Is intravenous long-acting opioid (morphine) associated with more postoperative hypoxemia than short-acting opioid (fentanyl) after non-cardiac surgery?

Background: morphine is a potent analgesic in decreasing postoperative pain; however its use is accompanied by many complications especially respiratory one. On the other side, fentanyl titration may cause less postoperative respiratory complications. Objective: To compare between intravenous long-acting opioid (Morphine), and short-acting opioid (Fentanyl) regarding postoperative hypoxemia after non-cardiac surgery. Patients and methods: A prospective randomized clinical study done on 52 patients, they were divided equally into two groups: Group M (Morphine) received (0.1mg/kg), and Group F (Fentanyl) received (1ug/kg) on induction, and supplemented by effective rescue analgesia. When postoperative VAS score ≥4 , patients in Group M received 5mg morphine as bolus ,and re-assess pain every 5 min to give another bolus ( the total allowed dose was 15mg/3-4h).For Group F 50ug fentanyl was given as a bolus ,and could be repeated (total allowed dose was 100 ug/1-2h.). Result(s): There were no significant difference between two groups as regard respiratory rate (RR) nor peripheral O2 saturation (SPO2) (P value0.05). Conclusion: Intravenous morphine as effective rescue analgesic is not associated with more postoperative hypoxemia, or respiratory depression than fentanyl

Can an enhanced recovery after surgery (ERAS) programme improve colorectal cancer outcomes in South Africa?

Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of cancer related deaths. It is estimated that CRC is amongst the top five malignancies in South Africa (SA) with an age standardised incidence rate of 10.2 and 6.1 per 100 000 for males and females respectively. The incidence is projected to increase in South Africa as a result of ageing, a growing population and an increase in prevalence of risk factors

Preoperative anaemia and clinical outcomes in the South African surgical outcomes study

Background.In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa (SA). The demographics of SA surgical patients differ from those of surgical patients in the European and Northern American settings from which the preoperative anaemia data were derived. These associations between preoperative anaemia and postoperative outcomes are therefore not necessarily transferable to SA surgical patients.Objectives. The primary objective was to determine the association between preoperative anaemia and in-hospital mortality in SA adult non-cardiac, non-obstetric patients. The secondary objectives were to describe the association between preoperative anaemia and (i) critical care admission and (ii) length of hospital stay, and the prevalence of preoperative anaemia in adult SA surgical patients.Methods. We performed a secondary analysis of the South African Surgical Outcomes Study (SASOS), a large prospective observational study of patients undergoing inpatient non-cardiac, non-obstetric surgery at 50 hospitals across SA over a 1-week period. To determine whether preoperative anaemia is independently associated with mortality or admission to critical care following surgery, we conducted a multivariate logistic regression analysis that included all the independent predictors of mortality and admission to critical care identified in the original SASOS model.Results. The prevalence of preoperative anaemia was 1 727/3 610 (47.8%). Preoperative anaemia was independently associated with in-hospital mortality (odds ratio (OR) 1.657, 95% confidence interval (CI) 1.055 - 2.602; p=0.028) and admission to critical care (OR 1.487, 95% CI 1.081 - 2.046; p=0.015).Conclusions. Almost 50% of patients undergoing surgery at government-funded hospitals in SA had preoperative anaemia, which was independently associated with postoperative mortality and critical care admission. These numbers indicate a significant perioperative risk, with a clear need for quality improvement programmes that may improve surgical outcomes. Long waiting lists for elective surgery allow time for assessment and correction of anaemia preoperatively. With a high proportion of patients presenting for urgent or emergency surgery, perioperative clinicians in all specialties should educate themselves in the principles of patient blood management

Cataract surgery in Ibadan, Nigeria: Visual outcome and post-operative refractive error

Background: Cataract is the leading cause of blindness worldwide and can be treated by various surgical techniques with good visual outcome.Objective: To describe the visual outcome and post-operative refractive status among patients who had cataract surgery in a tertiary centre.Methods: In a retrospective study, the demographic data, type of cataract, surgical procedure and complications, visual outcome and post-operative refractive status of the treated eye were retrieved from the hospital records of all adult patients who had cataract surgery.Results: Four hundred and sixty eyes of 456 patients (mean age 61.2 ± 17.3 years, Male: Female = 1.1: 1) had cataract surgery during the study period January 2012 and December 2014. The pre-operative visual acuity was < 3/60 in 415 (90.2%) eyes. All the surgeries were performed under local anaesthesia with 331 (72%) eyes undergoing extracapsular cataract extraction while 129 (28%) had small incision cataract surgery. Visual outcome in those who had a minimum of six weeks follow-up revealed unaided visual acuity of ≥ 6/18 in 185 (56.9%) eyes. Following refraction, 237 (72.9%) eyes had acuity of ≥ 6/18. Post-operative spherical refractive error ranged from ­6.75D to +4.50D (mean -1.61 ± 1.41D) while cylindrical error ranged from 0.00DC to 6.00DC (mean 2.33 ± 1.80DC). Pre-existing ocular problems contributing to poor post-operative visual outcome included glaucoma (50; 15.4%), and age-related macular degeneration (10; 3.1%). Conclusion: Extracapsular cataract extraction gave better visual outcome compared with small incision cataract surgery, but a higher incidence of post-operative cylindrical error was observed

