S. Fyneface-Ogan - Academia.edu (original) (raw)
Papers by S. Fyneface-Ogan
Journal of advances in medicine and medical research, Dec 15, 2022
Background: Hypothermia and shivering often complicate spinal anaesthesia for Caesarean section, ... more Background: Hypothermia and shivering often complicate spinal anaesthesia for Caesarean section, and has necessitated the search for an effective and affordable warming method for parturient. Aim: To compare the effects of intravenous fluid and local anaesthetic warming on core temperature during Caesarean section under spinal anaesthesia. Methods: One hundred and sixteen consenting parturients aged 18 to 40 years with ASA physical status class II scheduled for elective Caesarean section were recruited into the study. Patients were randomly allocated into groups I, II, III and IV. All the patients were preloaded with 15 ml/kg of normal saline over 15 minutes before institution of subarachnoid block in the sitting position. Warm intravenous fluid and warm intrathecal bupivacaine, warm intravenous fluid and intrathecal bupivacaine at room temperature, intravenous fluid at room temperature and warm intrathecal bupivacaine, and both intravenous fluid and intrathecal bupivacaine at room temperature were administered to patients in groups I, II, III, IV respectively. Data collected included core temperature (tympanic membrane) using a thermoscan, shivering using the 5-point scale of Wrench. Neonatal rectal temperature was measured and adverse effects observed on the parturients recorded. Monitoring of core temperature was continued in the post anaesthesia care unit until full recovery and discharge. Results: All the 116 patients completed the study. While core temperature change was highest (
The Nigerian Health Journal, 2011
Background: The evaluation and management of hyperthyroidism in pregnancy is challenging to perio... more Background: The evaluation and management of hyperthyroidism in pregnancy is challenging to perioperative care givers. The objective of this report was to demonstrate the role of single shot spinal anaesthesia in managing the haemodynamic challenges associated with untreated Graves ' disease in pregnancy. Method: Following a 500mls preload with normal saline, patient received 10mg of plain bupivacaine in the lateral position. Continuous monitoring of blood pressure, pulse rate, ECG, temperature, oxygen saturation was carried out throughout the procedure and into the post-operative period.Hypno-sedation was applied as required. Results: At the end of surgery, there was a decrease in the pulse pressure from 94mmHg to 81mmHg. Also the pulse rate decreased from 156beats/min to 121beats. Patient was transferred to the Intensive Care Unit for a few days and subsequently discharged and followed up in the Medical out-patient clinic. Conclusions: Uncontrolled Hyperthyroidism coexisting ...
Anesthesia & Analgesia, 2001
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy.... more Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy. A 27-year-old Nigerian woman, gravida 1, para 0, presented at 31 weeks' gestation with no previous history of hypertension heart disease, but morbidly obese (body mass index of 42 kg/m2), with uncontrolled and hypertension, severe pulmonary oedema who required an urgent Caesarean section is presented. The patient was admitted into the hospital's ICU for stabilisation. She was placed on oxygen by non-rebreathing face mask while receiving intravenous labetalol and frusemide. Following a worsening clinical state, an urgent Caesarean section was conducted under continuous spinal anaesthesia using 7.5 mg intrathecal 0.5% isobaric bupivacaine and was delivered of a 1.8 Kg live female baby with good Apgar scores. At the end of the surgery, mother and baby were transferred to the ICU and SCBU respectively. After a 7-day intensive treatment she was discharged. Since then she remained sym...
