Fidelis Onyekwulu - Academia.edu (original) (raw)

Papers by Fidelis Onyekwulu

Orient Journal of Medicine, Mar 25, 2021

Carotid body tumour is an uncommon tumour with potential to cause marked haemodynamic instability... more Carotid body tumour is an uncommon tumour with potential to cause marked haemodynamic instability intraoperatively and turbulent post-operative recovery. A carefully planned anaesthesia is very important for a successful peri-operative management.We report a case of a 44-year-old male that had carotid tumour excision under general anaesthesia. Nitroglycerin was used for hypotensive anaesthesia. Patient was electively ventilated post operatively in the Intensive Care Unit (ICU). Anaesthetic challenges encountered were discussed Key words: Neck, Paraganglioma, Resection, General anaesthesi

International Journal of Medicine and Health Development, 2009

Aim To measure patients’ satisfaction with anaesthesia care and use it as a tool to provide a fee... more Aim To measure patients’ satisfaction with anaesthesia care and use it as a tool to provide a feedback on the quality of practice of anesthesia in our centre. To examine the validity of this tool as a means of evaluating anaesthetic care. Study design This is a prospective questionnaire based study. They were standardised postoperative face to-face interviews with open-and close-ended questions. Patients were chosen by simple random sampling. The questionnaires were administered on the second postoperative day. The questionnaire was subdivided into a set of questions. Anaesthesia specific rating of preoperative visit, preparation, and anaesthetic administered were assessed on a 3-point scale. A 5-point scale was used to assess the overall rating of anaesthetic care. Results A total of 43 patients were interviewed. They were 17 males and 26 females. Anaesthesia specific rating showed that 90.1% of patients were satisfied with the preoperative visit, 95.3% with preparation, and 74.4% with anaesthesia. Study design was rated 40/60 using Patient Satisfaction with Anesthesia Care–Analysis Tool (PSACAT). Conclusion We conclude that the anaesthetic service offered in our centre is reasonably tolerated and acceptable to patients. Key words: Patient satisfaction, Anaesthesia, Enugu

International Journal of Medicine and Health Development, Aug 27, 2008

Aim:To evaluate the management of post thymectomy myasthenia gravis (MG) patient in our centre; t... more Aim:To evaluate the management of post thymectomy myasthenia gravis (MG) patient in our centre; to highlight those aspects of patient care that could improve outcome and to serve as a bench mark for developing a standardized protocol for management. Method: A retrospective study of 5 cases of post thymectomy MG patients managed in the intensive care unit [ICU] of University of Nigeria Teaching Hospital, Enugu, Nigeria between 1995 and 2001 was carried out. Diagnosis of MG was done clinically and with positive edrophonium or neostigmine test. Data concerning demographic and clinical characteristics were obtained from the case records. Results:The patients spent 10 - 36 days in the ICU. They were between the ages of 20 and 36 years; 4 females and 1 male. Seven episodes of cholinergic crisis and 4 episodes of myasthenic crisis were recorded with no mortality. Conclusion:The use of standard protocols for management of post thymectomy MG would produce better results in terms of the number of cholinergic and myasthenic crises, and duration of respiratory support. Keywords : Intensive care, Myasthenia gravis, Thymectomy Journal of College of Medicine Vol. 13 (1) 2008: pp. 44-47

Congenital Heart Defects - Recent Advances [Working Title], 2022

Unlike in the Western world, the delivery of cardiovascular services to children and adults born ... more Unlike in the Western world, the delivery of cardiovascular services to children and adults born with congenital heart defects (CHDs) in Nigeria is grossly inadequate. There are problems all through the ages of these unfortunate patients. Accurate statistical data of CHD in Nigeria is lacking, but it is comparable to 8 per 1000 live births as seen in other countries. The burden is presently being ameliorated by medical tourisms and foreign cardiac surgery missions, but such services are still inadequate. There is a need for the government to share resources between this noncommunicable (CHD) and communicable diseases. When this is done with assistance of international partners and humanitarian organizations, a sustainable pediatric cardiac surgery program will be established that will definitely enhance the care of these patients at childhood, adolescent, and adult stages of their lives.