Telmisartan decreases microalbuminuria in patients with type 2 diabetes mellitus following coronary artery bypass grafting

Objective: This prospective study aimed to investigate the effects of the selective angiotensin receptor antagonist, telmisartan, on microalbuminuria after coronary artery bypass surgery in patients with diabetes mellitus.Methods: Patients were divided into two groups with block randomisation, using the sealed envelope technique: group T (telmisartan group) consisted of patients who received the angiotensin receptor blocking agent telmisartan 80 mg daily for at least six months in the pre-operative period; group N-T (non-telmisartan group) consisted of patients who received no telmisartan treatment. Clinical and demographic characteristics, operative and postoperative features, microalbuminuria and high-sensitivity C-reactive protein levels were compared.Results: Forty patients met the eligibility criteria for the study. The groups did not differ with regard to clinical and demographic characteristics, and operative and postoperative features. Microalbuminuria levels between the groups differed significantly in the pre-operative period, first hour postoperatively and fifth day postoperatively. C-reactive protein levels between the groups differed significantly on the fifth day postoperatively.Conclusion: Telmisartan was useful for decreasing systemic inflammation and levels of urinary albumin excretion in patients who had type 2 diabetes mellitus and had undergone coronary artery bypass surgery

Pediatric adenotonsillectomy in a low resource setting: Lessons and implications

Objectives: To examine the practices related paediatric adenotonsillectomy in our setting especially in relation to blood request and transfusion, routine investigations, post-operative analgesic practice and complications. Methods: We reviewed the record of paediatric patients who had adenotonsillectomy in our facility over a 5-year period to obtain relevant information to our study. Results: There were 33 males and 19 females with mean age of 3.27 ± 2.76 years. Sinus tachycardia was found in 11(21.2 %) of the subjects and T wave anomaly in 1(1.9%) of the subject. Thirty-five (67.3%) patient had adenotonsillectomy, 13(25.0 %) adenoidectomy only and 4(7.7%) tonsillectomy only. Majority of the patients (24, 46.2%) were classified as ASA physical status I. Pre-operative blood request rate was high (49, 94.3%) though the transfusion rate was 1.9 % (1 patient). Acetaminophen combined with other analgesics was used for post-operative analgesia for most of the patients. There was significant weight gain post-operatively among patient Conclusions: Cold steel adenotonsillectomy is safe and effective in our environment. We believe that there is no justification for routine pre-operative blood request as a preconditions for surgery. We also like to suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting

Etude des facteurs influencant les resultats cliniques de la chirurgie de la fistule uro-genitale obstetricale au CHU de l'hopital du Point G Bamako Mali

Le but de cette etude etait d'identifier les facteurs influencant les resultats cliniques de la chirurgie de la fistule uro- genitale obstetricale. Il s'agissait d'une etude transversale; qui a porte sur les facteurs influencant les resultats dans la prise en charge de fistule uro-genitale; allant du janvier 2011 au janvier 2012 au service d'urologie du CHU du Point-G. Cette etude a concerne 115 patientes souffrantes de fistule uro-genitale. La cure de la fistule uro-genitale a represente 17 % des activites du bloc. La fermeture de la fistule a ete obtenue dans 68;7% des cas. Ce resultat a ete influence par certains facteurs; dont les facteurs lies a l'etat du tissu peri-fistuleux (bonne trophicite du tissu; ou fibrose peri-fistuleux). Les fistules operees avant tout remaniement tissulaire peri-fistuleux ont ete fermees dans 71;42 % des cas. Les facteurs lies a la patiente et aux soins : celles operees pour la premiere fois ont un taux de reussite de 68;42 %; seulement 47;62 % de succes chez les patientes qui se sont presentees apres cinq ans. Les facteurs lies au siege anatomo-clinique : les fistules de la cloison vesico-vaginale et cervico-uretro-vaginale ont occupe un taux de succes de 76;92 %. Les facteurs lies aux soins regroupent : l'experience du chirurgien; les chirurgiens du service d'urologie contrairement aux autres chirurgiens ont 76;19 % de reussite contre 25%. La voie d'abord de la fistule etait en rapport avec le siege anatomo-clinique; ainsi les fistules trigonales et uretero-vaginales abordees par la voie haute ont ete reussies dans 85 %. En plus de ces facteurs le suivi post-operatoire; les instruments; les fils de suture; la table operatoire; l'eclairage de la salle ont amelioree aussi les resultats