The Nigerian postgraduate medical journal, 2014
The aim of this study was to compare the duration of postoperative analgesia and possible adverse... more The aim of this study was to compare the duration of postoperative analgesia and possible adverse effects produced by caudal bupivacaine 0.25% at 1 ml/kg with or without 1.5 ug/kg of neostigmine in children undergoing unilateral herniotomy. Sixty-six children aged 1-6 years, of ASA physical status classes I or II for elective unilateral herniotomy under general anaesthesia without premedication were studied. The patients were randomly allocated into two groups of 33 each. Group B received caudal analgesia with plain bupivacaine 0.25% at 1 ml/kg alone, while group BN received caudal analgesia using a mixture of plain bupivacaine 0.25% at 1 ml/kg and neostigmine 1.5 ug/ kg. Postoperatively, monitoring of pain scores and time to first analgesic request and, total dose of analgesics administered in the first 24 hours were recorded. All the patients participated throughout the study. There were no differences in the demographic characteristics (age, weight, ASA status)between the two gro...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Childbirth has been recognised as the most painful experience known to women. This study aimed at... more Childbirth has been recognised as the most painful experience known to women. This study aimed at studying the efficacy and safety of the single shot spinal analgesia for pain relief in labour. One hundred and twelve parturients in labour were randomized into two groups of 55 paturients each. Group B received 2.5 mg of spinal plain bupivacaine only while Group BF had 2.5 mg plain bupivacaine with 25 gg of fentanyl. Onset of sensory block, time to achieve maximum sensory block, duration of sensory and motor block and the level of block were recorded. The need for oxytocin augmentation, instrumental delivery, neonatal Apgar scores and umbilical artery blood pH were recorded. The numeric rating pain scores for groups B and BF were significantly reduced from a mean prespinal score of 8.17 +/- 0.96 cm and 8.30 +/- 0.23 cm respectively to a mean post-spinal pain score of 0.23 +/- 0.45 cm and 0.09 +/- 0.47 cm respectively, p = 0.000. The mean duration of analgesia in Group B was 61.60 +/- ...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
This study was conducted to determine normal ranges of sterno-mental distance (SMD) and thyroment... more This study was conducted to determine normal ranges of sterno-mental distance (SMD) and thyromental distance (TMD) and to examine the relationship of these measurements to each other and the body mass index (BMI). The SMD, TMD and BMI were assessed in a total of 409 apparently healthy adult subjects comprising 218 male and 190 female participants who volunteered for the study. The parameters were measured by standard methods and the obtained data analysed for the degree of association using Pearson Correlation Statistics. Mean values of SMD and TMD were significantly higher in males than in females. The BMI was statistically same in both sexes. Sterno-mental distance correlated positively with TMD in both sexes (r = 0.86, p = 0.005) while BMI correlated negatively with SMD (r = -0.166, p = 0.108) as well as to the TMD (r = -0.147, p = 0.04) in both sexes. In young healthy adult populations the SMD and TMD are strongly related to each other but are unrelated to the BMI. Males tend to...
The Nigerian postgraduate medical journal, 2006
The purpose of this study was to evaluate the role of needle diameter of the same tip configurati... more The purpose of this study was to evaluate the role of needle diameter of the same tip configuration in the causation of Post Dural Puncture Headache (PDPH). This prospective, single blind, randomised study compares the incidence of PDPH from two spinal needles (Becton Dickinson Whitacre sizes 25 G and 26 G needles) in obstetric patients. One hundred women undergoing elective and emergency Caesarean delivery under spinal anaesthesia were recruited. Each of the patients was interviewed using a standard questionnaire and reviewed until the seventh day postoperative. Both intraoperative and postoperative complications that occur were promptly treated. There was no significant difference in the number of attempts at insertion in both groups, although a shorter time was achieved in group25. PDPH occurred in 6.0% of those in group25. There was no difference in the insertion characteristics between the two needles.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Episiotomy is the commonest obstetric surgical operation performed to increase the introitus to e... more Episiotomy is the commonest obstetric surgical operation performed to increase the introitus to enhance vaginal delivery. This study was to compare the effect of two local anaesthetic agents on postpartum perineal pain and time for demand for oral analgesics. A randomized double-blinded controlled clinical trial was conducted in primiparous women who had spontaneous vaginal delivery, comparing 1% plain lidocaine and 0.25% plain bupivacaine infiltration for the repair of selective episiotomy or perineal injury. The two groups were comparable in sociodemographic characteristics. At 2 and 4 hours, women who had perineorraphy under lidocaine had significantly higher pain scores on the Visual Analogue Scale (VAS) than those who had the repair under bupivacaine, (4.0 v. 2.0)and(6.0 v. 3.0)respectively. At the 6h hour, the mean pain score for the bupivacaine group was 4.0 on the VAS while the lidocaine group had already received a dose of oral analgesic (Ibuprofen 400 mg) following severe ...