level was determined simultaneously post-induction, pre-transfusion and postoperatively using (SpHb) readings from Masimo Pronto® Pulse CO-Oximeter (Rainbow® SET® Technology Masimo Corporation, Irvine, CA) and haemoglobin analyzer with laboratory spectrophotometry (tHb). Results A total of 244 sample pairs were analysed; 110 post-induction, 24 pre-transfusion and 110 post-operatively. There was a significant difference in mean haemoglobin between SpHb and tHb during the study at all time periods, p<0.0001. The overall mean haemoglobin was SpHb 12.02 ±1.86 g/dl, and tHb10.49 ±1.92 g/dl, p<0.0001, bias (1.5 ±1.76 g/dl), and limits of agreement-1.9 to 5.0 g/dl. There was moderate Pearson correlation (0.57) between SpHb and tHb measurements. The mean pre-transfusion haemoglobin was SpHb 10.25 ±1.96 g/dl, and tHb 8.26 ±1.27 g/dl, p<0.0001, bias, 2.0 ±1.89 g/dl and limits of agreement, -1.7 to 5.7 g/dl. Conclusion It is concluded that SpHb overestimated haemoglobin measurement as compared with tHb. Hence the Masimo Pronto was found to be inaccurate as compared with laboratory spectrophotometry in intraoperative haemoglobin measurement. The bias was too large and limits of agreement too wide between SpHb and tHb to make appropriate transfusion decisions.
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    Open Access
    How frequent is homologous blood transfusion during pediatric adenoidectomy and tonsillectomy?
    (Woltlers Kluwer, 2016-10) Adekola, O. O; Akanmu, N. O; Bamigboye, B. A; Akinola, M. D; Adedolapo, H. L; Dada, O. I. O; Somefun, A. O
    Background: Blood is routinely grouped and cross matched for elective adenoidectomy and, or, tonsillectomy at our institution. This practice has led to unnecessary delay and cancellation of surgery. Materials and Methods: This was a prospective study conducted in children aged one and half to nine years scheduled for adenoidectomy and, or, tonsillectomy from January, 2012 to April 2013. We investigated the need for routine preoperative grouping and cross matching of blood, and the immediate complications following adenotonsillectomy. Data collected included the number of blood cross matched and transfused, pre- and postoperative haemoglobin, estimated blood loss, duration of delay in commencing surgery due to lack of blood and the immediate complications following adenoidectomy and tonsillectomy. Results: A total of 129 patients were studied, adenotonsillectomy was performed in 88.37%, adenoidectomy in 7.75%, and tonsillectomy in 3.88%. The median estimated blood loss was 100 IQR (60-100 ml), 145 pints of blood were requested in all, one pint in 77.93% and two pints in 22.07%. The Cross-match to Transfusion Ratio, Transfusion Index and Blood ordering quotient were zero (0) respectively. The median duration of delay before surgery commenced on account of lack of blood was 84 IQR (27.5-119.5) mls. Primary haemorrhage was observed in 4 (3.1%), accidental extubation in 13 (10.07%), hypoxia 5 (3.88%) and cardiac arrest in one patient (0.78%). Conclusion: The cross-match to transfusion ratio, transfusion index and blood ordering quotient were zero, which suggest that cross-matched blood is unlikely to be required, and there was low blood usage. Therefore, the routine practice of preoperative grouping and cross matching of blood seems unnecessary adenoidectomy and, or, tonsillectomy. It is recommended that group and save should be encouraged because of shortage of blood in our country.
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    Open Access
    Regional anesthesia for small incision cataract surgery: Comparison of subtenon and peribulbar block
    (Woltlers Kluwer, 2018-01) Adekola, O. O; Aribaba, O. T; Musa, K; Olatosi, J. O; Rotimi-Samuel, A; Asiyanbi, G. K; Onakoya, A; Akinsola, F. B
    Background and Objective: The recent trend in cataract surgery is the use of regional ophthalmic nerve blocks or topical anesthesia. We determined and compared the effect of peribulbar and subtenon block on pain and patients’ satisfaction, following small incision cataract surgery (SICS). Methods: This was age‑sex‑matched comparative study involving 462 ASA I‑III patients, aged 18 years and above scheduled for SICS. They were assigned to receive either peribulbar block (Group P) or subtenon (Group ST). The pain score and patients’ satisfaction with the anesthetic experiences were recorded by a study‑masked anesthesiologist during surgery and postoperatively at 30 min and 1, 2, 4, and 24 h. Results: The median numeric rating score was significantly lower in the subtenon group than the peribulbar group: During surgery, Group ST 1 (1) versus group P 1.5 (2.25), P < 0.001. At 30 min after surgery, Group ST 0 (1) versus Group P 1 (2.5) versus P < 0.001, and at 1 h after surgery, Group ST 0 (1) versus group P 1 (2), P = 0.002. Ten patients had akinesia in the peribulbar group compared with one in the subtenon group. Chemosis was significantly higher in the subtenon group 10 (3.2%) than in the peribulbar group 0 (0%), P = 0.035. Similarly, a significant difference was not with subconjuctival hemorrhage; subtenon 14 (4.5%) versus peribulbar 2 (1.3%), P = 0.105. Conclusion: The use of subtenon block resulted in lower pain scores and higher patient’s satisfaction than peribulbar block. However, subconjuctival hemorrhage and chemosis were more common with subtenon block.