Caesarean section wound infiltration with ropivacaine versus placebo: Survey of chronic pelvic pain after 4 years' follow-up

Objective.To test the hypothesis that optimal management of postoperative pain may reduce the risk of developing chronic pelvic pain in women who undergo caesarean section.Methods. In a randomised trial in 2006/2007; ropivacaine was infiltrated through all the layers of the anterior abdominal wound in patients undergoing caesarean section. The outcome was a reduction in severe pain or the need for rescue narcotic analgesia within 1 hour after the operation in the ropivacaine group compared with a placebo group (relative risk 0.51; 95 confidence interval 0.38 - 0.69). A follow-up study 4 years later was designed to assess the prevalence of chronic pelvic pain by carrying out telephonic interviews with these women; of whom 77 were contactable and 75 were analysed. Data and statistical analysis were done using Microsoft Excel (2007); Epi Info (version 343) statistical and Review Manager 5 software.Results. Three out of 40 women in the ropivacaine group and 3/35 in the placebo group had persistent pelvic pain (total rate of chronic pelvic pain 8.1).Conclusion. There was no significant difference in the prevalence of chronic pelvic pain between the ropivacaine wound infiltration group (7.5) and the placebo group (8.6) after 4 years' follow-up

Post Operative Miscarriage Following Ruptured Appendix in Pregnancy

Acute appendicitis in pregnancy though rare; is the most common non- obstetric complication warranting emergency laparotomy. Gestational physiological changes make difficult the diagnosis and delay in diagnosis and surgery results in increased complications. We present a-24 year old primiparous lady at 16 weeks of gestation who was referred from a private hospital to the accident and emergency unit of the University of Port Harcourt Teaching Hospital with 6 days history of abdominal pain; fever and vomiting at an ultrasound gestational age of 16 weeks and managed as case of ruptured appendix in pregnancy. She had laparotomy and appendicectomy. Intraoperative findings were purulent peritoneal exudates; ruptured appendix with flakes of necrotic tissues and fecolith. She subsequently had post operative miscarriage 48hours after the surgery which was completed by manual vacuum aspiration. She did remarkably well and was discharged on the 7th post operative day. Delay in diagnosis of appendicitis in pregnancy and surgery correlates to a more advanced disease with an increased risk of appendiceal rupture; which may contribute to increased risk of further complications. Prompt surgical intervention should be performed when acute appendicitis is suspected during pregnancy

Etude epidemiologique et therapeutique des amputations consecutives aux complications du diabete

Introduction : Les complications du diabete constituent la 2 eme cause d'amputation apres les sequelles de traitement traditionnel avec complications fonctionnelles; esthetiques et psychologiques. Cette etude a pour but de determiner la frequence hospitaliere des amputations consecutives aux complications du diabete; de decrire les suites operatoires et le type d'appareillage utilise Materiels et methode : 20 cas d'amputations consecutives aux complications du diabete (ACCD) colliges du 1 octobre 2006 au 30 septembre 2007 a l'hopital Nianankoro Fomba de Segou . Resultats : la frequence etait de 31;25de toutes amputations avec un age moyen de 57 ans et un sexe de 1;87 .Un antecedent d'hypertension etait retrouve dans 18 cas(90);la notion de tabagisme 4 cas (20) ;7 (35) patients avaient un indice de masse corporelle compris entre 25 et 30 kg/ m2 et 15(75) etaient de diabete type II .La duree moyenne d'evolution variait de 5 et 9 ans .La jambe et le pied ont ete les sieges les plus frequents :15 cas(75).Le stade 5 de Wagner etait le plus frequent 12 cas (60) et une glycemie comprise entre 3 et 4;99 g /l dans 12 cas(60).Le staphylococcus aureus a ete le germe le plus frequemment retrouve dans nos prelevements 12 cas (60).La jambe a ete le niveau d'amputation le plus frequent 35(7 cas).15 (75) patients ont eu une evolution favorable .Nous avons enregistre 5 (15) de deces .La bequille a ete l'appareil de locomotion utilise dans 11 cas (55) Conclusion : Une prise en charge precoce du diabete permet d'eviter les complications