Nigerian Journal of Medicine

To examine the complications following nasotracheal intubation by documenting the nasal traumas o... more To examine the complications following nasotracheal intubation by documenting the nasal traumas observed with the use of untreated cuffed polyvinyl chloride tube in unprepared nostrils.

Patient Safety in Surgery, 2022

Background Tracheal tubes are routinely used during anaesthesia and in the intensive care unit. S... more Background Tracheal tubes are routinely used during anaesthesia and in the intensive care unit. Subjective monitoring of cuff pressures have been reported to produce consistently inappropriate cuffs pressures, with attendant morbidity. But this practice of unsafe care remains widespread. With the proliferation of intensive care units in Nigeria and increasing access to surgery, morbidity relating to improper tracheal cuff pressure may assume a greater toll. We aimed to evaluate current knowledge and practice of tracheal cuff pressure monitoring among anaesthesia and critical care providers in Nigeria. Methods This was a multicenter cross-sectional study conducted from March 18 to April 30, 2021. The first part (A) was conducted at 4 tertiary referral hospitals in Nigeria by means of a self-administered questionnaire on the various cadre of anaesthesia and critical care providers. The second part (B) was a nation-wide telephone survey of anaesthesia faculty fellows affiliated to 13 t...

International Journal of Research in Medical Sciences, 2020

Background: The feto-maternal outcome after delivery is precarious in developing country. The ana... more Background: The feto-maternal outcome after delivery is precarious in developing country. The anaesthetic technique and antenatal care as it affect this outcome is assessed. Methods: This is a 5-year retrospective study carried out at the University of Nigeria Teaching Hospital Enugu. Obstetric theatre records of patients who had caesarean section between January 1st 2011 and December 31st 2015 were reviewed. Data extracted from the records using a proformer included socio-dermographic characteristics, indications for surgery, maternal and neonatal outcome, and anaesthetic technique. The data were analyzed using SPSS Version 17 [SPSS Inc., Chicago, IL, USA]. Results: A total of 1574 patients had caesarean section within the study period and 1158 (73.6%) of the patients were booked, while 416 (26.4%) were unbooked. The total number of deliveries during this period was 6235 giving a caesarean section rate of 39.6%. More deaths on the operating table were recorded in the unbooked patie...

International Journal of Research in Medical Sciences, 2021

Background: Postoperative nausea and vomiting (PONV) is an undesirable outcome that parturient wh... more Background: Postoperative nausea and vomiting (PONV) is an undesirable outcome that parturient who undergo caesarean section experience. We compare the efficacies of IV glycopyrrolate and IV dexamethasone as prophyaxis against PONV in these paturient.Methods: This was a prospective, randomized, double blind placebo-controlled study of seventy six (76) ASA II patients aged 18-40 years who underwent elective caesarean section under spinal anaesthesia. Patients were randomly allocated to three groups, group G (glycopyrrolate): n=26, group D (dexamethasone): n=25 and group C (control; normal saline): n=25. Data collection was with the aid of a proforma which included the biophysical profile, Belville scoring scale for PONV, Likert scale was used for patient satisfaction and side effects were also documented. The data were analyzed using SPSS version 17 and presented in tables and figures.Results: The demographic characteristics and mallampati scores of patients in all 3 groups were simi...

Aim: To determin if cigarette smoking influences the cardiovascular response to direct laryngosco... more Aim: To determin if cigarette smoking influences the cardiovascular response to direct laryngoscopy and endotracheal intubation under general anaesthesia. Method: This was a prospective study of haemodynamic changes in response to tracheal intubation in 50 ASA 1 (ASA = American Society of Anesthesiologists) men undergoing elective general or urological surgery under general anaesthesia with endotracheal intubation. Twenty-five of the men were smokers of more than 10 cigarettes a day, while the other 25 were non-smokers. Anaesthesia was induced with thiopental and endotracheal intubation facilitated with atracurium. Measurements of systolic, diastolic and mean arterial pressures, heart rate and oxygen saturation were recorded at intubation, 45 seconds after intubation and at 30-second intervals thereafter for a period of 4 minutes. Results: Immediately after intubation, heart rate of smokers [mean: 105.0 (SD17) beats/min] was significantly greater (p Conclusion: This study showed tha...

