Anesthetic Techniques for Gynecological Surgeries in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria

Background: Gynecological surgery refers to surgery on the female reproductive system usually performed by gynecologists. It includes procedures for benign conditions, cancer, infertility and incontinence. Gynecological conditions are seen in the non-pregnant and early pregnant state up to 20 weeks gestation. . Just like every other surgery, they require anesthesia for the elimination of surgical pain and the surgical methods to a great extent, determine the choice of anesthesia employed. Anesthesia is usually in the form of regional, especially the neuroaxial type, or general anesthesia. This study was conducted to ascertain the anesthetic techniques employed for gynecological surgeries in the Benue State University Hospital (BSUTH), Makurdi, Nigeria and complications arising there from. Methodology: A retrospective and descriptive study of case files of patients that underwent gynecological surgeries between January 2016 and December 2018 in BSUH, Makurdi was carried out. A total of 156 case files of eligible patients were retrieved from the records department of BSUTH after approval from relevant authorities. Relevant information were extracted from the patients’ folders and transferred into a prepared proforma. The data collected were analyzed using SPSS version 25 using simple statistics. Result: A total of 156 cases were evaluated. The age bracket with the most number is that between 21 and 30 years which recorded 54 (34.6%). This was followed by the age group between 31 and 40 years which were 51, making up 32.7% of the study population. Uterine fibroid was the most recorded diagnosis with 36 cases accounting for 23.1% of the study population. This was followed by ruptured ectopic gestation which was observed to 23, representing 14.7% of the study group. Cancer (Ca) of the cervix recorded 22, amounting to 14.1% of the study group. Exploratory laparotomy was carried out 44 times accounting for 28.2% of the procedures. This was followed by myomectomy and examination under anesthesia (EUA) with 26, representing 14.7% of the variables each. Of the 156 anesthetic procedures undertaken, 56 (35.9%) were sub-arachnoid block (SAB). This was followed closely by general anesthesia with endotracheal intubation (GA/ETT) with 55 (35.3%). General anesthesia with face mask (GA/FM) came third with 35 (22.4%). Twenty-four episodes of complications were observed out of which pain occurred 10 times accounting for 41.7% of the variables. Hypotension occurred 8 times representing 33.3% of the variables. Accordingly, 24 modalities were employed for the management of complications of anesthetic techniques of which IV administration of ephedrine was done 8 times representing 33.3% of the variables. This was followed by IV administration of pentazocine that was done 5 times accounting for 20.9% of the variables. Conclusion: As a result of the vast array of gynecological diseases observed in this study, GA with tracheal intubation and GA with face mask together make up the anesthetic technique of choice for gynecological surgeries. The prominence of SAB as an anesthetic technique is not unexpected because many gynecological lesions are sub-umbilical in location, thus making them amenable to the technique which also possesses a lot of advantages. In addition, complications observed were few and included mainly pain and hypotension, none of which was life-threatening.

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Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

BMC Anesthesiology ◽

10.1186/s12871-021-01442-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mark C. Kendall ◽

Alexander D. Cohen ◽

Stephanie Principe-Marrero ◽

Peter Sidhom ◽

Patricia Apruzzese ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Adverse Events ◽

General Anesthesia ◽

Knee Arthroplasty ◽

Anesthetic Management ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Short Term ◽

Knee Replacements ◽

Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

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Anesthetic Choice for Functional Endoscopic Sinus Surgery

American Journal of Rhinology ◽

10.2500/105065892781976745 ◽

1992 ◽

Vol 6 (1) ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

John A. Fornadley ◽

Kevin S. Kennedy ◽

Joseph F. Wilson ◽

Peter T. Galantich ◽

Gregg S. Parker

Keyword(s):

General Anesthesia ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Patient Comfort ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Local Infiltration ◽

Local Technique ◽

Local Anesthetic Injection

Controversy continues concerning the optimal anesthetic technique when completing endoscopic sinus surgery. To attempt to investigate the results using different anesthetic techniques, experience with endoscopic sinus surgery over 12 months (233 cases) was retrospectively reviewed. The use of local anesthetic injection with or without regional blocks (specifically ethmoid and greater palatine) was evaluated, as was the choice of general anesthesia versus local technique in a context of blood loss, patient comfort, and complications. Regional block technique appears to add morbidity for little additional benefit. Endoscopic sinus surgery may be performed safely in appropriately selected patients using either general anesthesia or local infiltration with sedation.