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur ... more Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur in drug administration. We report three cases of such errors. The anaesthetic record of 3 patients who had errors in drug administration and discussion of the relevant literature. Through the years in anaesthetic practice at the University of Port Harcourt Teaching Hospital (UPTH), our Pharmacy has always supplied standard ketamine hydrochloride in a dark brown bottle containing 10 mls of the 5% solution. Suxamethonium chloride on the other hand was always supplied in a 2 ml clear glass ampoule. A change in this known packaging without prior notification resulted in near misses, all of which had the potential for serious morbidity. A strict adherence to standard procedure is necessary to minimize the risk, since there is no substitute for vigilance if morbidity and mortality is to be prevented.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Phaeochromocytoma is a rare surgically treatable cause of hypertension. The aim of this paper is ... more Phaeochromocytoma is a rare surgically treatable cause of hypertension. The aim of this paper is to present a case of phaeochromocytoma treated in Port Harcourt. The case record of a patent with phaeochromocytoma and a review of the relevant literature. A 40 year-old man presented with episodic malignant hypertension resistant to several anti-hypertensive drugs. A 24-hour urinary Vanillyl Mandelic Acid estimation was high at 68 mmol. An ultrasound scan revealed a huge right suprarenal mass. Preoperative medication was given to reduce the blood pressure and prevent perioperative arrhythmias. Under general anaesthesia with propofol, the tumour was explored. It appeared to invade the kidney and there were multiple hepatic secondaries. It was resected in block with the kidney. Intra- and postoperatively he had episodes of hypertension which were successfully controlled with a combination of intravenous chlorpromazine 50 mg, tramadol 100 mg and lorazepam 4 mg. Histopathology examination ...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
A 24-year old booked primigravida, with rheumatic heart disease in heart failure and lobar pneumo... more A 24-year old booked primigravida, with rheumatic heart disease in heart failure and lobar pneumonia presented in active labour. She was stabilized and prepared for an emergency Caesarean section that was successfully managed with Epidural Anaesthesia. She was admitted into the intensive care unit where the pneumonia and heart failure were managed by the physicians. The importance of proper follow up and treatment and, the need to perform more epidural techniques to meet the ever increasing challenges to the Anaesthetist are highlighted.
International Journal of Obstetric Anesthesia, 2013
Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of lo... more Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of local anaesthetic, maternal position may affect the speed of onset of sensory block and thus the haemodynamic effects. The aim of this study was to determine whether inducing spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position would result in less hypotension compared with the sitting position. One hundred American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomised to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S). Using the L3-4 interspace, patients received intrathecal plain bupivacaine, 10mg or 12 mg according to their height, after which they were placed immediately in the supine position with left uterine displacement. Maternal blood pressure was measured every minute for 10 min, every three min for 20 min and 5-minutely thereafter. Hypotension was defined as a fall in systolic blood pressure >20% or a value <90 mmHg. There was no difference in the lowest recorded systolic blood pressure in Group L (99.2±8.9 mmHg) compared with Group S (95.4±12.3 mmHg, P=0.081). However, the lowest recorded mean arterial pressure was greater in Group L (72.9±11.2 mmHg) than in Group S (68.2±9.6 mmHg; P=0.025). The incidence of hypotension was lower in Group L (17/50, 34%) than in Group S (28/50, 56%; P=0.027). Onset of hypotension was similar between groups. Hypotension occurred less frequently when spinal anaesthesia for caesarean using plain bupivacaine was induced with patients in the lateral compared with the sitting position. Values for the lowest recorded mean arterial pressure were greater but values for the lowest recorded systolic blood pressure were similar for patients in the lateral position group.
ISRN Anesthesiology, 2012
Obstetric Anesthesia Digest, 2014
African Journal of Anaesthesia and Intensive Care, 2011
Nigerian Quarterly Journal of Hospital Medicine, 2009
Localisation of the epidural space is one of the key steps in the provision of epidural analgesia... more Localisation of the epidural space is one of the key steps in the provision of epidural analgesia during childbirth. Many ingenious devices have been designed to improve the success of the puncture procedure. A clinical experience with a modified Macintosh epidural balloon in the localisation of the epidural space is described. Fifty ASA Class I-II consecutive parturients requesting pain relief in labour were enrolled in this prospectively randomized study. They were allocated to receive either air (LORA) or epidural balloon (EB) to assist in the identification of the epidural space. The end-point for the EB was marked by the collapse of the balloon while this was depended on the loss of resistance felt on the syringe plunger in the LORA. The primary outcome was ease of epidural space identification and adequate pain relief between the two groups. There were no statistical differences in age, height, weight, gestational age, gravidity and parity between the two groups. Twenty-two women in the EB group had a successful localisation at first attempt as compared to 14 women in the LORA group (p < 0.0126). The time taken to localise the epidural space was less in the EB than the LORA, (p < 0.0001). There were more Accidental Dural Punctures and failed blocks in the LORA group. The overall quality of block was better in the EB group. The epidural space was identified more often at the first attempt, and more swiftly, with the epidural balloon.