Nigerian Journal of Clinical Practice, 2020

Background: Shivering is a frequent undesirable event in patients undergoing cesarean delivery un... more Background: Shivering is a frequent undesirable event in patients undergoing cesarean delivery under spinal anesthesia. Postanesthetic shivering has a multitude of deleterious effects and different methods have been used to prevent it. We therefore compare the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. Aim: Comparison of the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. Subject and Methods: This is a prospective, double-blind, placebo-controlled, randomized study. The patients (n = 109) were randomly allocated to three groups according to the study drugs, namely tramadol 50 mg group (Group T), ondansetron 4 mg group (Group O), and saline 4 ml group (Group S) using envelope randomization. Statistical analyses were done using Statistical Package for Social Sciences 20.0. Results: A tot...

International Journal of Medicine and Health Development, 2021

The primary objective of capacity calculation is to reflect physical transmission limits in the p... more The primary objective of capacity calculation is to reflect physical transmission limits in the power grid into limits on commercial trades at the electricity markets. The Nordic capacity calculation methodology is currently based on a Coordinated Net Transmission Capacity (CNTC) approach. This paper investigates a structural change of the power supply, in conjunction with the introduction of Flow-Based Market Coupling (FBMC) in the Nordic region. Overall, the results indicate that total welfare increases and differences between average prices are smaller when using FBMC instead of CNTC, especially on a power system with increased wind power capacity. Index Terms-Capacity Calculation, Coordinated NTC, Flow-Based Market Coupling. Nomenclature Sets and indices e ∈ E Set of critical network elements h ∈ H Set of hours p ∈ P z Set of power plants in zone z z,zz ∈ Z Set of price zones Parameters C prod p,h Production cost for power plant p in hour h D z,h Demand in zone z for hour h K CN E e Max capacity on critical network element e K N T C z,zz Flow restriction from zone z to zone zz ptdf z,e Power transfer distribution factor of zone z on critical network element e Variables g p,h Generation from power plant p in hour h np z,h Net position of zone z in hour h t z,zz,h Transmission from zone z to zone zz in hour h

Clinical Medicine Research, 2017

This study was carried out to assess the awareness, perceptions, acceptance, and the level of uti... more This study was carried out to assess the awareness, perceptions, acceptance, and the level of utilization of epidural analgesia in relation to other methods of labor pain relief among prospective parturient attending the antenatal clinic in south eastern Nigeria. Women attending the antenatal clinic were interviewed using interviewer administered questionnaires containing both open and closed questions, to evaluate their awareness, perceptions, acceptance and level of utilization of labor analgesia in general and epidural analgesia in particular. Data were analysed using SPSS Statistics Version 21.0. The study included 150 women with mean age of 29.63±5.02. Most of the respondents (94.7%) had at least secondary school education. More than half the respondents (62.7%) knew about labor analgesia and 38.7% knew about epidural labor analgesia. Source of knowledge to vast majority (75.6%) were doctors and nurses. Majority of the multiparous respondents (81.27%) had moderate or severe pain in the previous confinement and only 53% had pain relieve. Of those who had pain relieve, two third hard breathing exercises while 4.8% had epidural analgesia. Majority of the respondents (72.7%) would want to have labor analgesia, and 53.3% desired epidural in their next delivery. There is poor level of awareness and utilization of epidural labor analgesia by women attending an antenatal clinic in south eastern Nigeria.