Evaluation of post-operative sensitivity and secondary caries in posterior composite restorations: a 12month study

Objective: To evaluate post-operative sensitivity and secondary caries associated with posterior composite restoration. Materials and Methods: The study involved restoration of occlusal and proximo-occlusal caries on premolars and molars of 62 patients seen at the out-patient clinic of the restorative department of the Lagos University Teaching Hospital. The restorations were completed with a micro-hybrid light curing resin composite (Unolux BCS; UnoDent; England). Following total etch procedure and use of a type 2 (5th generation/one-bottle) adhesive. The USPHSC or modified Ryge criteria was employed for direct evaluation of the restorations over the 12 month period. Results: Post-operative sensitivity was 3.5Bravo at baseline and 1.7Bravo at 12 months. No significant change in result was recorded for post-operative sensitivity at the end of the evaluation period. 100was recorded for the absence of secondary caries throughout the evaluation period up till the 6 th month when a failed restoration scored 1.7Bravo. At 12 months Alpha scores for secondary caries was 98.3. Conclusion: Post-operative sensitivity was kept to a minimum and there were no occurrences of secondary caries

Experience with penile circular fasciocutaneous flap in the treatment of long anterior urethral strictures

Objective: To evaluate our experience with penile circular fasciocutaneous flap urethroplasty for the repair of long penile and bulbar strictures. Patients and Methods: Between February 2003 and April 2005; a total of 21 circumcised patients with a mean age of 39 (range 11 - 79) years underwent penile circular fasciocutaneous flap urethroplasty for urethral strictures involving the penile and bulbar tracts. The average stricture length was 7 cm. Follow-up included retrograde urethrography at 3 weeks; 3 months and 12 to 18 months; and thereafter when needed; and evaluation of the urinary flow. The mean follow-up was 25.6 months (range 7 to 44 months). The clinical outcome was defined as success when the patient had a good urinary stream; a post void residual urine 50 cc; a peak urinary flow speed 20 ml/sec; a normal and smooth caliber of the urethra as shown on retrograde urethrography and no urinary tract infection. Results: Our initial success rate was 86(18/21 patients). An immediate successful outcome was achieved in 15/21 (71) patients. Three patients had an unsatisfactory urinary stream in the immediate post-operative period which resolved after a single dilation or optical urethrotomy. With a mean follow-up of 26 months 2 patients developed a stricture at the proximal site of the repaired urethra necessitating resection and re-anastomosis. One patient with lichen sclerosus developed recurrence of the stricture and was subjected to suprapubic cystostomy; then further staged reconstruction was done. Immediate post-operative complications were encountered in 4 patients in the form of secondary hemorrhage; ischemia and sloughing of the penile skin; urethrocutaneous fistula which closed spontaneously and a decreased sensation at the lower limb in one patient each. Conclusion: Circular fasciocutaneous flap urethroplasty is a highly effective single-stage method of reconstructing long urethral strictures. It provides ample tissue for urethral substitution

Effectiveness of Early Quadriceps Exercises after Anterior Cruciate Ligament Reconstruction

OBJECTIVE. To systematically review the published information regarding the effectiveness and safety of early postoperative quadriceps muscle exercise training on pain; joint laxity; function and range of motion in postoperative anterior cruciate ligament (ACL) reconstruction adult patients. DATA SOURCES. Five databases (CINAHL; PEDro; Pubmed; Science Direct and the Cochrane Library) were searched for studies published from January 1990 to May 2007. StTUDY SELECTION. Publications describing research into the effectiveness of early quadriceps exercises after ACL reconstruction were included. A total of three eligible articles met the inclusion criteria. DATA EXTRACTION. A review of the three eligible studies was undertaken to describe the key study components. The PEDro Scale was used to determine the methodological quality of the selected trials and the level of evidence of all the eligible studies was categorised according to the evidence hierarchy by Lloyd-Smith.24 Relevant data were extracted by the two reviewer groups to reduce bias. DATA SYNTHESIS. Due to study heterogeneity a meta-analysis could not be conducted. Effect sizes were calculated provided that sufficient data were provided. Outcome measures included range of motion (ROM); functional performance; pain and knee laxity. The methodological quality of the studies did not vary considerably across the studies and the average PEDro score was 66. Marginal significant differences were noted in knee ROM at 1 month ostoperatively; pain day 1 postoperatively; knee laxity and subjective evaluation of function at 6 months postoperatively. CONCLUSION. Early quadriceps exercises can be performed safely in the first 2 postoperative weeks; but clinically significant gains in ROM; function; pain and knee laxity were not evident. Further research should include standardised interventions; measurement time frames and outcome measurement tools to allow for a meta- analysis to be conducted