Port Harcourt Medical Journal, 2011
Journal of advances in medicine and medical research, Dec 15, 2022
Background: Hypothermia and shivering often complicate spinal anaesthesia for Caesarean section, ... more Background: Hypothermia and shivering often complicate spinal anaesthesia for Caesarean section, and has necessitated the search for an effective and affordable warming method for parturient. Aim: To compare the effects of intravenous fluid and local anaesthetic warming on core temperature during Caesarean section under spinal anaesthesia. Methods: One hundred and sixteen consenting parturients aged 18 to 40 years with ASA physical status class II scheduled for elective Caesarean section were recruited into the study. Patients were randomly allocated into groups I, II, III and IV. All the patients were preloaded with 15 ml/kg of normal saline over 15 minutes before institution of subarachnoid block in the sitting position. Warm intravenous fluid and warm intrathecal bupivacaine, warm intravenous fluid and intrathecal bupivacaine at room temperature, intravenous fluid at room temperature and warm intrathecal bupivacaine, and both intravenous fluid and intrathecal bupivacaine at room temperature were administered to patients in groups I, II, III, IV respectively. Data collected included core temperature (tympanic membrane) using a thermoscan, shivering using the 5-point scale of Wrench. Neonatal rectal temperature was measured and adverse effects observed on the parturients recorded. Monitoring of core temperature was continued in the post anaesthesia care unit until full recovery and discharge. Results: All the 116 patients completed the study. While core temperature change was highest (
The Nigerian Health Journal, 2011
Background: The evaluation and management of hyperthyroidism in pregnancy is challenging to perio... more Background: The evaluation and management of hyperthyroidism in pregnancy is challenging to perioperative care givers. The objective of this report was to demonstrate the role of single shot spinal anaesthesia in managing the haemodynamic challenges associated with untreated Graves ' disease in pregnancy. Method: Following a 500mls preload with normal saline, patient received 10mg of plain bupivacaine in the lateral position. Continuous monitoring of blood pressure, pulse rate, ECG, temperature, oxygen saturation was carried out throughout the procedure and into the post-operative period.Hypno-sedation was applied as required. Results: At the end of surgery, there was a decrease in the pulse pressure from 94mmHg to 81mmHg. Also the pulse rate decreased from 156beats/min to 121beats. Patient was transferred to the Intensive Care Unit for a few days and subsequently discharged and followed up in the Medical out-patient clinic. Conclusions: Uncontrolled Hyperthyroidism coexisting ...
Anesthesia & Analgesia, 2001
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy.... more Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy. A 27-year-old Nigerian woman, gravida 1, para 0, presented at 31 weeks' gestation with no previous history of hypertension heart disease, but morbidly obese (body mass index of 42 kg/m2), with uncontrolled and hypertension, severe pulmonary oedema who required an urgent Caesarean section is presented. The patient was admitted into the hospital's ICU for stabilisation. She was placed on oxygen by non-rebreathing face mask while receiving intravenous labetalol and frusemide. Following a worsening clinical state, an urgent Caesarean section was conducted under continuous spinal anaesthesia using 7.5 mg intrathecal 0.5% isobaric bupivacaine and was delivered of a 1.8 Kg live female baby with good Apgar scores. At the end of the surgery, mother and baby were transferred to the ICU and SCBU respectively. After a 7-day intensive treatment she was discharged. Since then she remained sym...
