Department of Anaesthesia
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ItemAnalgesic Efficacy and Adverse Effects of Intrathecally Administered Neostigmine in Patients Submitted to Spinal Anaesthesia(University of Khartoum, 2015-04-07)Background: Spinal administration of neostigmine as a non-opioid analgesic appears to provide a potent, long lasting analgesia. The present study was designed to evaluate the effects of the addition of different doses of neostigmine on the characteristics of spinal anaesthesia using bupivacaine, and to assess their postoperative analgesic efficacy and safety in patients undergoing infraumbilical surgery under spinal anaesthesia. Methods: In this prospective study, we studied sixty Sudanese patients, classified as class 1 and 2 according to the American society of anesthesiologist (ASA), in the age group 19 - 65 year old. They were scheduled for infra-umbilical surgery under spinal anaesthesia. Patients were randomly allocated to one of three groups (n=20 each): group one received intrathecal bupivacaine 15 mg, and group two received intrathecal bupivacaine 15 mg and neostigmine 50 μg, and group three received intrathecal bupivacaine 15 mg and neostigmine 100μg. The onset of anaesthesia, the duration of complete postoperative analgesia, the time to use of the first rescue analgesics, the overall 24-h VAS pain scores, and the incidence of adverse effects, if any, were recorded for 24- h post drug administration. Intraoperative and postoperative blood pressure, heart rate, and oxygen saturation, and total amount of analgesic consumed overall 24-h, were also recorded. Results: Onset of anaesthesia (level to pinprick at 5 and 10 minuets) was significantly earlier for group 2 and 3 patients compared with group 1 patients. Motor block (time to lift leg) was greatly prolonged for group 3 patients. There was a significant prolongation in the duration of absolute analgesia between different groups (p < 0.05). Group 3 patients, also showed a lower overall 24-h VAS pain score and prolonged time to first rescue analgesics. There was a dose dependent increase in the severity of nausea and vomiting with highest VAS nausea score in group 3 patients. Conclusion: The combination of 50 μg or 100 μg neostigmine with 15 mg of hyperbaric bupivacaine, given intrathecally, delayed postoperative pain for 4.7 – 6 h and lowered the number of rescue analgesics, in dose dependent manner. Because the better quality of analgesia was obtained with an increased (statistically significant differences) in incidence of untoward side effects, larger samples should be studied before this application can be routinely used clinically.
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ItemExtra tracheal Airway Management in Spontaneously Breathing Anesthetized Patents( University of Khartoum, 2015-04-06)A prospective randomized study was performed on eighty patients presented for elective minor surgical operations under general anaesthesia using extra tracheal airways and spontaneous breathing in Khartoum Teaching Hospital and Soba University Hospital during the period from March to October, ٢٠٠١. The patients were divided into two groups:- ١. Group ١: ٤٠ patients in whom laryngeal mask airway was used. ٢. Group ٢: ٤٠ patients in whom cuffed oropharyngeal airway was used. The study aimed to analyze the efficacy and safety of laryngeal mask airway and cuffed oropharyngeal airway, safety and efficiency of the two devices, haemodynamic changes during insertion and intra- and post-operative complications. The study concluded that the laryngeal mask airway as well as the cuffed oropharyngeal airway ara safe and efficient in the management of spontaneously breathing anaesthetized patients.
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ItemAnalgesia During Labour: A Comparison Between Two Methods: Epidural Marcaine And Intrathecal Pethidine In Pregnant Sudanese Ladies(University of Khartoum, 2015-04-02)This study was designed to determine the awareness of Sudanese ladies about epidural & spinal analgesia and to compare the various effects of epidural Marcaine versus intra-thecal Pethidine during labour . The prospective experimental study which was conducted at Suba university hospital in the period from August 2003 to January 2004 approached 78 healthy ladies .Only 37 ladies agreed to participate in the study (20 were given intra-thecal Pethidine and 17 epidural Marcaine), where as most of those who refused had no specific reasons. Contrary to the previous studies where epidural analgesia was considered as a factor for the increasing rate of instrumental delivery, in this study there was no statistically significant difference in the mode of delivery. The onset of analgesia among the group which received intra-thecal Pethidine was more rapid compared to epidural Marcaine,while the duration and quality of analgesia during the labour was significantly better in the latter group . Newborn in both groups were assessed by Apgar Score at 5 minutes and none of them had a score less than seven . Complication following intra-thecal Pethidine were mainly nausea & vomiting, in the epidural group there was no motor complication.
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ItemGlycaemic effect of dextrose 5 % in children less than five years under general anaesthesia( University of Khartoum , 2015)Paediatric surgery account for 34 % of all surgical operations done under general anaesthesia (in Soba university hospital). Although dextrose 5% is known to cause hyperglycaemia, it is still the main intravenous solution used to replace fluid deficit and to maintain fluid balance in paediatric general anaesthesia in Sudan. This is an experimental study done in Soba university hospital and Khartoum teaching hospital to know the effect of perioperative fasting on blood glucose and to assess the magnitude of hyperglycaemia if dextrose 5% is used as the sole intravenous solution in paediatric anaesthesia. Fifty randomly selected children between the ages of one month and five years were studied. The fasting hours were calculated and blood glucose was measured by a glucometer at the induction of anaesthesia. No child was found to be hypoglycaemic despite a recorded fasting period of up to 12 hours. When blood glucose was measured at the end of surgery, and after replacing the deficit, maintenance volume and third space losses with dextrose 5%, it was found to be significantly elevated. The study concluded that: children can tolerate fasting for up to 12 hours without significant hypoglycaemia and replacing the fluid deficit with 5% dextrose infusion causes statistically significant hyperglycaemia. The study recommends that, dextrose 5% should be avoided as a sole maintenance solution for young children under general anaesthesia and its use should be limited for documented hypoglycaemia or to children who are subjected to it.