Nigerian Journal of Medicine, 2020

Original Article IntroductIon Pain is an unpleasant sensory or emotional experience associated wi... more Original Article IntroductIon Pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage. Phantom limb pains (PLPs) are painful sensations referred to absent limbs. With the foregoing in mind, PLP must be differentiated from entities such as "phantom limb sensation (PLS)" and "stump pain/residual limb pain (RLP)." PLP phenomenon was first described in 1552 by the French surgeon, Ambroise Pare, but the title was given to this entity in 1872 by the American neurologist, Silas Weir Mitchell. PLP is a real pain and can range from brief flashes of mild pain to constant severe pain. It is a common complication of limb amputations with a reported prevalence of 72% in a study. [1] Whereas most PLPs arise from amputated limbs, congenital limb absence accounts for a lesser prevalence. [2] Limb amputations in Nigeria Limb amputations are common orthopedic surgical procedures in Nigeria and provide a major means of saving lives when limb salvage is not feasible, especially with patients presenting late to health-care facilities with advanced limb pathologies. A national review of extremity amputations in Nigeria using data collected over two decades ago had reported the following indications for amputation; trauma (34%), complication following traditional bone setting (23%), malignant tumors (14.5%), diabetic gangrene (12.3%), infections (5.1%), peripheral artery disease (2.1%), and burns (2.1%). [3] Recent data, however, indicate a changing trend with a greater preponderance of diabetic foot gangrene as the most common indication for limb amputations [4-6] or following closely after trauma and gangrene from traditional bonesetters mismanaged fractures. [7,8] This is not unexpected Background: Phantom limb pain (PLP) is a common and distressing complication of limb amputations. Literature on PLP in Nigeria and indeed Africa is scant despite the high rate of amputations in published works. We sought to highlight the burden of PLP among Nigerian amputees in order to improve awareness and care by health-care providers. Patients and Methods: In this prospective cohort study, consecutive limb amputees were recruited and relevant data were collected by in-person interview at 1 week postamputation and subsequently by telephone survey at 6 months and 12 months. The sociodemographic and clinical information of the amputees were recorded, as well as presence of PLP and the treatment offered by the attending physician. The Chi-square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis, and the level of statistical significance was determined by P < 0.05. Results: One hundred and fourteen consecutive limb amputations were carried out in 113 patients over a 1-year period. The period prevalence of PLP was 63.6%, and of these, only 8.6% had this documented in their medical record. No predictor of PLP was identified in the cohort. Conclusion: PLP is highly prevalent among limb amputees in our cohort. We call for improved awareness and practice relating to PLP among health-care providers and partners, considering the vast population of amputees in the region.

International Journal of Research in Medical Sciences, 2019

Background: The maternal mortality rate in sub-Saharan Africa is high compared to other regions o... more Background: The maternal mortality rate in sub-Saharan Africa is high compared to other regions of the world. Management of critically ill obstetric patients is very challenging. We therefore evaluate the trends, clinical characteristics and outcome of the obstetric patients admitted into the intensive care unit of a tertiary hospital in sub Saharan Africa.Methods: This was a 9- year retrospective study carried out at the multidisciplinary Intensive Care Unit (ICU) of a University Teaching Hospital which serves as a referral centre for the south east region of the country. Data were collected from the patients’ record, ICU admission and discharge register. Also collected was data concerning labor ward admission and deliveries. Data was analyzed using SPSS Version 17 (SPSS Inc., Chicago, IL, USA).Results: The total admission into the ICU during the study period was 1243 patients of which 73 (5.87%) were obstetric patients. They were between the ages of 17 and 54 years with mean of 32...

Nigerian Postgraduate Medical Journal, 2019

Background: Obstetrical haemorrhage is a potentially preventable cause of maternal morbidity and ... more Background: Obstetrical haemorrhage is a potentially preventable cause of maternal morbidity and mortality; and measurements of surgical blood loss (BL) are often inaccurate. Accurate BL estimation is paramount as it may substantially alter the timing of interventions to control haemorrhage. The study compares the assessment of intra-operative BL by visual estimation with BL calculated from haemoglobin estimation using the HemoCue®201+. Materials and Methods: A total of 60 pregnant patients at term undergoing elective caesarean section under spinal anaesthesia were enrolled into the study. In the theatre, the patients' haemoglobin level was determined before and after the surgery using the HemoCue®201+; and a modified Gross formula was used to calculate the BL. BL was also visually estimated and documented by counting the blood-soaked abdominal mops and gauze pieces and multiplying them by the estimated volume of blood each would hold; fixed size mops and gauzes were used. Statistical analysis was performed to compare both methods using SPSS Version 17. To compare BL assessment, Pearson's correlation and the Bland and Altman's method of assessing agreement between two methods of clinical measurement were used. Results: The mean visually estimated BL (EBL) and HemoCue calculated BL (CBL) were 470 ± 221 ml and 563 ± 204 ml, respectively (P = 0.125). The bias (mean difference between both methods) was negligible (45.25 ml), and the limit of agreement between both methods was −222.20–275.43 ml. The discrepancy between the two methods increased when BL was ≥500 ml. Conclusion: This study showed that visually EBL was closely related to HemoCue CBL when the quantity of BL was <500 ml.