The Nigerian postgraduate medical journal, 2014
The aim of this study was to compare the duration of postoperative analgesia and possible adverse... more The aim of this study was to compare the duration of postoperative analgesia and possible adverse effects produced by caudal bupivacaine 0.25% at 1 ml/kg with or without 1.5 ug/kg of neostigmine in children undergoing unilateral herniotomy. Sixty-six children aged 1-6 years, of ASA physical status classes I or II for elective unilateral herniotomy under general anaesthesia without premedication were studied. The patients were randomly allocated into two groups of 33 each. Group B received caudal analgesia with plain bupivacaine 0.25% at 1 ml/kg alone, while group BN received caudal analgesia using a mixture of plain bupivacaine 0.25% at 1 ml/kg and neostigmine 1.5 ug/ kg. Postoperatively, monitoring of pain scores and time to first analgesic request and, total dose of analgesics administered in the first 24 hours were recorded. All the patients participated throughout the study. There were no differences in the demographic characteristics (age, weight, ASA status)between the two gro...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Childbirth has been recognised as the most painful experience known to women. This study aimed at... more Childbirth has been recognised as the most painful experience known to women. This study aimed at studying the efficacy and safety of the single shot spinal analgesia for pain relief in labour. One hundred and twelve parturients in labour were randomized into two groups of 55 paturients each. Group B received 2.5 mg of spinal plain bupivacaine only while Group BF had 2.5 mg plain bupivacaine with 25 gg of fentanyl. Onset of sensory block, time to achieve maximum sensory block, duration of sensory and motor block and the level of block were recorded. The need for oxytocin augmentation, instrumental delivery, neonatal Apgar scores and umbilical artery blood pH were recorded. The numeric rating pain scores for groups B and BF were significantly reduced from a mean prespinal score of 8.17 +/- 0.96 cm and 8.30 +/- 0.23 cm respectively to a mean post-spinal pain score of 0.23 +/- 0.45 cm and 0.09 +/- 0.47 cm respectively, p = 0.000. The mean duration of analgesia in Group B was 61.60 +/- ...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
This study was conducted to determine normal ranges of sterno-mental distance (SMD) and thyroment... more This study was conducted to determine normal ranges of sterno-mental distance (SMD) and thyromental distance (TMD) and to examine the relationship of these measurements to each other and the body mass index (BMI). The SMD, TMD and BMI were assessed in a total of 409 apparently healthy adult subjects comprising 218 male and 190 female participants who volunteered for the study. The parameters were measured by standard methods and the obtained data analysed for the degree of association using Pearson Correlation Statistics. Mean values of SMD and TMD were significantly higher in males than in females. The BMI was statistically same in both sexes. Sterno-mental distance correlated positively with TMD in both sexes (r = 0.86, p = 0.005) while BMI correlated negatively with SMD (r = -0.166, p = 0.108) as well as to the TMD (r = -0.147, p = 0.04) in both sexes. In young healthy adult populations the SMD and TMD are strongly related to each other but are unrelated to the BMI. Males tend to...
The Nigerian postgraduate medical journal, 2006
The purpose of this study was to evaluate the role of needle diameter of the same tip configurati... more The purpose of this study was to evaluate the role of needle diameter of the same tip configuration in the causation of Post Dural Puncture Headache (PDPH). This prospective, single blind, randomised study compares the incidence of PDPH from two spinal needles (Becton Dickinson Whitacre sizes 25 G and 26 G needles) in obstetric patients. One hundred women undergoing elective and emergency Caesarean delivery under spinal anaesthesia were recruited. Each of the patients was interviewed using a standard questionnaire and reviewed until the seventh day postoperative. Both intraoperative and postoperative complications that occur were promptly treated. There was no significant difference in the number of attempts at insertion in both groups, although a shorter time was achieved in group25. PDPH occurred in 6.0% of those in group25. There was no difference in the insertion characteristics between the two needles.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Episiotomy is the commonest obstetric surgical operation performed to increase the introitus to e... more Episiotomy is the commonest obstetric surgical operation performed to increase the introitus to enhance vaginal delivery. This study was to compare the effect of two local anaesthetic agents on postpartum perineal pain and time for demand for oral analgesics. A randomized double-blinded controlled clinical trial was conducted in primiparous women who had spontaneous vaginal delivery, comparing 1% plain lidocaine and 0.25% plain bupivacaine infiltration for the repair of selective episiotomy or perineal injury. The two groups were comparable in sociodemographic characteristics. At 2 and 4 hours, women who had perineorraphy under lidocaine had significantly higher pain scores on the Visual Analogue Scale (VAS) than those who had the repair under bupivacaine, (4.0 v. 2.0)and(6.0 v. 3.0)respectively. At the 6h hour, the mean pain score for the bupivacaine group was 4.0 on the VAS while the lidocaine group had already received a dose of oral analgesic (Ibuprofen 400 mg) following severe ...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur ... more Error is inherent in any complex human endeavour. It is therefore not unusual for these to occur in drug administration. We report three cases of such errors. The anaesthetic record of 3 patients who had errors in drug administration and discussion of the relevant literature. Through the years in anaesthetic practice at the University of Port Harcourt Teaching Hospital (UPTH), our Pharmacy has always supplied standard ketamine hydrochloride in a dark brown bottle containing 10 mls of the 5% solution. Suxamethonium chloride on the other hand was always supplied in a 2 ml clear glass ampoule. A change in this known packaging without prior notification resulted in near misses, all of which had the potential for serious morbidity. A strict adherence to standard procedure is necessary to minimize the risk, since there is no substitute for vigilance if morbidity and mortality is to be prevented.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Phaeochromocytoma is a rare surgically treatable cause of hypertension. The aim of this paper is ... more Phaeochromocytoma is a rare surgically treatable cause of hypertension. The aim of this paper is to present a case of phaeochromocytoma treated in Port Harcourt. The case record of a patent with phaeochromocytoma and a review of the relevant literature. A 40 year-old man presented with episodic malignant hypertension resistant to several anti-hypertensive drugs. A 24-hour urinary Vanillyl Mandelic Acid estimation was high at 68 mmol. An ultrasound scan revealed a huge right suprarenal mass. Preoperative medication was given to reduce the blood pressure and prevent perioperative arrhythmias. Under general anaesthesia with propofol, the tumour was explored. It appeared to invade the kidney and there were multiple hepatic secondaries. It was resected in block with the kidney. Intra- and postoperatively he had episodes of hypertension which were successfully controlled with a combination of intravenous chlorpromazine 50 mg, tramadol 100 mg and lorazepam 4 mg. Histopathology examination ...