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Types of anesthesia for different sacroiliac joint interventions

10.1093/med/9780197607947.003.0005 ◽

2021 ◽

pp. 51-66

Author(s):

Behnum A. Habibi ◽

Mark N. Malinowski ◽

Chong H. Kim

Keyword(s):

Radiofrequency Ablation ◽

Minimally Invasive ◽

General Anesthesia ◽

Sacroiliac Joint ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Anesthesia Care ◽

History Of ◽

History Of Anesthesia ◽

Joint Injections

There are a variety of anesthetic techniques commonly used for sacroiliac joint (SIJ) procedures. For example, diagnostic SIJ injections do not necessitate anesthesia, while open SIJ fusions require general anesthesia. This chapter, targeted to practitioners performing SIJ procedures, covers the basic elements of these techniques. After a brief discussion of the history of anesthesia in relation to SIJ procedures, each common anesthetic technique is discussed, in order of increasing sedation. Local anesthesia is discussed for intraarticular joint injections, blocks of the nerves innervating the SIJ, and radiofrequency ablations of these same nerves. Monitored anesthesia care is discussed for procedures such as minimally invasive SIJ fusions and the Simplicity radiofrequency ablation technique. The use of neuraxial anesthesia, via either spinal or epidural blocks, is considered for lateral SIJ fusions. Finally, the use of general anesthesia for lateral and open fusions is reviewed.

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Anesthetic Techniques for Urological Surgeries in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.5.403 ◽

2020 ◽

Vol 2 (5) ◽

Author(s):

M. E. Efu ◽

E. I. Ogwuche ◽

B. A. Ojo ◽

B. A. Eke

Keyword(s):

Local Anesthesia ◽

Relevant Information ◽

Epidural Block ◽

University Teaching ◽

University Hospital ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

State University ◽

Female Ratio ◽

Urological Surgery

Background: Urological surgery entails operating on the urinary system. Like every other surgery, they require anesthesia for the elimination of surgical pain. The organ to be operated as well as surgical approach determines the choice of anaesthesia used. This may be in the form of regional (including neuroaxial anesthesia) or general or even local anesthesia. This study was conducted to ascertain the anesthetic techniques employed for urological surgeries in the Benue State University Hospital (BSUTH), Makurdi, Nigeria. Methodology: This was a three-year retrospective study carried out in BSUTH, Makurdi, Nigeria. A total of 125 case files of eligible patients were retrieved from the records department following approval of an application. Relevant information was extracted from the patients’ folders and transferred into a prepared proforma. The data collected were analyzed using SPSS version 25 using simple statistics. Results: The age group with the highest number is that between 61 and 70 years, recording 40 (32.0%). The mean age was 54.0±20.4 Males were a clear majority with 119 cases accounting for 95.2% while only 6 cases (4.8%) involved females. The male to female ratio was 19.8:1. Most of the patients belonged to ASA II which recorded 70 (56.0%). Of the total of 125 diagnoses made, cancer of the prostate (CaP) was the highest with 63 (50.4%). The most common surgical procedure was prostate biopsy which was undertaken 58 times accounting for 46.4% of the procedures. Caudal block was employed most with 59 (47.2%). This was followed by Local infiltration with 30 (24.0%). Eighty-eight patients had surgery on day case basis while 37 patients underwent surgery as in-patients representing 70.4% and 29.6% of the study group respectively. Conclusion: Urological procedures are mostly infra-umbilical and are thus quite amenable to either regional or local anesthesia. This study has shown that caudal epidural block is the anesthetic technique of choice in urological surgery in this centre. Local anesthesia and sub-arachnoid block are next in that order. GA is not often employed. LA and regional techniques involve fewer disturbances to the respiratory system, and these were the anaesthetic methods mostly employed as established in this study.