Journal of College of Medicine, 2012

ABSTRACT Aim: To evaluate the practice of therapeutic Paediatrics bronchoscopy in our environment... more ABSTRACT Aim: To evaluate the practice of therapeutic Paediatrics bronchoscopy in our environment; to review the anaesthetic practice in our centre, and compare them with universally accepted standards.Patients and Methods: This is a retrospective review of cases of foreign body aspiration in children treated at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between 2002 and 2008. Foreign body aspiration was diagnosed clinically and radiologically. Data concerning demography, clinical characteristics, anaesthetics and complications were obtained from the hospital records.Result: A total of 45 patients were studied. They were between the ages of 6 months and 11 years, 29 males and 16 females. A total of 64 procedures were carried out, of which 38 (59.4%) were bronchoscopy. Bronchoscopy was done with Stortz ventilating bronchoscope under general anaesthesia. Repeated doses of suxamethonium were used as muscle relaxant in 92.1% of cases.Conclussion: Rigid bronchoscopy for aspirated foreign body is a safe, effective and often life saving procedure in the hands of experienced anaesthetist and bronchoscopist. A close rapour between the two teams is necessary for a desired outcome.

The Internet Journal of Anesthesiology, 2011

The purpose of this case report was to enumerate the challenges confronted by the anesthesiologis... more The purpose of this case report was to enumerate the challenges confronted by the anesthesiologist while conducting anesthesia for Bidirectional Glenn Shunt (BDGS) surgery and discuss the complications that could arise from this procedure.The patient presented with multiple congenital heart anomalies and cyanosis. Off-pump BDGS surgery was carried out under general anesthesia. Surgery and anesthesia were uneventful.

The Nigerian postgraduate medical journal

The aim of this study was to evaluate the efficacy of intravenous tramadol in control of shiverin... more The aim of this study was to evaluate the efficacy of intravenous tramadol in control of shivering in obstetric patients under spinal anaesthesia and to determine the minimal dose of tramadol that is effective. This was a prospective, randomised, double-blind, cross-sectional study of 144 pregnant women at term who had an indication for caesarean section. The patients were randomly allocated into three groups at the occurrence of shivering. Group T0.5 received 0.5 mg/kg of tramadol (n = 47), Group T0.25 received 0.25 mg/kg tramadol (n = 47) and Group TNS received 0.05 ml/kg of normal saline (n = 46). Statistical analysis was performed using Statistical Package for Social Sciences version 17. There were no significant differences between the groups with regard to age, weight and duration of surgery. There was a statistically significant difference in the time of cessation of shivering after the treatment for various groups (P = 0.000). A total of 80.1% responded to the treatment in G...

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016

Zika virus is an emerging mosquito-borne virus that is relatively unknown, unstudied and under-di... more Zika virus is an emerging mosquito-borne virus that is relatively unknown, unstudied and under-diagnosed, but has potentials to spread to new geographical areas that favour survival of Aedes mosquitoes. It is associated with an alarming rise in babies with microcephaly that require much care and support with a lot of financial assistance. This is a review article on Zika virus and birth defects; a worrisome issue in today"s obstetric and medical practices. Since Zika"s discovery in Uganda, the virus was known to occur within a narrow equatorial belt from Africa to Asia with no or mild symptoms. It has emerged as a global public health threat over the last decade with accelerated geographic spread of the virus in the last nine years. The risk of Zika virus to the fetus is poorly understood, difficult to quantify and problematic. The causal link between Zika virus and microcephaly was initially speculative, strongly suspected and scientifically unproven. However, on 13th April, 2016, it was concluded that Zika virus is the cause of microcephaly and other severe fetal brain defects. The Center for Disease Control and Prevention (CDC) authors reviewed and weighed evidences using established scientific criteria to conclude after a careful review of the report published in the New England Journal of Medicine. There is no prophylaxis, treatment or vaccine to protect against Zika virus infection. However, preventive personal measures are highly recommended to avoid mosquito bites.