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
A 24-year old booked primigravida, with rheumatic heart disease in heart failure and lobar pneumo... more A 24-year old booked primigravida, with rheumatic heart disease in heart failure and lobar pneumonia presented in active labour. She was stabilized and prepared for an emergency Caesarean section that was successfully managed with Epidural Anaesthesia. She was admitted into the intensive care unit where the pneumonia and heart failure were managed by the physicians. The importance of proper follow up and treatment and, the need to perform more epidural techniques to meet the ever increasing challenges to the Anaesthetist are highlighted.
International Journal of Obstetric Anesthesia, 2013
Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of lo... more Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of local anaesthetic, maternal position may affect the speed of onset of sensory block and thus the haemodynamic effects. The aim of this study was to determine whether inducing spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position would result in less hypotension compared with the sitting position. One hundred American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomised to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S). Using the L3-4 interspace, patients received intrathecal plain bupivacaine, 10mg or 12 mg according to their height, after which they were placed immediately in the supine position with left uterine displacement. Maternal blood pressure was measured every minute for 10 min, every three min for 20 min and 5-minutely thereafter. Hypotension was defined as a fall in systolic blood pressure >20% or a value <90 mmHg. There was no difference in the lowest recorded systolic blood pressure in Group L (99.2±8.9 mmHg) compared with Group S (95.4±12.3 mmHg, P=0.081). However, the lowest recorded mean arterial pressure was greater in Group L (72.9±11.2 mmHg) than in Group S (68.2±9.6 mmHg; P=0.025). The incidence of hypotension was lower in Group L (17/50, 34%) than in Group S (28/50, 56%; P=0.027). Onset of hypotension was similar between groups. Hypotension occurred less frequently when spinal anaesthesia for caesarean using plain bupivacaine was induced with patients in the lateral compared with the sitting position. Values for the lowest recorded mean arterial pressure were greater but values for the lowest recorded systolic blood pressure were similar for patients in the lateral position group.
ISRN Anesthesiology, 2012
Obstetric Anesthesia Digest, 2014
African Journal of Anaesthesia and Intensive Care, 2011
Nigerian Quarterly Journal of Hospital Medicine, 2009
Localisation of the epidural space is one of the key steps in the provision of epidural analgesia... more Localisation of the epidural space is one of the key steps in the provision of epidural analgesia during childbirth. Many ingenious devices have been designed to improve the success of the puncture procedure. A clinical experience with a modified Macintosh epidural balloon in the localisation of the epidural space is described. Fifty ASA Class I-II consecutive parturients requesting pain relief in labour were enrolled in this prospectively randomized study. They were allocated to receive either air (LORA) or epidural balloon (EB) to assist in the identification of the epidural space. The end-point for the EB was marked by the collapse of the balloon while this was depended on the loss of resistance felt on the syringe plunger in the LORA. The primary outcome was ease of epidural space identification and adequate pain relief between the two groups. There were no statistical differences in age, height, weight, gestational age, gravidity and parity between the two groups. Twenty-two women in the EB group had a successful localisation at first attempt as compared to 14 women in the LORA group (p < 0.0126). The time taken to localise the epidural space was less in the EB than the LORA, (p < 0.0001). There were more Accidental Dural Punctures and failed blocks in the LORA group. The overall quality of block was better in the EB group. The epidural space was identified more often at the first attempt, and more swiftly, with the epidural balloon.
Port Harcourt Medical Journal, 2011