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Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01350-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Menglu Jiang ◽

Jiawei Ji ◽

Xin Li ◽

Zhenqing Liu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anesthesia ◽

Control Group ◽

Study Group ◽

Clinical Trial Registry ◽

Blood Oxygen Saturation ◽

Blood Concentrations ◽

Number Of Patients ◽

Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

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Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients

Children ◽

10.3390/children8080642 ◽

2021 ◽

Vol 8 (8) ◽

pp. 642

Author(s):

Giuliano Marchetti ◽

Alessandro Vittori ◽

Fabio Ferrari ◽

Elisa Francia ◽

Ilaria Mascilini ◽

...

Keyword(s):

General Anesthesia ◽

Pediatric Patients ◽

Pain Syndrome ◽

Intercostal Nerve ◽

Anesthetic Technique ◽

Intercostal Nerve Block ◽

Thoracic Epidural ◽

Burning Pain ◽

Significant Difference ◽

Group B

We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.

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Large Tracheal Papillomas: A Difficult Anesthetic Problem and an Apparent Cure

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947508400217 ◽

1975 ◽

Vol 84 (2) ◽

pp. 233-237

Author(s):

Edward Cardfn ◽

George B. Ferguson

Keyword(s):

General Anesthesia ◽

Operative Procedures ◽

Anesthetic Technique ◽

Respiratory Embarrassment

A six-year-old female with papillomatosis of the trachea causing respiratory embarrassment was operated upon under general anesthesia. Utilizing a specially designed anesthetic technique to fit the problem and utilizing a cryoprobe followed by electrodessication, the lesions were removed. Furthermore, simple operative procedures and the use of bovine wart vaccine has, over the course of seven months, resulted in an apparent cure.

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Patient Demographics, Characteristics, and Intrahospital Mortality of Different Ischemic Stroke Subtypes in a Tertiary Hospital during Five-Year Period

Medical Sciences Forum ◽

10.3390/iecmd2021-10315 ◽

2021 ◽

Vol 6 (1) ◽

pp. 6

Author(s):

Sintija Strautmane ◽

Kristaps Jurjāns ◽

Estere Zeltiņa ◽

Evija Miglāne ◽

Andrejs Millers

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Reperfusion Therapy ◽

Cardioembolic Stroke ◽

Study Group ◽

Large Artery ◽

Patient Demographics ◽

Stroke Subtypes ◽

Female Predominance ◽

Study Population

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The goal of the study was to evaluate patient demographics, characteristics, and intrahospital mortality among different ischemic stroke subtypes. Materials and Methods. A retrospective observational non-randomized study was conducted, including only ischemic stroke patients, admitted to Pauls Stradins Clinical university hospital, Riga, Latvia, from January of 2016 until December 2020. Ischemic stroke subtypes were determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria as a stroke due to (1) large-artery atherosclerosis (atherothrombotic stroke (AS)), (2) cardioembolism (cardioembolic stroke (CS)), (3) small-vessel occlusion (lacunar stroke (LS)), (4) stroke of other determined etiology (other specified stroke (OSS)), and (5) stroke of undetermined etiology (undetermined stroke (US)). The data between different stroke subtypes were compared. Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, the most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p < 0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors. This was also statistically significant, p < 0.05. Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF, and different IS subtypes among our study population demonstrated not only statistical significance but also a strong association, Cramer’s V = 0.53. The majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients, 770 (34.2%), p < 0.05. The overall intrahospital mortality among our study population was 570 (12.0%), with the highest intrahospital mortality rate noted among CS patients, 378 (66.3%), p < 0.05. No statistically significant difference was observed between acute myocardial infarction and adiposity, p > 0.05. Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy, and intrahospital mortality.