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    Open Access
    Central venous catheter insertion in critical illness: Techniques and complications
    (Woltlers Kluwer, 2018-04) Adekola, O. O; Irurhe, N. K; Raji, V. A; Desalu, I
    Background: Werner Forssman, in 1929, first described central venous catheter (CVC) insertion when he canalized his own right atrium through the cephalic vein. It is now a routine procedure in critical care. We investigated the pattern of insertion of CVC in our intensive care unit. Patients and Methods: A prospective observational study conducted in a 5-bed general intensive care unit of a 770-bed university teaching hospital. All prospective patients admitted from January 2013 to June 2014 were recruited. The technique, site and complications following insertion were documented. All had postprocedure chest radiography performed to confirm catheter tip position. Results: The most common site and technique of CVC insertion were the right internal jugular vein (IJV) 71 (79.8%), and the anatomic landmark (AL) 66 (74.2%), respectively. The mean catheter depth was significantly shorter in the AL (15.0 ± 2.4) cm than the Peres’ formula (16.5 ± 3) cm, P = 0.046. Catheter tips were correctly placed at the carina in 62 (69.7%) patients. The complication rate was 28 (31.5%), which was significantly higher in males 25 (45.5%) than females 3 (8.9%), P = 0.03, and increased by 57.9% with attempts >2. The most common complications were failure to insert 9 (10.1%), right carotid artery puncture (8.9%), and arrhythmias (5.9%). Pneumothorax was reported in (4.5%), all occurred with the subclavian approach. Conclusion: Central venous catheter insertion is more common through the right internal jugular vein, and with the anatomical landmark technique. The complication increased with attempts >2, male gender, and subclavian approach.
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    Open Access
    Aortic aneurysm: A life-threatening condition in a low-resource nation
    (Woltlers Kluwer, 2019-01) Ogunleye, E. O; Adekola, O. O; Dada, O. I. O
    Background: Aortic aneurysm is said to be uncommon in the black population; however, with the modification in lifestyle of the dark‑skinned people, and improved diagnostic facilities in Sub‑Saharan African nations, a surge in its presentation is more likely. If undiagnosed, aortic aneurysm can be catastrophic. We determined the epidemiology pattern and outcome of aortic aneurysm at our institution. Materials and Methods: This is a retrospective analysis of patients who presented with aortic aneurysm from 2000 to 2017. A pro forma was designed to analyze the bio data, characteristics of the aneurysms, clinical manifestation, treatment, and outcome. The Crawford, Stanford, and DeBakey criteria were used to classify the aortic aneurysm. The surgical management of the aneurysm was resection and its replacement with synthetic polytetrafluoroethylene prosthesis with antibiotic prophylaxis under general anesthesia. Results: A total of 17 patients were recruited, with a mean age of 62.75 ± 20.92 years. A high proportion were above 65 years, i.e., 7 (41.2%), and male gender, i.e., 10 (58.8%). The most common location of aortic aneurysm using Crawford criteria was Type IV followed by Type I, with Stanford criteria being Stanford Type B (13) and with DeBakey being Type III (3). Five operated were fusiform in shape. A higher proportion of patients, i.e., 14 (82.4%), had coexisting hypertension, and a positive history of smoking, i.e., 7 (41.2%). The 30‑day mortality was 64.7%, the operative mortality was 35.3%, and three patients (17.6%) were loss to follow‑up. A positive history of smoking increased the risk of dead, relative risk 3.375, 95% confidence interval 0.677–5.909, P = 0.04. Conclusion: Aortic aneurysm, though uncommon, is not a rare disease among cardiovascular disorders in a low‑resource environment. The most common shape and location were fusiform and Stanford Type B or DeBakey Type III, respectively. There was associated high 30‑day mortality (64.7%)