Varicocele primitive et fertilite : evaluation postoperatoire des parametres du spermogramme et de la fecondite

Objectif : Il n'existe pas de consensus concernant la capacite de la varicocelectomie a ameliorer la fertilite et la fecondite. L'objectif de cette etude retrospective etait d'etudier l'evolution postoperatoire de la fertilite masculine (par les parametres du spermogramme) et celle de la fecondite du couplePatients et methodes: Il s'agit d'une etude retrospective de 50 patients porteurs de varicocele palpable operes selon la technique de Palomo au service d'Urologie de l'Hopital Grand Yoff; Dakar; Senegal. Les parametres etudies sont les parametres du spermogramme (densite; mobilite totale a la premiere heure; vitalite) et du spermocytogramme (taux de spermatozoides de morphologie normale); une fois avant l'operation et a deux reprises apres (entre le 3eme et le 8eme mois et a partir du 9eme mois) et la fecondite postoperatoire du couple chez 35 patients. Resultats : L'etude du spermogramme retrouve; pour l'ensemble des patients; une elevation de la valeur moyenne de tous les parametres; sans normalisation; exception faite de la morphologie (spermocytogramme). L'evolution postoperatoire n'etait statistiquement significative que pour la densite. La majorite des patients (76a 92) presentaient des valeurs du spermogramme preoperatoires inferieures a la normale; excepte pour la morphologie (28) (spermocytogramme). Les parametres du spermogramme se sont ameliores pour 48 a 64des patients selon le parametre etudie. L'amelioration des parametres est d'autant plus importante que leur valeur preoperatoire moyenne etait basse. Les facteurs de bon pronostic postoperatoires sont representes par les patients les plus jeunes (moins de 35 ans) et ceux qui presentaient une varicocele bilaterale; une infertilite de type secondaire et une duree d'infertilite moins longue. Nous n'avons pas etudie la correlation entre le grade de la varicocele et la fecondite. Le taux de grossesse postoperatoire etait de 31;4. Les sujets feconds etaient plus jeunes; avaient une duree moyenne de l'infertilite moins longue et des parametres constamment plus eleves par rapport aux patients infeconds. Les ameliorations postoperatoires de la fertilite et de la fecondite dans cette etude etaient relatives et limitees. Conclusion: Par la frequence de la varicocele et ses consequences sur la fertilite; il s'avere necessaire aussi de mieux et de plus informer les populations sur cette affection; ses consequences et les resultats de son traitement sur la fertilite. De plus une collaboration plus etroite entre gynecologues; biologistes de la reproduction; radiologues et urologues-andrologues permettrait une prise en charge integree de l'infertilite du couple. Il est egalement necessaire; concernant l'infertilite; d'ameliorer la prise en charge psychologique du couple; et notamment celle de la conjointe

Effect of Gender on Postoperative Morbidity Following Lower Third Molar Surgery

Objective: The effects of gender on pain; swelling and trismus was evaluated in eighty patients of both gender referred for extraction of impacted lower third molar at the Oral and Maxillofacial Surgery Clinic of the University of Nigeria Teaching Hospital; Enugu. Patients and Methods: Eighty patients of both gender; randomly divided into two equal groups; participated in this study. Group 1 (n= 40) were the male patients while group 2 (n= 40) were the female patients. Their ages ranged between 18 and 40 years (mean 26 +6.4). The mean preoperative mouth openings between the two groups were similar. All the patients were treated under the same surgical and postoperative protocols. The lower third molars were extracted using the buccal approach method. The length of surgical intervention was recorded as the time between the first incision and the placement of the last suture. Pain; swelling and trismus were evaluated at 24 hours; 72 hours and 5 days postoperatively. Results: The result of the study indicates that the female patients had a statistically significant shorter operating time and experienced less swelling than the male patients (p 0.05). Pain was significantly more in the female patients than in the males (p 0.05). There was no significant difference (p 0.05) between the two groups as regards trismus. Conclusion: The inflammatory response following third molar surgery increases within 24 - 72 hours after surgery with the male patients exhibiting more inflammatory swelling than the females. However; women appear to be more sensitive to pain than men