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EFFICACY OF CROMOGLYCATE IN PERSISTENTLY WHEEZING INFANTS

PEDIATRICS ◽

10.1542/peds.96.2.401 ◽

1995 ◽

Vol 96 (2) ◽

pp. 401-401

Author(s):

Thad H. Joos

Keyword(s):

Pulmonary Function ◽

Sodium Cromoglycate ◽

Inhaled Corticosteroids ◽

Face Mask ◽

Young Group ◽

Young Infants ◽

Active Medication ◽

Symptom Scores ◽

Study Population ◽

Complicating Factors

Purpose of the Study. To evaluate the effectiveness of sodium cromoglycate in the treatment of persistent wheezing in children ages 4 to 12 months. Study Population. Thirty-one asthmatic infants without such complicating factors as gastroesophageal reflux, cystic fibrosis, bronchopulmonary dysplasia, etc, were enrollled. Sixteen received active medication and 15 received placebo. Methods. All 31 infants were observed for 3 weeks before the final enrollment with symptom scores recorded based on cough, wheeze, thoracic indrawing, and sleep pattern. Any noticeable problems were treated with albuterol delivered by a nebulizen and tightly fitting face mask. Pulmonary function parameters were determined by the "squeeze technique" on all enrollees. For the next 6 weeks, 16 infants received 40 mg of sodium cromoglycate in 4 mL solution via the nebulizer three times a day and 15 infants received 4 mL of normal saline three times a day. Symptom scores were meticulously recorded and again pulmonary function studies were performed. Findings. There were no significant differences noted between the sodium cnomoglycate group or the placebo group that led the investigators to conclude that sodium cromoglycate was not an effective agent in controlling asthma in very young infants. Reviewer's Comments. This appeared to be a very well done investigation and employed twice the dose of sodium cromoglycate e.g. 40 mgm tid, than most of us would use. It certainly makes one wonder especially in view of Dr. Shirley Murphy's similar results with sodium cromoglycate in premature newborns and its failure to prevent BPD. The use of inhaled corticosteroids to manage asthma in this young group of patients deserves such a carefully conducted study.

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Examination of Semantic Structures Used by Teacher Candidates to Transform Algebraic Expressions into Verbal Problems

Education Quarterly Reviews ◽

10.31014/aior.1993.04.03.355 ◽

2021 ◽

Vol 4 (3) ◽

Author(s):

Ayten Pinar Bal ◽

Keyword(s):

Teacher Candidates ◽

Quantitative Research ◽

Algebraic Expression ◽

Study Group ◽

State University ◽

Algebraic Expressions ◽

Purposeful Sampling ◽

Division Problems ◽

Addition And Subtraction ◽

Research Types

The aim of this study is to examine the semantic structures used by mathematics teacher candidates to transform algebraic expressions into verbal problems. The research is a descriptive study in the survey model, which is one of the quantitative research types. The study group of the research consists of 165 teacher candidates studying in the primary school mathematics teaching department of a state university in the south of Turkey in the 2019-2020 academic years. 73.2% of the teacher candidates in the study group are female and 26.8% are male. Criterion sampling method, one of the purposeful sampling methods, was used in the selection of teacher candidates in the study group. While the Algebraic Expression Questionnaire Form was used as the data collection tool, the evaluation rubric of verbal problems was used in the analysis of the data. As a result of the research, it has been revealed that pre-service teachers are more successful in transforming algebraic expressions into verbal problems, but they have problems in creating problems with algebraic expressions that make up systems of equations. Again in the study, it was concluded that pre-service teachers used addition and subtraction problems more than multiplication and division problems. On the other hand, when the problems in the type of addition and subtraction are examined in the study, in the type of combining and separating; It has been concluded that the category of equal groups is mostly used in the problems of multiplication and division.

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